Since the pandemic began, I have sent out over 100 emails; they take time to research and write. I learn every time I send one out, notably, I also learn from the feedback I receive from the people who take the time to read them. An email I received in response to my most recent email came from a wise, trusted, long-term friend and patient, and it made me pause and think. The person's point was that the quotation in my email regarding Paxlovid was a perfect and ironic example of the selection and confirmation bias that I try to avoid.

Rather than react and defend my position, I just settled back and absorbed that point of view. I think that the worst thing for one to do is "blow-back." This is when you dig in your heels and refuse to consider alternative viewpoints. Inherent in being human is bias; we can acknowledge it and re-visit the issue or ignore it and thus not evolve. I choose to evolve.

As it relates to the COVID pandemic, I have been a doubter because so much of the information we are getting from the CDC and FDA has not been consistent with what science has told us. And unfortunately, we have learned that many academicians who disagreed with the groupthink have been demeaned, shunned, and sometimes even fired. Process this: COVID-19 is a contagious, generally mild, illness for otherwise healthy people. If you have had COVID, and over 80% of the population has, either knowingly or unknowingly, this is your best immunity. And if you have been previously vaccinated with the primary series plus one booster, the benefit of taking the Fall booster is marginal, at best.

In my previous email, I gave my recommendations regarding vaccinations: RSV, mRNA Covid-19, and Novavax Covid-19. In addition, I gave my thoughts on using Paxlovid and included a quote from Sensible Medicine that had some political overtones. Sensible Medicine is a publication that I subscribe to as a paid subscription because, unlike others such as Medscape, Med Page, and many other publications, there are no advertisements. Thus, there is no influence by "big pharma."

I like the summary statement from Sensible Medicine because it speaks to an essential issue of using the best available science to make sound clinical decisions, namely, using published, peer-reviewed, randomized clinical trials to guide us in making recommendations. When Paxlovid first became available, there was great hope that it would be an efficacious and safe remedy; it was rapidly approved by the FDA and recommended for use by the CDC. There was initially only limited data to support its use, but now we have randomized controlled studies that show that using it does not change outcomes except possibly in one group: the unvaccinated.

As I have written to you previously, the risks include medication interactions (statins and anticoagulants), GI intolerance, and a 5-15% rebound rate of the infection after completion of the 5-day course. With this published data, I used my 35 years of experience to give you my recommendations, hopefully, without bias - just science.

My current vaccine recommendations:

• Yes, get the flu shot before mid-November. It reduces the risk for medical care by >50%.

• Hold off on getting further mRNA Covid boosters.

• If you feel vulnerable, take the Novavax Covid vaccine, which is more durable with lower side effects and risks; it is a traditional vaccine.

• Unlike the mRNA vaccines, the Novavax does not tell the body to make spike protein; it presents spike protein to the body, which will decay over time, thus not causing a possible prolonged inflammatory immune effect.

• Here is a Novavax locator to help you find it; I do not have any of these vaccines in the office.

• The RSV vaccine is new; I am recommending it for people over 75 with serious heart and lung issues. It is CDC approved for anyone over 60.

On a musical note: 

You've Got a Friend by the legendary Carole King, who wrote it, and James Taylor made it famous.

As a reminder, I'm no longer sending out daily updates and instead, I'm updating you periodically. I continue to enjoy writing these updates. Initially, these were only sent to my patients, however, I've been humbled to learn that, through social media, these writings have been forwarded and re-forwarded to many. This has brought me great joy to know that this simple act of sharing facts, thoughts, opinions, and hopes has touched you in some way. Hopefully I've been able to reassure you, maybe make you smile and laugh, soothe your worries, and comfort you. And maybe, just maybe, I've helped you to be in the moment!

Reach out and stay connected. Be well. Feel free to forward this on.

HAO 24/7

Reach out. Stay connected. Stay home. Save lives. The power of one. Be well.

Feel free to forward this on: spread the word, not the virus.

HAO

24/7

Harry Oken, M.D.

Adjunct Professor of Medicine

University of Maryland, School of Medicine

Office 410-910-7500

Fax   410-910-2310 

Cell   443-324-0823