In 2019, Drs. John Mandrola, Adam Cifu, Vinay Prasad, and Andrew Foy wrote an article titled The Case for Being a Medical Conservative. They wrote that the “choice of the term ‘medical conservative’ does not imply a political philosophy.” Instead, they recognized “that many developments promoted as medical advances offer, at best, marginal benefits”. The crux of their article was that:
The medical conservative adopts new therapies when the benefit is clear and the evidence strong and unbiased.
In a previous article titled Medical “Conservatives” Are Medical Radicals, I expressed my broad agreement with this philosophy, while noting that its authors fell short of it by taking a medically radical approach towards SARS-CoV-2 itself.
Additionally, though most of my articles advocate for COVID vaccines, I tried to take a medically conservative approach towards them. I’ve never hidden their blemishes, and I hope I never oversold them as a perfect panacea, especially considering how new they are and how new this virus is. I didn’t feel I could adequately predict their efficacy over the long term. For example, in a Twitter discussion on 4/3/2021, I said.
I’m very very optimistic vaccines will cut transmission of disease. I’m not certain of it. This is why I wear a mask still in public and when treating covid patients.
At the time, I didn’t think we had “strong and unbiased” evidence that the vaccines perfectly halted transmission. Though I was very optimistic, the situation called for caution and humility. As it turns out, the vaccines are far from useless in limiting transmission, though this changed depending on the variant, but they are obviously not an invincible wall either.
Other doctors felt differently in the spring of 2021. They were certain that vaccines halted transmission and offered perfect protection against infections and severe COVID. They suggested that the combination of vaccine-induced and “natural” immunity meant we should stop even trying to predict the course of the pandemic – “enough with these models” – and they tried to shame into silence anyone who still warned of the virus. For example, in April 2021 Dr. Vinay Prasad said that the “media’s breathless coverage of MIS-C and variants has been a disservice”. The Delta and Omicron variants would arrive soon thereafter.
(From May 2021)
Like many people, I am not innocent when it comes to overly optimistic predictions in the spring of 2021. Millions of people were getting vaccinated, and the vaccines were highly effective against the circulating SARS-CoV-2 strains. Meanwhile, COVID cases were plunging and variants were mere theoretical worries. It was an optimistic time and we have to be careful to avoid the hindsight bias. However, I tried to not let my enthusiasm get ahead of the evidence. I never claimed that vaccines offered 100% protection against bad outcomes or that they were certain to end the pandemic. In fact, I wrote in May 2021:
I hope this ages poorly, but given the large numbers of unvaccinated adults, COVID-19 is likely to remain a threat to American children for the foreseeable future, especially in regions of low-vaccine uptake. Many scientists doubt that the US will achieve the vaccination numbers needed for herd immunity.
Sadly, that didn’t age poorly. As such, I don’t feel hypocritical in criticizing medical “conservatives”, who abandoned their own principles, oversold vaccines, and misled people into thinking the virus had been forever tamed, when in fact the worst was yet to come.
However, the harshest criticism of these pollyannaish prognosticators is below.
(Fact Check: Dr. Prasad is cherry-picking the highest rates of vaccine myocarditis and not discussing its clinical course.)
