On Genetic Diversity and Vaccine Studies

Genetic diversity in medical research may be a good thing; using American racial categories is not a good way to achieve that diversity.

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Last week, I expressed my outrage that Moderna had delayed its Covid-19 vaccine trials to ensure that it had "enough" diversity in its vaccine subjects, a concern I deemed unscientific that cost thousands of lives. I got some pushback to the effect that there is evidence that people of different genetic backgrounds sometimes have different reactions to vaccines, and thus genetic diversity in research subjects is important.

Let's assume arguendo that such differences have enough medical significance sufficiently often that it is worthwhile to spend resources to ensure genetic diversity in vaccine research subjects (i.e., the volunteers who receive the vaccines during the research phase). The problem is that Moderna (and other researchers), following FDA regulations, is not looking for genetic diversity, but diversity as defined by U.S. statistical categories--white, Asian, African American/black, Native American, and Hispanic. While regulations ensuring representation from each category may increase the diversity of research subjects, they are very poorly designed to do so.

I noted in my previous post that "Asian American" as used in government statistics is an incoherent category, encompassing everyone from Caucasian Indians to East Asians to Austronesian Filipinos. Similarly, Hispanic is a linguistic/cultural category not a genetic one; African American encompasses everyone from Ethiopians, who are more closely related genetically to Jews than to sub-Saharan Africans, to those sub-Saharans, and includes people with substantial Native American and European heritage; and white includes people with origins everywhere from Ireland to Yemen and Afganistan.

So let's say a pharmaceutical company is looking to meet FDA guidelines, and also satisfy activists, by ensuring representation from American statistical groups. The company has its subsidiary in Ireland do its "white" testing locally. But wait! DNA researchers conclude that people from the Middle East can be divided into as many as four separate populations, and Europeans divided into as many as eight separate populations. Using Irish subjects provides "whites," but not a genetically diverse group of whites.

The company also hires the Mayo Clinic to find African-American subjects. Mayo, based in Rochester, Minnesota, sends its team to Minneapolis to recruit, and finds the right number of subjects. But most African Americans in Minneapolis are Somalis. Not only does this not reflect the broader population of Africans and African Americans, Somalis are genetically more similar to people in Saudi Arabia they are to people from other parts of Africa. So Mayo has added "diversity" to the study, but not much genetic diversity, and none that would pick up, say, whether people of West African origin have unique reactions to the vaccine.

Our hypothetical pharmaceutical company also has a subsidiary in Mumbai, India, which recruits "Asian" subjects for the study locally. But Indians are Caucasians, and have no particular genetic relationship with East Asians, who are themselves genetically diverse.

Finally, our company is based in Miami, and recruits its "Hispanic" subjects from the local Cuban-American population. Cubans have the highest percentage of European ancestry of all major American Hispanic groups, and the lowest amount of indigenous ancestry. Are they genetically representative of the Hispanic population? Only to the extent that they are mostly of Spanish origin, and Spain is the dominant genetic contributor to the overall Hispanic population. [Please note: In my previous post, I cited a study suggesting that the average American Hispanic is about 75% European in ancestry. I have been directed to other studies concluding that the percentage is more like 55%.]

Using these subjects would totally satisfy FDA "diversity in medical research" rules, even though they in fact provide limited genetic diversity, and fail to represent large swathes of both the American and general world population. The company would likely have achieved greater genetic diversity in its subject just by trying to get a random sample of volunteers from the broad American population. So if genetic diversity is indeed important, FDA regulations should be rewritten to require genetic diversity, rather than using American racial categories as a very crude proxy.

That said, the FDA regulations did not come about because of scientific concerns about achieving genetic diversity in medical research, but from lobbying by activists who wanted to achieve "representation" in medical research. As Steven Epstein explains in his excellent book, Inclusion: The Politics of Difference in Medical Research, the push by activists for "diversity" in medical research had the following goals:

(1) Statistical representation. Groups should be included in medical research according to their approximate percentages of the U.S. population. [Note there is no good scientific reason for this to proportional, as opposed, to say, equal numbers from each group.]

(2) Social visibility: Both researchers and research subjects should reflect American "diversity."

(3) Political voice: Researchers should ensure their research is addressing the needs of less-advantaged groups.

(4) Symbolic representation: Medical researchers must be allies in ensuring that society understands the medically-related problems facing various social groups.

Note that none of these goals are "ensuring that studies are scientifically valid," nor has the FDA ever really tried to explain why using American statistical categories is a sound scientific way to identify research subjects. For that matter, the FDA does not distinguish between clinical studies on disease and the effectiveness and safety of medications and vaccines, where American racial categories have little salience, and studies on sociological factors affecting public health, where they sometimes have salience (if used with proper caution). Faced with pressure to require attention to race and ethnicity in medical and scientific research, the FDA took the path of least resistance and simply required researchers to universally adopt the unscientific categories used by HHS and the rest of the government. (The FDA does allow, but does not require, companies to undertake more granular analysis.)

These rules make medical research a bit more expensive, which is itself a harm. In the Moderna case, when time was truly of the essence, they cost many lives for no scientific gain. More generally, as an editorial in Nature Genetics argued in 2004, the "use of race as a proxy is inhibiting scientists from doing their job of separating and identifying the real environmental and genetic causes of disease."

Twenty years ago, scientists predicted the use of race would subside in favor of much more scientifically salient DNA-based studies; instead, thanks in large part to the FDA (and NIH, which has similar regulations) "race" is more prevalent than ever. And many scientists believe that rather than advancing medical research, this use of race leads the medical profession to "(mis)attribute causality and thereby (mis)identify health care needs." George T.H. Ellison, et al., Racial Categories in Medicine: A Failure of Evidence-Based Practice?, PloS Medicine, Sept. 2007, e287, at 1434, 35.

 

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  1. Since you are on this topic (again) is there any FDA requirement, or practice by vaccine manufacturers, to require diversity in socioeconomic status or occupration among the testing subjects?

    Some have raised those categories, which certainly have affected rates of contracting COVID, and might affect effectivness of vaccination.

    So does the FDA require that, or does it just use race as a proxy for that?

    1. No. And it doesn't require race as a proxy for anything. It requires race b/c Congress required it to look into requiring race, and the path of least resistance was to adopt the standard statistical categories despite no scientific justification for doing so. In fact, the FDA allows all research to be done abroad, which would make the sociology pretty much irrelevant to the U.S., and requires researchers to use the same categories as in the U.S., even though they are especially ridiculous abroad. (Imagine requiring a Japanese subject in Japan to check off whether he is "Asian." Latin Americans have no idea what "Hispanic" is supposed to mean.)

      1. More or less what I thought.

        One more question. Does the FDA require, or did the vaccine manufacturers use, diversity in age? A while ago, I read that older people, particularly the elderly, had reduced immunizations from vaccination, and that might affect their reaction to the COVID vaccines. Age certainly has been a major factor in susceptibility to COVID.

        It would seem logical that if you are developing a vaccine that strikes particularly hard at the elderly, that you would want to test it on them.

        Anyone did that?

        1. Meant to say, It would seem logical that if you are developing a vaccine for a disease that strikes particularly hard at the elderly, that you would want to test it on them.

          1. And in fact, they did.

            https://clinicaltrials.gov/ct2/show/NCT04368728

            At various different dose levels in Phase 1;
            In 3 age groups (Phase 1: 18 to 55 years of age, 65 to 85 years of age; Phase 2/3: ≥12 years of age [stratified as 12-15, 16-55 or >55 years of age]).

        2. Yes, age diversity in test subjects was a priority for at least some vaccine developers. (Recollection of something i read months ago, i won't swear Moderna in particular was the subject).

        3. Yes, age cutoffs are typical for phase 1-3 trials.

          Typically, a trial will look for participants between 18 and 65 years of age. Younger participants run into a host of potential issues, especially much younger participants. Older participants have other potential issues.

          That's "typical." There are exceptions, for example, if you're looking at a pediatric drug, or one that you know will go into elderly populations.

          Other common cutoff criteria are pregnancy and certain medical conditions.

      2. Professor Bernstein...Happy New Year. Saw your post on ToI a while back. Glad to see you post here.

        Is it fair to say that our limitations in conducting a human genomic analysis of vaccine effects makes us use those standard statistical categories? I mean, you're right. The sociological categories are totally irrelevant. But our science hasn't gotten to the point where we can really analyze the effects of a vaccine at the genomic level.

        So what should a good scientist do, then? They don't have the tools (yet) to do the genomic analysis, because our science hasn't gotten to that point (though we are close, I think). Computational biology is in it's infancy, as I understand it.

  2. Yeah, but the HR people feel good about it, so it's a go.

  3. Best post on the VC in weeks.

    1. The original, 3 days ago, was just as good, but too many wokists intentionally misread it.

      1. I had missed it, thanks.

        1. I don't know how long you have been around, but Prof B's posts used to be a lot more incendiary, because they often related to Israel (or Lochner), both of which elicit strong opinions. Also, unlike most of the Conspirators,he engages with the commenters.

          So now some posters are predisposed to reject anything he says out of hand, even when those posts are self-evidently correct, like the past two on bizarrely unscientific FDA racial/ethnic categorizations.

          I'll admit that I now have similar reactions to anything Ilya S (or, even worse, David Post) writes, but I do try to tamp that bias down until it can be released in an appropriate forum, like a little league game.

          1. If there is anything the obsolete, intolerant, downscale fans of the Volokh Conspiracy can't stand, it is genuinely libertarian content.

            You deserve better than this right-wing whinefest, Prof. Somin.

  4. I am reminded of the Nuremburg Racial Purity Laws... 🙁

    1. Wow, you really are an idiot, aren't you. (I don't usually post purely pejorative comments, but yours merits a special exception.)

  5. I would be useful to have the studies collect and submit medical histories of trial participants which could allow some analysis of the social factors across different racial groups.

    Poverty is frequently cites as a factor for poor outcomes among African Americans, however there are more poor whites than blacks and most blacks aren't poor. Also official poverty rates don't include government assistance.

    African Americans have higher infant mortality rates than whites, but they also have children younger and more children outside committed relationships, but comparing similar profiles across races could be helpful.

    There are many other similar factors which may be studied but are seldom reported beyond the headlines about race.

    Looking beyond racial categories may in fact yield valuable insights that might help improve the health of all Americans.

    1. The most well known genetically based difference in African and coastal Mediterranean populations is the sickle-cell trait

    2. For the SARS-CoV-2 virus there are no known medical / physiological reasons why the disease should act different across different ethnicities. Absent such reasons delay in starting trials seems irresponsible to some degree,especially as additional persons of other ethnic backgrounds can be added in subsequent weeks.

      1. "For the SARS-CoV-2 virus there are no known medical / physiological reasons why the disease should act different across different ethnicities. "

        While there are no known medical and/or genetic difference across ethnitic lines, I would suspect that there are. The infection rates and death rates among East Asians is so much lower which cant be fully explained by the better mitigation efforts in those countries. Better mitigation does count for the better results, but there is likely to be some other factor that counts for a significant difference

      2. I seem to recall a UK study that not withstanding educational attainment, social standingl or income, blacks (as defined in the UK) had significantly worse outcomes than other groups.

  6. It seems, the medical hierarchy cut class in high school statistics. For a sample to represent a population, the most important feature is random selection. These trials have exclusion criteria, and one is not even allowed to carry out a parametric statistic. The sample was not randomly selected.

    Random selection, without exclusion criteria, would solve the racial problem and validate the study.

    1. Except we also require things like consent (volunteers) for medical research.

      Achieving a genuinely random sample when you are dependent on volunteers (self selection bias) is difficult.

      1. If you get ten times as many volunteers as you need, it's easy to reject the excess.

        1. If you get ten times as many volunteers as you need but all ten times have the same self-selection bias, you haven't solved the problem. On the other hand, if you get ten times as many volunteers as you need, then manually weed them out until you've "matched" the wider population, you no longer have a random sample and have introduced new systemic biases into your sample.

          1. The self selection bias means you didn't have a random sample in the first place.

            This is a problem with no easy or obvious solutions.

      2. The people who will get the vaccine must also consent, so the representation is not that bad.

  7. So it seems like your problem is not with Moderna, as you said in your previous post, but with FDA regulations. Did this change based on comments to that post or are you clarifying it?

    1. It looks to me like Moderna was using the FDA categories as a baseline, but the FDA isn't clear at all on how many people you need of all categories, and rather than pushing forward and telling the FDA that they have "enough" especially under the dire circumstances, Moderna for pr or whatnot decided it was important to get something close to proportional representation. So the FDA regs and Moderna are both at fault.

      1. Makes sense. I think that, regardless of genetic diversity, having a diverse group be the ones the vaccine is tested on may increase the credibility of the vaccine and decrease reluctance of some to take it that already have a mistrust of the medical community.

  8. I imagine Congress required the FDA to do this kind of thing for social and political reasons and I'm not sure there's anything significantly wrong with that. There's a long history of the medical and scientific community in the United States being wrapped in a bubble of ethnocentrism at best and being outright malicious/negligent towards many racial and ethnic groups. That's had real world repercussions that still linger today, and this kind of thing is probably meant to ameliorate those.

    As to the categories being 'ridiculous' because they are overinclusive or what not, it seems to me the same could be said of all kinds of classifications government use. Programs for 'disabled veterans' lump together an Air Force Reserve auto mechanic who served their entire time in Illinois and has a bad back with an Army Ranger with a prosthetic leg incurred in Iraq by an IED etc., etc., Does this mean all laws and programs for 'disabled veterans' are silly?

    1. Some supplementing evidence: "Across racial/ethnic groups, there are sharp differences: 70 percent of Asian Americans, 62 percent of whites, and 54 percent of Latinos say they would definitely or probably get a vaccine if available today, with 29 percent of African Americans saying definitely or probably."

      https://www.ppic.org/wp-content/uploads/ppic-statewide-survey-californians-and-their-government-october-2020.pdf

      It seems to me a very reasonable 'PR' attempt to lessen these differences would be able to go to, say, African-Americans, and say 'we made especial efforts to make sure people like yourself were well represented in our trials and research...'

    2. "I’m not sure there’s anything significantly wrong with that. "
      There would not be anything wrong with it except that we are in the midst of a highly contagious pandemic.

      Your comment about societal reasons (PR as you call it) is reasonable.

      1. My comment about the societal reasons was made in particular emphasis to the fact we are in a pandemic...If we develop treatments and strategies that don't appeal to large groups that's something on the other side of the ledger from the quickness to get a treatment, period.

        1. The development of treatments is independent from the building of societal consensus to follow the treatments. The PR campaign (as you call it) should not delays the lengthy and expensive porcess of development of multiple treatment modalities.

          1. It seems like you are saying treatments should never be delayed in development even if the development engenders distrust in the treatment...What would be the good in rushing a treatment for which no one trusts?

            1. Trust/distrust in a treatment is irrelevant. Efficacy is what matters. In your argument you discount human agency. Why? Because people make an affirmative choice to trust/distrust the treatment. The onus of making that choice is not on the developer of the treatment; that onus is on the individual.

              1. If a person or group distrusts a treatment they are less likely to undergo it. That seems relevant, no?

                As to agency, well, of course they make a choice to distrust, but of course that choice can be more or less rational (given, say, historical and contemporary conditions).

                1. If a person or group distrusts a treatment they are less likely to undergo it. That seems relevant, no?

                  And you think their decision to distrust the vaccine should prevent others who want it from obtaining it?

    3. "who served their entire time in Illinois and has a bad back "

      You misrepresent the facts. The issue is whether the condition is developed while the person was in service. It is certainly quite possible that a mechanic can injure his/her back while performing a task during actual service activities.
      Moreover, the benefit can be very different depending on the disability.

      1. Of course, my argument is is the concept/label 'ridiculous' because the group can be quite varied?

        1. No one used the word 'ridiculous" except for yourself. Having said that you have not actually replied to the objection that was made to what is essentially a "whataboutism."

          1. "In fact, the FDA allows all research to be done abroad, which would make the sociology pretty much irrelevant to the U.S., and requires researchers to use the same categories as in the U.S., even though they are especially *ridiculous* abroad."

    4. "That’s had real world repercussions..."

      In the 7 days ending yesterday, over 18k Americans died from covid. That is also a real world repercussion ... that gets repeated for every week of delay.

      For context, last year police killed 259 black people, or about 5 a week. Blacks are around 13% of the population, so that is at least 2340 blacks dying of covid last week. 2340 is quite a bit bigger number than 5. It's kind of hard to see the smaller number as an important crisis and the larger as unimportant. Especially since it is far from clear that there is any medical benefit, to people of any ethnicity, from the delay.

      1. If this kind of thing helped get the numbers of 'blacks' willing to get the vaccine higher then that would be a medical benefit, no?

        1. If activists and the government didn't have lobbying campaigns and rules that there be "enough" black subjects in studies, and instead explained that scientifically speaking race is not something that needs to be looked at, that might actually reduce concern more than having subject quotas. By having (and insisting on) such quotas, the message is saying that race is very relevant to medical research, which given the history you allude to, could give people less confidence in medical research. Jews were subject to horrific medical experiments by the most scientifically advanced country in the world within my parents lifetime. Ashkenazic Jews have some important genetic distinctions from the general European population. But no activist groups or government agencies are insisting that Jews be "represented" in scientific studies. So Jews don't worry about it. If the opposite were true, maybe it would be a big scandal if Jews weren't included.

          1. This seems like an extension of the argument 'groups like Jews were victimized against but there's no affirmative action needed for them, so why would affirmative action be needed for African-Americans.'

            The historico-social contexts might be very different from group to group (this might explain why there are so many more 'black' activists and efforts regarding them than there are for Jews too, no?), leading to different levels and types of distrust.

            Ultimately, this is an empirical question, isn't it? Would not being 'pushed' to have racial representation lead to more or less trust, use, etc., among certain racial groups or not? I don't think it can be assumed a priori one way or the other or solved by pointing to what's true for another group with bad histories (I mean, wouldn't that involve the same 'lumping' problem you are pointing out with racial groups?).

            1. Well, let's take Hispanics, whom Moderna was proud to announce ultimately constituted 20% of their research subjects. Why should Hispanics be suspicious of a study that doesn't include proportional representation of Hispanics, but Jews, Greeks, Arabs, Norwegians, or whomever are not, unless it's because someone tells them they should be suspicious? Doctors sow suspicion simply by asking about people's race on intake, which is almost entirely irrelevant to scientifically-valid treatment decisions.

              1. Again, isn't this the 'the way to get rid of racism is to stop taking race into account' argument? If we just got rid of the HR department and asking people their race on applications and such then there'd be no recorded discrimination at all!

                I mean, that's possible. But what's also possible is that many groups might assume that race is going to be taken into account (or in other key cases ignored, meaning their group will be left out) de facto and that keeping track of this officially is the only way to combat and police that.

                Ultimately, for this discussion, it's an empirical question as to which of these approaches would lead to distrust based on race in this area, right?

              2. "Why should Hispanics be suspicious of a study that doesn’t include proportional representation of Hispanics, but Jews, Greeks, Arabs, Norwegians, or whomever are not, unless it’s because someone tells them they should be suspicious? "

                Because Hispanics (rightly I should think) in America today are generally more likely to perceive bigotry towards them than Jews, Greeks, Arabs and Norwegians in America today generally do?

                1. They may perceive bigotry, but that's entirely irrelevant to vaccine studies. But if you tell them it's relevant, then they will think it is.

                  In any event it is an empirical question, though I don't see how you can get an empirical answer. But the fact that race is used, currently, in the following way, is sufficient to settle the question for me:

                  Particularly troubling, various treatment algorithms used by clinicians in a range of medical contexts “guide decisions in ways that may direct more attention or resources to white patients than to members of racial and ethnic minorities.” The algorithms are based on data regarding the risks and benefits of various treatment options to identifiable population groups, particularly African Americans. Not only are the data themselves often of dubious validity, but the way they are used in algorithms simply assumes that the data are picking up differences in genetic response to medical interventions."

                  There is no good reason to use race in these algorithms to begin with, beyond that the medical establishment insists we use race being being race-neutral would purportedly create the problems you suggest.

                  1. Let's say there is a law school with a history of preferring faculty and student applicants with a certain ideological bent, for the sake of argument we'll say right of center (libertarians, conservatives). After a while of such history the school gets a widely known reputation for this. A new Dean comes in and convinces the faculty and administration that actually what makes a good law faculty or student has nothing to do with ideology and that they should work to undo that reputation so that more people of other ideologies, say left of center, will feel comfortable applying there. In order to measure and police their progress they ask applicants, among many other things, to indicate their ideology. They even go further: students that indicate left of center are given, let's say, information on college groups such as the College Democrats, College Green Party, American Constitution Society, etc., in the hopes that they will see that other like minded students are on campus, feel more comfortable, build social relationships and other things that are suggested to increase matriculation and retention.

                    Now, you come along and say 'wait a minute, by asking students what their ideology is, by pointing them towards these groups, aren't we making them more aware of their ideology and more likely to feel like a beset upon ideological minority on campus?'

                    I guess that's a view, and a not unreasonable one. But I don't think the counter-view, which is that the measuring and 'pushing' are likely to engender more trust, is any a priori less reasonable. Ultimately, whether the Dean's approach or yours is correct is an empirical question (to be answered by something like surveying the students actual and potential, reviewing numbers, etc., [note, though, that under your approach it would be pretty darned hard to do this!]).

                    1. Except there is no history of black people suffering because they weren't specifically included in vaccine trials (to my knowledge, they weren't excluded, but they were underrepresented), and no evidence that having more black people in vaccine trials in the past would have changed the vaccines developed in any way.

        2. I think you are conflating two things:

          1)Is it good to test the vaccine across many demographic groups? Sure.

          2)Is it necessary to delay testing on anyone until you have a complete set of volunteers ready? Not when the delay costs thousands of lives a week.

          Let's go with your notion that GroupX is suspicious of vaccines, and won't be willing to take the vaccine until it has been tested on (just making numbers up) 1000 members of GroupX. No matter how eagerly you recruit them, though, it's going to take 10 weeks past when you have other groups recruited to assemble your 1000 volunteers (because, after all, you are positing that GroupX is uniquely distrustful of vaccines).

          So PlanA is to start testing as soon as you can, while continuing to recruit members of GroupX as fast as you can. If you do so, you will have at least some groups (and including members of GroupX that aren't vaccine skeptics) getting the vaccine much sooner, saving thousands of lives. Saving lives is good. And you aren't delaying, at all, getting it to members of GroupX either.

          As a hypothetical, let's have GroupX be members of a fictional 11th Day Adventist religion, who are hard to recruit because they have religious objections to vaccines. Are you willing to pay the price in lives to delay the vaccine for the entire country until you recruit enough 11th Day Adventists?

          n.b. that the vaccine will eventually protect even the 11th Day Adventists that never get the vaccine, via herd immunity. Delaying giving it to others hurts the Adventists, too.

          It's one thing if political correctness delays testing of a new acne drug, because acne usually isn't fatal. When the delay of a vaccine costs 18 thousand lives a week, that's a horse of a different color.

          1. What I'm arguing is this:

            It's a benefit to develop vaccines quickly, yes.

            It's also a benefit to develop vaccines in a way that ameliorates distrust in the vaccines in this case by particular groups.

            I think these are both moral weights that should be considered when developing vaccines (or any treatments, etc.,). Of course the first might outweigh the second (or the second might outweigh the first, though intuitively this seems less likely I'd admit).

            Then a separate question is, does increased representation in the development help alleviate distrust? That's ultimately an empirical one I think (and likely varying from group to group).

            1. What increases distrust is the public complaint that "we were not sufficiently represented in the trial" when there was no medical reason to delay the development of treatment or to expect that the treatment would have a disparate impact on diverse groups.

              1. So it's the fault of African-Americans for being distrustful, because they are just so ornery in thinking that what poses as cool, rational, race-blind science might not be?

                There's a long history of African-Americans being included (subjected more like it) and left out of scientific studies and trials professing to be cool, rational, race-blind science, do you acknowledge that? It's very likely that history that has people wanting today's research to take note of representation, to track and combat that.

                1. Again, you hurl an accusation based on something that I did not say.
                  I don't blame anyone for not trusting the US government.
                  No one called black americans ornery except for yourself. I have nothing to say about the history of medicine. That is not my expertise, but I'd like to hear about your expertise.
                  In any case that history is irrelevant to the development of treatment of SARS-CoV-2 infections that are of concern to people of color around the world. If I doubt that there is any medical basis for a disparate impact of the vaccines on different ethnicities,I am even more doubtful that it has to do with anyone's nationality.
                  If you are offended by such a comment, I am even more offended by your putting words in my mouth.

                  1. Whoa, I didn't realize you were so sensitive. No one is 'hurling' any 'accusation' at you, nor am I trying to put words in your mouth. I'm pointing out that you are arguing that "[w]hat increases distrust is the public complaint that “we were not sufficiently represented in the trial” when there was no medical reason to delay the development of treatment or to expect that the treatment would have a disparate impact on diverse groups," which is that the distrust is 'coming from inside the house' (so to speak, not saying your words) of the African-American community (or perhaps from 'activists' representing them), no? All I'm saying is that I think it equally or much more likely that the distrust was there all along for historical and sociological reasons and that the complaints about representations are either *results* of that or *observations* of same.

                    There's a long history of African-Americans being told they were being included, excluded or subjected to research and trials in ways that harmed them and all the while being told this was because of purely scientific reasons. Now they, with lots of good reason, are more likely to be distrustful of claims from 'purely scientific reasons' *even if the reasons are actually sound.*

                    So, you could say they would likely have a reasonable, though perhaps in this case incorrect, distrust in the vaccine. And then many of them *wouldn't take it.* And that would be a bad result for everyone no matter how fast or great the vaccine developed turned out to be.

                    1. Ah, but you have been "putting words in my mouth with your every response. Notice that I did not say that you were "oversensitive, even as I acknowledged that black americans, like many other american have many reasons not to trust the government. Yes, I did say that the line you have taken does serve to increase distrust. And that Sen Harris did more with the picture of her getting the vaccine, than anything that Moderna has done.

                      Having said all that, a much more reasonable cause for concern is the nearly total neglect of the sever reactions that could have been deadly in the UK what were averted only because the administering site had Epipens. The culprit is likely polyethylene glycol. But in the US we see no mention of that in the train of persons to administer vaccines. Therefore, I would not take the vaccine except in a clinical setting. So yes, people should not have blind trust and the public needs full information.

                    2. "And that would be a bad result for everyone no matter how fast or great the vaccine developed turned out to be."

                      I don't get that. If we vaccinated the 87% of the country that isn't black (or for that matter, 87% that is picked randomly, or the first 87% alphabetically, or ...) tomorrow, what would happen to the covid rate for the unvaccinated 13%?

                      Vaccination helps everyone, whether they get it themselves or not.

                      Eighteen thousand a week.

                2. So it’s the fault of African-Americans...

                  Your reliance on dishonest strawman arguments is sarcastr0-esque.

            2. How are you defining benefit, when you say = It’s also a benefit to develop vaccines in a way that ameliorates distrust in the vaccines in this case by particular groups.

              Is it something tangible?

              1. The benefit is that more people will take it if there's less distrust in it. That seems pretty tangible to me.

                1. It is your unfalsifiable assumption that delaying the vaccines trials would have that effect.

                  A well-developed public information campaign would have a better effect without delaying the trials

            3. "It’s also a benefit to develop vaccines in a way that ameliorates distrust in the vaccines in this case by particular groups."

              Except evidence is lacking that this way of developing vaccines does in fact ameliorate distrust.

              What happens if you delay development for this but then there is no positive impact in "trust" of the vaccine?

              1. Except evidence is lacking that this way of developing vaccines does in fact ameliorate distrust.

                Her argument depends on it being true, therefore it must be simply accepted as true...because.

  9. What caused more delay and problems in vaccines (and pandemic management in general) -- the clinical study issues Prof. Bernstein addresses, or the Trump administration's rampant failures.

    How much has this right-wing blog had to say about Republicans' botched pandemic response?

    Stand aside, clingers, and let the adults handle it from here.

    1. RAK,
      Neither of your alternatives made for any delays. In fact the money advanced up-front by the Administration was likely an accelerating factor.
      Unfortunately you are so diseased by TDS that you'd never know that.

      As for Ole WHite Joe doing better, he is setting himself up for failure by announcing a 1 million shot per day goal that would mean that the vaccination of the US will take 2 years AND when it is quite unclear that even 1 M doses per day can be administered.
      But you cling to your fantasies and the real world will spin as it does.

      1. You stick with your Trump-suckling ways, Don Nico.

        That suits you.

        Your betters will focus on a less-clingered, and therefore improved, future.

        1. You are just a broken record RAK. Cling to your BS rhetoric, calling everyone a Trumpist, a bigot etc. You are in fact the worst troll on this site and one of the worst bigots who comments.

          1. Republicans botched the pandemic response from top to bottom, causing avoidable death, misery, and economic damage. Clingers excuse this because Trump -- a petulant, overmatched, blustering boor who tailored his political persona to gullible, downscale clingers -- scratched their xenophobic, racist, stale itches.

            Ask the proprietor to censor me if you can't stand my departures from political correctness -- he has done it before, repeatedly, and I have no doubt he'd like to do it again.

            Otherwise, open wider, clinger.

            1. "Republicans botched the pandemic response from top to bottom, causing avoidable death, misery, and economic damage."
              I suppose you're speaking of Bill DeBlasio. Or maybe of Gavin Newsom, who state has now several hundred thousand more covid cases than any other state. I suppose that you have never noticed that sevral EU countries with left of center governments have had more cases and more deaths per 100k Persons than the US.

              But you never did notice those things because your closed mind clings, clings, clings, to your bitter partisanship.

              1. I'll just have to settle for stomping guys like you into political and cultural irrelevance in the culture war.

                I am content.

                1. A simpleton chewing his cud as you do would be content. CLing on to your chewing.

  10. GENETIC diversity is one thing, and the misclassification of races is relevant to that. But ETHNIC diversity is important too. Diet, exercise, sexual practices, substance-use/abuse, ....

    1. Mr Toad, those are behavioral patterns which may vary from region to region or even town to town

    2. Beyond the first or maybe second generation, ethnicity is a very weak proxy for diet, exercise, sexual practices or pretty much anything else on your list.

      A branch of my family is nearly pure scandinavian in ethnicity yet I bet only two of them have ever even tried lutefisk. My diet is closer to Korean than any place that I have actual ethnic ties to. Exercise? We're all flabby Americans in the midwest.

      Should you control for diet, exercise, substance abuse, etc? Of course. But why would you ever use a proxy when you can ask about, recruit for and test against those factors directly? Ethnic "diversity" adds nothing more to the science of biological testing than misclassified racial "diversity".

  11. Equal numbers from each group would make sense scientifically if we cared equally about the effectiveness in each group as that would provide maximum information about that. But we don't. We care more about effectiveness in larger groups than smaller ones. Being a minority has downsides, regardless of discrimination. Less effort is going to be put into fulfilling your particular needs, as there are fewer people to amortize fixed costs over.

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