March 3, 2021
(Update: I composed the message below early Tuesday morning, before Governor Abbot’s announcement. Obviously, that was the big news story of the day. Although sympathetic to the need to reopen the Houston economy, along with most medical experts, I believe the relaxation of restrictions is premature. Our current virus numbers in Houston show we are averaging around 1,000 new cases per day, and about 200 hospital admissions. In late September, new cases were under 400 per day, and hospitalizations averaging between 70 and 80. I am encouraged our numbers are going down, and optimistic that vaccinations will get us to the end of this crisis, but I would have preferred to see our viral prevalence numbers at or below September levels, with a community positive testing rate of less than 5%. (It is currently about double that level). The Governor did emphasize that the pandemic was not over, and that personal responsibility is important. The obvious risk is that many in our community will interpret this as a signal that we can now relax. We are so close to the end, but this is not the time to take our foot off the gas – it is time to redouble our efforts and push to the finish line.
Baylor will continue to exercise good viral control practices. Many businesses will as well. What can you do? Be a role model in the community. Mask, distance, stay out of crowded indoor spaces. Reward those businesses that continue to follow good practices. Thank them for their commitment. Stay positive – we will get through this. It is more important than ever to unite as a community and see this through to the end.)
Dear Members of the Baylor College of Medicine Community,
The good news this week is the approval of the single-dose vaccine developed by Johnson & Johnson. We now have three highly effective vaccines that we need to administer as rapidly as possible, to as many people as possible, to bring this pandemic to an end.
Now that we have choices, increasingly the question will be is “which vaccine should I get?” The very simple and very clear answer is “the first one you can.”
There are some differences among the three available vaccines. The J&J vaccine displays 66% effectiveness overall, but critically, is close to 100% effective in prevention of severe disease, hospitalization and death. This is an unequivocal homerun of vaccine development.
There are potential nuances related to variable response between age groups or effectiveness against emerging variant strains. However, bottom line, if you have an opportunity to be vaccinated today with any of the approved vaccines, take it. Your risk of becoming infected and critically ill while waiting for a different vaccine is far, far greater than any incremental benefit you might receive from waiting for an arguably more perfect vaccine.
What I just engaged in above is punditry – per Merriam-Webster the provision of an opinion in an authoritative manner, usually through mass media. The word “pundit” derives from the Hindi “pandit,” a term of respect for someone considered learned and wise. In these modern and increasingly divisive times, the term has taken on a somewhat negative connotation, used to describe someone who forcefully conveys an opinion on one side or the other of an issue, often with political overtones. Perhaps a better term would be “expert opinion.”
Regardless of what we chose to call it, as we race to vaccinate and look forward to emerging from the pandemic, all of us will be dependent upon reliable and responsible punditry. When can we safely reopen schools and businesses? How should my behavior change once I am vaccinated? When will live performing arts return? When should attendance limits on sporting events be lifted? Can I plan a “normal” wedding in the Fall?
These questions, and others, will be partially addressed by science and partially addressed by CDC guidance. The black and white edges of science and guidelines are critical, but most of where we actually live is gray and blurred. We will need to make personal and policy decisions based on incomplete information, and experts will be necessary to assist in this process.
There is an inherent challenge in relying on this expert opinion. There are suddenly a lot of physician experts out there, and sometimes the advice is contradictory. Many – I would say most – approach their punditry with the same commitment to professionalism they would in the care of a patient. Most experts want to provide information that is accurate, evidence-based where possible, and delivered in a manner accessible to the lay-person.
However, there are some who seem to be at best ill-informed, at worst conflicted and self-promoting. The confidence and passion of the speaker is not a reliable guide. As I have listened to the various experts, some of the most misleading information is promulgated by doctors who appear supremely confident. Some of the most thoughtful commentary comes from those who appear awkward and uncomfortable in front of the camera.
How does the general public know to whom to listen for reliable information? This is a surprisingly difficult question to answer. I have collected a few tips below. Many are factors that could be useful in choosing not only your trusted pundit, but your personal physician as well.
Qualifications and Credibility
- Is the physician or scientist on the faculty of a well-regarded school of medicine? Only half-way jokingly, I would say if you are listening to a Baylor faculty member, you can skip the rest of these steps. During the pandemic, we have viewed part of our community responsibility as getting good information to the public. Eighty-eight of Baylor faculty have engaged in over a 1,000 COVID-19-related media appearances. As a health sciences university, we are committed to freedom of academic expression and diversity of opinion. However, we also pay attention to what is said by our faculty. We work to assure the information we are providing to the public is factually accurate and relatively free of bias. Most faculty members from major schools of medicine would have similar expectations.
- Is the physician currently board certified and licensed to practice medicine? This information is readily available and helps to identify physicians who are actively engaged in the practice of medicine, and who have remained current in their fields.
- How would you characterize the expert’s internet profile? A quick Google search will give you some valuable information. Does the expert tend to be aligned with consistently controversial opinions? Do they appear to lean heavily to one end or the other of the political spectrum? The fact that an expert opines on controversial issues with a clear political leaning does not necessarily mean their information is biased, but it is a factor to consider. Have they been quoted by a variety reputable news organizations or published in the peer-reviewed literature? Again, this is not a guarantee, but gives me a level of comfort they may be a credible source.
Evaluate the Media Environment
- Pay attention to what you are watching, reading or listening. If an opinion is being offered by a hard news outlet or publication, I would tend to give it more credence than opinions offered on entertainment, opinion, or “infotainment” programming.
Characteristics of the Expert
- Why you choose to trust an expert is similar to why you choose to trust your doctor. Are they speaking in a language you understand, or are their explanations laden with jargon and buzz words? Personally, I prefer a physician (or expert) who appears to be trying to teach me something, rather than prove to me how much they know.
- Be wary if the expert appears overly dogmatic. Inherent in our response to a novel worldwide infectious disease, there is much we do not know, and our knowledge evolves over time. Be suspicious of any expert who answers every single question with certainty. I think anyone who has tried to make predictions about this disease would agree that it has humbled all of us at one time or another. Especially be alert for a special breed of dogmatism: Someone who claims to have unique command of knowledge, that no one else possesses. If you hear something like “let me tell you what no one else wants you to hear,” quickly cross this person off your trusted list.
Get a Second (or Third) Opinion
- As you form your own opinion, listen to a wide range of experts. Assess their credibility using some or all of the criteria above. When you hear two or three qualified experts consistently hit common themes and reach similar conclusions, you can have a greater degree of confidence the advice is sound.
We still have miles to go before we rest. As we engage in the happy task of reclaiming our normal lives and activities, there are many controversies to come – how much, how soon, how quickly? Our path will be clearer if we all become more discerning consumers of responsible punditry.
James T. McDeavitt, M.D.
Senior Vice President and Dean of Clinical Affairs
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