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Author Topic: Vaccine risks vs. benefits, a thorough mathematical consideration  (Read 38106 times)

GavJ

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Vaccine risks vs. benefits, a thorough mathematical consideration
« on: September 02, 2014, 06:04:50 pm »

First, right off the bat, spoiler alert: my end conclusion here is going to be that we don't have enough data available to know whether getting most vaccines is harmful or helpful, specifically in 2014 in America, to either the individual or to society as a whole. It is neither pro-vaccine nor anti-vaccine, so don't get your bustle in a bunch just yet.

Edit: In terms of "so what?" the actual bottom line here is that "people should stop being dicks to each other about personal vaccination decisions, when in reality, neither of any two people arguing about it has sufficient data to actually know who is making the correct choice, for themselves or society."

Anyway, this is how people SHOULD be talking about vaccines and making decisions about them, in a rational, scientific world:

1. The simple method you should consider when deciding to undergo ANY medical treatment - risk vs. reward.

I trust that this should be an uncontroversial starting point: You should undergo medical treatments that have a higher chance of helping you than they have a chance of hurting you.

Long version:
Spoiler (click to show/hide)

2. What are the known benefits of vaccines?
Short version:
Looking at death rate as a representative subset of total risks and benefits, and using measles as an example, the benefit to you over your lifetime of a measles vaccine in 2014 in America is in the ballpark of a 1/60,000,000 chance of it saving your life from a measles death.

Long version:
Spoiler (click to show/hide)

3. What are the known risks of vaccines?
Short version:
We don't know, because clinical trials only use ~2,000 people at most for vaccines, which obviously can't tell you about hypothetical death rates in the neighborhood 1/60,000,000, and even giant observational meta-studies (setting aside inherent weaker causal claims) don't have enough participants, use odd statistics, and also tend to focus only on thimerosal and autism to the exclusion of what you should care about more, which is "all risks (including current example of death) from any causes."

Long version:
Spoiler (click to show/hide)
4. Conclusion for individuals' risk/benefit for taking the measles vaccine regarding chance of death

You simply have no way to know with current data. Knowing benefits but not risks is equally as useful as knowing no data at all. Therefore, the only way to make a decision is gut instinct or intuition, and I see no scientific basis for telling yourself or anybody else that they are correct or incorrect about their decision in any objective sense. At this time, in the U.S.

(We BARELY even have enough data to be sure that current measles vaccines help more than they hurt even if we had the same infection and death rate as in 1960 pre vaccine!)

5. What about herd immunity? I.e. calculating based on societal risk/benefit?
Short version:
One, this is a pretty unethical basis for making policy. Two, even if we ignore that, we don't have enough data anyway to know whether the benefit to society is greater than the risk to society.

Long version:
Spoiler (click to show/hide)
« Last Edit: September 02, 2014, 10:56:09 pm by GavJ »
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GavJ

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Re: Vaccine risks vs. benefits, a thorough mathematical consideration
« Reply #1 on: September 02, 2014, 06:14:11 pm »

Apologies, put in DF general discussion by accident, at first.
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Sergarr

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Re: Vaccine risks vs. benefits, a thorough mathematical consideration
« Reply #2 on: September 02, 2014, 06:25:11 pm »

In America, we have strong precedent that citizens have a right to their own bodily integrity despite potential costs to society.
In America™, it's better to let millions of people die from smallpox, than to suffer a little bit of pain for a vaccination, which will 100% guarantee your life.

Smallpox has killed millions of people and was stopped by total vaccination. You are against total vaccination. Do the math.
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GavJ

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Re: Vaccine risks vs. benefits, a thorough mathematical consideration
« Reply #3 on: September 02, 2014, 06:31:46 pm »

...and first respondent failed to read the very first sentence of the thread. Come on dude.
Quote
...specifically in 2014 America...

2014 =/= 1914. Although the math and logic you should pursue if you do live in 1914 America would have been the same as here, the conclusion very well might have been different, and I am not commenting on that here.

(It should also have been clear that "You are against total vaccination." is incorrect as well. If the red line in the "long version" of the final section is at the bottom, then yes I would be for total vaccination. We just don't know if it is)
« Last Edit: September 02, 2014, 06:36:55 pm by GavJ »
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Baffler

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Re: Vaccine risks vs. benefits, a thorough mathematical consideration
« Reply #4 on: September 02, 2014, 06:37:42 pm »

What your numbers don't account for is the fact that measles, and other infectious diseases, are so rare (in the US anyway) because nearly everyone is vaccinated against them. Before the first measles vaccine, developed in 1963, measles killed or caused encephalitis far more often. According to the CDC, before the measles vaccine was developed, 3-4 million cases were reported in the US alone, with almost 50,000 hospitalized for the whole decade. I'm sure the case is very similar for diseases like rubella, and the big ones: smallpox and polio.

If we stop vaccinating people, the infection rates will without a doubt rise again. It probably wouldn't happen quickly, but it would certainly happen.
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GavJ

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Re: Vaccine risks vs. benefits, a thorough mathematical consideration
« Reply #5 on: September 02, 2014, 06:41:59 pm »

Quote
What your numbers don't account for is the fact that measles, and other infectious diseases, are so rare (in the US anyway) because nearly everyone is vaccinated against them.
Yes I do account for this, although I apologize in that it might have been unclearly labeled. See section 5, specifically, and click "long version" and see the enclosed graph.

The graph as labeled is supposed to be for societal benefit, but the exact same graph would also be valid as a description of your individual benefit (since I left the y-axis unscaled on purpose anyway). The same principles apply as the discussion of the graph in that section.

Specifically, as fewer people are vaccinated, the benefit for the next vaccination is higher even for your own personal benefit, because, as you point out, there are more sick people around posing a greater threat to you so the protection is more valuable.

At some point though this extra value to you might intersect with the risk to you, though. At which point your personal motivation to vaccinate should stop.



The result would be that if everybody were omniscient, pursued purely selfish goals, and followed the above logic, vaccination would at some point stop at some midpoint, like 30% or 60% or whatever at equilibrium with risk. It would not crash to 0, and it would not go back to 1960s levels.
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Graknorke

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Re: Vaccine risks vs. benefits, a thorough mathematical consideration
« Reply #6 on: September 02, 2014, 06:44:58 pm »

I think that if a vaccine was killing people it wouldn't be a very good vaccine.
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alway

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Re: Vaccine risks vs. benefits, a thorough mathematical consideration
« Reply #7 on: September 02, 2014, 06:46:18 pm »

This is silly. You can't calculate risk based on the assumption that everyone will be vaccinated when considering whether everyone should be vaccinated. Which is precisely what you're doing when you make a calculation based on '2014 america.' Very few people dying from a disease that nearly all are vaccinated against is not a reason to stop vaccinations. You do need to compare it to '1914 America' because that is the future you are proposing. Because the risk rises dramatically. You should factor it against 1 million cases, not 100. https://en.wikipedia.org/wiki/File:Measles_US_1944-2007_inset.png

Then you're literally handwaving away evidence of their safety.

And you know who is the greatest at risk population for measles? Those who can't get measles vaccines or are too young to have them. Infants, people with compromised immune systems, ect. There is no 'equilibrium,' it's just being a dick and purposefully screwing over the most at-risk segments of the population.

So yeah, vaccine denial bullshit is indeed bullshit, no matter how many big orange fonts you use.
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Strife26

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Re: Vaccine risks vs. benefits, a thorough mathematical consideration
« Reply #8 on: September 02, 2014, 06:55:43 pm »

Short story:

No.


Long story

Spoiler (click to show/hide)
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scrdest

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Re: Vaccine risks vs. benefits, a thorough mathematical consideration
« Reply #9 on: September 02, 2014, 06:59:22 pm »

Oh, and you're not accounting for time. Even if you could have the 'last vaccinated person' in this case, its benefit would be non-zero even at 100% effectiveness because of the ancient mystical truth.

People fuck.

And that causes more people to be born. Without the immunity. So it cannot be a linear function.
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GavJ

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Re: Vaccine risks vs. benefits, a thorough mathematical consideration
« Reply #10 on: September 02, 2014, 07:03:38 pm »

Quote
If we stop vaccinating people, the infection rates will without a doubt rise again.
As an entirely separate point to my preceding post, there is also additional reason to doubt it is true that rates would return to 1960s levels even if vaccination did return to 0%.

Measles was already steadily on the decline prior to a vaccine being developed (presumably due to improving care, education, sanitation, cheap fever reducers, etc.). The vaccine absolutely accelerated the decline a lot, but there was still an existing decline. It is logical to predict that even without a vaccine, this decline would have continued over time, and that with today's medical infrastructure, measles incidence and death rate would be very far below their 1960s levels.

See the following graph:
Spoiler (click to show/hide)
One would expect the green line to continue on its own with advancing care, which would suggest that the vaccines aren't really doing all that much nowadays.

In case you think that this is just a trick of the eye, and that green trend isn't real, here is a wider view showing much further back (England/Wales, but they progressed and vaccinated similarly):
Spoiler (click to show/hide)

The yellow triangle is almost surely people who would have died otherwise, but beyond that, there is no clear way to know. And as the wedge gets narrower, the likelihood of risks potentially outweighing the thickness of the wedge gets higher.

But again, that's an entirely separate argument from my main gist, and the extrapolation is not necessary to reach the main conclusion.
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TamerVirus

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Re: Vaccine risks vs. benefits, a thorough mathematical consideration
« Reply #11 on: September 02, 2014, 07:05:13 pm »

Oh, this will definitely be a !!FUN!! Thread
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Gentlefish

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Re: Vaccine risks vs. benefits, a thorough mathematical consideration
« Reply #12 on: September 02, 2014, 07:07:35 pm »

Yes less people -die- from the measels. That's medicine for you. Could you get a graph showing the number of cases of measels contracted?

GavJ

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Re: Vaccine risks vs. benefits, a thorough mathematical consideration
« Reply #13 on: September 02, 2014, 07:11:03 pm »

Quote
And that causes more people to be born. Without the immunity. So it cannot be a linear function.
No, I'm not. You evaluate your own risk and benefit for yourself (or minors under your care) at your current point in time, on an ongoing basis. As new people are born, it shifts the % people who are vaccinated, and if the benefits outweigh the risks for any given unvaccinated person after the shift then they should now consider being vaccinated.

Yeah, sure, if you're at societal equilibrium, it will wobble back and forth over the threshold by a handful of people, but who cares.

Quote
You can't calculate risk based on the assumption that everyone will be vaccinated when considering whether everyone should be vaccinated. Which is precisely what you're doing when you make a calculation based on '2014 america.'
I'm not... the risk of a vaccine has pretty much nothing to do with how many people are vaccinated. Whatever the small chance of anaphylaxis is, etc., whatever, it's going to be the same whether or not your neighbor is vaccinated...

Or do you mean "the risk of getting measles" i.e. as part of calculating the benefits? If so, that's exactly the assumption I need to make, when I live in 2014 America. What other possible assumption would you use? Should I decide to vaccinate in 2014 America based on my hypothetical self living in 1357 Bulgaria? What?

Quote
And you know who is the greatest at risk population for measles? Those who can't get measles vaccines or are too young to have them. Infants, people with compromised immune systems, ect. There is no 'equilibrium,' it's just being a dick and purposefully screwing over the most at-risk segments of the population.
An infant too young to get the vaccine potentially dying is not more important than my 1 year old infant potentially dying from a vaccine (since parents are usually going to be the ones doing this math for their children). Sorry, that makes no sense.

It's rate of death vs. rate of death. The few months of life in between being old enough or not is negligible for considering value of life (you might have an argument if it were some 50 year old weighing their life against a baby, but that's not how it goes down)
« Last Edit: September 02, 2014, 07:16:05 pm by GavJ »
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Dwarf fortress in 50 words: You start with seven alcoholic, manic-depressive dwarves. You build a fortress in the wilderness where EVERYTHING tries to kill you, including your own dwarves. Usually, your chief imports are immigrants, beer, and optimism. Your chief exports are misery, limestone violins, forest fires, elf tallow soap, and carved kitten bone.

GavJ

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Re: Vaccine risks vs. benefits, a thorough mathematical consideration
« Reply #14 on: September 02, 2014, 07:14:01 pm »

Yes less people -die- from the measels. That's medicine for you. Could you get a graph showing the number of cases of measels contracted?
Okay? Not sure what your point here is, but:
Spoiler (click to show/hide)
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Dwarf fortress in 50 words: You start with seven alcoholic, manic-depressive dwarves. You build a fortress in the wilderness where EVERYTHING tries to kill you, including your own dwarves. Usually, your chief imports are immigrants, beer, and optimism. Your chief exports are misery, limestone violins, forest fires, elf tallow soap, and carved kitten bone.
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