The Volokh Conspiracy
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"Diversity" Nonsense Cost Tens of Thousands of Lives
Moderna Delayed its Vaccine Trials to Ensure it had "Enough" Minority Representation
CNBC in September (but I just saw this today): "One of the developers in the lead for a vaccine to prevent Covid-19, is slowing enrollment slightly in its large clinical trial to ensure it has sufficient representation of minorities most at risk for the disease, its chief executive said."
This is particularly egregious because apparently Moderna felt the need to ensure sufficient representation of Hispanic Americans. Even if you buy the dubious notion that there is a significant chance that vaccines will have significantly different effects by "race," what race are Hispanics supposed to be, exactly? The average American Hispanic is about 3/4 European by descent, based on DNA studies. Essentially, then, Moderna allowed tens of thousands of people to die to ensure that "enough" white people who happen to have Spanish-speaking ancestors were included.
Like many stupidities, the very unscientific focus in biomedical research on having subjects that match official American racial categories is the product of government policy. [ADDED: To be more explicit, Moderna was following FDA rules mandating that the clinical trials have diverse subjects, with diversity based on the scientifically arbitrary racial and ethnic classifications established by the Office of Management and Budget in 1977 for civil rights enforcement purposes. At the time, the OMB warned that the "classifications should not be interpreted as being scientific or anthropological in nature." This did not stop the FDA (and NIH) from institutionalizing them into medical and scientific research. That said, Moderna likely went beyond the minimum that the FDA would accept to avoid outrage from those who insist on something like proportional representation.]
Even if, unlike me, you believe in "race" as a biological concept likely to have significant medical consequences, our American civil rights/affirmative action categories don't make any sense in that regard For example, we put Caucasian people from India in the same "racial" category as East Asians such as Chinese and Austronesians such as Filipinos. Indians and most Filipinos are not genetically close to East Asians, but are 40% of the "Asian American" population. When medical statistics are reported about "Asian Americans," we have no idea how things broke down among Indians, Chinese, Filipinos, and other groups, or even whether and to what extent the different groups were represented.
A chapter of my in-progress book on American racial classification (preview here) will discuss this in detail, but a shorter version can be found here. [BTW, if we have any readers with relevant medical/scientific expertise who would be interested in "peer reviewing" my chapter, please let me know.]
Serious question: Why did I only hear about this today? Why wasn't there mass outrage when this was reported in September?
[cross-posted on Instapundit]
UPDATE: Some readers have questioned where I got the notion that American Hispanics are, on average, mostly European in origin. The answer is from this study, published in the American Journal of Human Genetics: "On average, we estimate that Latinos in the US carry 18.0% Native American ancestry, 65.1% European ancestry, and 6.2% African ancestry." That's a bit off from the 3/4 I cited but:
(a) those figures add up to only 90%, the rest is assumedly unknown, so if you add 10% or so to each, you get up to 71.5%. Maybe it's a bit lower, maybe a bit higher. And
(b) then you have to consider the fact that the study uses the "Latino" category, whereas I (and FDA-approved studies like Moderna's) use "Hispanic." Hispanic Americans include non-Latinos whose ancestors (or themselves) immigrated from Spain, and who are 100% or so European in origin. Plus, you have self-described "Hispanos," Americans in the Southwest descended from Mexicans who lived in the territories conquered by the US in 1848. Their origins are overwhelmingly Spanish, and they generally don't consider themselves Latinos, but would likely identify themselves as "Hispanic." So between Spanish immigrants and their descendants and Hispanos add a percentage point or two, and you get that the average self-identified Hispanic American is "about 3/4" European by descent. If someone is aware of alternative estimates published in scientific journals, please let me know.
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“Serious question: Why did I only hear about this today? Why wasn’t there mass outrage when this was reported in September?”
Because the opportunity cost was too high — because no one was willing to risk career, property, and perhaps life as the risk of being labeled a racist.
Hey Bernstein, maybe you should look at this before opening your mouth:
https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html
“Before opening your mouth”
Tolerant and inclusive progressive alert!
Progressive? LOL
Relax kid, you have all of 2021 ahead of you to demonstrate your stupidity. Don’t blow your whole wad on the first day.
You’re not only uninformed; you’re arrogant to boot.
And gullible, willingly so.
Complaints about gullibility from the superstitious, Trump-grifted side of the aisle are always a treat.
My god, the stench that follows you. Please, as a New Year’s resolution: bathe with soap!
“Race and ethnicity are risk markers for other underlying conditions that affect health including socioeconomic status, access to health care, and exposure to the virus related to occupation, e.g., frontline, essential, and critical infrastructure workers.”
So nothing to do with the effectiveness of a vaccine or the risks thereof at all. Thanks for the non sequitur.
And yet the statistics still show that race clearly has an impact on COVID hospitalizations and deaths.
If they are hospitalized at a substantially higher rate, and yet still die at a substantially higher rate, then clearly race is something to be looked at with treatments and vaccines.
I don’t know why I bother pointing this out to someone who doesn’t believe in ‘race’ having anything to do with medical conditions.
If you want to pretend to have relevant input, try some 2021 continuing education:
https://en.wikipedia.org/wiki/Race_and_health#Race_and_disease
Or maybe you should stick to opining about law, instead of pretending that you’re a fucking Doctor now.
“And yet the statistics still show that race clearly has an impact on COVID hospitalizations and deaths.”
No, they don’t. They show that it correlates with the things that actually have an impact. That doesn’t make it one of those things.
Proxies can be useful when you don’t have access to the things they’re proxies for. If you DO have access to what they’re proxies for, they’re usually pretty stupid to use unless the access is very expensive, and the correlation very high.
They just killed a bunch of people because they’re race obsessed, don’t sugar coat it.
No, they don’t. They show that it correlates with the things that actually have an impact. That doesn’t make it one of those things.
Correct. Jason is a perfect example of the “I fucking love science” crowd who demonstrate absolutely no understanding of the fundamental principles of science.
Weren’t you croaking about pots and kettles downthread?
I was…because it applied to you.
It still does.
“No, they don’t. They show that it correlates with the things that actually have an impact. That doesn’t make it one of those things.”
No, it shows that there could be correlation, and there could be causation. The data does show that racial hospitalizations and deaths are substantially different.
If you’re going to hand out hundreds of millions, or even billions of doses of a vaccine, it’s wise to ensure a representative sampling of the various sets of patients who show statistically meaningful differences.
Perhaps you think it’s better to just inject everyone and then after the fact have to say “oh, people who are XXXXX shouldn’t have received this because it’s potentially dangerous/ineffective to them, sorry #trustusnexttime.”
So now you’re saying you think race could be the cause of poverty? Tell us all how race is a medical or genetic factor, instead of merely bigotry?
“Race and ethnicity are risk markers for other underlying conditions that affect health including socioeconomic status, access to health care, and exposure to the virus related to occupation”
Even if race were the cause of “socioeconomic status, access to health care, and exposure to the virus related to occupation”, that has nothing to do with a vaccine’s effectiveness. At best it should inform the distribution.
And as the NAACP itself has pointed out, there are more White people living in poverty than there *are* Black people…
What does this prove? there are more Toyotas than Yugos in junkyards, too.
“So now you’re saying you think race could be the cause of poverty? Tell us all how race is a medical or genetic factor, instead of merely bigotry?”
you’re just now running into this idea?
Your own idiotic comment shows you are thinking of distribution, not effectiveness. Your own idiotic comment condemns you to being a sciency fan, uninterested in actual facts.
So vaccines should be distributed to everyone, regardless of demonstrated efficacy, and the side-effects experienced by those for whom the vaccine may not be as effective is just too bad for them?
Keep flipping burgers.
Now you’ve fallen back on distribution, when the discussion was about testing and efficacy. You keep trying to pretend they are the same thing, and fool no one. I doubt you even fool yourself. Pretty sorry to think a burger flipper can out-think you.
“Now you’ve fallen back on distribution, when the discussion was about testing and efficacy.”
I suspect that he didn’t understand that that’s what the post was about.
Then you have a reading comprehension problem that this blog is never going to solve.
“Perhaps you think it’s better to just inject everyone and then after the fact have to say “oh, people who are XXXXX shouldn’t have received this because it’s potentially dangerous/ineffective to them, sorry #trustusnexttime.””
Potentially dangerous/ineffective. <– Pay attention.
You’re the only one who’s been confused from the beginning. There is no distinction to be made between efficacy and distribution, because vaccines serve no purpose in distribution if they aren’t effective in the first place. If the plan is to distribute them to everyone, the the efficacy for various groups know to have statistical differences is important to be aware of.
Maybe a remedial, or if we’re being honest, a basic course in English would do you some good. Then again, it probably wouldn’t help someone like yourself.
Jason,
Rather than discussing science, medicine or any other scientific discipline. You immediately fall back on ad hominem attacks at a kindergarten level.
One can only conclude that your thinking is shallow and politically motivated.
Whereas you cite studies and then claim they form a conclusion that they do not. In my circle, claiming something which is clearly untrue is called a lie.
I have no political affiliation, and never will. Partisan idiots will be treated as such at all times. I don’t care one way or another whether you like that or not.
n my circle, claiming something which is clearly untrue is called a lie.
In my circle, you’d be sitting at the kiddie table drinking from a sippy cup, with your peers.
“Jason,
Rather than discussing science, medicine or any other scientific discipline. You immediately fall back on ad hominem attacks at a kindergarten level.
One can only conclude that your thinking is shallow and politically motivated.”
Were you intending a demonstration of irony? Because doing exactly what you’re complaining someone else is doing is a pretty good demonstration of irony.
Because doing exactly what you’re complaining someone else is doing is a pretty good demonstration of irony.
Hypocrisy, perhaps…but not irony.
“Now you’ve fallen back on distribution, when the discussion was about testing and efficacy”
distribution is an important aspect of efficacy. No vaccine works sitting on the warehouse shelf, you have to get people to stick it in their arm for it to work at all.
You couldn’t be a better example of why lockdowns are stupid.
Your calendar should have clued you in on this:
It’s 2021 now. You’re no longer allowed to even pretend that you’re relevant or important to society. Crawl back under your rock.
More ideological BS. Your name calling is childish
But alarmingly accurate.
If Moderna ‘killed a bunch of people because they’re race obsessed,’ then how many people did Trump kill by downplaying the virus and denigrating the need to wear masks?
Let’s see if your partisan stupidity has improved or not for 2021. Things aren’t looking too great so far.
You know, AAA just recently warned us that driving while hung over isn’t much safer than driving while drunk.
Looking at your work here today, either you’ve just demonstrated that the same applies to posting, or you’re just a caustic dick even when sober. Happy New Year!
I treat people as they’ve demonstrated they deserve to be treated.
If you want to be coddled, find someone else to do it. I have no tolerance for partisan idiots, and no need for your fake platitudes.
Right back atcha, friend. And do us all a favor and drop the pretense that you’re non-partisan. I’ve been around here for more than 5 minutes.
Disliking Trump because he’s a piece of shit who’s drawn other pieces of shit to him out from the manure pile is an objectively non-partisan point of view.
It’s called ‘reality.’
I’m no fan of Biden’s proposed policies, but at least he isn’t a corrupt, narcissistic, pathological liar. Maybe you should re-evaluate your idols.
If you don’t want to be treated like a partisan fool, stop behaving like one.
I’m no fan of Biden’s proposed policies, but at least he isn’t a corrupt, narcissistic, pathological liar.
While I don’t know about the narcissism, there’s certainly evidence of corruption via one of his sons. And his serial bullshitting is the stuff of legend. Perhaps it’s time to brush the Cheeto dust off your “Hogwarts Alumn” t-shirt, move out of your parents’ basement and spend some time learning something about the issues you’re so ignorantly prattling on about.
‘At least he isn’t a corrupt, narcissistic, pathological liar.’ No, not partisan at all. You’ve been here spouting abuse, and speaking in support of shit policies, for quite some time. Don’t act surprised that nobody takes your claims seriously.
If you would like to try and dispute my characterization of Trump, your problem is psychological in nature. Perhaps someday you can come to grips with reality and truth, and realize how distorted your views of him were.
” there’s certainly evidence of corruption via one of his sons.”
Or at least, it’s partisan orthodoxy to pretend there is.
Or at least, it’s partisan orthodoxy to pretend there is.
I suppose we should all marvel at the fact that you can still type with your head so far up your own ass.
If they are hospitalized at a substantially higher rate, and yet still die at a substantially higher rate, then clearly race is something to be looked at with treatments and vaccines.
Treatments, yes…but vaccines? What is the relevance of statistics regarding those who have already developed the disease to a vaccine, the purpose of which is to prevent you from developing the disease? There certainly *might* be some race-based difference(s) in how the vaccine works, or side-effects…but the statistics you’re basing your argument have nothing to do with that. More likely, they’re mostly attributable to comorbidities, given the socioeconomic factors involved.
There *might* be genetic differences in vaccine reaction, but those genetic differences could be specific to all manner of groups. There are many “European/white” subgroups that have distinct genetic histories, such as Icelanders and Ashkenazic Jews. If the FDA etc were really concerned about finding genetic differences in reactions, they would try to get a broad profile of all sorts of groups and then try to tease out whether there is some particular genetic anomaly more frequent in certain groups that causes more side effects and/or less efficacy. Instead they use nonsense categories with no scientific grounding like “Asian American” and “Hispanic.” I talked about the former in the post, but on the latter, it includes people who are 100% European, 100% Indian/indigenous, and everything in between, including people with substantial African and Asian heritage. No one would use this category for scientific/medical if it didn’t come prepackaged from OMB, even though OMB specifies that the categories have no scientific basis.
Flagged
Good luck, you dim bulb, now crawl back to twitter or the daily kos or wherever you slimed in from.
Ah poor baby. Did you want to be violent.
” No one would use this category for scientific/medical if it didn’t come prepackaged from OMB, even though OMB specifies that the categories have no scientific basis.
”
The idea you’re grasping for, but failing to reach is “not reinventing the wheel”.
The goal is to recruit as diverse a spread of human subjects as possible. People are already generally aware of race as a categorization tool for human beings. So gathering a diverse racial makeup of individuals will give you other kinds of diversity, as well.
“If they are hospitalized at a substantially higher rate, and yet still die at a substantially higher rate”
The word “yet” in that sentence betrays a complete lack of understanding of basic statistics and statistical concepts.
The policy of most hospitals, and I believe the advice of the CDC, is that only the most seriously ill COVID patients should go to the hospital. Those with mild and moderate cases are advised to stay home.
So going to the hospital by this policy is a selection for the most seriously ill COVID patients. SURPRISE, SURPRISE, those die at a higher rate than those who stay home.
In fact, if you look at the CDC chart, hospitalization seems to be MORE effective for minorities than for non-minorities. For example, African Americans are 3.7 times more likely to be hospitalized, but only 2.8 times more likely to die. The other numbers are similar.
Having your hospitals running at 100% capacity changes the math. Being hospitalized means you’re actually getting care, while being turned away means you aren’t. Poof. Hospitalization isn’t selecting for the most likely to die any more.
“If they are hospitalized at a substantially higher rate, and yet still die at a substantially higher rate, then clearly race is something to be looked at with treatments and vaccines.”
With all due respect, you are embarrassing yourself and employing a basic lack of scientific knowledge.
Race is proxy for other characteristics that actually physically increase the chances of getting Coivd-19, as well as having worse outcomes. Race itself does not cause the effects.
Therefore, using race as a component of vaccine development will not increase the effectiveness of resulting vaccines for anyone of any race, and in fact, as this example shows, by causing an irrational delay, can actually cause negative effects.
It would be one thing if there was evidence that, to the extent you get past the inherent problems with biological concept of race in general, being a member of a particular racial group made you more likely to actually be more susceptible to the virus because of something about race itself. However, this evidence does not exist.
“With all due respect, you are embarrassing yourself and employing a basic lack of scientific knowledge.”
Since I know this is not factually correct, the rest of your comment can be safely ignored as irrelevant and likely incorrect.
You clearly have no understanding of causal inference.
Why so angry Bernstein? I wonder why.
Because what ordinarily is relatively harmless stupidity in this case may have meant 10,000 additional deaths.
Jason, the ethnicity of individuals is not though to effect the response to the virus. The working theory is that minorities do worse because they’re more likely to have underlying conditions, they have less access to healthcare, and they’re more likely to be exposed because they’re less likely to have cushy work at home jobs.
None of which is an excuse to delay the vaccine work. In fact, given the stats you posted, it’s likely that a disproportionate number of the folks affected by the delay were minorities.
Well, the ChiComs *were* rumored to be working on racially-specific bioweapons, so if this was something that they were playing with and it got loose, either intentionally or (more likely) accidentally, then it would be theoretically possible for there to be genetic (hence racial) differences in vulnerability to it.
If….
Sure, rumor is absolutely how you do science.
Of course, this CDC data says nothing about supposed increased risk of vaccine side effects for different races, which is presumably why it was considered necessary for more minorities to be included in the trials, but it’s good to see you’re keeping the dead herring alive.
Hey, Jason. A survey of the epidemiological data encompassing countries with 5.5 billion people shows no evidence whatsoever of susceptibility to covid-19 or severity of symptoms by race.
https://medrxiv.org/cgi/content/short/2020.09.30.20204990v1
That non-peer-reviewed study doesn’t address race at all.
In fact, the words “race,” “racial,” or “ethnicity” don’t exist in the text of the study.
So maybe you can explain your conclusion/lie?
How about you address the distinction between efficacy / testing and distribution?
How about you fuck off and stop pretending that you’re clever? I address your idiotic remarks where appropriate.
Spoiler alert: You’re still confused, and still wrong.
Jason,
There is no scientific basis for race
Secondly the study considered countries in all parts of the word. No differences were found for Africa or South America or the middle East. You no knowing except for partisan identity politics.
Have a good life.
You did a word search for race. Bravo. Did you look at the list of countries or its breakdown into regions? Did you find any evidence of ethnic differences. Did you notice that all data are WHO data (except for economic data? Did you notice that there is no correlation with national GDP. By the way, the CDC statistics you quote are not peer reviewed.
Keep clinging to your identity politics and let scientists discuss the science.
Your conclusion is not supported by the study, neither is it a conclusion drawn by the study, nor was it even something the study bothered to look at.
One can only conclude that you’re a liar.
Jason,
In two minutes you did not read the study, not to mention did not study the work. But now you carry on as if you have gone through it diligently. If there is anyone who is a liar it is yourself.
That fact is that you just can’t stand someone who disagrees with you. Just as bad as a Trumpist
By the way Jason,
As Editor in Chief of two international scientific journals I can tell you that peer review is no guarantee of correctness. Mot reputable medical journals charge $3000 to $5000 Article Processing Costs, nearly ruling out submissions from those without large research grants. The only inexpensive APC are in predatory journals mainly out of China in which the “peer reviews” are nearly worthless.
Learn some facts before you run your mouth.
By the way, some peer-reviewed studies turn out to be wrong, and then are erroneously cited and spread the disinformation further. Yet in the end, it’s still better to cite studies which have been peer-reviewed and their conclusions agreed upon than those which have not.
The fact that you are an EIC has no bearing on your arguments here, or the validity of your conclusions which are unsupported and unmentioned by the study in question.
By the way, in response to your other comment above, the difference in time between your post and my response was 20 minutes, not two.
By the way, Jason, that report says nothing about racial or ethnic susceptibility. It has a lot to do with patterns of behavior.
So what? If patterns of behavior appear more frequently in specific groups, why wouldn’t you look at the group that accounts for the behavior?
Your point is quite unclear. The reasons for the US experience across ethnic group is explainable by the demographics of “essential workers” who have been working outside the home.
Unless one has a scientifically sound reason to conclude that behavior will affect the vaccine effectiveness, one should proceed on criteria of physiology and medicine.
I think the argument here is that the vaccine works (or doesn’t) at a very low level cellular biology level – your immune system binds to the spike protein or it doesn’t – and the various socioeconomic factors are unlikely change things at that level.
And, if so, delaying the vaccine costs lives. The current death rate is maybe 15k people a week. Presumably at least 1500 of those are minorities. So a two week delay is going to cost a 9/11’s worth of minority lives (as well 27k other lives).
It seems to me to be a serious enough question to merit more than a ‘so what’.
Absaroka, you mention, “(or doesn’t),” but your reckoning excludes it. Your reckoning is all about, the vaccine works, get on with it.
By the way, why would anyone assume that socio-economic factors like fatiguing physical labor, or not, in close quarters, or not, with high environmental viral loads, or not, would be irrelevant to clinical outcomes, even if those are also based on, “low level cellular biology?” I doubt you would find many immunologists or auto-immune disease specialists who would dismiss factors such as those.
“you mention, “(or doesn’t),” but your reckoning excludes it. Your reckoning is all about, the vaccine works, get on with it.”
I’m trying unsuccessfully to follow your logic. We want to know if the vaccine helps, hurts[1], or has no effect. Whichever of those is true, we want to know ASAP, so that we can either get people vaccinated, or stop chasing a dead end and start trying something else. I’m at a loss to understand how this view is remotely controversial.
[1]IIRC, one of the early childhood disease vaccine candidates (measles, mumps, can’t remember) actually made for worse outcomes than not being vaccinated. Isn’t it nice to know that earlier than later?
“By the way, why would anyone assume that socio-economic factors like fatiguing physical labor, or not, in close quarters, or not, with high environmental viral loads, or not, would be irrelevant to clinical outcomes, even if those are also based on, “low level cellular biology?””
Proteins generally bind or they don’t. Whether you’re chopping wood or taking a nap. N.b., feel free to investigate all kinds of unlikely possibilities … just don’t hold up trials that have the possibility of saving lives to do so.
Absaroka, your past comments suggest you are not usually willing to comment so far outside your expertise, or at least your personal experience. That may mean notable specialized knowledge exists of which you are unaware. I suggest you talk to medical specialists in immunology and rheumatology.
Because that matters to who gets the vaccine (is, distribution), not how well the vaccine works.
I don’t understand what part of the OP you are disputing. If the virus affects people disproportionately based on socio economic factors and type of employment, with an obvious correlation to race but not a genetic one, what is the benefit of delaying the vaccine?
Should we have delayed it further to test specifically on front line workers since they are disproportionately affected by the virus? Do you see how silly that sounds?
What on earth does that have to do with probable vaccine efficacy?
Jason, are you a lawyer?
All PC is case. Zero tolerance for PC.
Social Justice Kills.
Literally.
Of course none of us know for sure, but I’m guessing social justice had nothing to do with the delay. More likely Moderna was looking ahead to possible FDA objections to their study during the approval process. Perhaps the deserved recipient of Prof. Bernstein’s ire would be the FDA, rather than Moderna.
Like I said in the post, Moderna’s policy originates with the government, discussed in detail in my link.
So which is it you’d like to whine about?
“Essentially, then, Moderna allowed tens of thousands of people to die to ensure that “enough” white people who happen to have Spanish-speaking ancestors were included.”
Did MODERNA allow tens of thousands of people to die, or did Government policy do that? You can’t keep your own complaints in order, and expect anyone to take you seriously?
“So which is it you’d like to whine about?”
It sounds to me like he’s whining about the fact that a bunch of people died unnecessarily.
He is complaining about the fact that an idiotic, non-scientific policy was implemented in a crisis, and resulted in thousands of unnecessary deaths. And yes, that policy was imposed by the FDA, which bowed to unscientific PC nonsense.
You have any more pseudo-intellectual nonsense to spout?
Wooosh!
He blames Moderna for this, yet in the comments claims it’s Government policy. How is Moderna at fault for following Government policy?
Two more swings. You can do it!
No, the post was amended to clarify that it is indeed government policy.
So now that your little mind feels it has scored a point against Bernstein, are you ready to address the real issue here. The policy, whether government mandated or not, is stupid, unscientific and potentially put lives at risk during a pandemic.
Or you can keep up the childish snark. Why don’t you just take a toy, stand in the corner, and amuse yourself.
And yet the words are still there for all to read.
“Moderna allowed tens of thousands of people to die to ensure that “enough” white people who happen to have Spanish-speaking ancestors were included.”
Also, after his clarification that it is in fact Government policy, there’s this “That said, Moderna likely went beyond the minimum that the FDA would accept to avoid outrage from those who insist on something like proportional representation.”
Unsupported allegations based on hypothetical ideological reasons.
All government policies that are unfriendly to the profit motive of drug companies to develop new thjngs are murderous.
I doubt 10,000 even shows up as a rounding error of needless deaths the past century due to this. And FDA-like organizations (killing millions via forced development delays, to save, maybe, a few thousand sob stories from the cameras) are only one of the problems.
Taxes punishing reward, making cost recovery less likely, as a calculation on whether to risk the investment to begin with, and high general business regulatoru burden, and finally, preening hyper-asshole politicians trying to get elected bloviating about the unconscionable profits of drug companies, all kill on a megascale.
Intentionally. That’s what “justice” is: we have decided to hurt some people and we think we have a good reason, so hurting them is “justice”.
Their reason is a mishmash of ancient grievances and envy and community organizer-style class war — divide people and get them to fight so you can lead one side against the other and personally benefit from your role as leader.
KevinP, maybe so. But do you suppose advocates of social injustice will be content to open the door to that kind of utilitarian analysis?
By Bernstein’s argument, every quantum of care used in designing a clinical trial is deadly. His reckoning excludes whatever positives might result from cares taken, or what the net effects might be. It’s foolishness, but foolishness founded on what?
With Bernstein—as with many libertarians—the foolishness is predictably founded on hostility to any policy not predicated on extreme individualism. Often, those kinds of arguments are much more about that hostility than they are about the ostensible subject under discussion.
Or to put it another way, the real subjects tend not to be those featured, but instead the various subtexts—against group advancement, for instance, or, most of all, against the notion of government itself.
Stephen,
You’ve constructed a gross exaggeration into an untenable strawman.
Berstein’s argument is that the delay in starting trails cannot be justified by an unverified hypothesis. That has nothing to do with individualism or libertarianism. So your consequent political screed does not follow.
You’ve constructed a gross exaggeration into an untenable strawman.
In other words, a typical Lathrop post.
Exactly, this is the one thing upon which he can be counted to do.
“In other words, a typical Lathrop post.”
You said something stupid again.
In other words, a typical YOU post.
I’m rubber and you’re glue.
C’mon lathrop…focus on the science here. For a purely scientific and objective evaluation of vaccination effects by race, there was zero need to delay the trial start to enroll a higher number of minorities out of proportion to their demographic representation. The same vaccination effect would have been noticed simply by virtue of the sample sizes (45K+ test subjects).
Now, does that delay translate to thousands and thousands of extra deaths? Probably not. But there are some.
It isn’t necessarily wild guessing. At some point, the deaths will start to come down due to vaccinations (as opposed to later herd immunity). At that point, we will know what each additional week, each additional day delay costs in terms of lives, whicb is alproaching 4000 a day in the US alone
By Bernstein’s argument, every quantum of care used in designing a clinical trial is deadly.
That’s not even remotely a reasonable conclusion to draw from his argument.
Lathrop is cool with 3,000 people dying every day, many of them the very minorities he claims to care about.
Let’s just make sure the vaccine is safe while another hundred thousand people die.
# Social Justice Medicine
David, you just identified yourself as a total idiot to anyone who has had so much as a single undergraduate micro biology class, but don’t let that stop you. Viruses, and diseases, do not operate in vacuums. They impact on people differently based on those listed factors and hundreds of others. Organisms develop immunity quicker based on those and hundreds of other factors. There are unintended consequences that are impacted by those and hundreds of other factors. And there’s often no way to know in advance which factors will impact which specific diseases or individuals so you need to account for as many as possible.
You might want to stick to subjects you actually know something about.
Krychek,
Bernstein’s basic complaint has nothing to do wit micro-biology and does not really call for name-calling. I always get annoyed with politicians and other who claim that this or the other actions cost lives. Dropping the atomic bomb on Hiroshima or firebombing Dresden cost lives. Moderna’s decision to delay star if trails was merely irresponsible based on no science, but heavily influenced by identity politics.
Have a happy and healthy New Year.
I don’t think it has been demonstrated that it was driven by identity politics. Moderna in fact would have had a powerful incentive to ignore identity politics since it was trying to get its vaccine to market ahead of its competitors. And my irritation with Bernstein – and you’re right that I shouldn’t have called him an idiot – stems from what I see as a baseless attack on Moderna due to a failure to understand how microbiology actually works.
Any vaccine involves lots of moving parts, including the fact that different groups will have different reactions to it. Without more, I’m not going to fault Moderna for being careful and examining as many risk factors as possible.
They are following FDA rules that require “diverse” vaccine subjects, diversity being defined by regulation as the categories used for federal statistics-gathering, invented primarily for civil rights enforcement, and explicitly not based on anything scientific. So there is no science here, at all, and Moderna’s decision has nothing to do with microbiology, only with stupid public policy.
Q. E. D., straight from the source.
I think you understand David’s actual point but are choosing to ignore it.
Do you believe the racial classifications used for purposes of diversity in this context are based on extremely useful genetic differences, or socially constructed differences?
Don’t you think genetic ethnic diversity is possibly different than sociatal racial diversity? And shouldn’t medical studies be very careful about which rubric they use?
Roman, I do understand Bernstein’s point. I choose to critique it.
Behind my questions lies a lifetime of personal experience with a cranky immune system—one which delivers my kind of symptoms almost exclusively to members of a small genetic cohort—but almost paradoxically, spares the vast majority of folks who carry the genetic variant which inflicts vulnerability. In short, you have to have the genetic variant to get the disease, but the variant doesn’t give you the disease. Some unknown factor, presumably experientially-mediated, gives you the disease, but only if you have both the variant and that unknown experience. Almost nobody without the genetic variant ever gets my kind of disease, no matter what their experience. No one has yet been able to disentangle those factors.
More generally, conversations with my doctors, my own lived experience, and conversations shared with others who have suffered decades-long bouts with autoimmune diseases, all point to a conclusion that genetic factors and experiential variables commonly interact to affect the severity of auto-immune outcomes, across a broad range of conditions. As we know—but so far only vaguely understand—auto-immune events figure notably in Covid-19 outcomes.
That points to a general conclusion which touches on the Covid19 conversation: as of now, disentangling genetic differences from experiential differences of the kinds commonly mediated by sociological variables, and studying them separately, is a vain hope. Medicine can’t do that yet.
“Do you believe the racial classifications used for purposes of diversity in this context are based on extremely useful genetic differences, or socially constructed differences?”
Doesn’t matter, if they get a sufficiently broad dataset of results to draw reactions from.
If you give your product to a wide range of people and then studying the results you notice that people with dark skin seem to be having complications at a higher than average rate, does it matter if the complication comes from having dark skin or something that correlates with dark skin?
Doesn’t matter, if they get a sufficiently broad dataset of results to draw reactions from.
It absolutely does matter. You can arbitrarily create a near infinite set of classification criteria on which to base a goal for your desired data set, any one/group of which might produce some unexpected correlation with negative reactions to the product. The result, of course, would be that testing of the product would never be completed before the universe fizzled out via heat death. To anyone with an IQ north of room temperature, it’s obvious that you need to base your testing requirements on criteria that are expected to be relevant in order to actually deliver the product in time for it to be of value. In this case, that “value” needs to be measured in terms of…among other things…the lives you know will be lost due to the delays caused by your desire to engage in testing that you have no real reason to believe will be useful, but might produce some data that might constitute evidence of some sort of problem.
“It absolutely does matter. ”
It absolutely does not. Either you tested a broad enough range of human subjects to detect all the important correlations or you did not. Either way, it doesn’t matter how you did or didn’t select your sample.
It absolutely does not. Either you tested a broad enough range of human subjects to detect all the important correlations or you did not. Either way, it doesn’t matter how you did or didn’t select your sample.
That’s got to be one of the most stupid exercises in hand-waving I’ve ever seen here.
” To anyone with an IQ north of room temperature”:
Why leave yourself out of the discussion?
David, please entertain the possibility that the FDA regulation may have the dual purpose of both being useful for civil rights enforcement and also in this case of serving the scientific purpose of taking into account as many variables as possible. The two are not mutually exclusive. Further, even in the absence of an FDA regulation, Moderna may well have decided to look at those variables anyway because doing so would have been good science.
Krychek, I’ll be happy to send you my entire draft chapter, but it’s enough to know what categories the FDA uses to know that it’s not really about science. Again, the relevant categories mandated are based on the racial/ethnic classifications the OMB invented in the late 70s. Not only did the OMB not claim that these were scientific categories, it explicitly announced that the relevant “classifications should not be interpreted as being scientific or anthropological in nature.” And they aren’t either of those things. So why does the FDA use them? Not because of science.
Notice how this is going: They make up an explanation that sounds good and is emotionally satisfying. You point out repeatedly how it doesn’t make any sense. They don’t care that it doesn’t make sense because their emotions are satisfied.
Next step will be them name-calling you and telling you that you’re dumb and/or ignorant for not simply agreeing with their emotionally-satisfying nonsense. And then they’ll try to change the subject and forget about it. Because additional thought threatens emotional dissatisfaction.
Notice how this is going. the fact that the original claims are not correct keeps getting pointed out, with explanations, but “THEY” keep explaining how it doesn’t make sense to them, therefore it cannot possibly right.
If you’re still confused, I used a different value for “THEY” than you did.
Gfy
Is that your notation for “gee, I guess you’re right”?
Why would they look at scientifically bogus categories such as Hispanic or Asian? They held the vaccine up for at least a week!!!!!! While looking for subjects from a fake category.
How can you sleep at night after supporting this insanity???
Krychek,
You say that “Moderna may well have decided to look at those variables anyway because doing so would have been good science.” More likely they thought it was good public policy.
” doing so would have been good science.” More likely they thought it was good public policy.”
Good science IS good public policy.
Good science IS good public policy.
But good public policy is not necessarily (or even usually) good science…which is the point that you’re missing.
I’m missing all the points I didn’t try to make, there, sonny boy.
the fact that you get it backwards doesn’t indicate that I did, too. Stick with critiquing the words I actually wrote.
LOL! You’re either one of the dumbest assholes on the planet or one of the most dishonest…or both.
” there is no science here, at all, and Moderna’s decision has nothing to do with microbiology, only with stupid public policy.”
Such a brilliant mind, able to jump directly to a conclusion without understanding anything about the subject.
Such a brilliant mind, able to jump directly to a conclusion without understanding anything about the subject.
That’s some kettle/pot stuff right there.
Please don’t be confused into thinking I used the words “brilliant mind” to describe you.
OK, I’m going to have to go wih you being one of the dumbest assholes on the planet.
“you’re right that I shouldn’t have called him an idiot”
“what I see as a baseless attack on Moderna due to a failure to understand how microbiology actually works.”
Perhaps true that the original offense doesn’t necessarily imply idiocy. But sticking to it after having the errors in his thinking explained for him surely does.
How does the inclusion of a fake, non-existent race, Hispanic, lead to the study of the efficacy of a vaccine?
You are truly an ideologue of the first order.
Maybe the next racial category to hold up the vaccine should be Smurfs or Trolls who are clearly underrepresented.
Because race itself is not a scientific category and is of limited usefulness. What is really meant is ancestry.
And you know this how? Don’t say it’s self evident. Provide the source, from Moderna, or admit it’s speculation that cuts extremely close to being a lie.
Because there’s no clear line of demarcation that tells us why, for example, people from India are considered Aryans and thus white, even though they have dark skin. In fact, there are lots of groups of people that don’t easily fit into any specific racial category. Google “race as a social construct” and you’ll find plenty.
” In fact, there are lots of groups of people that don’t easily fit into any specific racial category”
For example, children of mixed marriages.
“Maybe the next racial category to hold up the vaccine should be Smurfs or Trolls who are clearly underrepresented.”
It’s probably safe for trolls such as yourself to get the vaccine.
RE: “Viruses, and diseases, do not operate in vacuums.”
Actually, some bacterial spores can survive long periods in vacuum. They don’t need air.
strictly speaking, spores don’t “operate”. They sit and wait for conditions to improve.
Much the way boats that are on land because the tide went out are still boats, but are not very useful on land, until the tide returns and floats them again.
You’re right that South Asians aren’t especially related to East Asians (most are more closely related to West Eurasians), but Filipinos are in fact genetically close to Han Chinese & Vietnamese populations:
https://www.gnxp.com/WordPress/2018/01/27/genetic-distances-across-eurasia/
Filipinos were displayed in a picture there but left out of the table, since they weren’t the focus. This is more comprehensive and shows the distance between many East Asian groups in a table.
https://www.gnxp.com/WordPress/2018/09/26/vietnamese-are-not-that-much-like-the-cambodians/
The table entirely consists of East Asians/Pacific Islanders. It’s not as easy to interpret, since three groups are compared in each column, so you might want to enlarge the picture displaying each individual as a combination of colored lines indicating the proportion of principal components. There is a distinct principal component (light blue in color) associated with Austronesians in that, but you can see that it also appears (to a lesser extent) in the Han (mostly the southern Han, although northerners have a small amount).
Thanks for the links, last time I looked into this, there was significant controversy about Filipinos, but the general consensus seemed to be that a majority of Filipinos were more closely related to groups like the Maori, while a minority were more closely related to East Asians, and then there was a third group, I think, whose origins I don’t recall.
Spanish, probably.
Depending on when you samples were taken, possibly Americans.
I suspect the third group was the Negrito population of the Phillippines. I have no idea when you looked at this issue last and therefore what the current thinking was, but it may have emphasized links to the Australian aborigine and African pygmy populations, neither of which is given much credence today.
I should note that there is a relevant way in which South Asians should be considered separate from both white Europeans & east Asians regarding the coronavirus: doctors of South Asian descent have been noted as having far higher mortality rates in the UK than average, as have those of African descent. It has been hypothesized that vitamin D deficiency is involved (people with severe cases have been observed to have a deficiency, those deficiencies are more common in western nations among people of such ancestry). South Asians can vary a lot in terms of how much melanin is in their skin, so even there it’s not a simple matter of discrete categorization.
If we weren’t squeamish about such things for understandable reason, skin tone would be something to look at re susceptibility.
The same is also true for dying of lead poisoning following encounters with law enforcement personnel.
There’s a Radiolab episode about this doctor in the UK. When he introduced vitamin D pills to the medical staff, on the hypothesis of deficiency (apparently 80% in darker-skinned groups, the body creates vitamin D when in the sun) their death rates plummeted.
When he tried rolling this out to the larger community (of which he is part) he received pushback from political leaders, who wanted none of it, because it interrupted their (larger picture) political narrative the worse medical outcomes for minorities (in general) were due to racial problems and subsequent poverty.
A simple treatment to erase this in the case of Covid was downright evil more-of-the-same.
Thanks, that was interesting, here’s a link.
The whole thing was interesting, but if you only want the part Krayt was referencing, choose the transcript and search for ‘singhal’.
Demanding ethnic diversity (NOT racial diversity; ETHNIC diversity) is actually not quite as nutty as it seems at first. A new drug (or an old drug being used in a new way or for a new indication) can have different effects on members of different ethnic groups, not because of genetics, but because of cultural (or subcultural) factors. You know, diet, exercise, substance-use or abuse (recreational, misguided-by-fads, or sound and correct), sleep habits, sexual habits, etc.)
Don’t be so quick to assume that you understand an epidemiological question like this! Not everything in medicine and public health is always corrupt or pc just for the sake of being pc. A lot of this stuff is counterintuitive. Doing big clinical trials on ethnically un-representative samples does, sometimes, compromise the validity of the results. (Whether or not the skewing is bad enough to justify delaying a vaccine trial in the face of this crisis is, of course, an open question. I’m just saying, don’t automatically assume it’s an arbitrary decision for the sake of political correctness.)
The FDA rules that Moderna is following don’t require anyone to check true ethnic diversity, only diversity as defined by U.S. statistical categories that have no scientific basis.
“The FDA rules that Moderna is following don’t require anyone to check true ethnic diversity, only diversity as defined by U.S. statistical categories”
ANY diversity requirement provides better results than NO diversity requirement does. Assuring that you have tested thoroughly in populations likely to resist taking the damn thing because they suspect that the big company making the product and the government agency in charge of approving it don’t care if they have adverse reactions is part of getting them to adopt your treatment. It doesn’t work if you leave it in the factory… you have to get it into people’s arms.
” Doing big clinical trials on ethnically un-representative samples does, sometimes, compromise the validity of the results. … don’t automatically assume it’s an arbitrary decision for the sake of political correctness.)”
That’s a good point, and there’s another possibility. Organizations have cultures. I’ve worked for places that when you encounter a problem this morning, you get the relevant people together early this afternoon, hash out a solution, start implementing it later that afternoon, and finish it tomorrow afternoon. At the other extreme, I’ve worked for places that address exactly the same problem by scheduling a meeting for three weeks hence, at which time, with luck, a decision can be reached on who should have responsibility for solving the problem, after which regular biweekly meetings will be scheduled for the 11 months it takes to solve the problem.
When the first type of organization notices they have enough Norwegians to start the trial, but not enough Nigerians, they are likely to say ‘1)start on the Norwegians and 2)start beating the bushes for Nigerians, we’ll fold them in as soon as we get them’. After all, it might not work on either, and the sooner you know the sooner you can start on Plan B. But I suspect the culture of drug trials are cautious in the extreme, and tend towards the second model. That’s probably appropriate if your drug is the Next Big Thing for erectile dysfunction, but maybe not so great if people are dying by the thousands. But it’s really hard for organizations to change habits.
Absaroka, your reasoning is predicated on the notion that the drug works. If you know that, why have trials at all?
Or, maybe the trials are predicated on the notion that the drug might not work, or even do harm?
Have you considered whether urging a quick and dirty utilitarianism for a drug trial might clash in some way with Hippocratic medical ideals? Do you advocate to short-circuit those?
“…your reasoning is predicated on the notion that the drug works.”
Once more, for emphasis: “After all, it might not work on either, and the sooner you know the sooner you can start on Plan B”
Let’s just incentivize the drug companies to produce something that they say works, by say promising a liability shield for whoever gets to market first. We’ll have a vaccine tomorrow! Or at least, we’ll have something in little bottles labeled “vaccine” tomorrow, which is almost as good!
RE: “start beating the bushes for Nigerians”
Can’t the Nigerians beat their own bushes?
They would, if they could just get a little bit of help getting their money out of the country. If you can help, just indicate this by burning a small pile of US currency in front of your house, and they’ll find you and explain what they need.
“Organizations have cultures. I’ve worked for places that when you encounter a problem this morning, you get the relevant people together early this afternoon, hash out a solution, start implementing it later that afternoon, and finish it tomorrow afternoon. At the other extreme, I’ve worked for places that address exactly the same problem by scheduling a meeting for three weeks hence, at which time, with luck, a decision can be reached on who should have responsibility for solving the problem, after which regular biweekly meetings will be scheduled for the 11 months it takes to solve the problem.”
Of the two, which produced actual solutions, which fixed the old problem(s) without introducing new ones? After all, injecting bleach into the circulatory systems of patients would be 100% effective at preventing them from dying of Coronavirus.
That’s the type of solution you get offered when you demand something by end-of-day.
Diversity religion sacrifices people all the time. This is just the latest.
A lot of the people who die as a result of this delay aren’t diverse. The CDC even initially chose to vaccinate essential workers before the elderly, — even though their own data suggested that choice would cost lives — because the elderly are too white:
https://reason.com/2020/12/18/vaccine-cdc-essential-workers-elderly-racial-covid-19/
They changed their minds after they got caught.
There no American Lives Matter religion. Time to face up to it: the left considers you and your family to be second-class humans unless you’re one of the preferred identity groups in their power base.
Ben_ , I have been an outspoken critic of multiple aspects of diversity policy. There is no shortage of cogent arguments against it. You ought to try to find some of them, and use them. Because the stuff you spew here just makes you ridiculous, and entrenches diversity advocates in a belief that their opponents aren’t too bright, or maybe even malevolent.
I’m not a narcissist, so I don’t care how you (especially you) consider me. I assume that idea, that someone might not think everything in the world is about his own personal sense of himself, is too alien for you to understand.
You be you: keep saying things in order to get little pats on the head. I’ll keep pointing out how people like you end up hurting others intentionally because your choices are based on vanity and trying to stay in the the good graces of the cool kids club.
“I’m not a narcissist
You be you: keep saying things in order to get little pats on the head. I’ll keep pointing out how people like you end up hurting others intentionally because your choices are based on vanity and trying to stay in the the good graces of the cool kids club.”
Seek a competent therapist to work on your narcissist-denial. It’s gotten out of hand. Hint: You are a Trump-level narcissist.
Gfy
So you concede that I AM right.
Moral pointers from bigoted right-wingers — these days, among conservatives, there are only (1) conservatives who embrace bigotry and (2) conservatives who appease bigotry — are always a treat.
Enjoy the rest of the culture war, clingers. Especially the getting stomped by your betters and resenting your betters parts.
Your first sentence is completely wrong. But you manage to be horribly arrogant while simultaneously being completely full of shit. Really, you’re a lot like Trump in that regard.
The second paragraph is nonsensical. Which of your parts do you imagine everybody resents?
There is no apostrophe in that final sentence. Get an education, clinger. Focus on standard English.
He has no time for such things. “He sleeps all night and he works all day.”
There’s a chance the hanging around in bars is catching up to him.
“There no American Lives Matter religion”
No grammar matters religion be there be, either.
Gfy
Is this the modern version of Rush’s “ditto”?
Well, can’t tell you that I am surprised. Been saying this was going to happen for some time now…
A vaccine has zero efficacy if left in the bottle. Improving vaccine acceptance will speed reaching thresholds necessary to shift epidemic transmission to endemic transmission. And as transmission rates are greatest among groups such as hispanic, of-color, and similar, then ensuring greater rate of vaccine acceptance is a rational strategy.
The biology of race for immune response to this vaccine is most likely zilch. As the study was built, no biologic question was posed. Lacking a uniform, and objective, definition of hispanic, no biologic conclusions are possible from study results.
Israel seems to have no problem vaccinating their population. Wonder why….?
Fewer anti-science, modernity-disdaining evangelicals?
Interesting hypothesis. But as good empiricist, we have to test it.
Acc. to your hypothesis, one would expect the locales with the least evangelicals to be the most efficient in vaccinating their populations.
Whoops! The data does not support your thesis.
https://www.nbcnews.com/health/health-news/map-covid-19-vaccination-tracker-across-u-s-n1252085
Texas, which you consider a backwards state, is doing a bit better than NY, and much better than California in vaccinations per 100,000 in population. True, smaller states, in terms of population, are even better, but that is a function of it being easier to vaccinate a smaller population. And even there, states like North Dakota and Montana are the same as states like Maine and Vermont.
Empiricism. Trust it every time over knee-jerk bigotry.
My aunt and uncle live in Israel and recent were vaccined. (Both are over 75). They made an appointment at a clinic. At the end of the appointment, they saw some young people lining up to be vaccinated. They asked how they are getting the vaccine when they are not old enough?
The technician told them that each day they take a certain amount out of the freezer that they believe is enough for that day’s appointments. At the end of the day, there are often leftovers, either because of no-shows or whatever. The vaccines cannot be refrozen. Rather than waste them, they give them to younger people on a first-come, first-serve basis.
There is no such race as “Hispanic” or “Asian”. Any scientific reliance on these government made up nonsense categories is something, but it is not science.
The thing that it is, though, is called propaganda. Leftist propaganda to devide us into warring factions rather than uniting us on what binds us.
“There is no such race as ‘Hispanic’ or ‘Asian’.”
The ghost has spoken. It must be true, why would a ghost lie? The ghosts have ALWAYS been at war with Eastasia.
I get the sense that some posters here perhaps don’t have experience managing complex, time critical projects.
Let’s teleport ourselves back in time to the start of clinical trials. We don’t know if A)the vaccine will work at all or B)whether it will work the same for all groups (whether ethnic, or some biological distinction).
Time matters; thousands are dying every day. We have enough people in Group A to start testing. We don’t have enough people yet to test in Group B. Given the biology, we don’t expect differences between A and B, but you never know. What should we do?
Option 1 is start testing on the volunteers you have today, and move heaven and earth to get more of Group B to step up and volunteer. Option 2 is to do nothing until you have enough volunteers from Group B (,C, D, …).
Which option makes the most sense? We have Delay/NotDelay and Groups DoMatter/Don’tMatter, so four outcomes. Let’s go through them:
Delay/Don’tMatter – the delay had no benefit, and cost lives in GroupA, B, C, D, …
Delay/DoMatter – the delay still has no benefit, and still costs lives. For example, let’s assume that it is neutral for GroupA, it helps GroupB, and hurts GroupC. That’s all good to know, but every group except the last one to get enough volunteers still waited, and either missed the benefit, or missed out on knowing it was time to start looking for something else.
NotDelay/DoMatter – no harm done; for each group you get the results as soon as possible, i.e. when enough people from that group have volunteered.
NotDelay/Don’tMatter – this (which it turns out was the actual case[1]) is also a ‘no harm done’ situation. Like the prior one, each group gets results as soon as you have enough volunteers.
Both ‘Delay’ options mean some group waited longer than needed to start trials, and thus suffered unneeded deaths. Both ‘NotDelay’ strategies mean that every group gets it as soon as the data is available, and so minimizes unneeded deaths.
[1]“Moderna’s and Pfizer’s successful COVID-19 vaccines are not only 95 percent effective in preventing the coronavirus, but their final trial results have also revealed that they work equally well across age groups, ethnicities and genders.”
Assuming that the complex, time critical projects you refer to were successful, I’d hazard a guess that you had an accurate model of the problem domain.
Here you seem to be using a model which assumes that results from one group provide zero information about how the vaccine behaves when given to members of other groups. If that’s your assumption, it’s false. What that means is that getting results in a staggered fashion as you propose would required more total volunteers. To determine whether this was a good idea, your model would have to address the possibility that using more volunteers for the Moderna vaccine testing would make it harder to obtain volunteers for tests of other vaccines, delaying them.
The hardest part of the problem to model is, I suspect, public behavior. What impact would your approach have on people’s decisions about whether to get vaccinated? What affect does it have on the short term spread of the virus (based on how it affects mask wearing and social distancing behavior). I don’t think there are good models for this, and your argument appears to be based on a model that ignores them entirely.
I’m not tracking … can you elaborate?
Here’s my simplistic understanding of how these trials worked, just based on media descriptions, with all the caveats that come from that (and I welcome a more detailed description): essentially they give the vaccine or a placebo to thousands of people, then let them go live their lives. Then over time you track how many from each group contract covid. If after a while you find that, say, 100 of the placebo group caught covid, but only 5 of the vaccine group, then you would conclude the vaccine was 95% effective at preventing infection. Is that approximately right?
If it is, then can you explain why it is necessary to batch people in groups? What if whenever a volunteer walks in the door you flip your coin and give them either the vaccine or placebo, write down all their info, and let the go to become infected or not. Then at any given time you could slice the data to date any way you like – you might say ‘to date, we have enrolled 7243 pairs of Slavic women and the number of infections is 53:11 (placebo:vaccine). For elderly diabetic hispanics the numbers are 75:7, for people with type A blood it is 63:5, for type O blood 52:9’, etc, etc, etc.
Eventually you would have enough data on the infection (and complication) counts to say that the vaccine seems like a good gamble for certain groups. As more data rolls in you could offer the same recommendation for other groups (or not, e.g. if people who are allergic to peanuts have a bad reaction to the vaccine, you might advise them to skip it). Whenever you think you have all the data you need for left handed people with high blood pressure and arrhythmias, you refer those volunteers to another testing program.
The counter proposal here seems to be ‘if you haven’t lined up enough Samoan or Inuit volunteers yet, don’t start testing on anyone’. Can you explain why waiting like that requires fewer total volunteers, or affects mask wearing by people not enrolled in the trials, etc? And in particular, given the ongoing deaths, how the advantages of waiting outweigh the costs?
“The counter proposal here seems to be ‘if you haven’t lined up enough Samoan or Inuit volunteers yet, don’t start testing on anyone’”
This seems to be your proposal. Would you mind elaborating why you propose this approach?
The primary fear is that the vaccine has an unexpected harmful side reaction in some populations. You need enough data to be sure that any unexpected side reactions have causes that are not related to the vaccine. (Here’s a vaccine recipient who now has a shattered pelvis. He also fell off a four-story building. None of the other vaccine recipients have shattered pelvises. We can be fairly well assured that the vaccine doesn’t cause broken bones.)
If you don’t have a broad enough sample base to draw from, you risk missing a correlation between a harmful outcome and the cause. If your desired outcome is being able to say “this product is safe” you need to have tested against all the potential complicating factors.
Look at the difference in public confidence in a product that says “this product is safe to use, and we know because we tested enough different people, and enough different types of people, that we would have found any problems when we were testing.” and “as far as we can tell, this product is safe. It hasn’t harmed anyone that we know of, anyways”.
Here is the real kicker, IMO.
The CDC site linked to in some of the posts says:
Now this is likely true, ethnic minorities likely are in the higher risk categories noted there, and these factors, not race per se, are likely what contributes to their higher rates of infection and death.
But the question is, the Moderna study of I believe 45k, though ethnically balanced, was not, AFAIK, balanced for these socioeconomic factors. What kind of people would participate in a vaccine trial? Generally not poor people or frontline workers.
If socioeconomic condition or occupation are important factors in vaccine efficacy, then require diversity for those. Not the madeup racial categories the government uses.
A conclusion not in evidence from the premises.
“But the question is, the Moderna study of I believe 45k, though ethnically balanced, was not, AFAIK, balanced for these socioeconomic factors. What kind of people would participate in a vaccine trial? Generally not poor people or frontline workers. ”
Which is why you have to require the vaccine manufacturer to locate and include them in the testing.
Glad you think that you “have to” do something that the FDA does NOT require you to do and Moderna did not do. You apparently are so wedded to ideology that you do not realize you are supporting Prof. Bernstein’s point (and mine).
The FDA does not require me to do anything.
Now, are you imagining that you have a point? If so, try making one.
” You apparently are so wedded to ideology that you do not realize you are supporting Prof. Bernstein’s point (and mine).”
You, apparently, are so poor at reading that you didn’t notice where I said “the ideology doesn’t matter” It is Prof. Bernstein who’s dragging ideology to where it isn’t needed.
Lathering the rubes.
These guys spend their holidays
lathering the rubes.
Cukoo. Cukoo. Cukoo. Cukoo.
It’s 4 O’clock.
consider learning how to spell the word “cuckoo” if you want to use it regularly to mock someone.
The misspelling is a good way to provoke silly comments from the likes of you.
And I am imitating an animal sound, so it has no proper spelling.
By the way, have you figured out the difference between causation and correlation yet? Or are you ready to conclude that seriously ill COVID patients should stay home rather than go to the hospital\?
Having pissed around in medical research for 30 years and I’ve often had to deal with sex/race/ethnicity requirements when conducting biomedical research funded by the NIH and drug companies. While I never delved into the basis for these requirements I understood that data existed to support differences in peoples’ responses to drugs/vaccines based on those characteristics. So imagine my surprise, when a lawyer questions that nugget of scientific knowledge on which all that work had been done. So of course off I went to google and Pubmed. Google scholar dragged up more than 30,000 cites to the search “racial differences in vaccine efficacy”. Just one citation (Kurupati R, Kossenkov A, Haut L, et al. Race-related differences in antibody responses to the inactivated influenza vaccine are linked to distinct pre-vaccination gene expression profiles in blood. Oncotarget. 2016;7(39):62898-62911. doi:10.18632/oncotarget.11704) serves to highlight the differences of the phenotypic response, although the the gene level responses were pretty similar. There are valid and documented reasons that FDA has mandated types of inclusion criteria for the last 30 years. If pharmaceutical companies were more responsible on their own fewer of the regulations would be necessary. But of course their primary concern is the bottom line.
That seems to well justify a policy of ‘thou shalt not limit trials to one group’. But can you explain how it justifies a policy of ‘thou shalt not start a trial until you have adequate numbers of volunteers from every group’? Why not start the trials with the people you have, and report the results group by group as the volunteers arrive?
(honest question, maybe there is some logistics reason or something. Given your background I’d love to hear your thoughts)
Also, the FDA didn’t invent this requirement because it did scientific studies showing it should require racial categories to be used, but because Congress passed legislation more or less requiring them to do so. When the FDA issue proposed regs in 2003, the reaction from biomedical and pharmaceutical companies was brutal, but the FDA went ahead anyway. Just for example, Judith Molt of AstraZeneca observed that the sociopolitical the FDA sought to mandate (and has mandated) and categories and scientific/anthropological categories do not map together She explained that “the whole concept of ‘race’ has in later years been challenged based on a new understanding of the human genetic code, which indicates that the genetic differences between two person [sic] of the same race or ethnicity is just as great as between two persons of different race or ethnicity.” Molt argued that any c.onclusions arrived at by using the OMB categories to analyze data from medical studies would paint an inaccurate picture and result in decreased patient safety based on overgeneralizing to specific patients from data gained from looking at broad, unscientific groups.
In short, the FDA guidelines were a political/legal decision, not a scientific one.
“Why not start the trials with the people you have, and report the results group by group as the volunteers arrive?”
As a practical matter, whatever behavior you incentivize is the behavior you will get more of. So if you incentivize cutting corners, what result would you expect?
There may be genetic differences in response to vaccine. This is not the same as “racial” differences, and if there were “racial” differences, the US’s “racial” categories would not be a good way to get at them, as the categories are both incoherent genetically and internally multiracial. Also, the study you picked was a poor choice: “Race-related differences were caused by samples from younger African Americans, while results obtained with samples of aged African Americans were similar to those of aged Caucasians.” In other words, they found inexplicable differences between the allegedly reaction of younger blacks and older blacks, and decided to chalk it up to genetics, because I suppose no one wants to publish a paper that says “we got incoherent results, so sue us.”
“There may be genetic differences in response to vaccine.”
Indeed there may. The way you find out is by testing the vaccine against people of different genetics. So, the identical twins and clones are out of the testing study.
“This is not the same as ‘racial’ differences”
there are some genetic conditions that are more prevalent among specific racial groups, so testing across a diverse racial testing sample increases your chances of encountering the genetic differences in your testing. If there IS a harmful interaction, you want to find it in testing.
Ban the FDA. Replace it with Yelp reviews by patients and by doctors.
Yelp? Seriously?
Do you understand how easily Yelp reviews can be and have been manipulated?
No problem. Set up a comment site where one would have to prove getting a drug prescribed, and prescribing a drug, in the case of doctor comments.
So you want something more like Amazon reviews.
Amazon also has a fake review problem. People should upload their prescriptions prior to any ratings. The prescriptions would qualify them to comment as patients or as doctors. The prescriptions should not be available to the public, just to qualify to post a comment. They can block out identifying information prior to uploading them.
One problem with patient comments might be they would tend to the extremes of success or of failure. People with moderate effects, good or bad, might not be motivated to make the effort to comment.
Less biased academic or clinical groups can do studies and post them. For example, insurance companies are motivated to prevent deteriorations, and their reports would have more neutral validity than that of the manufacturer now reviewed by the FDA for approval. Drugs approved in countries with oversight equivalent to the US FDA, such as in Europe, and in Japan, should result in automatic approval in the US.
“Amazon also has a fake review problem.”
Which makes your advocacy for copying their system so dumb.
Good point. Totally off this topic, but Yelp shamelessly exploits its Section 230 immunity to extort fees from reviewed service providers. If Section 230 is to be reformed, that abuse should be remedied.
All these comments and no one mentioned that “race” is not in fact an objective thing that can be measured. There is no scientifically meaningful definition of race.
“Race” is a social construct, an invention of the 19th century. It belongs to same conceptual family as “blood purity”. A complete anachronism.
So, when you have endless arguments about something that cannot even be defined, what does that tell you? It tells me that people are in fact arguing about something /other than/ “race”. Race is a proxy.
DaveM,
The evolutionary biologist Ernst Mayr supplied a biological definition of race in his article, “The biology of race and the concept of equality,” in the excerpt as follows. It is an article worth reading.
In a recent textbook of taxonomy, I defined a “geographic race” or subspecies as “an aggregate of phenotypically similar populations of a species inhabiting a geographic subdivision of the range of that species and differing taxonomically from other populations of that species.” A subspecies is a geographic race that is sufficiently different taxonomically to be worthy of a separate name. What is characteristic of a geographic race is, first, that it is restricted to a geographic subdivision of the range of a species, and second, that in spite of certain diagnostic differences, it is part of a larger species.
In biology, the nature of “genetic drift” is fairly well understood. In the early stages, you start to get visible differences between individuals of the same species that have been drawn from populations that have been separated from each other. In the later stages, you get different species that can no longer interbreed.
Agriculture is based on this principle: Farmers select the varieties of their food crops that produce the best and grow more of them. Dog breeders, on the other hand, tend to select for plain cosmetic reasons, and that’s how you wind up with so many different breeds of dog.
“All these comments and no one mentioned that ‘race’ is not in fact an objective thing that can be measured.”
And nobody mentioned that cats can’t be seen by the human eyeball. For the same reason: It’s not true.
Racial characteristics are quite objective. It’s as obvious as the light reflecting off your skin!
Such medical rules are not about political correctness. A vast range of both diseases and treatments tend to be harmless for people of one race while tending to being fatal for people of another. This includes differences between Whites and Hispanics, and racial social identification or self identification is enough to accurately estimate the biological realities. It is something that every medical doctor knows, and that is because biological racial differences really do exist. The belief that biological races do not exist–that is noble, progressive, well-meaning, and completely out of touch with objective reality. Evolutionary biology would not even begin to make sense without the pattern of biological races, and the human species is an extreme example of the pattern, not an exception.
“A vast range of both diseases and treatments tend to be harmless for people of one race while tending to being fatal for people of another.” False.
“This includes differences between Whites and Hispanics.” Even falser.
Omniscience makes testing go faster, doesn’t it?
Should people submit DNA for racial classification, especially to get standing for discrimination claims?
Sure, that sounds MUCH easier and simpler than just looking at them.
African blacks have really dark skins. They outperformed whites in the 2010 Census. Should these “new Koreans” get affirmative action? The most famous became President of the US. He was raised by white grandparents, and attended top schools. His net worth went from $12 million to $40 million after he became President. Should Obama, with his African name, get affirmative action?
Most American South blacks are 40% from the British Isles, as Professor Gates said on his show on PBS. Should they get affirmative action?
The only people who should get affirmative action are the ones, such as yourself, unable to compete in a fair competition.
Going for the Kirkland award? Strange choice but if it makes one feel all warm and superior, then it’s all worth it.
OK, you can have affirmative action, too.
There are essentially no differences between the genetics of different races that accounts for different racial characteristics. Many of the diseases that are seen as affecting one race more than another are because of such things as where members of that race predominantly live, the access to healthcare they tend to have, access to nutritious food, etc.
You’ve cured Tay Sachs! Such wonderful news that it no longer exists. And also gone is sickle-cell disease and those Native Americans who can’t digest alcohol.
Sickle Cell disease is prevalent in Africa. Considering black people have more recent ancestors from Africa, it is more likely they will have the trait. It is the location their ancestors lived, not the race that they have.
I have not looked into the other things you mentioned so am not going to comment on them in only cursory research. Considering the topic we are discussing, I really don’t see the need for you to use the sarcasm and through it insult me. Personal attacks only serve to discredit the argument of the attacker.
“It is the location their ancestors lived, not the race that they have.”
You seem to think that these things are unrelated. All genetic diseases are inherited from the parents, as is racial makeup.
” I really don’t see the need for you to use the sarcasm”
Which, ironically, is exactly why you need the sarcasm.
If you can’t have a discussion without insulting people you are talking to, your argument either does not have actual support or you are choosing not to use the arguments that are available. Either way, you are discrediting your own argument by personally attacking me. Not saying that makes your argument false, but it hurts the credibility.
You are saying, a more valid diversity would be to include poor people in a vaccine trial. That is a great point, if that is right.
Poverty settings would be where a vaccine provides the greatest value. Such people should be sought out as the best test of the vaccine.
“Such [poor] people should be sought out as the best test of the vaccine.”
Which is why they are sought.
Been in practice 27 years. No one mentioned that to me in medical school(not even my former slave state racist school), nor have I found any reason to alter practice based on the superficial finding of a person’s race.
Inter-individual variability is wide enough that any subtle differences that race might impose is simply insignificant.
Can you support your statement regarding “…tending to be fatal for people…” of another race with a peer reviewed publication?
How do you treat Tay Sachs disease?
Good example, because the sort of “diversity” that the FDA requires wouldn’t pick up diseases disproportionately prevalent in Ashkenazic populations because Ashkenazic Jews (and Mizrahi Jews for that matter) are lumped in with whites.
” lumped in with whites.”
so they’re included in drug trials and vaccine studies, then?
No. The FDA requirements are oblivious to whether a “white” person is an Ashkenazic Jew, and Irish Roman Catholic, or a Lutheran Swede. The pool of white people could be anywhere from 0% or 100% of each group.
When they exclude white folks from vaccine trials, they exclude the Ashkenazi, sure. But when they recruit black people, they exclude the Ashkenazi again. good thing for them they got God looking out for them, I guess.
Good thing you are able to muster meaningless snark as a substitute for meeting the argument. Must make you feel good. Kind of like cotton candy, fluffy, sweet and full of empty calories.
Addictive as well, apparently.
“Good thing you are able to muster meaningless snark as a substitute for meeting the argument. ”
A meaningless argument deserves to be met with a meaningless counter-argument.
The treatment of Tay-Sachs the same regardless of the the individual’s heritage. The biology of Tay-Sachs, is the same regardless of one’s parentage. It is however more prevalent within certain ethnic groups.
Similarly, there is no reason that one would treat any other health condition differently whether that person is of Ashkenazi jewish ancestry or not.
There is the very dubious FDA labeling of the combination drug isosorbide dinitrate/hydralazine (two old and cheap drugs that become expensive when combined in a patent law ‘new’ drug), in which persons of self identified african descent. Clinical trial design was shit in that non-AA were excluded. Was it effective in the studied population of AA, yes, better than placebo, yes, better than any other active drug, no tested.
I do not know enough about the science or policy around this to offer an informed opinion, but another reason I can think of for Moderna wanting accurate representation of minorities in the trial is to enhance the credibility of findings. If the study were done with few black people, I think it likely that the black community may be less likely to trust the vaccine and receive it.
There is already distrust of medical professionals among many black people, so not having an accurate representation in the study could further enhance that and lower vaccination rates, which is the exact opposite of the goal of the study.
I am not saying this necessarily was or wasn’t a reason for Moderna’s decision, but it is a reasonable one to me if it was.
If your testing sample is drawn exclusively from middle-class white folks, you’re going to miss a fairly substantial number of potential interactions. What happens if you give the vaccine to someone with sickle-cell sickness? You won’t know unless you’ve tested it on someone who has sickle-cell sickness. Factor in all the different possible treatments for sickle-cell sickness, including no treatment at all, and you need a fairly substantial number of tests on people who use different treatments for sickle-cell sickness to be able to state authoritatively that your treatment is safe for people who have sickle-cell sickness. Now substitute every possible medical condition for “sickle-cell” and repeat until you know for sure that your product is safe for people with all of them. Miss just one that your vaccine interacts with, and see how many people will step up to take it.
European regulators found that Thalidomide was a safe and effective tranquilizer (which it is) but didn’t do adequate testing among fertile women, and they missed the fact that Thalidomide interacts poorly with developing fetuses. The US had a more thorough testing regimen and did not approve Thalidomide for use. This meant that American women were deprived of an effective tranquilizer that was available to European women. They were also deprived of dealing with Thalidomide babies.
“Even if, unlike me, you believe in “race” as a biological concept likely to have significant medical consequences, our American civil rights/affirmative action categories don’t make any sense in that regard”
It’s hardly a shocking revelation that people of different cultures have different living habits… traditional diet, for example, that can have significant biological effects.
If your goal is to encounter and identify as many problems as possible during testing, then any measure of diversity works.
The things that have biological reality and have significant medical consequences are far more granular than what is called race.
The most obvious physical characteristic that gets tied to “race” skin color, does not form discrete populations but forms a continuum from north to south through Africa and Europe.
The suggestion that the African Dinka tribe (average height 5’11”) and the Bambuti tribe (one of the “pygmy” tribes, average height 4’6″) are medically equivalent is nonsense.
By the way, the biological factors (such as skin color) that get lumped under “race” are generally evolutionary responses to local climate.
If you took fair skinned northern Europeans and an African tribe and swapped them geographically, then checked back on them 100 generations later, you would likely find that the “racial” traits associated with each group originally would have re-evolved in the other group.
Yes, indeed, where people live can produce different biological effects. If you want to know if your experimental medicine interacts poorly with African sleeping sickness, you probably won’t find out if you confine your testing to those who live at high latitudes.
The Moderna vaccine causes autism, which we know because we haven’t yet figured out anything else that definitely does cause autism.