For he to whom God gives no light, no light whatever has he! They that are whole have no need of the physician, but they that are sick…
- Mandating vaccines in general is viewed by many as unethical because mandates don’t allow informed consent. But specifically the COVID vaccines don’t protect others so mandating any dose is and was particularly unethical. Add to that unfavorable risk-benefit and unnecessary harms=tragic. - How do you practically assess individual risk and benefit? - I think it needs to be done on the individual level. Physicians can provide info specific to that person to help them make a decision weighing their own potential risks and benefits. Requires synthesis of data on individual risks/preferences, potential benefits/harms of treatment. (Twitter conversation April 12, 2023)
When two Mortal Fools face each other, there is a possibility good may come of it. This possibility, not a certainty, is contingent on one question - what is truth?1 When there is man in front of you, there is reasonable hope to discern what truth is here and now. In the reality of common sense as opposed to non-sense.2
Man is mortal. Man falls sick, suffers, and dies. No man can save this man in front of him from illness or death. It is impossible to know if this particular man will fall sick, and if he does, whether it will be a mild cold or a lethal plague. Statistical certainty of a safe drug in a population is often transitory.3 The passage of time corrects for it, eventually. A safe drug for the man in front of you does not exist. It is impossible to know how this man will respond to a drug, now. It is wrong to give medicine to the well man in front of you for the benefit of Bob in Papua Kong Sweden.4 COVID vaccine is a medication that treats risk of a severe disease in a population.5 The man in front of you does not have any individual risks that can be ascribed to him.6 He is not a population. He is not a universal man from a book on immunology or epidemiology.7 A risk is a property of some uncertain statistical population that cannot and must not be applied to this particular individual. The certainty of salvation in some statistical population does not exist in reality. You cannot claim that a vaccine will “save a life” of this particular man in front of you. It would be a lie because you do not know if this particular man will fall severely sick from COVID if left unmedicated. You can make this well man sick or kill him by giving him medicine. Doing wrong has no benefits. A hundred benefits do not justify one wrong.8 No amount of statistical biopolitical propaganda can cure me of the certainty of reality.
What is certain here and now — this man in front of you is not sick with the disease that the COVID vaccine targets - risk of a severe illness in a population. For all intents and purposes, regardless of other diagnoses and age, this man is well. Should you vaccinate him? Is giving medicine to well man good? Is this medicine good for this man here and now? Law and algorithms of population medicine relieve you of the pain and responsibility to discern truth. I am certain that I am bound by professional duty to this man in front of me, not a population. The decision to accept preventive treatment for risk in a population rests with the man who will bear the burden of this decision by living the consequences of it. You can help him. You may create an illusion of making this decision for him, alleviating some of his burden. Yet you cannot know for him. Knowing is a personal duty. It is his cross to bear.
Vaccination is not the question of risks and benefits, data or information. It is the question of wisdom and ignorance, knowing right from wrong. This man will decide what is right and wrong as he understands it. This man has to be able to wake up for the rest of his life, knowing that he did right, no matter what happens as the result of this decision.9 It is a delicate task. You need to assure this man understands reality without upsetting his peace. You do not want to turn his world upside down for the abstract truth or good. Truth and knowledge must fit in some proportion to the reality of a suffering body this man inhabits, as humbly and kindly as the circumstances allow it. There are but two Mortal Fools facing each other.
Imagine air all around you, except instead of air molecules there are unstable, ambiguous, abstract concepts, ideas, beliefs, feelings, thoughts, stories, histories, parables, and fears that shape the understanding of right and wrong for both you and the well man in front of you. You can estimate the meaning of these concepts to match your abstract knowledge about no-body to fit the reality this man inhabits in his body.10
Knowledge fitting is a mutual process when two knowers discern what truth is. Here. Now. As bound and limited by some tradition of knowledge. In good faith. A professional assesses the man in front of him to discern a good fit of all the abstract knowledge in his possession. The man himself senses if the knowledge feels right. This proportional mutuality, however imperfect, offers a possibility of humble truth arising between two Mortal Fools.
What can you contemplate to find a good fit for what is right here and now for this man in front of you? It is a loose framework of questions in no particular order.
Is there the Plague of Times, according to this man? Does this man have any concerns now? If yes, what are they? Is he afraid? What are his fears?
Whom or what is the object of medicinal treatment? Man? Fear? Uncertainty? Risk? Population?
What is man? What is life? Is man a life? What does it mean to live? What does it mean to exist? Is there a difference between living and existing?
Who has the power over life and death? What is the meaning of death and dying to him?
What does it mean to be healthy? How does health come to be?
What kind of background does this man come from - place of origin, family, education, faith, profession, age, etc?
What knowledge system guides his understanding of self as a body? Is he man? An immune system? A quadrillion of mitochondria? Is he a life? Does he perceive himself to be a unit in a statistical population?
What is his understanding of illness? What are his views on treatment vs prevention of illness? Is there a difference between falling sick as a natural occurrence vs falling sick because he did not do something right or did something wrong?
What was his experience with medicine and medications in the past?
What is his framework of right and wrong? Does he have an understanding of right and wrong? Does he try to game reality to gain benefit without any regard for right and wrong? Does he understand what reality is vs encoding of knowledge about reality?
Did he vaccinate routinely in the past? Does he have any concerns about this vaccine now, regardless of prior vaccination practices? What concerns does he have?
What are his views on medicine and medications in general? What treatments does he think work and do not work? What is his perception of a vaccine? Covid vaccine? What does he understand about the practice of vaccination?
Does he understand that a rare adverse reaction in a population can happen to him? If so, will he be able to accept it? Does he understand that he may fall severely sick and die even if he is “low risk”? Will he be able to accept it?
What will he likely to think if any illness happens or a new disease is diagnosed following vaccination? (February 20, 2024)
Did he have this disease in the past and recover? What is his state of health at this moment?
Is there anything else I can suggest that is non-pharmaceutical, regardless of the vaccination decision, that will ensure that this man is well every moment of the day, every day?
Can you avoid administering this medicine now?
What is this man willing to suffer? What is he willing to suffer for?
Is he willing to die for what he thinks is the right thing to do? Not as a heroic sacrifice. As an act in the natural course of living.
How does this man perceive responsibility for health and decisions about medical treatments? Will he blame anyone if something goes wrong? Whom will he blame?
Does he think/feel he should take this medicine here and now?
Does anyone pressure or coerce him into taking this medicine?
You rarely ask all of these questions. Most men are unable to explain the ideas that underlie their beliefs and decisions. There are constraints of knowledge, time, and law. You imagine the best you can or estimate all of the above based on the established medical history as well as what the man in front of you is able to articulate. It is upon this common sense understanding between the two of you, the truth has a possibility to be revealed. Often, a lot goes unsaid because it is too painful to be reminded that there is only one certain Truth. The rest is uncertainty.11
The only certainty I can offer you is that I shall not abandon you when you stumble and fall.
There are many traditions of discernment of truth. All are limited by some set of conditions.
Common sense refers to senses that allow us to understand reality. Non-sense is knowledge that arises through measurement and statistical analysis.
When we speak of a safe drug, we imply that it was tested and met certain criteria of safety in a population of people or patients, under ideal or controlled conditions or later in the real world. It does not mean that this particular person or a patient will not have an adverse reaction.
Modern scientific knowledge is abstract. It does not distinguish between populations separated by space and time. The practice of vaccination relies on the participation of all for the benefit of all to reduce symptomatic disease incidence, prevalence, and/or transmission as well as resources and time spent caring for the sick. Western idea of health is very closely tied to economy. It does not necessarily correlate with individual wellness or what is good for this person here and now. Clinical and population medicine interventions often try to accomplish the most with the least investment and contribution to individual wellness. Part of the problem are “inconvenient people” who may not want to do good or have varying ideas about health and what good is.
A vaccine is a drug that is given with the intent of prevention of a severe course of illness and/or death in a well person who is not sick. The practice of vaccination of a population attempts to reduce probability of severe illness in as many people as possible while harming as few as possible. All of these are calculated through statistical modeling. It is a practice of population medicine as part of population administration. Vaccination is simultaneously clinical, population, biopolitical, and ritual medicine.
Physicians and non-physicians prescribe and administer increasingly more medications to treat risk, not any particular illness, suffering, or disease. The very concept of disease and the practice of diagnosing disease centers around statistical risk, not a bodily ailment.
Gainty, C & de Michele, G 2019, 'The Disease of 'At Risk'', BMJ (Online).
Stern RH. Individual risk. J Clin Hypertens (Greenwich). 2012 Apr;14(4):261-4. doi: 10.1111/j.1751-7176.2012.00592.x.
Medical knowledge and statistical modeling rest on many unspoken assumptions and conditions. One of them is the idea of a universal man that is open to any kind of manipulation, has no questions, and will respond to treatment in a straightforward predictable way. A human animal on an Animal Farm.
Utilitarian logic and ethics are at the core of population medicine. What “ethically acceptable” wrong can I get away with to derive the most benefit? It is in stark contrast to deliberation within the tradition of wisdom. What is good to do here and now?
Would you do it all over again if the outcome of your decision was not what you hoped for? Hopefully, the answer is yes.
Modern scientific knowledge divorces symptoms, suffering, and illness from the body of man for ease of categorizing and processing it as metrical data. There is no abstract symptom, suffering, illness, or disease. It is always some-body that suffers it. Uncertainty and fear are not abstract. Some-body suffers them.
We fake certainty with the kinds of knowledge we ourselves make. We use statistics to give the impression of certainty to talk about uncertainty. It all falls apart when two Mortal Fools face each other.
Briggs, William. (2016). Uncertainty. The Soul of Modeling, Probability & Statistics.
Thank you dear, for this "full of gems" article.
It had been a while.
Wishing you a blessed Holy Week and glorious Pascha!