{"id":26715,"date":"2021-09-09T00:13:00","date_gmt":"2021-09-09T00:13:00","guid":{"rendered":"https:\/\/www.lifeandnews.com\/articles\/?p=26715"},"modified":"2021-09-10T01:56:56","modified_gmt":"2021-09-10T01:56:56","slug":"medicine-is-an-imperfect-science-but-you-can-still-trust-its-process","status":"publish","type":"post","link":"https:\/\/www.lifeandnews.com\/articles\/medicine-is-an-imperfect-science-but-you-can-still-trust-its-process\/","title":{"rendered":"Medicine is an imperfect science \u2013 but you can still trust its process"},"content":{"rendered":"\n

Venktesh Ramnath<\/a>, University of California San Diego<\/a><\/em><\/p>\n\n\n\n

The Conversation is running a series of dispatches from clinicians and researchers operating on the front lines of the coronavirus pandemic. You can find all of the stories here<\/a>.<\/em><\/p>\n\n\n\n

As an intensive care physician in Southern California who endured the onslaught of COVID-19 in 2020, it has been deeply disheartening to experience chillingly familiar scenes all over again. The ICUs in the University of California San Diego Health hospital network where I work<\/a> are again overflowing \u2013 especially with patients who need ventilators. Families peer through tinted hospital windows for glimpses of loved ones. And hospital administrators scramble<\/a> to keep up with necessary staffing and beds to accommodate the influx of patients.<\/p>\n\n\n\n

What is so vexing is that COVID-19 is still the culprit, despite the availability of highly effective vaccines<\/a> that slashed U.S. COVID-19 daily case numbers and hospitalizations<\/a> within months. The vaccines also allowed economies to begin to recover<\/a> and provided a way for people to experience some sense of normalcy again.<\/p>\n\n\n\n

In early spring, the efficacy of the vaccine engendered hope that herd immunity \u2013 in which infectious viral spread is prevented through a high proportion of the population\u2019s being immune to the disease \u2013 could be within reach<\/a> in months. Instead, pandemic panic is again suffocating us, largely because a large part of the public still shuns vaccination<\/a> \u2013 with only 62% of the eligible U.S. population fully vaccinated<\/a> as of early September 2021.<\/p>\n\n\n\n

I wanted an answer to the obvious question: Why?<\/p>\n\n\n\n

Straight from the source<\/h2>\n\n\n\n

So I turned to my patients for answers. At the bedside in their hospital rooms, I first asked about how they were feeling and performed detailed exams before addressing the elephant in the room. \u201cDid you receive the COVID-19 vaccine?\u201d And if not, I gently asked, \u201cDid you have a specific reason you could share with me, so I can understand better?\u201d<\/p>\n\n\n\n

Somewhat surprisingly, patients candidly told me their reasons for avoiding the vaccine.<\/p>\n\n\n\n

A common response I heard was that it was simply inconvenient. \u201cI was too lazy and I didn\u2019t get around to it,\u201d some admitted, looking away sheepishly as they did so. Curiously, they did not consider the myriad \u201cinconveniences\u201d of becoming infected, such as medical complications \u2013 including death \u2013 and associated costs for treatment, lost work, dependence on others for basic necessities such as child care, the risk of infecting family members, the potential for developing long-haul COVID-19<\/a> and more.<\/p>\n\n\n\n

Others expressed a fervid distrust of vaccine-testing methods, stating that people had been \u201cguinea pigs in past vaccine experiments that later caused autism.\u201d Yet more than 25 studies in the past 20-odd years have disproved any causal link between vaccines and autism<\/a>.<\/p>\n\n\n\n

Some felt that the forceful public messaging to get vaccinated belied true motivations of the authorities, adding: \u201cI mean, why are they pushing this so hard? Something must be wrong with it.\u201d Yet few question the strong public health stance on healthy eating practices and exercise, or wearing seat belts while driving.<\/p>\n\n\n\n

Still others feared the possibility of life-threatening side effects: \u201cThousands had heart attacks from the vaccine \u2013 it\u2019s all on the CDC website,\u201d they told me. So I took a close look<\/a> at the CDC website to understand their claims better.<\/p>\n\n\n\n

Reports of heart inflammation occurred in 699 cases out of 177 million vaccinated people, or 0.0004%, with causal links to the vaccines still being investigated. Development of blood clots causally associated with the Johnson & Johnson vaccine are also extremely rare<\/a>, occurring in 28 cases out of 8.73 million doses given as of May 7, 2021 \u2013 a rate of 0.0003%. This extremely low risk of blood clots is still significantly lower than the risk of blood clots<\/a> from an actual COVID-19<\/a> infection.<\/p>\n\n\n\n

Medicine as art and imperfect science<\/h2>\n\n\n\n

In some cases, political affiliation can partially explain<\/a> vaccine antipathy. But my patients\u2019 responses highlighted two other themes to me.<\/p>\n\n\n\n

First, people often forget that medicine is an art based on applied science<\/a>, not a deductive science based on irrefutable forces in nature like gravity. Patients and families often ask me in the ICU to predict what will happen to loved ones unequivocally, only to be disappointed when I avoid speaking in certainties.<\/p>\n\n\n\n

\"An<\/a>
Having to deliver devastating news and uncertainties about patient outcomes has taken a heavy toll on ICU physicians during the COVID-19 pandemic. Go Nakamura\/Getty Images News<\/a><\/figcaption><\/figure>\n\n\n\n

Once viewed as omniscient authorities<\/a>, doctors now openly acknowledge that limitations of medical data require scrutiny and careful application to particular circumstances. COVID-19 has reinforced our appreciation that there are no perfect cures or 100% guarantees of success. Rather, medicine is governed by what is probable. What are the chances I still may have cancer if the test result returns negative? Am I more or less likely to survive pneumonia by taking this specific antibiotic?<\/p>\n\n\n\n

Doctors must then engage in thoughtful analysis<\/a> of the strengths and weaknesses of scientific methods and data to optimize and tailor our recommendations for individual patients \u2013 without the luxury of perfect or even complete datasets to rely on. The vaccine has clearly been shown \u2013 its rare side effects notwithstanding \u2013 to provide an overwhelmingly high likelihood of benefit over potential risks to almost all individuals. This includes people<\/a> who have been previously infected with COVID-19<\/a>. Yet the unvaccinated continue to fixate on rare side effects to justify skipping the shot.<\/p>\n\n\n\n

Vaccines are medicines too<\/h2>\n\n\n\n

Many of my patients also seem to view vaccines and other public health-based recommendations like offers to buy a used car \u2013 with skepticism and independence, threatening to walk away at any moment. Doing one\u2019s part to stop the spread of disease is a culturally nuanced civic virtue, like safe driving<\/a>, which transcends absolute autonomy. In the U.S., most drivers willingly do not drive while intoxicated, cross lanes without warning or block other cars that are trying to merge. These are norms that make driving in the U.S. relatively efficient, safe and even pleasant compared with some other countries.<\/p>\n\n\n\n

The path to herd immunity, like highway safety, requires majority participation without immediate guarantees of complete personal freedom. Vaccines succeed not because they are 100% risk-free to the individual but because collective efforts focus on achieving the common good.<\/p>\n\n\n\n

Oddly, at the same time that my patients rejected the vaccine, they showed strong interest in receiving other types of medicine \u201cshots\u201d like monoclonal antibodies \u2013 which mimic natural antibodies \u2013 or anti-inflammatory medications. While some of these treatments<\/a> have demonstrated benefits in certain situations \u2013 others<\/a> have not<\/a>. And some present the risk of very serious harm<\/a>.<\/p>\n\n\n\n

I reminded my patients that the COVID-19 vaccine stimulates a person\u2019s own immune system to make antibodies that can neutralize the virus<\/a> and that surpass the capabilities of commercially created antibody formulations<\/a>. So the vaccines help prevent infection and development of serious illness from COVID-19 in the first place. People who experience the rare breakthrough infections<\/a> following vaccination generally have a shorter and milder course of COVID-19 infection<\/a> and are far less likely to end up hospitalized<\/a> than those who are unvaccinated. Vaccines also confer<\/a> longer-term protection<\/a>, whereas the other medications are used reactively \u2013 when a serious infection has already begun \u2013 and those medications have shorter-term results<\/a>.<\/p>\n\n\n\n

How past vaccination efforts succeeded<\/h2>\n\n\n\n

In the past, many vaccines that successfully vanquished societal outbreaks of polio<\/a>, measles<\/a> and mumps<\/a> are now routinely administered in childhood with minimal objection, despite the fact that there is no such thing as zero risk<\/a>.<\/p>\n\n\n\n

As I continue to have conversations with patients who suffer greatly from COVID-19 illness as a direct consequence of having avoided the vaccine, my own pain \u2013 for being an ineffective healer and witness to such loss \u2013 is inexorable. Overcoming this fourth wave of COVID-19 still feels out of reach until our vaccination efforts can somehow better emphasize the effectiveness of vaccines, even when scientifically imperfect, and prioritize civic health care responsibilities over pure autonomy. If not, I fear that our battle against COVID-19 will rage on.<\/p>\n\n\n\n

[Get the best of The Conversation, every weekend.<\/em> Sign up for our weekly newsletter<\/a>.]<\/p>\n\n\n\n

Venktesh Ramnath<\/a>, Associate Clinical Professor of Medicine, University of California San Diego<\/a><\/em><\/p>\n\n\n\n

This article is republished from The Conversation<\/a> under a Creative Commons license. Read the original article<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

Venktesh Ramnath, University of California San Diego The Conversation is running a series of dispatches from clinicians and researchers operating on the front lines of the coronavirus pandemic. You can find all of the stories here. As an intensive care physician in Southern California who endured the onslaught of COVID-19 in 2020, it has been […]<\/p>\n","protected":false},"author":44,"featured_media":26716,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[42,3410],"tags":[10459,4068,7559,7689,10456,5469,5470,10455,4151,3926,173,10458,10460,5272,10457],"_links":{"self":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts\/26715"}],"collection":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/users\/44"}],"replies":[{"embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/comments?post=26715"}],"version-history":[{"count":2,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts\/26715\/revisions"}],"predecessor-version":[{"id":26719,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts\/26715\/revisions\/26719"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/media\/26716"}],"wp:attachment":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/media?parent=26715"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/categories?post=26715"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/tags?post=26715"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}