In my four years in Congress, the phrase I most abused was “Consequences of Science”. Washington politicians, bureaucrats, and reporters – many of whom appear to have last attended science class in eighth grade based on their comments – have a penchant for developing guidelines and then teaching the opposition about the “science” that follows their agenda. As my grandpa always said: “Numbers lie and liars figure.” The Covid-19 policy is no exception.
In medical school, my classmates and I were taught to apply science practically to the messy world around us, rather than just following theories as if we were practicing medicine in a vacuum. When we got out of the classroom, many of us quickly found that not every clinical course was exactly what the textbooks said. The medical school graduates who quickly became the best doctors were the ones who listened to their patients, went back to their experiences, and applied science only as it made sense in certain circumstances.
Nothing is more difficult for a doctor to handle than a virus. For example, the human papillomavirus often causes cervical cancer and cancer. Our residency program for obstetrics and gynecology studied HPV as early as 1987 during my internship. From 1997 to 2003, by combining Pap smears with HPV strain identification, physicians were able to use technology to determine which patients were actually at risk for cancer and which were not just being watched. Finding the right use took about a decade, however, and as doctors had difficulty using the data to differentiate who was at high risk and who was at low risk, I found that the condition was often over-treated.
It took real trial and error to find the right approach. Along with the approval of the HPV vaccine in 2006, medical researchers have consistently produced enough scientific data over the past decade for doctors to know with certainty which patients should be monitored and which cervical procedures or hysterectomies are needed. This eliminated millions of unnecessary surgeries, preserved fertility, and in some cases reduced extremely premature delivery. As a doctor, I can say that what we have seen over the past year in terms of diagnosis and treatment, as well as vaccines against Covid, is truly a miracle. But the medical community is still developing its understanding of treatments and risk factors.
Viral infections during pregnancy are also completely unpredictable. Even if you understand risk factors, you never know how an individual patient’s physiology will react. How well patients fight off a virus depends on their natural immunity, which depends on all sorts of largely unrecognizable criteria. Whether it’s hepatitis, chickenpox, West Nile or the flu – my professor once said to me: “If you saw a case of a particular virus during pregnancy, you only saw one case.” His point? Apply the science as best you can, but each case has its own complexities. Developing better treatments takes a lot of time and real data to treat patients.
It is impossible to follow the science of most viruses with great certainty, especially a novel virus. The medical community knew from day one that the science about Covid would be predictably unpredictable and constantly changing. When government scientists – let alone politicians and journalists – present a hasty, incomplete hypothesis as an indisputable fact, they are acting against science – and often leading a preconceived agenda. Science is a systematic enterprise that organizes knowledge into predictions about the universe. It is not a gospel of indisputable, never-changing truth. As cancer treatments have changed over time, doctors will discover myriad false hypotheses that have been put forward as facts by government agencies and health professionals across all fields related to Covid-19. Science is never set.
Take the infamous theme of mask mandates. The bureaucrats’ overly safe “science” initially told Americans not to wear masks. Then we had to wear them inside. Then this was expanded to include wearing outside masks. Now, a good American has to put on two, maybe three masks, even if you’ve had the virus or vaccine, to “follow the science” unless you’re in a restaurant or with a small group that is also vaccinated. Then you are safe.
There is little scientific logic behind these shifts. As a precaution, please continue to wear your masks in public.
Now let’s talk about the application of science. Real-world evidence suggests that the effectiveness of a shot’s
or Moderna vaccine is between 72% and 92.6% after two weeks. Additional evidence suggests that the second shot could be made 12 weeks later instead of three or four weeks and could be equally effective. After every senior and high risk person receives two shots, applied science would suggest that we could save tens of thousands of lives by giving as many people one shot as possible and coming back for a second dose when more vaccines become available . This assumes that robust real world evidence deems a second shot even necessary, which the evidence may not confirm.
Consider this: if you had 200 Pfizer vaccines and 200 family members and it was up to you, how would you assign them? Current emergency use permissions require you to give 100 people two shots. Assuming it will be 95% effective, only 100 people would be vaccinated and 95 would be protected. Alternatively, you could give 200 people a shot, assuming 75% effectiveness, at least 150 people were protected. This approach has the potential to remove the relative supply constraints and hiccups that currently occur at mass injection sites. With every day that applied science is delayed, more people than usual are dying of Covid-19 and the opening of businesses and schools is unnecessarily delayed.
I’m not trying to be too strict. The Food and Drug Administration is responsible for ensuring the safety, effectiveness and safety of all medical devices. Congress should clarify how and when the FDA considers real evidence in emergency approvals during pandemics – and ensure that practical realities are taken into account.
State and local officials and health care providers across the country need to do the science and apply the theory to the world, not blindly follow it, as if we exist in a vacuum.
Dr. Marshall, a Republican, is a United States Senator from Kansas. He represented the First Congressional District (2017-21) and was a practicing obstetrician and gynecologist in Great Bend, Kan.
Journal Editorial Report: Paul Gigot interviews Marty Makary of Johns Hopkins. Image: Kamil Krzaczynski / AFP via Getty Images
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