The importance of focus

We see what we want, and miss what we don't look for

Before you go on, please take a minute to watch this video (it’s very short, and worth it). Don’t read further, or you’ll ruin it.

This video was sent to me years ago when I was very involved with cycling advocacy and safety. Many drivers will fail to see bicycles, motorbikes, and pedestrians, because their viewfinder is set to “CAR”. Jordan Peterson and others have discussed this issue at length. We don’t see what we don’t look for.

A closely related issue is that of confirmation bias. We notice facts that support our worldview, and are blind to those that may shake our beliefs. It’s the way human brains are built. (Jonathan Haidt explains this wonderfully in videos, and in his books).

This is why I was concerned when our mass COVID vaccination campaign started. The vaccines were new technology, never before used on a large scale. Plus, we were vaccinating in the middle of a pandemic for the first time ever, which raised concerns that we might cause antigenic imprinting, or potentially select for vaccine-resistant variants in the same way that antibiotic use can drive the evolution of super-bugs.

It was of great concern to me that primary care docs - namely family and ER physicians - were removed from the process of vaccination counselling and decision-making. We were told nothing about potential vaccine side effects, or how to report them if suspected. It was pounded into our head ad nauseum that the vaccines were SAFE AND EFFECTIVE, and that every patient should be vaccinated - full stop. We received multiple offers for online “education” on how to convince our patients to be vaccinated, but no education on the details of vaccine research. Few doctors have considered, let alone know the answers to questions like: How many research subjects were in the vaccine trials? How did all-cause mortality differ between vaccinated and unvaccinated groups? What is the statistical risk of getting a vaccine? Of not getting a vaccine? Despite not knowing these answers, doctors repeated the mantra that the vaccines are “safe and effective”.

When a physician did want to report side effects, the process was challenging and onerous. (Do an internet search to find the form, then if you can actually find it, check out the form in detail). Numerous physicians reported to me that public health officials rejected their adverse event submissions, writing off the reported conditions as being coincidental and unrelated to the vaccine. (They may be correct, but it’s not how drug studies actually work, as you’ll read in an upcoming post.)

Within a few weeks of the start of the vaccination campaign, it was clear to me that we would not get any useful data from adverse event reporting systems, as they were hopelessly inadequate and affected by physician bias. (I have previously related a story of a death from a blood clot 5 days after a booster, which was not reported because the physician felt the patient “probably would have had it anyway”). I am on record over a year ago in saying that the only way we will be able to evaluate vaccine safety is retrospectively through hospital records and mortality data. I think we’re now at the point of seeing that data become available, so read on...

No wonder we had preconceived notions

For healthcare workers (not to mention the general public), our viewfinders for 2 years have been firmly tuned to COVID. We see nothing else, because we’ve been told repeatedly that nothing else matters. Every physician and nurse in the hospital knows about the unvaccinated person in ICU. We hear that they were “previously well” and repeat that “fact”, even if the person was a smoker, 150 lbs overweight, and an undiagnosed diabetic. Stories of the VACCINATED patients in ICU do not circulate. It very quickly becomes “obvious” that it is stupid not to be vaccinated. Experts repeat this mantra on the news, and it becomes “TRUE” in the public consciousness.

Physicians were told that vaccination significantly reduces our likelihood of getting COVID, or passing it on. This was repeated until it became a “fact.” When we had massive surges in COVID in highly-vaccinated communities, or when data shows that COVID is actually MORE, not less, common in highly vaccinated regions, that data was ignored by curiously incurious journalists.

The first part of the “SAFE AND EFFECTIVE” mantra is “safe”. There was broad news coverage of every young person who died from COVID, even if they had significant comorbidities. In contrast, deaths after vaccination, even if they were strange or suspicious or in the young and healthy, got little attention, other than from what mainstream media refers to as “right wing” or “conspiracy-minded” outlets.

I have physician friends who insist that COVID vaccines are clearly safe, because if they were not it would be obvious to them as frontline healthcare workers. That is both narcissistic and a logical fallacy. Sadly it shows a misunderstanding of epidemiology and how it interfaces with frontline healthcare. Allow me to explain.

Over my 2-plus decades of ER work I’ve seen a lot of people with heart attacks (myocardial infarctions, or MI’s in doctor-speak). They are mostly older, and more often male. It is much rarer to see a young patient with an MI. Other than cocaine-induced (cocaine is to MI what anabolic steroids are to weightlifting), the youngest MI patient I have seen was 28. But that’s very unusual - a “zebra” in medical-speak (“If you hear hoofbeats in the barnyard, think horses not zebras”). In any given year I only see a handful of people under 50 with MI.

(An important statistical aside which I’ve touched on previously in reference to the Danmask trial: Small data sets are more prone to showing positive results by chance. Want to find out if a coin toss is biased? If you flip the coin 4 times, there is a 1/8 chance you will get all heads or all tails. Flip the coin 10,000 times, and the odds of having all heads or all tails are astronomically low. Bigger data sets are less likely to produce statistical anomalies.)

We see common things in the ER fairly regularly and predictably, factoring in seasonality and give-or-take a disease outbreak or two. But rare events are more unpredictable, due to the smaller size of the data set. I could see 4 young people with MI’s in a short period of time, just like 4 heads can come up when we flip a coin. Or maybe I’ll see zero. It doesn’t MEAN much whether I see zero or 4, because that’s just statistical fluctuation.

To know if there is a real increase in the rate of rare events, we need to keep statistics over time and look at the trend. Say that on average, an ER doc sees 5 MI’s in men under 50 per year, but in 2021 I saw 8. That might be chance, and perhaps my colleague only saw 2. The overall number in our ER, or our province, may not have changed. But if I saw 8, and my colleague did as well, and furthermore other ER’s experienced the same thing, that could mean a 60% (3 extra on a baseline rate of 5) increase in MI’s province-wide. I can’t tell. I’m in a forest, but I can only tell you about a few trees.

So there is no way for an individual doctor to know whether a health problem was due to vaccination, or whether vaccination benefit exceeds risk in general, even if he or she can give anecdotes from day-to-day experience. Our limited individual perspectives do not provide us the necessary data to scientifically determine that. One doctor working in the trenches somewhere doesn’t know whether extra patients in the cardiology ward this year outnumber the patients in the COVID ward. The answer to whether vaccines save lives overall will come from analysis of broad and well-kept data sets.

In a population that is at extremely low risk from COVID (for example, under-50, and healthy), even tiny risks from a vaccine could mean that the vaccine kills more people than it saves. Because COVID mortality rates can be less than 1 in 1 million in the youngest and healthiest demographic groups, there is no way to know if COVID vaccinations save, or kill, more people without massive longer-term research studies.

Finally Milburn gets to the original point…

So when one sees the type of data in this CBC story, I think the knee-jerk response to rule out vaccination as the cause of the mortality spike would be wrong. The journalist did not even mention it as a possibility, nor did the interviewee. That is unscientific.

Most Pairodocs readers will already know that CBC reporters are typically not right-wing anti-vaxxers

I would recommend taking a minute to read the article, but I’ll pick out a few things to highlight.

First, the reported 22% mortality increase is MASSIVE. We do not normally see that kind of variability in mortality data. Slight year-to-year fluctuation is expected due to changes in severity of flu and other infectious diseases, but these are typically small. 5% is a big change. And the spike is typically seen in winter months, when respiratory diseases are maximally transmitted.

Secondly, the article insinuates that in Quebec and Manitoba, we can simply subtract the COVID deaths from excess deaths to arrive at the number of excess deaths that were non-COVID-related. That is incorrect. Not all COVID deaths are “excess”. In fact, at this point the vast majority of COVID deaths are occurring in people at the very end of their life. If someone has COVID on their death certificate, but did not have his life shortened by COVID, that death is not “excess”. So the excess deaths that are possibly vaccine-related are potentially larger than one would conclude by subtracting COVID deaths, since the COVID deaths may not be part of the “excess”.

If the medical profession (or journalists) were actually curious, this spike in deaths would be the biggest news story and source of scientific controversy currently in the news. Ukraine and monkey pox might seem relatively minor in comparison.

What is suddenly killing 22% more New-Brunswickers than normal??

So I’ll speculate on the answer to the question that I would have hoped the media and our public health “experts” would be doggedly pursuing. In my reckoning, there are only 2 possible explanations as to why we would have a massive spike in mortality during the summer in Canada when it is entirely unexpected and unprecedented.

I have the t-shirt. No, seriously I do.

The first possibility is that these deaths are due to lockdowns. Many reasonable people predicted this when “two weeks to flatten the curve” slid into 2 months, then 2 years. It doesn’t take a great brain to see that locking us up in our homes, thereby reducing physical activity, exposure to sunlight, and social interaction while at the same time increasing alcohol and drug use and calorie consumption, might be problematic. And this impact on our personal health habits is only part of the problem. There were limitations or even elimination of medical care ranging from cancer screening to cardiac surgery. Unless one believes our healthcare system is useless (in which case you think we’d be upset at 50% of provincial budget expenditures going to fund it), shutting it down will necessarily result in a measurable amount of misery and early death. Lockdown may have proved that to be true.

The second possibility is that we are seeing a mortality increase from our mass vaccination program. But how to sort this out from lockdown mortality? If MI deaths went up from lockdown and lack of access to care, that mortality spike should have been most apparent around the time when hospitals were maximally locked down - specifically, in the first 6-12 months of the pandemic when ER and other healthcare access was most restricted (both intentionally, and unintentionally due to public fear). In our ER volumes fell by over 50% for some time, and we noted late presentations of heart attacks and strokes.

The period of increased mortality noted in the CBC article instead occurred during the summer of 2021, when hospital care was much more available than in 2020, and ER visits had returned to normal or supra-normal levels. If an increase in deaths was due to vaccination, we would expect it to be during or just after a time when we were mass vaccinating, which does indeed coincide with the period of time these excess deaths were seen. So this timing is suspicious. I got a memo from our local NSHA brass in the summer of 2021 saying that cardiology and neurology services were seeing “unprecedented” numbers of consults. The memo encouraged us to rationalize our use of those services because of the long wait lists. For me, it raised questions about vaccine safety - why were these wait lists suddenly so long?

There is more and more data accumulating that should cause concern in anyone who actually believes in the scientific method, rather than blind faith in authority. This paper from Nature is just one of many to see spikes in overall mortality, or in this case specific disease incidence, which clearly coincided with vaccination. Yes, correlation does not equal causation, but these changes are unprecedented, and an alternative explanation must be found if we are to rule out vaccinations as the cause.

Seeing the forest

If one takes COVID deaths at face value (a major act of faith in itself), over 6 million people have died of COVID worldwide since the pandemic began. This sounds dramatic until put into perspective. Over that same time, over 150 million deaths would normally be expected in our big world of almost 8 billion humans. So COVID accounts for less than 4% of deaths, and such boring and un-newsworthy causes of death like heart attacks, strokes, cancer, accidents and overdoses account for over 96%.

Is it more important for public health to focus on mitigating risks from things that kill 96% of us, or things that kill 4% of us? We locked down and enforced mass public vaccination with a vaccine whose side effects - especially long-term - range from poorly understood to completely unknown. By doing so, we may have swapped a small increase in risk for common causes of death (stroke, heart attack, etc) for a small risk reduction in an uncommon cause (COVID). That is about as logical as the Edmonton Oilers trading Connor McDavid for Chris Milburn. If you saw me play, you’d know what I’m talking about…