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| Dochotomy by MsLil (2021) |
(This article is a L-O-N-G read, and it is incomplete. Constructive comments are welcome.)
The ground rules for the debate
Dr Provax: Greetings fellow doctor, what do you know?
Dr
Novax: Afternoon doctor. What do I know? Not much. Well, not
entirely true. There's one thing I know: I'm done with the continual
coverage of COVID. It's been two years now.
Dr
Provax: Agreed. And with the latest variant, and two years to
prepare, it is time for nature to show the non-vaccinators the folly
of their reasoning.
Dr
Novax: Ah, so you're vaccinated?
Dr
Provax: Absolutely. You're not?
Dr
Novax: No.
Dr
Provax: Oh my God, why not? You’re crazy. We need to stop you
anti-vaxxers before you kill us.
Dr
Novax: Whoa, whoa. We’re friends, so I’m happy to have this
discussion, but only if we have ground rules.
Dr
Provax: What ground rules?
Dr
Novax: Let’s refrain from invoking any unproved metaphysical
entities such as God who are unnecessary to the discussion here. No ad hominem -- meaning you can attack the argument, but not the person. Calling me 'crazy' is ad hominem. And try to wind back the hyperbole
such as your presumption that I am an 'anti-vaxxer', and your exaggeration that non-vaccinators will kill everyone. Everyone? That seems a
lot strong: for one thing, if the vaccine is protective, then the
vaccinated ought not be especially threatened by the non-vaccinator’s choice.
Dr
Provax: Ah, yes, ok. I hear what you’re saying. Sure, tell me
why you’re choosing not to vaccinate.
Uncertainty & misrepresentation
Dr Novax: Well, we simply don’t know enough about the vaccines. The longest has only been in existence for coming on two years. We do not know the long-term effects of the vaccine.
Dr
Provax: Well, I’ve vaccinated, and I haven’t grown a second
head or a third arm.
Dr
Novax: Ha, clever. No, you have not, or at least, not yet! What if
it makes people sterile, or leads to premature death. What about the
"unknown unknowns"? What might be is surely uncertain.
Dr
Provax: True, but the scientists are tracking for all adverse
events, and to present, none of your fears are being realized.
Dr
Novax: Well that’s just not correct. There are reports
that some of the vaccines do cause serious adverse events, even death. Of course, the authorities aren’t very forthcoming about
that.
Dr
Provax: Well, they’re focused on the adverse consequences of
COVID itself: the roughly 30% who will suffer long COVID (UNSW
study & PLOSMedicine),
the roughly 10% who are hospitalized (Aust
Govt Report), and of course, the proportion that will
die. How come you’re more scared of the vaccine than the disease
itself?
Dr
Novax: You are quite correct, they are focused on the consequences of COVID. However, I just don’t see the disease as that scary.
Coronaviruses are mostly harmless, they give humans colds.
Dr
Provax: You're right, most coronaviruses are not deadly. But some
are. COVID, MERS and SARS are all caused by coronaviruses and all are
deadly.
Dr
Novax: Well I've heard experts say that COVID kills no more than
a regular flu.
Dr
Provax: Look, you’re entitled to your own interpretations, but
not to your own
facts*.
The annual flu in its worst forms kills about 300-600 thousand people
worldwide (WHO),
and in most years less. COVID has killed over 5
million people in just two years. My interpretation of
that fact, my opinion, my speculation is that it could have been
worse if the world had not implemented social distancing, masking,
isolation and vaccinations.
(*See Hannah Arendt: "Freedom of opinion is
a farce, unless factual information is guaranteed and the facts
themselves are not in dispute." Truth &
Politics, 1967)
Dr
Novax: My
interpretation of that fact is that it is over-reporting by including
people who have died with COVID rather than of COVID.
Dr Provax: Ok, let’s agree the number might not be exactly right. There is probably over-reporting as you're suggesting. But there is evidence of under-reporting too, so let's accept the five million over two years as a useful starting point. We can then see that two million or more people per year is over three or four times the rate of annual flu in a bad year, and that has been the rate over two consecutive years.
Dr Novax: Well, I’ve heard that over 99% of people with COVID survive.
Dr Provax: Well, I’ll accept that is correct, but point out that saying 99% fatality-free is like saying 99% fat-free. It may make you feel better, but it doesn’t change the fact that the balance is an undesired alternative. Let’s say it as it is: it appears that there are one to two deaths for every 200 people infected with COVID (0.5-1% IFR).
Dr Novax: Yeah, well the authorities will use exactly the same spin when they say that "COVID vaccines are safe and effective" (CDC). The truth that they are not 100% safe and not 100% effective is buried much further down. Ignorance is bliss – especially for those disseminating the ignorance.
Dr Provax: Perhaps this is understandable as an effort to encourage people to vaccinate. We know that negative events, even rare ones, will put people off. Just the same way that shark attacks scare people out of the water, and remain a perpetual fear in the minds of tourists visiting Australia.
Dr Novax: Understandable maybe, but it sounds like it is dubious ethically: exaggerate to get people to do what they want. I do not see that good intentions are sufficient to justify unethical behaviour. But really, I just don't understand. If the medical scientists are so smart, why don't they create something that strengthens our immune system?
Dr Provax: Well, that's what vaccines do. They provoke the immune system to respond to a relatively harmless molecule that helps prime the immune system ready to respond to the virus. It is kind of like practising tennis by hitting a ball against a wall. It's not the real thing, but it helps.
Dr Provax: Ok, let’s agree the number might not be exactly right. There is probably over-reporting as you're suggesting. But there is evidence of under-reporting too, so let's accept the five million over two years as a useful starting point. We can then see that two million or more people per year is over three or four times the rate of annual flu in a bad year, and that has been the rate over two consecutive years.
Dr Novax: Well, I’ve heard that over 99% of people with COVID survive.
Dr Provax: Well, I’ll accept that is correct, but point out that saying 99% fatality-free is like saying 99% fat-free. It may make you feel better, but it doesn’t change the fact that the balance is an undesired alternative. Let’s say it as it is: it appears that there are one to two deaths for every 200 people infected with COVID (0.5-1% IFR).
Dr Novax: Yeah, well the authorities will use exactly the same spin when they say that "COVID vaccines are safe and effective" (CDC). The truth that they are not 100% safe and not 100% effective is buried much further down. Ignorance is bliss – especially for those disseminating the ignorance.
Dr Provax: Perhaps this is understandable as an effort to encourage people to vaccinate. We know that negative events, even rare ones, will put people off. Just the same way that shark attacks scare people out of the water, and remain a perpetual fear in the minds of tourists visiting Australia.
Dr Novax: Understandable maybe, but it sounds like it is dubious ethically: exaggerate to get people to do what they want. I do not see that good intentions are sufficient to justify unethical behaviour. But really, I just don't understand. If the medical scientists are so smart, why don't they create something that strengthens our immune system?
Dr Provax: Well, that's what vaccines do. They provoke the immune system to respond to a relatively harmless molecule that helps prime the immune system ready to respond to the virus. It is kind of like practising tennis by hitting a ball against a wall. It's not the real thing, but it helps.
Expertise and misinformation
Dr Novax: There’s just so much information, and it keeps changing. Wash your hands, oh that doesn't help much. Wear masks, oh they don't help unless you’re wearing the latest and greatest version. Vaccinate with Astra Zeneca if you're over 60; oh no, only if you're over 50. Oh there’s a new variant, and now you have to go and get another shot because two doses of the first vaccine offer only limited protection. But wait six months before getting the booster, or no, make it five, no four months. And so it goes on. How is someone meant to know what to believe?
Dr Provax: In fairness, COVID is new, less than two years old. We're learning as we go along. It's a case of constantly updating to the latest and best knowledge.
Dr Novax: Precisely. We didn’t have perfect knowledge in the past, we can't be sure that what we think we know now is correct, and better knowledge may emerge in the future. So how does one decide what to do?
Dr Provax: Well, you can try and evaluate all the information, but that would require years of expertise. And those lay people who claim to know something that everyone else has missed are very unlikely to be correct. So I guess we have to use the tried and true short-cut of trying to assess the credibility of who is talking.
Dr Novax: So trust the experts? Even the experts disagree. There are lots of doctors who are saying things that are quite opposed to the views of others.
Dr Provax: Yeah, well there are doctors and doctors. My philosophy doctorate and your credentials as a doctor of chiropractic limit our authority to speak relative to experts in immunology. Even then, there are likely to be some with more relevant expertise in virology and vaccines than others.
Dr Novax: Well, there are experts who are nurses and academics and professors who are all throwing out conflicting opinions.
Dr Provax: Yeah, but that is virtually true by definition: an expert opinion is one that is opposed by at least one other expert opinion. We do not need experts to tell us something largely uncontested such as the earth goes around the sun. An expert is someone at the frontier of knowledge. And the frontier of science is a kind of wild west where what is true is much disputed. So I guess that the safest choice is to simply go with the majority expert opinion.
Dr Novax: Ha, but some of the most significant advances in knowledge come from someone, often a minority, overturning an older dogma. To use your example about the earth going around the sun, the majority expert opinion before the 1500s was the opposite, that the sun went around the earth. It took a string of individuals like Copernicus, Giordano Bruno and Galileo to convert the majority of experts to thinking the way we now think is the truth. Copernicus dodged ridicule and worse by stalling publication of his heliocentric ideas until his death. Bruno was burned for his beliefs, and Galileo spent years under house arrest for his beliefs.
Dr Provax: True, and so this could be one of those occasions where the minority has it right. But the occasions that the minority is right are rare: the vast majority of minority views turn out to be false. Minority views are right only a minority of the time.
Dr Novax: My concern is that all the voices speak with confidence that belies the uncertainty. The public health and government agencies speak authoritatively, even while best medical advice keeps changing.
Dr Provax: Perhaps, but the alternative is ‘fake news’ from social media platforms like Facebook and rebel news sites. They tell a good story as reflected in the fact that they are passed around so successfully, but they ain’t true. A lie can fly halfway around the world while the truth is still lacing up its boots: falsehoods fly, truths trudge.
Dr Novax: Ah, but from the layperson’s perspective, there is little to distinguish ‘fake news’ and ‘expert opinion’. Some people believe fake news, some believe expert opinion. Both speak authoritatively, yet both might be wrong. Ironically, the advantage of fake news is that it doesn’t change its mind! Fake news offers a certainty that is refreshing because the past two years of uncertainty feels just awful (Claire Wardle).
Dr Provax: Which simply reinforces that knowing the truth takes an effort. And if you’re not prepared to put in the effort, then probably best to go with the authorities.
Dr Novax: Except that the authorities speak stridently and authoritatively, signaling a certainty that they simply do not have.
Dr Provax: Again, necessary in an effort to offset the strident, authoritative tone of the fake news.
Dr Novax: Great, so both sides double down on their conviction, and both might be wrong. It appears no-one is going to win the battle based on information. We are being called on to make a decision, yet we agree that our knowledge of outcomes is uncertain.
Dr Provax: Well, yes, you have to commit to some action. At some point, inaction becomes a decision to do nothing, and therefore, to bear the consequences.
Dr Novax: So in an environment of too much information, much of it false or potentially wrong, it is hardly surprising that people simply decide what to believe, then try to find information to support what they believe rather than the other way around.
Dr Provax: Yes, well this is the well-known confirmation bias. We tend to find information to support what we believe rather than build beliefs from information.
Dr Novax: And of course, we're all subject to confirmation bias, both those for and against.
Dr Provax: Yes, that is a fair assessment.
Mandated Vaccination
Dr Novax: So my problem is
that despite this uncertainty which we appear to agree on, the
government not only makes policy that we should all vaccinate, but is
also making policy about restrictions on what we can do if we are not
vaccinated. They are making vaccination compulsory.
Dr Novax: Ok, so I agree that conditions are a part of living life in a civilized society. But why are they being imposed on my job. Why are they imposed on my going out to a bar or a restaurant? What is the risk posed by someone who is not vaccinated?
Dr Provax: Well, an unvaccinated person might infect a vaccinated person.
Dr Novax: As I understand it, with the latest variant, both vaccinated and unvaccinated persons can be infected, and can therefore infect others.
Dr Provax: But the unvaccinated are more likely to be infected and therefore more likely to infect others.
Dr Novax: Imagine it this way: if the vaccine worked perfectly, the unvaccinated would pose no concern at all as the vaccinated would be protected. However, the vaccine works imperfectly. And this has become the non-vaccinator’s problem. Why is that?
Dr Provax: Well there is another problem, the unvaccinated who get infected seem more likely to end up in hospital and need more care on average than those who are vaccinated. That means our socialized health system has to pay for their choices. I do not think it is unreasonable that non-vaccinators must bear the personal consequences of their decision to not vaccinate. If you fall sick with COVID and need hospital treatment, you will be at the bottom of triage, and must pay for your treatment as in Singapore. Or perhaps, as a non-vaccinator, you ought to be willing to pay a higher health insurance premium say like a smoker. Are you as a non-vaccinator prepared to pay more for your health care if you are infected by COVID?
Dr Novax: Well, maybe, but first, I want to push back on the idea that somehow my personal choices should exclude me from public health treatment. Young people are notoriously more likely than older people to engage in dangerous activities – driving dangerously, riding motorbikes, engaging in extreme sports but we do not exclude them from public health care. We allow people to make choices in our society, even ones that might result in harm to themselves. So if we’re going to be consistent, then we have to allow non-vaccinators access to health care like others. And again, I would highlight it is still relatively rare that these people will need care.
Dr Provax: The choice to not vaccinate generates a higher cost, so the non-vaccinators must be prepared to make a bigger contribution.
Dr Novax: Perhaps they do generate a higher cost, but how high is that cost in relative terms? Again, people make lots of choices, and some people cost our society more than others because of their choices, even illegal or disapproved choices – like drug-taking, smoking, alcohol consumption, etc. They still have access to health care. Besides, businesses are crying for workers and customers to keep our society going – for the common good. How does it serve the common good to have an unvaccinated person blocked from the workplace and the market, and made a welfare recipient?
Dr Provax: Hmm, well perhaps it is an effort to encourage people to vaccinate.
Dr Novax: I’m fine with encouraging people to vaccinate, but like any marketing effort, I baulk when the marketing effort uses more coercive force. As I said before, good intentions do not permit unethical behavior. I daresay you would agree – we do not like marketing to be deceptive and to target vulnerable people. The State's public health messaging omits truths – like the potential harms of vaccinations – and the State not only targets vulnerable people, but makes them vulnerable by denying them access to their job and the market. This seems a step too far to me, even if it is ostensibly for the common good. Being righteous is quite distinct from being right – although the righteous will often fail to understand that distinction.
Dr Provax: I guess the State has made an assessment and determined it is better for society that people vaccinate. They have asked people to vaccinate as insurance. If you refuse the insurance, you’re on your own.
Dr Novax: Well, let us return to the problem of adverse events from vaccination. They do happen as I think you’re prepared to admit even while you apparently condone the State’s effort to omit or hush-up such events because it might scare people. Informed consent is a part of virtually all medical practice whereby I must be informed, that is told about all the scary possible side-effects, and only then am I required to grant my consent. Vaccination seems to be a notable exception. The State wants to skip over the side-effects, and wants to over-ride consent.
Dr Provax: But side effects are just so incredibly rare.
Dr Novax: I believe that they are, but what about the individual that does suffer an adverse event. Will the State compensate those who suffer? And even if they do, how will they compensate someone who dies? Australia has a dismal history of denying adverse events from vaccination, and has no compensation program for those that do suffer.
Dr
Provax: Hang on, they're not making the vaccination compulsory.
Education is compulsory - everyone has to go to school no matter what
kids, their parents or others want. That's compulsory. Taxes are
compulsory - and that's good for all of us as it funds the health
system that cares for our health - including public vaccination
programs. Voting is compulsory – in Australia at least. Prison is
compulsory - if it's ordered by a judge. And if a war comes along,
men aged 18-22 might be conscripted to go into national service.
Vaccination is not compulsory, but your ongoing job as a chiropractor
may be dependent on being vaccinated. That's conditional rather than
compulsory.
Dr Novax: Okay, but it doesn’t seem right that they can simply make things ‘conditional’ as you call them.
Dr Provax: It doesn't feel right when new conditions are imposed, but we live in a society governed by conditions designed to protect the common good. And you probably support many of these conditions. My profession as a university lecturer requires a string of degrees, your profession as a chiropractor requires certain qualifications. These are an effort to at least partially protect individuals in our society from charlatans. There are many other conditions imposed, again in an effort to protect other, maybe vulnerable, individuals in society. If you want to drink alcohol, it is conditional on your being over the age of 18. If you wish to drive a car, it is conditional on your being over 17, and licensed, and in a registered, roadworthy vehicle, and that you use a seat-belt, and you do not use your phone while driving, and your blood alcohol is under .05, etc.
Dr Novax: The government is using this opportunity to increase their control over us. It is Orwell's 1984.
Dr Provax: The governments is trying to do one of the jobs for which it is appointed, to protect us from threats against the common good. We are in uncertain times with a current threat looming, and they impose conditions for the good of the many. They don't necessarily get it all right, but they are acting quickly with a hope of saving more lives. During the Spanish flu outbreak in 1918-1920, quarantine, social-distancing, lock-downs, masks were all used - and publically opposed. Public health measures are always somewhat controversial but encouragingly, during the Spanish flu, those that did implement protective measures early appeared to be more effective. And to your fear of ongoing government control, are you not encouraged that the restrictions imposed during the Spanish flu were relaxed and only recently re-imposed some 100 years later.
Dr Novax: Okay, but it doesn’t seem right that they can simply make things ‘conditional’ as you call them.
Dr Provax: It doesn't feel right when new conditions are imposed, but we live in a society governed by conditions designed to protect the common good. And you probably support many of these conditions. My profession as a university lecturer requires a string of degrees, your profession as a chiropractor requires certain qualifications. These are an effort to at least partially protect individuals in our society from charlatans. There are many other conditions imposed, again in an effort to protect other, maybe vulnerable, individuals in society. If you want to drink alcohol, it is conditional on your being over the age of 18. If you wish to drive a car, it is conditional on your being over 17, and licensed, and in a registered, roadworthy vehicle, and that you use a seat-belt, and you do not use your phone while driving, and your blood alcohol is under .05, etc.
Dr Novax: The government is using this opportunity to increase their control over us. It is Orwell's 1984.
Dr Provax: The governments is trying to do one of the jobs for which it is appointed, to protect us from threats against the common good. We are in uncertain times with a current threat looming, and they impose conditions for the good of the many. They don't necessarily get it all right, but they are acting quickly with a hope of saving more lives. During the Spanish flu outbreak in 1918-1920, quarantine, social-distancing, lock-downs, masks were all used - and publically opposed. Public health measures are always somewhat controversial but encouragingly, during the Spanish flu, those that did implement protective measures early appeared to be more effective. And to your fear of ongoing government control, are you not encouraged that the restrictions imposed during the Spanish flu were relaxed and only recently re-imposed some 100 years later.
Dr Novax: Ok, so I agree that conditions are a part of living life in a civilized society. But why are they being imposed on my job. Why are they imposed on my going out to a bar or a restaurant? What is the risk posed by someone who is not vaccinated?
Dr Provax: Well, an unvaccinated person might infect a vaccinated person.
Dr Novax: As I understand it, with the latest variant, both vaccinated and unvaccinated persons can be infected, and can therefore infect others.
Dr Provax: But the unvaccinated are more likely to be infected and therefore more likely to infect others.
Dr Novax: Imagine it this way: if the vaccine worked perfectly, the unvaccinated would pose no concern at all as the vaccinated would be protected. However, the vaccine works imperfectly. And this has become the non-vaccinator’s problem. Why is that?
Dr Provax: Well there is another problem, the unvaccinated who get infected seem more likely to end up in hospital and need more care on average than those who are vaccinated. That means our socialized health system has to pay for their choices. I do not think it is unreasonable that non-vaccinators must bear the personal consequences of their decision to not vaccinate. If you fall sick with COVID and need hospital treatment, you will be at the bottom of triage, and must pay for your treatment as in Singapore. Or perhaps, as a non-vaccinator, you ought to be willing to pay a higher health insurance premium say like a smoker. Are you as a non-vaccinator prepared to pay more for your health care if you are infected by COVID?
Dr Novax: Well, maybe, but first, I want to push back on the idea that somehow my personal choices should exclude me from public health treatment. Young people are notoriously more likely than older people to engage in dangerous activities – driving dangerously, riding motorbikes, engaging in extreme sports but we do not exclude them from public health care. We allow people to make choices in our society, even ones that might result in harm to themselves. So if we’re going to be consistent, then we have to allow non-vaccinators access to health care like others. And again, I would highlight it is still relatively rare that these people will need care.
Dr Provax: The choice to not vaccinate generates a higher cost, so the non-vaccinators must be prepared to make a bigger contribution.
Dr Novax: Perhaps they do generate a higher cost, but how high is that cost in relative terms? Again, people make lots of choices, and some people cost our society more than others because of their choices, even illegal or disapproved choices – like drug-taking, smoking, alcohol consumption, etc. They still have access to health care. Besides, businesses are crying for workers and customers to keep our society going – for the common good. How does it serve the common good to have an unvaccinated person blocked from the workplace and the market, and made a welfare recipient?
Dr Provax: Hmm, well perhaps it is an effort to encourage people to vaccinate.
Dr Novax: I’m fine with encouraging people to vaccinate, but like any marketing effort, I baulk when the marketing effort uses more coercive force. As I said before, good intentions do not permit unethical behavior. I daresay you would agree – we do not like marketing to be deceptive and to target vulnerable people. The State's public health messaging omits truths – like the potential harms of vaccinations – and the State not only targets vulnerable people, but makes them vulnerable by denying them access to their job and the market. This seems a step too far to me, even if it is ostensibly for the common good. Being righteous is quite distinct from being right – although the righteous will often fail to understand that distinction.
Dr Provax: I guess the State has made an assessment and determined it is better for society that people vaccinate. They have asked people to vaccinate as insurance. If you refuse the insurance, you’re on your own.
Dr Novax: Well, let us return to the problem of adverse events from vaccination. They do happen as I think you’re prepared to admit even while you apparently condone the State’s effort to omit or hush-up such events because it might scare people. Informed consent is a part of virtually all medical practice whereby I must be informed, that is told about all the scary possible side-effects, and only then am I required to grant my consent. Vaccination seems to be a notable exception. The State wants to skip over the side-effects, and wants to over-ride consent.
Dr Provax: But side effects are just so incredibly rare.
Dr Novax: I believe that they are, but what about the individual that does suffer an adverse event. Will the State compensate those who suffer? And even if they do, how will they compensate someone who dies? Australia has a dismal history of denying adverse events from vaccination, and has no compensation program for those that do suffer.
Dr Provax: In fairness, the State has implemented a COVID-vaccination compensation program since about December
2021.
Dr Novax: Yeah, I've seen that, but it vague on
what is granted to the person who dies. And anyway, how much
compensates for a death?
Dr Provax: I hear you, but if you accept the statistics, then more people will survive if vaccinated than if unvaccinated.
Dr Novax: I accept the statistics, even that more people will survive if vaccinated. But I resist the State’s right to restrict my freedom to choose medications for myself. I’m not insisting you do not vaccinate, I’m insisting on my right to choose for myself. You happen to have chosen vaccination, so of course it doesn’t bother you that the State insists that people be denied that choice. Ultimately, the State is asking me to buy their ticket in a lottery in which I do not wish to participate.
Dr Provax: I hear you, but if you accept the statistics, then more people will survive if vaccinated than if unvaccinated.
Dr Novax: I accept the statistics, even that more people will survive if vaccinated. But I resist the State’s right to restrict my freedom to choose medications for myself. I’m not insisting you do not vaccinate, I’m insisting on my right to choose for myself. You happen to have chosen vaccination, so of course it doesn’t bother you that the State insists that people be denied that choice. Ultimately, the State is asking me to buy their ticket in a lottery in which I do not wish to participate.
The Gamble
(to be continued!) 
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