'Noticing What Isn't Said'
CAERS SUBSTACK ARTICLE #12
‘NOTICING WHAT ISN’T SAID’
CAERS SUBSTACK ARTICLE #12
Humans are the most social creatures on the planet, and much of that is a result of our incredible ability to communicate in ways that no other species can match. We have many methods to share our thoughts with one another—orally, in writing, with body language, etc. Since infancy, we have learned that listening to what people say can help us to understand more about them and the world as they see it. An equally important lesson to learn, but one that is often less intuitive, is that we can often learn a lot from what people don’t say.
Early in the COVID pandemic we all heard authorities explain that the only safe way out of the pandemic was through development of a vaccine and subsequent mass vaccination. On one level that seemed like a sensible enough idea, one worthy of our attention. But on another level, there were things that were not said that were just as important, or maybe even more so.
For example, we were not informed that we have successful vaccines for only a small percentage of infectious diseases. We do not have vaccines against some the of the major infectious disease killers on the planet: HIV (causing AIDS), tuberculosis, malaria, and hepatitis C. We don’t have even have them for diseases that are less lethal: herpes, salmonella, and mycoplasma come to mind. And some vaccines, like that for the annual flu, have limited efficacy.
In fact, even though SARSCoV2, believed to be the causative agent of COVID, is a coronavirus, in truth no safe and effective vaccine against any coronavirus has ever been developed despite decades of trying. And that includes SARSCoV1, which was responsible for the original SARS in the early 2000’s, more than 15 years ago. So, it seemed odd that these details were not mentioned when the development of an effective vaccine seemed almost assured, even though they constantly emphasized that the SARSCoV1 was a ‘novel’ coronavirus. It was particularly strange given that most drugs and vaccines take many years, sometimes even decades, to be developed, in part because preliminary attempts often fail (it is estimated that less than 20% of all investigational drugs ever make it to market).
Had all of this information been provided to the public, many more of us might have considered the idea that a vaccine would quickly, safely and effectively return us to our previous lives to be wildly optimistic. That is why it can be so important to listen for what is not said in addition to what is said.
Also suspiciously absent from the narrative was any mention of treatment in addition to prevention. True prevention is relatively uncommon in medicine, and given how little we understand of disease that should not be surprising. In fact, much of what we refer to as prevention is really postponement: a pill that lowers your blood pressure does not guarantee that you will not have a stroke but simply offers the possibility of postponement, especially if you have other risk factors. If we knew enough to be able to prevent disease we would not have to rely so heavily on treatments.
This lack of reference to treatment is even more disturbing given that there are estimated to be almost 10 000 drugs available on the market worldwide which could be repurposed to help reduce the morbidity and mortality of COVID, a disease we were told was highly contagious and very lethal. Repurposing drugs is not unusual; often once a drug is released for use in one condition, it is discovered that it also useful in the treatment of another condition. The advantages to using a repurposed drug are multiple: 1) much is already known (dosage, warnings, etc.) as it has already been thoroughly studied prior to its release to the public who may have already used it millions of times for years or decades; 2) it is in actual production and quantities can be ramped up quickly; and 3) it is often generic and therefore inexpensive. Thalidomide is a drug released in the 1960’s as a sleeping medication that is rather infamous as it causes phocomelia (shortened or absent limbs), among other side effects, when ingested during a critical time in pregnancy. In careful study for over four decades since its release, we have learned, for example, that except when taken during pregnancy, it is known to be quite safe. In fact, it is so safe that it has been repurposed for the treatment of leprosy, provided that it is not ingested during pregnancy.
So, while we were waiting for a preventive vaccine for such a serious disease as COVID, why no mention of searching for a treatment in the meantime? Given the seriousness of COVID, why did the medical world not jump up and down with excitement as various clinicians around the world announced success in treating COVID patients with readily available and safe drugs? To the contrary, there was a confusing pessimism and negativity, even to the point of suppression of attempts to look for safe and effective treatments.
All of this should remind us that sometimes the most important things are not those that we communicate well, but the ones we don’t communicate at all, or even suppress. Of course, they are much harder to notice; it takes a lot more work to find them. And there is one very important concept that has not been mentioned at all since the release of the vaccines, and that will be the focus of our next article.
J. Barry Engelhardt MD (retired) MHSc (bioethics)
CAERS Health Intake Facilitator
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