Better in their words…

A recent paper in JAMA IM claims that individuals who were Republican were more likely to die during the pandemic than Democrats were after vaccines were out. This paper happily fuels a narrative that Republicans died because they are stupid and didn’t get vaccinated.

Unfortunately, however, the paper is flawed— it can’t prove this case. Second, it is divisive— you could never say something so nasty about any other group, but it is acceptable to condemn Republicans. Third, and worst of all, it ignores the failures of Democrats— that failure been consistently ignored. Let’s take a close look at the paper.

First, NPR, proud defender of school closure and toddler masking, is happy to cover it… surprise, surprise!

Second, the new Yale dean of public health, in response to the paper, happily proclaimed that leadership matters.

This is a bizarre take away b/c the paper does not address leadership. I suppose it is good to know public health continues to blindly support allegiance to democrats— that way it can be defunded since it is clearly a nakedly political instrument. Interestingly, Prof Ranney was pro school closure, pro-toddler masking, pro-vaccine mandates for 20 year old men who had covid— so perhaps praising the paper is a good sign the paper is actually no good at all.

Now, what exactly did the paper do?

It linked a small proportion of people living in Florida and Ohio to their 2017 voter registration. Among 30 million people in these states, 500k were able to be linked. (more on this). The authors compared excess deaths in these groups. They find it was similar pre-pandemic, and even in early pandemic, but separate post vaccine availability. Their conclusion: Republicans were too stupid to get vaccinated and died as a result. (more or less, this is how it is presented). Here is their figure.

Of course, the paper is hopelessly flawed.

Problems

1. It linked 2017 voting registration to people — but this does not account for people who turned on Trump in 2020. It doesn’t reflect being a Republican during the pandemic.
2. Just 500k people were linked, out of 30 million. This is a huge selection bias. The authors have no evidence the finding is generalizable to millions and millions they could not link, and did not study.
3. They don’t seem to adjust for age as a discrete value, but use age ranges. A 25 year old and 64 year old are in the same range. A 66 year old is the same as a 74 year old? Do they get the same adjustment? Is this even possible? If so, it is insane. If Republican voters are more likely to be 57 than 27, or 74 than 66, that is a big difference with respect to COVID outcomes that is essentially unadjusted for.
4. They don’t have vaccination records. Are you crazy? How are you going to make such an allegation without individual vaccine records to prove that it is indeed vaccination that resulted in the increase in death?
5. They don’t adjust for BMI, socioeconomic status, race, gender, education or other medical conditions. This is an unacceptable omission! Just because excess mortality is not imbalanced pre-covid does not mean there are not huge differences here that COVID exploits. COVID obliterates poor, overweight, older people. It hit people of lower SES harder. These authors don’t even consider that Republicans might be hit harder just because the party has more people lower down the socioeconomic ladder, particularly in the rust belt and in places like Florida. These differences can be preferentially exploited by COVID.
6. The method of matching people accepted 57% matches. WTF! so low. (yes this will merely attenuate the link, theoretically)

The authors go further arguing, “In addition to vaccines, nonpharmaceutical interven- tions, including facial masks … have been reported to contribute to reductions in transmission of COVID-19 or its severe outcomes… differences in support for these measures by political party affiliation emerged early in the pandemic”

Give me a break. This is pathetic, meant to rally the base. Masking has essentially an effect size of zero. We know that from randomized data.

It is OK to criticize Republicans as being stupid people who deserve to die

Throughout the pandemic, many in the academy criticized Republicans, and those who declined vaccines and masks, as being stupid and deserving to die. Many such memes appeared on social media. This is disturbing.

All people’s lives have value—- even those of the opposing political party. It is hurtful to see mostly liberal academics treat Republicans as if they are not human beings.

The same paper would not be in the journal if, instead of Republicans, it found higher excess death in any other or poor or minority group. Even if it was about people with higher BMI, or those who didn’t go to college, it would be considered unhelpful and bigoted. Yet, it is perfectly acceptable to attack this one group.

I find this horrific.

No one is studying the big problem— delaying the Pfizer vaccine, which was done by Democrats

It is curious that no research has been performed on the greatest pandemic blunder.

Pressured by Democrats, Pfizer changed the first look at the initial vaccine RCT— this delayed the vaccine approval beyond the 2020 election, but also delayed its use during the delta wave that winter. Likely, at least, tens of thousands are dead from this, but no well done paper has modeled the impact.

In my essay on the preprint, server, I discuss that based on external pressure, Pfizer changed the first interim analysis, ensuring that the vaccine EUA and roll out would be delayed. The external pressure was a letter written asking to delay approval.

This delay likely cost many lives. It also has no scientific basis, as I explain. It was essential Democratic politics (meant to torpedo Trump) around vaccines, which cost lives. Read my vaccine preprint and see many other un-investigated things. Why is no one studying this? Because it doesn’t fit the preferred narrative.

Conclusion

A recent paper in JAMA IM does not show that Republicans died post vaccine b/c they were stupid, and skipped vaccines, contrary to widespread framing. In fact, it is not clear from the paper— with its terrible methods— that Republicans died any more than would be expected based on age, BMI, socioeconomic status, and underlying medical problems. The paper did not have vaccine status, so it cannot comment. This is a big problem. Worse, we in medicine would not be comfortable criticizing any group for not getting vaccines if they were poor or minority, but we are happy to criticize our political opponents. Finally, it is interesting what we even study in medicine. We don’t study the vaccine delay bc it occurred driven by the opposite political party.

To me, the big picture: that most academics— especially the vocal ones— are fierce left wing Democrats, and, ergo, it is totally ok to argue, with weak data, that Republicans are evil and stupid and Democrats are infallible— is a dull an uninspired narrative. It will shred the last bit of trust in medicine. Sadly, many want to contribute to it.

Medicine is not political. As I explained in a recent post. It has to care about everyone. And methods have to be good. Sadly, that was not on display in this paper.