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Donald Trump nominates RFK Jr. to be Secretary of Health and Human Services.
I am not naturally sympathetic to criticizing policy or personnel decisions on the grounds that they "embolden" the wrong people, but I am going to make an exception here. The sheer magnitude of human suffering prevented by vaccines and antibiotics is hard to comprehend. Due to complex structural and psychological reasons, the developers of these treatments capture a miniscule fraction of the total utility surplus created.
Enter the pharma skeptics: I do not know what RFK Jr.'s specific stance on vaccines is, besides "more skeptical than the liberal establishment will accept", but I do know how Twitter works. Twitter is real. It affects real events in actual reality, up to and including the US presidential election. Trans issues are getting dumped from the mainstream Democratic Party agenda because of how much it gets dunked on on Twitter.
In this Twitter thread, the entire concept of rewarding companies for treating disease is getting dunked on like it's a Lia Thomas podium. This is of course not the only example I could have pulled, but it shocked me both because of it's location (Alex Tabarrok's feed), and because of the sheer intensity of what can only be described as concentrated stupid.
But perhaps the most alarming implications are for democracy itself. RFK's endorsement likely won Trump the election, not least because it paved the way for the Rogan endorsement. Republicans won by increasing their share of the stupid vote. Indeed, no party can win a national election without winning large swaths of the stupid vote. There simply aren't enough smart people to win. Perhaps this explains the modern political environment. The decision between Democrat or Republican boils down to a decision on which party's concession to the stupid vote will do the least amount of damage.
While going full "vaccines are bad and unecessary" is stupid the pro establishment fanatical close minded position is also stupid and there are valid issues animating RFK and others.
Most of twitter reactions you quote is in fact about the covid vaccine which isn't the same as vaccine in general.
It really seems that you haven't learned any of the lessons of covid, opioid crisis and Sacklers malfeasance. Or even the lesson of the eternal Marcuse's "we enlightened elites against stupid masses". The masses can be stupid, but the problem is that self proclaimed enlightened elites can be even stupider, or just have a tunnel vision that is animated precisely by this idea of them possessing all wisdom and others just wholly irrational idiots. Another complication is this resentment and hatred leads these self proclaimed enlightened elites to support harming the "stupid" under pretext of safety, and we saw with the reaction to the unvaccinated.
Pretending that this faction are the smart enlightened ones and others are idiots is Hanania tier propaganda talking point repeated ad nauseum. I find it interesting how a rationalist esqe associated space have this bad behavior as a common norm. A lot of shared people from both spaces and Tabarok retweets approvingly Hanania promoting a Thiel guy as the preferred option over RFK. Unfortunately it is propaganda here because the pro big pharma establishment faction is close minded and has huge tunnel vision.
Consider Covid's origins, which is actually a pretty big deal that it is plausibly developed for gain of function research (or perhaps that is the pretext for bioweapon research). That would be an example of a genuine overreach of the industry.
As would the overpromotion of opioids and the Sackler's malfeasance that lead to appreciably different outcomes in life expectancy between USA and other developed countries.
There is also an issue of whether foods in the USA are under-regulated since they do seem to have different and more risky substances than foods produced by at times the same companies for other parts of the developed world. Although overegulation can be a problem.
There is also the possibility that report from the national toxicology program that high fluoride water might be linked to lower IQ scores. Complaints about fluoridation has been another issue dismissed who pattern matched it as kooky, and low status.
Or whether these vaccines which are based on new technology actually are genuinely safe.
If we are going to have an authoritarian pro science regime, it should shut down wannabe "I am the science" types pro establishment types who are fanatical and close minded in a heartbeat and allow informed debate and not put in the pedestal those who don't have a willingness to oppose what ought to be oppose.
What we don't need is the dominance of those who are in practice pro corruption if it is entrenched elites doing it and servile to them and demonize those raising a fuss. Or have build up an understanding based of symbols of prejudged kooky issues not to be touched and side automatically with the way things are going. The "don't question XYZ sacred cow, you morons!" are a net negative that not only shouldn't be authoritarians but should experience themselves exclusion from running institutions and media, moderating social media and forums on the basis of their inadequacy for what their role ought to be.
Scientists, Big Pharma, politicians are all accountable for fuck ups and can only work well if they are willing to listen to reasonable criticisms and in fact, even among people whose agenda can include both some unreasonable stuff and some genuine opposition to corruption and plausible problems, there is a duty for those who pretend to be the smart people to be the types who can separate the baby with the bathwater. Those who want to be close minded and not accept valid problems, and promote this stupid "we the enlightened versus idiots" should make way for actual genuine enlightened elites instead of self proclaimed ones full of hubris.
Indeed, someone who claims to be a scientist might in fact be mistaken about their own essence, if they abandoned their role to be a scientist, and came to believe that "I am the science" and became a believer in unshakeable orthodoxy. Much of this problem can also relate to symbols like the fluoride one that had the symbol to their mind of ridiculousness even though it is a legitimate issue to consider and determine.
Of course, since I say you shouldn't throw the baby with the bathwater, we do need pharmaceutical companies developing cure. It is good when they get things right to be rewarded. But corruption and failure needs to be examined, opposed, and stopped. And it is in fact valid to consider the issue of whether expediency let standards to drop in vaccine development. Whether it is sufficiently safe and so on.
In climate change, and in other issues, the close minded fanaticism of pro establishment types is dangerous. Although the issue when it involves certain people involved with lobbies and networks, might include corruption and willingness to back down entrenched elites for their own benefit of being rewarded from it. Which can include funding, it can also include getting a more positive response from the media.
The reality is that the gains of function research that probably lead to covid might not have happened if the right people were in charge, and we had more people willing to question and oppose corrupt and immoral activities by powerful groups whether these is scientists or are pentagon if it was actually weapons research masquerading as research on diseases. It is dangerous to have people promote close midned, pro establishment gullibility and painting it as the epitome of enlightened intelligence thinking and demonizing opponents of it, by overly focusing on weakmen. While we can oppose both approaches of throwing away the baby with the bathwater, the entrenched elites are actually the bigger problem.
RFK who has wrote a book attacking Anthony Fauci therefore does not represent only a possible overeaction to elements of big pharma, and pharmaceutical research, but also part of a legitimate reaction. There can be both elements in people like him.
After covid, I see the climate change frontier as the one that raises the issue of overreaction of the "we are the science" types both in terms of reduction of freedoms, overreaction against opponents of their agenda who are going to be branded as enemies of science and in terms of a destructive net zero agenda.
Thank you for pointing out the major issues and reasons why RFK got put in this position.
This is the biggest issue for me. Science(TM) has become a religion, and many rationalish types still follow that religion even when it's obviously promoting false beliefs.
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Of all of Trump's cabinet picks, RFK Jr is the most unserious.
The credentials of the others at least seem fit for the positions.
It is a bit odd how worried people are about credentials. Look at the last number of HHS secretaries. Do they really have better credentials?
"Remember, a lone amateur built the Ark. A whole team of professionals built the Titanic."
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This is insightful. Xavier Becera is a completely empty suit, devoid of any substantive (object level) merit. And somehow we're willing to chalk that up to normal politics.
In truth, I think it might actually be directionally correct. An actual idiot that does nothing and thinks nothing of substance may actually be preferable to someone that knows enough to confidently fuck up.
Call it the Sorcerer's Apprentice Curve -- the utility function is concave in intelligence.
what substance he had was quite partisan - he argued against Little Sisters of the Poor, for instance
Of course he did -- any D appointee would have. That wasn't some personal view he brought with him to HHS.
any D appointee would have, maybe, but he was the one who actually had.
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In this case, being anti-vaccine and alt-health should be considered actively malicious.
The problem of the US are the high prices of finding and getting good care, and the byzantine system. The frustration of that has been successfully redirected into whole-system skepticism.
Which, fair enough. But outbreaks of preventable disease are bad. In the end, it will be interesting to see if RFK and the gribblers end up biting off more than they can chew by going after the immovable corn lobby.
The current HHS head is a HerbaLife fan.
Iโd love to have better options, and Iโm disappointed that the Trump one is this, but I think people badly underestimate how bad our institutions are.
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Gaetz seems like a POS. RFK is a philanderer who fried his brain, but did some good and doesnโt seem particularly malevolent.
Are you a measles virus or something? From a human perspective, RFK is visibly malevolent in a very obvious way.
Before he got on the Trump train, RFK devoted a significant part of his activism to discouraging parents from vaccinating their children against measles based on false claims that vaccines cause autism. His activism caused a measles outbreak in Samoa with 83 deaths.
If we measure malevolence by the degree by which the harm-to-victim exceeds the benefit-to-wrongdoer, killing kids for social media klout is the worst.
No, it didn't. The outbreak was ultimately caused by two nurses who diluted two measles doses with muscle relaxants instead of water. Two children died as a result, and the government paused MMR immunization for several months. When they restarted, they didn't immediately release the reason for the children dying, which probably limited uptake after that. The outbreak started in this environment, the government imported a lot of measles vaccine from India, the outbreak continued. It is at this point Kennedy comes in. He does claim the measles vaccine from India was probably defective and caused the outbreak to continue, but HE certainly was not the cause of it.
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There's more to political legitimacy than skill.
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my guess is that RFK Jr won't last very long. Remember Scaramucci? Trump likes to reward people for loyalty, and HHS is a decent prize, but RFK Jr has too big an ego to play subserviant to Trump for long.
The high number of people claiming that the trump picks won't last long seem to be hoping against hope. Trump does have a core number of people who do and are able to work with him over years and years.
RFK Jr is clearly a different personality than the establishment that wasn't able to last, so claiming that rfk will not last long seems premature.
Bannon was also idiosyncratic and he didnโt last long. So was Scaramucci.
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I'm not against Trump, I consider myself neutral. But it's just an objective fact that he churns through people around him quite quickly. I've never before heard of a president where his own vice president publicly came out against him, for example.
Steve Sailer once said that this kind of constant churn is common in a certain type of hard-charging, 80s, NYC business guy. I think that's a fair description for Trump.
I think some non-trivial portion of his starting picks won't remain in their positions until the end of his term. I'd say 25%. Either because Trump removes them or they remove themselves.
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I think this is a much-longer bow than you need to draw to be opposed to RFK being in charge of vaccines. Because, y'know, he might defund or ban them, which would very directly suck.
Also, remember that Twitter replies will skew in favour of opposition, because there's a thumbs-up and no thumbs-down.
Defund I guess maybe -- but most vaccines were invented 50 like years ago and are kinda cheap?
By what mechanism do you think RFK would ban vaccines though?
Unless I'm misunderstanding something about the org chart, the Secretary of Health and Human Services is among other things in charge of the FDA and could order it to rescind approval, and unless I'm misunderstanding something about US law that would mean they couldn't be traded in or administered.
It's worse than that -- as I see his successful confirmation would be a powerful advanced signal to those involved in the research and development of novel vaccines. Not just because of what he would literally do (although he could indeed have the FDA hold them up or otherwise increase the already-staggering cost of new treatments) but because of what it implies about the range of consensus views on vaccines.
At the same time, defeating his nomination would send a signal that his views are sufficiently out there that firms making vaccines don't have to worry about it.
Given the timelines of these things, these dynamics seem far more important than the specific FDA decisions to be made in the next 4 years (which, anyway, were baked-in years ago).
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What probability do you assign to this outcome? You may be poorly calibrated here.
Of him trying? Dunno, don't know his positions or conflict-comfort well enough.
Of him trying and it sticking? <10%, if nothing else he'd probably be impeached for that.
Thought about editing one of the above posts to note these but didn't get around to it.
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There's essentially zero possibility of this. Congress doesn't exercise direct oversight much, but they do on occasion, and RFK attempting to ban vaccines would certainly result in it.
Even before that, any serious changes to the FDA's approval process would either trigger the APA, or be close enough that courts would have easy opportunity to be pulled in. And attempting to slowboat things by just crawling up vaccine production facility tailpipes with thick rubber gloves trying to find the slightest mistake runs into the problem where that's already the FDA's normal procedure.
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Wouldn't it be awesome if we had a category for things other than "mandatory" and "banned"?
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This isn't even really an example of the markets rewarding companies. Their stocks went way up because the government gave them blanket immunity from liability to bring to market a technology that would normally take years of RnD and also preordered massive batches. This ended up being a failure of central planning because millions of doses went to waste after they failed to convince the court systems they could strong arm people into getting vaccinated and demand for the vaccines was lower than anticipated.
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You don't know what your opposition believes, but you're sure they're the stupid ones. Thanks for putting these two sentences in the same post because it saves me the trouble of having to argue them out of you.
While their language could have been more clear, I read OP as using "stupid" as a gloss for "without college degree." Obviously there are the kinds of people Taleb calls "intellectuals yet idiots", but I don't think that's who OP had in mind.
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If US big pharma is so great, why is US life-expectancy declining? Not just since the pandemic but even before then. Biotech and pharma shares were making huge gains in that period 2014-2019, yet life expectancy was stagnant at best. We can toss Tabarrok's thesis that pharma shares = life expectancy straight out the window. Consider US life expectancy compared to peers: https://x.com/The_OtherET/status/1857207679011180938
https://www.marketwatch.com/investing/index/djuspr
https://www.investing.com/indices/nasdaq-biotechnology-components
Why are there umpteen billions going into a massively drawn-out and complicated drug research process that barely seems to produce many good new drugs - and pennies for anti-aging research?
Why was there a massive opiate crisis, founded in part due to dodgy advertisements and concealment of risks?
Why is such an enormous proportion of the US population on anti-depressants? Why are so many children on ADHD medications and adderall? Overmedicalization has been linked to all kinds of problems.
Capitalism is not an unalloyed good. I believe in the market system. I believe it's generally superior to central planning and state-directed approach. But there are roles for regulation or state enterprises. Of course regulation can also create perverse incentives which I suspect is a big contributor to the problem. But free market fundamentalists like Tabarrok are nearly as bad as banocrat regulatory fiends and communists.
The fentanyl dealer on the street is nearly universally considered a social malefactor, I doubt Tabarrok would defend this particular class of entrepeneur. What about the pharma exec who launders standard human behaviour (unsatisfaction with a boring life or children not sitting still in class) as a disease, intensively advertises a 'cure' which is only partially effective and causes all kinds of side-effects later down the track? Regulation is needed to confront both of them.
The whole US health system is a Gordion knot that needs to be decisively cut through by some Alexander.
"The fentanyl dealer on the street is nearly universally considered a social malefactor, I doubt Tabarrok would defend this particular class of entrepeneur."
Legalization of drugs is a standard libertarian belief.
"If US big pharma is so great, why is US life-expectancy declining?"
It was declining due to covid and a bunch of people choosing to put fentanyl in their bodies. Many Americans choose to be fat. There was a time when individual responsibility was something conservatives believed in.
If the state lets fentanyl be sold in supermarkets, prices will fall and consumption will rise.
If the state shoots fentanyl dealers dead, prices will rise and consumption will fall.
If the state subsidizes corn production, HFCS will get added to more things and food will become more fattening...
Each individual choice swims in a sea of policy, that's why policy exists.
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Why are there so many firefighters at house fires?
Firefighters arriving after the fire starts is perfectly fine.
However, if the firefighters are wandering around with petrol and matches before the fire starts, then we have problems - especially when it comes to paying them a hefty bill for their services.
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For me it is amusing how much overlap there is between people who yell about their political opponents being communists, on the one hand, and people who would prefer that medical innovation be driven by a socialist rather than a capitalist system, on the other.
"I'm a free speech absolutist! [...] Of course burning the American flag isn't free speech!" Normies gonna normie, Conservatives are not Libertarians. Democrats have wanted a nice big government and now they're gonna get it good and hard... which is kind of fun but I'm gonna get it good and hard too and when the lefties take over I'm gonna get it good and hard again.
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I would be fine with a free market system if the liability shield was removed.
But in a real free market, a condition of sale could be that you wave any legal liability for injury.
Yeah but who would buy cures that have waivers?
Some people would I suppose, but only some, and with governments you don't get to price in that choice, you get to be experimented on regardless.
The problem is, we donโt have cures. We have drugs that at particular doses have positive risk/benefit ratios for a particular condition for most patients. If every bottle of Tylenol is priced to cover the liability for liver damage Iโm not sure pharmacies continue to exist.
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Probably approximately the same proportion of the population that uses software and websites with terms of service saying you
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Agreed you could waive liability but again Iโm struggling with the basic economics. If the vaccines offer a lot of value and very limited harm the liability point shouldnt be a big issue.
The issue is that rare coincidence do happen and causality isn't well-defined on an individual scale anyway.
For example, a lot of farmers used glyphosate (roundup) and, of them, a number of them (somewhat proportional to the overall risk) got rare cancers. Then those folks sued on a theory of causality that most scientists roundly reject, but won anyway.
But consider a hypothetical second agent that we know beyond a doubt increases the risk of some rare cancer by 25% (a huge relative risk). 5 farmers get this cancer and sue. Of them, 4 would have gotten it anyway and 1 got it due to agent. It's not just that a scientifically ignorant jury can't figure that out -- there is no answer. We can't assign that down to the individual level in that way -- all we know is something about aggregate risk.
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You can't trust the US legal system to determine if a vaccine caused an injury.
Why?
The jury system is not good at determining medical causation.
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Total immunity is a problem, but if the government had agreed to take on the risk for the pharma companies in this emergency situation instead of just waving it away (including paying out for vaccine injuries) that seems much more balanced. Operation Warp Speed was pretty much about "how fast can we get this done?" and that includes speeding up the safety trials. I don't know what the US actually did here.
The issue with that is the government socializes costs but privatizes benefits. So what do you predict would be the outcome?
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The fact that the State is an infinite well of everyone's money in this case makes this functionally the same.
Without a bounded fiscal policy, there is no incentive for the government to take the liability risk seriously. For this decision to have any chance to be good, whoever takes it actually has to shoulder some risk if they take the wrong one.
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The US situation is kinda a clusterfuck.
Most vaccines fall under the NCVIA, so any claims of injury go to the NVICP, where the standard of proof is hilariously low. It's a little more strict than a 'damn that's an ugly baby' fund, but not by much, and the willingness of the program to accept sometimes implausible alleged links has been used as support for no small number of implausible further links. Funds are drawn from a vaccine excise tax, which in theory, and in practice is a mix of Medi*, insurance and private dollars.
COVID vaccines were specifically exempted by the PREP Act in a different way, falling under the CICP. Where NCVIA is extremely fail-positive, CICP is the reverse: requiring "compelling, reliable, valid, medical and scientific evidence", and very happy to can claims over minor paperwork faults. As a result, the lack of any successful claims even into mid-2022 drove a lot of skepticism, and while they've since recognized some, the numbers remain implausibly low.
((There are some similar exceptions for smallpox vaccines and I think the military anthrax vaccine.))
I think it's more incompetence than malice, but the inability to find the Goldilocks zone badly undermines institutional trust.
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There are probably good reason to criticize this pick. You have not presented any of them. By your own admission, you don't even know what RFK Jr's stance on vaccines is (though you can probably guess it's not "ban them all"). Your linked twitter thread is about nothing more than the announcement hurting pharma stock, with the claim (from Taborrak) that "Pharma stocks nosediving means your life expectancy is nose diving." This is a silly claim on its face and Taborrak gets dunked on for it.
As George Carlin once said: โThink of how stupid the average person is, and realize half of them are stupider than that.โ
But that doesn't really have much to do with RFK Jr., who may be crazy but isn't stupid.
Aside is it just more or is Taborrak way better in podcast than text? I don't usually enjoy his posts on Marginal Revolution but think he's good on podcasts. I don't know what that says about me... but he's not the first person I've encountered that with.
Is he better in longform? Maybe this is just โtwitter brings out the worst in people.โ
He puts up much longer posts than Tyler does. My hunch is in light listening he just confirms my priors more. I think we're both keeping it a little more surface level.
Taborrak tends to justify his points in a very academic style with lots of citations to studies and statistics. Tyler lives on vibes and has strange infatuations with people like Girard and Zizek, not to mention his continual infatuation with Austrian economics. His greatest weakness is his belief that any prominent public intellectual actually has something meaningful to say and isn't just a charlatan.
Man, lately Tyler just seems so off the mark. He keeps talking about AGI in the most head-in-the-sand, dunky and dismissive way without even making clear claims or any concrete arguments. I think AGI doom is one of the most mind-killing topics out there amongst otherwise high decouplers.
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But Tabarrok didn't say "we should reward companies for treating disease". What he actually said (if you scroll up a few posts) was:
When I read this in the political context of the ongoing vaccine debates, the implied connotation I get is something like: "Listen here, you ignorant yokels. You might like to think that you're 'self-sufficient', but you're not. You depend on me, my tribe, the educated elites. Without us, you'd be dead. Specifically, you are dependent on the stock valuations of big megacorps continuing to rise. You know; stocks, the global finance market, i.e. that same thing that is the engine of mass immigration, the offshoring of industrial labor, the woke-industrial complex, and so many other things that you find politically abhorrent."
Obviously, he didn't write those exact words. But that's how it comes off. And that's a poor way to endear people to your cause, regardless of the actual merit of your claims. So the backlash he got on twitter makes perfect sense to me.
I mean, yeah. That is the implied connotation, because it's true. It's true the same way that you or I would tell the guys who set up the Capitol Hill Autonomous Zone that their project is doomed without the support of public infrastructure. That's just not how the world works. If they can't tell the difference between investment in medical innovation being driven by the expectation of future profitable sales, and the nebulous forces driving the educated consensus on immigration, then they are just stupid.
Well, not in an entirely unqualified sense, obviously. We know that people can live without vaccines, because they did so for thousands of years. Life expectancy may have been lower, sure, but modern medicine is not a necessary precondition for human civilization to exist.
Vaccines are not even the sine qua non of modern medicine- no doubt theyโre much cheaper than things like modern sewage systems and mass availability of antibiotics, but life expectancy started skyrocketing with improvements in sanitation and treatments for infection with vaccines more an acceleration of trend than a cause of it.
Smallpox vaccine was great because it put a stop to outbreaks of mass death. Measles and diphtheria vaccines were great because it ended a whole lot of infant and child mortality. Mumps vaccine is pretty good because it nearly wiped out a less deadly but still nasty childhood illness, similar with pertussis. Rubella also, and rubella is really bad for fetal development. Tetanus immunization is probably less important in the first world, but it is a bulwark against less-than-perfect sanitation.
Chicken pox vaccine is a step down from mumps vaccine; chicken pox is rarely fatal, though it is common and nasty. But when you're immunizing children against hepatitis B in the first world, then unless that vaccine is perfectly safe, you're probably past the point of diminishing returns.
Why is Tetanus less relevant in the first world? Are we less likely to get dirty cuts?
Most people in the first world don't roll infants around in the dirt, certainly. Also, there's something called neonatal tetanus which is probably caused by contamination of the blade used to cut the umbilical cord -- but not only is that something that should be very rare in the first world, the vaccine has to be given to the mother, not the infant.
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I refused hep b for my kids. Itโs clearly a scam and exhibit 1 in terms of the fda hhs and pharma collusion. It was an expensive to develop vaccine for gay men and it drug users. They couldnโt get enough customers to cover the cost of the drug so they got it on the newborn schedule. They give it to a baby in the first 24 hours.
Even if it were a miracle vaccine, it is absurd to give it to a baby in the first 24 hours of life. Itโs obvious that the reason they do this is because itโs a garunteed touch point for doctors to administer it. Prioritizing vaccine sales over all other considerations.
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And this is what is frustrating about modern vaccine discussions. Take for example the covid vaxx. It basically was useless unless you were old. But modern vaccines use the goodwill earned from the old vaccines to short circuit discussions on whether the new vaccines are worthwhile.
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โThe people who disagree with me are stupidโ is massively uncharitable, and well below what I expect of this place. Thatโs a stereotype of boo outgroup, and youโre saying it to the very word.
Thereโs a lot about what youโre saying thatโs right! But you donโt seem to have understanding of the reasons people are critical of big pharma, and instead are just calling them dumb. Itโs exactly the fact that people who criticize these things are immediately called every insulting name in the book that makes them become distrustful, resentful, and vengeful.
Are you trying to move past shady thinking here, or are you more interested in dunking on your outgroup? It would be much more productive to try and engage with what @Primaprimaprima said and develop a greater understanding of where your opponents are coming from โ that will make you much better at being able to be both compassionate and convincing.
I suppose I could have called them, "unable or unwilling to understand the production function of medical goods, the capital structure of pharmaceutical corporations, the inherent unfairness of mass tort litigation, the difficulty for an individual consumer to determine the expected utility to himself of a given medical product, p-hacking, and the extent of the natural human disease burden," but that would be just padding the word count.
Doesn't all of this get side-stepped if we're talking about a system where that isn't the case at all? Surely the Soviets developed some genuine medical tech all on their own state dime.
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No, thatโs not just padding out the word count: the two things youโve said are not equivalent.
In particular, now youโre actually discussing the values, beliefs, and arguments behind your position, which is a dramatic difference from โall my opponents are dummy dumbsโ.
And actually stating plainly your values means that people who are actually smart can now productively disagree with you: maybe someone can go โactually the production function of medical goods doesnโt work like that,โ or โmaybe tort litigation isnโt actually all that unfair,โ or โitโs actually not that difficult for the average consumer to make an informed decision about the expected utility of a medical interventionโ โ and then what youโve got is an actual discussion that can illuminate both sides!
And even if youโre right about 100% of your claims, the way you stated it before didnโt make you sound right: it made you sound like a bully relying on thought-terminating cliches. Someone whose arguments are well thought out and informed by evidence doesnโt need to act like that. Providing evidence, discussing trade offs, and engaging in constructive debate is what smart and credible people do. Calling people stupid is just, well, stupid.
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I don't know that I want to stan RFK here, but the status quo isn't inherently better: public health generally has a lot of egg on its face, not just from the pandemic. Attempts at COVID vaccine mandates seem pretty ham-handed in hindsight given their lack of long-term immunity. The FDA approved, over the advice of its own scientists, a very expensive drug for Alzheimer's that wasn't even found to be effective. Literally the current assistant secretary of HHS was found to have put political pressure on WPATH to remove age limits from gender medicine in its guidelines at a time when many Western countries have reviewed the literature and are questioning the practice for youth.
I get where you're coming from, but I find myself questioning whether putting RFK in charge will actually make things worse. At least he'll get push-back against crazy policies.
Agreed. If we're going to go with the "a purpose of a system is what it does", then the US public health apparatus is awful. We spend by far the most money in the world and get the life expectancy of (checks notes) Turkey, Ecuador, and Albania.
It would probably help if Americans drove less, exercised more, were less fat, did fewer drugs, and stopped shooting each other and themselves. However, the public health interventions needed to address these cultural and lifestyle issues are fairly unpopular.
Let's see what RFK can do. Maybe we'll start directing dollars towards effective interventions and away from ruinously expensive and ineffective ones.
I agree that America should be more like Europe and Asia by harshly prosecuting violent crime and refusing to tolerate drugs. We should probably also adopt European food standards where breakfast cereal has 5 simple ingredients instead of 20 unpronouncable ones.
Can you to be more specific about what effective interventions you're thinking about? The main causes of the European-American life expectancy gap is not a mystery, and I promise you it's not tripotassium phosphate or excessive vaccinations.
Like, stricter regulations on microplastics or whatever would be great, but the effects on life expectancy are going to be completely swamped by obesity, drugs, car accidents, and suicides. (Not to mention, the GOP traditional stance on environmental and health issues makes me think there's not going to be much appetite for imposing additional standards on industry).
The US prosecutes violent and drug crimes far more harshly than Europe, as I'm sure you are well aware. Tolerance is not the issue.
A focus on reducing obesity and preventing sickness would be a welcome change. Will it dramatically increase life expectancy? Maybe not at first, but it's a start. And it might at least stem the rapid increase in costs. We're getting very little for our expensive medical system.
What changes would you propose? Cities like Chicago and DC have done literally everything that establishment figures say is good, and look at the results. These are intractable problems. The state can't simply snap its fingers and will away problems. Except crime. That can be made much less via mass incarceration.
I am not aware. Here in Seattle open air drug markets are tolerated and people who have been arrested for dozens of crimes (including violent crimes) are frequently released onto the streets without trial. It's hard to imagine a more lenient system.
Reducing obesity is a goal, not a policy. Obama focused on reducing obesity. Didn't achieve much. What is the Trump administration and the GOP going to do? What policies that are both effective and palatable to a) Republican voters b) Republican elites do you expect them to pursue
Tax sugar (or Ozempic4All, if you're feeling pro-injection and like free healthcare). Invest in public transit and rework urban planning (15min cities are back, baby) so people drive less (fewer car accidents) and have more active lives (-obesity, +basically every other aspect of human health).
Of course, these are already ballot box poison (and that's before we even try to do anything about suicide, where massive social engineering might be more politically viable than restricting access to guns). Which points back to what I was originally saying: low American life expectancy is revealed preference re: lifestyle. Policies to address these issues have been floated repeatedly and outside of a few locations they've been shot down.
(Not a clue, re: drugs. There's some proximate interventions you can do to reduce OD deaths, but that's just nibbling around the edges of the problem)
Can you be more specific? Which establishment figures, which policies?
Sidebar: I would note that the stereotypically very liberal states like CA and NY have the highest life expectancy; the worst states are in the ultraconservative Deep South. Again, I don't think this is really about policy (cf. Idaho, which is also extremely conservative), except perhaps insofar as state governments could spend money on ameliorating the consequences of Southerners' unusually unhealthy lifestyles but don't (generally with the support of their electorate).
Well I'm pleased to inform you that the world did not start three years ago, nor did America's durable problems with drug use and violent crime, nor its unusually harsh sentencing practices. The US has mass incarceration. It, rather notoriously, has more prisoners per capita than almost anywhere on Earth, including actual totalitarian regimes. It doesn't seem to have had the desired effect. Unless you can do something about the processes that produce new criminals, the problem isn't going to go away just by throwing more and more people in prison.
I'm 100% with you. But first, we need the DOGE man to come and fix government.
Too many people think that dollars = progress. This is obviously false. California has spent on the order of $100 billion on high speed rail and has nothing to show for it. If we had the efficiency of Spain or China we could do stuff. Unfortunately we are hamstrung by a corrupt and incompetent government.
Until that is fixed, we could spend infinite dollars and get nothing for it.
So I assume that you agree with me that the best way to get car-free cities is to start by gutting the corrupt people who are preventing public money from being utilized.
Yes, rich people who benefit from our economic system have better life outcomes. How can we help disadvantaged people get the same thing? I don't think standard liberal politics have the answer. Look at Philly, DC, and Chicago.
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Perhaps the argument could be made that we can in fact throw the book hard at drug offenders, and that we have indeed done so to the point that DAs, lacking a less-harsh punishment, choose not to punish at all.
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I am not going to die on the hill that COVID vaccine mandates were a good idea, but I am absolutely going to die on the hill that Pfizer deserved to make shitloads of money for developing and manufacturing the product that effectively ended the COVID pandemic as a going concern.
Oh fucking bullshit. The war in Ukraine ended the covid pandemic hysteria. Nothing Pfizer or any of the other big pharma companies did.
Calm down.
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Covid hysteria was pretty much entirely over in the UK (thanks to vaccines!) by the time of the Ukraine war.
The vaccines were widely available by early to mid 2021, and yet hysteria continued in most western countries until everyone actually got Covid in January 2022 thanks to Omicron.
I don't doubt that vaccines saved lives in 2021, but they didn't stop the spread or end the pandemic.
Omicron ended the pandemic.
While I agree that Omicron as an event, i.e. the infection wave around January 2022, was the end of any real mainstream concern about COVID, there's pretty good reason to believe the apparent increased transmissibility of Omicron was an illusion: there's no significant differences in transmissibility between COVID variants (the technical term in that paper is "SAR" for "Secondary Attack Rate").
In other words, we would have seen a much smaller wave in the winter of 2021-2022 if everyone acted like they did in the winter of 2020-2021 (when vaccines were new enough that only the highest priority/luckiest had gotten them), but they didn't. Probably due to people worrying less about being careful due to vaccines, although probably also a good amount of people feeling like they had had enough of isolating after several months.
Interesting and probably true. If we just "let it rip" it's likely we would have ended with fewer overall deaths as the disease would have quickly exhausted itself. The Omicron event would have happened in March 2020 instead of January 2022.
Obviously, in this counterfactual, the acute phase would have been awful. Hospitals would have been overrun, but it's unclear how much lifesaving care was happening anyway. Irresponsible use of ventilators definitely killed lots of people who would have survived otherwise.
In nearly every country, the damage caused by the Covid response was worse than the disease itself. China gets an F. Australia gets a D-. Sweden did it best, but I think that's only because there wasn't a "Super Sweden" that simply ignored the disease completely. (Maybe some African countries fit that bill due to lack of state capacity).
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I can only relate my experience of what happened in the UK, as that's where I was living at the time, but fwiw this isn't really how things played out there. Once we reached mid-2021 all restrictions were lifted and people broadly went back to living their lives normally. There was some debate about whether to shut things down again due to Omicron, but this ended up not happening.
Didn't the UK have some sort of "Freedom Day" and then totally renege on it?
Yep, that's what people were colloquially (and maybe even officially, I don't remember) calling the day all restrictions were set to be lifted. I don't recall any limitations being re-imposed after that. I admit that for a while if you tested positive for covid you were still required to self-isolate for 10-14 days, but I wouldn't call that hysteria.
Prominent health officials were arguing for re-establishing some level of restrictions around the time of the Omicron variant but Boris Johnson overrode them on that.
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It depends on how you define hysteria. Most left-leaning people in my neck of the woods were pretty much done worrying about COVID as soon as they were fully vaccinated. There was still some residual level of concern, which I will agree largely ended with Omicron, but by Memorial Day 2021 very few people were doing anything beyond possibly masking up in busy areas.
I see outdoor maskies every day, and they almost always have leftist signifiers.
Mask requirements for businesses didn't end in my city until...well, I got so frustrated that I left for six months in January 2022. When I came back in 2023, they were finally gone.
I had predicted this at the beginning of the pandemic; people don't generally understand that even the yearly flu vaccine is ~70% effective. By the time they get a vaccine, they'll be so wound up and terrified that it won't be good enough; like a neurotic, there is no threshold of proof that will make the anxiety go away.
I remember the day the CDC officially ended the pandemic, a customer at work said it wasn't over for him. Gay. Corpo Tech job.
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Truckers (very memorably) were (newly!) banned from crossing the Canada-US border in early 2022 without proof of vaccination -- whether this was hysterical or not is I suppose something we could discuss, but I don't see how it could be because of a thing that was not 'a going concern'?
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I live in a blue state in the US. My kid graduated from high school in 2021. There was still a ton of covid hysteria during that time and we were supposed to be thankful the school allowed an outdoor graduation ceremony. (No prom. No other activities. Just junior and senior year in her room. No surprise that southern colleges were popular among her cohort and remain so now. Or that her cohort might be even more distrustful of authority than their gen x parents.) Her classmates that went to North Eastern colleges spent their freshman year (21-22) still masking, some still with predominantly virtual schooling. This year, my employer still wanted people with covid to report it to their hotline, even if we were full time working from home. A lot of people are still giving every appearance of still worrying a great deal about covid.
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Mask mandates remained in place. Mask mandates are hysteria.
I donโt know why people want to retcon what happened. Many doctoral theses should be written on this phenomenon
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Itโs amazing how only two years later people are re writing history.
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They were behind the South African mad scientist who produced Omicron?
I heard rumors that Omicron looked like it was developed through serial passage in lab mice, but do you have any details?
Nothing more than you do. The official story is some immunocompromised patient had it for a long time, but I go with "second lab leak".
Not all lab leaks are bad after all I guess?
Joking, obviously, but Omicron was probably the second most positive world event in my lifetime after the collapse of the Soviet Union.
If they ever find the guy who did it, I hope he gets a Nobel Prize for Peace and for Medicine.
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The 6 to 9 months between when most people were able to get the vaccine and when Omicron became prominent was worth a lot.
Maybe -- but the pandemic was still very much a 'going concern' in that period?
Yes. Tons of people were dying during that period. Even worse, the people in many countries such as Australia and China experienced mass imprisonment.
Vaccines saved lives, but they did not end the hysteria. Far from it. I still remember when they reinstated the mask mandate in Seattle in summer 2021 after a couple blissful months of freedom when we still thought the vaccines stopped the spread.
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Except it didnโt โend it as a going concern.โ People were still crazy and you still had cases.
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Views like your own do not seem uncommon to me, but they seem disconnected from common sense and I can't tell if I'm taking words too literally or if people have internalized so many weird perspectives on things that they've lost their clear-sightedness.
1: If somebody wins democratically, then that's democracy. If you dislike a democratic process, then you're arguing against democracy, and not for it. I can't make sense of rejecting a democratic result with the argument that something democratic is a threat to democracy.
2: I do not see anybody, anywhere, downplay the importance of vaccines and antibiotics. Not even when I follow your link. People dislike one specific vaccine (if you can even call it that), because it wasn't tested properly. And many of the connected companies have some shady histories. I don't even think it's relevant if these companies did anything bad or not, or if the vaccine is harmless or not. A large amount of people lost all trust in these companies and those who support them, and for perfectly valid reasons.
3: The correlation between IQ and ideology is weak, and it doesn't tell you which side is more correct.
Regarding 1: I don't know that I'm convinced by this. Suppose someone is the candidate of the "End Democracy Party." Someone who is pro-democracy could understandably be disappointed with their election. Of course, that would still be the democratic result, so their complaint is really with the populace that they have, that it is not a suitable one to attempt to maintain a democracy in.
Similarly, one could be disappointed with a decrease in the effectiveness in democratic governance. I think this was closer to what they were complaining about: that this indicates the need to win the "stupid vote," pointing to tangible harms wrought by people finding the wrong things appealing. "Democracy makes us listen to and appeal to the people with the bad opinions" is a valid critique of democracy, and so saying that that seems to be more the case than they once thought is an entirely reasonable sentiment.
2 is false. Vaccine skepticism in general has definitely risen since 2020 (the people putting in place mandates should really have considered the second order effects).
I'll in large part grant 3, though.
If a majority of people want to end democracy, I cannot think of an argument against it. If you're pro-democracy because you think the majorty is right, then you wouldn't be justified in stopping the majority from ending democracy. If you value democracy because it's correct, then you're also saying that you're wrong when the majority disagrees with you, which it would in this example. I can still save it, though. Suppose democracy was not about correctness, but rather about freedom. Then it would pain you to see people having the freedom to choose that they wouldn't want to be free anymore. But this choice imposes on the freedoms of those who still wants to be free. But if people say "I like democracy" when what they mean is "I like freedom", then people become confused and we reach the wrong conclusions, so it's important not to confuse ends and means. Democracy is not your highest value, it's something else which is unstated and which correlates with democracy.
Yes, but then it's not democracy which is optimized for, but rather "good opinions", which democracy once did better. But now we have a problem, for while I can agree with your take, there's no objective way to measure if we're correct or if we're mislead. For democracy used to be how we measured, and now we have made something out to be more important than democracy, which we have no way to measure.
Vaccine skepticism can be blamed on those who promoted the vaccines. They repeatedly acted like people who were out to mislead you and put you in danger, while stating the opposite. For instance, they said "These vaccines are completely safe", but also that neither these companies, nor the government, would be to blame if getting the vaccine went horribly wrong for you. "I promise you this is safe, but I take no responsibility for the consequences" is a statement which will make people distrust you. Now, this doesn't imply that the vaccine isn't safe, merely that it's reasonable and logical to doubt that it is. About 10 more things like this happened (documents being held back, people being told that herd immunity would occur, being being told that the vaccine prevented you from spreading or getting Covid, both claims which turned out to be false), etc etc etc.
So, again, even if the vaccine is perfectly safe, the only reasonable response to somebody repeatedly lying to you, and even trying to use political and legal pressure to force you to inject something in your body which hasn't even been properly tested, is resistance. It's not the counter-movements fault that people distrust vaccines, but the sheer incompetence of the main movement.
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RFK supporters I know personally are highly vaccine skeptical and believe in a kind of vaccine/autism link bailey. They do not support vaccinating kids for e.g. measles due to low death rates and are convinced that the only reason kids get so many vaccines is due to the pernicious influence of pharma companies. They are members of Facebook groups of hundreds of people where the consensus view aligns with their beliefs.
The vaccine schedule now includes hundreds of vaccines and the incentives are all screwed up. I think it's pretty reasonable to believe in vaccines as a technology in general and that a lot of them have been captured by special interests.
False. I count 32 doses recommended to all children from age 0 to 18, not counting a yearly flu vaccine and one dose of a covid vaccine.
https://www.cdc.gov/vaccines-children/schedules/index.html
This is a perfect example of the belief set I am talking about. The RFK supporters I know believe that kids are getting tens of vaccines in a single day.
Okay. Which vaccines in particular do you believe in?
how many of these doses include multiple vaccines?
to be frank, it's asinine to claim someone "wrong" if they believe MMR is 3 vaccines instead of one
why wouldn't you count these?
"hundreds" is wrong, but so is "32" even if we accept 1 dose=1 vaccine which is hardly some sort of objective fact
Sure, we can break down dtap and mmr into three vaccinations. That brings the total to 48. Still a far cry from hundreds, so I don't see what's asinine about saying that hundreds is wrong. There's just no way you can torture the numbers to get to hundreds.
Simply because in my experience most kids don't get these on a regular basis.
they're on the schedule
hundreds is wrong, but so is 32
the number of vaccines on the CDC schedule for a child born today through age 18 is ~80
How is it 80? 48 I counted above, plus 18 flu, plus 2 covid makes 68.
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Whatโs your experience?
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My mistake, I should have said dozens. I think I saw "hundreds" somewhere recently and internalized that for some reason.
The technology for smallpox vaccines could be totally sound, and the company that makes the shots puts too much mercury in them or something. A batch could be bad. Maybe the adjuvants are too strong. We have good heuristics for noticing when something causes noticeable immediate side effects, but not when something contributes to chronic stress. Maybe every shot contains one of the 32 arms of Exodia, and you need to catch them all to visit the shadow realm.
Children in the US are no longer vaccinated for smallpox because the disease is extinct.
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So... there's no actual vaccine that you "believe in", and your belief is strictly in the theoretical (but so far unattained) possibility of producing a good vaccine?
It's imminently reasonable to suspect that some vaccines are not manufactured well. That would be a very explanation for why 1) vaccines are a good technology that save lives 2) some people seem to be getting sick from them.
But there's no way to distinguish well manufactured and poorly manufactured vaccines?
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Let's not do the thing where the poster is directionally correct, but we're nitpicking the details. Yeah, it's not 100 shots, but it's a lot, and it's a lot more than before.
Let's flip it. Why should an infant be receiving Hep B and Covid vaccines? Why should they receive any vaccines that they didn't in 1990 (or whenever the Chicken Pox vaccine came out).
The post-1990s vaccines to have vanishingly little benefit and unquantified risk.
Wait a second. There is no "directionally correct" here - the poster said not 100 but "hundreds" and the true number is around 30. It's "directionally correct" in the sense that the sign is right, but that's about it. If he said "thousands", would that still be "directionally correct"?
And it's not a semantic nit, because we can mostly all agree that the ideal number of vaccines is greater than 0 and less than "hundreds". So where exactly we are on that spectrum is basically the entire discussion.
I don't think there's a good reason to vaccinate infants against COVID.
I don't know why infants are vaccinated against hep B but it's been recommended for newborns since the 1991 (and patented in 1972), so by your heuristic that one seems pretty safe.
It's not clear to me that this is the case, but I'd be curious to see if anyone has actually looked at this rigorously. I don't know off the top of my head which ones are post 1990s.
*not including the annual flu shots (sometimes multiple) and covid shots
I guess we'll just forget those even exist
Please show your math for "hundreds" of vaccinations on the schedule. I went through and counted, you can surely put some minimal effort in rather than low effort sneers.
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The RFK-associated site I saw claimed 7 shots in one day, which appears to be true. (RSV, Hep B, Rotavirus, DTaP, Hib, Pneumococcal, Polio).
That's much closer to the truth but not necessarily true.
So taking those two at 2 months instead of 3 months cuts the number to 5.
And polio is a going concern only in a couple of third world eastern hemisphere countries, so you can safely skip that one.
Polio doesn't work like that.
IPV which we use in the US (and basically anywhere where with the infrastructure to manage the necessary cold-chain) has no effect on infection or transmission of polio. It is highly effective at preventing severe disease (although polio normally presents as just a cold with no distinguishing symptoms, so we've never actually studied the vaccine's impact on mild disease), which is what we mean when we say the US has "eradicated polio". In practice, polio spreads largely through poor sanitation, not direct person-to-person contact, so improved sanitation has probably actually reduced spread a fair bit, but there's no reason to believe the vaccine has done so. And we don't know because no one tests for polio (although there's some small push to start doing some wastewater testing).
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What's old is new again
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7 shots in one appointment, however, is a plausible claim, even if it isn't necessary to do it that way.
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It's actually pretty easy to find such people in some corners of the Internet. For example: https://x.com/Inversionism/status/1857457277860540898.
Easy to find them on 4chan, too.
This is literally my first time seeing such a person. I've never intentionally looked for them, but I've interacted with quite a lot of people in the past few years.
Of all people that I have seen who refuse to get the Covid vaccine, everyone still get (and support) literally every other vaccine. I'd estimate people who are against all vaccines to be 0.1-1% of the population at most. You can't really go lower than that. 1% of the population has an IQ below 65, 1% of the population are psychopaths, 1% of the population are pedophiles. If an issue is so rare than it applies to about 1%, I don't think coordinated efforts to improve them (like education, peer pressure, or more laws) is going to help any. I just accept that a small portion of the population is a little crazy by statistic necessity.
Umm, the percentage of people who are just generally anti vax is not a majority, but itโs much higher than 1%.
I usually go to more right-leaning websites and communities, and I recall seeing maybe 6 or 7 actual neonazis, but I have never seen anyone write that all vaccines are bad. Maybe a tiny bit of tech-savviness filters out the low-IQ schizophrenics who recommends "all-natural" alternatives to everything. 1% sounds like a lot, though, but I can't refute it if I include the offline population and Facebook users.
Yeah, I imagine there's some level of selection in who you end up interacting with.
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Yes, it's much higher than 1%.
It's worth pointing out that nearly all the anti-vaxxers were far left until Covid.
Near Seattle, there is a place called Vashon Island which has long been famous for its loony leftists. Until recently, they had one of the worst childhood vaccinations rates in the country. About 20% of children weren't vaccinated.
Of course, when Covid came around, they immediately pivoted to pro-vax and are lining up to get boosters at rates far above the national and state average: https://www.perplexity.ai/search/what-is-the-anti-vax-rate-in-v-w87v8jS0S26qIiStqdWwUw
I don't think that's true.
It's true that being categorically anti-vax was extremely rare to the point of being unheard of among normie republicans, but the Alex Jones crowd had conspiracy theories out the wazoo about vaccines and it was common to object to the HPV vaccine. Yes, my filter bubble is less likely to vaccinate their kids against MMR, but the fringes already didn't trust vaccines. It's probably more accurate to say that antivaxxers were mostly far left; the far right getting majorly into alt medicine and opposition to vaccines was not my top prediction five years ago, but it's not a surprise at all. Normie republicans listening to the far right post covid, on the other hand...
Isn't this more of a 'why should my son take a shot so your daughter can (slightly) lessen the risk of her slutting around' thing than a true concern about vax safety?
Opposite valence- the culture war objection was โwhy are you assuming my daughter is a whore?โ.
I mean, yes, but the fact that vaccine safety was brought up as a serious objection to it indicates that anti-vax sentiment on the right isnโt entirely foreign.
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That was a big part of it, but maybe another part was it seems like it requires a few doses and lots of people are afraid of needles and want to minimize the number to just the bare essentials (an underappreciated element of vaccine opposition). I was too old by the time it became common, so HPV was never folded into my normal course of vaccination. I'm fairly pro-vaccine, so if I thought my monogamous self would benefit from it I would have consented. But then it became, "well, now I have to talk to my doctor about my lack of sexual partners, do I really want to have this conversation to get a shot that's not even marketed for my protection?"
Really, the fact that the HPV vaccine is marketed as protection from promiscuous sex is a bad, bad strategy because it pushes culture war buttons. But maybe that's the only reason at all it has any value. Does the HPV vaccine provide any protection against the many other kinds of HPV infections people can be exposed to, like warts on various parts of the body and things like that?
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RFK Jr provided a reasonable critique of vaccines. They are shielded for liability. Arguably the fox is guarding the hen house. So all things equal youโd expect vaccines to marginally fail the learned hand formula though not massively because reputation still matters.
That doesnโt mean vaccines are bad or even most vaccines or bad. It does mean bringing back liability seems like a reasonable step to encourage pharma companies to internalize the costs of vaccines.
Does RFK go too far? Almost certainly. But the core economic argument doesnโt seem fallacious.
I think there is a distinction to be made here between proven, old vaccines for serious diseases, and everything else. I'm much more comfortable with no liability for the former. I don't know to what extent this distinction is feasible in reality, tho.
Why? If the technology is proven and established with no problems, that is exactly the sort of situation where a liability shield provides the worst incentives. If we know that a given product is reliable and problem free, then shielding the manufacturer from liability gives them a direct incentive to reduce quality control and otherwise take risks/cut corners. If we know the technology works reliably, that's exactly when people SHOULD be liable for damages if they get nasty consequences from it.
I assumed no liability applies to known and expected side effects, and that for proven vaccines you can cheaply and reliably test for any outright manufacturing trickery since it is possible to just settle on a standard.
The motivation in part is that I think diseases like polio or mumps should be a separate conversation. Clearly those vaccines had gigantic positive effects, and take attention away from questionable products and tactics used to push these products onto the public.
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Speaking of that, I've seen the vax schedule for children these days and it does seem a bit... extreme.
https://www.cdc.gov/vaccines/imz-schedules/downloads/parent-ver-sch-0-6yrs.pdf
Like, does my kid really need 3 shots for Hep B? Can I just skip all the ones added after 1990 and call it good?
It's not like kids today are healthier than they were 35 years ago. If anything, the opposite is true. Given a messy, politicized epistemic environment, maybe it's best to revert to the last "known good state". There is knowledge encoded in survivorship.
In other words, I'm sure as hell not giving my infant a Covid vaccine.
From my research, they are all pretty clearly worth it in cost/benefit terms except the Covid vaccine (cause Covid hardly affects young kids). I have a baby and the pediatrician didn't even bring up the Covid vaccine - idk if she's tired of getting yelled at or also agrees with my analysis. But I'm happy to have given my baby all the other vaccines.
The main health difference between kids today and 35 years ago is obesity, and it's hard to imagine a mechanism where vaccines cause obesity. Especially when you look at the crap people feed their kids these days. So I'm just going to try to minimize that crap and I figure that'll probably prevent me from having a fat kid. Wish me luck! If your plan is to achieve the same thing just by not vaccinating, I wish you luck too, but you might need a lot more luck than me.
Even Hep B? My kid's not going to be engaging in sex tourism in Thailand (prior to age 18 at least).
On the potential negatives of vaccines, I won't pretend to be an expert. People are who very smart and know the science way better than I do say they are safe. But there are others who are just as smart (admittedly rarer) who say they aren't safe. The problem is that I can't trust the experts because I don't have Rube Goldberg amnesia. I see how full of shit experts are on all sorts of topics. So I can't trust them fully on any topic. If high quality anti-vax research was produced, it would be politically suppressed and careers would be destroyed. In that environment, truth seeking is impossible.
I'm not anti-vax. I think vaccines are one of the best inventions of all time. But I do see the large rise in childhood mental illness, autism, and yes, obesity, and I struggle to explain it. I don't see any harm in waiting to take the post-1990 vaccines when the benefit is not there and the risks (though probably low) are a hot button political topic.
Yeah, side effects from the Hep B vaccine are so low that the very low risk of Hep B itself (I know 99% of cases come from sex tourism in Thailand, but there's still that niggling 1% remaining) makes it worth it. But that probably is the closest one to not being worth it, after Covid.
Mental illness is social contagion and increased diagnosis. Autism is increased diagnosis. Obesity is eating more food and exercising less. Obviously there are other factors, but overall they don't seem too hard to explain. But even if they were hard to explain, idk why vaccines seem more plausible than 5g or chemtrails or whatever. It's all just vague gestures at stuff with no mechanism and no evidence.
How sure are you of this? It might be worth an effort post sometimes. I've seen some stats that suggest this is not the case at all, and that the real rates of autism have skyrocketed. I'll admit low confidence, so it might be worth it to hear from someone who knows better. Maybe you?
This is certainly the normie belief. But many serious people disagree with this hypothesis. I am one of them. A properly functioning human body will regulate hunger and activity levels to ensure homeostatis. In any case, this has been discussed ad nauseum in this forum, and is perhaps the hottest flame of the culture war. Probably best to just agree to disagree.
Yes, I mostly agree. Or, rather, the science is so bad and politicized that I certainly don't trust anti-vax research. If you listen to RFK talk, he does seem to propose some pretty solid reasons for why vaccines (as they are currently administered) could be harmful. But he's a lawyer, not a scientist.
In any case, if you are looking for someone to make the anti-vax case, it's not me. I will, however, not be giving my children Covid or Hep B vaccines. I will look into the benefits on the other ones, and probably stick to the rest of the schedule.
Yeah a lot of this has been debated to death. But I'm not sure if "eating more food and exercising less" is the normie belief. A lot of normies seem to believe in other stuff - some kind of poison in our food, some kind of environmental contaminant, some metabolic issue where 1000 calories/day doesn't result in weight loss, the belief that obesity is normal, etc. There may not be a majority belief about the cause of rising obesity, idk.
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From what Iโve seen, the majority of vaccines are very low risk. The concern I have is that the combined cocktail hasnโt really been studied.
My kids got most but not all of their vaccines.
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You need the Hep B vaccine in case some of the doctors and nurses giving all those shots have been engaging in sex tourism in Thailand.
And if they aren't, you're probably doing it wrong.
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Theyโre protected from liability because the US legal system is this complete bullshit thing where 1% of users complaining about a thing can bankrupt a company.
I was talking to someone who develops and sells their own perfumes recently and they mentioned that when getting insurance to sell their products it costs them more to get covered for sales in the US than the entire rest of the world combined!
One day I'll write an effort post about this, but the legal environment makes producing products in the U.S. impossible.
Good luck suing the Chinese company with brand name MoonShenBubble when your baby pacifier has lead in it.
On the other hand, if an American company makes 10,000 products, and even one of them gets targeted by lawyers, the whole company can be strip mined for cash. There will never be another Johnson & Johnson or 3M. It's all going to be made in China forever.
Might not be China, specifically, but yeah. International liability basically doesnโt exist even in the face of ruinously and maliciously bad behavior, local liability is absolutely crushing even in face of well-intentioned and innocent mistake, and the old solution of importers being responsible has collapsed in the face of big names outsourcing that to tiny and judgement proof third parties in the Amazon Marketplacificiation of internet sales.
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The reason that vaccines need to be protected from liability is because the cost of a wrongful death lawsuit is orders of magnitude higher than the value the vaccine manufacturer can extract per life saved. Tort litigation is just a really terrible system for dealing with diffuse risks like this, especially when the expected net public good is overwhelmingly positive.
This suggests the costs of vaccines donโt equal the value form vaccines unless the courts are overvaluing wrongful deaths.
What is the argument that there is a very large positive externality?
Let's do a little back of the envelope calculation.
https://pubmed.ncbi.nlm.nih.gov/9892452/
The actual infectious disease mortality in 1980 was 80k people. At 1900 mortality rates, it would have been 1.8M, so let's ballpark it at 1.7M deaths averted thanks to sanitation and antibiotics. FEMA values a human life at $7.5M. 1.7M people * $7.5M/person = $13T. US GDP in 1980 was $3T.
Obviously this is highly simplified, but I think it's safe to say that vaccine companies did not capture a large part of the benefits of vaccines.
But a large part of that value was captured by the customer (ie not an externality).
The argument for eliminating liability is that the cost benefit to the individual is negative (otherwise pharma could raise the cost to account for liability while customers would still buy since positive EV) but the benefit to society is positive.
Of course there could be an elasticity issue but that implies the cost to vaccines are much higher compared to what people think.
If the vaccine manufacturer is not capturing all the benefit of the vaccine but is liable for all the downside, it's clear that the math isn't mathing even for plainly good vaccines.
Just to expand, the three theoretical cases where liability prevents a valuable good from being produced is where there is a large positive externality (ie a benefit derived by neither the seller nor buyer such that the buyer is not willing to pay more), ability to pay for buyers, or where liability isnโt properly measured (eg the Bronx jury). Before we accept that the case applies here, we ought to actually prove it out. After all, vaccines didnโt have immunity from liability until the 1980s
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That just isnโt correct. The vast majority of manufacturers are subject to strict liability and they donโt capture all of the benefit. Yet they survive because they make an EV+ product.
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No it doesn't, because people don't pay anywhere near the QALY value of vaccines to the vaccine company.
Let's pretend we have a vaccine for smallpox (40-50% fatality rate in babies). People/governments pay maybe $100 per dose (https://www.cdc.gov/vaccines-for-children/php/awardees/current-cdc-vaccine-price-list.html). The value of a wrongful death is $10M, so you would break even on a $100 vaccine for smallpox at one wrongful death in 100,000, while the vaccine would save 40,000 to 50,000 lives per 100,000.
I actually have to compliment @Quantumfreakonomics here, because until 15 minutes ago I thought liability was reasonable.
Why wouldnโt pharma just increase the cost of the vaccine to cover the increased cost of liability?
In the end that's exactly what would happen. Rich people would pay a lot for vaccines, poor people wouldn't get them at all, and grifters would get rich off the back of lawsuits.
Measles would go back to killing thousands of people a year in the U.S.
Is this the world you want to live in?
These concerns just seem internally silly. The only reason prices would rise a bunch is if there are a lot of vaccine related harms. If the harms are very small, then the cost for pharma would be small meaning costs would not increase much.
So what is it? Do vaccines cause a lot of damage meaning drug costs would need to increase a lot? Or do vaccines cause little harm meaning costs would rise only a little?
Neither.
Vaccines (at least the non-MRNA variety) cause little harm but the American legal system often assigns huge legal damages that are not warranted. For reference:
https://www.cnn.com/2024/05/01/business/j-and-j-talc-cancer-lawsuits-settlement/index.html
https://www.bloomberg.com/news/articles/2023-08-29/3m-to-pay-6-billion-to-resolve-vast-military-earplug-lawsuits
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They might, but that ignores the collective benefits of vaccines. Imagine that our smallpox vaccine from above kills one in ten. Surely, compared to four in ten deaths from smallpox, we collectively are vastly better off with one in ten deaths and immunity to smallpox, or zero deaths if we can beat smallpox and phase out the vaccine. But now the vaccine company has liability for post vaccine deaths, and so a single dose of the vaccine is going to cost... $1M just to cover the liability. No patient/government is going to pay $1M to save a 4/10 of a life when there are cheaper QALYs to save elsewhere, so we will never beat smallpox and we will see 40% fatality rates in perpetuity.
The fair mathematical solution might be to limit the vaccine manufacturer's liability to the collective damages or to damages external to the vaccine (i.e. negligence). So if you have a vaccine which saves lives (or QALYs) on net, you have no liability, but you'd better be sure your vaccine saves lives.
This is the liquidity problem I mentioned but the reality is that practically speaking there arenโt vaxx that kill 1/10 (they would never hit the market because few diseases are so ubiquitous and deadly that it would make sense to take the vaxx).
But if a human life is worth 10m then this is spending a million to save 4 million. Thatโs great ROI! Why wouldnโt you spend that if you were a government?
In any event not sure it is worth spending so much time on a non central example.
Surely the answer is that the life of an arbitrary stranger is not worth anywhere near 10m. If you tout for charities based on cost per lives saved, as EA does, you find that the majority of people are not willing to spend $1 to save a life, much less $10,000,000. That figure is a political fiction designed to reflect voterโs estimation of their own (or a loved oneโs) life so as not to make the government unpopular.
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A number of diseases have been functionally eliminated in the USA; polio, measles, diphtheria, rubella. One person foregoing the vaccine gives them some small value with negligible cost, although who knows, maybe the value proposition is still there if you plan on traveling to the third world. Some of these things are really nasty if you get them as an adult.
The entire population foregoing vaccines would lead (eventually) to these diseases becoming endemic again. Polio alone was paralyzing 15,000 kids a year prior to the vaccine and killing a fraction of those. I suppose we could decrease the amount of vaccination to allow a little bit of endemic disease back just to improve the value proposition for individuals and please the economists. Thankfully, our forefathers knew that was Fucking Stupid as they watched kids dying of preventable diseases and made vaccines as mandatory as they could.
So, if you want to translate the above into econ-speak - where is the positive externality? And if you agree that eliminating diseases via vaccination is preferable to the alternative, how would you like to give pharma companies enough of a profit motive to make the things?
While we're on the subject, COVID notwithstanding, vaccines are horrifically underfunded for this exact reason. The USA vaccine market was 29 billion in 2024, and pre-COVID was only 17 billion. As an aside, the entire biotech ecosystem in the USA is only ~800 billion; just over half the market cap of Meta, a single tech company. The MMR vaccine costs 100$ and you get two doses over your entire life. This isn't exactly some massively profitable scheme whereby Big Pharma is fleecing hapless poors, it's just a convenient punching bag that plays well with the base.
Iโm suggesting that just like pretty much every other product there is no liability shield. It is a weird argument โ if Person A can be vaccinated then Person B being unvaxxed ought not impact Person A. Thatโs where Iโm not seeing the externality.
If we allow for liability, then Pharma will increase the cost of vaccines to cover liability. The vast majority of vaccines would show a small cost increase. The ones that donโt probably arenโt that valuable in the first place.
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