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Diana N's avatar

No invective re the Times, though as I point out to my children, given how much they get wrong when you happen to read about a subject you know well (for you medicine—in our house it’s more law, politics, and finance), why do you imagine they’re more reliable on other subjects?

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David AuBuchon's avatar

Another such natural experiment on recombinant vaccines:

https://www.nature.com/articles/s41591-024-03201-5

Probably similar. Haven't looked, but if this vaccine is supposedly more effective, it should also be more effective at allegedly preventing dementia, or misdiagnosed dementia at least.

Being relatively anti-vaccine, shingles vaccines are just about the only shots I would consider getting after 50 (but probably would not with current state of evidence and my faith in my acute treatments). At the very least I would never try and convince others not to get it. The core reason is that the risks of shingles seem so incredibly high. A proxy for overall risk can be risk of PHN. Incidence of PHN seems so extremely high. Somewhere I calculated a guess that 1 in 50 people are walking around with PHN at any moment. That seems absurdly high, but if you believe the references on the course of shingles and PHN, that's in the ballpark. Does this match with anybody's experience? I think I guesstimated an NNT to prevent (through repeated vax every 10 years, for life after 50) one case of PHN is 26.

Just too many questions for me:

- I have trouble believing recombinant vaccine giant efficacy numbers. No raw trial data. At the end of the day, no data = no vax for me. I just can't do that one. The older vaccines have some long-term data at least.

- I have trouble believing PHN is as prevalent as implied.

- No credible surveillance of harms (but this is a case where I am relatively willing to take what I will presume to be greatly undereported risks, just because the risk of PHN seems so high).

- Many promising acute treatments of viral infections and PHN never get researched. For example, I know a doctor who has had great success treating shingles with ozone therapy.

- Shingles is caused by childhood chickenpox vaccines which destroyed natural boosting. We have probably worsened cumulative societal harm by just shifting the problem to old people where it is much worse. One paper flatly states that under one of two prevalent ethical frameworks, childhood vaccination for chickenpox vaccination in youth can be considered unethical because it just shifts risk onto someone else. And not only that, it doesn't even save that kid the risk. He just has to wait decades now to reap it through shingles.

- Doesn't seem sound to me to get it if you've had shingles in the last 10 years

- No talk of testing for immunity before vaccinating.

Edit:

https://www.ncbi.nlm.nih.gov/books/NBK598509/

This paper says NNT to prevent one case of PHN over 3.5 years in trials is 350. For lifetime benefit, one might suspect about 10x that benefit perhaps? Or a little less. So maybe like NNV over a lifetime might be like 1 in 50?

Paper also states without citation: "Not all PHN is severe or lasts for years." Other references say otherwise. I can't figure this out.

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