Why I Let Phreesia Fire Me

I’m not sure who will read this. Might be a hundred people. Might be a hundred thousand people. The internet is funny in that way.

I’m more sure what most of those readers will conclude. Either that I’m a terrible person literally killing people. Or that I’m brave for standing up to authoritarianism. One extreme or the other. Society is funny in that way.

I’m most sure I’m neither of those. I’m simply sharing my story just in case someone who doesn’t proudly fit into either extreme view is curious or finds my perspective useful.

February

Let’s rewind about ten months. It’s February, maybe March of 2021. I am one of those people who hasn’t thought a ton about COVID vaccines. Not my area of expertise. I guess they seem like a good solution to this pandemic. Who wouldn’t want a quick and easy shot that stops the spread of this deadly virus, protects you from getting sick or dying, and will allow everyone to act human again?

Maybe I’m especially optimistic about vaccines because I work at Phreesia. It’s a fast-growing healthcare technology company where I am excited to be taking over as the Director of our Intake Engineering organization. I love interacting with all my interesting, hard-working, team-first colleagues, and am proud of the work we do — including fast pandemic responses like helping to coordinate the delivery of these very vaccines.

Perhaps I don’t think too deeply about the vaccines yet because I am last in line in Washington state. Though I sometimes feel old now by software engineering standards, I am relatively young by COVID standards. I’m also relatively healthy with none of the so-called comorbidities. And I work from home, so am not a frontline worker with high exposure risk. For these reasons, I am quite reasonably slated for last in line in my state’s vaccination rollout plan. I should be eligible in July or so. In the meantime, I am grateful that people like my parents are now able to be vaccinated. Not overly worried about myself. Latest statistics still suggest death is quite unlikely for me. The so-called “long COVID” has become my biggest selfish worry. Spreading COVID to the most vulnerable is my biggest altruistic worry.

April

The vaccine delivery has miraculously sped up. Even I will be eligible soon. Hmm. I should probably start researching these vaccines a little more.

I’m pretty sure they’re a good thing. I mean, I’ve never really worried about vaccines in the past.

Then again, I vaguely remember a surprisingly high number of the smartest people I know seem moderately vaccine-critical and have done things like delaying vaccinating their children, spreading their vaccinations out more than authorities usually recommend, or even skipped certain vaccines. So I should probably investigate some just to be on the safe side. Besides, skepticism is at the heart of science.

I consider myself fortunate to “know” (not personally, but follow closely from books, podcasts, and such) a small group of people in semi-related fields whom I trust. So I start there…

To my surprise, their outlook is a mixed bag. Some are very pro-vaccine, as I expected. But some are actually quite critical of these particular vaccines. And many are mysteriously quiet — no public statements I can find.

I guess this doesn’t entirely surprise me. I know many academic, public, and private organizations have been sliding more toward an advocate-first mindset rather than a truth-first mindset. So if it turns out these vaccines are not the silver bullet we hoped for, I won’t be shocked if vaccine advocates refuse to believe it. Especially surrounded by other like-minded advocates.

I try to do as much research as I reasonably can. Listen to as many arguments from all sides to minimize my own bias. And then reach my own conclusion.

June

I have concluded this mRNA technology is amazing. It may one day be considered one of the greatest inventions in human history. I won’t be surprised if within the next couple of decades it saves far more lives from cancer and other ailments than will have been lost in this entire COVID pandemic. It’s that good. But it’s also new and experimental. Having been in development for some 50 years but just now being used significantly in humans gives me great pause, not great confidence. I wish it could have been tested first on smaller populations to minimize catastrophic tail risk. Experimenting on the entire population of the earth at once, as many now seem to be in favor of, seems to me like irresponsible risk management.

The smartest people I know of on this subject, evolutionary biologists Heather Heying and Bret Weinstein, are growing increasingly critical of the vaccines. They raise interesting concerns relating to selective pressure we’re putting on the virus, unknowable long-term risk, and dangers from the spike protein itself among others.

I’ve followed them since long before this pandemic as their approach to finding truth and understanding our modern world makes a lot of sense to me. I find their arguments consistently compelling and trustworthy.

I’ve seen some credible counterarguments. And am trying to find more. But most come across more as carefully crafted propaganda. Cherry picked studies. Appeals to authority. Fear mongering. Shaming.

It’s starting to feel like the best of the United States and the worst of the United States all wrapped into one. Our hard work and ingenuity has helped roll out amazing vaccines in record time. Yet our singlemindedness and arrogance has blinded us to anything else. We still reflexively gravitate to quick-fix pills and drugs rather than acknowledging healthy diet and lifestyle. We wind up with a single solution for everyone, regardless of individual risk, that’s expensive, hard to distribute, and we’re all in on.

Speaking of the United States, we are starting to divide ourselves along political and ideological lines regarding vaccination decisions. No surprise given human nature and the nature of social media.

Tribe Conservative is beginning to act like everyone’s 20 years old and in great health. It’s just the flu!

Tribe Progressive is beginning to act like everyone’s 80 years old and immunocompromised. It’s a moral imperative to vaccinate everyone!

I wish we were more open and embraced each other’s natural strengths.

Tribe Progressive is naturally good at charging ahead with creative new solutions. Like mRNA vaccines. And the cost/benefit and risk/reward analyses for many older, unhealthy, or immunocompromised people do seem very compelling. I wonder how many older, unhealthy, or immunocompromised Conservative lives we could save if they trust the ingenuity of our Progressive friends and brave the inherent risk of something new.

Tribe Conservative is naturally good at being cautious with new things. Like mRNA vaccines. Maybe it’s not a good idea to put all our eggs in one basket. Maybe some young, healthy people should serve as a control group and opt out of this massive vaccine trial. Or certainly some of the people who’ve already acquired natural immunity from previous infection. I wonder how many cheaper, safer, easier-to-distribute preventatives and remedies we could still discover and deploy more broadly if we heed the wisdom of our Conservative friends and not bet the farm on mRNA.

The best ways to fight COVID now seem to be avoiding it, youth, good health, a strong immune system, and vaccines. Avoidance can perhaps be achieved by avoiding prolonged interaction with others in closed spaces, but is a tough tradeoff as life without human interaction is barely life. Reversing aging is still impossible as best I can tell. Good health can be achieved with good nutrition, sleep, and physical activity — all things that help protect against other ailments as well. Vitamin D supplementation seems to enhance the immune system, especially against COVID, and seems to have little risk. The vaccines clearly offer significant improvement against hospitalizations and death for some but have also been a bit underwhelming in terms of how long they last and how well they prevent infection and spreading. Plus long-term risk is still unknown.

For myself, I am going to wait for now on the vaccines. I’ve been supplementing Vitamin D for years as it’s compelling for other health reasons. Especially living in gloomy Seattle. I’m going to try losing a little more weight too. And eat healthier. Should help with COVID as well as many other things.

For others, I’m inclined to recommend Vitamin D, good nutrition, sleep, and physical activity for most everyone. Try the vaccines if you’re older or have high risk factors. Skip the vaccines, for now, if you’ve already had COVID. And certainly skip giving them to your children (which will come later). Mostly healthy adults between the ages of about 30 and 60 I could argue either way.

Why This Matters

Of course, that’s just my opinion. And if you’re thinking you should take it with a huge grain of salt, then I completely agree. If you’re thinking your personal health decisions are none of my business, then I agree with that too.

So imagine, if you will, that I am the governor of your state, the CEO of your employer, or the principal of your child’s school. Following my best understanding to date, I decree that everyone over 80 must vaccinate. Everyone under 20 is forbidden from vaccinating. And everybody in between can decide for themselves. Limited exceptions are permissible with approved doctors’ notes and for those volunteering in studies. Oh, and everyone must regularly submit blood tests to measure Vitamin D levels and those who fail will be sent home to photosynthesize or supplement before being allowed to return to work or school.

If your reaction is your health decisions, and those of your children, are, generally speaking, none of my business, then we’re in agreement. It’s authoritarian and the antithesis of liberty.

August

Phreesia announces a vaccine mandate. No exceptions for remote workers. No exceptions for previously infected people with natural immunity. Exceptions for those with approved doctor’s note. Exceptions for those with approved clergyman’s note.

I am not surprised. I had assigned about a 20% chance to this possibility.

I am disappointed though. I was always proud of how Phreesia treated their employees like adults and trusted them. I even emphasize this trust when hiring. And most of all I’m disappointed because this matters to me.

I am incredibly fortunate that I don’t need to work right now. I recently reached the magical financial independence milestone partly due to good luck, partly due to timely advice, partly due to embracing minimalism, and partly due to wise investing. I mention this not to boast or to brag. I’m not sure if I like talking about this publicly yet. I mention it because it’s essential to this story. (And because I might share some of my financial lessons on this blog later for anybody interested.) It’s easy to take a principled stand when you can afford to.

But if this was as recent as a year ago, when I still needed my job, or at least a job, I probably would have caved to the peer pressure. Quietly accepted the sizable bribe of keeping my job. I’d like to think I would have stood up for my principles. But I doubt I would have. I’d have taken the vaccine against my best judgement. Boosted as ordered. And kept quiet.

I know many people have done just that. Taken the vaccines against their will. Vaccinated their children against their will. I don’t blame them at all, for I would have done the same thing. Most don’t have a real choice in the matter. They can’t realistically change jobs, move to a different state, or enroll their children in a different school system. In many cases, I disagree with their choices and their reasoning. But in all cases, I respect their decisions.

Quite simply, it’s because their voices are being silenced and ignored that I feel like I should at least try to make my voice heard. Because I have that rare luxury of not needing my job or any other job. I have the freedom of speech that so many do not right now.

With some sadness for the people I will miss, but with no hesitation, I inform my superiors that I will not comply with the vaccine mandate and urge them to reconsider.

December

As promised, Phreesia fires me.

It’s disappointing as I will miss my colleagues, the noble work we did, and of course the pay.

It’s a relief as I will not miss the stress, the schedule, or the other costs of modern corporate jobs.

It’s perhaps also liberating and rewarding that I now am free to share this story with others. Scary too as I know there’s that group who’s certain I’m a terrible person. Perhaps a younger me would even have felt the same way. But for those of you who are still reading this story, I hope you find my perspective interesting and valuable.

I hope health officials will remember to be skeptical, critical, and scientifically minded. No matter the pressure, truth must come before advocacy.

I hope Phreesia executives and board members will reconsider their policy one day, truly embrace diverse perspectives, and trust their employees with their own health decisions.

I hope owners and board members of other companies and organizations will consider doing the same.

I hope state officials and policy makers will remember to trust those they represent and to represent each and every one of them.

I hope everyone will be respectful of the rights, decisions, and opinions of your employees, your constituents, and your fellow human beings.