Ross Douthat
Op-Ed columnist for The New York Times

What Medical Stories Do We Trust?

Let me tell you a medical story; you decide what you make of it. A person has a routine medical experience, the kind that all their neighbors have had as well. But afterward they have weird symptoms, odd forms of pain, fatigue that just goes on and on and on.
The medical system can’t help them, so they join online communities that provide validation but not a cure. And they develop a strong sense of betrayal, a belief that the system knew this was possible and just let it happen to them.
Now, let me give you a few more details. The person I’m describing is an overweight 50-something Indiana man who watches Fox News and refused to wear a mask in the fall of 2020. The routine medical experience that preceded his mystery illness was his taking — because his employer required it — the Covid vaccine.
Are you suddenly forming a theory of what’s wrong with him? Are you inclined toward psychosomatic explanations, thinking that he’s taking the aches and pains of age and blaming them on the liberals and their vax?
Well, hold on, because I’ve deceived you: Actually the person is a 35-year-old college educated woman living in Brooklyn who works out five days a week, takes anti-anxiety medication and marched, fully masked, in the 2020 George Floyd protests. Her medical experience was getting Covid itself, despite her multiple vaccinations, and thereafter falling into a long-Covid trough she can’t escape.
Now if you are, like her, a liberal professional, maybe you’re less likely to default to psychosomatic explanations. On the other hand, if you’re a conservative, her description may be what you expect to hear: Another blue-state long-Covid hypochondriac, obsessing over every twinge the way she obsesses over every passing mood, all to justify her desire to keep everybody in a mask.
Maybe you default to neither stereotype, in which case I apologize for stereotyping you. But you probably recognize the interpretations I’ve just presented, the bipartisan tendency to be dismissive of outlying medical cases when they threaten your side’s narrative of the Covid era.
I’m thinking about this because of my colleague Apoorva Mandavilli’s new story about people who have suffered, or claim to have suffered, life-altering vaccine injuries after getting the Covid shot. These long-haul afflicted naturally feel abandoned by a medical establishment that’s uncomfortable with outlying cases in the best of times, but in this case is especially resistant to conceding anything that might seem to empower anti-vaccine paranoia.
And no doubt vaccine skeptics will seize on my colleague’s story, while many staunch vaccine supporters will be made uncomfortable at the idea of too much attention being paid to these cases. But again, were this a story about the similar kinds of chronic symptoms that cluster around some people after they’ve had Covid itself, the lines of skepticism could easily reverse. (A figure like Alex Berenson, for instance, the one-man band of dissent from every anti-Covid strategy, is full of warnings about unknown long-term effects of the vaccines and full of scorn for people who claim long-term effects from Covid itself.)
As someone who’s suffered from a controversial chronic illness that isn’t Covid-related, a message that I try to bring to this conversation is that you should be able to extend sympathy to people with difficult conditions first, before you worry about how that sympathy might threaten your medical worldview or policy regime.
Sometimes these people will vindicate your skepticism: Hypochondria certainly exists, ideology and psychogenic conditions no doubt interact.
But often chronic illness falls in patterns that reflect the deep mysteries of the body more than the assumptions of the mind. In my colleague’s story about vaccine side effects, some of the afflicted are exactly the kind of liberal professional people you’d expect to be eager vaccine advocates. Likewise with long Covid: I have personally counseled a couple of young, fit, right-wing men embarrassed to acknowledge their long-haul symptoms within a conservative-leaning peer group.
Accepting the credibility of these outliers doesn’t have to overthrow your overall perspective on Covid-era issues. The existence of vaccine side effects, and any incentive there might be to undercount them, doesn’t undermine the evidence that vaccination saved a lot of lives. The risks of long Covid don’t prove that the pandemic emergency should never end.
The outliers should, however, shake your certainty that the mysteries of the human body can fit perfectly into any simple “biopolitics,” and give you more sympathy for the desire to to opt out of any given health regime.
You won’t be the outlier, don’t worry, and if you are it’s probably in your head is a natural mode of thinking for healthy people.
But once you’ve been the outlier, or had an outlier in your life, you know the real territory is different than any biopolitical map, and there are more ways than most people realize to get lost.

The New York Times