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Words of Healing: Drivers of the COVID-19 Story : Emergency Medicine News

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COVID-19, medical crisis, pandemic

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But it is, when not duly considered against, an almost irresistible tendency of the human mind to become a slave to its own assumptions; and when he has once become accustomed to reasoning, feeling, and conceiving, under certain arbitrary conditions, he ends by confusing these conditions with the laws of nature..

—John Stuart Moulin

Part of the medical history of COVID-19, under certain arbitrary conditions, confused assumptions with a law of nature and directed personal desires in 2020 and 2021 that should have been driven by a larger scientific community of well traveled minds. Just look at some of the treatments offered: chloroquine/hydroxychloroquine (Cochrane Database System Rev. 2021;2[2]:CD013587; https://bit.ly/394Eggz); zinc (JAMA Netw Open. 2021;4[2]:e210369; https://bit.ly/3nwBlpa); Vitamin D (Cochrane Database System Rev. 2021;5[5]:CD015043); azithromycin (JAMA. 2021;326[6]:490; https://bit.ly/3kaapJJ); plasma infusion (JAMA. 2021;325[12]:1185; https://bit.ly/399l4hr); ivermectin (JAMA. 2021;325[14]:1426; https://bit.ly/3kc5KHu); and remedy it. (Lancet Infect Dis. 2021;S1473-3099[21]00485-0).

These are just a few examples of the pharmaceutical interventions that have been prematurely and alarmingly promoted as heroic, usually with a social media cape embroidered with the words “Doctor Says.” Of course, the general public has a limited understanding of the distance between the training of an ophthalmologist and that of an infectious disease specialist, let alone that of a virologist or immunologist. (The Washington Post. 2021 Jul 22; https://wapo.st/2VHdjwh.)

When all of these “potentially life-saving remedies” proved ineffective, news sources and social media pundits framed the failures as a humiliation, and Average Joe and Josephine could be heard screaming in grocery store lines: “They start again, changing their thoughts!” How can we take back the driver’s seat so that American society has a healthier and truer journey?

Three ways

We must speak as a scientific community. I don’t know why the Infectious Diseases Society of America guidelines for COVID-19 weren’t pasted in all hospitals and published in all news sources. (IDSA. 2021; https://bit.ly/2JWttMu.) I don’t know why national bulletins aren’t repeatedly published by IDSA, American College of Emergency Physicians, American Academy of Pediatrics and American College of Physicians verifying the solid science of the effectiveness of masks, the need for a vaccine, and the unlikely reality of repurposing an old drug for a new virus.

The professional medical science community needs to turn up the volume loud and repeat in one clear voice: “There is no real scientific debate about the value of masks and vaccines!” The quack and the doctor untrained in infectious diseases must be exposed and drowned.

We have to admit that important clinical medical science is rare. The brain alone is good at making mistakes; we call this bias. The scientific method exists to minimize bias. We publish and distribute studies so that there is a public and community record of historical professional medical memory. We need this memory to change behavior; this is called learning.

This search for true knowledge is nomadic and extraordinarily difficult. It is not a straight or easy path. If you go it alone and don’t use the landmarks of the community as a whole, you’ll probably die. It is one of the most difficult landscapes to navigate wisely.

There are conflicts of interest such as Genentech and the America Heart Association with IV tPA for stroke. (BMJ. 2002;324[7339]:723; https://bit.ly/3AqPQOM.) There are failures to find consensus on terms and what we are really dealing with, such as with the Centers for Medicare and Medicaid Services and sepsis. (JAMA. 2016;315[8]:801; https://bit.ly/3tLId36.) There are times when weak clues are mistaken for bold new medical directions such as therapeutic hypothermia. (Before Cardiovascular Med. 2021;8:642843; https://bit.ly/3nzRkD0.) And the list of overzealous and reckless wrong turns can be mind-boggling like TXA and vitamin D for everything. (REM. 2021;43[5]:9; https://bit.ly/3vv9MgK.)

Do not expect significant clinical medical science; it is a rare and stubborn gem. It shouldn’t be surprising to admit that over 99% of what we regularly dig in hopes of medical treasure ends up being more dirt and rock. Spoiler alert: we’re not as smart and in control as we think.

Failures should be publicly displayed. Failures are essential. They add to a cloud of data points over time surrounding an elusive factual line. More important is the public acknowledgment of these false turns. Humility is not humiliation; it is a sign that we always travel with a map engraved by a scientifically honest pen. Humility and hope are not opposing messages; they are synergistic. Admitting wrong turns is a commitment to a process and a path to minimize mistakes. We shouldn’t confuse optimism with brash ego and raw opinion. We need to separate our ideology from the data of our scientific journey.

History comes alive

Maya Angelou wrote in her poem for the 1993 US presidential inauguration, “On the Pulse of Morning”, “History, though it’s heartbreaking pain / Can’t be ignored, but if faced / With courage it won’t does not need to be experienced again. During this pandemic, we’ve heard from many self-proclaimed “doctors” who were brash and often dishonest. We treated each new pharmaceutical hypothesis with hyperbolic, amnesiac idiocy of statistical probability of failure.

And we didn’t let go of a hypothesis when solid scientific data presented itself proving its ineffectiveness because it was no longer a scientific method; it was somehow linked to everyone’s social and political identity. If we face this ugly story with courage, can we hope not to relive it? Can our society understand that the regular dumping of scientific rocks and dirt heightens the diamond brilliance of vaccine discovery in a miraculously brief period, nothing less than a medical holy grail for the healing of the world?

We need to draw a different map for our next medical crisis. Physicians, as a unified and vocal community, must invite the public to come to their hallway. We would like passengers to share their destination with us. Although we are far from perfect, we should humbly insist on the honor of driving, and our license plates should say: “Speak the truth”, “Love your neighbour”, “Wear a mask” and “Do vaccinate yourself”.

Dr. Mosleyis an emergency physician in Wichita, KS.