mlma

Karma: 8

mlma 30 Oct 2017 2:48 UTC
0 points
in reply to: michael_b’s comment on: Pitting national health care systems against one another

That’s incorrect. I know that my generation was vaccinated against a more limited set of diseases and has survived pretty well.

“There’s no need for the smartphones. I know that my generation only had landlines to use, and has survived pretty well.”

“Back in the day, smallpox was just a fact of life. Most people lived. What’s the big deal about it anyway, afterall, we survived pretty well, and it’s not like it was holding our society back”

“Why do we need to wash our hands before surgery? We’ve survived pretty well so far like this.”

Just because you have not personally seen someone die from a vaccine preventable disease doesn’t mean that it doesn’t happen, or that it’s okay.

mlma 29 Oct 2017 20:42 UTC
0 points
in reply to: michael_b’s comment on: Pitting national health care systems against one another

Thanks for opening my eyes to the air bag conspiracy!!!!1

Haha, right? I definitely did a double take when I first learned that.

As a reader of this site I expect you would pick up on the fact that I was outsourcing this to national health care systems because humans are bad at researching literature on a scientific field of study without coming to conclusions that support their preconceived notions. Even when they know they’re susceptible to this kind of bias.

But you’re outsourcing without having had asked the right question or acknowledging the subtlety in your outputs.

Your question in particular isn’t “what are the only vaccines I should get”, it is “how do I best protect the health of my child”. If you wanted to ask “which vaccines are absolutely, without a question important to the human race?”, then your approach arguably has validity.

I reject the assertion that you are truly outsourcing this to national healthcare systems in good faith, because you admitted to having “fear that a doctor is about to stick my kid with a needle because there was a meeting in a shady room between a pharma rep and a CDC official”. Do you have any evidence that that kind of “pharma collusion” isn’t happening in any other countries? If you can’t believe what some of the experts say because of an unbased/unquantified fear, then what value does any of the evidence have to you at all? If you put arbitrary weights on certain pieces of evidence, then you’re weighting it in favor of coming to a conclusion that supports your preconceived notions.

If you’re truly outsourcing this information to national health agencies, you would come up with a vaccine list that is the union and not the intersection. After all, they are experts who should know best, so we should defer to them, right? The intersection is merely the list that is your absolute top priority, and the union is the list of vaccines that experts believe are also important.

Like many of the other people in this thread have stated, there’s a difference in disease risk and incidence based on where you are living. If you were outsourcing this to national health agencies in order to answer the question of “what do I get to protect the health of my child”, then you would weight more highly the guidances of the agencies that are most relevant to you. Instead, you’re looking at countries with population sizes that are like, 2% of that of the country you’re living in, located in a entirely different geography, with different population dynamics and concentrations, and trying to say that they are ‘equal’.

More on the point of looking at the importance of prevalence when making vaccination decisions:

One of the things about infectious diseases is that the more you have of it in a population, the more you tend to get. If prevalence of a disease is really low, even without vaccination, you’re not likely to get this disease. This has huge impacts on why some places would recommend it and some other places wouldn’t. For example, Denmark doesn’t recommend hep B vaccine, but most of the EU does, and so does the US. Denmark’s hep B virus prevalence is 0.03%, the EU as a whole guesses around 1%, and the US is at 0.4% (though this number is believed to be an underestimate). You’re over 10 times less likely to get hep B if you’re living in Denmark vs living in the rest of the EU or the US. Given this information, would you choose to believe Denmark’s guideline’s or the US’ guidelines when making a decision about your US-born child?

mlma 29 Oct 2017 19:26 UTC
0 points
in reply to: michael_b’s comment on: Pitting national health care systems against one another

Less anecdotally, I haven’t found a lot of evidence that adults are suffering horribly from diseases that children today are routinely vaccinated against. Is the cost-benefit of the added vaccines as good as the cost-benefit of the 80s era vaccines? Some arrows point to the US having a lower threshold for recommending them, given the variance between nations.

A lot of the big childhood vaccines are things that kill kids (MMR, rotavirus, Hib). So you’ve got survivorship bias there.

As for the other stuff, a lot of the diseases that adults are suffering from that children are vaccinated against today don’t manifest as obvious infectious disease. If you know anyone who has ever had shingles, you know someone that had suffered from a disease that children today are routinely vaccinated against (varicella). If you know someone who has had cervical cancer or genital warts, you likely know someone who has suffered from HPV (highly recommended vaccine for preteens). If you know someone who has had liver cancer, there’s a chance it’s because of Hepatitis B (no vaccine for HCV yet :/).

Of course, you don’t have to look anecdotally for that.

Part of the cost benefit change is also due to the fact that we can actually treat a lot of these cancers now, instead of just “sorry, nothing we can do, go home and get your affairs in order.” For example, even though mortality rates from liver cancer might still be similar, 1-year survival rates have increased. So now, each case of a preventable cancer might cost us a lot more, so we’re much more motivated to prevent it.

Even if the cost benefit is not as good as the cost benefit of the 80s era vaccines, the fact that many not only have a favorable cost-benefit ratio, but are even cost saving should make them an strong choice for implementation.

mlma 25 Oct 2017 7:57 UTC
8 points
on: Pitting national health care systems against one another
Here’s some information about some of the diseases you have mentioned and their associated vaccines.

Hep A is not routinely offered in the UK because it’s considered very low risk there. Even in the US, hep A is usually only something that gets introduced after someone visits a high incidence country. Likely, hep A’s risk in the US is partly because we share a border with a high incidence country. Hep A is spread through contaminated food and water, and it takes an incredibly low amount of virus to cause disease in a person. When you get it as an adult, it can lead to some really serious liver complications, and many cases end up hospitalized. Likely, hep A in the UK is because they don’t expect to get an influx of people coming in who are infected with hep A. By the way, currently, we are experiencing a hepatitis A outbreak of unprecendented scale and duration in San Diego, CA, and Michigan.

The point of the chickenpox vaccine is only partly to protect the kids. The vaccine will also mean that kids who are vaccinated against chickenpox won’t get shingles. Also, when you get it as an adult, it is Bad Times.

Meningococcus vaccine isn’t recommended until you’re 12 years old. The CBA on it has been a bit back and forth, but this one is likely due to cultural things—meningococcus meningitis outbreaks are common when kids from all sorts of different places end up in one place (aka, college, frats (especially!!), team sports, spending a lot of time in close contact with others). Because the course of the disease is real quick (healthy to dead in less than 24 hours) and morbidity is so bad, it’s pretty much recommended due to an abundance of caution. Two years ago, Santa Clara University had a case, and the state responded by mass vaccinating everyone on campus—something like 5,000 people in two days. Such an effort was hideously expensive, but still worth it to the state in terms of morbidity avoided.

Hep B is recommended because 1) there’s no cure for it, and 2) having HBV increases your risk of liver cancer by an insane degree. Infection as a kid usually leads to lifetime infection in a carrier state (or to disease progression), whereas infection as an adult is less likely to lead to chronic illness. It’s really common in East Asians and Africans, and HBV is also considered endemic in Latin American countries. Of your listed countries, the USA is also the most ethnically diverse. Basically, you’re risking putting your kid at risk for liver cancer down the line. Also, HBV costs Medicare a shit ton of money every year in liver transplant/ liver cancer treatment costs.

For your point #2, those aren’t “cultural” differences. It is literally the difference in your risk of getting the disease. TB is endemic and fairly high incidence in pretty much all of Asia. The US recommends against TB because we are a low incidence country and not vaccinating people makes it a whole lot easier for us to detect cases (case detection is through looking for immune reaction against TB. Having a vaccination means you have to either do a more involved test or a chest X-ray).

Every single disease on that list has significant morbidity associated with it, if not now then later in life.

The government also makes cars have seatbelts and airbags; is this because seatbelt and airbag manufacturers lobbied the government? How dare they make you pay for features you don’t want! If you think you’re never going to need that airbag, why should you pay for it?

As a reader of this site, I feel like you should understand that humans are very bad at evaluating small percentages. Under this lens, look at the risk of harm that the vaccination poses to your child, then look at the risk of harm that getting the disease may pose to your child.

The cost benefit analysis you should be doing is how much it will cost you to do this today versus how much pain it’s going to cause your kid in the future.

mlma

Every single disease on that list has significant morbidity associated with it, if not now then later in life.

The government also makes cars have seatbelts and airbags; is this because seatbelt and airbag manufacturers lobbied the government? How dare they make you pay for features you don’t want! If you think you’re never going to need that airbag, why should you pay for it?