Category: Health

A dentist friend (yes, even dentists need friends!) looked into becoming a COVID-19 vaccination center. She’s amply qualified to inject people (“so is a janitor,” says a med school professor friend). She earns her high income by serving a low-income high-risk population so it would make perfect sense for the parents of her patients to come in and get stuck.

What’s stopping her? “It costs $12,000 for the fridge and I don’t think I’d be able to get reimbursed for giving shots. I’m set up to bill for dental services and being able to bill for medical is a whole different procedure.”

(How is it possible to prosper when the patients are poor? Medicaid doesn’t pay quite as much as private dental insurance for any given procedure, but it is common for children on Medicaid to need $10,000+ in dental surgery due to candy+lack of brushing. An upper middle class child might yield a slightly higher payment for a cleaning, but that is the only revenue that can be obtained from treating the upper middle class child.)

Marketing to MassHealth (Medicaid) customers in Worcester, Maskachusetts, a city whose entire economy consists of mining poor people (medical, dental, criminal prosecution and divorce/custody/child support litigation in a magnificent brand new courthouse).

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Doctors take the Hippocratic Oath, in which they promise, depending on the version, to “do no harm”, do what will benefit their patients, and avoid “overtreatment.”

Suppose that a healthy slender 20-year-old calls up to a doctor’s office and says “By governor’s order, I am not allowed to leave my house unless you stick me with a COVID-19 vaccine.” Is it ethical for the doc to vaccinate him/her/zir/them?

A healthy slender 20-year-old is more likely to be killed in a car accident driving to/from the doctor’s office than he/she/ze/they is to be killed by COVID-19. Can the doctor ethically and consistently with the Hippocratic Oath intervene in this person’s body? Even if we had years of data proving these brand-new vaccines safe, they are unnecessary for a 20-year-old with no health conditions that would render him/her/zir/them vulnerable to COVID-19. A doctor isn’t supposed to do unnecessary things to patients.

How about the argument that sticking Patient A with a vaccine with help Patients B, C, D, and E? That’s a fine public health argument, and maybe a technician working for the state could do it, but it doesn’t seem consistent with the physician’s oath.

I asked a medical school professor friend for his thoughts on this. He couldn’t think of any other situation in which doctors apply procedures to patients for whom there is no medical benefit with the justification that others will benefit. He did not believe that vaccinating the young/healthy against COVID-19 was consistent with the Hippocratic Oath.

Readers: Are we breaking new ethical ground here? Is there an ethical problem? (If the answer is that there isn’t an ethical problem, can we start harvesting organs out of young people in order to keep old people alive? Common sense organ control tells us that young people don’t need two kidneys and a full-size liver, right?)

Ethical question #2: Is it ethical to throw out vaccine doses because you’re too lazy to post on Facebook or Twitter or call a few friends? From “CEO of Health Center Explains Why COVID Vaccine Doses Had to Be Thrown Out” (NBC Boston):

The CEO of the Brockton [Maskachusetts] Neighborhood Health Center says doses of the COVID-19 vaccine were thrown away on Christmas Eve while they were vaccinating health care workers, due to some of those workers not showing up for their inoculations.

“Since the vial is only good for six hours after we start using it, there was no way we could put it in your fridge like we do the other vaccines and just use it in the morning,” Joss said. “There was just no way to salvage the remaining doses.”

“For our staff, that vaccine is just like gold. They’re protecting it like nothing else,” said Joss. “And yet, I think, at the same time, just by the fragility of the vaccine, I think it’s probably, it’s probably going to happen here and there.”

It’s like gold, but sometimes we need to throw gold away because it is too tough to find additional humans in thinly settled eastern Maskachusetts (Brockton itself has a population of roughly 100,000 and a continuously raging coronaplague among its low-skill immigrants). (Of course, in New York “providers who knowingly administer the vaccine to individuals outside of the state’s prioritization protocols may face penalties up to $1 million, as well as revocation of all state licenses” by governor’s order, but our governor hasn’t issued any new orders since #59 on December 22 (the “emergency” declared nearly a year ago continues, but we’ve had no new orders for two weeks).)

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One of my instrument flying students recently traveled back to his native Russia and got the Sputnik V vaccine (his wife had it too and the result was two days of fever for her, no significant negative effect for him). Although the U.S.-approved Pfizer-BioNTech and Moderna vaccines are supposedly quite effective, they’re also brand new technology that has never previously been tried in humans (see, from 2018 Nature, “mRNA vaccines — a new era in vaccinology”).

What about the idea of traveling to a country where a vaccine based on more conventional adenovirus technology is available? In addition to the Russian vaccine, the Oxford/AstraZeneca product meets this definition (explanation of function in NYT).

Why not take a trip to a Mexican beach resort, for example, and pay a private clinic for a dose of the AstraZeneca product? (produced and/or packaged in Mexico) Then go back a month or two later for some more poolside margaritas, a stop at a UNESCO World Heritage site, and the second dose?

(Why not get one of these vaccines here in the U.S.? The FDA might not approve it before 100 percent of Americans are infected (roughly half are already if we use the 8X multiplier that the CDC suggests). Even if the FDA does approve it, the centrally planned distribution strategy might make a adenovirus-based vaccine impossible to obtain as a practical matter.)

Readers: Which would you rather have? A leading-edge mRNA vaccine or a slightly-more-conventional adenovirus vaccine? (or no vaccine at all?)

[A medical school professor friend: “The adenovirus vaccine is more likely to have a known side effect than the mRNA vaccine. The mRNA is much more likely to have an unknown side effect.” Why did he prefer? “I don’t want to feel bad for a day or two and the probability of a significant negative effect from the mRNA vaccine is small, so I’d rather have the mRNA vaccine. In reality, it doesn’t matter because so many Americans will have been immunized by a COVID infection by the time I get my vaccine that my actual protection will come from herd immunity.” He does work in a hospital, but seldom sees patients and therefore is not likely to get a vaccine before March.]

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Sweden, in which coronaplague was allowed to rage while the population continued sending children to school, sending adults to work, restaurants, the gym, etc., will have about the same death rate in 2020 as compared to 2010 (stats; be sure to adjust for population growth of 9.5 percent from 9.34 million in 2010 to 10.23 million today). This suggests that most of the people whose deaths were tagged to COVID-19 were, as the Swedish MD/PhDs said, on track to die from some other cause at some point in 2020. In other words, COVID-19 kills humans who are already 98-99 percent dead (watch out, Joe Biden, even if you do have a Dr. in the house).

What we’ve heard so far from the vaccine trials are the following:

• the vaccines don’t stop people from getting infected or spreading the infection to others
• the vaccines cut down on symptoms and severity of an infection

So… the vaccines might actually make an epidemic worse, in terms of the percentage of the population infected, because people who are infected won’t feel sick and therefore won’t #StayHomeSaveLives.

Maybe this would be fine if we can be sure that vaccinated people won’t die with a COVID-19 toe tag. But do the clinical trials tell us that? Did they go to nursing homes and find the sickest oldest most machine-dependent humans? Given that nursing homes are completely locked down, even if they had found such trial subjects, what could be learned from folks who, by design, are shielded from all exposure?

Let’s have a look at the Moderna FDA paperwork. Only 3 people in the vaccine group, out of 15,208 total, died during the study (approximately 3 months; see pages 17 and 18), which tells you that Moderna picked a much healthier population with a much longer life expectancy than the kinds of people who have been tagged on death with COVID-19 positive test result. (If we assume that a typical COVID-19-tagged death is among those with a life expectancy of 4 years, we would have expected at least hundreds of deaths during a similar study of vaccination among people who really need the vaccination. Note that the Swedish data suggest that 4 years is an overestimate.)

Table 6 says that 4 percent of the study participants had “two or more high risk conditions” and that 25 percent were over 65 years of age, but here in Maskachusetts before the state pulled the age-related data, the median age of a “COVID-19 death” was 82 and more than 98 percent of those had an “underlying condition.”

It is nice that a healthy out-and-about 66-year-old develops a good immune response from these injections, but does that tell us that an extremely unhealthy 82-year-old with just a year or two of life expectancy will develop a similarly good immune response?

So… is it fair to say that we can hope, but not expect, these vaccines to stop the kinds of “COVID-19 deaths” that have been Americans’ consuming obsession?

(A med school professor friend: “Good question, probably not.”)

Loosely related…

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Just as Big Pharma’s worst enemy in D.C. is on his way out, we have “Pfizer says early analysis shows its Covid-19 vaccine is more than 90% effective”. In a world where a lot of people have no goal other than avoiding COVID-19, will Pfizer shareholders now become infinitely rich?

I’m wondering if there will be so much competition in the coronaplague vaccine market that this ends up being only moderately profitable.

First, maybe it isn’t that difficult to create immunity to coronavirus. Here’s a curve of COVID-19-tagged deaths in Sweden.

After a few months of mixing in schools, workplaces, restaurants, gyms, etc., it would appear that a lot of Swedes became immune (otherwise, how to explain the drop in deaths? The Swedes didn’t change their laws or behavior after mid-March. From the IHME prophets:

If it was that easy for Sweden to build immunity, maybe most of the current vaccine candidates from all around the world will work fairly well (WHO report on 47 currently in clinical trials, which also mentions 155 in preclinical evaluation). Except in the U.S., therefore, competition should work to drive down the price.

Related:

• from September: “Trump signs new, expanded executive order to lower U.S. drug prices” (Reuters)
• from July: “Donald Trump goes to war with big pharma…” (Daily Mail)
• from July 2019: “Big Pharma won’t like Trump’s next move after rebate rule is abandoned, investors fear” (CNBC)

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