Evidence Comes in Many Flavors

Dr. Mandrola recently wrote an article in his Stop and Think Substack site on vaccinating children. He says he really hesitated before he hit the post button with all the heated arguments about vaccinations. He is trying to address the hard questions in science and health, he says, by looking at evidence from many perspectives. I understand his hesitancy as I have felt the same anxiety posting about vaccinations on this blog.


Within a reasonable arena of discussion, I added my list of concerns about vaccinations to the discussion. I am not a physician, but I would like to stand back and look at some issues which I think get lost in the statistical discussions about vaccination. All vaccinations, actually.

I have struggled with the whole vaccination issue even before the pandemic, not because I am an anti-vaxxer, but rather because I don’t think we look for some of the really important issues when we collect data, whether it’s for vaccinations, medical research, or even data collected from death certificates. From my perspective, when you begin to hone groups for research to make them all as similar as possible, throwing aside the outliers because they have some trait researchers have deemed unwanted in the group, bias is introduced. The results of the study may be fine if you happen to fit the group traits. But for those who don’t fit in the group, the results of the study may not apply quite so neatly.

Am I suggesting there’s no reason for research? Absolutely not. I am simply trying to bring to the surface that public health goals tend to take research results which fit a study and apply those results to a large population which the results may or may not fit.

Bernice Hausman, a sociologist, has looked at the history of vaccination from her profession’s perspective in Anti/Vax: Reframing the Vaccination Controversy. She observes that the study of pandemics, whether the Spanish Flu or the Bubonic Plague, do not take into consideration the demographics of those who die from the wild diseases. Her studies indicate that the high death rates to pandemics hit the poor and undernourished far harder than those with a comfortable life style. This raises the question as to whether demographics are ever collected in research studies, and if collected, are they included in the factors reflecting risk. In other words, do researchers ever track whether the poor and undernourished die from the condition being studied at a higher rate than people who are more fortunate? We know women of color have a much higher maternal mortality rate than the overall rate for the United States. This discrepancy is openly attributed to bias in those providing health care. Would we find a similar disparity in vaccination data if demographics were included in the risk factors.

I believe much of the data surrounding COVID has been collected without a lot of attention to consistency. Some states required those writing death certificates to list COVID as cause of death even with multiple comorbidities listed. In Minnesota, State Senator Scott Jenson raised this issue and got called before the state medical board for his trouble. Compound that bias with the medical community’s constant arguing about what kind of treatment works and what kind does not. So basically everyone with COVID was treated in a number of different ways. Can anyone really say one treatment is effective and one is not? Some studies showed vitamin D didn’t make any difference. Well, why study vitamin D by itself when it’s used in combination with a number of other medications?

Our local physicians treat COVID with a “cocktail” of many ingredients, including vitamin D. Patients are sent home with medications and return daily for outpatient injections. There have been no deaths from COVID in our local hospital, even among 80- and 90-year old patients. Because I know I have access to effective treatment of COVID and won’t be sent home without medication to wait for hospitalization until I can’t breathe, I see vaccination for COVID differently than many. I’m not a physician or a statistician but I am concerned the many kinds of variations I’ve cited could cause a lot of differences in not only the research results but also in the application of this data by those making public health decisions.

The whole notion of “herd” immunity implies we are all the same in our reactions to disease, medication, and yes, vaccinations. We know that many people get COVID and don’t even know it. But do we know what percentage of the population this is? Do we know how many people with early COVID are sent home without medications until they enter the late stage lung involvement? And finally, this is a flu-type virus. We know the flu virus changes every year and vaccination is for those who get flu shots a yearly event. Is COVID any different?

I have survived many years without vaccinations, including flu vaccinations. Others with a similar background may decide to be vaccinated for COVID. I have no problem with that. But if I choose not to be vaccinated, it’s not because I am an antivaxxer or am reticent for some unknown reason. I believe the data surrounding COVID has been collected inconsistently so the risk factors for getting the disease and for recovering from the disease are very skewed. The recovery is much more likely if patients are sent home with appropriate medications and the combination of medications many physicians know work were used appropriately in the treatment of the disease. But instead, the medical community is still arguing over whether vitamin D works.

The medical community needs to deprecate the notion that one size fits all, and that includes the misguided notion that “herd” immunity is good for everyone. Instead, we have physicians attacking physicians who think outside the box and treat the patient instead of forcing a lock-step “standard of care” on those who may well have a different set of attributes than those studies from which the “standard of care” is derived.

Risk is meaningless if you’re a zebra. My contention is that there are many more zebras out there than anyone believes. The medical community needs to stand down and let patients decide, in consult with their primary care physician, what is good for them, even if physicians disagree with the patient choice. This is, after all, the basis of informed consent and the basis of the physician/patient relationship.

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