Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?
This is your opportunity to ask questions. No question too simple or too silly.
Culture war topics are accepted, and proposals for a better intro post are appreciated.
Jump in the discussion.
No email address required.
Notes -
You can't trust what I haven't presented. I could do so, and I strongly expect to be correct, but I already do enough trawling of medical literature when I'm being paid for it.
It's your child, and I have some respect for your right to make decisions on their behalf, even if I think they're bad decisions.
My man, you're going from wrong to confused. There's good reason why you don't see doctors or nurses pull out dose calculators to account for body weight when giving every vaccine I can think of it. It's because it doesn't matter. If little Tommy is 4'6 and 35 kilos or 4'9 and 45 makes next to no difference, and this holds true once you're past the size of a premature infant on death's door, going to a land whale who needs a mobility scooter. Vaccines aren't like paracetamol, the dose-response curves are VERY different when it's the immune system we're talking about. Someone with a peanut allergy isn't twice as likely to die if you give them two peanuts versus one.
You're not doing a good job at probabilistic reasoning, but an eczematous rash is a minor vaccine reaction, and of very little consequence. If it was life threatening, I presume you'd have pointed that out, and even then, you'd be better off consulting your pediatrician about whether they could narrow it down to a particular constituent of the two common rotavirus vaccines in the States (fetal bovine serum or porcine circovirus, if I had to guess from looking at composition), and take precautions when administering future vaccines with similar compositions. Believe it or not, most doctors would be happy to answer those questions and offer reassurance if warranted, especially if you're paying them.
I think you can use this sort of pseudo-science to justify vaccines post hoc. You can also use the same pseudo-science to justify not taking them at all.
I know quite a few people who got lasting side effects from the Covid vax, and it’s nearly heretical to talk about it. (These are people I know IRL, not internet reports) That alone makes me extremely skeptical about anyone saying how there are ~zero risks from any and all vaccines. Why is there a giant propaganda campaign to cover up the risks? Am I just some crazy statistical outlier who knows 3+ people very closely who’ve been vaccine maimed, even though it “hardly ever occurs” in the general population? I wouldn’t bet on that
I would, I guess.
Adverse reactions are going to cluster for one reason or another.
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People win the lottery despite the odds not being in their favor.
If you've bought a ticket, and then you find a million pounds in your bank account, then congratulations, knowing that the odds were stacked against you doesn't mean you've not won.
I know literally zero people who have been "vaccine maimed". I used to be responsible for a COVID ICU before vaccines too, and I can definitely tell you that I saw plenty die of it.
It is far more likely that you are either:
Lying. On the internet, anyone can be a dog, or claim to be one.
Mistaken.
Surrounded by people who are mistaken or lying.
Assuming 150 people you could "closely know" (Dunbar's number as a first approximation), then someone, somewhere, out there in the world will find 3 people who were harmed by vaccines. Because vaccines are not perfectly safe, and I've never claimed that. If you consider people who are mistaken about their illness being caused by a vaccine, then the number skyrockets.
I think the immense propaganda to get vaccinated and stfu should tell you something, and a curious rationalist should wonder why there is this pressure for vaccines and no other medical intervention or medicine?
If I say “I don’t believe in antibiotics, I won’t be giving my kids any” generally people are like “lol weird but ok”. “I don’t believe in braces, teeth with straighten themselves out over time” … “haha ok good luck”
Why is it totally different about vaccines? I believe it’s because there are way more side effects than stated, and pharmaceutical companies make more money than god by mandating they go into everyone’s arm starting from birth. Therefore requiring heavy propaganda and narrative control campaigns.
Last thing I’ll say: clearly you are the type of person who strongly enforces the “right” point of view and socially polices other people’s takes on vaccines. If I had a vaccine side effect and you were my friend, I’d probably be mum about it
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I don't know one single person who had lasting adverse effects from the vaccine. This includes professionally. I do know many with acute effects (including myself).
I've also met a few people who have made claims of adverse effects but they've all been clearly mistaken (typically it involves active mental illness, or sometimes other clear medical causes of the problem which they attribute to COVID).
I'll be real with you, I find the fact that you're being downvoted so heavily rather frustrating.
We're both doctors, and we're not perfect. Most doctors aren't perfect either, but I would expect you'd agree with me when I say the majority of our colleagues are smart, conscientious people who genuinely want to do right by the people who see them.
We've conceded that vaccines have risks. We've pointed out scenarios where vaccination might be technically net positive, but of such minuscule effect that people shouldn't run around screaming because they've missed a shot. We've pointed out circumstances where the calculations change, and that vaccination schedules are made for the whole population, and not just for conscientious upper middle class nerds who take care of their health.
If I was being paid at US rates, you'd bet I'd walk any neurotic person through an entire questionnaire that ticks off boxes and adds up net QALYs for any given vaccine. This isn't really feasible at scale, and mass media is necessarily something that must scale and reach the LCD.
Yet I see more FUD than I want to here. Somehow the whole profession is discredited by covid, even though quite a few doctors would happily tell you that the way the pandemic was handled was far from perfect.
It all strikes me as a gross over-correction. The public should trust the medical field and the US government less because of our errors, but some people are throwing out the unvaccinated baby with the bath water.
I know we've got more than our fair share of contrarians, the Motte encourages their presence, but damn.
We agree mistakes were made.
What follows? And then what?
One option is that people just straight-up stop trusting experts. You don't like that option, for what seems to me to be a number of fairly solid reasons. What's your proposed alternative, and where do you see it being implemented?
Doctors go through lengthy training, but while you can't just walk into a hospital and ask to become an intern, the textbooks are free, and so is most of the research and literature (if you know how to use libgen).
If you can't parse the literature and weigh up the risks and benefits with confidence, then I'm afraid the only solution is to look at people you think are trustworthy and do as they suggest.
There's a reason that doctors tend to be highly paid professionals in almost every country, and it isn't all regulatory capture. (British doctors make above median wages, but nowhere near a free-ish market would settle as we're victims of regulatory capture).
This is because medicine is difficult. It's also the easiest it's ever been, now that so much knowledge and resources are available to anyone with an internet connection. If you've taken high school biology and have an LLM, there's practically nothing you can't theoretically learn given the time and will. This is often impractical, hence why you want to pay someone who doesn't need to do this.
I think a sensible reaction to covid pandemic measures would be to demand governments provide far more evidence to justify a lockdown longer than a month. If it's not abundantly clear that you're dealing with a disease that kills upwards of several % of the population, by the time that period is over, then demand the lockdowns end or violate them in public protest.
You should trust doctors very slightly less, trust governments and government medical bodies quite a bit less, but IMO, if you're at the point where vaccines seem net-negative to you, you've over-shot the mark.
If you really want to, there's always the option of litigation against government officials if you can prove they willfully lied. If they encouraged lockdowns when it became clear it wouldn't help, or overstated the benefits of vaccination (without the benefit of hindsight), then they should be accountable for the harm.
the sensible reaction is Governments don't get to lockdown anymore.
You had the power, you abused it, you don't get the power anymore.
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My concern at this point is not justifying a lockdown more than a month. I believe there is now sufficient backlash on that particular subject.
My concern at this point is what other thing that might be demanded next time.
If I have a pilot who forgot to put the landing gear down, went through remedial training on the subject, and was reinstated, my concern is not so much the pilot forgetting to put the landing gear down a second time. That particular item has been well-established. My concern is moreso "what other things might the pilot have forgotten that weren't covered in the remedial training?" Same idea.
(This is why remedial training often covers far more than just the specific incident.)
Government officials often have immunity.
The burden of proof lies the wrong way for this to help in practice, as all of these are nigh-unfalsifiable.
Of course, if your intent is for this to be a bureaucratic tarpit then your job is done here. I sincerely hope that is not your goal.
Do you have better alternatives? At the end of the day, if you're unhappy with the government, then you need to elect a better government. I presume that it wouldn't be impossible to strip bureaucrats of their immunity if the laws was changed to reflect that. What else could I really advise, that someone shoot Fauci?
In a way, the new Republican government reflects the deep unrest with previous medical policy. RFK isn't a fan of vaccines.
The reason I advocate for governments having the ability to impose lockdowns and quarantines is because pandemics can be highly dangerous. Covid was initially believed to have a ~1-10%% CFR for the first few weeks, and on the higher end, the serious possibility of several hundred million people dying justifies some action be taken. I think a month is enough to narrow the CFR down, leaving aside the primary benefit of reducing spread.
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I feel that.
Not sure what to do about it, though.
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The impression I've gotten in my time here is that most people are pretty much just smart enough, with a side helping of tech-bro-ism.
Medicine seems easy/simple from the outside in a large part because most people here are young and healthy and don't interact with the complicated parts of the field. Most people here also don't exist in fields where a lit review is a thing (in a large part because most of the people who do that are far left at this point). A half assed opinion piece is considered an authority and their's no need to read primary source material or contra narrative information critically.
We (docs) also get used to hardcore digging in because of skin in the game. If I pick the wrong medicine my patient fucking dies. That means I'm naturally going to have much more "informed" commitment to my medical views (even when they turn out to be a wrong) than somebody arguing on the internet without significant consequence.
Add in the political climate - nothing I say when defending medicine is going to do anything to separate me seeming like one of "those" COVID people to skeptics.
All those types of things together and more and you get my downvotes and the vitriol.
You should use this as a Gell-Mann Amnesia moment however. As my media diet continues to improve I get access to more and more better primary source material and you see things like rampant factual inaccuracy here on other topics outside of medicine that I've just happened to have been informed about.
We are still pretty good here! But outside of a few reliable posters you'll see a lot of very confidently stated low information stuff being promulgated.
Ultimately most of the people still complaining about COVID are having a tantrum. I get why they are having a tantrum, I was not happy about some of the policy decisions - but it's still a throwing the baby out with the bathwater moment.
Fortunately for my sanity, I've filtered my Twitter feed to the extent that the most profound cases of retardation miss me haha.
This is what irks me the most. Short of going full Dr. Phil and taking up full-blown vaccine denialism, what can I say to people with that mindset and convince them? It's an utter mode collapse, there are certainly people in this thread who have views more nuanced than "all vaccines are amazing and harmless" and "vaccines are designed to turn you into a gay frog", but it confuses me.
I'm rather fortunate that medicine was never this politicized either in India or the UK. There isn't the same degree of digging in of heels and treating arguments as soldiers rather than an attempt to establish empirical fact.
COVID lockdowns were a bust, but even if they'd curbed the disease, I'm unsure if it was worth it if it pissed off tens of millions of people in the States to the point that even basic medical knowledge became untrustworthy.
Do these people not note that there are >180 other countries out there? If vaccines were a scam or net harmful, then you'd find at least a few countries that rejected them wholesale. The only ones without state vaccination programs are absolute basket-cases, and even they have the sense to accept foreign medical aid.
...which was repeatedly stated at the start of the pandemic by people who were later denounced as COVID deniers and largely memory-holed since then.
(I'd love to give references, but for the obvious problem with this.)
I don't necessarily disbelieve you. But the level of justification for lockdowns at Day Zero, 30, 90 and 365 varied significantly.
Remember that in the very early days, we genuinely weren't sure of COVID's CFR, if there's a disease that's spreading like wildfire and you aren't sure it won't kill tens or hundreds of millions, then I think an initial lockdown is sensible. Once it becomes clear that it's nowhere as bad as it was thought, and the primary risk was for old and sick people, then lockdowns should have been lifted. I don't think that this was obvious until several months in, and I was doing my best to stay abreast. There was genuine terror that I and other doctors could catch it, and that it had a very real chance of killing us. I think around 3 months in, I was personally feeling safer, but still worried about spreading it to the elderly members of my family, and still was right up till vaccines became available.
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If it makes you feel better you can usually have a healthy conversation about this in real life if you are sufficiently skilled, I've converted anti-vaxxers before, but it's nearly impossible to do online for all the reasons most things with any amount of heat are nearly impossible to do online.
Additionally most people have some things they are absolutely retired about, with many people feeling hopelessly abused by social justice and modern leftist politics they are likely going to be retarded about anything that touches that stuff at all.
I do wonder if some of your surprise comes from being in India during COVID - the way things felt in the UK or US vs India may make for some difference in experience or expectation?
I've never met an anti-vaxxer in person, though I'm not usually in the business of handling vaccinations! I agree that if you establish a good therapeutic relationship, it's possible to make people come around.
India was far more sane about lockdowns. I think ours lasted 4 to 6 months, and eventually the government realized it was economically untenable if nothing else.
We never had an anti-vax movement of note, everyone and their dog was fighting for a shot when they became available.
I actually don't know what it was like in the UK at the time, it wasn't on my radar nearly as much as the US was. All I remember is reading about scandals where Dominic Cummings was caught partying during the same time the government was demanding everyone stay home.
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I suppose I am confused. Development is more important than body weight, but I'll concede the point rather than double down because of my misapprehension.
As for medical care, my child had a doctor, then she moved, and now we have a RN. As for calculations, of course you haven't presented any, but I have done my own sanity check, and I'm satisfied with my numbers.
To show my work I found this:
So, without any vaccine, we're talking 500 deaths per year, in a country of roughly 180 million (1960 census numbers). This is one death every 360,000 people, or an annual risk of .000002778 per person per year.
Traffic fatalities are about 1 per 100,000,000 miles travelled (0.8 in ten-year old data). Cancelling out all the tens and hundreds and thousands, and assuming about 10,000 miles driven in a year, I'm left with driving as 25-30x more dangerous than measles before the vaccines.
That's using pre-vaccine numbers and pre-vaccine prevalence. Post-vaccine, as a free rider, it's much lower. This doesn't justify an active intervention. It's firmly in the realm of take-it-or-leave-it.
And again, when I do these numbers on what is supposed to be the most useful, safest, most justified vaccine, I'm left wanting. When I consider Hep B which they want to give children in the first hour post-birth despite no plausible method of transmission, I'm left with the conclusion that nobody is willing to discuss the actual risks, they just want to enforce compliance. That the CDC people really do view me as sheep, or cattle, as part of their herd.
I do genuinely appreciate this, thank you.
To address the rest of your comment, I will point out what I see as potential errors:
The measles vaccine isn't given by itself in most of the world, so you're looking at calculating the combined benefits of simultaneous vaccination for measles, mumps and rubella vs the combined risks.
Restricting the potential harm to just death is incorrect. Even a mild bout of measles has quantifiable harm, and in the link you've provided, they quite clearly mentioned that before vaccination, 3/10 of measles victims had:
Ear infection
Pneumonia
Encephalitis (swelling of the brain)
Subacute sclerosing panencephalitis (a disease characterized by progressive neurological deterioration and early death)
Hemorrhagic measles – includes seizures, delirium, difficulty breathing and bleeding under the skin
Clotting disorder
Death
None of these strike me as very pleasant, leaving aside that that's just one of the three diseases that the MMR shots protect against robustly.
If you wanted to quantify the harms of driving, then you also need to consider disability and not just death, and ideally monetary damages. You also need to look at the benefits, for many people in the US and elsewhere, living without access to a car is debilitating by itself.
As you can see, both I and @throaway05 are more than happy to discuss risks. And so are most other medical professionals, in my experience. The average NHS paediatrician gains nothing personally by taking extra time to talk to patients about their concerns, but does it nonetheless. They don't get to bill you extra for the privilege.
It's unfortunate that your child had a vaccine reaction, but it was a mild one. Even if their wellbeing was your only concern then you should seek to sit a doctor down and go over a proper cost-benefit analysis and even potentially figure out the likely culprit for the previous reaction.
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Hep B can be transmitted from mother to child at birth, if not medically prevented.
How does post-exposure vaccination work? I can't wrap my head around it when the mother and child were sharing every bodily fluid possible for 9 months.
It's wild that it works, right?
Not quite - the whole point of the placenta is to share oxygen and nutrients without directly sharing blood, and apparently the Hep B virus generally doesn't make it through an undamaged placenta, or through an undamaged amniotic sac (which makes amniocentesis a risk for infected mothers), whereas some Hep B antibodies do make it through the placenta, and some accumulate in the placenta and may form a bit of a "barrier" there.
I'm not an expert in any of that, though, and it looks like part of the answer is "luck". Some viruses slip through the placenta much more easily than others, despite the obvious natural selection issues to the contrary.
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That requires the mother to have it, which means if she doesn't, there's no plausible method of transmission.
Most mothers do not have it.
Yeah, we're down to 1000 mother-to-child transmissions a year in the US. The tradeoff here is between "a lot of babies get a vaccine they could have gotten later" vs "a few babies get a disease they can't get cured later".
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