[HN Gopher] Single-Shot and First Doses First
___________________________________________________________________
Single-Shot and First Doses First
Author : drocer88
Score : 38 points
Date : 2021-02-27 16:33 UTC (6 hours ago)
(HTM) web link (marginalrevolution.com)
(TXT) w3m dump (marginalrevolution.com)
| ambicapter wrote:
| Oh god that first comment rings so depressingly true. Is this
| just the nature of mankind forever or is there some way of
| setting up incentives such that this doesn't play out exactly the
| same way every time?
| beaconstudios wrote:
| Yes but AFAIK we don't do it. Incentive structures can be
| treated as causal structures if you simplify by saying that
| incentives "cause" people to act a certain way. The disciplines
| involved in fixing or improving causal structures are systems
| theory and cybernetics. But these tools are extremely under
| utilised.
| monkeypizza wrote:
| from an earlier post in the series:
|
| Michael Osterholm, Regents Professor, McKnight Presidential
| Endowed Chair in Public Health, the director of the Center for
| Infectious Disease Research and Policy (CIDRAP) and state
| epidemiologist for the Minnesota Department of Health:
| ...Imagine you are setting across the table from two people both
| of whom are 65 or older, both with underlying health conditions.
| You have two doses of vaccine, one in each hand. And you say to
| them I can give two doses to you or to you but then the other
| person gets nothing. Or I can give one dose to both of you. And
| this is what I know. At the very least, one dose is likely to
| prevent serious illness, hospitalization and death. Two doses
| will probably even prevent clinical disease with B.1.1.7. But the
| other one of you; if you get infected with this virus, which I
| think substantial numbers of Americans will, things are not
| looking good for you. What do you want me to do? If
| that is your Mom or Dad. Your Grandpa or Grandma. What would you
| do? This is where the rubber meets the road. I think
| if the data bears it out we can save so many lives in the
| upcoming weeks and we are missing that opportunity.
| I have already made my choice. I am postponing my second dose. I
| want my second dose. But I am confident that I can wait. And I
| can only hope that my second dose, which I have just deferred,
| will go to someone who it will save their life. It will make a
| totally different world for that family. You know
| some could argue that this could be the end of my career. But I
| could not sleep with myself at night if I didn't do this. I just
| know in my heart of hearts that this is something we must do if
| we are going to save lives.
|
| https://marginalrevolution.com/marginalrevolution/2021/02/os...
| melling wrote:
| ... or you could give both doses to the other person because I
| can wait 3-4 months.
|
| In the US there are
|
| - 25 million Americans over 75
|
| - 50 million 65 and older, including the 75 year olds
|
| We have given out 70 million doses.
|
| I think we're around 40 million jabs a month, hopefully that
| increases to 60 million soon
|
| There's no need to experiment.
|
| However, if we find >3-4 weeks between jabs is fine, let's do
| it.
| monkeypizza wrote:
| The comparison was between giving 2 doses
| to one person over 65, and nothing to another other person
| over 65 giving one dose each to two 65+ people
|
| We have evidence that total harm prevention under the second
| case is higher than the first case, and it also makes perfect
| logical sense, and there are public health officials
| confirming this.
|
| On the other hand we have tradition, custom, specific tests.
|
| Say vaccines were tested based on administration in a blue
| room, but weren't tested in a room painted red. Why are you
| able to assert without tests that the room color is
| irrelevant, but are asking for proof that giving two people
| 85% resistance is better than one person with 95%, when all
| the evidence supports it? What is leading to wanting to
| strictly adhere to the exact tested procedure? How do you
| square your disagreement with the public health officials
| actively investigating this issue in the linked posts?
| wang_li wrote:
| We did 50 million in the last thirty days.
| [deleted]
| monkeypizza wrote:
| > There's no need to experiment.
|
| People who haven't caught coronavirus yet are still likely to
| catch it and be at risk. That is, new people are still being
| infected and are likely to be for a few more months yet.
|
| What calculation are you running to say that changes to
| policy which might increase first-dose protection are not
| worth making to protect them?
| DanBC wrote:
| (I upvoted you, and I'm not sure why you're getting downvotes).
|
| > > Or I can give one dose to both of you. And this is what I
| know. At the very least, one dose is likely to prevent serious
| illness, hospitalization and death.
|
| We don't know this from testing. We know it from real world
| data -- we've given a bunch of people their first dose and then
| we measured what happened.
|
| Imagine you tell people "we're going to give you two doses of
| this vaccine. You'll have the first dose today, and then you'll
| have your second dose in X weeks. We know this is safe and
| effective from the clinical trials. Do you want to go ahead?"
|
| And then, after you've given them the dose, you say "well,
| actually, looks like vaccine production is pretty slow, and we
| really need to vaccinate as many people as possible, so we're
| going to delay giving you your second dose".
|
| There's a strong argument for doing that, but it's not
| obviously the right thing to do. Informed consent is an
| important part of healthcare everywhere. And vaccinations are
| so important that anything that interferes with trust needs to
| be really carefully examined.
| monkeypizza wrote:
| Good point. I'd imagine we could leave it voluntary, and just
| start the "delayed 2nd dose" policy later.
| JohnicBoom wrote:
| Just so you don't have the wrong idea, Osterholm's suggestion
| is that everyone who has already been given the first dose
| already should get the second dose as planned. Only for new
| vaccinations should we apply the new plan.
| devinplatt wrote:
| Naive question: given that there is a sort of pareto distribution
| in covid vulnerability, and that the vaccine rollout prioritizes
| vaccinating the most vulnerable first, doesn't it also make some
| sense to prioritize stronger vaccinations (2 doses of Pfizer or
| Moderna) for the early recipients of the vaccine?
|
| Increasing the speed of the rollout with delayed second doses or
| skipping second doses sounds compelling for other reasons, but it
| does seem like a more complex calculus to me than many articles
| online want to admit.
| simonh wrote:
| By delaying the second dose, more of the most vulnerable
| cohorts can be vaccinated more quickly. By the time you get to
| vaccinating significantly less vulnerable cohorts with their
| first dose, you will also be second dosing the most vulnerable
| cohorts.
|
| So it's not really a case of denying the most vulnerable a
| second dose in order to give significantly less vulnerable
| people a first dose.
| JohnHaugeland wrote:
| Why have we, as a nation, not yet learned to reject pseudo-
| intellectuals and their false medical knowledge?
|
| This is little better than anti-vaxxing
| stevesimmons wrote:
| Alex Tabarrok has been arguing in Marginal Revolution for "First
| Doses First" since mid-December.
|
| Back then, media commentators and the medical establishment
| objected "But the clinical trials were for two doses".
|
| Sadly, very few people acknowledged that prudence had a very real
| cost in additional infections, deaths, risk of mutations, slower
| economic recovery.
|
| The consensus only shifted to "First Doses First" after the
| faster spreading UK and South African variants emerged, and the
| risk of inaction became more obvious.
|
| If we step back from Covid-19, this kind of one-sided thinking is
| all too common in daily life.
|
| We need more training (at school, university, in media debates)
| that the choice is never "Do A or not".
|
| It is "do A instead of B (and compare the likely costs and
| benefits of both)". Or "do the first bit of A, learn some more,
| and do A' or go back to B". Etc.
|
| Real options improve expected outcomes!
| nojito wrote:
| Advocating first dose first before we got clinical trial data
| to support it is a gross slap in the face of every potential
| dose recipient.
| leesalminen wrote:
| And there's the overly charged language that makes everything
| worse.
| nojito wrote:
| Using the general public as guinea pigs is not ethically
| sound at all.
| leesalminen wrote:
| Agreed!
| dalbasal wrote:
| I disagree. Without weighing in on the merits of each strategy
| too much, I think there is/was a case to be made for each.
| Also, as you say, consensus did shift. It wasn't a totally
| fixed mindset. In any case, a decision had to be made. There
| were always going to be dissidents with a case, regardless of
| the decision.
|
| I don't think the problem is actually a decision making
| problem. The 2021 problem is that we're handling disagreements
| poorly. Whichever decision got made, there would be some
| dissent.
|
| If you're in a dissident "First Doses First" camp, the other
| camp is corrupt, pigheaded pseudoscientific bastards that need
| to go back to school and learn how to think. If/when "the
| establishment" comes around to your thinking, it's just more
| proof of this... this article is a case in point.
|
| The establishment side (2 doses, in this case), feels obliged
| to defend their position, often over defending, making things
| worse. It quickly devolves into rivalrous rage, both trying to
| delegitimize the other. Laying piles of bodies at each others'
| feet. Ad hominems. Accusations of quackery,misinformation and
| attempts to shut the other up.
|
| You end up here regardless of the decision taken. All roads
| seem to lead here atm.
|
| >" _This is evidence of what I call magical thinking-an undue
| focus on the clinical trial design as having incantatory power_
| "
|
| Sheesh! Magical thinking... Incantatory power? What earns the
| FDA these insults?
|
| In December, they're rolling out two-shot strategy, conforming
| to the clinical trial design. There is some reason to think
| that a one-shot first might work better. The "right" answer is
| complicated, (a) it depends on unknowns that'd need more
| clinical trials to learn and (b) it depends even more on
| execution issues related to vaccinated hundreds of millions of
| people. Different, hard to quantify risks involved in each
| strategy.
|
| Two-three months later, they're have a one-shot strategy as
| well. Presumably, this has been in the works for the entire
| period.
|
| Meanwhile, Alex makes them out to be witches trying to cure
| covid with willow bark. It's grossly unfair. Maybe they were
| wrong and you were right, but _Magical thinking & Incantatory
| powers..._ that is vitriolic bullshit.
| DiggyJohnson wrote:
| > I disagree.
|
| I think you and GP have nailed it actually. To use the
| educational perspective from the top comment, I would want
| this to be the discussion content for a
| lesson/section/chapter on the principle of the "existence of
| candidate decisions" (this is the most dense sentence I've
| ever written).
| tshaddox wrote:
| > Sadly, very few people acknowledged that prudence had a very
| real cost in additional infections, deaths, risk of mutations,
| slower economic recovery.
|
| > The consensus only shifted to "First Doses First" after the
| faster spreading UK and South African variants emerged, and the
| risk of inaction became more obvious.
|
| But isn't this exactly what _should_ happen if we're comparing
| risks? It seems entirely possible that there was a well-
| understood risk to giving only 1 shot when the trials were for
| 2, and that risk was higher than the risk of virus outcomes
| _before_ the new variants, but then the risk was lower than the
| risk of virus outcomes _after_ the new variants. I don't know
| if this was the case, but it seems very plausible and
| reasonable. Other things could change these relative risks too,
| like how quickly we have been able to get vaccinations done.
| raverbashing wrote:
| True. While it is important for the advancement and validation
| of treatments, Evidence Based Medicine and the quest for
| "perfect RCTs" has become the new cult for a lot of people
|
| RCTs are a validating procedure, it doesn't mean that people
| are having zero protection after one dose (of course it is
| great if we can quantify that and see if it's worth it or not)
|
| As an example, see how for the AZ vaccine the people that got
| half a dose accidentally at first got (apparently) more
| protection than from whoever has gotten a first full dose,
| however, only the full dose was approved (though on the other
| hand, the J&J vaccine has more virions than the AZ one)
|
| > Sadly, very few people acknowledged that prudence had a very
| real cost in additional infections, deaths, risk of mutations,
| slower economic recovery.
|
| Exactly. Now we just need to convince people that maybe, just
| maybe, it would be a good idea to not have susceptible
| populations be Vitamin D deficient during a pandemic. You know,
| just in case.
| fallingknife wrote:
| We don't need more training in school. That's where this type
| of procedural, bureaucratic thinking comes from in the first
| place.
| dragontamer wrote:
| Procedural bureaucratic thinking happens to be a very
| effective way at finding concensus.
|
| Make sure everyone speaks their turn, make sure everyone has
| a voice. That takes bean counting and nitty gritty arguments.
| No way around that.
|
| Robert's rules suggests that everyone at a meeting gets two
| chances to speak on any subject, no more. A big issue with
| today's discussion is that a few powerful and full of
| themself individuals take up all the oxygen in the room,
| removing other people's voices from consideration.
|
| Say your point, then one followup later as other points come
| up. Then your turn is over and other people talk.
| stevesimmons wrote:
| My point, expressed more fully, is: "teach people to design
| projects with measurable outcomes versus the status quo;
| calculate an NPV to make your implicit assumptions and biases
| explicit; look for ways to restructure your project plan into
| intermediate goals where you can reassess your strategy (aka
| "real options"). And your projects will, on average, cost
| less and be more successful." My meta-point is: these are
| useful skills that can and should be taught more widely.
|
| Your argument is essentially "No", is it not?
|
| I'm not sure how that helps improve the situation.
| dalbasal wrote:
| This is basically the primary curriculum of current
| management training. The more people "train" in it, the
| more we get to a stupid "ruled by metrics" world.
|
| IRL, you can't actually be scientific outside of certain
| cases. Bad/fake science can be worse than no science. Fake
| objectivity is usually worse than subjectivity. The whole
| things gets bogged down into "searching under the
| streetlamp" problems.
|
| If you can find a problem that fits the solution you (+
| most bogus management consultants of the last 10 years) are
| advocating, it'll work. Mostly, it gets bolted on to
| whatever people are doing as an additional layer of
| bullshit. Nonsense analytics + politics.
| throwawaysea wrote:
| As an aside, I feel like suggesting this on social media will
| likely get you banned or in the least, you would have your posts
| labeled with a warning, and have to endure attacks from others
| for "not trusting the experts". First doses first, and I would
| argue first doses as fast as possible (not having various
| "equity" focused schemes slowing things down), are very logical
| stances to hold. In the least, they are reasonable to bring to a
| societal discussion. The fact that we can't openly talk about
| such ideas with friends, coworkers, or broader society is sad.
| kcartlidge wrote:
| Way back when, I wasn't convinced about our (UK) vaccination
| stance; from the start of the rollout it has been first doses -
| with the gap for the second set at 12 weeks.
|
| The British Medical Association said it was wrong, and there was
| international condemnation. Now the WHO have endorsed an 8 to 12
| week gap. They've also recommended the AZ jab for all age groups
| over 18, despite French and German comments otherwise (I'm not
| anti either, I'm a remainer and respect both, but their
| politician's uninformed comments denigrating the AZ jab were
| downright dangerous, and the EU is now sitting on unused doses of
| it).
|
| I don't know whether we've rather unexpectedly got something
| right in this sorry mess, or just had a very lucky break.
|
| _Edit: I 'm in the first-doses camp, but not first-doses-first,
| as the UK is doing two doses in parallel but with an extended gap
| so a larger volume of first doses go out 'quickly' but people
| aren't just left with the one. Feels like a good compromise to
| me._
|
| I also have to say, despite the fact that it is absolutely
| nothing to do with me, it does feel quite good that the Oxford
| jab is by far the cheapest and also being manufactured by third
| parties across the world at pretty much cost. They done well.
| taxicabjesus wrote:
| I try to read all perspectives. I appreciate that a lot of people
| believe vaccination is the only way out of the pandemic, but I
| think it's a mistake to put 'all the eggs in one basket. I
| haven't noticed much in the way of efforts to help people become
| healthier so they can have mild cases of COVID-19, COVID-21,
| COVID-23, etc.
|
| Furthermore, why are the medical industry wasting vaccine supply
| on people who are already immune due to surviving their
| infection? If a person loses antibodies after 6 months from a
| natural infection, why would they be expected to have antibodies
| for longer from a vaccine?
|
| I haven't noticed many attempts to rationalize vaccinating people
| who've already had a case of the SARS-CoV-2. The CDC says "Yes,
| you should be vaccinated regardless of whether you already had
| COVID-19. That's because experts do not yet know how long you are
| protected from getting sick again after recovering from
| COVID-19." [0] But that's just "trust us we're experts."
|
| [0]
| https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.htm...
|
| This week I learned my hair stylist had a mild case in January.
| She diligently wears her mask, but was not protected from getting
| exposed to her symptomatic co-worker. She was symptomatic herself
| for 5 days, and recovered without getting too sick. (Her husband
| was not so lucky, but survived his hospitalization.) She said
| she's waiting patiently until she too can get vaccinated.
|
| My uncle got himself hospitalized in December 2020 or January
| 2021. He recovered, but just got vaccinated anyways, even though
| he certainly still had the antibodies. My brother said our uncle
| was attesting to his faith in in the vaccine - I think the
| technical term is "virtue signaling". I think my uncle ought to
| know better than to use vaccines recreationally.
|
| My brother and his wife both had SARS-CoV-2... He was rather sick
| for a week or two. She was asymptomatic, but tested positive for
| antibodies. They both got vaccinated, 7 months after their
| illness/exposure. My brother was presumably coerced by his
| workplace, she was probably virtue signaling too.
|
| SARS-CoV-1 burned out after two years. Why would this version be
| any different?
|
| Is not vaccinating people who've already recovered from SARS-
| CoV-2 the smarter approach to achieving population immunity?
| Majromax wrote:
| > Furthermore, why are the medical industry wasting vaccine
| supply on people who are already immune due to surviving their
| infection?
|
| Suppose you're running a vaccine clinic. It's infinitely easier
| to check prospective patients for their bare demographic facts
| -- age, residence status, etc -- than it is to first administer
| an antibody test to see if they qualify for the vaccine.
|
| At best, you'd stretch supplies by 1/(1-seroprevalence), so
| maybe 30-40%. But in turn, you'd need to take multiple steps to
| verify patients, and you'd likely lose some along the way who
| would otherwise qualify (just from the hassle or multiple
| contacts).
| manwe150 wrote:
| I think you're being downvoted since you are rhetorically
| asking questions people have already beat to death. The main
| two answers being (a) each virus behaves differently, so
| extrapolation should be done carefully, and not just from your
| personal experience with surviving past flu's (b) there isn't a
| limit on how much vaccine we can produce in total, so there
| isn't really a good reason not to get it. That's perhaps like
| saying the flu vaccine is only half effective (which is true),
| so I'd rather get sick twice as often, rather than signal that
| I trust science.
| vmception wrote:
| the mRNA vaccines give the body a blueprint for antibodies,
| whereas actual exposure has the body creating non-uniform
| reactions. so that means prior exposed people should "use
| vaccines recreationally", as in "have a medical professional
| administer the dosages after an appointment".
|
| the singleshot vaccines are not mRNA based and just help
| jumpstart coverage. the only goal now is coverage, and these
| increase the delta week over week of how fast and how far that
| coverage is. it will allow municipalities to rationalized re-
| opening all services sooner, by simply having a record of how
| much of the population has been addressed.
|
| there are many people and organizations and medical
| professionals making efforts to help people become healthier.
| many people are trying to find specific links and everything
| they have right now is _much worse_ than "trust us we're
| experts" because people don't know. fortunately there is a
| large audience that would prefer certain messaging to come from
| anybody _but_ an expert, know anybody like that? so take all
| the supplements and stay active, because it can 't hurt right?
| all the correlations support it. that's the exact approach
| regarding the vaccines too, there is no use of any of the
| approved vaccines worldwide that is worse than contracting
| covid, even asymptomatic covid. if you are of the predilection
| that taking vaccines is the same as candy flipping then it
| should be obvious that will guide your thoughts, the goal of
| the heads of state is to get enough vaccines available as soon
| as possible, and that's what they are doing.
| carbocation wrote:
| If your "normal times" scientific standards need to change for an
| emergency, then they were never appropriate to begin with.
|
| But here, I do think the scientific standards are OK. What should
| be changed in an emergency is not scientific rigor, but the
| amount of resource that we are willing to spend on the problem
| with an expectation of waste.
|
| With that mindset, throwing money at the problem to fund trials
| that address a wide range of questions (e.g., 1 vs 2 doses of
| Pfizer/Moderna, 2 vs 4 vs 6 weeks for booster timing, etc) would
| have been the way to go.
| kevinmchugh wrote:
| Note that the link takes you to the comments. Scroll up for
| context.
| ketamine__ wrote:
| > My view is that it would be good if the J&J vaccine was
| followed by a booster-perhaps of some other vaccine-but that it's
| individually fine and in fact socially beneficial to get more
| people protected quickly by delaying the booster for at least 12
| weeks to when vaccines are less scarce. I don't currently see a
| reason for thinking differently about the Pfizer and Moderna
| vaccines.
|
| Not an expert, not a researcher, but an economist...
| [deleted]
| monkeypizza wrote:
| What is the relationship of his credentials to his logical
| argument? By arguing from credentials you implicitly take the
| side of the status quo in history; you'd have been arguing
| against every overturning of conventional wisdom.
|
| I'm not saying all rejection of convention is correct,
| obviously - but if you look at the specifics of the argument,
| not the status or credentials of the arguer, it seems more
| likely to come to a correct judgement.
| notatoad wrote:
| Regardless of his qualifications, his point is interesting: J&J
| seems to be about as effective as a single dose of Pfizer.
| There was a whole bunch of worry about what would happen if
| people got only one of their two Pfizer doses.
|
| Was that worry all for nothing? Was it backed up by any
| science? If there was legitimate reason for concern, why do we
| not have the same concern around the j&j vaccine?
|
| (I'm not trying to advocate any of these points. I'm even less
| qualified than an economist. But they seem like legitimate
| questions)
| nicoburns wrote:
| > Was that worry all for nothing? Was it backed up by any
| science? If there was legitimate reason for concern.
|
| I believe it was because of a lack of evidence either way.
| The Pfizer trials were two doses. So we didn't know for sure
| how well one would work. The decision to only do one was made
| on the basis that this works well for most (but not all)
| vaccines. It is now known that it indeed works for the Pfizer
| vaccine, and so it seems to have been a good decision. The
| concern was that it would not and would set the vaccination
| programme back by months.
|
| > Why do we not have the same concern around the j&j vaccine?
|
| I'm not sure, but I suspect the J&J vaccine was trialed as
| one dose from the outset.
| Rapzid wrote:
| > Regardless of his qualifications, his point is interesting:
| J&J seems to be about as effective as a single dose of
| Pfizer.
|
| The most compelling J&J number is, IMHO, the 100% efficacy at
| preventing hospitalizations and deaths. Is a single shot of
| the double-shot vaccines that effective? AFAIK that study was
| never run..
| monkeypizza wrote:
| Other related posts including quotes from supporting experts:
| https://marginalrevolution.com/?s=first+doses+first
|
| This is more about looking at the ability of our systems to
| change their response in emergencies; why are obvious things so
| hard to do, when they both fully make sense, and are supported
| by an interested group of experts, against a larger but less
| interested group of conventional, rule-following experts?
| Majromax wrote:
| > This is evidence of what I call magical thinking-an undue focus
| on the clinical trial design as having incantatory power.
|
| This isn't complicated. Once we have clinical trial evidence, the
| protocols tested form the _standard of care_.
|
| With no standards of care (i.e. no tested vaccine, here), then we
| can only guess about what might be better than nothing. It's fair
| to make that decision on a balance of probabilities -- try
| something if it's 51% likely to help (absent negative side-
| effects, anyway).
|
| But once we have such a standard, the very deliberate
| conservatism of our medical science means we need compelling
| evidence before supplanting it. I think it's very likely that a
| single dose of Pfizer/Moderna is adequately protective in the
| medium term (weeks to months), but this was not fully tested.
| It's not appropriate to start experimenting on the general
| population based on a hunch.
|
| This community is IT-centric, so think of it like experimenting
| on a production system. Even if you are 80% sure that something's
| likely to work out, the risk of failure is so catastrophically
| high that _you don 't do it_ when any other option is open to
| you.
| monkeypizza wrote:
| > It's not appropriate to start experimenting on the general
| population based on a hunch.
|
| By varying the parameters of the situation, could you be
| induced to change your view? i.e. vary CFR up to 1%, 10%, 50% -
| given that you acknowledge that the natural experiments we are
| observing from single-dose administration suggest most of the
| immunity granted by a vaccine is in the first dose - at what
| point do you budge?
|
| If you admit that for a 50% CFR, you would not insist on
| following the established standard of care, then the question
| is where is the border for you, where your recommendation
| flips, and you consider early end to quarantine, reduced life
| loss, to be worth moral hazard of ad-hoc decisions, or not
| following the standard of care would bring?
| dalbasal wrote:
| Here's the thing... they _did_ budge. Alex is so caught up in
| dunking on the FDA that you might miss the fact they just
| approved a one-shot... within days of hsi last article
| dunking on them for not doing it.
|
| Presumably, that approach was being studied all along (in the
| three months that it's even been a decision.
|
| Everyone assumes the FDA are being rigid and bureaucratic
| regardless of what they actually do. How do you write an
| article ripping them for magical thinking as they do the
| thing you're saying they should do? The fact that the FDA
| didn't pull a u-turn on the same day a"maybe this" thought
| occurs to a welfare economics professor is enough to accuse
| them of negligence every week.
|
| Now, it doesn't even seem like even doing what he thinks they
| should do is enough. They're still caught up in "magical
| thinking." What for, giving any weight to clinical trial
| design at all.
| monkeypizza wrote:
| Sure, Alex should update his criticism, but it's still
| valid to look back at why it took this long; First Doses
| First has been out for a while - it's been 2 months since,
| for example, Tony Blair publicly advocated for it.
|
| I think the gains we would get from even a single day
| earlier application of First Doses First probably outweighs
| the pain caused to the FDA by Alex criticizing them.
|
| https://www.businessinsider.com/blair-one-
| covid-19-vaccine-s...
| Majromax wrote:
| > at what point do you budge?
|
| Around the same time that you dispense with phase 3 trials
| entirely. It was more likely than not that the Pfizer/Moderna
| vaccines were effective by the time they'd completed phase 2
| studies. If that is our standard, then we ought to have begun
| vaccinating at-risk individuals on a volunteer basis then --
| in Fall of 2020.
|
| To me, it's inconsistent to both say we need a full phase 3
| clinical trial to grant authorization to a vaccine, but then
| to ignore the protocol of that phase 3 trial when
| distributing it.
| baggy_trough wrote:
| The deliberate conservatism of medical science may be
| appropriate in "peacetime", but it is murderous in "wartime" (a
| pandemic).
| ridaj wrote:
| The "what have you got to lose" approach doesn't have a great
| track record either... Even wartime medics take time to
| disinfect their tools
| baggy_trough wrote:
| Certainly one could go too far in either direction, but
| there's little doubt we are too far in the status quo /
| conservative direction at the moment.
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