Better in their words…

I spent the last week in Europe. I gave talks in 3 cities, and met with hundreds of people. The last leg of my trip was Denmark, where I gave a lecture on Real World Data. (You can listen to the talk on Plenary Session and find slides on The Drug Development Letter) Over discussions spanning 2 days, it dawned on me: Denmark and I agreed on pretty much everything.

COVID19 policy

Mandatory masking in America hospitals never had evidence, and it certainly makes no sense — readers of Sensible Medicine have heard me make that argument before, and thankfully some US hospitals are (at last) lifting it. But in Denmark they lifted masking in hospitals over a year ago!

Over dinner, I was asked which of my COVID-19 positions was most controversial in the US. For me it was my Atlantic article critical of masking children, particularly those as young as 2 year olds. The Danes were shocked.

“But masking a 2 year old is crazy!” and “I cannot imagine anything more stupid that that.”

Many simply did not believe me that it occurred. “How could they?” and “What are they thinking?”

When I told them the recommendation came from the US CDC and American Academy of Pediatrics, they were silent— jaws on the floor.

Vaccination policy was another shared interest. “Focus on old people who had not had COVID already,” they argued, which is my position. When I told them that colleges were mandating bivalent boosters to twenty year olds who already had COVID19— they were stunned. “Why would they such a thing?”

Finally, on schools, the Danes were horrified to learn that so called ‘progressive’ cities like SF and Los Angeles kept schools closed for 18 months. “Those poor children!” they cried.

Oncology

My lectures on Oncology topics in the US generate considerable debate, but in Denmark there was a lot of head nodding.

“Our clinical trials are simply not applicable to most patients I see in clinic”. I don’t even remember who said that anymore, it was either me or someone from the audience.

In general, we all agreed that trials, due to poor design, often exaggerated or invented benefit, that the cost of drugs was too high, that too many in oncology were complicit with bad clinical trials. Yes, we need more randomized trials. And, of course, real world data is being hijacked for commercial purposes.

We agreed that many KOLs are cheerleaders with concerning conflicts of interest, and most of all that a sane society cannot spend more and more on oncology drugs without considering the value they provide.

After the talk, someone approached me, “I suspect you will find that most of us in this room agree wholeheartedly with you.”

Why Denmark?

Why did the doctors in Denmark agree with me so often? The answer is simple: we share values and methods. The value we share is that the goal of society is create a level playing field— equality of opportunity— and that is why we have to prioritize spending on children’s nutrition over marginal or ineffective cancer drugs.

We share the value that commercial interests are necessary and powerful, but the public should incentivize products that work, and ensure profiteering does not occur.

Finally, we share the method that evidence— particularly evidence with minimal bias— is the best way to know what works. Denmark has long had a strong tradition of evidence based medicine.

There is a third reason— at least for COVID— why we agree so often. Neither of us was distracted by Donald Trump. In the USA, progressives largely failed on covid policy because they could not acknowledge Trump was right about anything. He was right about the evidence for masks, and school closures, and both the Danes and I can admit that.

When you combine shared values and a shared method the conclusion to many policy issues is clear. The Nordic countries do a better job with COVID19 policy and cancer drug policy than the USA. We could learn from them. Its been refreshing to visit, and I look forward to returning to the USA to continue the battle of ideas.