According to the Encyclopedia Britannica:
Postmodernists deny that there are aspects of reality that are objective; that there are statements about reality that are objectively true or false; that it is possible to have knowledge of such statements (objective knowledge); that it is possible for human beings to know some things with certainty; and that there are objective, or absolute, moral values. Reality, knowledge, and value are constructed by discourses; hence they can vary with them. This means that the discourse of modern science, when considered apart from the evidential standards internal to it, has no greater purchase on the truth than do alternative perspectives.
A more concise description comes from Moe Szyslak of The Simpsons who said postmodern art is “weird for the sake of weird“, which echoes my previous description of contrarian doctors and their “almost petulant need to be different, no matter the evidence”. This essay will explore how, under the guise of “reason”, doctors, desperate to be different no matter the evidence, have embraced the position that there are no aspects of reality that are objective and that feelings matter more than facts.
The flu versus COVID for children: Part 1
With this in mind, let’s revisit a disagreement I’ve had with several doctors about which disease is worse for children, COVID or the flu.
It is not controversial to say that normal life ended when the pandemic began. Everything but hospitals shut down, and we all started wearing masks. Even though nearly all government-mandated restrictions vanished long ago, many people have yet to resume their pre-pandemic lives. It is further not controversial to argue that human behavior affects the spread of viruses. A lone hermit in the woods will never contract or spread COVID, while fans of crowded, indoor karaoke bars will have encountered the virus many times by now, and likely spread it to many others as well. As such, the only apples-to-apples comparison between the flu and COVID is to examine their impact since the pandemic started.
Moreover, when discussing a virus’s impact on a population, we must consider two factors; how deadly it is and how contagious it is. While a child with COVID has the same very low risk of dying as a child with the flu, COVID is much more contagious, and so it affected more children. Had we allowed COVID to rip through unvaccinated children, as several doctors proposed, it would have harmed many more of them.
The numbers tell an unambiguous story.
Mitigation measures that dented COVID obliterated the flu. During the first year of the pandemic, influenza killed just 1 child. As things opened up, that number predictably rose, and the pediatric flu death toll now stands at 33 since the pandemic’s start. During this time, according to the CDC’s COVID Data Tracker, COVID has killed over 1,700 children. This ever-growing number would certainly be higher without the vaccine. During one week last year (12/16/21), the American Academy of Pediatrics added 38 children to its grim death tally, more than the flu killed in two years. Even looking at pre-pandemic years, COVID still extracted a higher toll on children than nearly every flu season.
Image credit: Dr. Jeremy Faust
Hospitalization numbers reinforce this point. The CDC reported that the flu hospitalized just 9 children ages 5-11 during the 2020/2021 flu season, while COVID hospitalized 8,300 children that age during this time (slides 14 and 28). Additionally, a recent study of 66 pediatric ICUs found,
The number of children admitted each quarter with a primary diagnosis of COVID-19 or MISC during the first 15 months of the pandemic was twice as high as that for influenza during the 2 years before the pandemic. Influenza outcomes were observed during a time with no unusual public health measures in place (2018 to early 2020), while those of SARS-CoV-2 occurred while masking, social distancing, and remote schooling occurred. Those measures were sufficient to markedly decrease critical illness from many respiratory viruses, including nearly eliminating influenza admissions to these PICUs. Without these measures in place for this largely unvaccinated population, SARS-CoV-2 would likely have led to a number of critically ill children several-fold higher than seen with prepandemic influenza as well as more deaths.
Around 140,000 children have been hospitalized with COVID, and as Noah Louis-Ferdinand explained, this can be very serious for some children. Though dire outcomes remain rare, they should not be glossed over. Moreover, the flu doesn’t cause MIS-C. While it has happily vanished for now, it has affected at least 8,639 children, and most affected children need ICU-level care. 70 children have died of MIS-C. We are still learning about long-COVID in children and we have to be humble about the possibility of long-term sequelae.
Of course, this discussion has zero relevance to vaccinating children. Normal people don’t want any child to suffer or die for lack of a vaccine. We should obviously vaccinate children against both viruses. Still, I looked at the numbers a year ago and concluded “COVID-19 is Deadlier Than the Flu for Children“. Nothing has happened since then to change my mind.
Everything about my belief is surprisingly controversial. Prominent and influential doctors believe the flu is worse than COVID and use this belief to argue against pediatric vaccination.
- Vinay Prasad (2/4/2021): “It is generally not controversial to argue that SARS-CoV-2 in kids is roughly, roughly the same as influenza, maybe even less severe than influenza, seasonal influenza in kids… it’s far more deadly in older people than it is in younger people…”
- Jay Bhattacharya (7/21/21): “They are, as you say, Steve, at very low risk for bad outcomes from this virus. Very few healthy, young children died from this virus, more died from the flu last year.”
- Scott Atlas (9/22/2021): Children “die from the flu at a higher rate” than from COVID
- Martin Kulldorff (12/17/21): Their Covid mortality risk is miniscule and less than the already low risk from the annual influenza, so the vaccine benefit for healthy children is very small.
- John P.A. Ioannidis (March 28, 2022): “COVID-19 probably caused substantially fewer deaths in children and adolescents <20 years old (~20,000) versus 3 seasons of typical influenza.”
For reference, when Dr. Prasad made his comment, at least 227 children had died of COVID (slide 31), while one had died of the flu. COVID has been killing many more children than the flu since the start of the pandemic, though these doctors claim the opposite is true.
Against Scientific Gatekeeping: Three areas of agreement
Beyond this shared belief, these five doctors were all favorably mentioned in an article titled “Against Scientific Gatekeeping” by Dr. Jeffrey Singer, which was published at the Orwellian-titled Reason Magazine. His article reveals yet another tool in the vast arsenal available to COVID-minimizing doctors, namely the denial that there are aspects of reality that are objective.
As I often do, I will start with several areas of agreement. First, Dr. Singer stresses that science must be open to new ideas. So long as these ideas are supported by reason and evidence, I agree. As the saying goes, “It pays to keep an open mind, but not so open your brains fall out.” I previously expressed my admiration for Dr. Katalin Karikó, a scientist who toiled anonymously for years because she loved research. Though few saw its value until recently, her work led to the mRNA vaccines. Scientists like her need to be encouraged and supported.
Second, I agree that people who ask “legitimate questions and concerns about the vaccines”, should not be labeled “anti-vaxxers” or “COVID deniers”. Though we need to be on guard against bad-faith JAQing off, I’ve said exactly this, writing:
We need to leave room for people to have good faith disagreements and questions without inappropriately smearing them as “anti-vaxxers”.
Dr. Bhattacharya, for example, was wrong to call Dr. Fauci “the number one anti-vaxxer” because Dr. Fauci wisely didn’t tell people two vaccine doses rendered them permanently invulnerable to COVID.
Third, I agree with Dr. Singer when he said we need not tolerate nonsense. He said,
Openness to unconventional ideas has its limits. We don’t take flat‐earthers seriously. Nor should we lend credence to outlandish claims that COVID-19 vaccines cause infertility, implant people with microchips, or change their DNA.
I don’t think Dr. Singer really believes this though. His central thesis was that these five doctors are brave, heterodox thinkers who have been victims of an intolerant “priesthood” that previously suppressed pioneers such as Ignaz Semmelweis and Edward Jenner. You’ll recognize this bit of sophistry as the Galileo gambit.
According to Dr. Singer, the persecution of brave, maverick doctors continues unabated today at the hands of “an orthodoxy enforced by a priesthood”. As he put it:
Challenges to the priesthoods that claim to represent the “scientific consensus” have made them increasingly intolerant of new ideas… If anyone, expert or otherwise, questions the orthodoxy, they commit heresy. The result is groupthink, which undermines the scientific process.
He was upset that “gatekeepers”:
Dismissed epidemiologists as “fringe” when those specialists dared to question the conventional wisdom.
I’m no philosopher, but that sure sounds like postmodernism to me.
I’m sure Dr. Singer will furiously reject this comparison. But let’s be very clear about what he is saying. He believes that doctors who claim 33 is larger than 1,700 (or 1 is larger than 227) are simply expressing “new ideas” and questioning the “conventional wisdom”. He feels these doctors are many things, but wrong is not one of them.
In contrast, Dr. Singer believes that those who defend the idea that 1,700 is larger than 33 are merely “priests” hunting heretics. According to Dr. Singer, who specifically lambasted SBM and Dr. David Gorski (who responded here), we “undermine the scientific process” by our silly insistence that basic facts still matter. His essay is a wholesale a rejection of the belief “that there are statements about reality that are objectively true or false”. When it comes to doctors with stellar academic credentials, there is no truth, just opinions, and the only people who should be criticized are the “priests” who engage in “groupthink” by claiming that larger numbers are, well, larger.
Of course all cranks talk this way, especially those who claim that COVID vaccines cause infertility, implant people with microchips, and change their DNA. They too feel they are just expressing “new ideas” and questioning the “conventional wisdom”. They too claim to have been “exiled by the medical establishment” for their courage and independent thought. They too bring up Semmelweis, and they are certain history will enshrine them in the pantheon of misunderstood genius. This is such a trite genre.
“The carnage is unspeakable.”
And what exactly does Dr. Singer feel these “priests” are guilty of? Did we at SBM prevent these doctors from influencing politicians or stop them from making YouTube videos? Did we issue thinly veiled threats that people we disagree with should be decapitated? Of course not. Most of us here at SBM are frontline healthcare workers, and we know members of our profession have been harassed and attacked during this pandemic. Violence against healthcare workers horrifies us, and Dr. Gorski and myself have both expressed disgust at threats against Dr. Ioannidis. Other doctors, sheltered from the consequences of their words, get a kick of adding fuel to this fire. Yet, Dr. Singer feels these doctors must be protected from SBM.
You see, we’ve criticized these doctors with words, and Dr. Singer feels we shouldn’t have done this. He was very bothered by one of Dr. Gorski’s articles titled “The Great Barrington Declaration: COVID-19 Deniers Follow the Path Laid Down by Creationists, HIV/AIDS Denialists, and Climate Science Deniers“. Dr. Singer didn’t specify any areas of disagreement or flaws with this article. He just didn’t like the title. That’s it! He was offended on principle that anyone had the audacity to strongly and openly disagree with well-known doctors merely because they wanted unvaccinated children to get COVID. Dr. Singer’s criticism of SBM was literally devoid of content.
And now we learn what these priests guilty of. They are guilty of speaking in a tone that Dr. Singer deems indecorous. (I discussed this deflection technique here.) According to Dr. Singer, Dr. Ioannidis was “pilloried by the medical science priesthood and its supporters in the media”, while Dr. Prasad “was subjected to personal attacks by peers.” Dr. Singer was upset that Ioannidis’ work was called a “black mark” and that NIH Director Francis Collins wanted a published “take down” of the “premises” of the Great Barrington Declaration.
Dr. Singer feels these “premises” are sacrosanct and that famous, contrarian doctors should be immune from strenuous, public criticism no matter what they say. It doesn’t seem to bother him that unvaccinated children have died of COVID or that healthcare workers have been attacked by misinformed patients. Instead, he feels the real tragedy is that doctors who posted pictures of guillotines and advocated exposing unvaccinated children to the virus were called “fringe” by other doctors in a private e-mail. Our words hurt their feelings.
Dr. Singer doesn’t seem to have much respect for the fortitude of the doctors he defends. He is clearly worried about their delicate sensibilities and feels the entire world should be their safe space, where everyone gets a participation trophy. I disagree. Doctors who publicly voice “heterodox” opinions have no right to immunity from “personal attacks by peers”, especially since those supposed “personal attacks” nearly always consist of substantive criticism.
Our disagreements with these doctors are never personal
Of course, our disagreements with these doctors are never personal, and they extend well beyond whether or not the flu is worse than COVID for children.
- Did large numbers of people die with COVID not from COVID? No.
- Is the death toll inflated because doctors were too quick to intubate people at the pandemic’s start? No.
- Is the death toll inflated because doctors filled out death certificates inappropriately – even fraudulently? No.
- Did over 100% of NYC residents contract COVID during its first wave? No.
- Do the words “shelter-in-place orders and quarantines” really mean “a rapid seroprevalence study and a focused protection approach”? No.
- Is the risk of death “completely negligible” for healthy people under age 65? No.
- Did the pandemic end in 2020? No. Did the pandemic end in 2021? No. Did this pandemic end this spring? No.
- Did Florida protect “the vulnerable by vaccinating the older population” right before the Delta wave ripped through the state? No.
- Is amplifying someone’s words silencing them? No.
- Would “focused protection” have actually worked? No.
- Will masks and vaccines lead to the next Hitler? No.
- Did most hospitals maintain largely empty wards? No.
- Should doctors have mocked people who wanted a booster before Omicron ripped through the population? No.
- Did the pandemic kill just 10,000 Americans? No. Did the pandemic kill just 40,000 Americans? No. Did the pandemic kill 20,000-40,000 Americans? No.
- Will vaccinating children kill elderly people? No.
- Should unvaccinated children get COVID because old people are more vulnerable? No.
- Should every public health measure be studied in a massive randomized-controlled trial in the middle of a raging pandemic? No.
- Will children’s “risk of covid will decline precipitously” after “all adults are vaccinated”? No.
- Should doctors legitimize anti-vaccine conspiracy theorists? No.
- Were claims that 20%-60% of adults would be infected “substantially exaggerated”? No.
- Were many frontline healthcare workers fired due to vaccine mandates? No.
- Is it appropriate for a senior scientist to discuss the physical appearance of a young scientist who disagrees with him? No.
- Did the US achieve herd immunity 3-6 months after the lockdowns ended? No.
- Are vaccine side-effects worse than death for children? No.
- Are frontline healthcare workers the “laptop class”? No.
- Is it acceptable to truncate graphs and omit key information to mislead readers? No and No.
- Should doctors spread anti-vaccine myths abroad? No.
Though Dr. Singer’s article was devoid of substantive criticism, that’s not true of our work. Myself and many others have written volumes detailing our disagreements with these doctors. Dr. Singer ignored all of it. He was either ignorant of these criticisms or he purposefully avoided them to spare himself the effort of having refute them. He’s so enamored with his simplistic heroes and villains narrative that he never considers the “priests” may have valid criticisms of the “heretics”. It’s easier to mindlessly throw around juvenile jeers of “groupthink” than do the hard work of trying to understand and engage with one’s critics and their ideas.
“For children, getting sick and recovering is part of a natural and healthy life.”
As SBM readers know, my articles have detailed how these doctors minimize COVID’s impact on children. In addition to claiming it’s less harmful than the flu, they’ve often portrayed pediatric COVID as beneficial, both for society at large and for individual children. Dr. Ioannidis lamented that children might avoid infection by saying, “School closures may also diminish the chances of developing herd immunity in an age group that is spared serious disease”. Similarly, in an article titled “Should We Let Children Catch Omicron?“, Dr. Prasad wrote that “For children, getting sick and recovering is part of a natural and healthy life”. Meanwhile, in the real world, because it was so contagious, Omicron killed and hospitalized more children than ever before.
Given their overtly pro-virus proclivities, it’s no surprise these doctors have repeatedly denigrated the benefits and exaggerated the risks of pediatric vaccination. Several are unabashedly anti-vaccine for young people. In one such article titled “The Ill-Advised Push to Vaccinate the Young“, Drs. Kulldorff and Bhattacharya wrote:
The idea that everyone must be vaccinated against COVID-19 is as misguided as the anti-vax idea that no one should. The former is more dangerous for public health.
Over 1,000 children have died since that jaw-dropping sentence was written last year, and tens of thousands more have been hospitalized. In this article, they absurdly argued that children should be left vulnerable to COVID since it’s more dangerous for grandma. They said:
While anyone can get infected, the old have a thousand-fold higher mortality risk than the young.
The vaccine isn’t perfect, but it has proven effective in multiple studies at limiting severe outcomes. Though these doctors have written tomes on pediatric COVID themselves, you’ll generally not learn any positive news about the vaccine from them. Instead, like anti-vaxxers demanding a randomized trial of the entire vaccine schedule, they lament that the vaccine wasn’t studied in impossible, unethical trials of hundreds of thousands of children.
This reveals another of Dr. Singer’s errors. These doctors aren’t expressing “new ideas” at all. Those of us who are familiar the anti-vaccine movement know their sort of blather predates even Edward Jenner. As Dr. Gorski discussed in his article “Everything Old is New Again“, we’ve heard this all many times before. The only thing that’s new is Dr. Singer’s demand that anti-vaccine doctors be spared from criticism.
It didn’t used to be this way. Prior to the pandemic, a doctor who suggested children get the measles and bashed the MMR vaccine would be rightly lumped in with frauds like Dr. Andrew Wakefield. For example, after a doctor fear mongered about a vaccine for a less dangerous virus, the flu, Dr. Prasad appropriately said:
Wow, this quack is the head of an institute of an actual medical center?
Fast forward to 2022, and Dr. Prasad now feels that for a deadlier virus:
Any strong advocate for kid covid vaccination is off their rocker. It really doesn’t matter. The risks are super low.
This is not challenging the “conventional wisdom”. As the pre-pandemic Dr. Prasad would have realized, calling vaccine advocates psychotic and saying “it really doesn’t matter” that some children are severely affected by COVID is anti-vaccine. Only someone who denies “there are objective, or absolute, moral values” could pretend otherwise.
“We want them infected”
Beyond this, Dr. Singer has odd notions of “gatekeepers” and “heretics”. He’s right that we at SBM reflect the medical consensus regarding vaccination. Only a few heretics, with no real-world responsibility for sick children, see the data and are “heterodox” enough to conclude, “Since 33 is larger than 1,700, unvaccinated kids should get COVID “.
In contrast, doctors who actually treat sick children know the virus has devastated some of them. They’re also familiar with the research showing the vaccine can limit these rare harms, and so they want to protect their patients. If Dr. Singer feels we at SBM are “priests”, “gatekeepers”, or whatever because we support pediatricians, we’ll just have to live with his condemnation. I’ll sleep just fine knowing Dr. Prasad thinks I am “off my rocker” because I want zero children to suffer or die for lack of a vaccine.
Though these heretics are a small minority, this does not mean they are not themselves gatekeepers. They’ve had a big megaphone and a lot of influence. These “silenced” doctors helped set COVID policy for the entire country for much of the pandemic. The Trump administration largely embraced their “herd immunity through mass infection” approach. One science adviser there reflected this when he said:
Infants, kids, teens, young people, young adults, middle aged with no conditions etc. have zero to little risk….so we use them to develop herd…we want them infected…
Their desire to get “them infected” continues today in Florida, whose Department of Health is now explicitly anti-vaccine. They’ve also testified in courts and before Congress, where their testimony has been rightly deemed unreliable (here and here). They are routinely published and favorably quoted in the international media, reassuring everyone COVID’s threat is overblown and the pandemic is over. A few have been on Fox News delivering this same message since the start of the pandemic. Several have large social media followings, and they’ve all made a ton of widely-seen YouTube videos. They’ve been everywhere this pandemic- except hospitals.
Not only are they celebrities, their ideas won. Pediatric vaccination rates are abysmal – just 2% of young children have been vaccinated. While this alarms doctors who care for sick children, it’s exactly what these doctors wanted. As pediatric hospitalizations rise to match the peak of the Delta wave last summer, Dr. Singer should congratulate them on their success.
In contrast, my articles supporting pediatric vaccination get read by several thousand people, perhaps, and my requests to speak at their conferences have been ignored. I’ve not advised presidents, and I can’t just call up Florida Governor Ron DeSantis. I doubt Reason Magazine, which claims to be dedicated to “free minds”, will amplify this article, though they have my permission to publish it. Saying this modest website has been a “gatekeeper” for these ubiquitous, powerful doctors is as silly as saying 33 is larger than 1,700.
But what else is Dr. Singer’s article other than a postmodern homage to dangerous silliness? Though he says we need not give “credence to outlandish claims”, he demands we do exactly this. His entire article is dedicated to the premise that “reality, knowledge, and value are constructed by discourses”, and therefore, we must not call outlandish claims outlandish so long as they originate from an “icon of the movement for evidence-based medicine”.
He’s wrong. No one gets a free pass.
We have no obligation to give credence to outlandish claims just because they come highly-credentialed doctors with who have “published and critically reviewed hundreds of medical research papers”. We shouldn’t give credence to outlandish claims that the pandemic ended last year, or the year before that. We shouldn’t give credence to outlandish claims that the key to Magical Herd Immunity Land is to let COVID run rampant in unvaccinated children. We shouldn’t give credence to the outlandish claim that children should remain unvaccinated because older people are at more risk. We shouldn’t give credence to the outlandish claim that it’s beneficial when unvaccinated children contract a virus that has killed 1,700 and hospitalized 140,000 of them. It’s not “groupthink” to argue that children have the right to be protected against a potentially dangerous virus. It’s basic medical ethics, and only someone who treats “reality” as a mental construct could claim otherwise.
The flu versus COVID for children: Part 2
Though I’ve read these doctors’ confident and authoritative statements that the flu is worse for children than COVID, I’ve not seen a detailed defense of this claim, nor have I seen it explained why this belief implies that “COVID was overblown“, as opposed to “We never should have let so many children die of the flu.” Even before the pandemic, I felt it was shameful that we casually accepted so many pediatric flu deaths, especially when an effective vaccine is available.
I think these doctors are just wrong to say the flu is overall worse for children than COVID. I also think they know they have a hard case to make. This is why they never – and I mean never – simply state the number of children who have been killed by each virus since the pandemic again. They have the good sense to know most people believe that a virus that kills 1,700 children is worse than one that kills 33.
I have no problem sharing facts and defending my ideas. That’s why I wrote “COVID-19 is Deadlier Than the Flu for Children” in the first place. However, I don’t think my premises are sacred, and given the suffering I’ve seen, I won’t melt if someone calls me “fringe”. So, I’d really love for one of these doctors to write an article titled “The Flu is Deadlier Than COVID-19 for Children“, as long as it includes these two essential numbers – 33 and 1,700 – and explains why doctors should tolerate even a single unvaccinated child dying from either virus.
Since Dr. Singer thinks it’s wrong to call these doctors wrong, he should write that article. He’s got a start already.