Nobody wants the new COVID19 booster; And a new STAT piece pushing it, is wrong

Uptake is 2%; That's what happens when you push medical products with no evidence

The new fall COVID 19 booster, does it:

1. reduce the risk of severe disease?

2. have any positive effect, if you have already had covid?

3. slow the transmission of the virus (even transiently at best)?

4. have side effects/ downsides

The answer is the only thing we know for certain is #4; we have no idea, and never will have a precise estimate of 1-3. The US FDA did not ask for appropriate studies of these topics. It is likely that retrospective observational studies will be done later— and I can already tell you they will claim success— but this is not reliable. The people who get boosters are different than those who don’t, and this will plague the analyses, as we showed in the New England Journal. This is called the healthy vaccinee bias.

In a new piece in STAT a PhD scientist Jennifer Dowds plays medical doctor and claims there are 8 reasons you should get a shot; let’s consider the reasons and reassess

1. Little downside

   The author claims there is little downside, but this is preposterous. Katie Sharff has established a rate of myocarditis of one in 10,000 from the first booster in young men. This is likely an order of magnitude higher than the absolute risk of severe disease for a young man who already had two doses. So there's a net harm from the first booster in some demographics. Next, even if you're not a young man, there's the risk of being in bed for a day. By vaccinating a thousand people, a lot of people will be in bed for one day. They're simply no evidence that the booster will save more days of infection then the days lost from getting the shot. Finally, I find it obnoxious that somebody who's not a medical doctor and has never written a prescription is lecturing people about what side effects are acceptable. You have no clue. When you administer any medical product, there is risk, particularly idiosyncratic risk. If you don't have evidence that there's a net benefit, you better think twice. Every doctor learns this lesson the hard way. If you don't have the experience, please don't comment about side effects.

2. It is not obvious who is high risk. The author claims that we don't know who's at high risk of severe disease. This is true, but it cuts the other way. Practicing doctors know we have not seen a patient with ARDS from covid in a long time. Absolute risks are low even in vulnerable groups. Where is the evidence that even high risk people benefit? There is none.

3. Covid vaccines protect against COVID. Sorry again. There is no evidence the booster protects against getting COVID. The author is extrapolating from prior boosters. And even those shots had a very transient effect that regressed to zero. If you live long enough, you're going to get COVID repeatedly. I have no idea if a yearly booster changes that number

4. Vaccination lowers the risk of long covid. At least that's what she claims. Sorry. There's no evidence that is true. In order to justify that claim, you have to run a sham controlled study. The control arm has to feel equally sick. And then you need to measure I have no idea if a person subjective end points. That's never been done. The observational studies that have been done are of extremely low quality. The people who did not get vaccinated are fundamentally different. This is called confounding. Basic epidemiology would teach you that you cannot rely on these studies.

5. Fewer infections means less transmission. This is a laughable claim. There are 8 billion people on the planet. The virus is circulating through all of them, all the time. Thinking that boosting a few people in one rich nation that is ignorant about medical evidence and wants to keep Pfizer rich will change the dynamics of a global pandemic, is like thinking pouring a glass of water on your lawn will change the dynamics of a forest fire.

6. Lots of people didn't get the last booster. On this point she's correct. And fewer people will get this one, and fewer will get the next one. It's pretty disturbing that the White House is allowing Pfizer to market these products without running randomized control trials. Very likely the White House advisors are going to work on the board of directors of Pfizer very soon. This is what happened with Scott Gottlieb, the former FDA commissioner and current Pfizer board member. This is naked corruption. The American people can tell.

7. Kids benefit from the vaccine, she claims. This is such a ludicrous statement. There has not been a single reliable study that vaccinating a healthy child for covid has any benefit. Now all kids have had covid anyway. The potential benefits of a booster are even smaller. Again, it would be irresponsible, bordering on malpractice to even administer this to a child. No European nation is pursuing the boosting of healthy children aggressively.

8. The cost benefit makes sense. I can't even entertain this concept because we have no idea if there's any benefit at all. The stat author is just using a model that has inputs that have been invented. If you make up things, you can reach made up conclusions.

Ultimately it's disappointing to see anyone who recommends a medical product to hundreds of millions of people without evidence. We have learned the painful lesson, those of us who actually prescribe medications, that a lot of things you assume may be wrong. And randomized trials are necessary to learn the true net effects. Just because the Biden administration is working, hand in hand with Pfizer doesn't mean we have to accept it. Boycotting an unproven medical product is the only way to get them to runs trials in the future. Thankfully Americans are doing that. 2% uptake is the current rate and is abysmal. Pfizer is reporting losses. And they're projected earnings are crushed.

Pfizer stock is down, and so is the integrity of the medical profession.