Abraham Wald and Critical Thinking in Healthcare

Sometimes you need to think outside the box

From https://en.wikipedia.org/wiki/Abraham_Wald

Every aspiring healthcare professional should read the semi-apocryphal account of Abraham Wald.

In 1943 in an attempt to mitigate loss of bombers during the Air War in Europe, the United States Army turned to the Statistical Research Group at Columbia University.  The Army wanted to fortify the aircraft with more armor, but armor added weight that limited performance. It was felt that the optimum amount and distribution of that armor could be found through a statistical analysis of the damage to returning aircraft.  Preliminary data indicated that the survivability of the aircraft was inversely proportional to the number of hits it had received.  Most of those hits occurred to the wings and fuselage, and the Army felt that increasing the armor in those regions, where most of the hits occurred, should logically lead to an increase in survivability.

Wald disagreed.  He pointed out that the armor should be concentrated around the engines because aircraft hit there never returned at all to have the hit counted!  Wald had correctly understood survivorship bias.

Reading this article in the February 6, 2024 issue of JAMA by Norman and co-authors made me wish that the editors of the journal could have channeled Abraham Wald.  The authors make the case that infants exposed to COVID-19 “vaccination” during pregnancy showed “no adverse neonatal outcomes”.  The design of the study included only live-birth infants who had reached at least 22 weeks gestation.  Thus, any infants lost during pregnancy were not counted.  They were like the planes that never made it back to base. Thus, to infer that COVID-19 vaccination was “not associated with adverse pregnancy outcome” fails because of survivorship bias.

Although studies proclaiming the safety of COVID-19 and lack of association with loss of pregnancy are in the literature, this letter and referenced study calls that into question.  In particular, it points to the lack of inclusion of VAERS data in a pivotal study that claimed no increase of risk for COVID-19 “vaccine” in pregnancy. That study by Rimmer and associates stated its limitations:

Our analysis was limited to observational evidence with varied reporting, high heterogeneity and risk of bias across included studies, which may limit the generalizability and confidence in our findings.

It would be bad enough if the acceptance of the articles by Norman et al and Rimmer et al and the promulgation of this assertion was just due to a poor understanding of bias in scientific studies.  After all, such unaccounted biases of many types abound in medicine and other published scientific studies. In 2005,  John  P. A. Ioannidis went so far as to explain why most published research findings are actually false.   The pressure to publish, even if the results cannot be repeated, is strong as academic advancement seems to be dependent upon publication numbers rather than validity.  More ominous, however, is the possibility, raised by Berry et al  that ideology rather than truth could be a  primary driver of some investigations regarding COVID-19.  

It has become clear that a major change in the way we admit and advance professionals in healthcare is in order.  While excellence in the STEM subjects is necessary, it is not sufficient.  Emphasis on critical thinking, courage, ethics and moral reasoning must be prioritized.  Medicine, like all of society, is struggling to overcome the intellectual nihilism and fluid nature of “truth” of the Postmodern mindset. This article by Marcel Kuntz frames the struggle in relationship to genetic modification of organisms, but it could just as easily be applied to medicine. The article was written in 2012.  Paradoxically, now many of the “scientists” have taken up the mantle of the Postmodern cause and are arguing from the other side of the issue! Ideology, not objective truth, is the prime objective.

Medicine has reached a new iteration of Lysenkoism!  (I wonder how many editors of medical journals even know of Trofim Lysenko?) Unless it is reversed quickly, the consequences will be catastrophic.  Reform is unlikely to come from within.  It will necessitate the broader  intervention of society as a whole, as the primary stakeholder in health and healthcare.