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Peer Review and the Scientific Process

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Renegade:
This may be off topic, but I wouldn't mind some of your input here.
Recently, a lot of people around me have been getting worked about about the anti-vaccination issues.  I've been listening to the arguments, and I must say that I'm legitimately confused.  Politics or beliefs aside, the question I want to answer is, "Should I vaccinate?  How do I make this decision wisely?"
-superboyac (February 09, 2015, 05:02 PM)
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If you consult with a doctor that isn't blindly religious on the issue, most likely your doctor will recommend vaccination, but not necessarily for everything. Not all people need all vaccines. There actually is room for thought on the topic, though the current dialectic pretty much excludes any rational debate.

For example, do you need to be vaccinated for Japanese encephalitis? It's a horrible, crippling disease that utterly destroys people. Chances are that you don't as it is only found in certain places.

Are you at risk for cervical cancer? If you're male, then no. And here is where the insanity begins, because there are quite a few people that want forced vaccinations for boys. I.am.not.kidding.

Talk to 1 or more doctors. Read up on the issues.


The closest I've been able to come to an answer is along these lines:
Let's say there's a disease where I have 5% chance of dying.  The vaccine is available, and with it there is the 1% risk of dying.  So in that case, the gamble is mathematically worth the risk.
-superboyac (February 09, 2015, 05:02 PM)
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That's correct given that you will get the disease. If there's a 1% chance of contracting the disease, then 5% * 1% vs. 1% doesn't justify the vaccine, mathematically that is. But that doesn't take into account other possible problems from the disease, e.g. 50% chance of blindness, etc.

All too often people talk about mortality rates, but blindness, deafness, and many other horrible effects also come with some diseases.

Then there are diseases like rubella that aren't serious (or as serious as others). Rubella is mostly relevant for pregnant women.

But it's just not that simple.  Do we know these percentages?  What if the vaccine is for a non-lethal disease, like a cold or mild flu?  Are these risk quantification reliable?  I don't know the answer at all, to be honest.  And it's a sensitive issue in my circles as there actually are cases of life-altering mental problems that have been attributed to vaccination.  I never ask, but I want to ask how do we know it was the vaccines? 
-superboyac (February 09, 2015, 05:02 PM)
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How do we know? Good question. When you look at some of the crippling effects in some cases, and the timelines, then it's pretty obvious, but that's not scientific proof, though it is sometimes enough to get settlements from the secret vaccine courts.

When a friend of mine gets a flu shot, he's pretty much guaranteed to get the flu -- and he no longer gets any flu shots. But, that's annecdotal.

I think it really depends on the person - not all people are the same.

Oh, I just remembered a bit more insanity... This is fun~! ;D

A common argument that I read all the time is about "the children" and how people want to exclude unvaccinated kids from schools.

Ok. For the sake of argument... Let's run with that. ;)

Some vaccines turn the recipient into a carrier for anywhere from 2 weeks to 90 days.

So, for those vaccines, shouldn't vaccinated children be excluded from schools until they are no longer contagious? Not all kids can get the same vaccine at the same time (if that even mattered).

In the first bit above, we have no evidence that any unvaccinated child has any disease, but in the second instance, we have clear evidence that the child is contagious. What to do? :P

Fun fun fun~! ;D

I do like to pick on the pro-vaccine crowd as they're such wonderful targets, and especially the sanctimonious, uneducated ones that merely parrot what they heard on CNN. Picking on the anti-vaccine crowd isn't really much fun. Like, how do you make fun of a kid getting measles, which has a 0.1% mortality rate in developed countries? There really isn't much of a joke there.

40hz:
Information on the different types of vaccines can be found here. Approaches being considered for future vaccines can be found here.

@Ren - IIUC you can't (except in that rare situation with the old oral polio vaccine - which is no longer administered) come down with the illness that an attenuated-live vaccine is designed to provide immunization for unless the batch that was administered was defective. And my understanding is that cases of defective vaccine batches making it into actual circulation are extremely rare occurrences.


Some vaccines, however, do lower your overall immune response such that you're more susceptible to an opportunistic infection while your body is generating the immuno response to the pathogen in the vaccine. So I'm guessing your friend may be getting sick after being vaccinated for flu because his immune system doesn't respond well to vaccination, and either takes a bigger hit, or takes longer than usual to recover from one. If so, during that period he's more open to infection by any one of the thousands of other flu strains in the environment that the "annual" flu vaccine (which only covers a small number of the most anticipated strains) is engineered to help you deal with.

That's why some people who come down with a serious flu infection also wind up with a case of "shingles" or pneumonia during their illness or recovery. (Happened to me once.) Which is why they're also starting to recommend people in certain age brackets be vaccinated (or re-vaccinated) for chickenpox/shingles along with pneumonia.

However, the real benefit of vaccination is realized when most of the population is immunized because vaccines go a long way towards reducing the disease's vectors of transmission. If one person contracts in a group of immunized people, the disease doesn't spread. Possibly a few others (including those vaccinated) will become infected. But that's about as far as it will go.

If a large portion of the population is not vaccinated however, and isn't already immune from a previous brush with that infection, you have the very real potential for another Disney scenario. The deadly consequences of uncontrolled contagion are such that even in the world of military planning, germ warfare is almost automatically ruled out as an option . And it's not due to any sense of showing decency towards a real or imagined enemy. It's done mainly out of a sense of "enlightened self-interest." And the military also routinely vaccinates troops "just in case."

When professional mayhem creators such as the military acknowledge the dangers of contagion enough to rule it out as a weapon system, and vaccinate their own as a precaution based on established knowledge of how disease propagates and spreads, I find it interesting that so many people (who pride themselves on their self-'education') - and who benefited from vaccination themselves while growing up - are so convinced of the inefficacy and "danger" of vaccines. And with so little solid evidence to support their belief. Indeed, there's a huge amount of rock solid scientific evidence that clearly and directly contradicts the anti-vaccination argument. And now they're so convinced that their Googled "instant expertise" exceeds that of the genuine professionals in the field that they're even willing to put their own (and other's) kid's health (and lives) on the line to prove they're right. That just boggles my mind. Small wonder they had to drag that old brickbat "Conspiracy!" and toss some ad hominem attacks into the discussion to 'support' their position.

But it is true that vaccines are not a panacea for every individual. And they may harm a minuscule portion of the population despite all the precautions taken to assure their safety. There will always be boundary conditions and exceptions in biology. And risk will always be present with any vaccine or medication, no matter how slight.

FWIW my doctors have always advised me to avoid crowds and take it easy for a day or two after I've gotten a vaccination so my system has time to adjust. Vaccines aren't one of those simple "dose & go" or "magic bullet" solutions like antibiotics often are. They don't kill or ameliorate an infection themselves. They "encourage" your body develop its own defense against them. Which takes your body time to fully boot up.

Like most things in medicine, it seems like it's seldom "just one simple thing," but rather a combination of factors on different levels of an individual's health regime (i.e. locale, environment, genetics & gender, age, diet & nutrition, exercise, competent medical care and advice, drugs, vaccines, timing, etc.) that yields the most benefit.

I've been given to understand that vaccines (by themselves) aren't a magic cure-all. But I haven't heard immunologists or competent medical doctors claim they are either. Vaccines are, however, damn good insurance. With vaccines it's all about risk minimization and mitigation. Because at this stage of our medical knowledge and technology, that's about as good as we can make it.

Renegade:
@Ren - IIUC you can't (except in that rare situation with the old oral polio vaccine - which is no longer administered) come down with the illness that an attenuated-live vaccine is designed to provide immunization for unless the batch that was administered was defective. And my understanding is that cases of defective vaccine batches making it into actual circulation are extremely rare occurrences.
-40hz (February 10, 2015, 08:35 AM)
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Sorry, but no. There are some vaccines that make the patient contagious for a period of time. You only need to check the insert to verify.

You can find it in some inserts under some section  like in the below, 5.8 "Risk of Vaccine Virus Transmission". Here's a bit for the VARIVAX vaccine:



There are more. That's just one. The recommendation is for 6 weeks.

Here's a bit from another insert:



That lists 28 weeks, or 7 months.

Again... just what part of this is hard to understand for people? Everyone wants to believe that vaccines are some sort of magical pixie dust.

PUBLIC SERVICE ANNOUNCEMENT (PSA):

VACCINES ARE NOT MAGICAL PIXIE DUST!

Vaccines are, however, damn good insurance. With vaccines it's all about risk minimization and mitigation. Because at this stage of our medical knowledge and technology, that's about as good as we can make it.-40hz (February 10, 2015, 08:35 AM)
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Yes. Exactly.

But the pro-vaccine crowd almost ALWAYS touts all the positive benefits and completely ignores any of the possible adverse issues or other "inconvenient" facts. Again... this is about approaching the topic sanely and measuring benefits vs. costs.

I'm sorry, but nobody gets to choose what parts of reality apply to them. Unfortunately, 100% of reality applies to everyone... vaccine advocates included.

This only goes to show, yet once again, how the mainstream views are so grossly distorted and perverse.

What really pisses me off is all these self-righteous zealots who preach "science" and then want to ignore anything that doesn't fit their personally acceptable narrative. This is a recurring theme in many fields, not just in "vaccines".

Gravity applies to Wile E. Coyote just as it does to everyone else. Nobody escapes nature. Not even psychotic zealots. :P

Now, chickenpox (for the Varivax vaccine above) isn't very serious. But it's just one example. Not all vaccines are equal, and the zealots trying to portray them as all being unicorn farting rainbows do nothing to help the situation.

Each vaccine needs to be treated on its own merits. Period. End of story. Most offer great benefits, but lying about them does not engender trust.

Given the massive disinformation and the non-stop lies about vaccines, can we blame people for being against them?

Or, would you trust someone that you knew constantly lied to you?

This isn't difficult to understand -- the vaccine zealots do more harm than good when they constantly lie and cover up inconvenient facts time and time again.

40hz:
Ok. I stand corrected. But that's also VARIVAX. (Chicken-pox, right?) So how many more vaccines have similiar concerns precisely? Current anti-vax arguments say all vaccines are unacceptably dangerous. I don't think that's correct.  (BTW, chicken pox is a very serious illness if contracted by an elderly person or someone with severe respiratory health problems.)

Going back to the the chance of spreading something post vaccination - if people who are exposed are already immunized either from a previous bout with the actual disease - or have been previously vaccinated as most vaccine protocols recommend - the individual infection is extremely unlikely to spread to those exposed.

Again, they're citing a boundary situation that could possibly become an issue if only a few people are vaccinated - and the majority of the population are not. If 99% of the population is already immune, the occasional person who may become contagious post-vaccination does not pose a serious risk to the general population. Just the holdouts

Exceptions can be given till the cows come home. I think it's more beneficial to focus on the norm as long as those exceptions remain exactly that - statistically insignificant.

Just my :two: anyway. The demand for perfection remains a barricade to accomplishing demonstrable good - if you allow it. :)

Vurbal:
I would suggest that what is relevant is the observational data and results of experiments/trials and the falsifiability of those experiments/trials - be it wind speeds, global temps, numbers of infections/vaccinations, the incidence of caries in certain age groups, or something else.
-IainB (February 09, 2015, 10:36 PM)
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This times infinity.

I hadn't been paying attention to this discussion for a while, and I'm going to wait to add my specific thoughts on a couple of the specific topics until I have time to write. And yes, that means walls of text, so I apologize in advance.

I did, however, want to highlight what IainB posted because he managed to summarize the entire issue in as succinct a manner as possible. For a much wordier treatise along the same lines, I highly recommend the transcript of a lecture Michael Crichton gave at Cal Tech shortly before his death.

Aliens Cause Global Warming

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