Just a follow up … several years later:
ETA: your list included vaccines. I’m highlighting that causality has been established and accepted in the Vaccine Injury Table.
Was there some kind of “gotcha” perceived here?
Brachial plexus injury due to using an incorrect anatomic site for vaccine administration has been classified as a VICP table injury eligible for compensation for nearly three decades.
Since the thread has been revived, what do “space out the vaccines” advocates think of Trump’s newly announced “demand” that some childhood vaccines not only be split into separate components, but given in five separate 20% increments, which he thinks will drastically reduce autism? 
In the case of MMR, that would mean instead of one shot, children would get 15 shots over an extended period of time. That should delight the kiddies, as well as their parents who’d have to take time off work to drag them in for all those extra visits and shell out $$ for copays.
It’s highly unlikely that drastically weakened vaccine doses will supply immunity comparable to what’s achieved now, and not out of the question that vaccine reactions will be increased by such a regimen.
Add in the cost of vaccine reformulation and extended studies to determine immunogenicity and safety, and it would be a long time before these weak vaccines hit the market, if companies are even willing to completely revamp their manufacturing processes and finance trials, rather than just exiting the market, which is what RFK Jr. and his antivax allies hope for.
So are any others who posted in this thread saying “Right on, Donald!”?
You can’t be too careful, y’know. 
When i talked with my doctor about my fall flu and covid shots at my annual physical, he told me a recent study found that the shots were slightly more effective if given 2 weeks apart. But he said the difference was small, and if i wanted the convenience of doing both at once, that was fine.
Every time a combined vaccine is developed (like Tdap, MMR, or the flu+covid vaccine that Moderna is testing) there are randomized studies to determine if the combined vaccine works as well and is as safe as the separately administered vaccines. Given the number of combined vaccine on the market, i think it’s safe to say that in general it’s fine to combine vaccines.
In general, any significant delay of, for instance, the elements of the MMR, mostly means that more kids go longer without protection from dangerous diseases. Most vaccines are recommended as early as the child’s immune system will produce a long-term response, and for some especially risky diseases, an early dose is recommended before that, to give temporary protection while waiting to be able to get longer-term protection.
I don’t know whether there’s broad interest in reigniting the entirety of this particular topic, but … I feel like I addressed that piece upthread:
Generally speaking, there’s a ginormous combinatorial problem in testing:
- A relatively large number of vaccines, some of which are combination vaccines
- Lots of possible dosages for each
- A nearly infinite number of timing possibilities that probably need to consider sequence (ie, in what order are the vaccines administered), too
Couple that with what is a theoretically infinite individual human physiology and the ethical constraint of pediatric testing, and you get something extremely complicated.
As I’m fond of saying, the RCCT (Randomized Controlled Clinical Trial) may well BE the very best we have, in some ways, it’s dwarfed by the potential impact – and difficulty in controlling for – nearly infinite individual human physiology and the potential role IT can play in medicine.
Which IS the reality that is currently wrestled with – sensibly – because doing something is, in this case (vaccines), far better than doing nothing.
But I think the combinatorial issue should leave us open to the idea that the algorithm should constantly be refined, the basic assumptions questioned, and new hypotheses be rigorously considered and explored.
NONE of which is to say that I think Trump or RFK, Jr. has ANY idea what they’re talking about, or that vaccines are inherently dangerous, or that they case Autism.
That’s not just a question for vaccines, it’s an issue for almost all medicine. When doctors test a new protocol for treating cancer, they don’t have the wherewithal to test every combination of every treatment.
All you know is that this finite number of combinations was tested, and some of them did better or worse.
With cancer, there’s a lot of improvement possible in the outcome, and a lot of new stuff being developed and new studies. My husband’s care is literally based on the protocol of a study that hasn’t been completed. But with childhood vaccines, we have a protocol that produces excellent outcomes. It’s probably not the very best possible protocol. But it’s a tested protocol that produces excellent immunity and the serious side effects are very rare. There’s a good reason that most of the research is around new vaccines, and not around rejuggling the schedule for vaccines that are known to work well.
I would argue that:
- It’s all a matter of degree. The same principle doesn’t apply equally to every single scientific method process executed in Medicine, and/but
- It’s very important as a principle, and something we should never lose sight of, and
- Those injured by treatment, as a group, would probably be vociferous supporters of continuous improvement.
I think we should take great pains to both increase reward and decrease risk at the same time.
I think the National Vaccine Injury Compensation Program is neither an unalloyed good nor – clearly – an unalloyed bad.
There is a moral hazard aspect to it …
There’s organized reporting and tracking of vaccine reactions, and especially of serious ones. The federal VAERS database releases anonymized data of adverse vaccine reactions that’s available to anyone. Some vaccines have been pulled because of that. There was one for infant diarrhea that i remember because a friend’s kids got the vaccine shortly before it was removed. (She was pleased that her kids had been able to get it, as they hadn’t suffered the adverse reaction, and they were protected from a moderately serious disease.) The J&J covid vaccine was also pulled, because it had more adverse reactions than other options, so it was deemed a poor choice. (I think that wasn’t done until the novavax vaccine was approved, so that Americans had a non-RMA option.) I’m sure there have been others, that’s just two that I’m personally aware of. But despite lots of pre-release testing, sometimes a vaccine proves riskier than intended, and is removed from the US market.
I assume other countries have similar monitoring.
Honestly, I’d rather my research dollars go towards improving cancer treatment, and optimizing many other aspects of healthcare than chasing after a potential very small improvement in the current vaccine schedule.
I know that answer doesn’t help you. But i think you gave your friend bad advise in suggesting he delay his kids’ childhood vaccinations. Bad because the existing data suggests that that decreases the benefits of vaccines without decreasing the risks
I get it.
But my friend’s PhD in Computational Biology makes him unusually and highly skilled in vetting my advice, and led him to have fruitful discussions with his kids’ pediatricians with whom he came to his own well-informed and considered conclusions.
I don’t particularly ‘trust’ the average person with incredibly complex stuff, but I did, and do, trust him.
Honestly - nah. Being expert in one thing often gives a false sense of confidence to second guess experts in fields outside your area of expertise.
Coming in late here, and won’t spend too much energy on it. It exhausts me too frequently at work.
First in terms of the “concerns” regarding that protecting from so many illnesses is exposing to more things to react to -
The total number of antigens in the childhood schedule has fallen dramatically over the past several decades: was more than 3,000 to roughly 300–320. Even as the number of vaccines and diseases covered has substantially increased, with dramatic reduction of many serious diseases. Biggest drivers of the drop was the switch from whole cell pertussis vaccine to acellular, and the end of small pox vaccine.
For childhood vaccine preventable diseases: what we know is that the current recommended schedule is effective and extremely low risk; and we know that delaying the schedule is decreasing the period of time children are protected from the diseases and from being potential vectors spreading it to others, decreasing the protection of the herd, with zero evidence that such delays have any offsetting benefit, indeed not even any rational reason to think it would. Delays risk real harms for no benefit known or logically expected. I engage. I’ll take getting a refuser to do a delayed schedule as a win and work to prioritize the most important ones to get done first. But they are NOT doing right by their kids or by the community. They have increased risks to both by real amounts for no benefit.
Thus demonstrating the risk of extrapolating from the many to the one 
Sorry. That’s as far as I read. This topic doesn’t get my juices flowing either 
Yeah this illustrates exactly how exasperating deal with this shit in the office is.
Checks forum. GD. Deep cleansing breath. Not the Pit. Respond appropriately for venue.
Parents come in having heard recommendations from people who don’t know much. Things like:
And I engage. I explain. But mostly they listen for as far as @DavidNRockies read. The frustrating thing is that it is mostly. If ALL then easy, no need to waste my breath. But some actually hear and engage. So for the sake of the few times they aren’t already closed off to any discussion, and of those the few times they actually engage at least part of the way, I have to invest the time … although I do now try to get a sense of the lights going off early and cutting to the chase of stating the increased risks of death and disability to their child and to others with no benefits, sign here that you have been told please.
I prefer to get them separately since they often have side effects. I’d rather just deal with one set of side effects at a time rather than lots of side effects and their effects magnified. For instance, the flu and covid vaccines give me a sore arm and make me feel a little sluggish. I’d rather get one shot at a time and deal with one sore arm and feeling a little sluggish a couple of times instead of getting both shots at once and having two sore arms and feeling a lot sluggish. That’s also based on conveniently being able to drop in for the shot at my local pharmacy. If I had to schedule a Dr’s appointment, I might decide to get them both at the same time to avoid the hassle of the Dr appointment.
If I’m getting a vaccine I’ve never had before, like shingles or pneumonia, then I’ll just get that one all by itself no matter what. Since I don’t know the side effects of that new vaccine, I wouldn’t want to get multiple vaccines and deal with a strange mix of side effects.
There’s a name for that affliction .
It also explains how contrarians come up with petitions from “scientists” and “doctors” that support pseudoscientific propositions.
At 75, I just got my first flu shot ever. No reaction except a sore arm. I got a covid vaccine at the same time. I had no reaction to my first shingles shot, but the second one caused a lot of anxiety after (I read it may have had to do with revving my immune system so much).
While my PhD friend doesn’t (AFAIK) have a Nobel Prize, his training does give him the ability – in conjunction with his kids’ pediatrician – to:
- Differentiate between live/non-live, series/non-series, and high/low community circulation
- Have a sense of the combinatorial impact of the variables at play
- Make a reasonable estimate as to the amount of latitude that could reasonably be inferred from the basic timeline framework on some of the recommended vaccines
- Have a thoughtful discussion about where a conscientious parent and an open-minded physician might see flexibility that doesn’t materially increase risk
I have another dear friend who was a highly sought-after Oracle Database Administrator who worked in biotech. He used to frequently tell me that “PhD’s think they’re the only once with a license to think.”
Turns out, that’s not exclusive to Nobel Prize winners.
OR PhD’s for that matter.
The basic quantitative science in an issue like this – as an actuary would well understand – is separate and distinct from the sociological population management (or numerous other) issues that come into play.
The risk models that an actuary might produce are but one input in complex business decisions made in the C-Suites, but there should be an ability to tease out the math FROM the other issues.
The mere fact that something is, today, the best available evidence means we shouldn’t ignore it without a compelling basis for doing so, but neither should we rest on our laurels and assume that – given time and new information – the model shouldn’t be revisited and cannot be improved.
In no way is vaccine science static. In addition to continual review of current practices, there’s ongoing research into such matters as new and potentially improved adjuvants, and the safety and efficacy of combining vaccines. Changes in the vaccine schedule are debated, not only to potentially incorporate new vaccines but to change the way current ones are given (for instance, single-dose HPV vaccination vs. the two-dose regimen).
I know. And I didn’t mean to imply otherwise. I meant to reinforce the significance of a pretty important basic precept.
Equally important was my reminder not to dismiss the best available evidence without a compelling reason.
But there are people who stick religiously with the manufacturer’s oil change interval recommendation, and then there are people who send a sample in for analysis in an effort to optimize their engine for their particular operating parameters.
As I’ve said before, the RCCT is as good as it gets, but it’s up against a mind-boggling number of potential (“combinatorial”) variables, and – while sample size, randomization, reproducibility, replicability, blinding, multi-center, etc., etc., are excellent approaches to reducing the impact of those variables – they’re collectively doing a whole lot of work, which is where confidence intervals and margins of error come in.
The more we shift toward “precision medicine,” the less of a factor that will be for individuals, and the easier it will be to improve the risk:reward calculus.
But that’s not today.
Meanwhile, I may or may not change my oil at 3,000 miles, and I may very well advise some to work with their physicans to determine if it might be appropriate to make some alterations to some components of the vaccine recommendations.
So, speaking as an actuary, it’s not usually worth looking for the very best possible [anything]. The gold standard is a tool or algorithm or schedule that’s good enough.
If something better is available for the same price, (and with childhood vaccines, most of the cost is the time to go get jabbed, and the parent’s time off to make it happen) or something MUCH better is available for a slightly higher price, sure, go for it.
I’m personally thrilled that the really unpleasant old pertussis vaccine was replaced with one that has much milder side effects, for instance. But except for outliers (like specific vaccines that are especially unpleasant) or incorporating new vaccines, i don’t think the vaccine schedule is broken and needs fixing.
I mean, if your kid doesn’t go to daycare, it’s probably okay if they use some different schedule so long as they get everything before they go to school. But kids who hang out with lots of other kids need as much protection from communicable diseases as they can get, as soon as reasonably possible.
That basically flies in the face of the idea that science and medicine are processes of continuous improvement.
From which we pretty much all benefit.
It really isn’t an all/nothing proposition.
And they are. But most of that improvement is in areas that need a lot of improvement. Like cancer, heart disease, joint disease, …
The biggest advancements in vaccines are regarding new infectious diseases, like covid and ebola. And told diseases that we now understand enough to vaccinate for, like HPV. As they should be.
When you say, “i have $x of research dollars to spend, where should i spend it?”, adjusting the schedule of existing childhood vaccines is extremely low on my list of priorities.