The very concept of merit has been destroyed and replaced with judgement calls on celebrity (necessary for leadership role) and subservience to the political whims of the last 15 minutes (and you had better switch in the next 15 minutes or you're out).
Lab leak theory was dismissed and actively suppressed. Inflated claims were made a priori about absolute vaccine efficacy that any responsible researcher who have not made.
Moreover, the trouble with trying to shut down real disinformation, eg claims that vaccines were more dangerous than the virus, is that many people will view any sort of paternalistic behavior by the government, especially around speech, with suspicion. ("Why do they care so much about what I say? They must be hiding something")
In the age of social media, I think the study of public health needs to consider more seriously the effects of viral psychology. The irrationality and stubbornness of people needs to be expected when planning public policy.
From my perspective, it’s hysteria borne out of the difference in requirements for urban health policy vs. rural health policy, and the fact that rural people quite often travel through urban areas (e.g. airports).
Talk to anyone from Wyoming and ask what Covid was like during the worst days, and then talk to an ER doctor who worked in New York City.
Cynically, I want to blame it on the absurd lack of empathy of rural Americans and a complete lack of ability to imagine day-to-day lifestyles that do not match their own.
Were there a few scandals? For sure, I will not deny that. But I have the distinct urge to invent time travel for the hemmers, hawers, and devil’s advocates and transport them to New York Presbyterian in April of 2020.
Edit: I also have to credit rightwing media, of course, for capitalizing on the opportunity to manufacture a wedge issue that every American had an armchair opinion of. Chicken and egg, of course, but media ghouls will be media ghouls.
So if someone says they oppose paternalism in public health and yet supports the Trump administration's public health efforts, I'm not sure how to avoid the conclusion that they're lying.
> The very concept of merit has been destroyed ...
It's the subversion of truth. I think that way of saying it is more accurate, addresses the consequences, and is less occluded by jargon: People care about truth; 'scientific expertise' may seem esoteric to most people.
I think HN is frequently part of that process: Merit - expertise, actual trials and evidence - is replaced both by sensational too-clever hot takes / takedowns, and by political/social advocacy.
Most threads begin with a takedown, a 2 minute drive-by from an amatuer, often of years of research by someone spending their life studying the matter. For some issues, we all know what side many will take before you know any facts or evidence.
These comments are normalized and given greater credibility than the OP and than valuable comments. How is that any different than the things we criticize (other than the FDA's subversion of truth [EDIT:] is far more consequential [sorry, I didn't finish that sentence!])
There are valuable comments to be found; maybe that's one difference, but I'm wonder how the signal-to-noise compares with other forums.
Very different. Decisions with enormous health implications, enormous financial implications, are made at FDA.
At HN, most people are here to learn, here to understand more.
Vinay Prasad is a fraud, completely unfit for the leadership role he was placed into, making baffling and arbitrary decisions on his own, overturning those with far more experience, knowledge and expertise.
If a HN comment gets things wrong, a few people might be misinformed, if they are credulous enough to not double check things.
When the FDA makes decisions like they have been making, thousands to millions of peoples' lives are worse off, and billions in capital is wasted.
Discussion forums of all sorts are incredibly valuable, even when they get things wrong. I have lots of complaints about the overhyping of, say, CRISPR, especially on HN, but whatever, it's a far far higher signal-to-noise than a random person I meet around town. Mention you work on drug development for big pharma to the random person and they think you're evil, at least HN is less likely to have that basic misconception.
What’s with him being allowed to continue to practice at the University of California [1]?
this is how Martin Shkreli described his work of identifying drug patents to buy that he could jack up the prices on. If that's the extent of the description you gave, I think random people would be right to first think you are doing something evil
That should be their primary objective.
Yes, I started writing that and didn't finish the sentence (see my edit near the end of the GP).
But I don't let HN off the hook: The attitude I described in the GP represents and perpetrates the same outlook that politically supports or tolerates this behavior from the FDA. HN users generally legitimize that approach rather than discrediting it.
> Mention you work on drug development for big pharma to the random person and they think you're evil
I think that's paranoid: The random person won't know what that means. Few who know will also know or care about the social implications. Of those who do, only some will be knee-jerk critical of big pharma, and fewer still of research rather than the business side. It's also a victim perspective: Big Pharma has enormous power; punching up at power by questioning, criticizing, and being skeptical (or even cynical) is not at all the same thing as punching down at the vulnerable. If someone wants the power and resources and salary of Big Pharma, benefitting from its enormous power, the pushback and reputation impact comes with it (though the latter is usually positive - great resume material and credibility).
There's a substantial "learn and understand" cohort, but there are other factions. At the start of the pandemic, there were 2 posters explicitly here to proselytize Trump style conservatism. I'm reasonably certain there was an anti-vaxx voting ring 2020-22, and I suspect there's remnant Elon fanboy and MAGA coordinated voting.
I'd love to be proved wrong on these things.
Be specific?
(I have complaints - I thought Dr. Meissner was wrongheaded about opposing allowing EUA to extend to pediatric populations. But the committee as a whole functioned well and balanced the urgency of the situation with the need for voluminous data.)
I’m so curious how someone goes from being a professor to a science denier? I simply can’t imagine that journey.
These people are all delusional ideologues. If reality does not match the ideology, reality must be wrong.
* it was a Trump political appointee who had made a “shocking” decision to not even review the vaccine
* it was despite the objections of the subject matter experts and career scientists
* it was despite the submitted study results being exactly what the FDA had previously approved
* the vote to go the opposite direction of him was unanimous
I mean sure, you could find an odd scientist who doesn't believe in something that 99.999% of scientists agree on, appoint them as the political head of an agency to overrule the 99.999% of scientists, and call that a “difference of opinion between scientists”, but…
They'll just ban it again. Science got a temporary victory but I predict it won't matter.
This guy is a disaster. But really it's not just him. It's the entire organizational structure that puts him, or any other one person, in the position that they have the power to do this. There is simply no one qualified.
We need to have expert scientists to set up trials and review the design of the trials and conduct the analysis of the data. This is something that is generally objective and not able to be done without skills and experience. But then you have to make a decision based on those results. And the decision is some sort of risk reward trade off. While science can quantify what that tradeoff is, which path to take is fundamentally outside of the scope of science.
Trade offs are not objective determinations at all because they are based on subjective preferences. And therefore it makes no sense to force it into a one size fits all approval or denial by some centralized body. The only rational approach to such a trade off is to allow each individual to choose for themselves. The only person's opinion on whether the risk justifies the reward for the experimental Huntington's disease treatment is the patient's. The best we can do with science is to use it for its intended purpose to produce good data for him to make his choice.
In the United States, pharma companies make money when insurance companies (and the government, but less so than in many other nations) buy their product to give to patients. In practice, very few people are paying for vaccines out of pocket.
Insurance companies in particular hate, hate, hate giving anybody money for any reason. They will not pay for something unless you beat them over the head with how well it works. And if they don't believe you, they'll do their own analyses. Better to blow a few million on a study than spend a few billion on unnecessary treatments. (This is the same reason that there's a car-insurance funded highway safety institute crash-testing cars.)
And yet, every year, they insist on making the flu and COVID vaccines free and pushing it on as many people as possible! I guarantee you if you call your insurance company and ask if they think you should get a flu or COVID vaccine, or any vaccine, really, they'll say, yes please.
Why would they do that if these vaccines were going to cost them money by a) being useless or b) being harmful? There is simply no incentive!
The reason everybody wants you to get the damn shot is that the shots work, and the downside risks of them are smaller and cheaper than the downside risks of the things they prevent. Capitalism would make it very difficult to repeatedly sell vaccines that don't work, or hurt you; you might get away with it once, but after that, the reward's just not there.
I don't know how one responds to that, if one distrusts vaccines, other than to suggest a much larger and more complex evil conspiracy than is plausible to most people.
This article has no data about why mRNA flu vaccines will improve these outcomes, and has no data about the risk/benefit ratio or how it was calculated. It doesn't even cite the "studies" it mentions. It's a remarkably bad article written for low information readers by a low information author.
Hard pass until I see some hard data.
Here's the top-line comparison:
Healthcare encounter:
new: 80 (0.4)
existing: 120 (0.6)
Each group had roughly 20k participants, mostly white.
No actual control group, no independent third party study. Junk.
