Issue 123
January 23, 2022
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Throughout history, the miracle of medicine has been politicized.

In the mid-1800s, a Hungarian physician named Ignaz Semmelweis plied his trade in a Vienna hospital. Dr. Semmelweis was baffled why a disproportionate number of mothers were dying of puerperal fever in one particular maternity ward. (Puerperal fever, or childbed fever, is a bacterial infection of the female reproductive tract.) Semmelweis observed that ~15% of all new mothers became sick and later died vs. only 1-2% of mothers in the hospital’s other maternity ward.

Determined to find out why Dr. Semmelweis worked feverishly (excuse the pun) and took copious notes on a vast number of potential factors between the two maternity wards. All his findings were unremarkable. In fact, after exhaustive research, the only difference Dr. Semmelweis noted was that doctors staffed the maternity ward with the abnormally high mortality rate; the other maternity ward was staffed by midwives.

Doctor Semmelweis excluded all potential determinants aside from who was delivering babies. Eventually, he unearthed what he believed was the cause of the disparity. In addition to delivering babies, physicians on the maternity ward were also dissecting cadavers with their bare hands. On numerous occasions, a doctor would dissect a cadaver and then later deliver a baby. By doing so, the doctor would unknowingly expose the mother to infectious bacteria. Conversely, midwives’ only duty on their ward was to deliver babies; bacteria were not introduced from cadaver to hands and thus onto the mother.

To prove his hypothesis, Dr. Semmelweis instructed all doctors and midwives to wash their hands with chlorinated lime before entering a delivery room. (In the 1850s, handwashing was an afterthought to both the medical community and the general populace. The consensus at the time was that germs spread via malicious odors in the air.) Semmelweis took special care to implore and ensure all doctors who had recently touched a dead body to wash their hands.

Astonishingly, as Dr. Semmelweis expected the mortality rate on the maternity ward staffed by physicians quickly converged to that on the ward staffed by midwives. Indeed, a simple hygienic step that almost everyone now takes for granted – handwashing - saved thousands of mothers and millions of lives thereafter.

Politicization & Ostracization

Dr. Semmelweis’ reward for applying rigorous science to answer one of the most head-scratching questions of his time? Ridicule. Colleagues called him crazy. How dare he claim that fellow physicians were the ones responsible for the deaths of so many women? Was he in cahoots with the makers of the chlorinated lime solution to earn outsized profits (might that sound similar to modern-day conspiracy theories regarding the pharmaceutical companies who manufacture COVID vaccines and tests?).

Furthermore, Dr. Semmelweis had a messaging problem. He did not speak German well and lacked diplomacy. This handicapped him when communicating why handwashing was so important. Exasperated, Semmelweis essentially gave up. He rarely spoke at medical conferences and did not publish the findings of his discovery for ~15 years. Subsequently, he was fired from his job, had a nervous breakdown, was committed to a mental hospital, and died soon after. Indeed, when medicine becomes politicized, the results can have, shall we say, adverse side effects.

Decades after Semmelweis’ death, washing ones’ hands became a widely accepted and applied practice in – and out – of hospitals. Billions of people now wash their hands multiple times per day. This simple practice continues to save countless lives. And posthumously, Ignaz Semmelweis finally received the credit he so deserved.

Don’t Let Your Gardasil Down

The merits of organ transplantation, certain medications, psychotherapy, and even handwashing have all been the subjects of politicization. However, throughout history, despite their importance in controlling/ eradicating some of the deadliest diseases known to humankind, nothing in medicine has been politicized more than vaccines.

In 2006, Gardasil, a vaccine against the Human Papilloma Virus (HPV) was approved and brought to market. HPV is often – though not always – sexually transmitted. In fact, virtually all sexually active adults (prior to 2006) have been infected with HPV. Typically, the virus “clears” on its own. However, sometimes it lingers. If left untreated, it can lead to cervical cancer in women (and penile & anal cancer in men). There are many strains of HPV, but two types (16 & 18) are responsible for causing the greatest number of cervical cancer cases. (All versions of Gardasil prevent HPV 16 and 18. The newest Gardasil vaccines are effective against nine different strains of HPV.)

Gardasil was a wonderful medical breakthrough. It was the first vaccine that prevented a specific type of cancer. However, to be effective, Gardasil had to be administered to a woman before she became sexually active. As such, teenagers were the main recipients. Critics pounced despite the benefits of receiving a jab that could prevent cervical cancer. “Gardasil will inspire teens and young women to have sex!” “Gardasil will destroy the chastity of young girls!” “Gardasil will encourage deviant sexual behavior!” were common headlines of the day.

Of course, Gardasil provided little if any impetus to engage in, or refrain from, sex. Those decisions were made irrespective of the vaccine. What it did do was help protect young people against HPV. Eventually the hysteria subsided. And most teenage girls and young women receive Gardasil to protect themselves against HPV/cervical cancer. (Subsequently, Gardasil was approved for males to help prevent penile and anal cancers and mitigate the spread of HPV to their partners.)

It was fortuitous that Gardasil was invented just before social media was harnessed to spread misinformation and kernels half-truths. One could only imagine the tweets that would have arisen about Gardasil if this safe and effective vaccine was brought to market 10 years later. (Twitter was also created in 2006.)

Mixed Messaging & COVID-19

Undoubtedly, the primary reason there has been so much resistance to COVID vaccines is that the virus itself has become politicized. However, another reason is due to flawed messaging from public health officials, including the Centers For Disease Control & Prevention (CDC).

As our readers know, at TQC we are strong proponents of vaccines and have been inoculated for COVID. However, we feel it is appropriate to acknowledge the following: there has been a subtle shift in the public health narrative surrounding covid vaccines that is providing ammunition for antivaxxers, conspiracy theorists, and even people who are on the fence about getting a jab.

Initially, the message from CDC was analogous to: “COVID vaccines are safe and effective at both blocking the transmission of the virus and protecting against severe disease and death. Breakthrough cases are very rare. Virtually all people in hospitals are unvaccinated.”

Then the CDC’s message subtly changed to something along the lines of: “COVID vaccines are safe and effective at both blocking the transmission of COVID and protecting against severe disease and death. Breakthrough cases happen occasionally. Most people in hospitals are unvaccinated.”

From there the CDC’s message shifted to something akin to: “COVID vaccines are safe and effective at protecting against severe disease and death. Most people in hospitals that succumb to the virus are unvaccinated.” (No mention of breakthrough cases.)

As we know, breakthrough cases are everywhere. The number of breakthrough cases has gone parabolic because the virus mutates quickly, and the efficacy of COVID vaccines dissipates over time. However, instead of the CDC going through detailed steps to educate the public about this (especially about the virus mutating), they simply changed their narrative without providing enough corresponding information as to why.

For these reasons, we can understand why people are questioning these vaccines. Things change. When they do, public health officials are responsible for explaining what that change means, not simply changing their message. Like Ignaz Semmelweis 150 years ago, in medicine, messaging matters

This week in The Wall St Journal, CDC Director Rochelle Walensky conceded that her agency could have done a better job communicating to the public. We agree.