As a Geriatrician and nursing home physician, I am saddened by how much unproven treatments/recommendations are foisted on these elderly patients because they are “high risk” and we should "do something” to help them and mitigate their risks. Even those doctors who don’t agree with the vaccine recommendations often say it should be reserved for nursing home and elderly patients. But as Vinay points out, why would I want to give it to these vulnerable patients if there is NO EVIDENCE that this vaccine booster helps anyone, and actually there is some indication that it might make them more susceptible to infection (https://doi.org/10.1093/ofid/ofad209)? So even though the UK recommendation on the new booster is more sensible than the US, as Vinay says, “everyone is wrong". I don’t want to do something unless I have a good idea it will help my patients, even if they are 90 years old - especially if they are 90 years old
Vinay writes that observational data will not help b/c the people who seek boosters will be different than those who don't.
But this same criticism applies to RCTs, ie, the people who agree to take part in RCT's will be different than the people who don't.
This doesn't mean that RCTs are worthless any more than it means observational studies are worthless. But RCTs are not the be all and end all of scientific knowledge. What happens, for instance, if you come up with 2 RCT's that come up with different results?
You would have to look for confounders that explain the different results the same way you do with observational studies. It would be nice if RCTs were the holy grail and we could ignore all else. But they are not and RCTs do not allow us to ignore the totality of evidence we have.
I am a practicing orthopedic surgeon in Maine. I am part of a group who is putting together a CME event (journal club) on the current. medical literature around Covid vaccine. We are selecting four topics around Covid vaccine, and will ideally have two panelists that have opposing views/interpretations of the each paper's findings/summaries. I am optimistic that this educational event will promote open professional discussion amongst ALL physicians in Maine on the Covid vaccine topic. @Dr.Prasad: I am recruiting our panelists now. Would you be interested? Thanks.
Your science based opinion is appreciated. as a post 80 CHF IDE person, and recipient of 5 shots. I may or may not have had mild covid, but suspect (with no data :-) heart meds might could have compromised or even nullified any real benefit from them. Also never did feel the need for a flu shot, and more so now with similar concern.
I can remember when the flu shot was enforced upon us in our large healthcare system. Sadly (or not) I am a natural rebel in that when someone tries to force me into something I will fight. Regardless I took those flu shots vowing that when I was retired I’d opt out, which I have. My first Covid shot was outta fear. Once I learned that IBD folks had less efficacy if on a TBF inhibitor, I just figured I’d wait for natural immunity (which I was stunned by Fouci’s claims about that!). Have not had another shot and won’t.
The key point is funding by Big Pharma. That’s what counts. Flu shots shouldn’t be recommended, but they are still not as harmful as covid shots. This is fascism in full bloom. The capture of the entire governments of the Western world by giant pharma corporations and their minions. Sadly the physicians are front line minions. Few question the recommendations. How many refused to get the mandatory shots? Right?
My inner conspiracy theorist says there’s 2 reasons for pushing vaccines.
1) the scary one: they know more about this virus then they are telling and really think everyone needs more protection.
2) the financial one: the government is using it to prop up the markets by giving Drug companies money. Another financial aspect is that they want to fill Pfizer’s pockets with money because they know at some point they will get sued because of adverse effects and the government won’t be able to keep them protected so the money is for future compensation and legal fees.
Aside from the incompetence that Dr Prasad has been stating, those would be the only other reasons I could think of.
I am curious your thoughts on the similarities and differences between covid vaccination and influenza vaccination as relates to the need to best guess the circulating variants in a given season?
As a Geriatrician and nursing home physician, I am saddened by how much unproven treatments/recommendations are foisted on these elderly patients because they are “high risk” and we should "do something” to help them and mitigate their risks. Even those doctors who don’t agree with the vaccine recommendations often say it should be reserved for nursing home and elderly patients. But as Vinay points out, why would I want to give it to these vulnerable patients if there is NO EVIDENCE that this vaccine booster helps anyone, and actually there is some indication that it might make them more susceptible to infection (https://doi.org/10.1093/ofid/ofad209)? So even though the UK recommendation on the new booster is more sensible than the US, as Vinay says, “everyone is wrong". I don’t want to do something unless I have a good idea it will help my patients, even if they are 90 years old - especially if they are 90 years old
Vinay writes that observational data will not help b/c the people who seek boosters will be different than those who don't.
But this same criticism applies to RCTs, ie, the people who agree to take part in RCT's will be different than the people who don't.
This doesn't mean that RCTs are worthless any more than it means observational studies are worthless. But RCTs are not the be all and end all of scientific knowledge. What happens, for instance, if you come up with 2 RCT's that come up with different results?
You would have to look for confounders that explain the different results the same way you do with observational studies. It would be nice if RCTs were the holy grail and we could ignore all else. But they are not and RCTs do not allow us to ignore the totality of evidence we have.
I am a practicing orthopedic surgeon in Maine. I am part of a group who is putting together a CME event (journal club) on the current. medical literature around Covid vaccine. We are selecting four topics around Covid vaccine, and will ideally have two panelists that have opposing views/interpretations of the each paper's findings/summaries. I am optimistic that this educational event will promote open professional discussion amongst ALL physicians in Maine on the Covid vaccine topic. @Dr.Prasad: I am recruiting our panelists now. Would you be interested? Thanks.
Your science based opinion is appreciated. as a post 80 CHF IDE person, and recipient of 5 shots. I may or may not have had mild covid, but suspect (with no data :-) heart meds might could have compromised or even nullified any real benefit from them. Also never did feel the need for a flu shot, and more so now with similar concern.
I can remember when the flu shot was enforced upon us in our large healthcare system. Sadly (or not) I am a natural rebel in that when someone tries to force me into something I will fight. Regardless I took those flu shots vowing that when I was retired I’d opt out, which I have. My first Covid shot was outta fear. Once I learned that IBD folks had less efficacy if on a TBF inhibitor, I just figured I’d wait for natural immunity (which I was stunned by Fouci’s claims about that!). Have not had another shot and won’t.
The key point is funding by Big Pharma. That’s what counts. Flu shots shouldn’t be recommended, but they are still not as harmful as covid shots. This is fascism in full bloom. The capture of the entire governments of the Western world by giant pharma corporations and their minions. Sadly the physicians are front line minions. Few question the recommendations. How many refused to get the mandatory shots? Right?
Did you refuse?
My inner conspiracy theorist says there’s 2 reasons for pushing vaccines.
1) the scary one: they know more about this virus then they are telling and really think everyone needs more protection.
2) the financial one: the government is using it to prop up the markets by giving Drug companies money. Another financial aspect is that they want to fill Pfizer’s pockets with money because they know at some point they will get sued because of adverse effects and the government won’t be able to keep them protected so the money is for future compensation and legal fees.
Aside from the incompetence that Dr Prasad has been stating, those would be the only other reasons I could think of.
Isn't the real question for any of us whether or not something we do will lessen the risk of being significantly ill in a given period
of Time?
I shouldn't really care whether the virus in particular is identified as influenza a b or CV, but rather will doing something keep me healthy...
I am curious your thoughts on the similarities and differences between covid vaccination and influenza vaccination as relates to the need to best guess the circulating variants in a given season?