Playing games with other people’s children

Two weeks ago, our kids went back to school. Your kid, and mine. Kids who may be infected by COVID, who could suffer from Long Covid, who could die from COVID. Seven days later, Ontario confirmed more than 60 COVID cases per million in people under 20. (The number last year: 10 cases per million.)

Not a promising start. If you’re a parent or caregiver of a school-age child, you might have a few questions for Doug Ford and Stephen Lecce. Or, maybe, just one question: What precautions has your government actually taken to protect our kids?

Precautions. It’s a word we hear a lot these days. In medicine, we often discuss the importance of “the precautionary principle.” At its heart, this is a simple restatement of the Hippocratic oath, often summarized as “first, do no harm.”

But the precautionary principle doesn’t apply only to doctors. Most of us, implicitly at least, expect precaution from those in government and public health. Most of us expect that, in situations of risk, those in authority will not proceed until there is reasonable assurance, including for the most vulnerable among us, that it is safe to do so. Most would believe this a tenet of a civilized society, especially in matters of health and life.

But, in fact, we often hear arguments that the precautionary principle obstructs “progress” and “innovation.” (In other words, it is a threat to profit.) And because the most palatable alternative to precaution is “risk,” opponents of the precautionary principle propose the alternative, “Risk Management” – about which, sadly, we hear more and more in medicine.

But what happens when the precautionary principle is ignored in the interests of “Risk Management?” Nothing good. In Canada alone, there are grim examples: the contamination of our blood system; a devastating story of surgical deaths in children; the approval and promotion, despite serious risks, of biosynthetic “human” insulin. And, not only in Canada, the harms arising from other prescription drugs are often approved before adequate assessment of safety.

Now, as they return to school, a normally happy milestone for many children, the Ontario government is playing the “Risk Management” game.

Of course, the government doesn’t admit to playing this game. But they know the truth. And, deep down, parents do, too.

What precautions has your government actually taken to protect our kids?

All of this takes me back a quarter century ago, to another September, during which I was raising concerns about the safety of a drug I’d tested in clinical trials in children. After my earlier publication had suggested promise for this drug, my publicly funded trials had been supplemented by money from Barry Sherman, CEO of the pharmaceutical company Apotex. Worried that the drug may be harming children, I indicated my resolve to inform parents, and to publish my data. In response, Sherman warned of “all legal remedies” should I do so. It was a promise on which Sherman later made good, several times: decades of litigation followed.

I reported my concerns about the drug to pretty much everyone in authority at the University of Toronto. Most of these people listened, politely. And then, often less politely, told me I was wrong. Or, rather, that I might be wrong. The explicit, consistent message from all these administrators, who were also supplied with information from the now-infamous Gideon Koren, was: This is a scientific controversy. In other words: We are willing to risk that you might be wrong.

Later, we discovered that at the time of my inconvenient revelations, the university had been negotiating the largest donation in its history from none other than Barry Sherman. As Professor Arthur Schafer later delicately phrased it, “Some were led to speculate that the university’s failure to support Nancy Olivieri might not have been unconnected to its eagerness to secure financial support from Sherman.”

To quickly summarize the next two decades of my story, Risk Management was not a winning strategy. That large donation never materialized. Serious harms to patients have been observed, locally and worldwide; other aspects of “risk management” in this long conflict destroyed many vulnerable children and families.

Still ongoing after 25 years, my story reflects in part the influence of the pharmaceutical industry in medicine and research. This, on its face, doesn’t seem to have a lot to do with the reopening of schools. But we’d be wrong to miss the parallels. As in my September long ago, September 2021 is showing us what many in authority are willing to risk.

This time, the authority is a provincial government. Rather than support the precautionary principle and spend money – possibly a lot of money – on improved ventilation in schools, better masks, smaller class sizes and other measures, this government has been willing to gamble that, with more a million unvaccinated kids in crowded classrooms, those screaming from the rooftops that COVID is airborne “might be wrong” – or at least, bewilderingly, that they are somehow not entirely right.

This government is, in essence, ready to risk that what has happened last month in Scotland and is happening in the U.S.A. will not happen here. That, with no reduction in indoor density, enforcement of physical distancing or limits on class sizes, we’ll be enjoying a “safe September.”

Simply stated, although informed about avenues to safety, all simpler than the development of a vaccine, our government appears willing to “manage” risks – in children.

All this, while sadly familiar, still makes no sense. And not just to me. Physicians across the country have been asking all summer: Why are we prepared to take these risks with children? What are we saving here? And who are these disciples of Risk Management?

Here is who they are: many men and women of business and politics who perceive the risk of reopening as the literal cost of doing business. But they are academics, too – clinicians and scientists who, in discussing COVID in children, downplay both childhood infection and transmission. This is, at best, cavalier in the face of a novel infectious disease and, at worst, an abandonment of the precautionary principle.

Here, we often segue into the argument that children must be in school. I would offer a reframe: children must be in safe schools. And if you are an expert and you believe they must be in school, your advocacy for the safest schools we can possibly create may make a difference.

In the meantime, I am watching with apprehension as we play another game of Risk Management, this time with the safety of children. A game which violates the arguably most important rule of all: First, do no harm.