Largely Covid is not a serous disease in the pediatric population. The side effects and deaths from the "vaccine" should not be underestimated. We, as a scientific community, have no idea what this experimental mRNA vaccine will have on epigenetics or future generations. The side effects may be with us for generations, for a disease that has a mortality of less than 0.0001%
I applaud Sensible Medicine for hosting opposing POVs, especially on controversial topics. And I appreciate reading well-written articulations from learned individuals which highlight their differences of opinion.
I agree with the author that avoiding a doctor’s visit (or even ER visit) is still a meaningful outcome. However, I continue to find such endpoints to be misnomers of “moderate to severe” manifestations of anything. Perhaps this is my adult cardiology frame, but we care most about hard endpoints. Mortality when possible; MI/stroke at least; and reduced all-cause hospitalization only if necessary to juice numbers and power. So an endpoint like this would be scoffed at. A benefit of “convenience” does not a “moderate to severe” manifestation make.
I agree with the author that this is a reasonably well done observational study. But 6 years into COVID, we should be past this level of data quality. I no longer want to see “associations, with properly disclosed limitations”. I want to see evidence of causation at this point.
I disagree about the difference btw ARR vs RRR as merely being stylistic. I absolutely loathe RRR, as it is a meaningless number in describing effect size without knowing the event rate of either the study and/or control group. And once you bother with learning the event rate in either group, you are almost there at identifying ARR anyway….so you might as well go to, report, and rely on the ARR number. A “huge” (large number) RRR of a rare occurrence is still a clinically meaningless effect size. I would also note that Pharma love to report big numbers cuz they probably sound more impressive (except when it comes to NNT).
I appreciate this substack allowing discussions and debate.
I think the authors of any opinion piece or review, in full transparency, should also disclose if they receive funding from companies directly or indirectly through institutions they do research for in their positions or have any ties to the products they are giving their opinions about just like is required of any research article. This is a known issue in our current medical system that has contributed to the great loss of trust in our system. I am
more inclined to consider the authors view if I can see they are willing to be fully transparent in this regard.
I don't see it as re-litigating the past 6 years. I want my pound of flesh. I want people to go to jail for lying. For coercion. For selling out their soul for a grant from Fauci.
A carefully reasoned and convincing disagreement based on data presented calmly, without inflammatory language and with respect. This is what constructive discussion should be. Well done.
I hope that commenters who disagree are able to present their arguments in a similar fashion, and express themselves without anger, resentment or dismissiveness. So far, that doesn’t seem to be the case. Alas.
Young doctor indoctrinated to WANT the Covid modRNA vaccine. The tired “safe and effective” trope. How much will he pressure parents? And how about IgG class shift?
Good counterpoint, well written. Unfortunately, both writers are misled. No observational study of any design can ever properly answer a question on treatment effects. It is folly to think so, and a mistake that has led to deep and pervasive misunderstanding and fruitless arguments on both sides. The confounders are far too powerful, and the studies are worthless. Policy makers must recognize this and support randomized trials embedded within vaccine rollouts so we can learn from each season and choice. And SM should help trumpet the point.
If parents were told that this platform had never been used in the human body for a vaccine, and we do not know how long it lasts in the body and what the long-term side effects may be how many parents would agree to it? What were the studies on long term fertility of these drugs?
Thank you so much much for your analysis. This was very helpful and thoughtfully stated , however I can’t help but wonder if your area of specialty might have tipped the balance in favor of the vaccine as you undoubtedly care for for children at high risk of infection and complications. In the primary care world where I practice, I am struggling to be sure MMR is accepted with an outbreak looming just across the border in South Carolina. This is the challenge of caring for most children: time to converse with parents and explain risk benefit.
"Parents want to protect their children, even from small risks." The paternalism of the government compounded by the paternalism of the medical establishment combined with the natural paternalism of parents! We can't protect children from all the small risks without incurring a lot of unintended harm. What we need are reasonable, medically informed assessments of the tradeoffs. I don't think this made the case.
What tradeoffs do you think haven't been captured by the existing literature on COVID-19 vaccination in children (including but not limited to this MMWR analysis)?
More medical interventions are not without costs--there are doctors’ visits, adverse reactions, long-term as-yet-unknown potential harms. In my personal experience, my family has autoimmune risk factors and my daughter was required to take many COVID vaccines to attend school, though she also had had COVID, tested often, and had a bad reaction to the vaccine. Recommending prophylactic medicine that is likely to help very few people relative to those treated is quite common and the result is we are treated as patients first and humans last. This leads to less trust in medicine that is truly lifesaving.
It seems to me that your concerns primarily have to do with the distribution of vaccination benefits and harms, rather than the net population effect of vaccination.
Unfortunately no amount of research will ever give us absolute confidence if a vaccine will help or harm a given patient. That uncertainty exists for any medical intervention, including cardiac catheterization, appendectomy, statins, etc. All we can say is that the patient is more likely to be helped than harmed, based on the best evidence we have.
However, just as we can't predict who might suffer a rare serious adverse effect from vaccination, we also can't predict who will have a serious or fatal infection prevented by a vaccine. Every pediatrician has seen the "no significant past medical history" patient critically ill in the ICU with a vaccine-preventable infection.
I agree with you that because of the intrinsic uncertainty in any medical intervention for a given patient, we should be transparent about trade-offs, benefits, and risks. But we should not conflate the intrinsic and unavoidable patient-level uncertainty with uncertainty about the population-level evidence of benefit - for vaccination, the latter is extremely strong.
To be clear: I do not conflate the intrinsic and unavoidable patient-level uncertainty of VACCINATION relative to the population-level evidence of benefit. I also understand very well that there is uncertainty in any medical intervention. Given that we are fallible, and often wrong, I believe the "first do no harm" dictum should apply. Every pediatrician may have seen the "no significant past medical history" patient in the ICU with a (perhaps) vaccine-preventable infection, but patients who have experienced iatrogenic harm are often less visible but no less sympathetic. At a population level, there are MANY of them, and will be more, if we don't ask hard questions and try our best to understand "the best evidence we have." Re: COVID vaccines for young people, the evidence seems to support that there is only a very large population-level benefit if you completely disregard the population-level harms and potential harms. I believe Judea Pearl has a very clear explanation of the tradeoffs of a large-scale intervention when the expected benefits are very small in his excellent The Book of Why.
Erudite presentation of the topic. Thanx. The NNT of 34 certainly falls within general acceptable range of reasonable therapy but as always an informed decision by parents requires neutral presentation of this factoid along with its negative correlate that 33/34 kids will get no benefits.
NNT is a helpful number for epidemiologists and policy makers to compare the relative usefulness of interventions. But for parents and patients? Not so much. At the extremes, i.e. NNT=2 or NNT=1000, NNT is easy to grasp. But what is a parent supposed to do with an NNT of 34? Estimate how many asymptomatic infected children their toddler will play with at preschool?
Better to present the known risks and potential benefits and, if known, place these in the setting of current prevalence.
Thank you very much for your writing. Really appreciate different points of view.
Largely Covid is not a serous disease in the pediatric population. The side effects and deaths from the "vaccine" should not be underestimated. We, as a scientific community, have no idea what this experimental mRNA vaccine will have on epigenetics or future generations. The side effects may be with us for generations, for a disease that has a mortality of less than 0.0001%
This is a fair piece.
I applaud Sensible Medicine for hosting opposing POVs, especially on controversial topics. And I appreciate reading well-written articulations from learned individuals which highlight their differences of opinion.
I agree with the author that avoiding a doctor’s visit (or even ER visit) is still a meaningful outcome. However, I continue to find such endpoints to be misnomers of “moderate to severe” manifestations of anything. Perhaps this is my adult cardiology frame, but we care most about hard endpoints. Mortality when possible; MI/stroke at least; and reduced all-cause hospitalization only if necessary to juice numbers and power. So an endpoint like this would be scoffed at. A benefit of “convenience” does not a “moderate to severe” manifestation make.
I agree with the author that this is a reasonably well done observational study. But 6 years into COVID, we should be past this level of data quality. I no longer want to see “associations, with properly disclosed limitations”. I want to see evidence of causation at this point.
I disagree about the difference btw ARR vs RRR as merely being stylistic. I absolutely loathe RRR, as it is a meaningless number in describing effect size without knowing the event rate of either the study and/or control group. And once you bother with learning the event rate in either group, you are almost there at identifying ARR anyway….so you might as well go to, report, and rely on the ARR number. A “huge” (large number) RRR of a rare occurrence is still a clinically meaningless effect size. I would also note that Pharma love to report big numbers cuz they probably sound more impressive (except when it comes to NNT).
“Well done observational trial” is an oxymoron. Just doing an RCT of vaccination in children in the post covid era would resolve this issue
I appreciate this substack allowing discussions and debate.
I think the authors of any opinion piece or review, in full transparency, should also disclose if they receive funding from companies directly or indirectly through institutions they do research for in their positions or have any ties to the products they are giving their opinions about just like is required of any research article. This is a known issue in our current medical system that has contributed to the great loss of trust in our system. I am
more inclined to consider the authors view if I can see they are willing to be fully transparent in this regard.
I have no industry funding
I don't see it as re-litigating the past 6 years. I want my pound of flesh. I want people to go to jail for lying. For coercion. For selling out their soul for a grant from Fauci.
A carefully reasoned and convincing disagreement based on data presented calmly, without inflammatory language and with respect. This is what constructive discussion should be. Well done.
I hope that commenters who disagree are able to present their arguments in a similar fashion, and express themselves without anger, resentment or dismissiveness. So far, that doesn’t seem to be the case. Alas.
Young doctor indoctrinated to WANT the Covid modRNA vaccine. The tired “safe and effective” trope. How much will he pressure parents? And how about IgG class shift?
Good counterpoint, well written. Unfortunately, both writers are misled. No observational study of any design can ever properly answer a question on treatment effects. It is folly to think so, and a mistake that has led to deep and pervasive misunderstanding and fruitless arguments on both sides. The confounders are far too powerful, and the studies are worthless. Policy makers must recognize this and support randomized trials embedded within vaccine rollouts so we can learn from each season and choice. And SM should help trumpet the point.
Comparing the Covid "vaccine" to a seatbelt or bike helmet is ridiculous. Parents were NOT given informed consent on these products. For example, people were told the product stayed in local in the muscle and left the body around 72 hours, now we know that the virus is noted at 700 plus days. https://news.yale.edu/2025/02/19/immune-markers-post-vaccination-syndrome-indicate-future-research-directions
If parents were told that this platform had never been used in the human body for a vaccine, and we do not know how long it lasts in the body and what the long-term side effects may be how many parents would agree to it? What were the studies on long term fertility of these drugs?
Thank you so much much for your analysis. This was very helpful and thoughtfully stated , however I can’t help but wonder if your area of specialty might have tipped the balance in favor of the vaccine as you undoubtedly care for for children at high risk of infection and complications. In the primary care world where I practice, I am struggling to be sure MMR is accepted with an outbreak looming just across the border in South Carolina. This is the challenge of caring for most children: time to converse with parents and explain risk benefit.
"Parents want to protect their children, even from small risks." The paternalism of the government compounded by the paternalism of the medical establishment combined with the natural paternalism of parents! We can't protect children from all the small risks without incurring a lot of unintended harm. What we need are reasonable, medically informed assessments of the tradeoffs. I don't think this made the case.
Thank you for your thoughtful comment.
What tradeoffs do you think haven't been captured by the existing literature on COVID-19 vaccination in children (including but not limited to this MMWR analysis)?
More medical interventions are not without costs--there are doctors’ visits, adverse reactions, long-term as-yet-unknown potential harms. In my personal experience, my family has autoimmune risk factors and my daughter was required to take many COVID vaccines to attend school, though she also had had COVID, tested often, and had a bad reaction to the vaccine. Recommending prophylactic medicine that is likely to help very few people relative to those treated is quite common and the result is we are treated as patients first and humans last. This leads to less trust in medicine that is truly lifesaving.
Thank you for the reply.
It seems to me that your concerns primarily have to do with the distribution of vaccination benefits and harms, rather than the net population effect of vaccination.
Unfortunately no amount of research will ever give us absolute confidence if a vaccine will help or harm a given patient. That uncertainty exists for any medical intervention, including cardiac catheterization, appendectomy, statins, etc. All we can say is that the patient is more likely to be helped than harmed, based on the best evidence we have.
However, just as we can't predict who might suffer a rare serious adverse effect from vaccination, we also can't predict who will have a serious or fatal infection prevented by a vaccine. Every pediatrician has seen the "no significant past medical history" patient critically ill in the ICU with a vaccine-preventable infection.
I agree with you that because of the intrinsic uncertainty in any medical intervention for a given patient, we should be transparent about trade-offs, benefits, and risks. But we should not conflate the intrinsic and unavoidable patient-level uncertainty with uncertainty about the population-level evidence of benefit - for vaccination, the latter is extremely strong.
To be clear: I do not conflate the intrinsic and unavoidable patient-level uncertainty of VACCINATION relative to the population-level evidence of benefit. I also understand very well that there is uncertainty in any medical intervention. Given that we are fallible, and often wrong, I believe the "first do no harm" dictum should apply. Every pediatrician may have seen the "no significant past medical history" patient in the ICU with a (perhaps) vaccine-preventable infection, but patients who have experienced iatrogenic harm are often less visible but no less sympathetic. At a population level, there are MANY of them, and will be more, if we don't ask hard questions and try our best to understand "the best evidence we have." Re: COVID vaccines for young people, the evidence seems to support that there is only a very large population-level benefit if you completely disregard the population-level harms and potential harms. I believe Judea Pearl has a very clear explanation of the tradeoffs of a large-scale intervention when the expected benefits are very small in his excellent The Book of Why.
Thank you for clarifying your position.
I think our disagreement is more philosophical than empirical. Appreciate the respectful dialogue.
Well said.
Thanks. Appreciate your reasonable, medically informed assessments!
The difference in side-effect profile between very young patients and adolescent patients was new to me -- and thus useful/helpful to consider.
Erudite presentation of the topic. Thanx. The NNT of 34 certainly falls within general acceptable range of reasonable therapy but as always an informed decision by parents requires neutral presentation of this factoid along with its negative correlate that 33/34 kids will get no benefits.
NNT is a helpful number for epidemiologists and policy makers to compare the relative usefulness of interventions. But for parents and patients? Not so much. At the extremes, i.e. NNT=2 or NNT=1000, NNT is easy to grasp. But what is a parent supposed to do with an NNT of 34? Estimate how many asymptomatic infected children their toddler will play with at preschool?
Better to present the known risks and potential benefits and, if known, place these in the setting of current prevalence.