Though marred by misunderstandings on each side, it was a surprisingly productive discussion.
Though marred by misunderstandings on each side, it was a surprisingly productive discussion.
T his week Joe Rogan, the extremely popular and sometimes controversial podcast host, invited Dr. Sanjay Gupta, chief medical correspondent for CNN, on his show. The dichotomy was fascinating to behold. After all, Rogan is the definition of what journalism hates today — a freelancer outside the editorial control of old media — and Gupta the epitome of medical journalism in America today. But surprisingly (or maybe not, for those of us familiar with Rogan and Gupta), this was one of the most productive conversations to have been conducted in this country since the beginning of the coronavirus pandemic.
You would be hard pressed to come up with another instance of a representative of a major news outlet appearing on a podcast or non-mainstream outlet the way Gupta did, traveling to Austin to sit across the table from Rogan. As Gupta himself said, many of his friends advised him not to do it. And yet what resulted was a rare moment of bipartisan discussion — calm, rational, and cordial.
Rogan has been one of the leading voices of skepticism regarding COVID. He isn’t an anti-vaxxer per se, but he questions its value for healthy adults and children. Gupta, on the other hand, is one of the standard-bearers of traditional medical expertise in this country — he was even considered for the post of surgeon general at one point.
As the discussion began, Gupta correctly pointed out that one of the most worrisome side effects of the COVID vaccines, myocarditis in the young (predominantly young males between the ages of eight and 19), occurs at a rate of 0.8 per million people after the first dose; after the second dose, the number jumps to 5.8 per million. This is an extremely low rate, but the side effect is indeed likely correlated with the vaccine. Gupta then presented the key finding, which many people (including Rogan) don’t realize: The rate of myocarditis in children who have COVID is much higher — about 16 times higher, in fact. That is still fewer than 100 out of every million children, but the risk of myocarditis clearly is higher with the disease than with the vaccine.
Trying to make the case for universal vaccination, Gupta explained that, among all patients, a person vaccinated for COVID is eight times less likely to acquire the virus in the community than someone who is unvaccinated or otherwise not immune (meaning they didn’t gain immunity from being infected with the virus). Additionally, vaccinated people who get breakthrough infections remain infectious for a much shorter period than those who are unvaccinated. As time goes on, the vaccine’s immunity appears to drop across the board, which is one reason why the government is now recommending boosters. Furthermore, approximately 95 percent of people hospitalized with COVID over the past six months were unvaccinated.
The vaccine quite clearly reduces your likelihood of getting infected and, if infected, of getting sick enough to require hospitalization; and it dramatically reduces your risk of death from the disease. That is about as successful as one can hope.
Rogan, like many who remain skeptical of mainstream medicine’s recommendations, doesn’t appear to realize that, although children are at far less risk than adults, the risk to children of long-term sequelae from COVID — “long-haul” COVID — is ten to 20 times greater than the long-term risks of the vaccine.
And this gets back to the key problem with much of the discussion over the pandemic since early 2020: We are terrible at both understanding and communicating the concept of risk.
If Gupta failed at all in this discussion, it was in not clearly communicating the risks for some of the more complicated scenarios that Rogan presented to him. For example, Rogan asked whether the risk of vaccinating children is a greater or lesser risk than getting COVID. With the data we have today, we know that the risk of dying from COVID is far less for an unvaccinated child than for a vaccinated person over age 70. However, the data also clearly show that the risk for children of death from COVID is far greater than for children from getting the vaccine, by a factor of ten to 20.
Rogan brought up a study by four researchers suggesting that post-vaccination myocarditis resulted in more hospitalizations in boys under the age of 17 than did COVID infections. Although Rogan understood the headline correctly, what he didn’t understand are the multiple caveats that the authors offered in the discussion section of the paper. First, in comparing hospitalization from myocarditis with that from COVID infections, they were comparing two very different cohorts of patients. Second, they themselves admit that they are not sure about the correlation and that further study is needed.
Additionally, indications for testing for myocarditis once a child is admitted to the hospital is not the same as testing for it in outpatients. This apples-to-oranges comparison complicates Rogan’s understanding of this study. The take-home point is this: The risk of myocarditis is many, many times greater with COVID infection than that caused by side effects after taking the vaccine.
Rogan doesn’t seem to understand that nuance, and he doesn’t seem to understand the risk/benefit in this case. A CDC study lays out the direct comparison of myocarditis from COVID and myocarditis from the vaccine:
In recent months, there has been concern about a small risk of myocarditis after receiving an mRNA COVID-19 vaccine. A June study showed among males ages 12–29 years — the group with the highest rates of myocarditis after vaccination — there would be an estimated 39 to 47 cases of myocarditis for every million second doses of vaccine. Authors of the new study say their findings support health officials’ assertions that the benefits of vaccination outweigh the risks.
But ultimately, the science is not, and never has been, the biggest problem in this debate. The crux of the problem is and always has been our failure to properly communicate.
From the very beginning of the pandemic, health experts have given conflicting recommendations, illogical assertions, and often downright incorrect information. When experts have had to change their recommendations based on new evidence, they have seemed reluctant to admit that they were in error in the first place. For the public, the public-health authorities’ shifting opinions and advice, backtracking, and outright contradictions undermined their credibility.
The federal messaging on booster shots is just the latest example of confusion. In his conversation with Rogan, Gupta described how the White House announced vaccine boosters long before the FDA or CDC had come to any conclusions on the matter. It seems clear that the White House didn’t have the data on which to base their announcement, making an end run around scientists for political reasons.
Despite the political pressure, the FDA and CDC have been slow and meticulous in their approach to the booster shots. Gupta correctly says that booster policy should have been led by the scientists and not the politicians, a mistake that undermined the messaging to the public.
Rogan repeatedly asked Gupta what data support claims of the vaccination’s immediate benefits and what we know about possible long-term effects of the vaccine. But the latter is impossible to know; the novel coronavirus is, after all, novel. Long-term effects can’t be determined until we have a longer term to study. But as for short-term vaccine effects, the data are quite clear. We have more data on this therapeutic than any other drug in human history. With literally billions of doses having been administered, the side-effect profile compares very favorably with that of many other commonly used drugs.
Rogan was at his strongest in the discussion when he brought up the news coverage by CNN of his recent COVID infection and his decision to take the antiparasitic drug ivermectin, which has both human and veterinary uses. CNN (as well as other mainstream news outlets) attacked Rogan for taking a “horse dewormer”:
“It’s a lie on a news network. . . . That’s a lie that they’re conscious of. It’s not a mistake,” Rogan said to Gupta as the longtime medical analyst appeared on his show this week. “They’re unfavorably framing it as veterinary medicine.”
“Do you think that’s a problem that your news network lies?” Rogan asked. “Dude, they lied and said I was taking horse dewormer.”
“Yeah, yeah, yeah, they shouldn’t have said it was horse dewormer,” Gupta responded. “If you got a human pill, because there were people who were taking it, the veterinary medication, and you’re not obviously because you got it from a doctor, so it shouldn’t be called that.”
Many at CNN continue to refuse to admit they lied, including Don Lemon, who this week repeatedly misled his viewers on this issue.
Gupta’s honesty here, by contrast, is refreshing. It is a rare moment when a media personality is willing to admit an outlet’s obvious failure to live up to the journalistic code of ethics. During this entire discussion, Gupta was largely right about the science, and his ability to admit the truth regarding CNN lends him more credibility overall. And Rogan’s questions were legitimate and reasonable; none of them were out-of-bounds. As a physician, I regularly hear questions like Rogan’s from parents concerned about getting their kids vaccinated.
It was all the more disappointing, then, that Gupta was unable to successfully answer the risk/benefit questions. Is the risk of getting COVID worse for kids than the risk of vaccination? The answer should have been a resounding yes. Flip that around: Do the benefits of vaccination for kids outweigh the risks of getting COVID? Again, absolutely, yes. Rogan asked if the risk for adults of getting the vaccine is lower than the risk of going without it: The answer is yes. Gupta seemed to have difficulty in making this clear in a way that Rogan would find persuasive.
But this is not to pile on Gupta. The medical profession as a whole simply has not been able to explain the risk/benefit calculus to a segment of the population resistant to the vaccine. Many hear Anthony Fauci as talking down to them, whether on masks or gatherings or vaccines. Biden called people’s questioning of the value of masks “Neanderthal thinking.” Is it any wonder that people aren’t going to listen to him on matters related to their health?
This is where Gupta and Rogan did the country a true service: They had a two-hour discussion representing our greater debate over COVID in civil and respectful terms. Maybe Sanjay Gupta persuaded some people at least to take a second look at the data, and that in itself would make this a worthwhile endeavor. The true hope is that instead of the silly demagoguery that has dominated much of the discussion during the pandemic era, more discussion like this can occur, for the benefit of everyone.