[AR] Re: ... Coronavirus
- From: Norman Yarvin <yarvin@xxxxxxxxxxxx>
- To: arocket@xxxxxxxxxxxxx
- Date: Tue, 24 Mar 2020 13:30:05 -0400
On Tue, Mar 24, 2020 at 08:23:25AM -0700, Henry Vanderbilt wrote:
On 3/23/2020 4:32 PM, Norman Yarvin wrote:
On Mon, Mar 23, 2020 at 12:37:48PM -0700, Henry Vanderbilt wrote:
On 3/21/2020 1:26 PM, Henry Spencer wrote:
And if your prototype vaccine turned out to kill more people than the
virus? That is unfortunately *not* an unrealistic possibility.
What he said. One word: Thalidomide. Don't look for widely-distributed
vaccine in less than a year, and most likely longer than that.
So we should wait for the Chinese to develop and test the vaccine
first and find any problems, like we did with the Europeans and
thalidomide? (Pretty much all the 'flipper babies' were European;
score one for FDA bureaucratic delay.)
That'd likely work (the Chinese can be quite competent medically, are
often realistic about their cost-benefit calculations, and sure can
act fast), but the cost of delay is rather different: thalidomide was
sold as a morning sickness treatment, which was never a matter of dire
urgency.
Strawman. I said nothing about "waiting for the Chinese". One year+ is
already a remarkably accelerated schedule for developing and fielding a
vaccine, for the reason both I and my non-evil twin implied: Adequate
testing to acceptably mitigate risk of negative effects outweighing the
benefits. The Chinese are no more likely than we to shorten that period
without disaster.
They're not going to wait for us, though; they've already published
photos of a heroic doctor being injected with a trial vaccine. Sure,
they're much more willing than we are to kill people with a botched
attempt, but that's really our mental problem, not theirs: when you're
playing for high stakes, you have to be willing to up the ante.
Meanwhile, my point in mentioning Thalidomide was that the risk
mitigation /was/ botched, not that the risk/benefit calculations were
comparable. You accuse me of a false equivalency I did not make.
Rude.
I said no such thing, and intended no such implication. I phrased it
as a question; it could have been answered with a simple "No". I do
apologize, though, for not adding the much more concrete argument,
which is that thalidomide belongs to a different class of drugs (small
molecules manufactured by chemists), with a very different risk
profile. The main risks from vaccines are things like autoimmunity
and disease enhancement, which are admittedly there (I went into them
a bit in my reply to Henry Spencer), but seem manageable even with an
abbreviated testing schedule. And how most vaccines fail seems simply
to be that they don't work: they don't confer enough immunity. The
only danger in that case is thinking that they _do_ work, and that's a
matter of doing appropriate statistics.
Obviously Thalidomide was aimed at a relatively narrow luxury
market, while COVID-19 vaccine will of necessity end up administered to
a very large part of the world population. And you mention the higher
cost of delay, but omit mentioning that the fact most of us /will/ end
up taking it /hugely/ increases the risk side and thus the due diligence
needed.
That's not the only way to use vaccines. With the smallpox vaccine,
for instance, in the third world, they had a practice of flying in
doctors and containing an outbreak by vaccinating the people around
it. Besides, the idea is still to ramp things up, monitoring as we
go, not to suddenly insist that everyone must be vaccinated. It's
just that the ramp-up doesn't have to be done in the traditional
fashion. To my mind, the way to do it would be exponentially: at any
stage we'd be trying it on (say) no more than twice the number of
people it had been tried on before. As we've seen with the virus
itself, exponential growth gets you very far, very fast, even if the
initial steps are modest.
On the whole, the CDC and FDA shouldn't be thought of as being any
more on the ball than any other big government agency is (say, NASA).
There's lots of expertise inside the brain of the elephant, and it
never forgets, but it can produce mind-boggling amounts of excrement.
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