Vaccines

https://skeptoid.com/episodes/4596

Stan you really should vet the credentials of the "experts".

I'm interested in facts, not impressed by 'experts'. Are you really trying to tell me that you're happy with the way things are set up Steve? Seems to me that there is little or no control on big pharma, they can basically do what they like in the US. 

I for one don't want the same 'freedom' given to corporations in this country, especially with government enforcement. It's scary, but you seem not to be at all bothered?

If anyone is interested, this is the study which is referenced in the first part of the video. I only watched until he started talking about learning disabilities after presenting this study, since by that point I had already identified numerous problems with misleading and false information (I figured there was no point in filling my head with misinformation). 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5360569/

If anyone is actually interested in discussing potential non-specific effects of DTP vaccines in west-african children at very high risk of infant mortality, I did find good information on the subject (the question has been studied for decades - for example, the authors of that particular study have been mining that data from the early 1980's, for at least 15 years). However, that seems pretty far removed from the concerns the anti-vax crowd has about privileged white kids.

Linda

I'm interested in facts, not impressed by 'experts'. Are you really trying to tell me that you're happy with the way things are set up Steve? Seems to me that there is little or no control on big pharma, they can basically do what they like in the US. 

I for one don't want the same 'freedom' given to corporations in this country, especially with government enforcement. It's scary, but you seem not to be at all bothered?

Let's keep it to does vaccination work?

Let's keep it to does vaccination work?

Don't you see that answering that question properly demands proper oversight of the industry, which  is presently missing.

Don't you see that answering that question properly demands proper oversight of the industry, which  is presently missing.

We could start by looking for useful information about whether there is proper oversight of the industry (rather than depending upon being misinformed about it). I'm curious about how you and others would do so.

Linda

Don't you see that answering that question properly demands proper oversight of the industry, which  is presently missing.

9
I see them as two separate questions. The first question is: Does vaccination work? The other concerns the self serving business practices of drug companies. I certain the misinformation presented by anti-vaxers such as Hurmy is far more worrisome and certainly could have graver consequences.

Pretty much (for your purposes, anyway).

This is why everyone says that you're a smug know-nothing asshole. Why not just say "yes"? Why do you feel the need to add "for your purposes, anyway"... as if I'm being disingenuous or twisting something... as if there is any room for debate about this point and you'll condescend to humor me.

Asshole.

The CDC's yearly vaccine effectiveness studies are test-negative case-control studies. Agree? (hint: "YES" is the correct answer)

No, odds ratios don't depend on the underlying incidence... No, again, the underlying prevalence of ILI and propensity to seek medical care do not alter the equation.

You're completely wrong.

Although I can't find it at the moment, one of the CDC's presentations of their study noted the underlying assumptions. And a quick google search can find many study authors mentioning the fact that this test-negative case-control methodology relies on these assumptions. Here is just one I found within 5 seconds:
https://www.ncbi.nlm.nih.gov/pubmed/23499601
"With the assumptions that (a) the distribution of non-influenza causes of ARI does not vary by influenza vaccination status, and (b) VE does not vary by health care-seeking behavior, the VE estimate from the sample can generalized to the full source population..."
"The cost of the test-negative design is the additional, difficult-to-test assumptions that incidence of non-influenza respiratory infections is similar between vaccinated and unvaccinated groups within any stratum of care-seeking behavior, and that influenza VE does not vary across care-seeking strata."

I'm not sure what you were going for with this.

I provided an example case where these assumptions are bad and the test-negative case-control study would show high VE even if practically the only people getting sick are vaccinated.

Isn't it true VE is not the only statistic needed to gauge flu vaccine benefit?

Yes. That's why there are many different studies done to gauge benefit (and risk).

VE means nothing without knowing the risk of getting the flu while unvaccinated. So a person would need to know the likely infection rate in their group in order for VE to provide any measure of benefit.

Let me explain this to you again since you can't seem to wrap your mind around it.
If the probability of getting the flu for a healthy 35 year old male is 1 in a trillion and that person takes a vaccine with 50% VE, then he now has a 1 in 2 trillion chance of getting flu. The vaccine provides a negligible benefit.

If the probability of getting the flu for a 75 year old alcoholic is 1 in 2, then 50% VE would lower the probability to 1 in 4 - a substantial benefit.

There is no good data on flu risk and estimates I've seen vary wildly from <1% to 20%. Without good data on unvaccinated risk, VE can tell us nothing about the benefit.

My personal experience is that I've only once in my life had the flu and it was when I was child and it was around the age that I received my one and only flu shot. I rarely ever encounter anyone who has the flu or has had the flu recently. Since there is not really much good data to go on, I'll just go on my personal experience and say that the actual chance of me getting the flu as a healthy person is very very low, so even a high VE would provide me with negligible benefit and it would carry additional risks.

Does pro-vaccine propaganda and advertisement make anyone aware that VE % alone means nothing?

I don't know. People seem to follow the advice of their physician and public health advisors, which makes the point moot, I suspect.

Of course you know. You're just being obtuse again. The CDC's VE estimate gets disseminated as the sole number upon which people are supposed to gauge benefit. It gets talked about on TV talk shows and news programs. It is included in flyers and advertisements and employee handouts. But the VE estimate is never accompanied with unvaccinated risk or infection rate which is necessary to gauge benefit.

This is why everyone says that you're a smug know-nothing asshole. Why not just say "yes"? Why do you feel the need to add "for your purposes, anyway"... as if I'm being disingenuous or twisting something... as if there is any room for debate about this point and you'll condescend to humor me.[

Asshole.

The CDC's yearly vaccine effectiveness studies are test-negative case-control studies. Agree? (hint: "YES" is the correct answer)

I was trying to be nice and make sure that I didn't lead you astray. There are some minor technical differences between this study and a classic case-control study. For our purposes here, those minor technical differences don't matter. But they might in a different study, so I wanted you to be aware that you couldn't necessarily take what you know about this study and apply it to another.

You're completely wrong.

Although I can't find it at the moment, one of the CDC's presentations of their study noted the underlying assumptions. And a quick google search can find many study authors mentioning the fact that this test-negative case-control methodology relies on these assumptions. Here is just one I found within 5 seconds:
https://www.ncbi.nlm.nih.gov/pubmed/23499601
"With the assumptions that (a) the distribution of non-influenza causes of ARI does not vary by influenza vaccination status, and (b) VE does not vary by health care-seeking behavior, the VE estimate from the sample can generalized to the full source population..."
"The cost of the test-negative design is the additional, difficult-to-test assumptions that incidence of non-influenza respiratory infections is similar between vaccinated and unvaccinated groups within any stratum of care-seeking behavior, and that influenza VE does not vary across care-seeking strata."

They are referring to whether the VE estimate can be generalized to the general population. The assumption is that the controls are drawn from the same population as cases (in this case the "population" is people presenting to a clinic with an ILI). Within that population, VE is the same regardless of the portion of that population which is vaccinated (if the vaccine makes you susceptible to non-influenza ILI, that portion will be larger). However, you may not be able to generalize back to the general population.

This is a moot point, though. This kind of study doesn't tell you if the influenza vaccine makes people more likely to get non-influenza ILI (which I think is what you were getting at). However, studies which do look for this specifically have found that, if anything, influenza vaccine seems to provide some additional non-specific protection against other ILI. 

I provided an example case where these assumptions are bad and the test-negative case-control study would show high VE even if practically the only people getting sick are vaccinated.

VE means nothing without knowing the risk of getting the flu while unvaccinated. So a person would need to know the likely infection rate in their group in order for VE to provide any measure of benefit.

Let me explain this to you again since you can't seem to wrap your mind around it.
If the probability of getting the flu for a healthy 35 year old male is 1 in a trillion and that person takes a vaccine with 50% VE, then he now has a 1 in 2 trillion chance of getting flu. The vaccine provides a negligible benefit.

If the probability of getting the flu for a 75 year old alcoholic is 1 in 2, then 50% VE would lower the probability to 1 in 4 - a substantial benefit.

There is no good data on flu risk and estimates I've seen vary wildly from <1% to 20%. Without good data on unvaccinated risk, VE can tell us nothing about the benefit.

Yes. I specifically agreed that more information than just VE is necessary. ("Yes. That's why many different studies are done to gauge benefit (and risk).")

Of course you know. You're just being obtuse again. The CDC's VE estimate gets disseminated as the sole number upon which people are supposed to gauge benefit. It gets talked about on TV talk shows and news programs. It is included in flyers and advertisements and employee handouts. But the VE estimate is never accompanied with unvaccinated risk or infection rate which is necessary to gauge benefit.

I don't actually know this. I don't watch TV talk shows or news programs, or pay much attention to flyers. The vaccine information sheet I received yesterday for my flu shot doesn't include this.

Linda

I was trying to be nice and make sure that I didn't lead you astray.

Hah... B.S. ...you were using rhetorical tactics to try and assert your superiority and authority. Now you're acting like the victim. It is impossible to have a productive conversation with you, because it is impossible to build consensus around any set of facts. Even when something is blatantly obvious, you won't simply agree on it without throwing in misdirection, rhetorical tactics, or tossing it in a word salad.