Journalist-turned-ER-doctor Matt Bivens has unique insight into the double-edged hype around Paxlovid, America’s favorite exorbitantly priced miracle drug

Call it the “propaganda two-step.” A corporate or political actor makes dubious claim X, which quickly appears as stronger claim X + 1 in headlines. Insinuation married to exaggeration creates deception. With the two-step, neither party is fully responsible for the end claim.

In May of last year, an observational study concluded Pfizer’s ubiquitous Covid-19 treatment Paxlovid was “associated with a decreased risk” of hospitalization or death. A short time later, in the January 4th New York Times story, “Paxlovid Cuts Covid Death Risk. But Those Who Need It Are Not Taking It,” the same study was cited to make the claim that Paxlovid is “stunningly effective in preventing severe illness and death.” It was a classic example of two-stage exaggeration.

Matt Bivens is in a unique position to see both ends of the construction of medical misconceptions. He entered the workforce as a journalist. We were co-workers at the Moscow Times, where he covered war in Chechnya and rose to become the paper’s editor-in-chief, publishing a major expose about irregularities in Vladimir Putin’s 2000 presidential election. After leaving Russia, he quit reporting to become a doctor, becoming director of emergency medicine at St. Luke’s Hospital in New Bedford, Massachusetts. Both his clinical work and ideas for simple, cost-effective reforms in emergency treatment led the Standard-Times to name him Man of the Year in 2017.

Matt’s a close friend, but no one I know has a better eye for spotting gaps between reality and hype in medicine, as he can see issues from the journalism side and the medicine side. He has a particular worry with Paxlovid, which he’s written about multiple times on his site

. The most recent article, “The Bad Taste of Paxlovid,” focuses on the scattershot evidence for the drug’s effectiveness and Pfizer’s opportunistic profiteering. Pfizer pulled in an incredible $18 billion from the federal government — more than we’d ever spent for any pill in one year — and when the feds stopped buying it, raised the price for a course from $530 to $1,390.

“What we don’t know — still — is whether this is even a useful medication,” he wrote. “Frankly, it’s starting to feel like a long con.”

Matt also seized on the constant references to Paxlovid in news coverage as a “lifesaving” medication. As you’ll hear, there’s not a lot of convincing evidence the drug does anything at all, much less proof that it saves lives. He notes a more cautious review by the Cochrane group found the drug “may” be associated with reduced death, but the conclusion is based on “low certainty” evidence.

As an ER doctor, Matt saw Covid-19 at the clinical level from the start, treating patients when it was widely feared to be severely lethal, then watching as a procession of controversies he saw earlier than most captured wide public attention: from masks to ventilators to lockdowns to vaccines to treatments like Remdesivir and Paxlovid.

He writes about many of these issues, and his background as a journalist and editor prompts him to see and capture interesting big-picture themes even in small episodes. In “On the Meaning of Life,” he describes navigating a maze of philosophical absurdities when a patient who is both dead and has a DNR arrives in the bureaucratic no-man’s land between an EMS stretcher and a hospital. “Life in the American Rat Park” is an updated take on the famous study showing rats trapped alone in a cage with water and cocaine will keep choosing coke straight through to death. For ages this was understood to describe an inherent issue with addiction, but what if the problem was the cage and the loneliness?

Matt came with me to San Francisco to help sort through the first batches of Twitter Files material, and was one of the first to spot patterns in the 2020 election Slacks that we eventually followed to key disclosures about the FBI and Department of Homeland Security. Recently Matt stopped by and we talked about Paxlovid:

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