Dear Mr. Allely,

I recently read your article on Sensible Medicine titled “doctors in charge of Sensible Medicine owe you an apology.

First, let’s discuss the risks of the vaccine. You cited a recent paper from Israel and said, “the risk of myocarditis from Pfizer vaccination in males from 16-29 years as 10.7 in 100,000. So roughly 1 in 10,000.” Though the rates of vaccine-myocarditis vary widely from one study to the next, that rate seems reasonable to me, especially when discussing adolescents, nearly all of whom received the Pfizer vaccine. This was the only sensible part of your essay.

With regards to the clinical course of vaccine-myocarditis, you castigated Dr. Eric Topol who described the condition as “mild”. You said:

Whether a median of three days of hospitalization can ever be considered mild is another question. I would argue that if you take a healthy young middle school boy and put him in the hospital for a few days you’d damn well better be sure the upside from your intervention is far greater.

However, you failed to let your readers know it’s not just Dr. Topol who describes vaccine-myocarditis this way. The Israeli paper you cited said:

The clinical course appears to be mild and benign over a follow-up period of 6 months, and cardiac imaging findings suggest a favorable long-term prognosis.

Literally every study on this topic reports the same thing, and though grave outcomes have occurred, including the deaths of a few young men, they are vanishingly rare. Here’s a collection a papers on the subject, none of which you quoted:

  • “All patients in this series had a benign course; none required intensive care unit admission” (Dionne)..
  • “All 7 patients resolved their symptoms rapidly” (Marshall)..
  • “All were discharged after a median of 2 days. There were no readmissions or deaths” (Diaz).
  • “Hospital course is mild with quick clinical recovery and excellent short-term outcomes” (Jain).
  • “All patients received brief supportive care and were recovered or recovering at the time of this report” (Montgomery).
  • The clinical course of vaccine-associated myocarditis-like illness appears favorable, with resolution of symptoms in all patients” (Rosner).
  • ” All the cases were clinically mild” (Mevorich).
  • “Acute clinical courses were generally mild” (Gargano).
  • “The mild phenotype of myopericarditis cases in our study were comparable with cases described in other studies, except 1 patient with myocarditis and MIS-C, who needed treatment at intensive care unit” (Nygaard).
  • “Most cases of myocarditis were mild or moderate in severity” (Witberg).
  • “The clinical course was mild in all six patients” (Mouch).
  • “All patients had resolution of their chest pain, were discharged from the hospital in stable condition, and were alive with preserved left ventricular ejection fraction at last contact” (Larson).
  • “Most cases of suspected COVID-19 vaccine myocarditis occurring in persons <21 years have a mild clinical course with rapid resolution of symptoms” (Truong).
  • “95% are considered to be mild cases” (Israel Ministry of Health).
  • “Most vaccine-associated myocarditis events have been mild and self-limiting” (Patone).
  • “Most cases were mild, and the symptoms resolved without extensive intervention” (Lee).

I won’t criticize you for saying vaccine-myocarditis shouldn’t be called “mild”. We both agree that it’s a big deal whenever a child is hospitalized, and around 20% individuals have persistent symptoms. However, your quarrel about calling vaccine-myocarditis “mild” isn’t just with Dr. Topol – it’s with dozens of doctors from around the world who, unlike us, actually cared for these patients and wrote the papers we read and cite. Your misinformed readers won’t know what they said. They’ll just think it was just Dr. Topol who minimized vaccine-myocarditis.

Your discussion of COVID’s risk was blatant misinformation. I really don’t know how else to describe it. To minimize the virus, you cited a CDC MMWR from June 2021 titled “Hospitalization of Adolescents Aged 12–17 Years with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States, March 1, 2020–April 24, 2021“. It found:

COVID-19 adolescent hospitalization rates from COVID-NET peaked at 2.1 per 100,000 in early January 2021, declined to 0.6 in mid-March, and rose to 1.3 in April. Among hospitalized adolescents, nearly one third required intensive care unit admission, and 5% required invasive mechanical ventilation; no associated deaths occurred.

You claimed that since no adolescents were vaccinated at this time, “these data is the worst case scenario”. You said:

At the peak of hospitalization from Covid in this age group, 2.1 per 100,000 adolescents were hospitalized with Covid. None died. Pfizer’s vaccine data from the NEJM study suggests that just under 9 per 100,000 adolescent boys were hospitalized with myocarditis. None died. So risk of hospitalization from Pfizer’s vaccine series may have been over four times as likely to land a young boy in the hospital than Covid over this time period.

Everything about this is wrong. Let’s go over the problems one at a time. First, you stated no adolescents died, which was true for the 204 hospitalized adolescents in the CDC report from COVID-NET data. However, that data doesn’t tell the whole story. COVID-NET is a surveillance network that covers about 10% of the US population. That other 90% matters. The American Academy of Pediatrics, which collected data from 43 states, reported that 296 children had died by the end of April 2021. So yes, some adolescents died of COVID during this time period. Your misinformed readers won’t know this.

Moreover, your comparison is absurd. You wrote, “So risk of hospitalization from Pfizer’s vaccine series may have been over four times as likely to land a young boy in the hospital than Covid over this time period”. However, the risk of an adolescent being hospitalized was 2.1 per 100,000 the week ending January 9th, 2021. This was not their risk of being hospitalized during the entire first 13 months of the pandemic. Your statement would have been accurate had you said, “So risk of hospitalization from Pfizer’s vaccine series may have been over four times as likely to land a young boy in the hospital than Covid on January 9th, 2021.” Of course, every vaccine would fail if its risks and benefits were judged this way.

Common sense should have told you the adolescent hospitalization rate was higher than 2.1 per 100,000. If the hospitalization rate were this low, this would mean that only 450 adolescents ages 12-17 would be hospitalized if every single one of them was infected in the US. In fact, many thousands of adolescents have been hospitalized.

Additionally, you provided no rationale for why you chose to evaluate to risk of the virus only from March 1, 2020–April 24, 2021. Did COVID vanish after this? No. In fact, the second year of the pandemic was much worse for children than the first. Mitigations measures vanished, and the Delta and Omicron variants arrived causing unprecedented illness in children. The time period from March 1, 2020–April 24, 2021 was far from the “worst case scenario” as you said. In reality, 20% of pediatric deaths occurred during the Omicron wave. About 180 children died from COVID in January 2022 alone. Your misinformed readers won’t know this.

Hospitalization Rates Ages 12-17

Of course, the Delta and Omicron variants would have taken a much greater toll on adolescents had none been vaccinated, and to your credit you acknowledged “that vaccines decrease the risk of severe disease”. This is all vaccine-advocates have ever said. However, it’s a really important point, and you short changed your readers by glossing over it.

To pick one study you ignored, a CDC MMWR titled “Characteristics and Clinical Outcomes of Children and Adolescents Aged <18 Years Hospitalized with COVID-19 — Six Hospitals, United States, July–August 2021” found that “Among 272 vaccine-eligible (aged 12–17 years) patients hospitalized for COVID-19, one (0.4%) was fully vaccinated”. That seems like a pretty big deal to me. Why didn’t you tell your readers about this?

Moreover, this CDC report found that children hospitalized with COVID were very sick, and a few died:

Approximately one half (54.0%) of patients hospitalized for COVID-19 received oxygen support, 29.5% were admitted to the intensive care unit (ICU), and 1.5% died; of those requiring respiratory support, 14.5% required invasive mechanical ventilation (IMV).

Neurological complications are not rare in children hospitalized with COVID. Despite this, you wrote, “Covid hospitalization in young men is rare and mild, if we want to use Dr. Topol’s standards”.

Really?

Can you not see the difference between a child hospitalized for a few days with vaccine-myocarditis and a child intubated for nearly 1.5-weeks with COVID? After being intubated for 11 days, 15-year-old Paulina Velasquez said:

My message, technically is: If you’re eligible to get the vaccine, please do. I plan on getting vaccinated as soon as my doctor lets us know when I can.

She spent over a month in the hospital and had to relearn basic motors skills. Such outcomes are not common with COVID, thankfully, but they are not exceedingly rare either. Other children have needed amputations or had strokes. Over 1,800 children have died of COVID, including healthy teenage boys who were eligible to be vaccinated. Over 9,000 children have suffered from MIS-C, and most of these children go to the ICU. 74 children have died of MIS-C. It’s not minimizing vaccine-myocarditis to say these grave outcomes are exceedingly rare from the vaccine. No children are known to have died from it.

Your readers won’t know any of this. You didn’t discuss this CDC report or any of the other 19 studies (I compiled them here) showing that the vaccine has already protected many children from the worst harms of the virus, including MIS-C. Even though they say things like “All 7 deaths occurred in patients who were unvaccinated” you decided not to inform your readers about them. Even during the Omicron wave, studies reported that only unvaccinated children died of COVID.

I am not a mind-reader, so I don’t know if the glaring omissions and inappropriate comparisons in your article were because you didn’t know basic information or because you purposefully neglected to mention anything that would undermine your argument. Assuming your article merely reflected your ignorance of this topic, the good news is that there is a simple way to prevent this problem in the future. If you write about a subject outside your expertise, ask someone who is an expert to read your article first. They will likely bring a perspective you lack.

I am sure there are pediatricians at your medical school who can tell you what it is like to care for a child sick with COVID. I suggest talking to them would be more useful than a conversation with the doctors at Sensible Medicine, none of whom care for sick children. Maybe you could ask them whether their hospitals were filled with children suffering from vaccine side-effects or from COVID. I think I’ll know what they’ll say.

I am sure other experts will help you too. Dr. Frank Han, for example, is a pediatric cardiologist who has treated children throughout the pandemic and published on vaccine-myocarditis. I imagine he’d be willing to read your articles. Like you, I am not an expert in pediatric cardiology, so I’ve asked for his help before.

I do worry, though, that there may be a larger problem. I fear that you weren’t careless. I worry that you started with a conclusion and selectively presented only the information that would advance your narrative. I worry that you purposefully avoided sharing facts that cast the vaccine in a good light or the virus in a bad light.

This is characteristic of writers on Sensible Medicine. I previously wrote about these doctors and said, “If ten data points are needed to understand the risks and benefits of the vaccine, they cherry pick the three that support their position”. Some doctors at Sensible Medicine unabashedly want unvaccinated children to get COVID, saying that that it is “natural and healthy” when children get sick and that pediatric COVID vaccine-advocates are “off their rocker“. This is why they receive favorable coverage from leading anti-vaxxers such as RFK Jr.

I can’t help doctors who simply don’t care whether their work is accurate and thorough. However, I can warn you. I advise you to read a previous article of mine (and this by Dr. David Gorski) about the dangers of doctors who have to say increasing outrageous things to pander to their audience. That article concluded that having the wrong audience is worse than having no audience.

I imagine my article will upset you. You’ll feel victimized and attacked. That’s how everyone feels when criticized. However, I urge you to resist the natural temptation to immediately dismiss what I’ve said simply because it was blunt and critical. We all make mistakes, and I’ve had to issue a couple corrections to my writing here. I’ve thanked the people who pointed out my errors. Only people who disagree with us can point out our flaws and make us better. Surrounding yourself in an echo-chamber, like many writers at Sensible Medicine, is a guaranteed way to make sure you won’t improve.

You are an adult who is responsible for your own words, especially when you use your credentials as a medical student. However, the editors of Sensible Medicine did you a grave disservice by letting you publish your article. They owe you an apology, and I mean that very seriously. It was their job to help you know your limitations and ensure your writing met basic standards of academic quality. They failed you. Their careers are safe. Yours is just starting.

So let me try to help you in ways they won’t.

Those who oppose child COVID vaccines are contradicting nearly every pediatrician and medical association with the relevant expertise. These are the people who cared for sick children throughout the pandemic and created the medical literature we rely on. They may be wrong. They are not infallible or immune to challenge, even from a medical student. However, you have to backup your arguments with thorough, rigorous data, not just the cherry-picked, manipulated data points that fit your narrative. To paraphrase you, if you take a 14-year-old football player and expose him to a virus that could kill him, you’d damn well better be sure you had a good reason not to vaccinate him.

While it’s fun to pretend that you are smarter than doctors with the real-world experience and responsibility you currently lack, I suggest that you keep in mind this quote by David Brin.

Author

  • Dr. Jonathan Howard is a neurologist and psychiatrist based in New York City who has been interested in vaccines since long before COVID-19.

Posted by Jonathan Howard

Dr. Jonathan Howard is a neurologist and psychiatrist based in New York City who has been interested in vaccines since long before COVID-19.