Free-Rider Argument - Page 8

[mamakay]

And with the way it works, they're guaranteed to get people buying the additional doses:

http://www.reuters.com/article/gover...29730720070314

And when vaccinated children were infected, they tended to be sicker, probably because they were older.

"If you're unvaccinated and you get it later in life, there's a 20-times greater risk of dying compared to a child, and a 10 to 15 times greater chance of getting hospitalized," said Jane Seward of the Centers for Disease Control and Prevention in Atlanta, who worked on the study.

The findings, reported fully for the first time in Thursday's New England Journal of Medicine, have already had an impact.

They helped prompt the CDC's Advisory Committee on Immunization Practices to recommend a booster shot between the ages of 4 and 6.

"You can check out any time you like, but you can never leave"

[Deborah]

In the U.S., the ACIP is the committee which adds to vaccines to the recommended schedule. The states use these recommendations to mandate vaccines. And the pediatricians use the recommendations as a guide to when and how many shots to give.

The FDA, I believe, runs this committee. And they do mass conflict of interest waivers for the people who serve on this committee and other committees.

This system is the last piece that keeps the vaccine machine happily rolling along.

I was interested to see, however, that the recommendations hit a bit of a bump when it came to Gardasil. The man behind the curtain had his butt sticking out. Some stories actually got into the news about Merck manipulating the state legislatures to get them to mandate the vaccine.

The response to the problem? Two attempts to pass laws (NY and CA, I believe) to have all CDC recommended shots AUTOMATICALLY added to the mandates without any discussion by the legislative arm at all. This failed, but I think they'll be back.

[mamakay]

The FDA, I believe, runs this committee. And they do mass conflict of interest waivers for the people who serve on this committee and other committees

Naw, it's the DHHS that's over the CDC/ACIP. I think ACIP appointment comes right from the President.

ETA:Just re-checked..it's the Secretart of the DHHS that appoints the ACIP members.

[Deborah]

But I think I'm right about the conflict of interest waivers!

Thanks for sorting that out, mamakay.

[anewmama]

Chickenpox is often considered a harmless childhood disease, but before vaccination, 100 children died each year from complications of chickenpox in the United States alone.

So, all childhood death is sad, but they have mucked this up to save 100 deaths? That seems such a small number. And to have the vaccine cause all these other secondary problems?!

[Sileree]

Bleh. The 100 children stat is not true, of 100 people who died only 30-40 were children according to the CHOP website of all places.

[shuttlt]

Hi everyone. I've been unable to log on to the forum for 24 hours (we decided to play let's spend Sunday in the emergency department at the local hospital). I just wanted to say how much I agree with the bulk of what's been posted. All the stuff about packaging up things like herd immunity and putting a pretty bow on it, when actually it is complex and messy thing.

Incidentally, we were asked by the nurse whether he was up to date with his vaccinations, even though the problem didn't obviously have anything to do with that. I think it was some form of small hemangioma (though it really looked more like a blood blister) on the side of his nose that started bleeding and we couldn't make it stop. Why vaccines were relevant, I have no idea. I guess it was a standard form that the nurse wanted to fill in with a bunch of catch all question. Two minutes before seeing the doctor he decided to do some DIY surgery and removed the whole thing himself, which didn't help the bleeding any. He loved the attention and made dinosaur noises while flirting with the nurses, mean while his mum and I were in full panic mode. Last night was like the first couple of weeks, trying to stay awake all night to make sure he was still breathing.

Ah! parenthood...

[ema-adama]

Originally Posted by shuttlt

Last night was like the first couple of weeks, trying to stay awake all night to make sure he was still breathing.

Ah! parenthood...

I hope you are all feeling better and getting some rest.

[shuttlt]

Originally Posted by ema-adama

I hope you are all feeling better and getting some rest.

Thanks.

[mamakay]

Glad it wasn't too traumatic for the kid. Poor parents, tho. lol

[Deborah]

bumping this, just to make sure that everyone has said everything they want to say...before it drifts off to the afterlife zone for threads

or as my granddaughter said after their cat died "the big futon up in the sky"

[medusaatemydog]

i think simply put.... no one should be forced coerced or manipulated into using a medical procedure or therapy they do not want... It is an invasion of the body/person and if this mandatory thing with vaccination does not go away...you will have very little rights to have a say in what happens to you and your body in the future...future generations may very realistically spend thier lives in servitude to the pharmecutical entity.... i don't think it matters if vaccination works, which i do not believe it does.... but it is a very good tool for control and in the future there is a possibility a person will have no say in what happens to thier body and will have no control over thier mortality.... modern medicine has no ethics when it comes to "mandatory" anything.

People have this ridiculous idea that we can get rid of disease...disease is part of what it is to be a living biological being.... you can vaccinate all you want, something else will be there to take it's place

[zylph]

Originally Posted by mamakay

Sometimes they know what to "suspect", sometimes not.

Deborah mentioned (was it in this thread?) the "insane optimism" with which new vaccines are introduced. Having that zeal is sort of a prerequisite for work in the upper teirs of public health, it seems.
The Immunization program is the child of a "public-private partnership". The "private" end of things, of course, is not going to have a motive to talk about how their product might not actually work out so great. In fact, the people who call the shots there have an obligation to promote their product and make money for their companies, more or less at all costs. So you will never, ever see Wyeth talking about how staph replaces pneumococcus until they have a staph vax, for example.
So we're left relying on the "public" side of things for any hope of an objective evaluation of the possibilities, but in addition to their problem with "insane optimism", those individuals spend quite a lot of time being...very very friendly...with their "private" partners.
I don't think it's corruption, but I do think there's an amazingly powerful groupthink and phenomenal amount of bias that sets in in these circles.

Yes, working in any type of public health setting does require a great deal of zeal and 'insane optimism.' Because whatever disease you're working on, you know just how bad it can be. Measles is not a dread disease for the vast majority of people. But for some, it can be really terrible - disfigurement, brain damage, death. These are the people you're trying to save. And a bias does creep in, but I don't think that it's necessarily all profit-driven. You'd have to be inhuman if you worked in a hospital in San Francisco in the 90s and didn't cheer on AZT, the first antiretroviral, even if the confidence turned out to be a bit misplaced. Because you knew how bad HIV/AIDS was back then.

I'm not saying there shouldn't be any checks on this bias towards optimism, just that it's kind of unavoidable. When you work in public health or biomedical sciences, it is not really all that lucrative and you put in a lot of hours. But you do it because you want to help and of course you're going to be optimistic about new treatments.

Also, I think you'd be surprised how much planning goes into vaccines. I work on Hepatitis C - there's not even a promising vaccine candidate yet. But there are probably about a hundred papers out there talking about what risk groups should be in the clinical trials, how big these trials are going to need to be if the vaccine is genotype-specific, is this vaccine going to need to be subsidized given how it's transmitted (mostly intravenous drug users in industrialized countries), should it be prophylactic or preventative or preventative only among high-risk groups, etc.

And of course profit plays a role. It's unavoidable given how we approach health care. From a utilitarian standpoint, the best thing that pharmaceutical companies could do is drop everything and start to work on malaria treatments and antibiotics that are more effective for tropical diseases. A soul-crushingly low amount of money is spent on this. But given that vaccines actually make relatively little money for pharma companies, I would be more worried about how much drugs like Ambien and Singulair are being pushed.

[mamakay]

Also, I think you'd be surprised how much planning goes into vaccines. I work on Hepatitis C - there's not even a promising vaccine candidate yet. But there are probably about a hundred papers out there talking about what risk groups should be in the clinical trials, how big these trials are going to need to be if the vaccine is genotype-specific, is this vaccine going to need to be subsidized given how it's transmitted (mostly intravenous drug users in industrialized countries), should it be prophylactic or preventative or preventative only among high-risk groups, etc.

I know there's a lot of planning, but the manufacturers have a lot of say in that, too. For one thing, once they're at phase II or beyond, they can tell the ACIP that they're not even going to make the product at all without a universal recommendation (which morphs into state mandates over time).
This has happened before. (I'll find a link if you want).
Another motive to vaccinate "everyone" is price tiering. Mass vaccination in the US brings the manufacturing costs down, then Europe can afford them, then developing nations...and the vision of being able to save MILLIONS of lives REALLY fuels the "insane optimism".

And a bias does creep in, but I don't think that it's necessarily all profit-driven. You'd have to be inhuman if you worked in a hospital in San Francisco in the 90s and didn't cheer on AZT, the first antiretroviral, even if the confidence turned out to be a bit misplaced. Because you knew how bad HIV/AIDS was back then.

I don't think it's profit driven on the part of people in public health. I think they are completely convinced of the fundamental goodness of everything they do. They are just wanting to save lives.
But industry, with it's own motives, uses that zeal for it's own purposes and sort of muddies the waters with questionable data and "scenarios" presented as fact.

But given that vaccines actually make relatively little money for pharma companies, I would be more worried about how much drugs like Ambien and Singulair are being pushed.

Old vaccines aren't profitable, but the new ones very, very much are. Merck and Wyeth make more money from their vaccines than they do anything else.
I guess I'm also more worried about vaccines because of the mandatory aspect. Nobody gets threatened with jail for not taking Ambien.

[Deborah]

There is an old saying that special cases make bad law (or something sort of like that) and I'm beginning to suspect that special cases make for bad public health policy.

Because some children and adults can die from measles everyone has to be vaccinated, regardless of the consequences, which are still unknown, 40 years into the vaccine program in the U.S.

Special cases should offer a special research opportunity to figure out why, once in a while, a mild childhood illness turns deadly. Instead, it always seems to turn into a special research opportunity to develop another universal vaccine program.

So, Hepatitis C. Is this going to become another universal vaccine because some people die from the disease? Does that really make sense?

[zylph]

Originally Posted by mamakay

I know there's a lot of planning, but the manufacturers have a lot of say in that, too. For one thing, once they're at phase II or beyond, they can tell the ACIP that they're not even going to make the product at all without a universal recommendation (which morphs into state mandates over time).
This has happened before. (I'll find a link if you want).
Another motive to vaccinate "everyone" is price tiering. Mass vaccination in the US brings the manufacturing costs down, then Europe can afford them, then developing nations...and the vision of being able to save MILLIONS of lives REALLY fuels the "insane optimism".

Oh, I'm sure it has happened before. Really, ever since effective tests have come out for HepB (to test the blood supply and biologicals), there's not much need to vaccinate people who are not intravenous drug users or health care workers. In this country. But having HepB scheduled in every country to prevent perinatal transmission (the 24 hours after birth thing) makes it far more affordable in developing countries, like you said. For people who don't think that vaccines are risky, there's no real drawback to this. Developed countries, even though the vast majority of the populace is never going to be exposed, get to block the transmission cycle. And the vaccine does a world of good in less developed countries.

Oh, and you were right about Varivax and Gardasil - I had no idea how much money those made for the companies involved (I guess those $300 vaccine courses add up to a lot).

I doubt that HCV is ever going to really be a universal vaccine, mostly because the virus is so variant. There are 13 genotypes out there now (well, probably more than that actually) and they are incredibly different from one another. Whatever vaccine does come out (if it comes out) is probably going to be genotype-restricted. Meaning that it will be more useful therapeutically to treat people who are already infected. And the transmission probabilities are even lower than HepB for low-risk populations (non-IDU, non-healthcare).

[mamakay]

I doubt that HCV is ever going to really be a universal vaccine, mostly because the virus is so variant. There are 13 genotypes out there now (well, probably more than that actually) and they are incredibly different from one another. Whatever vaccine does come out (if it comes out) is probably going to be genotype-restricted. Meaning that it will be more useful therapeutically to treat people who are already infected. And the transmission probabilities are even lower than HepB for low-risk populations (non-IDU, non-healthcare).

Hmm..
It seems like there would be more money to be made in developing a multi-valent prophylactic HepC vax that would be eventually be expected to be introduced globally. So, I bet there's more money out there being thrown in that direction, or will be once someone in academia or some little biotech company figures out how to make it.

Plus, the technology behind theraputic vaccines seems to be lagging pretty far behind the preventive ones in general.