If he says don’t “because in his experience, it was raising the risk of infection,” it tells me that he doesn’t understand the very basics of science such as confirmation bias. Unless of course “his experience” is conducting a double-blind peer reviewed study.
As mentioned earlier, that would probably be a deal breaker in him being my doctor.
It’s possible he was familiar with the theory of orginal antigenic sin and believed that was happening with COVID but didn’t really think explaining that to a layperson was a billable use of his time. When he said, “In my experience,” he clearly meant it as a warning/qualifier, that was evident in his tone. Which implies to me he knows the difference between research and observation.
IOW not a dealbreaker for me, but I’m not going to take his COVID advice.
Sure thing. I’m certainly not dictating (or even recommending really) what you should do.
I’m not trying to disdain physicians writ large; I’m sure that many are hardworking and knowledgable within their areas of specialty, but non-medical scientist physicians in general do not have an extensive background in research science and except for understanding terminology are not necessarily better at critically interpreting scientific studies than a well educated layperson. And even research scientists can be biased or misled outside their area of knowledge (or even sometimes within it) leading to false confidence in factually unsupportable opinions.
No, when a physician gives advice outside his specialty that is contrary to broadly accepted guidance, it should be questioned rather than dogmatically accepted as truth. In this case, an immunologist recommended that the o.p. not get a booster “…because in his experience, it was raising the risk of infection,” which is an opinion that is contrary to the general consensus of virologists and epidemiologists. In general, when someone qualifies an opinion with “in my experience”, unless the question is specifically about their experience it should be treated as anecdotal and subject to personal biases versus opinion based upon statistical data and peer-reviewed studies.
Stranger
What’s that phrase? “Question Everything”.
But note that folks who are very well versed in the subject, like Paul Offit, don’t like the CDC’s stance that we should be “boosting everyone from aged 6 months up, every year” [or more often, as it turns out].
He, and others who are hard to simply dismiss as talking out of turn, say reserve the boosters for those most at risk of severe disease. He’s in his 70s and recommended against it for his younger family members, and said he wasn’t getting it himself(*). Is anywhere in the Western hemisphere (outside of North America) recommending a “boosters for all” program? As far as I can tell, most are limiting it to older people and those with high risk otherwise (compromised immune systems).
Now, if OP is one of those at high risk of severe outcomes, then it seems his immunologist may well have been talking out of turn.
(*) I haven’t heard much about this subsequent to his February 2023 NEJM letter. Maybe he’s changed his stance in the interim.
Okay, i read that study, and i can give what i believe is an explanation for what they found.
The people in the study who didn’t bother to get boosters were (largely) people who had recently been infected with covid. If you pick apart the data what it actually shows is that vaccination + prior infection gives more robust immunity than vaccination alone. And the study was done at a time when the available vaccine had not caught up with the virus (before bivalent/omicron vaccines were available, but after omicron was out there.)
Of course, vaccination remains far safer than infection. So if you have a choice, go for vaccination. But if you’ve recently recovered from covid, another dose of vaccine is likely wasted time, money, and annoyance. At least for a few months.
In fact, if I’m not crossing studies in my head (and I’ve read a lot, so i might be) i think the goal of the investigators was to show that prior infection is effective at generating immunity. Remember when the FDA was arguing that only vaccines counted? Yeah, that was dumb and that’s been amply disproved.
But we have a lot of contemporary evidence that the fall 2023 vaccine was effective to protect against the winter 2023/2024 viruses.
At best, your doctor is confused.
That sounds pretty good. As for the timing of variants vs. vaccines, the study’s day 0 was when the BA4/5 bivalent first became available, so yes BA4 and 5 had already been circulating and I believe were the primary infectious cause at that time.
So the just prior vaccine would be outdated in terms of protection against BA4/5. And then on the back half of the 90 day study window, other variants had largely supplanted BA 4 and 5.
I ran into that one and skimmed it while looking for the peer-reviewed version of the Cleveland Clinic study. I’m pretty sure it showed vaccination + prior infection was superior to either alone. But now I can’t find the danged thing.
I’m a lady. According to the CDC, I am at increased risk for a few reasons. I have asthma, for one thing. However my new asthma medication has been working a lot better, so much so that my asthma problems were minimal with my first (known) bout of COVID over the holidays. Not that it was a fun time, but I didn’t end up in the hospital. So you see, I have a doctor who really helped me where it counted most.
Whoops, my mistake; sorry. I didn’t read the whole thread carefully enough.
My wife’s asthma has always been easily and well controlled. But for my youngest daughter it’s seemed like a long slog of changing meds plus over-strong side reactions. They see the same asthma specialist. So glad to hear your doctor is doing a great job of it because I know tough to manage cases can be miserable.
Long ago I spent the better part of a year doing secretarial work in a clinical research center, where cutting-edge work was being done on HIV antiviral cocktails, sickle-cell anemia treatment, and type II diabetes management. It was really interesting.
One of the more interesting bits (other than the guy who wanted to sell one of his testicles to us) was the full-time statistician on staff. His primary job was to analyze study designs and data to ensure that they were designed for statistical power and that the results were interpreted in a statistically rigorous and meaningful fashion.
Ever since then, when I hear teachers or other folks talking about data-driven decisions, I remember that statistician and think, “amateurs!” It’s really, really hard to make a data-driven decision that’s statistically rigorous and meaningful.
So true. There are a lot of ‘junk science’ studies getting published these days, that are not well designed nor given adequate statistical analysis. Yet these studies get a lot of press, quite often with misleading or even wrong headlines attached to the story.
I took a lot of statistics courses in my early years, enough to become slightly ok at it for a brief time until I forgot the details of how to do it. But it seems a lot of physicians who get their papers published don’t even have the bare basics down. Or even worse, they use the basics incorrectly, or on the wrong items to prove their point.
There’s a huge trend in education for teachers to gather as a team and make “data driven” decisions. But it has a couple of issues:
My father is a retired physician, and part of his retirement was driven by similar forces in the medical community. His strength as a physician (AFAICT) is that he was remarkably good at establishing a rapport with patients and getting to the root of problems and helping patients create a plan for their health that they could trust and rely on. When everything started moving toward spreadsheets, he became less effective.
Man, do I relate to that.
My husband is a clinical psychologist with a heavy research background (including a deeper knowledge of statistics than I will ever have) and I think one of the greatest things he got out of his schooling was the ability to tear apart basically any study. It’s annoying when you’re trying to socialize with him by sharing something you learned, though, because he’s always got a reason why the thing you learned is bullshit.
LOL, I have that tendency too. But out of deference to those I converse with (especially the Mrs.) I’ve managed to tone down my ‘Everything is bullshit’ response.
Now I just claim (mostly in my own head) that 90% of everything is bullshit. And think of Ted Sturgeon.
He promised he would work on it.
By the by - this is now a Ron Desantis talking point:
So perhaps your doctor heard it from him.
I follow Paul Offit (on his “Beyond The Noise” segment on Microbe.tv) and think that he is knowledgable and generally authoritative but in this case I don’t think there is any paucity of SARS-CoV-2 vaccine boosters, and the problem is really getting people who need boosters to actually get them. I’ll also note that while presentation of COVID-19 is generally ‘mild’ for people under 65 who don’t have confounding factors, the incidence of ‘long covid’ (Post-Acute Sequelae of COVID or Post-Covid Condition) has remained essentially consistent (insofar as it is being reported with any consistency) regardless of how benign the initial illness was. It still isn’t clear how protective how vaccination is against PASC/PCC but the general inference is that it reduces significance and duration, which is sufficient reason for getting boosted for enduring immunogenicity.
In any case, unless the o.p. has misinterpreted her allergist, the physician isn’t recommending against boosting to reserve the supply of vaccines for critically vulnerable patients but because it “was raising the risk of infection,” which is just nonsense.
I deal with a lot of statistics with regard to process control and simulation, assessment of dynamic environments, and surveillance of chemical and mechanical aging trends, and it is indeed very difficult to make statistically-meaningful predictions or validate a correlation with what is typically a small or highly varied data set. It is also really easy to fool yourself into believing that a regression or other data fit is valid if you don’t understand the limitations of metrics and methods to assess correlation. It really takes a lot of deep thinking and understanding of statistical methodology sufficient to really be confident that the data supports a conclusion, and it is unreasonable to expect a clinical physician to be sufficiently conversant in data analysis to critically evaluate a study based upon statistical assessment. (In theory, that is what peer review is supposed to do but has largely failed as evidenced by the “replication crisis” in medicine and psychology.)
Also known as “That F***ing Guy”.
Stranger
Sometimes I wonder if there’s anything we can do to bridge that gap. Because it seems important to me for clinicians to be using the best available evidence to treat a condition or even make a recommendation. I have an axe to grind on that particular point, but assuming it’s not a reasonable expectation for a clinician to know all of this stuff, what then can be done?
Some are actively resistant to the idea that any study might know better than they do. In my experience, ego is often so much a part of this.
As someone who harped constantly on the topic of study design with my teams, I’d add that this is an additional skill I don’t expect a clinical physician to be conversant with, but it’s so important. The ability to unpack potential problems and biases in a study is critical.