Anti-vax confidence and the certainty of knowing nothing
I had a patient recently who had a serious case of myopericarditis that was quite challenging to treat due to a particularly aggressive presentation and a waxing and waning course.
If you were to ask any physician what causes most cases of myocarditis (inflammation of the heart), pericarditis (inflammation the sack around the heart), or myopericarditis (inflammation of both), they would give you the same answer - it was the body’s response to a virus.
And so when my patient did a TV segment on her illness, that’s exactly what we talked about:
But if you talk to someone who lives in the fictional world where Covid vaccines are poisoning us all, I was committing crimes against humanity by omitting the obvious role of the Covid vaccine in causing this case of myopericarditis.
I still can’t believe the amount of anti-vaccine sentiment that followed this segment.
The number of emails and messages I got about my medical treatment and diagnosis was pretty surreal, as was the threatening nature of many of the messages.
So many of these people were certain that I wasn’t just incorrect, but that I was nefariously wrong, negligent, and doing it all for money from Pfizer.
I had people tell me that I had blood on my hands, that they hoped my family would suffer from vaccine-induced myocarditis or death, and that I was going to pay for my actions in pushing this horrid treatment on the innocent masses.
This segment got picked up by a lot of anti-vax outlets, and the response was predictable
This case really struck a nerve with a lot of people who blame the Covid vaccines for everything from infertility to Damar Hamlin’s cardiac arrest, and it got a ton of attention on Twitter.
If you’re interested to see some of the insanity, click on this link and read some of the comments.
Peter McCullough did a segment with Michelle Tafoya (and apparently John Stockton was involved too) where he reported with certainty that he knew the diagnosis in this case was vaccine-related myocarditis:
I’ve written before that vaccine-induced myocarditis is certainly a real risk, although risk varies based on age and sex. And of course this diagnosis was on my list of possibilities.
But in the segment above, Peter McCullough is either a liar or an idiot.
He’s probably a liar because any actual doctor knows that you can’t make a diagnosis without knowing the details of the case - and if he doesn’t know that, then he’s just an idiot.
To be clear, he doesn’t know anything about this case - he didn’t look at the labs, the EKG, the cardiac MRI, the echocardiogram, or anything else. He didn’t take a history, do a physical exam, and he knows literally zero details of this case.
He’s making it all up.
When someone tells you that they know something about a medical case but they haven’t looked at the data or spoken to the patient, they’re lying to you
Anytime someone famous gets sick, there’s a rush to judgment on social media where people with varying levels of expertise feel the need to comment on the case.
But an honest doctor will tell you the truth - when you don’t know the details, you don’t really know anything.
When I wrote about Damar Hamlin’s cardiac arrest, I hope that I was very clear that without specific information about the history, physical exam, and medical testing, you can’t draw any firm conclusions about what happened.
Sure, you can make educated guesses, but to say anything with certainty is some combination of dishonest, insane, and stupid.
The majority of people who think the vaccine caused harm in this case aren’t lying - they just literally know nothing
When I first started thinking about the social media messages, my initial inclination was to talk about the Dunning-Kruger effect and how that applies to the majority of anti-vaxxers.
But that’s not really accurate, because it implies some level of knowledge, rather than what we see here, which is the complete absence of knowledge.
It’s the John Snow effect. They know nothing.
They haven’t read any of the papers, taken care of any of these patients, or done anything other than regurgitate nonsense that they heard from someone who probably hasn’t done those things either.
It’s really hard not to respond to the social media messages, but it’s also pointless to answer them
When you have a lot of people telling you that you’re wrong about something, I think the natural inclination for many of us is to second guess ourselves, or to try to prove everyone wrong.
And so I initially spent a whole bunch of time looking at these messages and trying to figure out a clever thing to say that would make them all realize they were wrong and send me apologies instead of threats.
But then I thought about the scene in Good Will Hunting where Robin Williams talks about Will ripping his life apart with one quip about a painting, and then his realization that Will doesn’t actually have the faintest idea what he’s talking about:
And so that’s how I started thinking about the people who were sending me these nasty messages: they just don’t have the faintest idea what they are talking about.
These people don’t know anything about this particular medical case. They also don’t know anything about the data on vaccine side effects.
If you get vaccine induced myocarditis, the clinical history should be straightforward
The data on myocarditis after Covid vaccination suggests that it happens quickly, in the order of a week or two, with the vast majority of cases happening within just a few days:
And we’ve had vaccines for decades, so we know a lot about the short term and long term impact of vaccination on risk.
The long history that we have about vaccine related side effects suggests that even delayed vaccine side effects become apparent within a few months.
So taking a history becomes really important - knowing when someone had a viral infection or when someone received a vaccine lets you figure out how much you need to suspect a side effect of a treatment versus a natural phenomenon.
It would be nice to have the level of confidence that these people do
There’s a part of me that’s a bit jealous that all of these folks get to live in a world with absolute certainty.
Unfortunately, the world I live in is filled with risk-benefit analyses and nuanced discussions on how to apply murky data to actual people’s lives.
I don’t think that there’s any topic in medicine that I have that level of confidence in.
And so when someone tells you that they know anything in biology with absolute, 100%, complete certainty, it’s a red flag that they’re either lying to you or lying to themselves.