mRNA technology may be both a remarkable scientific tool and a very effective marketing machine. Those are not mutually exclusive. The challenge is distinguishing a promising platform, a useful treatment, and a product promoted beyond what the evidence can support.
In early 2020, COVID-19 was frightening. We did not know how readily the original strain would spread or how much illness and death it would cause. We soon learned that risk was concentrated among older adults, people with serious comorbidities or immune deficiency, and nursing-home residents. Those were the people who needed protection most.
Operation Warp Speed delivered mRNA vaccines quickly. The platform is adaptable: Once a viral genetic sequence is known, a vaccine can be designed and manufactured without using live virus. Developing and deploying the initial vaccine series during an emergency was reasonable. When the house is on fire, it makes sense to use the fire extinguisher rather than convene a committee to debate the color of the smoke.
The problem came later. As the virus evolved and people acquired immunity through vaccination, infection, or both, individual risk became far more variable. Yet boosters were promoted with nearly the same urgency for healthy young people with prior vaccination and infection as for older, immunocompromised, and otherwise high-risk patients.
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Should the question have been individualized: What additional benefit is likely for this patient, given age, comorbidities, prior infection, prior vaccination, and current risk? Additional doses could reasonably benefit people at high risk of severe disease. That does not mean every healthy person with hybrid immunity should have been treated as though the expected benefit were the same. “One size fits all” may work for souvenir T-shirts. It is less persuasive as a medical philosophy.
This is where churnalism became consequential. I am borrowing the term from Adam Cifu, MD, an editor for Sensible Medicine; his discussion of the Moderna-Merck melanoma announcement made the point well: A press release can generate tremendous excitement while leaving clinicians and the public without the information needed to judge a treatment’s actual value.
Churnalism is journalism that recycles press releases and institutional messaging with too little original reporting, fact-checking, or critical appraisal. It is what happens when a press release puts on a lab coat and gets mistaken for peer review.
This problem is not limited to COVID-19 or cancer vaccines. Hantavirus, measles, Cyclospora outbreaks linked to produce, Ebola, and mpox are real public-health concerns. But the news cycle can turn each outbreak into an apparent personal emergency for anyone with an internet connection. It is excellent at telling us something is “spreading.” It is less reliable at explaining whether it is spreading toward us, how it is transmitted, who is most likely to be harmed, and what to do besides panic, avoid lettuce, and inspect the garage in a hazmat suit.
The same communication failure affected booster coverage. Recommendations and relative-risk claims often moved faster than discussion of absolute benefit, durability of protection, prior infection, adverse effects, and the groups most likely to benefit. Relative risk makes terrific copy. Absolute risk is less dramatic, which may explain why it is so often left in the trunk.
Moderna and Pfizer had obvious commercial interests in continued vaccine campaigns. That is not shocking; corporations are not charities with stock tickers. Public-health leaders and journalists had an obligation to scrutinize claims, acknowledge uncertainty, and distinguish high-risk from low-risk populations.
Dr. Fauci became the public face of an orthodoxy that too often treated provisional judgments as settled science. School closures, vaccine requirements, masking, double masking, the 6-foot rule, and stay-home orders were presented with a confidence that often exceeded the underlying evidence and too rarely addressed trade-offs or collateral consequences.
A scientific leader need not agree with every critic. But “the science” should never mean, “Please stop asking questions.” Science is supposed to be a process, not a bumper sticker. When dissent is treated less as part of scientific inquiry than as a character defect, public health begins to resemble a religion: Join the congregation or risk being called a heretic.
Aaron Rodgers was one of the more visible casualties of that atmosphere. His COVID-19 vaccine hesitancy made him an easy target, and he was widely reduced to a caricature: the reckless athlete who had wandered outside the boundaries of acceptable opinion. Yet the Netflix documentary, Enigma: Aaron Rodgers, leaves a more complicated impression. One may still disagree with some of his views, but he comes across less as a villain than as someone unwilling to surrender his judgment simply because public opinion demanded it. That distinction mattered then, and it matters now.
This brings us to the potentially exciting use of mRNA technology in cancer. The Moderna-Merck melanoma study combines pembrolizumab, an established checkpoint inhibitor, with a personalized mRNA neoantigen therapy. Pembrolizumab and other checkpoint inhibitors have already transformed melanoma care. The new possibility is that an mRNA therapy tailored to mutations in an individual patient’s tumor may strengthen the immune response to an already effective treatment.
That is genuinely promising. But promising is not proven, and a press release is not a result. Moderna’s stock rose sharply after the announcement. Investors can celebrate early; clinicians should wait for complete data. A rising stock price is not a survival benefit.
Before celebrating, we need absolute benefit, adverse effects, discontinuations, quality-of-life outcomes, overall survival, cost, and confirmation in larger trials. mRNA is neither inherently miraculous nor inherently sinister. It is a powerful tool. Whether it becomes a miracle, a marketing machine, or both depends on the indication, the population, the evidence, and how honestly uncertainty is communicated.
The next time the news warns that something is spreading, a booster is essential, or a treatment is revolutionary, ask: “For whom, by how much, compared with what, and at what cost?” If those questions are not answered, you are not being given science. You are being given a trailer. And trailers are designed to make you buy a ticket.
That is why we keep watching. Fear and anger are not bugs in the media business model; they are the hook. A worrying headline gives the brain a jolt: Perhaps this danger is coming for me or my family. An infuriating headline supplies a villain. So we click, share, and scroll for the next dose of dread, convinced that one more article will tell us whether to worry, whom to blame, or whether our lettuce is plotting against us.
The cycle is good for traffic. It is not always good for judgment.
Patients deserve information that distinguishes danger from drama, risk from rhetoric, and a real public-health threat from an attention-grabbing trailer for the next news cycle.
Harry Oken is an internal medicine physician in practice in Howard County and an adjunct professor of medicine at the University of Maryland. He graduated from the University of Maryland in 1983 and completed internal medicine training there from 1983 to 1987, including a year as chief resident.
He taught ambulatory medicine to internal medicine residents for twenty-eight years as a clinical professor of medicine, and he served for fourteen years as chairman of medicine at Howard County General Hospital. He has been medical director for the Columbia Association since 2007.
Oken has been recognized as a Best Doctor in America and as a Baltimore magazine “Top Doc.” He has published articles in professional journals and is the coauthor of BOOM: Boost Our Own Metabolism.
