Boosting Josh Marshall
Josh Marshall has a good post about Covid 19 boosters. His site www.talkingpointsmemo.com is the other site for which I pay actual money. Unfortunately, I see the good post is for subscribers (like me) only, so I will just have to show my respect by free using the hell out of it.
Josh wants a Covid 19 booster shot and he doesn’t think that the experts who won’t let him have one are basing their decision on actual expertise as opposed to shared customs, norms, and standard operating procedures which are typical of all organizations including the FDA and the CDC and which are not science.
I agree so so much. I will now free use three paragraphs
and
I agree entirely that we should and must distinguish between actual expertise and the “penumbra” around expertise. Like all communities, communities of scientific experts develop customs, norms and traditions. Those are not science — here the question is “what are vaccines for?” Exactly as Marshall explains, proposed answers to that question are not scientific hypotheses with testable predictions. They are value judgments on which no one is or can be more expert than anyone else (and that goes for you too Pope Francis, and at least you seem to accept it unlike Benedict may he continue to be benedetto with no self awareness at all).
I do have one quibble (of course). Marshall does not quote any “public health officials, doctors and epidemiologists” . He also doesn’t distinguish between public health officials on the one hand and doctors and epidemiologists on the other. I want to distinguish between legal authority and expertise. Fortunately, since January 20 2021, the people with authority to judge vaccines are actual medical experts who are not improperly over-ruled by political appointees. However, they are not the whole scientific community and their decisions are not necessarily the scientific consensus. “Respect the science” and “respect the FDA and the CDC” are different statements . I agree with both, but respect for law in general and the belief that the Pure Food and Drug Act is a good law do not add up to making the decisions of the FDA identical to the science.
Here I think one of the habits of thought of biomedical researchers include “Never mess with the FDA. Ever. If you do, they will shut you down.” This is recognition of the power of the FDA, and the fact that there is no higher court of appeal if they say no. I don’t know all that many biomedical researchers, but I have never ever heard one take the name of the FDA in vain. This is a rational response to the power relationships, but it is not science.
Another issue is that having followed the “standard of care” is a valid defence against medical malpractice suits. As a result, written standards were established in the 1970s during the first wave of medical malpractice lawsuits. Establish an official standard and follow it is a rational response to the risk of malpractice liability. It is not science and it is not even arguably in the interests of patients who are doomed to horrible deaths if provided with standard care (note I am not thinking of Covid 19). There is no scientific or ethical defence of the extreme (small c) conservative bias of MDs.
This helps explain why they are reluctant to change their advice due to the delta variant and also unwilling to say that they don’t know what non doctors should choose to do. An agreement on a standard of care is a legal defence — their admitting that they don’t know enables juries to decide that they know better and impose damages.
At my age even “mild” covid is “serious”.
I don’t want to be sick even for a day. One less “good day” of the remaining that I have left.
Goes down to ~80 (which is normal), booster kicks it back up to ~96. Six months later, repeat.
Pfizer, with a little help from Israel, is making a fortune. Josh isn’t that old (~52)
Considering that large swathes of Africa have vaccination rates in the single digits, the concern of “global one percenters” over the risk of a flu-like bout of COVID strikes me as small minded. Moreover, given the origin of the delta variant, it’s irrational to believe that the risk of a healthy double synthRNA vaxxed USAnian is greater than the risk of a new variant emerging due to the unwillingness of wealthy nations to vaccinate poor people with the best available vaccines.
I agree (and Josh Marshall agrees) that getting one shot in everyone is more important than getting a third shot in, well, people like me (age 61 no known risk factors except I way a bit more than I would like to weigh).
He discussed that in the posts I free used, but I was interested in the part about what is expertise and what is science.
” . . . I have never ever heard one take the name of the FDA in vain.”
My wife is a faculty in one of the top oncology divisions in the nation. She deals with the FDA a lot, and she takes the name of the FDA in vain all the time. Just not to their face.
“I agree entirely that we should and must distinguish between actual expertise and the “penumbra” around expertise.”
It has become fashionable in certain circles, including certain commenters on the AB threads, to sneer at experts and expertise. Of course, those who do so only confess to their own emotional insecurities. In the real world, people pay dearly for expertise. I know this from personal experience. Real experts know the limits of their expertise.
It is true that certain “experts” are branded as experts for political reasons. Scott Atlas is an MD, but a radiologist with no expertise in infectious disease. Rand “Aqua Buddha” Paul is an MD, but a self-accredited ophthalmologist with no expertise in infectious disease. They are denominated as “experts” by the media who also lack any expertise.
As an industrialized society in the 21st century, we must make decisions based on expertise. Nobody questions the expertise of engineers who design roads, bridges, cars, airplanes. But apparently any clown who can log into FB or a blog comment thread can deride expertise if it doesn’t conform to their personal views, even when it involves human lives. Sad.
Joel
the only person i know who thinks someone here on AB sneers at real expertise is you. Let us be a little honest here: it was your “fe-fe’s” that got hurt when I tried to suggest to you that your expertise…whatever it is in…is not any more valid in morality and politics than mine, say, or any other person. After that your anger kept you from even reading what I said when I was agreeing with you.
I entirely agree (as far as I can tell) with Waldmann here. except that he seems willing to replace unquestioning acceptance of “expert” opinion, outside its own field, with unquestioning acceptance that “the government” should decide these things.
fine, if we could trust the government to respect human rights. the insane Right uses normal human fear of excess government to sell a program not to limit government power over individuals, but in fact to increase it so long as that power remains in the hands of themselves…or at least does not limit their (the insane Right) power to cut their own taxes, keep wages low, and prevent “the people” from enacting and enforcing laws to protect themselves from the insane rich.
The answer to this is to avoid insulting and threatening the people who have been seduced by the insane right, and present what rational arguments we can for the policies we beleive in…taking into explicit consideration the real fears that people have, and the real danger to ourselves of just trampling over them because of hysterical fears of our own.
I did not explain my view well. I respect scientific expertise. I accept that it is better to have an FDA than to not have an FDA.
I do not *always* question *everything* that the FDA does. I am not even aware of everything that the FDA does. I do question FDA policies, approaches, standard practices and their general attitude.
I condemn the FDA here
I question the FDA here
https://www.bradford-delong.com/2005/05/robert_waldmann.html
“ I think that it is important to get the FDA out of the way (by executive order if necessary).”
I meant to say that the FDA is not science and that my respect for science does not cause me to respect the FDA.
I also said I think it is better to have an FDA than to abolish all regulation of pharmaceuticals. Deciding that creating an government regulatory agency was the least bad option doesn’t mean deciding not to question what they do.
@Coberly
LOL! You lied about me repeatedly. You are not man enough to admit it and apologize. Shame on you.
tell you what, Joel, I am not man enough to waste my time talking to you. but I am as easily baited as the next guy. I’ll try to do better next time.
The public may have only recently become aware that the Covid-19 vaccines only reduce the severity of the disease but that information was available from the time the phase 3 trials began. How many even used positive tests as a criteria as opposed to symptoms – multiple symptoms that would not catch asymptomatic illness or even the very mildest cases? Not that it matters when the subject is what the public thinks.
When billions still don’t have access to vaccines I find the ethics of boosters for all troubling. What is the relative danger to us from allowing immunity to wane in a subset of the vaccinated population here compared to having a large percentage of the world population totally unvaccinated? It is not so much ignoring the fact that boosters are necessary as prioritizing getting the world vaccinated. It may be expertise and shared norms that are making the decision, not either-or.
I would like to think that we could have both – fully vaccinated poorer countries and boosters for all here, but that will be year after next, most likely.
I agree (and Josh Marshall agrees) that getting one shot in everyone is more important than getting a third shot in, well, people like me (age 61 no known risk factors except I way a bit more than I would like to weigh).
He discussed that in the posts I free used, but I was interested in the part about what is expertise and what is science.
On ethics it is clear that we have a duty to share the vaccine.
also on rational self interest we would benefit more from preventing the evolution of new variants than from preventing all breakthrough infections.
so, like you (and Marshall) I agree that the top priority should be to get the vaccine to everyone, and my booster sure can weight.
Jane E
I think i agree with you about rest of the world vs “3rd shot against mild disease” at least for now, subject to further thought and experience.
don’t know what “mild disease” means over a lifetime. don’t know what it means to rate of infection from vaccinated to unvaccinated. don’t know how it affects ultimate “herd immunity,” don’t what it matters to a population that won’t wear a mask in a crowd or avoid crowds.
but i am fairly sure leaving the rest of the world unvaccinated will give the virus all the time it needs to mutate and spread back to us in a more dangerous form. still, i am not ready to go to war to force everybody in india and africa, not to say America, to get the shot but not . good policy to “encourage” immunization, even by moderate coercion (if you are not vaccinated you can’t play at our house), but not good policy to even talk about “forcing” people to get the shot. gives the insane Right the right to say, “see, we told you so.”
Waldmann
if any of that was addressed to me, I am pretty sure I agree with you. I don’t know anything about the ins and outs of the FDA or CDC, but what you say makes sense according to my first principles.