I admit to being statistically illiterate, but does this make any difference in the statistical result? (Basing success on minimum vaccine effectiveness of greater than 20%?)
From the article: “The prespecified criterion for success for the primary end point and RSV-related secondary end points was a minimum vaccine effectiveness of greater than 20%.”
Great discussion. Around 2013 our small little 7 md IM office stopped drug lunches. No good information. always nice people. Of course pharma wouldn’t hire an jerk but save yourself from the $15/crappy meal that shows up on the sunshine act and deal with push back from your employees who end up crabbing about the meal anyway, but have no skin in the game.
Absolutely wonderful, and very brave, discussion. IMHO the consistent and inveterate failure of NEJM to conduct reasonable peer review is one of the great underlying reasons for a tilted culture of overtreatment and system failure, despite unparalleled cost. Well done, gentlemen, as always. So important.
Very timely discussion for me. I need to decide if I give permission for a 70 yr old relative in a nursing home to get an RSV vaccine or not.
I am hesitating,leaning towards refusing but willing to have data convince me otherwise. Reading manufacturer's monograph seems like a good place to start. So I asked the nurse in charge which of the three available vaccines they would be giving. I got a blank look. "It's the RSV vaccine" she says. I know, but there are several RSV vaccines... She didn't seem to understand my question. Her colleague tries t come to the rescue: she's asking if it's Moderna of Pfizer. I reply that I am not asking about the covid vaccine, but the RSV one. And I decide to drop the conversation.
My understanding (and any MDs here please correct me if I am wrong) is that vaccinated or not the chances of dying from RSV are pretty small. And unlike polio or shingles, the risks of permanent debilitating damage from RSV is extremely small too.
I agree the risk of RSV hospitalization is not large - but probably higher for your relative than the cited article would suggest, because living in a nursing home is a significant risk factor: https://pmc.ncbi.nlm.nih.gov/articles/PMC11565855/?
Not only were the vaccines of yesteryear more efficacious (live-attenuated/inactivated) but they were also safer. Cutting corners to make the vaccine quicker and cheaper has made Pharma more money and has introduced more side effects. Love you guys and these Fortnights
Great discussion again guys! I can’t emphasize enough how valuable your critiques are in teaching me to “look under the hood” of study design. Just a few days ago I was caring for a patient with intermediate risk PE. She was smiling at me wondering what all the fuss was about. Your intuition is screaming “ I can’t imagine subjecting this person to catheter directed thrombolysis”. It’s assuring when evidence aligns with common sense!
I admit to being statistically illiterate, but does this make any difference in the statistical result? (Basing success on minimum vaccine effectiveness of greater than 20%?)
From the article: “The prespecified criterion for success for the primary end point and RSV-related secondary end points was a minimum vaccine effectiveness of greater than 20%.”
Great discussion. Around 2013 our small little 7 md IM office stopped drug lunches. No good information. always nice people. Of course pharma wouldn’t hire an jerk but save yourself from the $15/crappy meal that shows up on the sunshine act and deal with push back from your employees who end up crabbing about the meal anyway, but have no skin in the game.
Absolutely wonderful, and very brave, discussion. IMHO the consistent and inveterate failure of NEJM to conduct reasonable peer review is one of the great underlying reasons for a tilted culture of overtreatment and system failure, despite unparalleled cost. Well done, gentlemen, as always. So important.
Very timely discussion for me. I need to decide if I give permission for a 70 yr old relative in a nursing home to get an RSV vaccine or not.
I am hesitating,leaning towards refusing but willing to have data convince me otherwise. Reading manufacturer's monograph seems like a good place to start. So I asked the nurse in charge which of the three available vaccines they would be giving. I got a blank look. "It's the RSV vaccine" she says. I know, but there are several RSV vaccines... She didn't seem to understand my question. Her colleague tries t come to the rescue: she's asking if it's Moderna of Pfizer. I reply that I am not asking about the covid vaccine, but the RSV one. And I decide to drop the conversation.
My understanding (and any MDs here please correct me if I am wrong) is that vaccinated or not the chances of dying from RSV are pretty small. And unlike polio or shingles, the risks of permanent debilitating damage from RSV is extremely small too.
I agree the risk of RSV hospitalization is not large - but probably higher for your relative than the cited article would suggest, because living in a nursing home is a significant risk factor: https://pmc.ncbi.nlm.nih.gov/articles/PMC11565855/?
Figure 1 summarizes the results nicely.
There is the joke that nurseries have been invented by germs as a way of propagating themselves. Nursing homes are even worse...
Not only were the vaccines of yesteryear more efficacious (live-attenuated/inactivated) but they were also safer. Cutting corners to make the vaccine quicker and cheaper has made Pharma more money and has introduced more side effects. Love you guys and these Fortnights
AI disagrees with you guys. What does that say about AI? Thanks for being there.
If you talk and argue with the AI for long enough it may change its mind.
Great discussion again guys! I can’t emphasize enough how valuable your critiques are in teaching me to “look under the hood” of study design. Just a few days ago I was caring for a patient with intermediate risk PE. She was smiling at me wondering what all the fuss was about. Your intuition is screaming “ I can’t imagine subjecting this person to catheter directed thrombolysis”. It’s assuring when evidence aligns with common sense!