4 ms·

It's much, much harder to understand the data if you don't have a control group. But once you have an effective treatment, you no longer have a control group if

It's much, much harder to understand the data if you don't have a control group. But once you have an effective treatment, you no longer have a control group if you're at all ethical. You cannot keep a working treatment from people just to do more science, that is deeply and fundamentally unethical. So the moment we knew the vaccines worked, the science got harder. Well, that point also save an enormous amount of lives, so I don't think this is something to complain about. It's still possible to do a lot of good science now, even randomized controlled trials. They just can't compare to unvaccinated groups, but you can still do stuff like compare double-vaccinated with triple vaccinated.

incrudible 5y ago
A lot of data now shows that double vaccinated are infected with Omikron more often than unvaccinated. I do not know what causes this or what it means, but imagine for a moment there were no unvaccinated left: Your vaccine could be arbitrarily harmful with a new variant and you would not be able to tell.
- fabian2k 5y ago
  That is simply wrong. There is one study that listed negative effectiveness against Omicron for the vaccines. That study did not control for any confounding factors, it simply was not designed to measure this particular thing, it was focused on a different question. There are some strong fundamental reasons why we would not expect the vaccine to be harmful with future variants. And even then we would still be able to detect if it was.
  - incrudible 5y ago
    It is not one study, national data from Denmark, UK, Germany and Canada shows that double vaccinated are infected at a higher rate. I am not jumping to conclusions that this means efficacy is negative, because that would require a controlled trial with an unvaccinated group. Do you catch my drift?
    - fabian2k 5y ago
      Please show the data that claims that double vaccinated are more likely to be infected than unvaccinated people by Omicron. And raw infection counts are not an answer here as the vaccinated and unvaccinated people are clearly not matched populations you can compare without adjustments.
      - incrudible 5y ago
        > And raw infection counts are not an answer here as the vaccinated and unvaccinated people are clearly not matched populations you can compare... That's the point! That's why we need controlled trials. With an unvaccinated group. You know, the thing that you say we can't have, because it's unethical. > ...without adjustments. As usual, there's an XKCD for that: https://xkcd.com/2560/ https://xkcd.com/2560/
    - bigfudge 5y ago
      There’s no way of running a controlled trial of this sort when 80% of the population have already been vaccinated. You can design better or larger observational studies though.
lurquer 5y ago
> But once you have an effective treatment, you no longer have a control group if you're at all ethical. You cannot keep a working treatment from people just to do more science, that is deeply and fundamentally unethical. You could easily find millions of potential study participants who don’t want the vaccine. The study wouldn’t be double-blind, but it would be single-blind and better than what they chose to do.
- mandmandam 5y ago
  It's astounding how rare this rather obvious course of action has been in the global conversation.
breck 5y ago
> you no longer have a control group if you're at all ethical. > You cannot keep a working treatment from people just to do more science, that is deeply and fundamentally unethical. I see this position put out there a lot and generally go unchallenged. For the record some people think the opposite: that it was unethical to unblind the placebo group so early. At the time you could estimate that continuing the placebo group might lead to ~60 unnecessary deaths from Covid-19 and a few hundred more serious cases. That is in the lucky scenario where the early success held. But in all scenarios, in return for a few dozen volunteers risking their lives, billions of people would benefit from randomized, placebo-controlled trial data which the NIH itself calls the "gold standard" as to "whether or not a treatment is safe and effective". IMO the harms we have gone through from flying in the dark (people underhyping/overhyping the vaccines), multiplied by the number of people involved, make this a case where unblinding was unethical. It is very easy to imagine that far more life was lost in the general population from being in the dark than was saved by unblinding the volunteer study population. (There's also the issue of whether or not it would have been practical to keep the participants blinded. I think that's a challenging topic of its own orthogonal to the ethical question.)
- deleted 5y ago
  [deleted]

incrudible 5y ago

A lot of data now shows that double vaccinated are infected with Omikron more often than unvaccinated. I do not know what causes this or what it means, but imagine for a moment there were no unvaccinated left: Your vaccine could be arbitrarily harmful with a new variant and you would not be able to tell.

fabian2k 5y ago
That is simply wrong. There is one study that listed negative effectiveness against Omicron for the vaccines. That study did not control for any confounding factors, it simply was not designed to measure this particular thing, it was focused on a different question. There are some strong fundamental reasons why we would not expect the vaccine to be harmful with future variants. And even then we would still be able to detect if it was.
- incrudible 5y ago
  It is not one study, national data from Denmark, UK, Germany and Canada shows that double vaccinated are infected at a higher rate. I am not jumping to conclusions that this means efficacy is negative, because that would require a controlled trial with an unvaccinated group. Do you catch my drift?
  - fabian2k 5y ago
    Please show the data that claims that double vaccinated are more likely to be infected than unvaccinated people by Omicron. And raw infection counts are not an answer here as the vaccinated and unvaccinated people are clearly not matched populations you can compare without adjustments.
    - incrudible 5y ago
      > And raw infection counts are not an answer here as the vaccinated and unvaccinated people are clearly not matched populations you can compare... That's the point! That's why we need controlled trials. With an unvaccinated group. You know, the thing that you say we can't have, because it's unethical. > ...without adjustments. As usual, there's an XKCD for that: https://xkcd.com/2560/ https://xkcd.com/2560/
  - bigfudge 5y ago
    There’s no way of running a controlled trial of this sort when 80% of the population have already been vaccinated. You can design better or larger observational studies though.

lurquer 5y ago

> But once you have an effective treatment, you no longer have a control group if you're at all ethical. You cannot keep a working treatment from people just to do more science, that is deeply and fundamentally unethical. You could easily find millions of potential study participants who don’t want the vaccine. The study wouldn’t be double-blind, but it would be single-blind and better than what they chose to do.

mandmandam 5y ago
It's astounding how rare this rather obvious course of action has been in the global conversation.

breck 5y ago

> you no longer have a control group if you're at all ethical. > You cannot keep a working treatment from people just to do more science, that is deeply and fundamentally unethical. I see this position put out there a lot and generally go unchallenged. For the record some people think the opposite: that it was unethical to unblind the placebo group so early. At the time you could estimate that continuing the placebo group might lead to ~60 unnecessary deaths from Covid-19 and a few hundred more serious cases. That is in the lucky scenario where the early success held. But in all scenarios, in return for a few dozen volunteers risking their lives, billions of people would benefit from randomized, placebo-controlled trial data which the NIH itself calls the "gold standard" as to "whether or not a treatment is safe and effective". IMO the harms we have gone through from flying in the dark (people underhyping/overhyping the vaccines), multiplied by the number of people involved, make this a case where unblinding was unethical. It is very easy to imagine that far more life was lost in the general population from being in the dark than was saved by unblinding the volunteer study population. (There's also the issue of whether or not it would have been practical to keep the participants blinded. I think that's a challenging topic of its own orthogonal to the ethical question.)

deleted 5y ago
[deleted]