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The problem with this line of reasoning is that there is a huge difference between controlled trials (which are obviously imperfect themselves) and post-hoc ana

by cuspy 4y ago

The problem with this line of reasoning is that there is a huge difference between controlled trials (which are obviously imperfect themselves) and post-hoc analyses of uncontrolled real-world outcomes. There's a big leap of faith in trusting our public health authorities' ability to accurately measure and faithfully represent the real situation. Just to name one small issue, our only measurements of vaccine efficacy are case counts, covid hospitalizations and covid deaths. Each one of these measurements is confounded by population-level differences in testing rate, testing polices (ie routine testing on entrance to hospital), PCR cycle count, and many other factors. There is no longer a monitored control group, so we can't ever account for any group-level differences or confounds. I've seen no attempt to address these issues. We also have no access to reliable data about confirmed adverse effects. A year later, it is still very hard for a person to quantitatively assess his/her own age-stratified risk/benefit tradeoff, even with the confounded efficacy measures. So, given all that, why isn't skepticism reasonable anymore?

fabian2k 4y ago
The effect of vaccinations is huge here, especially if we focus on deaths and hospitalisations in elderly people. There are of course issues with using data that only observed and not part of a strict randomized and blinded trial. But the difference observed in many different studies between unvaccinated and fully vaccinated is simply so enormous that it doesn't really leave any room for doubt. The effect of the vaccines is so huge that you only have to look at a Kaplan-Meier plot and will immediately see the huge difference. And we don't have a single study here, we have a lot of different ones that all indicate that the vaccines are very effective and safe.
- cuspy 4y ago
  I would trust sound data and transparent analyses showing age-stratified risk analyses if they existed. With all respect, what you just wrote is essentially hand-waving and talking past what I wrote. High effectiveness for elderly people (which I find plausible but also still deeply confounded by testing rate differences) in no way justifies mandates for people in their early 20s. In some proportion of hospitals, when someone who is not vaccinated goes to hospital for any reason, they are tested for COVID-19. If found positive this is counted as a COVID-19 hospitalization. We have no access to the precise rate of these incidental hospitalizations. In some of these hospitals, it is the policy that vaccinated people who go to the hospital are NOT routinely tested unless they have symptoms. If this is the policy at a substantial number of hospitals, it could dramatically change the "effect size" of the measurements that we are talking about. The same issues essentially applies to COVID-19 deaths and cases. Large effect size alone generally isn't convincing when you're using such fundamentally confounded sampling procedures, merged age-groups with wildly different risk profiles, and data aggregated across long time-windows with different population sizes.
  - twofornone 4y ago
    These confounders are everywhere. Sort of in the way that only the dumb criminals get caught, we're probably missing many more confounding factors because our statistical analyses have limitations. Now add the stigma around questioning the vaccines political/financial pressures and you have a recipe for poor quality science. It's not a conspiracy, people just tend to look away from things that could endanger their livelihoods. An emergent property of socioeconomic systems. A failure mode, so to speak.
simonh 4y ago
I really don’t see why there is a huge leap of faith with coronavirus vaccines, but not with the many safe, effective vaccines and medications we all benefit from throughout our lives. Have you always felt this way about the medical profession? Have you any specific reasons to doubt the medical profession and it’s institutions, across many nations and accreditation agencies, now in particular?
- twofornone 4y ago
  >but not with the many safe, effective vaccines and medications we all benefit from throughout our lives. Because mRNA is a novel technology and that people obliviously make this argument is a testament to the effectiveness of the "safe and effective" propaganda. >Have you always felt this way about the medical profession? Have you any specific reasons to doubt the medical profession and it’s institutions, across many nations and accreditation agencies, now in particular? There were numerous reasons to be skeptical before covid - regulatory capture and the replication crisis in particular. Suddenly bringing these up gets you branded an anti-vaxxer. Wr shouldn't be blindly trusting our modern institution, it has strayed increasingly far from clean science over the years, now you have influences from industry and unrelated politics, in addition to the pressures that come with sticking close enough to orthodoxy to maintain a career and receive funding for grants. When I was younger I also had much more trust in our institutions, but with age and experience I have grown to recognize how imperfect they are, and none of those imperfections disappeared when the president decided he wanted a new vaccine yesterday; in fact many of those problems were enormously amplified.
  - simonh 4y ago
    Novel medical technologies are developed all the time. Every year new life saving treatments and drugs come out that transform the lives of people all over the world. Medical technology is still very much on the vertical part of the technological development S-curve, and development and testing methodologies have been improved and refined over many decades of experience, in many countries around the world working together to develop best practices and cross-check each other's work. Why are you particularly concerned about these ones? Are there any others of the many, many new medical technologies coming out for which you have the same concern, or is it all of them?

by cuspy 4y ago

fabian2k 4y ago

The effect of vaccinations is huge here, especially if we focus on deaths and hospitalisations in elderly people. There are of course issues with using data that only observed and not part of a strict randomized and blinded trial. But the difference observed in many different studies between unvaccinated and fully vaccinated is simply so enormous that it doesn't really leave any room for doubt. The effect of the vaccines is so huge that you only have to look at a Kaplan-Meier plot and will immediately see the huge difference. And we don't have a single study here, we have a lot of different ones that all indicate that the vaccines are very effective and safe.

cuspy 4y ago
I would trust sound data and transparent analyses showing age-stratified risk analyses if they existed. With all respect, what you just wrote is essentially hand-waving and talking past what I wrote. High effectiveness for elderly people (which I find plausible but also still deeply confounded by testing rate differences) in no way justifies mandates for people in their early 20s. In some proportion of hospitals, when someone who is not vaccinated goes to hospital for any reason, they are tested for COVID-19. If found positive this is counted as a COVID-19 hospitalization. We have no access to the precise rate of these incidental hospitalizations. In some of these hospitals, it is the policy that vaccinated people who go to the hospital are NOT routinely tested unless they have symptoms. If this is the policy at a substantial number of hospitals, it could dramatically change the "effect size" of the measurements that we are talking about. The same issues essentially applies to COVID-19 deaths and cases. Large effect size alone generally isn't convincing when you're using such fundamentally confounded sampling procedures, merged age-groups with wildly different risk profiles, and data aggregated across long time-windows with different population sizes.
- twofornone 4y ago
  These confounders are everywhere. Sort of in the way that only the dumb criminals get caught, we're probably missing many more confounding factors because our statistical analyses have limitations. Now add the stigma around questioning the vaccines political/financial pressures and you have a recipe for poor quality science. It's not a conspiracy, people just tend to look away from things that could endanger their livelihoods. An emergent property of socioeconomic systems. A failure mode, so to speak.

simonh 4y ago

I really don’t see why there is a huge leap of faith with coronavirus vaccines, but not with the many safe, effective vaccines and medications we all benefit from throughout our lives. Have you always felt this way about the medical profession? Have you any specific reasons to doubt the medical profession and it’s institutions, across many nations and accreditation agencies, now in particular?

twofornone 4y ago
>but not with the many safe, effective vaccines and medications we all benefit from throughout our lives. Because mRNA is a novel technology and that people obliviously make this argument is a testament to the effectiveness of the "safe and effective" propaganda. >Have you always felt this way about the medical profession? Have you any specific reasons to doubt the medical profession and it’s institutions, across many nations and accreditation agencies, now in particular? There were numerous reasons to be skeptical before covid - regulatory capture and the replication crisis in particular. Suddenly bringing these up gets you branded an anti-vaxxer. Wr shouldn't be blindly trusting our modern institution, it has strayed increasingly far from clean science over the years, now you have influences from industry and unrelated politics, in addition to the pressures that come with sticking close enough to orthodoxy to maintain a career and receive funding for grants. When I was younger I also had much more trust in our institutions, but with age and experience I have grown to recognize how imperfect they are, and none of those imperfections disappeared when the president decided he wanted a new vaccine yesterday; in fact many of those problems were enormously amplified.
- simonh 4y ago
  Novel medical technologies are developed all the time. Every year new life saving treatments and drugs come out that transform the lives of people all over the world. Medical technology is still very much on the vertical part of the technological development S-curve, and development and testing methodologies have been improved and refined over many decades of experience, in many countries around the world working together to develop best practices and cross-check each other's work. Why are you particularly concerned about these ones? Are there any others of the many, many new medical technologies coming out for which you have the same concern, or is it all of them?