Real-life medicine is usually messy and complex .

Dr Sue Ieraci Emergency physician in Sydney , NSW .

And for that reason , it ’ s a little like patient care .

If we think back to the beginning of the pandemic , many of us were worried about the time needed to develop a vaccine .

We knew that , until an effective vaccine arrived and could be delivered en masse to millions , lockdowns and public health measures were our only means of control .

Money was invested and teams around the world worked to exhaustion to develop and test the numerous vaccine candidates .

They adapted known technology , such as mRNA technology , and ran huge phase III trials . All this was done with minimal delay .

And for the first time , this was being broadcast through the mass media on a daily basis .

We knew who was running the trials , we knew what the interim results were , we knew what side effects might

emerge and we soon knew the statistical risks of those side effects .

But once the approved vaccines were available , doubts arose .

Suddenly , these long-awaited vaccines were “ too rushed ” and “ not

tested enough ”. And through a misunderstanding of the technology , some started to describe them as a form of “ gene therapy ”.

Maybe , as a community , we had failed to understand the old assumption that “ new vaccine development takes years ” does not therefore mean

they are tested in individuals for years . So , scientists became saviours and villains at the same time .

While we rely on research scientists — often working for pharmaceutical

manufacturers — for breakthroughs that can advance medicine in significant ways , we are also ready to demonise them when we perceive they have fallen short .

Not everyone was ready to accept

that a misstep along the way wasn ’ t necessarily the result of a stuff-up but simply the business of science .

Remember when the Oxford-AstraZeneca phase III trial was suspended last year in order to investigate a potential adverse event in a single patient ?

It ’ s not offering therapeutic miracles but weighing up risk and benefit , usually based on incomplete , partial and sometimes highly complex information .

It was world news for a week .

Imagine if there was a global broadcast every time a test subject for a new antihypertensive or antidiabetic therapy had an unexpected symptom

not yet investigated for causation .

Doctors understand the processes of medical research and the difference between correlation and causation , yet it is easy to get caught up in the reaction to these news stories .

PICTURE CREDIT

The spectacle of science during coronavirus shows its subtleties , limitations and wonders .

I also remember when it was reported that two elderly aged care residents had been given “ the wrong dose ” of vaccine early in Australia ’ s COVID-19 vaccination rollout .

That was national news , with politicians jumping and shouting and everyone talking about reporting the doctor who had administered the dose to AHPRA .

The recipients were asymptomatic and the doses highly unlikely to harm . In the event , no-one was except for the doctor , who was sacked .

However , as a result of the past 18 months of this exposure to realtime science , I feel that — beyond the ‘ shock-and-horror ’ headlines — many patients better understand what it is their doctors are doing .

It ’ s not offering therapeutic miracles but weighing up risk and benefit ,

usually based on incomplete , partial and sometimes highly complex information where the outcomes aren ’ t certain and things can go wrong without anyone involved having stuffed up through incompetence or ignorance .

This ranges from what sort of contraceptive to recommend to choosing an anaesthetic agent or a surgical approach . Is the mood-stabilising effect of lithium worth the metabolic risk ?

Many in the community have come to understand that ‘ effective ’ and ‘ safe ’ don ’ t mean that the therapy — or vaccine — is effective 100 % of the time in 100 % of people with 0 % adverse effects .

After all , even breathing and eating come with a failure rate .

Hopefully more people also understand the limitations of the so-called ‘ miracle cures ’ when touted , for reasons good or bad , by some within the medical profession .

Whether this is a repurposed drug or chemical hyped as a COVID-19 fix ( the results with ivermectin have been very disappointing so far despite the continued noise from some quarters ) or a celebrity clinician who is promoted as having the best outcomes , patients may more readily understand what we are talking about when we , as their doctors , interpret the fine print for them .

Terms and conditions always apply .

Ultimately , we can all be seduced into making emotional decisions .

We might want our new home designed in a certain way , but the architect and engineer can bring us back to reality .

We might want to send our child to our beloved old school , but their teacher might advise otherwise .

We might practise medicine in a certain way because of a previous error until colleagues point out that nobody is perfect and we need to work through the fear .

In turn , it is our role to help our patients work through the fear and uncertainty related to COVID-19 , to navigate the choices ( where they exist ) and accept the requirements ( where they are necessary ).

The spectacle of science in a time of coronavirus hopefully means patients can see , understand and accept the

subtleties and limitations of our clinical care , as well as its wonders .

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