# What good are clinical trials?



## Gavjenks (Mar 24, 2014)

In general scientific research, we use a confidence interval of 95%, that is, we call a relationship "significant" if we are 95% sure that the data aren't just a result of noise.

My problem I would like to talk about is that when it comes to medical outcomes, 95% is often grossly inappropriate as a responsible confidence interval, and yet clinical trials are designed around it still. Rendering them in most cases almost completely useless for actually assisting me in making good medical decisions.

*Example #1: Athlete's foot cream*
Athlete's foot is annoying, but it is a pretty minorly bad thing.
Death is a really really majorly bad thing, however. Even if there's a very tiny chance of it happening due to using the cream, I'm not going to want to use the cream for its minor benefit, right? And by "tiny chance" I mean that I expect there to be MUCH MORE confident than a p < 0.05 level that the athlete's foot cream is not going to cause, say, kidney failure. If there's even a 1/1000 chance that there exists a relationship between athlete's foot cream and sudden death, given the data, I probably would decline to use that medication.
But the problem is, _nobody has any way whatsoever of guaranteeing me that degree of certainty_. Because they don't run tens of thousands of people in foot cream clinical trials. They maybe run a few hundred usually. Enough to satisfy a power analysis that operates on a 0.05 level ONLY.

(and in case you think this is a frivolous example, ketoconazole fairly common antifungal drugs were announced last year to be pretty solidly linked to total liver and adrenal failure, and possibly birth defects, and only to be used orally as a last resort in severe deadly fungal infections, long after being released and used widely. And I didn't even KNOW that when I started writing this example half an hour ago!)

*Example #2: Flu vaccines*
Some numbers (all from the CDC) for people under 65 years of age (most of these numbers aren't known for people over 65 is why I restrict it):
% of people who get the flu when unvaccinated = roughly 15%
% of THOSE people who would have gotten the flu but don't, due to being vaccinated = roughly 60% in average seasons (i.e. in simpler terms ~40% of people it "doesn't take")
So far = roughly 9% likelihood that a given vaccine actually ends up saving you from anything
Then, the likelihood of a person with symptoms being hospitalized = roughly 0.1% (although this is only ballpark guessed by experts)
So far = roughly 0.009% likelihood that a given vaccine saves you a trip to the hospital.
Then, percent of those people who die = nobody knows. The CDC doesn't even know how many people die of the flu, not even within an order of magnitude of precision. But even the most liberal estimates would be something like 1% of hospitalized people.
So far = at most, about 0.00009% likelihood that a given vaccine will save your life. I.e. something like 1/1,000,000, (a number with truly horrible precision to it, though).

Okay, so if I want to decide whether to take a vaccine or not, I also want to know how likely a vaccine is to kill me itself. Is it higher or lower than 1/1,000,000?

Well, thanks to clinical trials for flu vaccines only involving a few hundred people, the answer is: nobody has a remotely vague idea. All they can tell you is that it is probably less than about 1/100 to kill you (likely much much lower, but that's what the data can GUARANTEE). (Note: this is all for death only, but the numbers are similarly fuzzy / almost completely unknown for any other severe complication or side effect you could name)

*So how do I make an educated decision whether it helps me more than it hurts me? I can't. I have to flip a coin. So what good is the clinical trial doing me? And why am I being told it's a great thing?*



And so on and so forth for pretty much every MINOR drug or medical procedure out there. Major procedures like heart transplants are actually much easier to make educated decisions on, because the deadly outcomes either way are so much more common, that we have plenty of data to get the precision we need. It's the minor ones that nobody has any clue about when you get down to it. 

So is it even ethical to "prescribe" such minor things, or promote them? Versus, for example, simply saying "Here are our best known odds. You have permission to get this done if you want, but you have to follow your own intuition." That would be the HONEST way...


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## Designer (Mar 25, 2014)

I just finished a book an this.

Tainted Truth - The Manipulation of fact in America by Cynthia Crossen 

The author analyzes surveys, studies, and clinical trials, and points out that we consumers and our doctors need to understand how they are produce, who paid for them and how they are affected by bias of the researchers and the drug companies (who often pay for the research).

Another thing we need to understand is the mathematics of statistics, in order to have a better grasp on the risks involved.


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## mmaria (Mar 25, 2014)

I was thinking about vaccines just yesterday.

Too bad my English is not that good to say more about the subject but I'm interested to see what others think. 

My thoughts are similar to Cynthia's (mentioned here in a nutshell by Designer, didn't read the book or anything) and being a highly sensitive person ( I'm allergic to lots of chemical ingredients in cremes, gels, medical products and else f.e.) colored my opinion on this subject


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## runnah (Mar 25, 2014)

Well take your flu vaccine example. You can't just say 1 in every 100,000 dies of the flu. If you use a sample group of healthy young people the number would be closer to 1 in a million, but if you use a sample group of elderly people you'd get a much higher ratio.


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## runnah (Mar 25, 2014)

mmaria said:


> I was thinking about vaccines just yesterday.
> 
> Too bad my English is not that good to say more about the subject but I'm interested to see what others think.
> 
> My thoughts are similar to Cynthia's (mentioned here in a nutshell by Designer, didn't read the book or anything) and being a highly sensitive person ( I'm allergic to lots of chemical ingredients in cremes, gels, medical products and else f.e.) colored my opinion on this subject




The risks greatly outweigh the harm on the vaccine issue. Google images of smallpox, measles etc... it will make you thankful for modern science.


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## kathyt (Mar 25, 2014)

Here is my thought on vaccines. It is real quick. If vaccines did not exist, then most of us would not be here right now reading my comment on TPF this very second. The end.


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## runnah (Mar 25, 2014)

kathyt said:


> Here are is thought on vaccines. It is real quick. If vaccines did not exist, then most of us would not be here right now reading my comment on TPF this very second. The end.



Well the last hot blonde that told me about vaccines said they were bad so I don't know what to think.


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## kathyt (Mar 25, 2014)

runnah said:


> kathyt said:
> 
> 
> > Here are is thought on vaccines. It is real quick. If vaccines did not exist, then most of us would not be here right now reading my comment on TPF this very second. The end.
> ...


Let ME give you your vaccines. Bend over.


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## mmaria (Mar 25, 2014)

....and the thread goes in another direction...


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## runnah (Mar 25, 2014)

mmaria said:


> ....and the thread goes in another direction...



I was being serious until you and Kathy sidetracked me. 

Anyways. Statistics are way more complicated than people assume. Like I said before saying "1 in a 100" doesn't really tell people very much. You have to ask questions about sample size, sample make up, testing procedures such as were they double blind, triple blind, and were the final results peer reviewed. More often than not clinical studies are BS and are used more as marketing speak than actual scientific study.


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## mmaria (Mar 25, 2014)

runnah said:


> mmaria said:
> 
> 
> > ....and the thread goes in another direction...
> ...


What have I done!? 

Anyways. I don't believe in statistics that is presented to us, consumers. I'll almost always and no matter in what field that research took place, assume worse regarding the data that's been showed to us. Medicine and medical products are almost the same as any other products there is when it comes to marketing and selling.


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## TreeofLifeStairs (Mar 25, 2014)

I agree that there are many clinical trials that are done with bias, but a double blind peer reviewed study does carry weight in my mind. 

Another thought is weighing the side effects. I see commercials for medications that will treat something trivial (your athletes foot example) and then they will rattle off the possible side effects at the end and the side effects will often be far worse than the original ailment. The flip side is the person that is dieing  of cancer and there is a drug that has been shown to have promise but the patient cannot take it because it hasn't been fully tested. They care very little about the side effects at that point. They just want the chance that they'll live. 

Maybe this is the point of the OP.


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## Gavjenks (Mar 25, 2014)

> I agree that there are many clinical trials that are done with bias, but a double blind peer reviewed study does carry weight in my mind.


My argument is not about bias. For purposes of this thread, I am assuming that all clinical trials are done by perfect science robots who never make methodological errors and have zero political or personal opinions, etc. etc. My argument is purely based on the extremely low numbers of participants compared to the number you would need to actually conclude the information that any normal person would be interested in / find useful for real decisions.

In short, for rare events like death or mutilation (either vaccines causing them OR vaccines preventing them), the data is so sparse that it might as well be a couple of anecdotes from your neighbors. Almost literally.



> Another thought is weighing the side effects. I see commercials for medications that will treat something trivial (your athletes foot example) and then they will rattle off the possible side effects at the end and the side effects will often be far worse than the original ailment. The flip side is the person that is dieing of cancer and there is a drug that has been shown to have promise but the patient cannot take it because it hasn't been fully tested. They care very little about the side effects at that point. They just want the chance that they'll live.
> 
> Maybe this is the point of the OP.


I'm not sure I have much of a problem with people weighing death more heavily than side effects. There's not necessarily a "right" answer to how you relatively weigh one versus another versus quality versus time, etc.

I just would want people to have more accurate numbers available to them to make their own decisions, that's all.



runnah said:


> Well take your flu vaccine example. You can't just say 1 in every 100,000 dies of the flu. If you use a sample group of healthy young people the number would be closer to 1 in a million, but if you use a sample group of elderly people you'd get a much higher ratio.


1) Nobody knows how effective the flu vaccine is on elderly people reliably. It seems to vary wildly from particular strain to strain. All they really seem to know is that in general it is some amount less effective in the elderly on average. 

2) It is a mistake to just assume that the elderly suffer more from flu by default. Swine flu in particular appears to be LESS of a risk for seniors than for middle aged adults, and the few people who absolutely died of that this year were disproportionately not senior citizens.

3) Seniors are prone to already having various complications when they get the flu, so it's really hard to even know though whether they die of the flu. If some dude is already dying of AIDS for instance, and gets the flu on a compromised immune system, and then also gets pneumonia, and then dies, how do you report that? The answer is three different people report it 3 different ways and it's a huge mess.



Bottom line: almost every step of the way, we don't have the data to conclude anything particularly strong or useful right now. For seniors we have even less data, because well there are fewer of them, and we also run even smaller studies on them, and they seem to be more variable.



> Here is my thought on vaccines. It is real quick. If vaccines did not exist, then most of us would not be here right now reading my comment on TPF this very second. The end.


The public opinion on, for example, measles immediately prior to the vaccine being introduced was NOT abject terror. People were not dropping dead in droves in the street. It was more along the lines of a typical sitcom plot device to keep a kid home from school.

This is because by the 1960's, roughly 99.9% of the death rate of measles had already been eradicated without the usage of any vaccines. Nor is this an atypical case. Presumably the vast majority of the elimination of endemic measles was because of:
-Soap and water treatment improvements
-Fever reducers / NSAIDs
-Better life support and symptom care in general
-Better hospital access in general (roads and frequency)
-Better hospital conditions and antibiotics to fight secondary infections
etc.

Vaccines clearly helped spike downward deaths after introduction, and they do certainly work, but they may well have been _redundant_, and didn't necessarily save that many people. By no means is it reasonable to say "most of us wouldn't be here." Unless maybe you're thinking of 1960 BC, not 1960 AD...




Same goes for pertussis



and scarlet fever, which is especially interesting since we now have zero deaths most years from it, and a vaccine was in fact never nationally used. (in wales, England, or the US)


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## kathyt (Mar 25, 2014)

Every single drug I give has potential side effects listed that can be as long as my arm. Usually the benefits of the drug are greater than the "potential" side effects for a doctor to prescribe the medication in the first place. The bold lettered side effects are the ones that the greatest number of patients generally report. These are the ones we care the most about, and monitor the closest. As a consumer, I would look at the pros and the cons of the medication to determine if it is truly worth the risk of the potential side effects. Just like anything else, one must do their research and determine which pathway is right for them. Sometimes medications are not always the best option, and sometimes it is the only option.


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## kathyt (Mar 25, 2014)

Gavjenks said:


> > I agree that there are many clinical trials that are done with bias, but a double blind peer reviewed study does carry weight in my mind.
> 
> 
> My argument is not about bias. For purposes of this thread, I am assuming that all clinical trials are done by perfect science robots who never make methodological errors and have zero political or personal opinions, etc. etc. My argument is purely based on the extremely low numbers of participants compared to the number you would need to actually conclude the information that any normal person would be interested in / find useful for real decisions.
> ...


Okay. Don't get vaccinated then. That is your choice, and by all means please use your data as a reference. I was just giving my opinion, and I am sure you will drag this out till kingdom come. I don't have time for that.


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## runnah (Mar 25, 2014)

Vaccines are a preventative measure designed to eliminate a disease from a herd population. Yes the US has improved greatly as far as sanitation is concern but many many countries have not. In these cases vaccines are very helpful as medical care and sanitation are very sparse.


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## limr (Mar 25, 2014)

Gavjenks said:


> 1) Nobody knows how effective the flu vaccine is on elderly people reliably. It seems to vary wildly from particular strain to strain. All they really seem to know is that in general it is some amount less effective in the elderly on average.
> 
> 2) It is a mistake to just assume that the elderly suffer more from flu by default. Swine flu in particular appears to be LESS of a risk for seniors than for middle aged adults, and the few people who absolutely died of that this year were disproportionately not senior citizens.
> 
> 3) Seniors are prone to already having various complications when they get the flu, so it's really hard to even know though whether they die of the flu. If some dude is already dying of AIDS for instance, and gets the flu on a compromised immune system, and then also gets pneumonia, and then dies, how do you report that? The answer is three different people report it 3 different ways and it's a huge mess.



My mother developed Guillain-Barre after her last flu shot a few years ago. Spent 2 weeks in the hospital and took months more at home to really recover. Had to also contend with a case of the shingles that she probably would have avoided had it not been for her weakened immune system.

Does an anecdote prove anything? Of course not. But because the anecdote is personal, it's going to affect my decisions about the risks of a certain treatment. There's fairly strong evidence that the flu shot caused the Guillain-Barre. There's some thought that it could run in families. Is it a sure thing? Far from it. But in this case, a "slight chance" is too much of a risk for me, and I plan to avoid the flu shot until someone can prove more definitively that it is a) going to help me, and b) not going to give me a different disease.

It's bad enough that the numbers can be skewed in ways that can mislead the public, but what's worse is that these skewed results are being fed to us through a fear-mongering media. It's not like the public is reading the scientific journals - some do, but the majority don't. They're reading 3 or 4 short, regurgitated paragraphs on Yahoo or MSN that give even LESS of the story, or watching it on Dr.Oz who MUST know what he's talking about because he is a doctor and he has a show, right? And he gets really really serious when he tells us stuff, right?


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## Designer (Mar 25, 2014)

kathyt said:


> Every single drug I give has potential side effects..



Just tell your patients to "rub some dirt on it".


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## Gavjenks (Mar 25, 2014)

> Okay. Don't get vaccinated then. That is your choice, and by all means please use your data as a reference. I was just giving my opinion, and I am sure you will drag this out till kingdom come. I don't have time for that.


I think you're missing my point slightly.  I don't think people should not get vaccinated, or that they should.  do get some vaccines and would give children of mine some vaccines, not sure.
My point is that we actually don't have any idea whether vaccines help more than they hurt when it comes to MAJOR outcomes like death or disability.
We don't know how likely they are to kill you (from, say, allergic reactions or whatever)
We ALSO don't know how likely they are to save your life (from normal diseases they vaccinate for)

So yeah, I mean get a vaccine, don't get a vaccine. The thread's not about vaccines. It's about general lack of data for any medical procedure, and the fact that when we decide to get anything or not get anything, we are usually simply flipping a coin or going off of pure gut instinct (or our doctors are), NOT hard data.

And my argument is that at the very least, *people should be made aware of the degree to which we actually have no idea whether various things are more likely to kill you or save your life*, so that they can make their own decisions better, based on their own intuitions. That's all.



> Vaccines are a preventative measure designed to eliminate a disease from a herd population. Yes the US has improved greatly as far as sanitation is concern but many many countries have not. In these cases vaccines are very helpful as medical care and sanitation are very sparse.


The example being used in the OP is flu vaccines. With 60% efficacy and about 1/3 of the adult population getting a vaccine any given season, the actual immune rate is only about 18% of the population.
Herd immunity doesn't kick in until generally about 85-90%+ for most diseases, according to the CDC. So herd immunity is not remotely relevant for the flu in the United States (or anywhere else). One of the reasons I chose that example in the first place, to not get bogged down in that unnecessary extra complication.


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## Designer (Mar 25, 2014)

limr; When they decide which flu virus to make a vaccine for, they are guessing.  

My doctor said "Yeah, but it is an educated guess."  

I always forego the vaccine.


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## Designer (Mar 25, 2014)

Sorry about the vaccine talk, man.


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## robbins.photo (Mar 25, 2014)

runnah said:


> kathyt said:
> 
> 
> > Here are is thought on vaccines. It is real quick. If vaccines did not exist, then most of us would not be here right now reading my comment on TPF this very second. The end.
> ...



So a hot blonde was attempting to imply to you that she had a high probability of carrying a social disease during casual conversation.  Umm, what does that tell you then Runnah?  Lol


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## Ysarex (Mar 25, 2014)

mmaria said:


> runnah said:
> 
> 
> > mmaria said:
> ...



^^ yes.

We must often live with the fact that we don't know everything -- that the information we have is incomplete. Statistical trials are a way to add additional weight to help us make as informed a decision as possible. BUT Maria is pointing out another layer of process taking place. *This other layer of process is most often the determinate process.*

When we can't know for sure but must still chose a course of action we're forced to place benefit of doubt. In other words, without certainty, do we then place benefit of doubt with the public good or with corporate profit. Do we place benefit of doubt with an individual's health and safety or with making money.

When you look at how some of these problems work themselves out through our courts the answer is clear.

Public: "We think your chemical is causing cancer in our children!"
Corporate Lawyer: "Do you have irrefutable scientific proof of that?"
Judge: "Without irrefutable scientific proof the law says I must give benefit of doubt to corporate profits. They can keep using that chemical."

That's how it works here in the good old USA. Maria, like most of the rest of us, has intuitively figured that one out. As for clinical trials, who pays for them and for what purpose?

Joe


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## Gavjenks (Mar 25, 2014)

> limr; When they decide which flu virus to make a vaccine for, they are guessing.


Also true. But even if they guess perfectly, they STILL have no idea whether the actual injection they come up with on any given year is more likely to kill you or to save your life, or whether it is more likely to hospitalize you or save you from the hospital, or more likely to give you encephalitis or save you from encephalitis, etc. etc. at the time they release it, even if it is a normal 60% effective, and even if it was the exact right strain to focus on.

Just one more layer of uncertainty you're describing piled on top of the other dozen. 

And again, vaccines are just an example it's easy to visualize and that there are numbers for.  Same is true of almost every other procedure, except that due to less media interest and tax dollars, we know even LESS about those...


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## manicmike (Mar 25, 2014)

The OP had to be one of my biggest concerns while getting my Psychology degree. I have to say, I tend to agree with everything you said in the first post gavjenks.


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## runnah (Mar 25, 2014)

Gavjenks said:


> *people should be made aware of the degree to which we actually have no idea whether various things are more likely to kill you or save your life*, so that they can make their own decisions better, based on their own intuitions. .




As a math guy you should know that it is impossible to calculate all the variables in the equation. Clinical studies are the best educated guess that can be made.

The best advice is to consult your doctor and pay attention to how your own body reacts to certain food and medicines.


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## Gavjenks (Mar 25, 2014)

runnah said:


> Gavjenks said:
> 
> 
> > *people should be made aware of the degree to which we actually have no idea whether various things are more likely to kill you or save your life*, so that they can make their own decisions better, based on their own intuitions. .
> ...



I don't mean exact numbers. Obviously we don't know those. I mean presenting people with the data that we do know. Something like this, but of course more streamlined and universally understandable (I'm drafting this in 2 minutes, whereas you would actually spend days or weeks or months making up a template and dialogue):

"Okay Mr. Patient, so there's this vaccine they made this year. Here's what we know: The data suggests that with a high degree of confidence, we can say that the vaccine has some amount less than a 1/157 chance of killing you itself. And we can also say with equally high confidence that the vaccine has some amount less than 1 1/314 chance of saving your life from the flu. To be clear, the actual numbers could be anything lower than those, and the only reason the numbers are different that I just told you is that we ran different numbers of test subjects, not that we are more sure of either relationship. It could actually be 1/50,000 to kill you and 1/70,000 to save you, or 1/70,000 to kill you and 1/50,000 to save you, or 1/1,000,000 and 1/500. Any combination below what I told you at the start."

"Now, do you want to get this vaccine or no? it's up to you given that information."


I.e.
Give people whatever thresholds we ARE 95% confident of, and don't make any other assumptions for them, and let them decide from there on their own intuitions. Then same basic thing for any other medical procedure we have any amount of data on.



> Clinical studies are the best educated guess that can be made.


They are the best source of an educated guess we have, but they aren't being USED in an educated manner or their actual results being given to patients to MAKE their own educated guesses.
Doctors aren't better at flipping coins than I am, and they almost certainly have different biases and opinions about quality vs. quantity of life and acceptable risks, etc. than I do.
Thus, *I am more qualified than a doctor to make an intuitive guess for my own medical procedure*, if you simply give me the same numbers as them.

So yes fine, run clinical trials, but only if you're actually going to use them correctly.


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## The_Traveler (Mar 25, 2014)

runnah said:


> Anyways. Statistics are way more complicated than people assume. Like I said before saying "1 in a 100" doesn't really tell people very much. You have to ask questions about sample size, sample make up, testing procedures such as were they double blind, triple blind, and were the final results peer reviewed. *More often than not clinical studies are BS and are used more as marketing speak than actual scientific study*.



I agreed with you up until then.
The bold part is a vague unprovable generalization.
Clinical studies done at any healthcare organization go through several layers of review - for every conceivable issue - before they get approved.

Some of the problems with clinical studies are getting large enough samples, randomizing samples that refelcts the population and having some certainty that the sample are similar. 

And the statistics by themselves mean nothing.
When something is 'statistically significant' (at say 95%), all that means is that, for the sample sizes tested and their standard deviations, the differences between the samples are so large that they would happen only 5% of the time by chance. - assuming that the distribution is randomly distributed in both groups - and that's a big assumption. 
It's up to the scientists to decide whether that difference is clinically significant or not.  

There's a huge amount more to it but that's not a short discussion.


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## runnah (Mar 25, 2014)

Gavjenks said:


> Doctors aren't better at flipping coins than I am, and they almost certainly have different biases and opinions about quality vs. quantity of life and acceptable risks, etc. than I do.
> Thus, *I am more qualified than a doctor to make an intuitive guess for my own medical procedure*, if you simply give me the same numbers as them.
> 
> So yes fine, run clinical trials, but only if you're actually going to use them correctly.



Now you are just being silly. Doctors have more education and experience to base their decisions on than you do with some stats. It's not just a numbers game, its a big picture thing.


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## runnah (Mar 25, 2014)

The_Traveler said:


> runnah said:
> 
> 
> > Anyways. Statistics are way more complicated than people assume. Like I said before saying "1 in a 100" doesn't really tell people very much. You have to ask questions about sample size, sample make up, testing procedures such as were they double blind, triple blind, and were the final results peer reviewed. *More often than not clinical studies are BS and are used more as marketing speak than actual scientific study*.
> ...



I should have been more specific. Clinical studies for OTC products is what I was referring to. Clinical trials for actual prescription drugs ad treatments are a different kettle of fish.


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## pixmedic (Mar 25, 2014)

I am 95% certain that 99% +/-  of the adult population (in the U.S. anyway) has a choice as to whether or not they want themselves or their children to be vaccinated. 
I think I can say with some degree of certainty, +/- 1%, that whether or not they base that decision on any significant research, or consults with multiple medical professionals, or even questioning the effectiveness-vs-risks of said vaccines is ultimately up to them.


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## Gavjenks (Mar 25, 2014)

runnah said:


> Now you are just being silly. Doctors have more education and experience to base their decisions on than you do with some stats. It's not just a numbers game, its a big picture thing.


1)
What exactly do you think doctors learn in medical school that makes them better able to decide from the same set of numbers which choice better fits my personal opinions on life outcomes?

Seriously, what part of the curriculum? My brother is a medical doctor and I'm pretty familiar with the different phases of his education, and I'm not aware of any part of medical school or residency that would make him more qualified than me on a decision like this.

In fact, my own psychology and philosophy degrees and subsequent years earning a living doing research have given me *MUCH MORE* statistics training and real world application of statistics and scientific analysis and interpretation of published studies than he got in school or in his career.

2)
Even if I wasn't a professional researcher, I would still be perfectly capable of interpreting numbers collected and presented to me in a clear way. Once it's been collected from studies and put in a tabular format, you only would need a high school education, if that, to make an informed decision from it. If you still trust doctors more and want doctors to offer their own opinion ON TOP OF giving us the raw numbers, then fine, that's okay. But I don't see any argument here for keeping the data from us. Give *both*. 

Policies that just assume every lay person is an ignorant slob who must be shielded from any critical thinking of their own decisions are inappropriate and dangerous.

3)
You're right it's not "just a numbers game." There are a bunch of non-numbers factors involved, almost all of which I know better than my doctor on.

Because there is no "best medical decision" in almost any case in any objective sense. There are always tradeoffs in intangibles. For example, chemo buying you a few extra years, but you're going to be super sick during them, is it worth it or not? There's no objective answer to that. It depends on the patient's current amount of unfinished business in life, their philosophy, how much they care about quality vs. quantity. There's NO way for the doctor to know any of those things, which constitute the majority of the decision to be made. I know myself and my preferences infinitely better.

This is equally true of vaccines and any other procedure too. In fact, it's even MORE true of something like vaccines, because death and complications are so much less likely than with chemotherapy, that we have much less data on the complications. So it's an even greater %age of gut instinct and philosophy and subjective junk. But for some reason they just aren't treated the same way. That's what is bothering me.



> I should have been more specific. Clinical studies for OTC products is what I was referring to. Clinical trials for actual prescription drugs ad treatments are a different kettle of fish.


This is an interesting distinction which is also troubling.

How do you know whether to run something as an OTC trial versus a prescription trial, if you haven't run the trial yet, and have no idea how dangerous it might be? There is yet another layer of guesswork going on at this decision point.



> It's up to the scientists to decide whether that difference is clinically significant or not.


Yes, but they don't have the training to do so. I know they don't, because nobody does, because it's mathematically / clinically / logically / in every other way *impossible *to extrapolate from data on 500 participants to make decisions about events which might be critically important even at rarities as low as 1/1,000 or 1/10,000. It simply can't be done. You need vastly more raw data.

*It's exactly like saying "Hm, I wonder how often this die will land on a 6? Let's roll it 3 times, tabulate the results, and then make a conclusion."*


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## Gavjenks (Mar 25, 2014)

> I am 95% certain that 99% +/- of the adult population (in the U.S. anyway) has a choice as to whether or not they want themselves or their children to be vaccinated.


For now, yes. Looking at the way things have been headed, I'm not so sure that will necessarily be the case 10 years from now.
I just now spent all of 15 seconds searching on google and already found this op ed piece, for example, from just two days ago, in the NYT:
Eliminate Vaccine Exemptions - NYTimes.com

Crazy stuff comes up like that more and more often, all the time recently. And yes it ebbs and flows with flu season, but there's also a clear trend over years as well.

This stuff matters! Think about the ridiculousness of potentially legally forcing people to inject chemicals into their arm _when nobody on the planet actually knows_ how likely those chemicals may or may not be to kill you or disable you, or how likely they are to save you from dying or disability!  Madness.  Also, even stuff as simple as "what if I have a proven record of severe allergic reactions to past vaccines?" "Lolnope! Gotta take it anyway, and then proceed to go into anaphylactic shock. It's for your own good."  .... Hopefully it's just some kooky op ed people, and stays there, but who knows.

Or maybe something comes out of that. And maybe it even expands outside of vaccines to random other medical treatments that strangers and/or politicians are going to decide I should have.


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## Gavjenks (Mar 25, 2014)

(Sorry triple post, didn't realize heh)

Also, in my experience, for some reason medical research tends to be way more hit and miss than psychology research. Average quality is maybe similar, but medical studies are much more either awesomely done, or complete piles of shockingly abysmal BS that seem to have been designed by middle school students.  For example, here's a vaccine article I looked at yesterday while thinking about this. It's not about anything too controversial, so it's good for this thread. Their claim is that the flu virus makes you more sociable, as maybe an evolutionary chemical adaptation or something.  Cool concept, maybe it's true, okay, great. How did they study it?

Change in human social behavior in response to... [Ann Epidemiol. 2010] - PubMed - NCBI

Turns out that:
1) "Exposure" to the flu virus was in fact just a vaccine shot (i.e. "we are lazy and cheap and partnered with our colleague at Walgreens or whatever for a quick publication rather than thinking it through at all."). Thus,
 1a) It's dead virus, not live, which totally changes your immune response details and chemical reactions, and thus doesn't tell you anything about potentially evolved natural infection strategies. Instead it can just be a random thing that happens when dead viruses are encountered from the start, but not live ones...
 1b) It's injected in arm muscle, not mucus membranes. Also totally changes the immune response details and defeats the purpose of the study.
 1c) It's a syringe with not just viruses but a bunch of other crap like aluminum and preservatives and whatnot. Maybe vaccine preservatives make you more sociable, for example? You'll never know since you failed to make any effort to isolate variables properly.

2) They didn't run any control group! The "controls" were the same people before and after their vaccine shot, not actual blind sham injection separate controls. Lol?
 2a) Maybe you get more sociable after getting any injection!
 2b) Maybe you get more sociable from exposure to fresh air during your trip to the lab and social interaction with experimenters... hurr durr.
 2c) Maybe you get more sociable when you just participated in a cool study and want to go tell all your friends, so you talk to more people after because you want to tell the story...

^*That's* the quality of probably 2/3 of the medical studies I look up. *That's* the sand foundation you're basing your trust in if you rely on doctors to interpret information and make decisions for you sight unseen, even when they DO have the statistical power they would need. Again, some studies are awesomely done, but the number that are like this one clearly implies that at least a pretty decent chunk of reviewers out there thought this was great research, and that a big chunk of consumers of the research are happy with it. Add on too few participants on top of methodologies like those, and it gets way more depressing.


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## limr (Mar 25, 2014)

Gavjenks said:


> 2) They didn't run any control group! The "controls" were the same people before and after their vaccine shot, not actual blind sham injection separate controls. Lol?
> 2a) Maybe you get more sociable after getting any injection!
> 2b) Maybe you get more sociable from exposure to fresh air during your trip to the lab and social interaction with experimenters... *hurr durr.*
> 2c) Maybe you get more sociable when you just participated in a cool study and want to go tell all your friends, so you talk to more people after because you want to tell the story...
> ...



First, a big ole facepalm at the design of that 'study.'

Second, I'm all punchy from being tired and headachy, but the 'hurr durr' somehow hit me in a way that has left me subject to uncontrollable giggles.


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## runnah (Mar 25, 2014)

Well I am glad to see that Gav knows more than a trained medical doctor. 

Arrogant much?


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## pixmedic (Mar 25, 2014)

i know that there are different strains of the flu. 
and I know that the flu vaccination is based on whatever the most prevalent strain is that season, which does not preclude you from getting another strain. 
and and I know that I got the flu shot from work last year, and a few weeks later came down with the worst case of the flu I have had in years. 
and and AND my partner, who did _*not*_ get the flu shot, managed not to catch the flu at all. 

This could entirely be coincidental. I do not know with _*any*_ degree of certainty that getting the flu shot -vs- not, and the fact that I got the flu and my partner did not, are related in any way shape of form. 

im just sayin. next flu season i may rethink getting the flu shot.


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## Gavjenks (Mar 25, 2014)

runnah said:


> Well I am glad to see that Gav knows more than a trained medical doctor.
> 
> Arrogant much?


I am essentially a trained study designer and interpreter full time (during the majority of semesters when I have had research grants and minimal teaching loads). So yes. I am better at interpreting studies than doctors who spend a comparatively tiny part of their time doing that, and who probably have 10% as much education in that specialty. I'm still also interested in the doctor's information they give me with regard to results of my blood work or whatever clinical stuff is relevant at the time, of course. But to the extent that their decision is based on LITERATURE, not clinical issues, I would prefer to take over for my own decisions on that front.

Plumbers are better at plumbing than landlords are who only fix pipes occasionally.
Particle physicists are better at particle physics than are high school science teachers who cover that curriculum as 5% of their semester.
Etc.


Also, when it comes to medical decisions about YOUR body that involve YOUR philosophical preferences, everybody always has an inherent advantage in making the right decisions for them over a doctor who is mostly a stranger usually. You know yourself and your philosophical opinions about medical care in general better than your doctor does, even if you're a dog walker. It is entirely unclear whether these advantages in self-knowledge do or do not on the whole override the advantages the doctors have over average patients in literature knowledge, when it comes to making a final decision on treatment.* BOTH should be presented to patients* so they can choose the mixture of information they will decide on:
A) The doctor's opinion
B) The raw facts that they might apply their own philosophy to in a way the doctor couldn't anticipate.

That way, if you feel like going by the doctor's opinion 100%, then you can. If the dog walker wants to go by 70% doctor, 30% their instincts about the numbers themselves, great, they can. If I want to go 50% doctor, 50% study results, then I can too. Providing the most information allows everybody the most freedom and control over their own medical care.



Note that I'm not saying people should get to decide to get MRIs just cause they feel like it, or prescribe themselves medicines. I'm only talking about information for potential NEGATIVE decisions to NOT get certain things done to your body.


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## baturn (Mar 25, 2014)

OP - you have a better chance of dieing in a fatal accident on your way home from the Dr. or pharmacy than from any of the  purchases you made there or shots you may have received. Your decisions are your own to make and if doing all that math makes it easier for you, go for it. All I get from it is an enormous headache, and I'm now off to the medicine cabinet without doing any research at all.


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## Gavjenks (Mar 25, 2014)

> Your decisions are your own to make and if doing all that math makes it easier for you, go for it.


Vaccines are a hobby and I've researched them a lot, but for most products I don't have the time to do the math.

I guess essentially what I'm suggesting is that a centralized institution of some sort collates basic data from studies, does enough of the math to provide standardized summary thresholds, and prints it on medications or on handouts for common enough procedures. *Just like the nutrition labels* required on the back of food that give you all the standardized collated math summaries for nutrient ratios, basically, but for medicine risks from known studies.

So instead of 300 million people wastefully attempting to or not bothering to do research independently, 5 guys do it once, and print it on the product, and there you go. the they check up on it once a year or whatever to update. Way more efficient, honest, useful. We already trust lay people to interpret and make decisions if they please on nutrition data, why not on clinical trial outcome data? You could even have those same standardized layout sorts of things: instead of iron and folate and riboflavin, it's cardiovascular, lungs/airways, brain, immune system, gastrointestinal, death, psychological, etc. best known odds.


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## runnah (Mar 25, 2014)

Gavjenks said:


> So instead of 300 million people wastefully attempting to or not bothering to do research independently, 5 guys do it once, and print it on the product, and there you go. the they check up on it once a year or whatever to update. Way more efficient, honest, useful. We already trust lay people to interpret and make decisions if they please on nutrition data, why not on clinical trial outcome data? You could even have those same standardized layout sorts of things: instead of iron and folate and riboflavin, it's cardiovascular, lungs/airways, brain, immune system, gastrointestinal, death, psychological, etc. best known odds.



It cannot be done. There can be no standardized side effects label because each person is different. There are too many variable that come into play in how a person reacts to vaccines, drugs or food. Sure you can do a broad list of known side effects like you hear on TV but to be specific you'd have to consult a doctor.


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## Gavjenks (Mar 25, 2014)

> There can be no standardized side effects label because each person is different.


It's based on clinical trials, the entire concept of which are testing for *population *averages, not accounting individually for each person's physiology. So yes, it can be done, and is in fact already done every single day in clinical trials. All that's needed is collating that data and printing it. And yes, of course you still need a doctor to check for drug interactions and tell you about it in the first place and make sure you aren't contraindicated, etc. etc. still need a prescription.  I would just want to present this data _alongside _their counsel. Or for OTC drugs, just in addition to the normal labels there already. Maybe also put asterisks next to condition categories especially likely to have special considerations for large groups of people (like diabetics), etc.

But roughly, something like this that I just whipped up:




If you have absolutely no data, then you just put "1" in that spot. Because you're always 95% confident that there's a lower than 1/1 chance of any side effect.  Higher numbers are more reassuring. Round everything to 1 or 2 significant digits.

For prescriptions, in large part this would be a *conversation facilitator* for most people more so than a circumvention of doctor's suggestions.


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## BrickHouse (Mar 25, 2014)

Gavjenks said:


> > Your decisions are your own to make and if doing all that math makes it easier for you, go for it.
> 
> 
> Vaccines are a hobby and I've researched them a lot, but for most products I don't have the time to do the math.
> ...



I often use something that is called a Cochrane review. It collates large amounts of GOOD quality studies and makes recommendations based on the available evidence.


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## runnah (Mar 25, 2014)

Gavjenks said:


> > There can be no standardized side effects label because each person is different.
> 
> 
> It's based on clinical trials, the entire concept of which are testing for *population *averages, not accounting individually for each person's physiology. So yes, it can be done, and is in fact already done every single day in clinical trials. All that's needed is collating that data and printing it. And yes, of course you still need a doctor to check for drug interactions and tell you about it in the first place and make sure you aren't contraindicated, etc. etc. still need a prescription.  I would just want to present this data _alongside _their counsel. Or for OTC drugs, just in addition to the normal labels there already. Maybe also put asterisks next to condition categories especially likely to have special considerations for large groups of people (like diabetics), etc.
> ...



But you are putting data on there that is nothing more than a guess. You even showed this by saying "Actual rates etc...". All this would accomplish is to scare people. 

Yes if you had 100 people, identical in every way, take product A and one died, then that would be a result. But since we all vary on a genetic and environmental level, the "1 in 100" is meaningless information. Even if the study were specific enough to say that diabetic men above 50 from Nebraska need to be wary of heart issues, you'd still don't end up with a solid result..

But at the end of the day the best way is to say, *"Side effects may include blah blah blah, please see your medical doctor before taking." *Boom that it, that is all the info you need to give people. Then it is up to the individual to ask their doctor, who knows all their medical issues, if the product is right for them.


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## Gavjenks (Mar 25, 2014)

> But you are putting data on there that is nothing more than a guess.


No, it's based on* clinical trials.
*Not random guesses...
These numbers are a direct relative to p values they already publish (it's not a p value, it is related to it fairly directly, though)

You could even go do this retroactively fairly easily.  The larger the studies they invested in, in combination with drugs that show low side effects (compared to controls!) = smaller fractions can be guaranteed at 95% confidence.

That is purely objective, very well defined, and actually quite useful.




You *SHOULD BE* scared if the numbers are low, because that means they have either barely tested the thing, or it has tons of complications reported above baseline (or worst of all, both). So if people are scared by low numbers, then that's good... that's the whole point. I *want *to scare people away from things that are dangerous or untested... and push them toward things that are widely tested and safe.  

Don't you?




Edit: if you want to give people some perspective, it's easy: just draw up the same chart for something like "driving 100 miles in your car" and a few other intuitive things, and put them up on a website linked from the label. People can go and compare to get a better sense of what the numbers mean in comparison to normal risks they undertake every day.


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## Gavjenks (Mar 25, 2014)

> But you are putting data on there that is nothing more than a guess.


Wait, do you mean "it's a guess" as in it's an estimate from the data, not a hard absolute number?

In that case, yes, it's an estimate with a degree of unsureness on either side, based on finite data. ...You know, sort of like _every other_ belief or conclusion about the facts of the universe that you or any other human has ever had since the dawn of our species.

That's just how science and knowledge works. If you require 100% accuracy before accepting or acting on things, then you're going to die of thirst in a couple days, because you'll be paralyzed from making any decisions at all about anything.


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## table1349 (Mar 25, 2014)

Personally I think that all those that have doubts about the safety of a vaccine or vaccines should definitely not take any vaccine that they are afraid of.  Frankly the human gene pool could use a little chlorine in it.


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## pixmedic (Mar 25, 2014)

gryphonslair99 said:


> Personally I think that all those that have doubts about the safety of a vaccine or vaccines should definitely not take any vaccine that they are afraid of.  Frankly the human gene pool could use a little chlorine in it.



chlorine nothing....at this point it needs some strychnine
[h=1][/h][h=1][/h]


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## table1349 (Mar 25, 2014)

pixmedic said:


> gryphonslair99 said:
> 
> 
> > Personally I think that all those that have doubts about the safety of a vaccine or vaccines should definitely not take any vaccine that they are afraid of.  Frankly the human gene pool could use a little chlorine in it.
> ...




Only because we can't get our hands on some Agent Orange.


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## manicmike (Mar 25, 2014)

gryphonslair99 said:


> Personally I think that all those that have doubts about the safety of a vaccine or vaccines should definitely not take any vaccine that they are afraid of.  Frankly the human gene pool could use a little chlorine in it.



So you suggest vaccinating against things that typically aren't life threatening like chicken pox?


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## weepete (Mar 25, 2014)

A lot of the time you are comparing apples with oranges though. 

I'd suggest a short further learning course like a PHD in Public Health Medicine if you really want to understand the subject better. :hugs:


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## table1349 (Mar 25, 2014)

Well only if you consider the following unimportant. 



       Secondary bacterial infections

       Pneumonia

       Encephalitis (inflammation of the brain)

       Cerebellar ataxia (defective muscular coordination)

       Transverse myelitis (inflammation along the spinal cord)

       Reye syndrome. This is a serious condition marked by a group of  symptoms that may affect all major systems or organs. Children with  varicella should not be given aspirin because it increases the risk of  Reye syndrome.

       Death

From John Hopkins University.

Sever complications tend to happen in Adults and those with compromised immune systems.


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## manicmike (Mar 25, 2014)

For most people, chickenpox is a mild disease.- Mayo Clinic.

I can do this all day long too.


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## manicmike (Mar 25, 2014)

Actually, no I can't. I don't have the energy to argue with people on the internet.


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## table1349 (Mar 25, 2014)

Frankly it don't matter to me, chlorine, strychnine, agent orange, it's all good.


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## skieur (Mar 25, 2014)

Apparently we should be doing much more pointed questioning of doctors and their diagnoses as well as the downsides of drugs, procedures and treatments, according to the latest medical studies.

The American Medical Association did a study of 100 men who had high PSA blood tests supposedly indicating prostrate cancer, follow up biopsies which further "confirmed" prostrate cancer and finally operations to take out the prostrate gland which was tested as well for cancer. The result was loss of urinary and bowel control and therefore loss of the quality of life for those that had the operation.

BUT only 25 out of 100 in the final test after the operation truly had cancer and only a smaller number had a form of cancer that would have actually been potentially fatal.

To put it another way and use a different quote: More men die WITH prostrate cancer than die FROM prostrate cancer.

So, I wonder, with an approximately 1 in 12 chance or less of having a deadly form of cancer, how many men would RISK their quality of life?


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## Gavjenks (Mar 26, 2014)

gryphonslair99 said:


> Well only if you consider the following unimportant.
> 
> 
> 
> ...


Yes, these things can be caused by chickenpox. All of them could also be caused by the vaccine, too, however. Which is the whole point of this thread, that you don't seem to be commenting on.
Is it rare/unlikely? Sure. So is having any of those things happen from chicken pox itself...
Rare vs. rare, not enough data or studies to know which is rare*R *= how do you rationally decide? Avoiding encephalitis from chicken pox would be stupid if the thing you use to avoid it turned out in the end to be even more likely to give you encephalitis... 

And that's assuming you even have the best numbers in front of you. If you don't, because you don't have time to research them or have the expertise, and nobody is telling you, then it's even more hopeless to rationally decide.




Again, it's like wanting to know whether some slightly weighted dice end up on "5" versus "6" more often, but the dice have only ever been rolled like 4 times in testing, and even those results are hidden from you unless you spend hours researching and have a university database subscription or similar.


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## pixmedic (Mar 26, 2014)

as riveting as this all is, I think there is probably a 95% chance that <5% of the <2% of TPF members that read through this thread will actually give >1% of a crap about all this. 

in all seriousness though, I am personally all for adding as much legitimate clinical information to all paperwork associated with drugs of _*any*_ kind. 
the more educated people are about the drugs they are taking, the better chance they have of making the best informed decision for themselves. 
that being said...people still have to make the effort to get that info, understand the implications, and they still have to have some monicker of trust in the system that produced that information.  (that is where the breakdown might occur)


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## kathyt (Mar 26, 2014)

pixmedic said:


> i know that there are different strains of the flu.
> and I know that the flu vaccination is based on whatever the most prevalent strain is that season, which does not preclude you from getting another strain.
> and and I know that I got the flu shot from work last year, and a few weeks later came down with the worst case of the flu I have had in years.
> and and AND my partner, who did _*not*_ get the flu shot, managed not to catch the flu at all.
> ...


The most popular and current form of the influenza vaccine is actually formulated to prevent multiple strands of the Flu. Not just one. From my experience, so many patients state that they got the "Flu" after getting the vaccine,  but never actually tested positive for Influenza. They just had flu-like symptoms. Big difference.


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## pixmedic (Mar 26, 2014)

kathyt said:


> pixmedic said:
> 
> 
> > i know that there are different strains of the flu.
> ...



well, I dont know since i didnt go to the doctor. 
all i do know is that it laid me out for a week, and it didnt matter to me whether it was influenza or just symptoms.


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## kathyt (Mar 26, 2014)

pixmedic said:


> kathyt said:
> 
> 
> > pixmedic said:
> ...


That is my point. The common cold can do the same thing, and can have similar symptoms.


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## pixmedic (Mar 26, 2014)

kathyt said:


> pixmedic said:
> 
> 
> > kathyt said:
> ...



Seems like that almost makes the flu vaccine a random shot in the dark. You might still get influenza,  might get something just as bad.


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## Gavjenks (Mar 26, 2014)

Regarding the flu strain argument last few posts:

The flu vaccine is roughly 85% effective at protecting you from every single strain it was made for, on average.
This number not being 100%, combined with the fact that they always miss some strains = the final number of about 60% efficacy for protecting you from the flu overall for a season.


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## BrickHouse (Mar 26, 2014)

The common viral upper respiratory infection, what people call "the flu", is not what the flu vaccine is about. True influenza infection can cause life-threatening respiratory collapse, even in the young and healthy (in fact, often in the young and healthy due to a robust immune system and something called cytokine storm). This true influenza that places people in the ICU or the morgue is what the vaccine is trying to prevent. It is an educated guess based on what the prevalent strains are circulating in Asia in the spring time (based on epidemiologic data, we know that most of our flu strains start over there and spread to us by fall). Some years it is very good (see 2 seasons ago), some years it is not (this year and only approx 60% coverage). Bottom line, when it works, it saves lives. Countless lives. For most people, the 1-2 days of feeling crappy (which is a good thing, by-the-way, it means you mounted a good immune response and have better immunity) is well-worth the risk of getting what could be a very debilitating problem.


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## Gavjenks (Mar 26, 2014)

> This true influenza that places people in the ICU or the morgue is what the vaccine is trying to prevent.


It is exactly the same virus that makes some people mildly ill and missing a couple days of work, and that kills other people. H1N1, for example, kills some (very very few people, but some) and makes other throw up a few times, and still others almost nothing. I'm not sure what you're really talking about with this language of "true" viruses versus... what? Impostor viruses? There are finite strains, they know what they are, all of them have some small chance of killing, and they simply don't have the time or resources or knowledge or sometimes ability to make a vaccine for all of them every season. Or if they do, not a fully effective one.



> Bottom line, when it works, it saves lives. Countless lives.


What data do you have to support this claim? The CDC doesn't even know how many people die of the flu within an order of magnitude of precision (seriously, it's like "I dunno, maybe 500? Maybe 5,000?"). Much less do they know how many would have died without a vaccine, in EITHER direction, because we _barely _know how effective the vaccines are at even just preventing flu, much less likelihood of saving lives. And we have equally little idea how likely vaccines are to kill you themselves.

So you have an equation you can't solve because it requires 2 parameters and we know neither of them.



Let's say, for example (purely hypotheticals, since again we don't know):
Vaccine is 1/500,000 likely to kill or debilitate you.
Taking a vaccine is 1/750,000 to save your life or prevent debilitation from the flu that you otherwise would have experienced if you didn't take it (see OP).
^
If so, then everybody in America taking vaccines would prevent 466 deaths/disabilities, but CAUSE 700 deaths/disabilities, for a net loss to the country.
Or, it could be the other way around, and cause a net gain.

We have no idea.


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## BrickHouse (Mar 26, 2014)

I'm talking about true influenza viruses versus some of the other couple hundred viruses that can cause influenza-like illnesses. Adenoviruses, parainfluenza viruses, etc etc. None of which are the Influenza A or B strains that are in the vaccine. Those mild infections are extremely rare to actually be Influenza positive when we test them.


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## Gavjenks (Mar 26, 2014)

BrickHouse said:


> I'm talking about true influenza viruses versus some of the other couple hundred viruses that can cause influenza-like illnesses. Adenoviruses, parainfluenza viruses, etc etc. None of which are the Influenza A or B strains that are in the vaccine. Those mild infections are extremely rare to actually be Influenza positive when we test them.


Okay, I see. So what does that have to do with the conversation?


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## BrickHouse (Mar 26, 2014)

The conversation was bordering on morphing into a "we don't need the flu shot" string. Just jumping in to describe why we give the flu shot. The floor is now yours.


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## Gavjenks (Mar 26, 2014)

BrickHouse said:


> The conversation was bordering on morphing into a "we don't need the flu shot" string. Just jumping in to describe why we give the flu shot. The floor is now yours.


No that is indeed exactly what I'm saying. We (MIGHT) not need the flu shot.  
Or we might. I'm saying nobody knows if we do or not.


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## BrickHouse (Mar 26, 2014)

I watch unvaccinated people, perfectly healthy as well as elderly or ill, die from it every single year. I can't even think of a time where I've had a vaccinated person die, or even be admitted, with an influenza infection. I'm sure it happens but I don't know of any. 

As a physician, all I make to you are recommendations. I recommend you get a flu shot. I recommend you have your cancer treated. I recommend you have your heart reperfused. What you do with it is your business. If you don't think the literature is there to support getting a flu shot then don't. That's all there is to it. Your body, your life. I don't lose any sleep over what you do to it.


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## Gavjenks (Mar 26, 2014)

> I can't even think of a time where I've had a vaccinated person die, or even be admitted, with an influenza infection.


I never suggested they would die _from an influenza infection._
I'm suggesting they might die from _side effects_ from their medication (the vaccine shot), that may look nothing like influenza at all. Instead it might look like "random" seemingly unrelated heart attacks, or delayed anaphylaxis, or so on and so forth. Who knows? Medicines have all kinds of crazy side effects. Many are things that you would never guess are related from just looking at one patient in an office or ER. They are things you would need *clinical trials* and population level statistics compared to controls to detect, not anecdotes.

At the end of the day, a guy (hypothetically) dying from a heart attack a week later caused by a vaccine is just as tragic as a guy dying from influenza that a vaccine would have saved him from. So if we want to judge the overall most benefit to society, we need to know the population rates of both types of outcome. Your observations confirm that one of those numbers is greater than zero, but doesn't tell us the actual population rate, and doesn't tell us anything about the other number.



> As a physician, all I make to you are recommendations. I recommend you get a flu shot. I recommend you have your cancer treated. I recommend you have your heart reperfused. What you do with it is your business. If you don't think the literature is there to support getting a flu shot then don't.


But 
1) Why are you recommending it if you don't have the opposite literature to convince you of the opposite? Given no literature either way, shouldn't you be neutral in your suggestions to people? and
2) I don't always have time to do all the lit review myself, which is why I would hope that the medical community is doing it for me and only recommending things that are well established to help me more than they hurt me. Yet every single time I do take the time to look into a specific thing (I'm talking about long term drugs, not obviously necessary stuff like trauma surgery), this never turns out to be the case...


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## BrickHouse (Mar 26, 2014)

You are exhausting.


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## kathyt (Mar 26, 2014)

BrickHouse said:


> I watch unvaccinated people, perfectly healthy as well as elderly or ill, die from it every single year. I can't even think of a time where I've had a vaccinated person die, or even be admitted, with an influenza infection. I'm sure it happens but I don't know of any.
> 
> As a physician, all I make to you are recommendations. I recommend you get a flu shot. I recommend you have your cancer treated. I recommend you have your heart reperfused. What you do with it is your business. If you don't think the literature is there to support getting a flu shot then don't. That's all there is to it. Your body, your life. I don't lose any sleep over what you do to it.


Boom!!!!! That is what I call a BrickHouse. So OP go donate all your extra time at a shelter or something, because you have waaaaaaay too much of it! Love, your nurse and your doctor.


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## Gavjenks (Mar 26, 2014)

BrickHouse said:


> You are exhausting.


I'm sorry, but I don't have a ton of sympathy for it "being too much effort" to justify life or death recommendations to patients or the community.

If you don't have the data to support it and/or the time to justify the recommendation, then that's fine. There are only so many hours in the day, I understand. _But if so, you simply shouldn't make the recommendation._ OR the industry needs to have a centralized system in place that efficiently presents all of the data in one place in a way anybody can understand, so that you can just point to that instead, like I was suggesting earlier in the thread. And I don't mean some website that just says "You should take this medicine." I mean the actual data. Just like nutrition labels do.

One way or the other, it needs to be justifiable. Otherwise I have no way of knowing which recommendations are offhanded guesses and which ones are rock solid, and it defeats the entire purpose and value of a recommendation.


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## table1349 (Mar 26, 2014)

Damn, the whole chlorine, strychnie, agent orange thing is going to be really useful for conversations around here in the hopefully near future.  :mrgreen:


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## kathyt (Mar 26, 2014)

gryphonslair99 said:


> Damn, the whole chlorine, strychnie, agent orange thing is going to be really useful for conversations around here in the hopefully near future.  :mrgreen:


Chloroform would be very useful around here. I might have some in my medicine cabinet. Let me go check.


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## BrickHouse (Mar 26, 2014)

Favorite pick up line with all my dates:  "tell me, does this napkin smell like chloroform?"


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## gsgary (Mar 26, 2014)

Last time I used atheletes foot cream it made my penis grow 2 inches to a foot but I don't use it as a rule


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## kathyt (Mar 26, 2014)

gsgary said:


> Last time I used atheletes foot cream it made my penis grow 2 inches to a foot but I don't use it as a rule


Oh gsgary, way to side track our meaningful thread here.


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## table1349 (Mar 26, 2014)

BrickHouse said:


> Favorite pick up line with all my dates:  "tell me, does this napkin smell like chloroform?"


You  sure it was a pick up line or a put down line???


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## table1349 (Mar 26, 2014)

kathyt said:


> gryphonslair99 said:
> 
> 
> > Damn, the whole chlorine, strychnie, agent orange thing is going to be really useful for conversations around here in the hopefully near future.  :mrgreen:
> ...


Make sure you have a some matches handy as well.  If your going to do a job, make sure you do it right.


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## table1349 (Mar 26, 2014)

gsgary said:


> Last time I used atheletes foot cream it made my penis grow 2 inches to a foot but I don't use it as a rule


That's not how you told it at the Pub the other night.  The other night you said that the atheletes foot cream made you grow a 2 inch penis on your foot.


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## gsgary (Mar 27, 2014)

gryphonslair99 said:


> BrickHouse said:
> 
> 
> > Favorite pick up line with all my dates:  "tell me, does this napkin smell like chloroform?"
> ...



"Get your coat you have pulled" is my best chat up line or "i like painting have you got any cracks that need filling"


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## limr (Mar 27, 2014)

gsgary said:


> gryphonslair99 said:
> 
> 
> > BrickHouse said:
> ...



Yeah, you'd pretty much be wearing the contents of my glass


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## gsgary (Mar 27, 2014)

limr said:


> Yeah, you'd pretty much be wearing the contents of my glass



JOKE


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## limr (Mar 27, 2014)

gsgary said:


> limr said:
> 
> 
> > Yeah, you'd pretty much be wearing the contents of my glass
> ...



(I know, shhhhhhh!)


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