5 ms·

> > This is obviously not foolproof, but it seems like a substantial bulwark against obvious confounders. > I mean...they had controls? That's good. But otherw

> > This is obviously not foolproof, but it seems like a substantial bulwark against obvious confounders. > I mean...they had controls? That's good. But otherwise, there's no way you can tell from what is written. Even if the controls are perfect (which I don't grant without more detail), the implementation of the controls can still allow for confounding. > > they were comparing children who were eligible for the vaccine and those who weren't, and that couldn't have been easily confounded > You can trivially get confounding based on that. Just pick the kids who are healthier, and call them "eligible". Or pick the ones who are older (which they did, as you note), and voila...infinite time bias! Kids who make it to age N are more likely to survive to age N+1 than kids who make it to age N-1 (I mostly disregarded the between-group differences based on age, for this exact reason. It's too easily confounded.) They did use two control groups, that's the whole point so you compare the difference between the age groups for the area where they vaccinated and the area where they didn't. That reduces confounding factors, e.g. based on area. > More commonly, bias of this form sneaks into a study. Particularly in a place like sub-saharan Africa, the set of people who are even willing to engage with you, mysterious doctor-magician, are of a fundamentally different nature than the ones you never see. They probably do all sorts of things that make them a little bit healthier, on average. And you base that assertion on what? Your prejudice ("mysterious doctor-magician", do you think about what you're implying here?!). In reality based on the studies I have read people in underdeveloped nations are significantly more likely to engage with health professionals and less likely to believe in anti vax or other anti science prkpaganda across all classes than in developed nations. Also one should note that in developed nations the effect is the other way around, anti vax sentiments are strongest (and therefore less likely to get vaccinated) in richer classes, who tend to generally have healthier lifestyles. > It's hard to correct for that, and it's a real problem when the primary metric is "community survey of all-cause mortality". For example: are the community surveyors also magical stranger doctor-magicians, or are they just regular people? It matters. It's much easier to look at all cause mortality than cause specific mortality, because you include more confounding factors. It's the much better study.

timr 3y ago
> And you base that assertion on what? Lots and lots of prior research, as well as direct experience talking to people who run these kinds of experiments. It's practically the #1 most common theme you will hear from anyone who has run a public health campaign in a third-world country. Just for example [1]: "From the onset, Northern Nigeria presented an extreme challenge. The transmission of polio in Northern Nigeria was due to complex health, economic and social issues such as poor demand for and access to health services, low immunization coverage, few available skilled health workers, extreme poverty, low literacy, and community resistance to immunization and government services. Other factors such as the safety of the vaccine, religious factors, and community distrust of government health systems played a major role in increasing transmission. This led to a reemergence of polio in Nigeria, especially in the Northern states. Even in areas where polio immunization was not controversial, failure to engage parents and discuss why a fully vaccinated child may develop polio disease, for instance, reinforced and increased parents’ negative perceptions of the polio program." > "mysterious doctor-magician", do you think about what you're implying here?! I'm not implying anything. I'm saying it explicitly. I'm certainly exaggerating for effect, but I'm saying it explicitly: lots of people in poor countries are fearful of medical professionals. I don't know why that's surprising -- it's true right here in the USA, as well, and one of the reasons why certain ethnic groups have disproportionately bad medical outcomes. > less likely to believe in anti vax or other anti science prkpaganda across all classes Oh, stop. Nobody in this discussion is "anti science" -- I have a doctorate, in a biological science. Nor am I "anti-vax". It's helpful if you don't characterize people who critically analyze research with an entire class of fictional villains. Because that actually is what scientists do. [1] https://www.ajtmh.org/configurable/content/journals$002ftpmd$002f101$002f4_Suppl$002farticle-p74.xml?t:ac=journals%24002ftpmd%24002f101%24002f4_Suppl%24002farticle-p74.xml https://www.ajtmh.org/configurable/content/journals$002ftpmd...
- cycomanic 3y ago
  Just a quick clarification, I was not accusing you of being anti-science or anti-vax. I was using that as a short-hand for people the who don't want to get vaccinated, I'm sorry if I gave you the impression that I'm talking about you. Regarding the "reaching only people based on certain educational background" I think choosing a citation about northern Nigeria is quite selective. The assertion that people in Africa are more vaccination skeptical seems to be a gross overgeneralisation and is vaccination acceptance rates vary greatly between countries (not surprising as this is the same in the developed world as well). > I'm not implying anything. I'm saying it explicitly. I'm certainly exaggerating for effect, but I'm saying it explicitly: lots of people in poor countries are fearful of medical professionals. Well your choice of language certainly makes an association to stereotypes of "superstitious primitives" > I don't know why that's surprising -- it's true right here in the USA, as well, and one of the reasons why certain ethnic groups have disproportionately bad medical outcomes. Yes some ethnic groups, would these somehow be more likely to engage with the medical professionals that engage with the control groups, or go to the hospitals while being opposed to the "mysterious doctor-magicians"? Also the modern "health-suspicious" population in the USA (and other developed nations) is primarily composed of well off, well educated socio-economic backgrounds, e.g. just look at where recent measles outbreaks happened.

timr 3y ago

> And you base that assertion on what? Lots and lots of prior research, as well as direct experience talking to people who run these kinds of experiments. It's practically the #1 most common theme you will hear from anyone who has run a public health campaign in a third-world country. Just for example [1]: "From the onset, Northern Nigeria presented an extreme challenge. The transmission of polio in Northern Nigeria was due to complex health, economic and social issues such as poor demand for and access to health services, low immunization coverage, few available skilled health workers, extreme poverty, low literacy, and community resistance to immunization and government services. Other factors such as the safety of the vaccine, religious factors, and community distrust of government health systems played a major role in increasing transmission. This led to a reemergence of polio in Nigeria, especially in the Northern states. Even in areas where polio immunization was not controversial, failure to engage parents and discuss why a fully vaccinated child may develop polio disease, for instance, reinforced and increased parents’ negative perceptions of the polio program." > "mysterious doctor-magician", do you think about what you're implying here?! I'm not implying anything. I'm saying it explicitly. I'm certainly exaggerating for effect, but I'm saying it explicitly: lots of people in poor countries are fearful of medical professionals. I don't know why that's surprising -- it's true right here in the USA, as well, and one of the reasons why certain ethnic groups have disproportionately bad medical outcomes. > less likely to believe in anti vax or other anti science prkpaganda across all classes Oh, stop. Nobody in this discussion is "anti science" -- I have a doctorate, in a biological science. Nor am I "anti-vax". It's helpful if you don't characterize people who critically analyze research with an entire class of fictional villains. Because that actually is what scientists do. [1] https://www.ajtmh.org/configurable/content/journals$002ftpmd$002f101$002f4_Suppl$002farticle-p74.xml?t:ac=journals%24002ftpmd%24002f101%24002f4_Suppl%24002farticle-p74.xml https://www.ajtmh.org/configurable/content/journals$002ftpmd...

cycomanic 3y ago
Just a quick clarification, I was not accusing you of being anti-science or anti-vax. I was using that as a short-hand for people the who don't want to get vaccinated, I'm sorry if I gave you the impression that I'm talking about you. Regarding the "reaching only people based on certain educational background" I think choosing a citation about northern Nigeria is quite selective. The assertion that people in Africa are more vaccination skeptical seems to be a gross overgeneralisation and is vaccination acceptance rates vary greatly between countries (not surprising as this is the same in the developed world as well). > I'm not implying anything. I'm saying it explicitly. I'm certainly exaggerating for effect, but I'm saying it explicitly: lots of people in poor countries are fearful of medical professionals. Well your choice of language certainly makes an association to stereotypes of "superstitious primitives" > I don't know why that's surprising -- it's true right here in the USA, as well, and one of the reasons why certain ethnic groups have disproportionately bad medical outcomes. Yes some ethnic groups, would these somehow be more likely to engage with the medical professionals that engage with the control groups, or go to the hospitals while being opposed to the "mysterious doctor-magicians"? Also the modern "health-suspicious" population in the USA (and other developed nations) is primarily composed of well off, well educated socio-economic backgrounds, e.g. just look at where recent measles outbreaks happened.