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#151 of 157 Old 03-05-2009, 07:27 PM - Thread Starter
 
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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"
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#152 of 157 Old 03-06-2009, 02:17 PM
 
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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
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#153 of 157 Old 03-08-2009, 09:48 PM
 
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Originally Posted by mamakay View Post
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.
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#154 of 157 Old 03-08-2009, 10:43 PM
 
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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".

Quote:
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.

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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.
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#155 of 157 Old 03-08-2009, 11:25 PM - Thread Starter
 
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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?
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#156 of 157 Old 03-14-2009, 09:39 PM
 
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Originally Posted by mamakay View Post
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).
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#157 of 157 Old 03-15-2009, 01:09 AM
 
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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.
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