Crozet Annals of Medicine: Facts Are Stubborn Things

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There’s no crying in baseball! – Tom Hanks, “A League of Their Own”

There’s no lying in medicine! – Rob Reiser, in a league of his own

Clinical medicine is practiced in a culture of radical honesty. Doctors never lie to other doctors about clinical care or results. Nurses never lie to other nurses about patients’ care. No one caring for patients ever lies to another care giver about any facet of the patient’s history, physical exam, imaging or laboratory results or the outcomes of procedures.

This culture is baked into the practice for an important reason. The only way to reach accurate diagnoses when working in high-functioning complex teams is for the entire team to have an agreed-upon set of facts that are true and that are conveyed honestly. Any deviation from this would inevitably lead to harm. People would get hurt.

If the medical student forgets to ask about headache but tells the resident the patient does not have headaches, important diagnoses will be missed. If the nurse reports a medication given when he forgot to give it, all sorts of consequences can follow.

This is so obvious to everyone on my team that we never even talk about it. We don’t teach it medical school. We don’t include it any of our oaths. It just is. I doubt if most physicians even notice it or think about it. 

Many other workplaces share this culture of radical honesty. Really any endeavor where the outcomes depend on precise understanding of facts and relationships shares this approach. NASA comes to mind. 

I have been thinking about this recently as our country has been overtaken by a torrent of lies from our leaders and on our social media platforms. We no longer have an agreed-upon set of facts that are true and are conveyed honestly. And people are getting hurt.

On January 30, a mob of antivaxxers massed to shut down a major vaccination site in California where people were getting COVID vaccinations. The mob believed the lie that vaccinations were more dangerous than COVID. 

To date half a million Americans have died of COVID. Not one single American has died of COVID vaccination. Of note, 63 million doses have been administered as of February 21. 

Because of all the lies told about vaccinations, up to 30% or more of the U.S. population may refuse the COVID vaccination. We may never reach herd immunity, the pandemic will continue and many lives will be needlessly lost. But we can do better.

We can do better if we are diligent about tracking down the sources of our information and critically evaluating how that information was obtained.

Here are the facts about vaccines and the source of our information.

In 1998, the prestigious medical journal The Lancet published a provocative study that linked the Measle/Mumps/Rubella (MMR) vaccine with the development of autism. This was an easy association for the public to make. After all, the MMR is given in early childhood, which is also when autism is diagnosed. The author of the study was a British surgeon named Andrew Wakefield.

The study was small, just 12 children were included, but the impact was large. Many advocacy groups were formed to resist childhood vaccines. The problem with the study wasn’t just its small size, which many physicians pointed out, but rather that the author of the study falsified all of the results.

Remember when I said doctors don’t lie? I meant in clinical practice. Andrew Wakefield is the exception that proves the rule. 

Wakefield, in addition to falsifying his results did not reveal that he had been funded by lawyers who had been engaged by parents in lawsuits against vaccine-producing companies. The children in the study weren’t referred to Wakefield by other doctors as he claimed, but rather were referred by the same lawyers. They were children whose parents were already engaged in lawsuits against vaccine companies. Wakefield’s study would directly prove their case. Wakefield received over $750,000 for his perfidy.

All of this came to light because of a long-running investigation by the London newspaper The Times. Hardworking mainstream journalists uncovered facts, presented them to the public and invited others to refute them with provable other facts. No one could, and so we have an agreed upon set of facts that were conveyed honestly. 

Since then, every study that looked for a link between vaccines and autism, and there have been scores of them, has found absolutely no causation of autism from the MMR vaccine or any other vaccine. Vaccines, like all interventions, have some side effects. But the vast good they do far outweighs any small number of side effects. Get a COVID vaccination! 

In the end, Wakefield’s paper was retracted, and Wakefield was stripped of his medical license. The system worked.

Now apply this same paradigm to the political strife and violence that is threatening our republic. The braying mob does not herald truth. Investigators, journalists, courts and other arbiters of truth do. Other journalists or fact-finders can dispute any facts, but only with provable facts of their own. 

Facts are stubborn things. They are there if you want to find them. But you have to keep an open mind. In the words of Daniel Patrick Moynihan, “You are entitled to your opinion. But you are not entitled to your own facts.” 

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