A Response to Dr. David Gorski of Wayne State University: On Rational Public Discourse About the COVID-19 Vaccine, Outside of Your Twitter Echo Chamber.

Dr. David Gorski, Chief, Division of Breast Surgery, Associate Professor of Surgery and Oncology, Wayne State University School of Medicine.

[Note of Correction: On initial publication of this article I misspelled Dr. Gorski’s last name as “Gorsky” with a Y — with apologies to Dr. Gorski, I’ve corrected this error now.]

On January 29, 2021, Dr. David Gorski a breast surgeon at Wayne State University School of Medicine wrote an irate article referring to a public letter of warning I’d written to FDA and Pfizer leaders about a potential danger to some people receiving COVID-19 vaccines.

You may read my article HERE.

The source of Dr. Gorski’s ire was not so much my scientific opinion, rather he was fuming about the fact that Mr. Robert F. Kennedy Jr’s public advocacy Magazine, The Defender, had elected to opine on my letter and re-publish it.

You may read the article in The Defender, HERE.

Dr. Gorski’s opinion and tone was a bit surprising to me, because he is an academic physician with scientific credentials. To be clear, Gorski understands the potential scientific problem I’ve raised and does not disagree with it. But he seems to believe that maybe I should not have expressed it in public or that I should chastise Mr. Kennedy’s Magazine for referring to it.

You may read the ireful and long diatribe by Gorski, HERE.

What Gorski is alleging is that Mr. Kennedy is using my letter to stoke vaccine hesitancy — and he is critiquing me for permitting this usage of my scientific opinion and public letter to the FDA . As if I have any control over Mr. Kennedy’s, or his own, choice to opine or adopt my opinion piece however they wish to.

“It’s called living in America, David.”

To be clear, had I uploaded my letter to FDA and Pfizer into the FDA’s public comment portal, Mr. Kennedy would have had free access to it also. So really, what Gorski is suggesting is that I either not publish such a letter of concern, or that I demand that Kennedy withdraw his reference to my letter.

I intend to do neither of what Gorski is erroneously suggesting I should. Because, I believe that Dr. Gorski’s opinion is not aimed at creating consensus. It is aimed at getting a cheer from his echo chamber of followers, who do not see that it may very well be possible to convince a large proportion of the American public that these vaccines are highly likely to be effective — AND that they can be administered rationally and safely by mitigating against all real and potential safety risks.

I also found it quite unfortunate that a seemingly decorated academic physician-scientist at a place like Wayne State University could be so intellectually childish in engaging colleagues in public — after all, I know Gorski took Immunology 101 in Med school and gets what my concern is. And, he knows exactly what kind of professional training I have — as well as, the inevitable public advocacy I had to engage in as a surgeon and husband, for the past 10 years of my life.

But, really, people like him have no idea what it’s like when systems fail people!

So, in the end, it’s sad to see that Gorski is missing my point — and truly, he’s making a fool of himself. Just to get a few cheers in his echo chamber.

So, I took it upon myself to respond to the Dr. Gorski in an email. You may read it below.

I do wish that people like Dr. Gorski and his followers on Twitter could see how remarkably similar their behavior is to trump and his people in this instance: unreasonable, irrational, unempathic and bombastic.

Perhaps, David Gorski could slow down, think, be a bit more polite and engage in a reasonable discourse with the subset of Americans we must all earn trust from as experts. But I have my doubts that he is able to — I’ve tried to reason with his type before in a different public health fight. They almost never get it.

Here is my email to David Gorski of Wayne State University — for the record:

____________________________________________________________

From: Hooman Noorchashm <noorchashm@gmail.com>
Date: Fri, Jan 29, 2021 at 5:13 PM
Subject: Your Article
To: <gorskid@med.wayne.edu>
Cc: Woodcock, Janet <Janet.woodcock@fda.hhs.gov>, Marks, Peter <Peter.Marks@fda.hhs.gov>

Dear Dr. Gorski,

I’ve read your article referencing my opinion piece about vaccination of recently convalescent and infected COVID-19 patients:

https://respectfulinsolence.com/2021/01/29/noorchashm-spreading-fear-of-covid-19-vaccines-on-an-antivax-website/

Of course I very much appreciate your detailed reading of my opinion. To be 100% clear, I have a good command of immunology and I fully grasp the critical importance of vaccinating as many people as possible, as quickly as possible, with an effective vaccine in the face of the pandemic challenge we are now facing.

That said, I am not fooled into believing for a moment that safety can be assured to citizens, when such speed and scale is being deployed as we are correctly aiming for. Nor do I ascribe to the idea that for the benefit of the majority in an ethical society, it is justified to accept minority harm — especially when such harm is amenable to prediction or mitigation. That approach is, in fact, an abuse of utilitarian medical ethics, for which I have a healthy respect — so long as it is adequately calibrated against safety for those identifiable souls who might be in real or potential harm’s way.

To be crystal clear, my concern is that indiscriminate vaccination of the recently convalescent or actively infected COVID-19 patients might pose an immunological danger to them — and particularly those who are elderly, frail or have cardiovascular disease or risk factors.

This is a specific immunological risk prognostication, deeply steeped in an understanding of antigen specific immune responses to vaccines, in a setting where Emergency use of the vaccine is being proposed for the entire US population within a year. Therefore, unlike normal circumstances, we do not have the luxury of waiting for “evidence” of such a risk being material. We MUST use best scientific judgement to protect those definable minority subsets, which are in harm’s way.

Also, let me be clear, based on my scientific understanding of the mRNA technology, I am nearly certain that the Pfizer and Moderna vaccines will be two of the most powerful vaccines ever made and brought to market. I fully expect that these vaccines will be highly effective in preventing disease.

Still, I am not willing to forego the safety of a minority subset of people whose lives I can forecast, based on immunological principles, may be in harm’s way. And because, the risk I speak of is highly specific and amenable to a precise mitigation approach (i.e., screening before vaccinating — especially in high risk groups) — it is not ethical to use utilitarianism alone to justify doing nothing about the potential risk defined.

Now, I am not sure if you understand the nuance I am pointing to — and I feel that you are so mechanically trained to defend vaccination, you may not be amenable to seeing my reasoning. But perhaps I am wrong.

With regards to Mr. Robert F. Kennedy Jr’s publication referring to my article, I did not give specific permission to him, nor would I have withheld my consent for him or anyone (including you) to refer to it. You see, this is what the free press and freedom of expression is about in America. You and Mr. Kennedy are both welcome to refer to my opinion piece from your own lens.

That said, and despite the fact that I would dispute some of what Mr. Kennedy and his colleagues have stated in the past, I find your direct attack on me defamatory — his, not. Use of words like “idiot” are more a reflection on you as a professional than on myself. Frankly, it is unbecoming of your title as Associate Professor of Surgery.

I respectfully suggest that we either: a) continue our public discourse in a fully respectful and cogent way as two fellow physician-scientists and to include all sides, or b) discontinue the interaction entirely, if you insist on being bombastically foolish.

In the end Dr. Gorski, about 50% of the American population is failing to accept the critical need for this vaccine. A large subset of this population will never be amenable to scientific reasoning. But I believe that another large proportion of this population is legitimately concerned about the safety of this vaccine as the root cause of their hesitancy. My bet, is that if we respect these folks’ concerns as professionals instead of blowing them off, or worse calling them “stupid” and “idiotic” as you and some of your followers on Twitter seem amenable to doing, we might be able to convince them that these vaccines are and can be used reasonably safely. We may actually be able to earn trust for a change.

I do think that you ought to edit your description of me in the article you published, in the interest of protecting your own professional reputation — the folks who know me as a friend and colleague are who they are and they are all reading your words — I assure you that I do not belong to some crazy fringe group. I am nobody’s “idiot” on the immunological concern I’ve raised.

I have no problem with your critique that Mr. Kennedy’s organization may be using my words for political purposes to cause vaccine hesitancy. That error, would be something Mr. Kennedy would have to live with. But I suspect that even he understands that in this pandemic the vaccine might be a matter of our national survival. Of course, I also know that you are referring to my article to be political and gain notoriety as a pro-vaccine physician.

Of course, i will note that at the moment, we have no issues with vaccine hesitancy. MANY people are waiting for the vaccine and there is only a limited supply. So your gratuitous criticism of me is simply unnecessary and rude — at the moment. Not to mention it missed the point of concern I’ve raised with FDA.

It is your choice how you’d like to proceed publicly from here Dr. Gorski. As Mr. trump demonstrated to us, bombastic fools usually lose in the end — so let us treat each other with respect and reason. Maybe, just maybe, our nation can find a way out of this quagmire. Calling people “stupid idiots” reflects on only you as an academic physician-scientist.

Let me know how you’d like to proceed — I assure you that bigger eyes than you think are on you now.

Polite. Always polite David!

Sincerely,

Hooman Noorchashm MD, PhD

Hooman Noorchashm MD, PhD is a physician-scientist. He is an advocate for ethics, patient safety and women’s health. He and his 6 children live in Pennsylvania.

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