Dr. Vinay Prasad echoes a common antivax trope that portrays concern about a deadly disease as irrational fear

[Editor’s note: I have, for the first time in five years, taken two whole weeks off from both meatspace work and the blog (although I can’t seem to completely quit Twitter for two whole weeks, as some of you might have noticed). The reason? It’s my thirtieth wedding anniversary. (Last time was my 25th.) As a result, there is no new material today. I had thought of simply posting a “rerun” of one of my past SBM articles that I’m particularly proud of and consider a “classic,” but instead Dr. Prasad gave me an excuse to repost an article from my not-so-secret other blog published a couple of weeks ago. The excuse? A recent Substack by him titled “When scientists’ anxiety disorder interferes with other people’s lives“. It’s behind a paywall, but it might as well be the same article as the one that I deconstructed a couple of weeks ago by Dr. Prasad published on his less histrionic Substack Sensible Medicine titled “Legitimizing irrational anxiety is bad medicine“. In both cases, the message is the same. Doing anything more to avoid COVID-19 than we used to do against the flu in 2019 and before is “irrational” and evidence of an “anxiety disorder”, both among the public and scientists and physicians who have supposedly ‘imposed their anxiety disorder” on society. It’s an old antivax trope, namely that concern about infectious disease is evidence of excessive irrationality, fear, and even mental illness, such as an extreme anxiety disorder. Truly, Dr. Prasad is, at best, a useful idiot for antivax propagandists or, at worst, now officially antivaccine himself. I’ve also added a bit of text from the previous version, in order to address Dr. Prasad’s latest Substack (at least, what I as a nonsubscriber could read of it). So this post is actually updated!]

Those of us who had followed the antivaccine movement for a long time before the COVID-19 pandemic spread throughout the world in early 2020 have been routinely alarmed, amazed, and disappointed at how easily certain “COVID-19 contrarian doctors”—as some of us like to call those who have consistently minimized COVID-19 severity and opposed public health interventions such as “lockdowns” and mandates for masks and vaccines—have slipped into longstanding talking points and tropes of the antivaccine movement. These are often doctors who never, ever would have said anything even vaguely antivaccine before the pandemic but now routinely parrot “old school” antivaccine talking points, whether they realize them to be antivax or not. An example of just such a talking point is to portray people who actually take precautions against being infected by COVID-19 of being “irrational” or having “irrational” fear or anxiety. The fear and anxiety are acknowledged, but then immediately portrayed as less than rational or even as not rational at all.

Worse than that, these “COVID-19 contrarians” portray taking precautions to avoid COVID-19 as being more than just irrational, but outright pathological, with people who still wear N95 masks, for instance, being accused of “irrational anxiety” or “fear” just because they don’t want to be infected by a virus that has killed over a million people (and counting) in just the US alone and is still widely circulating in the population. This narrative is of a piece with longstanding antivaccine messaging that portrays vaccination programs driven primarily by irrational fear in order for the medical profession, big pharma, and government to exercise “control” over you. I’ve lost track of how many times I’ve read variations on this theme over the last two decades, which is why I took note of an article on a Substack called Sensible Medicine titled “Legitimizing irrational anxiety is bad medicine“. The author? Who else could it be but Dr. Vinay Prasad, the adult oncologist who fancies himself an expert in pediatrics, infectious disease, epidemiology, and virology? In his Substack, he argues that we should treat COVID-19 like the flu and do no more or less to protect ourselves against COVID-19 than we used to do for the flu—but with one telling omission.

Before I discuss his analogy (and telling omission), let’s look at his contempt for the “irrational”. If you don’t get the idea about how “irrational” the ever-eminent (in his own mind) Dr. Prasad thinks precautions against COVID-19 are now for most people, he nails it home with a subtitle:

Healthy middle age people carrying CO2 monitors need frank advice to stop.

Quite honestly, I had been unaware that CO₂ monitors were a thing any more. Dr. Prasad mentions these monitors multiple times in his post, in particular citing photos of them on Twitter. So I did what my curiosity led me to do and searched Twitter for the term “CO₂ monitor”. Most of what I found were Tweets advocating such monitors in rooms to indicate when ventilation is inadequate and therefore the risk of COVID-19 transmission in the room probably elevated. Yes, I found among the top Tweets people advocating such monitors, but they didn’t sound anywhere near as fearful and—dare I say?—irrational as Dr. Prasad leads his readers to believe.

For example:

This one amused me, mainly because it seems as though Dr. Prasad is making fun of Elon Musk:

And there were stories like this:

My overall impression was that these people were not being irrational, just cautious, and that having better ventilation is a good thing, even leaving aside the question of how low your CO₂ reading needs to be to decrease the risk of aerosol transmission of COVID-19 to very low levels. I can see one reason why Dr. Prasad might want to target such monitors as an example of “irrational” anxiety, though. Many of the Tweets advocating them tend to recommend them in schools in order to reduce transmission there, and Dr. Prasad and the Brownstone Institute for which he writes have been nothing if not unrelentingly hostile for a long time to masks (which are portrayed as horrifically harmful) and any other COVID-19 mitigations in schools, such as school closures and virtual learning.

Of course, the very title of Dr. Prasad’s little rant should tell you what I’m talking about when I point out that “COVID-19 contrarian” doctors often echo antivax talking points. There was a time when I used to give people like Dr. Prasad the benefit of the doubt and assume that they were clueless that the arguments they were making were not new and, prior to the pandemic, had been staples of antivaccine propaganda going back decades. Indeed, on several occasions, that benefit of the doubt led me to state emphatically and unequivocally that, no matter what I thought of him otherwise, I didn’t think that Dr. Prasad is was any way antivaccine. Nearly a year later, I can no longer say this about Dr. Prasad with nearly much confidence as I used to. As for the other “contrarians,” they have been told time and time again, with examples, that these talking points are old antivax tropes. They either refuse to believe or continue to use them anyway. Truly, the “new school” COVID-19 antivaxxers are coming more and more to resemble “old school” antivaxxers from days gone by.

The overall message of the post is simple: Anyone who is middle-aged or younger and relatively healthy shouldn’t worry about COVID-19 anymore, and if you continue to take precautions you’re a victim of “irrational anxiety” stoked by the public health infrastructure. In fact, Dr. Prasad suggests that you might even be mentally ill:

Medicine has always drawn a distinction between appropriate and inappropriate emotions. If someone experiences sadness, loss of appetite, and lack of desire to get out of bed, it is relevant if they just lost a spouse versus if this is simply Wednesday.

Similarly, if you take appropriate precautions when you climb Half Dome you are being reasonable, but if you refuse to climb 12 stairs out of fear of heights, you are not, and you might benefit from mental health care.

It’s time for medical professionals to advise young, middle age, healthy people to throw away your n95, leave your C02 monitor at home and get back to life. These are not proportionate responses. You are not acting reasonably. Someone needs to tell you.

See the narrative? If you are young to middle-aged and still insist on wearing an N95 in public, then Dr. Prasad thinks that you are, at best, being very irrational and, at worst, might even be suffering from mental illness. Why? Because to him there’s no sense in resisting any more. You can’t avoid it, and you’re supposedly so low risk that worrying about COVID-19 is irrational.

As I said, irrational:

Anyone who plans on being around for the next decade has only two things guaranteed: You will definitely get Covid19 and you will definitely pay taxes.

As of Sept 2022, everyone in America has had plenty of opportunity to be vaccinated if they wish. Among those who haven’t, rates of COVID-19 are sky high. Most have had and recovered from the virus, making their risk from reinfection low. Even those who’ve been vaccinated suffered breakthrough at astonishing rates. Finally, the virus itself has drifted towards less lethality.

Why bother trying to avoid getting a disease that, even if you accept Dr. Prasad’s estimation that it’s no longer any more deadly than the flu? I also can’t help but note the evolution in the antivax/COVID-19 minimization narrative from March 2020 with respect to influenza. Back then, the narrative was that COVID-19 was no worse than the flu. Funny how now, in 2022, Dr. Prasad’s narrative is that it’s “no worse than the flu” now that we have vaccines and boosters, even as he has resisted vaccine mandates for anyone who’s not elderly or so chronically ill that even he has to concede that they are high risk for severe COVID-19 and death.

In fact, let’s do a little compare and contrast. Here is Dr. Prasad now:

The IFR for Covid19 is now less than flu. Fear of long COVID is irrational. In so far as it exists, you have to accept it. In so far as it is overblown, you can ignore it. There is no good evidence boosters or Paxlovid or anything changes it. That evidence would require a clear consistent and reproducible definition. Good luck with that.

Over the next few years, COVID-19 will engulf everyone on Earth. Over the next few decades, it will engulf everyone many times over.

Given: you’re eventually going to get Covid19 and it’s less dangerous than flu, you should take all the same precautions you used to take for flu, but no more.

Here’s a little more of Dr. Prasad’s characterization of “irrational” fear—oh, and tribalism, because of course Dr. Prasad thinks it’s all “virtual signaling.” (Normally, I don’t make fun of typos, but I’ll make an exception for Dr. Prasad.) Anyhow:

At this moment in time, COVID19 is not a risk big enough to most people to justify behaving differently than you did pre-covid. When I see a healthy 20 year old wearing an n95 mask outside, I feel pity for them. They are the victim of irrational messaging, virtual signaling, tribalism, and possibly also fear and anxiety. We should encourage them to live normally, and relax.

Now let’s go back to 2020. I will quote a certain someone who said the following but whom I will not identify until after the quote. I emphasize that this quote does not come from Dr. Prasad. I am quoting this statement from June 2020 in order to illustrate how similar antivax messaging was then to Dr. Prasad’s messaging now. Also, I won’t reveal who said this until after you’ve had the chance to soak in the quote in all its condescendingly wrong glory:

What is the group that is really at risk? Let’s be honest about this and say something that might get me some trouble here, but let’s be honest. That group is very well known. It’s people over the age of 65—not just because you’re over the age of 65, but you’re sick with other diseases. You have heart disease. You have COPD. You have diabetes. You have issues, many of those issues coming from the fact that you didn’t treat your body very well while you were on this planet. And I want to talk about this for one minute as we close this down. That 0.26% are the most sick among us, and I have nothing against you. Go ahead and bubble wrap your house. Lock yourself in your basement. Go and do what’s necessary.

That’s not all, though:

So here’s what we do. Let’s go outside. Let’s take off our masks. We’re not on drugs, and we don’t need to be on drugs. Let’s catch this cold! Whether or not it’s just the 20% of us and maybe we’re not even in that category, let’s give it a college try to catch this cold, so that we can protect the pharmaceutical-dependent amongst us!

Of course, this quote comes from six months before the vaccines started rolling out. In any event, I have to ask: Don’t these two passages sound a lot alike? There’s the same “don’t worry, be happy” attitude, the same characterization of COVID-19 as not dangerous to people who aren’t old and sick already, the same minimization of COVID-19 (Dr. Prasad likening it to the flu and this latter person likening it to a bad cold), the same call to stop masking and not do anything that we didn’t do to protect ourselves from disease before the pandemic.

So who is the second person who two years ago was urging people to “catch this cold” while characterizing those who want people to take precautions as not just irrational but selfish as well? Regular readers know, as I’ve quoted him saying this a number of times since June 2020 as an example of an antivaxxer who denies the severity of COVID-19 and basically advocates that most people return to pre-COVID-19 behavior. That’s right. It’s longtime antivax influencer Del Bigtree, the man who had before the pandemic previously teamed up with Andrew Wakefield in order to produce an overwrought antivax movie VAXXED. Here’s a hint: If you find yourself sounding like Del Bigtree when it comes to COVID-19 mitigation measures, you really should take a long hard look at how you got to this point. Major soul searching is in order for you.

In fact, I can’t resist quoting another antivax influencer, Dr. Bob Sears, who posted this to his Facebook group about measles vaccines, back in the day when we were worried about measles outbreaks due to low vaccine uptake. The parents of some of his patients were concerned and contacting him. He basically washed his hands and told them to “chill out”:

Notice the same dismissive tone exhibited by Del Bigtree and Dr. Prasad, particularly the last part:

I love you all, and love caring for you all. But just chill out. Measles will never go away – it’s always going to be a very small risk. If you aren’t comfortable with that, get the vaccine. If you don’t want the vaccine, accept the risk.

Of course, I strongly suspect that Dr. Prasad knows exactly what he’s doing. He seeks out a small minority of people whose precautions against COVID-19 he considers ridiculously excessive and then does his best to portray them to be as “irrational” as possible, even though he has to massively exaggerate to do it:

Looking down at your Co2 monitor and snapping photos for twitter is no way to live. You need some frank advice: it’s time to stop, for your own sake and those around you.

Also, you’re worthless and weak.

Don’t worry, though. It’s not your fault (at least not entirely). Dr. Prasad assures you that you shouldn’t feel bad about your utter worthlessness and weakness in the face of the flu COVID-19, because your worthlessness and weakness in the face of COVID-19 aren’t your fault (at least, not entirely your fault). They’re largely the CDC’s fault—and that of the Democrats as well:

The CDC has done you a disservice. It has enabled people to act irrationally by pushing Paxlovid in people in whom it was not studied. It encouraged people to mask without ever generating data if the community recommendation worked, and worse: long after it made sense. It recently encouraged healthy 20 year olds to wear an n95— that is frankly bad advice. Any covid benefit dwarfed by the downsides of making a 20 year old think they are vulnerable and weak. The CDC may be doing this for political rather than medical reasons. It caters to the most irrational pole of one political party. Alternatively, the agency is filled with work from home people— who themselves could benefit from frank advice.

Got that, all you millennials? The CDC and the Democrats have turned you all into a bunch of wimps and crybabies! Come to think of it, now Dr. Prasad is sounding a lot like Tucker Carlson and all the far right wing pundits who are trying to portray caution in the face of a global pandemic as hopeless cowardice, all because they worship “strength” and masculinity and view collective action and action that doesn’t as undermining manliness…or something. Indeed, Dr. Prasad’s messaging is custom-designed to appeal to a certain…other…political leaning.

In fact, it’s worse than that. If you are still masking your children, particularly children in daycare, Dr. Prasad thinks you’re not just irrational, he thinks…well…let me just quote him, so that you don’t think I’m exaggerating:

You would never shield your face from an infant in daycare, for hour after hour, day after day. Doing that now is deranged. The potential downside far exceeds any potential upside.

That’s right! Those of you who want to protect daycare workers and small children with mask mandates aren’t just worthless and weak. You’re downright deranged! (What was that Dr. Prasad keeps lamenting about as far as rhetoric around COVID-19? “Loss of civility” and “obsessive criticism” of people like him? Yes, I’m calling him out for hypocrisy, but his hypocrisy is nothing new.)

And all you workers who have the temerity to hope for safe workplaces during a pandemic, Dr. Prasad has news for you, along with a heaping helping of contempt, slippery slope fallacy, and a dash of reductio ad absurdum aimed at academics:

You didn’t complain that your employer was trying to encourage people to show up to work, so they can justify paying them. Don’t do that now. It seem unreal that professors, who have been handsomely paid and never asked to take risk pre-vax, are refusing to work post-vax—- refusing to work in 2022. Will they refuse to work in 2030? The virus isn’t going anywhere.

It is, of course, no coincidence that Dr. Prasad is laying down the opprobrium particularly harshly on academics, given that academics have tended to be the ones most concerned about the pandemic and the least receptive to his style of “don’t worry, be happy” blandishments disguised as “sensible medicine”. His argument also serves the large corporations that are trying to force their workers to stop working virtually and come back to the office, whether it’s safe or not, which totally tracks with his association with the “free market” libertarian think tank the Brownstone Institute and a certain other ideology. I also can’t help but note that condescendingly and contemptuously lecturing and mocking people is a great way to persuade them…not. Dr. Prasad is barely middle-aged, but he sounds like a 70-year-old lecturing young people, whom he views as not as tough, smart, moral, or good as his generation was.

That’s probably why Dr. Prasad doesn’t limit his attacks to just academics, but also challenges his critics with another slippery slope attack, just stretching it all the way out to 2025 or even 2030:

Some may disagree with my prescription: If you do, you should articulate the reason. Do you really think you can avoid COVID-19 indefinitely? Are you going to carrying a CO2 monitor in 2025? How long will you continue this? Do you think it’s possible you’re acting irrationally?

The slippery slope fallacy is, of course, a logical fallacy and generally a bad argument in all but a rare handful of cases in which the path down the “slope” is actually clearly laid out and strongly supported. In this case, it’s just a convenient strategy to portray his critics and those whom he sees as “irrational” as cowards duped by the CDC. Reductio ad absurdum can be an effective rhetorical strategy, but it’s not an actual argument based on science and facts.

But what about long COVID, that constellation of baffling and often debilitating symptoms suffered by a disturbing percentage of people who have recovered from COVID-19? Glad you asked! Dr. Prasad thinks you’re irrational to fear that too:

Fear of long COVID is irrational. In so far as it exists, you have to accept it. In so far as it is overblown, you can ignore it. There is no good evidence boosters or Paxlovid or anything changes it. That evidence would require a clear consistent and reproducible definition. Good luck with that.

What a jerk! (I used a somewhat…stronger…word in the original version of this post and only toned it down to keep Dr. Novella happy.)

You know, a physician who dismisses patients’ symptoms with a jaunty “Good luck with that!” is not a physician I want to see caring for patients. Even those of us who consider chronic Lyme disease to be a fake diagnosis don’t dismiss patients that way. (Quite the opposite, in fact, no matter how much chronic Lyme quacks try to portray us otherwise.)

It’s not just young, presumably healthy, people, though. In his latest paid Substack, he goes on to blame physicians and scientists for letting their supposed anxiety disorders interfere with everyone else living their lives. I’ll quote what is readable without a subscription:

A key concept in psychiatry is that an idea or compulsion or personality trait can be acceptable if it doesn’t bother you, but becomes harmful and pathological when it interferes with your daily life. It’s ok to be obsessive, but it is obsessive compulsive disorder if it interferes with your day to day.

What word do we use to describe doctors, scientists and policy makers whose personal mental health issues affect their policy recommendations? The lives of others? If someone’s anxiety makes them more likely to support school closure, masking 2 year olds or lockdown, how should we consider them?

It is pathologic for anxiety to harm your own life, but I believe we enter the realm of catastrophe when personal mental health issues affect sweeping policy matters. Let’s consider some examples of vocal policy analysts (doctors, scientists, professors) who’s comments might be concerning.

That first paragraph sounds nearly identical to what Dr. Prasad said in his earlier Substack, doesn’t it? Notice how he now goes beyond just blaming anxiety and fear for COVID-19 precautions to claiming that physicians and scientists are all irrational blobs of fear and anxiety who can’t help but impose their fear and anxiety on society at large. In fact, he refers to their anxiety as pathological and says that they have “personal mental health issues”!

Back in May, I wrote about a similar sort of argument, in which Dr. Lucy McBride described what she referred to as “coronaphobia.” Here’s a link from Twitter:

And this is what Dr. McBride had said about her own article:

Basically, the message is the same: Stop being irrationally afraid and just catch COVID-19, already! As I said then writing about Dr. McBride and say now writing Dr. Prasad, it is not my intention to deny that there are people out there suffering from anxiety and depression due to the consequences of the COVID-19 pandemic, some of whom might even require treatment. There are. What I am going to point out is how the messaging that Dr. McBride doubled down on a year after she had first promoted it was very similar to messaging that I’ve been encountering for many years coming from the antivaccine movement. Although Dr. McBride probably doesn’t realize it, she is echoing an old antivax trope that does exactly the same thing: Seeks to shame those who fear vaccine-preventable diseases. I listed examples going back years in my post about her article; so I won’t repeat them here.

I will, however, note that Dr. Prasad goes beyond Dr. McBride’s shaming of people with anxiety over the pandemic. Dr. McBride at least tried to sound empathetic discussing what she clearly viewed as “irrational” fears of her patients. (What is a phobia, after all, but overblown and irrational fear or anxiety?) Dr. Prasad is dismissive of those fears as “irrational,” stoked by the CDC, and arrogantly lectures those who still have concerns as being not just completely unrealistic but cowardly and paranoid—deranged, even! (“Given: you’re eventually going to get Covid19 and it’s less dangerous than flu.” So stop being such a cowardly wimp and “catch that cold”—I mean flu.)

On the other hand, I do want to be as charitable as possible, even after venting a bit about Dr. Prasad’s general jerkishness. That’s why I can’t help but wonder about one part of Dr. Prasad’s post: “…you should take all the same precautions you used to take for flu, but no more.”

Here’s what I mean: What were “all the same precautions” that we used to take for flu? According to Dr. Prasad they included this:

You definitely washed your hands in the winter back in 2019, and you should do that now. At the same time you don’t have to be excessive about it. You can do it like you did before, reasonably.

I sense that Dr. Prasad missed…something…in his description of the precautions we used to take against the flu before the pandemic. What specific precaution am I missing? Hmmm..

Oh, wait, I know!

Dr. Prasad forgot to mention yearly flu vaccines. I’m sure it must have been an oversight on his part. After all, before the pandemic, the CDC did recommend that everyone over the age of 6 months be vaccinated against the flu every year before the start of the flu season—and still recommends it! That was a key part of taking “all the same precautions you used to take for flu, but no more,” wasn’t it? Even Dr. Sears mentioned the measles vaccine! He just dismissed parents who were worried about measles by saying, in essence, that they should get their kids vaccinated if they’re  worried. Odd, isn’t it, that Dr. Prasad didn’t at least say something like that along the lines of, “If you’re so worried about COVID-19, get vaccinated and boosted.” He didn’t. In that, he is actually worse than many pre-pandemic antivaxxers.

Indeed, by Dr. Prasad’s logic, then—ignoring all his dismissive rejection of masks and other nonpharmacologic interventions against COVID-19—we should at the very least also model our precautions against COVID-19 (which, like the flu, is here to stay according to the good doctor and we’ll just have to learn to live with it) on those that we routinely took against the flu before the pandemic, which was to get vaccinated every year, starting as an infant.

I have to assume—in the interests of the most charitable interpretation of Dr. Prasad’s post—then, that Dr. Prasad is recommending that everyone, starting at the age of six months, follow CDC recommendations for vaccination against COVID-19 as well—just as many of us did for vaccination against the flu—given that the CDC recommends vaccination against COVID-19 for everyone over the age of 6 months, a recommendation that is very much like its recommendation for the flu, minus the yearly vaccine. (At least the CDC isn’t recommending yearly COVID-19 boosters yet although such a recommendation in the future does appear likely.)

Again, I’m sure that it was just an inadvertent oversight that Dr. Prasad didn’t mention the vaccine, right? Surely he couldn’t mean that we should behave differently and not get vaccinated against COVID-19, could he? It was he who made the comparison and said that we should treat COVID-19 the same way that we treat the flu and take the same precautions for COVID-19 as the flu, not I. It must have been an error that he didn’t use this comparison to urge everyone to get vaccinated and boosted. It must have!

Anxiety over the pandemic is a real problem. I am by no means minimizing it, as there is a real pandemic anxiety syndrome that is accepted. Rather, I’m pointing out how Dr,. Prasad is actually minimizing it by intentionally conflating real anxiety disorders provoked by a once-in-a-century ongoing crisis with much more reasonable concerns. He’s also using a false comparison with the flu that completely leaves out one key element that many of us did every year to protect ourselves against it. Again, I’m done being charitable with Dr. Prasad. He knows exactly what he is doing, and what he is doing is no different than what the Brownstone Institute (with which he is affiliated) and Tucker Carlson are doing: Downplaying COVID-19 and exaggerating the risks of the vaccine, all while portraying a desire not to get the disease as irrational fear—or even actual pathology, such as a severe anxiety disorder.