BY ANISH KOKA
The phrase “intellectual dishonesty” gets thrown around a lot these days. It’s used to delegitimize arguments that aren’t in keeping with “the scientific consensus” – they are arguments that use data selectively to support a narrative. They are the opposite of a rational, balanced, and nuanced summary of the data.
So I thought it would be an interesting exercise to see how Cardiologists writing for the Journal of the American College of Cardiology arrive at their position on vaccines. The paragraph in question follows:
The question raised in the JACC perspective is whether “the pre-omicron benefit-to-risk equation continues to hold in populations with the highest vaccine adverse event rate, particularly adolescent males”. The next few paragraphs that follow cite a number of references to eventually arrive at the conclusion that “Even in the adolescent male population, the entirety of the protective effect of COVID vaccination, particularly in preventing severe COVID, hospitalization, MIS-C, and death, continues to clearly exceed the risk of VAM (Vaccine Associated Myocarditis). “
The references cited are a series of “recently published studies” that “now enable a more precise quantification of the risk-benefit ratio in the omicron era”. Reference 1 is a CDC morbidity and mortality weekly report.
The title immediately gives away the problem with using this particular reference to answer the question posed about risk-benefit ratios in adolescents. This particular reference studies adults to find lower deaths in vaccinated vs. unvaccinated individuals. And that’s not all. The study is a retrospective study that did not even attempt to adjust for differences between the groups. The major limitation of poring over a retrospective database of the vaccinated and unvaccinated is that the two groups may have intrinsic differences within them that account for the different outcomes observed. Vaccinated individuals may test at different rates, or be generally healthier than the remaining unvaccinated, and so in the words of the study authors – “this ecological study lacked multivariable adjustments, and causality could not be determined.”
The next study cited is another CDC report used to support the claim that mrna boosters are highly effective against severe illness. But once again, the study cited involves adults, and once again, the study cited is a retrospective study that is at best weakly supportive of a causal link.
The final study in the series of studies is from the influential Journal of the American Medical Association that purports to show that “boosters afforded a 66% reduction in symptomatic infections vs a two dose regimen”. One would hope this would be a higher quality study than the prior CDC reports, but its just more of the same — an adult, retrospective study that cannot promise the boosted and unboosted do not differ in ways that cannot be adjusted for with the variables measured in the dataset.
Incredibly, the three references used to make a definitive statement about the risk to benefit ratio of the COVID vaccine in adolescents, have Zero adolescents in the trials. The concluding statement discusses the risk to adolescents of MIS-C : a serious autoimmune disease that has been diagnosed recently, and linked to prior COVID infection, but makes no mention of CDC data that has seen a marked drop-off in the risk of MIS-C with each successive COVID surge.
We also know from the CDC report to the Vaccines and Related Biological Products Advisory Committee (VRBPAC) Meeting, the highest rates of myocarditis are actually in 16-17 year olds. The rate of myocarditis after 2 doses in 16-17 year olds is double that found in the 18-24 year old group.
So, yes, I find it a bit stunning that the CDC and cardiologists writing for JACC see fit to answer the question of risk/benefit of vaccines to young men by blatantly obfuscating. The question is if the risks for young men related to vaccines exceeds the risk of being infected by Sars-COV2. The answer provided by the CDC and the cardiologists writing for JACC is to use three retrospective studies on adults that weakly shows a possible benefit of vaccines and boosters in 18-49 year olds.
There is no evidence provided here that boosters/third doses actually prevent severe disease in adolescents, and given the wide age range (18-49) studied, even in young men! In a prior era, it would be natural to assume the CDC and JACC would provide a detailed thoughtful, nuanced analysis of a complex issue and leave open multiple possibilities when it comes to risks and benefits of vaccines in certain high risk demographic groups. But instead we are treated to a definitive conclusion that “even in adolescents…. the benefits clearly exceed the risk of VAM (Vaccine Associated Myocarditis)”.
One could even call it intellectually dishonest.
I have to make the obligatory post-script here that I oversaw the administration of hundred of mrna vaccines starting in March of 2021 in my cardiology clinic. The vaccine efficacy data for the original data was from thousands of patients and I certainly felt given the devastation wreaked on many of my patients in 2020 that the vaccines were the best chance of avoiding morbidity and mortality. The process to get the vaccines from the city department of health was a somewhat arduous 3 month process, and once the vaccines were on hand, there were daily reporting requirements that I dutifully performed for the many months we were administering vaccines. To accommodate the rush of patients, employees, volunteers, and conscripted children worked multiple weekends to administer the vaccines. So I’m especially disgusted by medical colleagues who label any concerns registered about vaccine adverse events as “anti-vaxx”. Registering concern over a vaccine adverse event does not make doctors or patients “anti-vaxx”.
Anish Koka is a cardiologist.