Real-Life Doctors Behaving Badly

What Happens When You Break the Greatest Taboo in Science

This week, very sad news broke about the Surgeon General of Florida.

My intention for my first real column on this platform was to write something funny, but then Dr. Joseph Ladapo excluded some findings from a state-driven study about Covid-19 vaccines and I veered off on an irate tangent. This is a huge deal, y’all.

Maybe data deletion doesn’t immediately strike you as a reprehensible action. But consider: when certain data from the Florida study (including the sensitivity analysis) contradicted Ladapo’s controversial conclusions about the risk of death from myocarditis associated with mRNA vaccines, he acknowledged that the data might not support his position and called for more study.

Just kidding! What he actually did: he removed the portion of the report that made him look wrong. Then he issued real-world recommendations on the basis of the altered report. When he was caught, months later, after a public records request revealed the changes, he referred to the magical deletion of the data as merely “revisions and refinements” that were justified because … wait for it … since the dawn of Covid, all the other scientific interpretations of vaccine research have been biased.

Omigod! If it contradicts something you believe, a mountain of meticulously researched and peer-reviewed global data must be wrong because of bias, but surreptitiously removing stuff in order to bolster your own ideology is NOT bias. Got it!

I, for one, am psyched that it’s suddenly cool to manipulate data to make it say what we want. I intend to ‘revise and refine’ certain incidents out of my driving record, so I can have better insurance rates! And hoo boy, am I ever going to ‘revise and refine’ my reported earnings to the IRS! On that note, I’ll just ‘revise and refine’ the test scores of my kids, so they can all get fabulous scholarships! Yippee!

Ha. Just kidding again. I’m actually a stellar driver with barely any income but brilliant kids. Or maybe I’m not. What is reality, anyway? Who knows? The data might indicate anything!

Joking aside, I’m crushed by this. Messing with medical data so you can claim your position is the correct one is about as scientifically acceptable as trumpeting the results of a study that was conducted by your dog. That’s not how science works. It’s a terrible breach of ethics for our profession.

Dr. Ladapo is not wrong in querying whether or not vaccine risks exceed actual disease risks, but it is never, under any circumstances, honest to do what he did. Yes, data does undergo a lot of analysis and sometimes data has to be excluded if it is flawed in certain ways. But you don’t just change it or delete it! You show the data and note the reasons for the exclusion. According to multiple reports, Dr. Ladapo just hid the stuff that contradicted his beliefs and even changed the language of the conclusions. His assertions were shared hundreds of thousands of times and are believed by a significant portion of the public*.

In the world of science, that kind of manipulation is straight-up unholy. But it also appears Dr. L is no stranger to touting regular old flawed methodology. Months earlier, on the basis of an almost comically glitchy study, he issued a proclamation that young men should stop receiving mRNA vaccines against Covid-19.

This is a fairly complicated issue: no one denies that the mRNA vaccines appear to increase the risk of myocarditis—heart inflammation—especially in young men. However, for most people there is considerable evidence indicating the risk of myocarditis is higher with an actual Covid infection than it is with vaccination.

Moreover, there is evidence that the severity of myocarditis, which is mostly a limited and nonlethal condition, tends to be much worse at the 90-day mark when it follows an actual viral infection such as Covid-19 than it is when it follows vaccination—a finding that applies to young men*. And, of course, when you are judging the relative risk of contracting Covid versus getting a vaccine, you shouldn’t only think about myocarditis: you also have to take into account other conditions caused by Covid, such as blood clots, organ damage, and the miserable, horrifying constellation of problems associated with Long Covid. I understand that some people believe the risks of vaccines are understudied. I worry about that myself. Vaccines carry real risks. But so does viral infection. The best way we can tease out the relative risks is through accurate data.

It is not easy to compare the relative risk of myocarditis for young men. But it’s not impossible: there is some data. We need to be really careful about understanding the cause of death in anyone who was recently vaccinated—and we cannot rely on preliminary information from a database like VAERS (the Vaccine Adverse Event Reporting System), because that information does not demonstrate causation. If anyone shares with you a vaccine-related death based on data from VAERS, they have been misled.

Dr Ladapo, however, chose to base his anti-vaccination recommendation on one study in particular and that study was absolute crap. It was not peer reviewed. He refused to identify the authors. It was unpublished and identified its findings as ‘preliminary.’ There were colossal methodological problems: it used death certificates instead of more accurate hospital data, didn’t compare risks of vaccinations with benefits, wasn’t statistically significant, had a minuscule sample size, and, most egregiously, tried to skew the conclusions by excluding anyone with a Covid-related death.

Ladapo argued that since immunity is now higher in this phase in the infernal existence of Covid, there’s less reason to tolerate vaccine-related side effects. But he made his public policy recommendation by citing an “abnormally high rate of heart-related deaths” on the basis of this one putrid paper that didn’t even contain good evidence that the deaths in question were of cardiac causes. Meanwhile, he ignored a massive amount of data from better-designed studies.

Over the months, his various positions on Covid have produced gushing adoration from noted medical expert Tucker Carlson, but this one has caused a firestorm among most other scientists, physicians, virologists, and academicians. In March of 2023, the CDC issued a faux-polite public rebuke to Dr Ladapo’s various heated claims regarding vaccination. You can read the letter, along with citations of actual data, here.

Even Ladapo’s mentor at Harvard, health economist David Cutler, stated to the Washington Post that while he appreciated Ladapo’s inquisitiveness on Covid-related public health practices, he considered the Florida study to contain severe methodological problems … and that was before it was known that Ladapo actually altered a report. According to Politico, who was able to review the original work after receiving it via a public records request:

“The newly released draft of the eight-page study, provided by the Florida Department of Health, indicates that it initially stated that there was no significant risk associated with the Covid-19 vaccines for young men. But “Dr. L’s Edits,” as the document is titled, reveal that Ladapo replaced that language to say that men between 18 and 39 years old are at high risk of heart illness from two Covid vaccines that use mRNA technology.”

Look, to say it once again: you cannot just change data to make it say what you want it to say. Medical advice should be divorced from ideology. I am not politically aligned with Dr. Ladapo, but speaking for myself, he’s right that there’s enough data about myocarditis to make me question whether I should vaccinate my teenaged son against Covid.** But as a parent and a physician, I need people to present accurate and complete data. Otherwise, it’s just spin.

In a later post, I’m going to team up with a scientist I greatly respect to walk you guys through how to evaluate medical and scientific data as a layperson. And I promise: my next post will be more lighthearted! In the meantime, please don’t base any medical decisions on guidance from the Surgeon General of Florida.

XX,

Kimmery

*And by the way: when I searched for news reports about this breaking story, I couldn’t find a single story from a right-leaning publication. I’m sure there must be some stories, somewhere, that will reach people who get their news primarily from center-right sources, but I couldn’t find them easily. What I found instead were a slew of laudatory opinion pieces from last fall about Ladapo’s conclusion that vaccines are dangerous. This matters, a lot, because the people who saw Ladapo’s conclusions may never know what he did to justify them, and they'll continue to believe the data he cited.

**Among patients aged 12-39 years with no predisposing comorbidities, the relative risk of heart failure or death was markedly higher for myocarditis associated with covid-19 disease than for myocarditis associated with vaccination (relative risk 5.78, 1.84 to 18.20) Husby A, Gulseth HL, Hovi P, et al Clinical outcomes of myocarditis after SARS-CoV-2 mRNA vaccination in four Nordic countries: population based cohort study BMJ Medicine 2023;2:e000373. doi: 10.1136/bmjmed-2022-000373

***Ultimately, I did decide to get him vaccinated. The bulk of the evidence—as of that date— did in fact indicate the risks of Covid were significantly higher than the risks of vaccination for teenage boys. There was also the risk of him infecting other more medically vulnerable people—and since over a million Americans have died from Covid and many many more have suffered long-term effects, that was a valid reason to vaccinate a teenager. But I’d change my mind regarding future vaccination if enough new evidence emerges suggesting the risks have become greater than the benefits.