Great article! By taking the larger view one can easily understand many second, third and fourth order effects of covid and just about everything else in medicine.
Astonishingly, public health "experts" -- the ones responsible for creating guidance to the government -- don't understand these obvious issues. Aren't they supposed to promote public health writ large? Their crude guidance on so many things covid is akin to a surgeon treating a digital splinter by amputation.
Here's another suggestion for higher order effects derived from covid vaccine recommendations and mandates: Standard vaccine acceptance and uptake is reduced. Part of this is a second order effect because of unavailability of medical appointments, a second-order effect. Worse, and more long-term is the public's reduced confidence in health authorities recommendations on routine vaccinations. I'd call this a fourth order effect.
that's a doc who's thinking is spot on. Practicing medicene at it's finest. Too many people jump to the first conclusions, without going beyond the other possible outcomes.. Well Said Doc!
Perhaps one second order effect of lockdowns was failure to get solar exposure, with impacts on vit. D levels and BP. (UV-A rays and short infrared rays lower BP and possibly reduce strain on the heart.) Lower vit. D levels may have resulted in longer duration of covid and flu symptoms and therefore increased inflammatory damage.
I always appreciate your writing, John.....even though I'm just a curious human (read: not a Dr.) I usually can understand your message.
As for COVID, mRNA therapies, etc....your essay does bring up some very important and valid 2nd and 3rd order perspectives, which were so easily dismissed, or at least subordinated during the first 18 months of the COVID pandemic.
Respiratory virus' have been around forever, so we could have probably mapped out the potential health and mortality levels sensibly. We do it every year for seasonal flu.
But in the COVID-era, the "fear messaging" took control of the narrative very quickly, and overruled many well established public health "truths". Suppressing the Great Barrington protocols stands out as particularly odd.
But what really lit my suspicion sensor was how the medical community so quickly accepted so many shortcuts in testing of mRNA therapies. I won't go into all the oddities we observed with this new treatment technique. Suffice it to say, a "one size fits all" (read: you must get vaccinated, to keep your job, to go places, be in the military, etc....) approach to medicine seemed like very weak medical protocol. Alternate approached/beliefs, from the professionals in the medical community, were not widely shared.
And now we seem to be experiencing a striking increase in "all cause mortality". This seems to be a huge issue that is not being discussed by the medical community. We know that the data is difficult to fully analyze (and this too is an issue, for an industry that has so much knowledge and capability). https://ourworldindata.org/excess-mortality-covid
I would very much like to understand how the professional medical community is thinking about this issue. This could be a much bigger issue that the effect COVID is having on some socio-economic underclass in our society.
Excellent column. People in my orbit know that I talk about higher order effects all the time. Clinical studies often answer the first order effect, because the question and causality are discrete. But the higher order effects are neglected. Good decision makers will have a broader view.
Interesting! My first two thoughts--in earliest 2020-- on hearing of this 'disease" were: 1) Chinese bio-weapon [guess I was wrong to blame them] and 2) this will 'fix' the problem of funding Social Security
Great article! By taking the larger view one can easily understand many second, third and fourth order effects of covid and just about everything else in medicine.
Astonishingly, public health "experts" -- the ones responsible for creating guidance to the government -- don't understand these obvious issues. Aren't they supposed to promote public health writ large? Their crude guidance on so many things covid is akin to a surgeon treating a digital splinter by amputation.
Here's another suggestion for higher order effects derived from covid vaccine recommendations and mandates: Standard vaccine acceptance and uptake is reduced. Part of this is a second order effect because of unavailability of medical appointments, a second-order effect. Worse, and more long-term is the public's reduced confidence in health authorities recommendations on routine vaccinations. I'd call this a fourth order effect.
Take a look at this paper and see the reduction in care-seeking behavior, measured by reduced EMS calls for heart related incidents.
"One possibility suggested by our data is that patients with acute coronary syndromes are not presenting for care, resulting in an increase in OHCA."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293523/
Writing about economics, Tom Sowell calls this "stage-one thinking."
Another great post - thank you.
Until those causal speculations are validated, isn't it too early to use them to question the validity of the interventions?
Excellent. Thank you.
Thank you!
Thank you for this column sir. A Canadian general cardiologist colleague who would one day appreciate sitting down for a chat. Well written.
Thanks much, Dr. Mandrola, one of your most compelling. Definitely a piece I'll pass on to other readers.
Awesome, John. Makes sense:
Thanks for the enlightenment.
Gotta look down the road.
that's a doc who's thinking is spot on. Practicing medicene at it's finest. Too many people jump to the first conclusions, without going beyond the other possible outcomes.. Well Said Doc!
Make us think! Well done.
Perhaps one second order effect of lockdowns was failure to get solar exposure, with impacts on vit. D levels and BP. (UV-A rays and short infrared rays lower BP and possibly reduce strain on the heart.) Lower vit. D levels may have resulted in longer duration of covid and flu symptoms and therefore increased inflammatory damage.
I always appreciate your writing, John.....even though I'm just a curious human (read: not a Dr.) I usually can understand your message.
As for COVID, mRNA therapies, etc....your essay does bring up some very important and valid 2nd and 3rd order perspectives, which were so easily dismissed, or at least subordinated during the first 18 months of the COVID pandemic.
Respiratory virus' have been around forever, so we could have probably mapped out the potential health and mortality levels sensibly. We do it every year for seasonal flu.
But in the COVID-era, the "fear messaging" took control of the narrative very quickly, and overruled many well established public health "truths". Suppressing the Great Barrington protocols stands out as particularly odd.
But what really lit my suspicion sensor was how the medical community so quickly accepted so many shortcuts in testing of mRNA therapies. I won't go into all the oddities we observed with this new treatment technique. Suffice it to say, a "one size fits all" (read: you must get vaccinated, to keep your job, to go places, be in the military, etc....) approach to medicine seemed like very weak medical protocol. Alternate approached/beliefs, from the professionals in the medical community, were not widely shared.
And now we seem to be experiencing a striking increase in "all cause mortality". This seems to be a huge issue that is not being discussed by the medical community. We know that the data is difficult to fully analyze (and this too is an issue, for an industry that has so much knowledge and capability). https://ourworldindata.org/excess-mortality-covid
I would very much like to understand how the professional medical community is thinking about this issue. This could be a much bigger issue that the effect COVID is having on some socio-economic underclass in our society.
Excellent column. People in my orbit know that I talk about higher order effects all the time. Clinical studies often answer the first order effect, because the question and causality are discrete. But the higher order effects are neglected. Good decision makers will have a broader view.
Interesting! My first two thoughts--in earliest 2020-- on hearing of this 'disease" were: 1) Chinese bio-weapon [guess I was wrong to blame them] and 2) this will 'fix' the problem of funding Social Security