Please continue the series. These debates are so frustrating, mainly because the people I tend to think are more credible overall (doctors and scientists) take shortcuts of logic and exhibit bias that is impossible to defend. Example - Paul Offit, a man who is obviously highly intelligent, once compared myocarditis rates observed via hospitalization surveillance (a floor) to that seen in the fishing expedition athlete covid myocarditis study (a ceiling). COME ON MAN. He would never in a million years accept that type of apples and oranges comparison if it were tipped in the other direction. This is the kind of thing that drives me nuts. We need more people like yourself, who can just stop being hysterical, calm down, and follow long ago accepted standards of medical evidence to wherever they lead, and without concern as to which "side" is left applauding.
Ya, I think it's easy for everyone (myself of course included) to make mistakes on this stuff. I like Paul Offit, I definitely appreciated his concerns and "no" vote on the safety evidence behind the maternal administration of Abrysvo. He seems less skeptical of vaccine-sans-antigen placebo groups than I am, which is reasonable. Maybe an opportunity for dialogue in the future, who knows.
Yes, there is no denying that it is brave to be the lone abstaining vote as he has been several times, all the more so since he is firmly rooted in the establishment and must have known that his dissent would make waves.
Vinay Prasad observed at one point that the problem with a widely accepted scientific view with overwhelming evidence supporting it, is that it allows people to be on the correct side and accumulate a track record of being a good expert, without actually knowing why they believe what they believe (as you point out early in your article). Right or wrong, Offit knows why he believes what he believes on older vaccines. Many other "experts" have voiced the same opinions as him for years in order to be on the right team, but since they didn't actually know why they think what they think, they were left fumbling in the dark when it came to Covid, voicing reflexive, hysterical positions based on partisanship and fear of being perceived as belonging to the wrong ideological group.
When questioned by lay people, these types of experts are unwilling to admit just how shaky the foundations of their (still probably correct) beliefs are, eg "I was told that this is the correct opinion by someone I assume knows what they are talking about", and lash out defensively, further eroding trust among the general public. The only way out is some humility and solid, step by step analysis that builds a case from the ground up, as you have done here. Looking forward to more.
Thank you, from a pediatrician eager to think and communicate clearly about these issues, and help families not throw out the baby with the bathwater. I've been doing this long enough to have seen some illnesses go away (Hib and meningococcal meningitis most importantly, chicken pox too). I remember detailed discussions of studies re risks and benefits of Hib vaccine as a resident, and a gradual roll out, even while Hib disease was a routine and life threatening pediatric illness. I'm pretty sure that one was done right, though haven't gone back and looked at studies.
I've started to question many things I've taken for granted, which is painful, but it's better to get closer to the truth. Please keep it up!
Thank you! Ya the book does a good job including that Hib, VZV, measles, mumps, and rubella all have strong evidence of herd immunity, with MMR vaccine having basically eliminated infections from those last three. They caveat the pneumococcal vaccine's herd immunity as specific to serotype, but that's kind of the point. Will try and go through the details in the future
That will be great. I hope you'll look at the data for nirsevimab too. I have read those studies, and it doesn't make sense to me to use it universally. I'm braced for having to tackle this in the fall, and for the likely declaration of RSV emergency to sideline thoughtful discussion of pros and cons. My grasp of statistics is not sophisticated so I recognize I might miss things, but I'm sure the results are slanted to make it look better than it is, not worse. It's a huge loss to be unable to trust institutional pediatrics (AAP and academic specialists) to help us with this interpretation. I didn't realize how untrustworthy the institutions were till recently. (sorry this is a bit off the topic of current piece:)
Great post, Dave. I am currently reading the book myself.
Have you heard of Paul Thomas' study comparing variably vaccinated children to unvaccinated children? Not a perfect RCT but it may inform your research. The Oregon Medical Board suspended his license after it was published.
Thanks! Just took a look. Hard to really draw conclusions from non-randomized studies unfortunately. I think if the VSD is used to do a much larger/detailed study it could provide more meaningful information.
Excellent post! Regarding the issue of most doctors not reading beyond the abstract thus not realizing the true nature of the placebos in vaccine trials.... in many cases even if they read every single word of the main paper text they still would not know. Oftentimes the composition of the placebo is only detailed in the supplementary materials such as the trial protocol.
Thank you! I agree that those information are typically not listed, when I am able to find details they are often in the protocol. I was trying to make a broader point about trials beyond the topic of vaccines specifically, being that they tend to be distilled into one-liner takeaways, if discussed at all. Of course there is more rigor depending on the specialty and norms surrounding EBM in a given specialty, but by and large people don't have time to dig into the weeds.
Please continue the series. These debates are so frustrating, mainly because the people I tend to think are more credible overall (doctors and scientists) take shortcuts of logic and exhibit bias that is impossible to defend. Example - Paul Offit, a man who is obviously highly intelligent, once compared myocarditis rates observed via hospitalization surveillance (a floor) to that seen in the fishing expedition athlete covid myocarditis study (a ceiling). COME ON MAN. He would never in a million years accept that type of apples and oranges comparison if it were tipped in the other direction. This is the kind of thing that drives me nuts. We need more people like yourself, who can just stop being hysterical, calm down, and follow long ago accepted standards of medical evidence to wherever they lead, and without concern as to which "side" is left applauding.
Ya, I think it's easy for everyone (myself of course included) to make mistakes on this stuff. I like Paul Offit, I definitely appreciated his concerns and "no" vote on the safety evidence behind the maternal administration of Abrysvo. He seems less skeptical of vaccine-sans-antigen placebo groups than I am, which is reasonable. Maybe an opportunity for dialogue in the future, who knows.
Yes, there is no denying that it is brave to be the lone abstaining vote as he has been several times, all the more so since he is firmly rooted in the establishment and must have known that his dissent would make waves.
Vinay Prasad observed at one point that the problem with a widely accepted scientific view with overwhelming evidence supporting it, is that it allows people to be on the correct side and accumulate a track record of being a good expert, without actually knowing why they believe what they believe (as you point out early in your article). Right or wrong, Offit knows why he believes what he believes on older vaccines. Many other "experts" have voiced the same opinions as him for years in order to be on the right team, but since they didn't actually know why they think what they think, they were left fumbling in the dark when it came to Covid, voicing reflexive, hysterical positions based on partisanship and fear of being perceived as belonging to the wrong ideological group.
When questioned by lay people, these types of experts are unwilling to admit just how shaky the foundations of their (still probably correct) beliefs are, eg "I was told that this is the correct opinion by someone I assume knows what they are talking about", and lash out defensively, further eroding trust among the general public. The only way out is some humility and solid, step by step analysis that builds a case from the ground up, as you have done here. Looking forward to more.
Please continue the series! This is fascinating and important. Thank you.
Thank you, from a pediatrician eager to think and communicate clearly about these issues, and help families not throw out the baby with the bathwater. I've been doing this long enough to have seen some illnesses go away (Hib and meningococcal meningitis most importantly, chicken pox too). I remember detailed discussions of studies re risks and benefits of Hib vaccine as a resident, and a gradual roll out, even while Hib disease was a routine and life threatening pediatric illness. I'm pretty sure that one was done right, though haven't gone back and looked at studies.
I've started to question many things I've taken for granted, which is painful, but it's better to get closer to the truth. Please keep it up!
Thank you! Ya the book does a good job including that Hib, VZV, measles, mumps, and rubella all have strong evidence of herd immunity, with MMR vaccine having basically eliminated infections from those last three. They caveat the pneumococcal vaccine's herd immunity as specific to serotype, but that's kind of the point. Will try and go through the details in the future
That will be great. I hope you'll look at the data for nirsevimab too. I have read those studies, and it doesn't make sense to me to use it universally. I'm braced for having to tackle this in the fall, and for the likely declaration of RSV emergency to sideline thoughtful discussion of pros and cons. My grasp of statistics is not sophisticated so I recognize I might miss things, but I'm sure the results are slanted to make it look better than it is, not worse. It's a huge loss to be unable to trust institutional pediatrics (AAP and academic specialists) to help us with this interpretation. I didn't realize how untrustworthy the institutions were till recently. (sorry this is a bit off the topic of current piece:)
Great post, Dave. I am currently reading the book myself.
Have you heard of Paul Thomas' study comparing variably vaccinated children to unvaccinated children? Not a perfect RCT but it may inform your research. The Oregon Medical Board suspended his license after it was published.
https://www.paulthomasmd.com/drpaulsblog/holding-the-oregon-medical-board-accountable
https://www.paulthomasmd.com/uploads/6/4/8/3/64831775/ijerph-17-08674-v5.pdf
Thanks! Just took a look. Hard to really draw conclusions from non-randomized studies unfortunately. I think if the VSD is used to do a much larger/detailed study it could provide more meaningful information.
Excellent post! Regarding the issue of most doctors not reading beyond the abstract thus not realizing the true nature of the placebos in vaccine trials.... in many cases even if they read every single word of the main paper text they still would not know. Oftentimes the composition of the placebo is only detailed in the supplementary materials such as the trial protocol.
Thank you! I agree that those information are typically not listed, when I am able to find details they are often in the protocol. I was trying to make a broader point about trials beyond the topic of vaccines specifically, being that they tend to be distilled into one-liner takeaways, if discussed at all. Of course there is more rigor depending on the specialty and norms surrounding EBM in a given specialty, but by and large people don't have time to dig into the weeds.
Thank you for writing and looking into this very important topic. Our kids in the US are NOT healthy!
Please continue the series. This is very helpful information!
Thank you for your insightful points. It would be nice to continue commenting on other parts of the book.