It’s called “the green journal.” When I was in medical school in the 1970’s, it was the source most frequently quoted by faculty at OHSU. The American Journal of Medicine is the official journal of the Alliance for Academic Internal Medicine, a prestigious group of internal medicine department chairs at the top 125 medical schools across the U.S. In addition to its academic rigor, one of its primary stated aims is to enhance knowledge and improve effectiveness of public health interventions.
On September 28, 2023, the green journal published a paper that was stunning. The focus was an analysis of studies pertaining to masks published in the CDC's Morbidity and Mortality Weekly Report (MMWR). This CDC journal is the most influential federal health journal in the United States, widely cited, though not externally peer reviewed.
Researchers at the University of California-San Francisco and the University of Southern Denmark analyzed 77 studies published in MMWR after 2019. Conclusions favoring masks were seen in over 75% of the studies despite only 30% of those studies having actually studied mask effectiveness and less than 15% having statistically significant results. None of the 77 studies were randomized, yet over half drew causal conclusions.
This independent review noted that 70 of the 77 studies published in MMWR had at least one CDC coauthor. Former CDC Director Rochelle Walensky was singled out for citing a low response phone survey with non-significant results, as evidence that masks reduce infection by “more than 80%.” Authors pointed out that although some studies reported higher case rates in the masked group than the comparator group, all these studies concluded masks were effective.
None of the studies mentioned higher quality randomized studies which failed to find evidence for mask effectiveness. The researchers concluded that the level of evidence generated was low and the conclusions were most often unsupported by the data.
The authors’ final statement was both brutal and blunt: “our findings raise concern about the reliability of the (MMWR) journal for informing health policy.” How could the CDC come to this place?
Understanding behavior often begins with the maxim “follow the money.” Financial incentives are the easiest to demonstrate.
In 2018, it was discovered that a $100 million alcohol consumption study run by NIH scientists was funded mostly by beer and liquor companies. Emails proved that NIH researchers were in frequent contact with those companies while designing the study which was aimed at highlighting the benefits, and not the risks, of moderate drinking.
The National Institute of Allergy and Infectious Diseases (NIAID) is just one of many institutes that comprise the NIH. Dr. Anthony Fauci served as NIAID Director from 1984 to 2022. The NIH owns half the patent for the Moderna vaccine. The NIAID will earn millions of dollars from Moderna’s vaccine revenue.
The CDC was an agency free of contributions from pharmaceutical companies until they formed a nonprofit called the CDC foundation. From 2014 through 2018 alone, the CDC Foundation received $80 million from corporations like Pfizer, Biogen, and Merck.
75% of the FDA’s scientific review budget was paid for by pharmaceutical companies in 2017. A Science investigation (2018) found that 40 out of 107 physician advisors on FDA committees received compensation from big pharma companies of up to $1 million or more.
From its origin, WHO could not receive donations from pharmaceutical companies – only member states. That changed in 2005 when WHO revised its financial policy to permit private money. Since then, 80% of its financing comes from private donors including Covid vaccine manufacturers AstraZeneca, Pfizer, and Merck.
None of this, however, explains the incompetence exposed by the American Journal of Medicine. What is exposed is that it is dangerous to assume that, because people are in positions of responsibility, they are therefore behaving responsibly.
As powerful the influence of financial profit, science captured by ideology is more malignant. Money can be followed. Fraud, where conclusions are neither true nor useful because the data is cooked, can be exposed. Bias is more subtle. Science, as a sociological construct becomes less about truth, and more about activism. A specific type of welfare program to children of rich parents who were clever in school.
It is impossible to ignore we live in a world of activists. People who want to do good, as they understand good. Sadly, they are often so poorly trained in critical thinking and causality that science barely helps us. Many studies lack controls. Many are hopelessly flawed with confounding or bias. Most academics create causal conclusions that aren’t true. Even when they are true, they can’t be scaled. The field of science has become full of careerist who churn out low credibility studies.
This malignancy is amplified when ideologic entities forge integration with institutions of power who are administered by such people. Now we are drawing closer to understanding the MMWR debacle.
The World Health Organization (WHO) is undeniably influential across the globe. WHO was designed in 1946 to coordinate international public health. Its mission was to address high burden diseases that cause avoidable sickness and death in countries lacking the resources or technical expertise needed.
“Life-years lost” is an important concept in public health. Most people would prioritize a 5-year-old with pneumonia over an 85-year-old dying with dementia if a choice had to be made. When truth was important, preventable diseases such as malaria, tuberculosis, AIDS, other infectious diseases, and effects of undernutrition were the priority.
In terms of equity, it would be ludicrous to divert resources from African children dying of the above causes in favor of mass Covid vaccination. That Covid vaccine is much more expensive than malaria management. Covid kills at an average age less than 1% of Africans even live to. Half of Africans are under 20 and nearly all had immunity against Covid before Omicron immunized the rest.
How do you then explain the fact that such a vaccination program was run by WHO and continues underway? This was not a mistake but a deliberate act. It is an example of wealthy corporations and foundations determining global priorities while a propagandized public is removed from decision making regarding their own well-being.
The people in charge knew the age at which people die of Covid-19. They knew most people already had immunity. They knew the worsening of other disease that resource diversion would drive. In the same way, they had known that closing schools would entrench future poverty and that closing workplaces in crowded cities would enforce poverty whilst having no impact on virus transmission. So, why would they act so irrationally?
The Bill and Melinda Gates Foundation provides $250 – 300 million a year to WHO. This is more than the entire United States contribution. What is being purchased is influence. And this enables the possibility for the values of a single rich philanthropist to set the global health agenda.
It is essential to understand that people, not viruses or research findings, make decisions and those decisions are based upon values. Science does not tell us what to do anymore than the telephone tells us what to say. And what we are progressively seeing is that social and ethical values play a role in the production and dissemination of science.
In my final (Part IV) blog on corruption and conflicts in medicine, I will expose how implicit bias has a powerful influence in both the personal and population-based health decisions we face today.
Tim Powell MD