- This is a topic I've been meaning to address
for a long period of time,
but I had an isolated incident happen to me on TikTok
that I think is very emblematic
of what's happening on social media,
specifically within the healthcare or medical community
that I find to be very, very problematic.
And I wanna say on the outset of this video
this is not intended to attack anybody.
There's gonna be a reason why we cut out everyone's names
out of the video, their usernames,
because the purpose of this is to get the medical community
on the same page,
to make sure that we improve our communication style,
myself included and learn from situations just like this one
in order to facilitate the message
of greater good or public health.
A month ago, I posted a short, a cutdown of my interview
with Sebastian Maniscalco on the topic of RSV.
Right now with RSV,
one of the leading theories of why
there's such a run on hospitals is because
generally kids get RSV in their first three years of life.
There's like a 50% chance each year
that they get their first episode.
And their first episode with RSV is usually the worst.
The time that where they need breathing treatments
maybe ICU stay.
And we've held our kids back from school
grandparents and everybody that could've gotten them sick
for the last two years.
So now the children that would've gotten it
each year have all gotten it at the same time
and it was their first time.
So it kind of creates a run on hospitals.
That's the leading theory.
RSV is a respiratory virus
that actually affects people of all ages,
but it happens to be worse
in the very young and the elderly.
What's been going on in our communities
is that we've seen higher rates of hospitalization
for children with RSV over the last season
which means basically starting late October, November.
And we had some theories circulating
as to why that was going on.
I presented one of the leading theories
and I specify one of the leading theories
very strongly here because I largely believe,
as a physician myself, who treats children,
that this is a multifactorial situation.
Meaning that there's probably multiple factors
and multiple theories that are to be true.
And each of them have holes
because they do not on their own.
Explain the given spike in RSV hospitalizations.
The theory of COVID co-infection, fluid co-infection,
and immune dysregulation, partially true.
The fact that the timing has been thrown off
and our seasonal patterns have been thrown off.
The fact that pregnant patients
weren't exposed to RSV while pregnant,
therefore transfer less protection for newborns,
partially true.
The one that I presented, spoke to the fact
that children over the last two years or so
had less exposure to RSV
because we were protecting them from COVID.
We were not having normal activities,
normal interactions,
their siblings were not going to school,
their parents were not going to work,
and as a result, they, they had less exposure to RSV.
When you have less exposure,
you are less likely to get RSV.
And children who get RSV for the first time
usually get a worse case of RSV.
I wasn't saying anything about children's immune systems.
I wasn't saying anything about
our mitigation methods for COVID.
I was simply saying that
because they had less exposure to RSV,
that more children were exposed to RSV this season
as we're going back to regular life.
And as a result,
more of them were getting it for their first time,
which means more severe cases.
So it's basically just a timing issue.
Nothing to do with the strength
or weakness of their immune systems.
In fact, this theory about the timing being thrown off
was not my theory.
It happens to be one of the leading theories
that was spoken in news by New York Presbyterian Hospital.
It was on ABC news.
Doctors on NPR talked about this.
Dr. McGeer from University of Toronto
said it perfectly in this interview.
- There's no question in my mind
that the biggest impact of this excess in illness in kids
and in our ICUs, is related to the fact
that kids just weren't exposed to RSV.
- After posting this TikTok,
I got comments from other doctors
who were debating the validity of this theory
whether this is the theory
that explains the recent spike in RSV
and some of their arguments were right.
I actually agreed with their arguments.
They were saying that in Sweden
they did not have a strict of a lockdown,
and yet they're still having this spike.
Why is that the case?
And I'm not an expert on Sweden, by the way.
I don't know exactly what their healthcare system is like.
So I don't even pretend to know that.
One of the theories going around right now
is about COVID immune system dysregulation.
That some doctors believe,
that all these children that have had COVID in the past
have a weakened immune system.
Therefore, as a result, RSV affects them more.
There may be some truth in this
because any co-infection whether we're talking about COVID,
flu, rhinovirus these types of co-infections
can make your immune system have fluctuations
in its ability to fight other viruses.
So that's partially true.
There's some even data showing
that some immune cells are impacted
by having COVID in the past
the concept of immunity debt has popped up
among certain circles, where they believe
having children protected from exposure
has led them to have a weakened immune system.
And this is not what I was saying.
This is not how immune systems work.
Yes, there is a hygiene theory that long term,
chronically, over the course of our lives,
if we hyper protect ourselves from bacteria
and constantly disinfect everything
it could have a meaningful impact of our lives.
But over the course of one or two years
protecting children from a serious situation like COVID
that initially we knew very little about
and then we learned more and it was very scary
and our hospital systems were overwhelmed
will not impact their immune system
so much so that they're weakened.
That is not what I was saying.
And anyone pushing that is inaccurate.
To my disappointment,
this past week, I started seeing an increase
of attacks from other medical professionals
on this TikTok that I did not expect.
Because I totally see how we can debate
what is the reason for this RSV spike.
But I started seeing personal attacks.
In fact, there was one comment that upset me
because the person came in and said,
"Wow you pretend to be a so-called "doctor." in quotes.
"Here's an immunologist's perspective."
And it was like a personal attack
on me as if I'm not a real doctor, treating patients.
When I have RSV patients, I have COVID patients.
I give guidance. I strive to be the best doctor that I can.
I've tried to be an accurate voice
with evidence-based medicine throughout the pandemic
and to have this doctor do a personal attack on me
to upset me, so I blocked them.
In fact, that was one of my New Year's resolutions
to try and not pay attention
to the negative comments as much
that I don't feel are reflective of who I am as a person
and block and move on.
But when I blocked said person,
they created content around the fact that I blocked them
as if I was silencing their medical voice.
That I am a medical grifter,
that I am the same as Dr. Oz in fueling misinformation,
which is so disheartening
because the whole reason this YouTube channel exists,
is to put out evidence-based medicine.
So to be accused of spreading it myself
just kills me because it doesn't make a lot of sense to me.
Why are, are people doing this?
Some of the negative comments
pointed out that I was blocking and deleting comments
from people who disagreed
with this theory that I was presenting.
And that's not the case.
I believe in healthy discourse and debate
we need more of it.
It just needs to stay respectful
because the only reason I blocked
the individual I mentioned earlier
was they started personally attacking me in life.
If you ever want to have a meaningful conversation
or even a debate with someone,
you can't start it off by saying,
so you're a so-called doctor
or call them a name and hope that they're gonna listen.
These same people who say these things
about me and attack me also have been attacked themselves
and know what it feels like.
So we have to approach this empathetically.
We need to do a better job
in social media when it comes to healthcare communication.
These are still sort of hurdles that we need to get across
as communicators when it comes to a public health setting.
And I think it's really important
that we move away from toxicity
within the medical community.
'Cause otherwise what happens is it fractures our ability
to educate people.
We fuel tribalism, we lead people
more confused than educated.
They feel like this person knows the answer
and this person's evil, this person's bad.
And this type of dichotomy
this black or white thinking is unhealthy
because medicine is not a hundred percent science.
There is an art to it.
There are individual distinctions
that need to be made per patient.
That's why generalized medicine is not the same
as what is accurate for the person sitting in front of you.
So please, doctors online,
I know that we've been attacked
throughout the last few years
for putting out accurate information.
We have seen a rise, a tremendous rise in misinformation.
But do not lead this to create displacement anger
on other physicians or other individuals
or even your patients who may say things
that you disagree with you may find slightly inaccurate.
Because the more we attack
and the more we label everything as misinformation,
the more it takes away our ability
to be true fact checkers and educators.
I'm actually such a fan of healthy debate.
I love it when people tell me that I'm wrong
and have a meaningful discussion with me.
You've told me I've been wrong several times
and here's a full video with all the mistakes
that I've made in my videos over the last few years.
I hope you enjoy it
and I hope as always, you stay happy and healthy.