Offline: The distance between us

1000 people gathered in the magnificent Light auditorium at Friends House on a bleak winter evening in London. They were there to hear Dr. Aseem Malhotra, a cardiologist, answer the question, “Has Big Pharma Hijacked Evidence-Based Medicine?” Most of those assembled wanted to know Malhotra’s views about the safety of COVID-19 vaccines. Critics might argue that his pronouncements on vaccines should be dismissed. But to understand why vaccine hesitancy has become such an important public health challenge, one must study his arguments and claims, even if one finds them misplaced.

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Malhotra began with two “principles”. First, fear inhibits our ability to think critically. Second, wilful blindness protects prestige and fragile egos. He quoted Stephen Hawking: “The greatest enemy of knowledge is not ignorance, it is the illusion of knowledge.” He described how two review papers he wrote on “Curing the pandemic of misinformation on COVID-19 mRNA vaccines through real evidence-based medicine” were the most rigorously peer reviewed of his career (they were published in the open access Journal of Insulin Resistance). He argued that society was faced with a “pandemic of misinformed doctors”. He praised John Ioannidis for his claim that we live during a period of “medical misinformation”. He suggested that “honest doctors can no longer practice honest medicine”. He claimed that randomized trials exaggerate the benefits of new interventions, while minimizing their risks. He agreed that the pharmaceutical industry had developed many life-saving medicines, but these medicines were “overused”. He explained how the use of relative risk reductions can be misleading. He noted that doctors should always practice shared decision making with patients. Malhotra moved onto his main theme—namely, his claim that there was an increased risk of heart attack after receiving an mRNA COVID-19 vaccine. He spoke about a “close to non-existent” benefit from mRNA vaccines during the omicron phase of the pandemic. He implied that one could not fully trust the independence of vaccine regulators. He seemed to correlate differences in cardiac arrests between 2020 and 2021 with vaccine roll-out. He spoke about the importance of the commercial determinants of health. He showed a slide entitled, “Key facts on vaccines based on the highest quality data and best available evidence”. There were nine bullet points, including the statement, “Unprecedented harms reported by the yellow card scheme”. He quoted Michael Marmot: “A poor quality or stressful job can be more damaging to health than being unemployed”. He introduced a new phrase—”the psychopathic determinants of health”, by which he meant the adverse influence of corporate power on medicine. He spoke about his own father’s death, the primary cause of which was, in his view, the COVID-19 vaccine. He urged the audience to tweet that they call on the Secretary of State for Health “to #SuspendTheMRNAjabsnow until the raw data is released for independent analysis”. He ended his talk with a quote from Harvey Milk. Some audience members gave him a standing ovation.

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On Oct 13, 2022, the British Heart Foundation issued clear advice to the public: “There is no evidence that people are at risk of cardiac arrest in the days or weeks following the [COVID-19] vaccine.” Malhotra’s method of argument deserves scrutiny to understand why it persuades some people. Frame one’s view as the reluctant endpoint of a personal journey. Quote respected scientists. Stand up to corporates. Place oneself firmly on the side of patients. Emphasize well-described concerns about the presentation of research evidence. Allude to correlations. Make the call for access to raw data an issue of trust and transparency. The meeting ended rowdily. “Lying ****”, shouted one audience member. “You are part of the fraud,” shouted another. “They want most of us dead,” said one more. A physicist from University College London reported his “gut feeling” that mRNA vaccines were unsafe. A general practitioner argued that “most doctors are trained to do as they are told”. Someone suggested that WHO should be abolished and received enthusiastic applause. “People are dropping dead,” said another. The audience began to fragment amid shouts and insults. The last words I heard as I exited were from someone alleging the pandemic’s origin lay in a 30 nucleotide sequence amplified into a bioweapon. This descent into unreason is what happens when you inflame public anxieties. It needs to stop.

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