
Yes, that’s a sort of oxymoron. So let me put it this way. Put more weight on an expert’s opinion than a non-expert’s opinion. But also evaluate the soundness of the arguments used by experts; don’t accept them uncritically.
A recent article at Yahoo followed a predictable path, pointing out how a low income Florida county is full of lots of obese people who refuse to get vaccinated. The reporter has great sympathy for the overworked health care workers in their underfunded medical facilities. Then the article took a surprising turn:
On Wednesday morning, chief nurse Paige Tolley received a call from the clinic across the street, where Davis works, about rising COVID-19 cases.
“Are y’all seeing multiple daily, too?” Tolley said on the phone. “Keep sending them if y’all need to. We’ll be here.”
Tolley said cases have “really picked up in the past couple weeks,” mostly among unvaccinated people.
“I hate to see the infection rate like it is,” she said.
She and her staff print information on the vaccine from the CDC to give to patients. She encourages them, especially those with health conditions, to get vaccinated “if they think it’s the right thing to do.”
She empathizes with those who refuse. “I’m not going to push anything on anybody,” said Tolley, who hasn’t been vaccinated.
“I don’t know what the virus would do to me, I don’t know how it would affect me, because everybody’s different,” she said. “I also don’t know what the vaccine would do.”
Her coworker, risk control nurse Janna Martin, a mother of three, also hasn’t gotten a COVID-19 vaccine. She’s afraid of unforeseen fertility ramifications. While experts say such claims are unfounded, Martin said her doctor suggested she hold off. [emphasis added]
And this:
Martina said his wife, a nurse for 14 years, told him the vaccines hadn’t been studied enough. “She hasn’t taken it either.”
Those who say that I should “stay in my lane” and trust people with training in health care (something I lack), would presumably say that I should defer to the expertise of doctors and nurses. Indeed in the comment section of my two blogs I am frequently chastised for offering opinions on issues outside of my area of expertise. But while I’m not a medical professional, I don’t find the arguments used by the people quoted in the article to be at all persuasive.
I do believe that expertise is a plus, other things equal. But you also need to consider whether the expert’s reasoning process sounds persuasive. We know that even experts (including economists) are prone to making basic cognitive errors. When doctors were asked a question that required Bayesian reasoning regarding disease probabilities, many of the doctors made an elementary error.
One might argue that ordinary doctors and nurses are not the relevant “experts”, and that we should instead look to the FDA or CDC. But that approach also has its drawbacks, as government officials may feel pressured to offer not the view that they believe is most likely to be true, rather the view that can be justified based on pre-existing and possibly inappropriate criteria. Are they engaged in sound cost/benefit analysis? (I.e., for society, not for their own career.)
Tolley said she knows the pros and cons of the vaccines authorized for emergency use by the Food and Drug Administration but considers them “just experimental right now.”
She’s right! The FDA does consider it “just experimental right now”.
Here’s another case where an economist disagrees with the experts at the FDA:
Personally, I’m included to agree with Dube. That’s not because I think I know more about vaccines than the people at the FDA, rather it is because the FDA is not offering sound logical reasoning for its policy stance. I suspect that many of them privately agree with Dube, but don’t feel free to state that opinion publicly.
Recently I heard a public health expert on NPR. I don’t recall the exact details, but much of the interview consisted of the expert basically saying “Option X is almost certainly best and will likely be approved soon, but for now were are recommending option Y.” And this was not just on one specific issue; he was making this argument repeatedly in response to several of the interviewer’s questions.
READER COMMENTS
Steve
Jul 26 2021 at 4:12pm
I’ve seen people who are scared of this quoting that data about how some part of the vaccine accumulates in the ovaries. One person who passed along this data added the comment, “So it doesn’t just stay in your muscle like they say! It travels throughout the body infecting every organ.”
Did somebody EVER say that a vaccine shot stayed local in the muscle it was injected in? That’s a pretty ignorant understanding of the human body. Quite the straw man if I’ve ever seen one.
m
Jul 27 2021 at 1:09pm
“Did somebody EVER say that a vaccine shot stayed local in the muscle it was injected in? That’s a pretty ignorant understanding of the human body. Quite the straw man if I’ve ever seen one.”
Selection of vaccine delivery site is quite important for triggering an immune response of the type you want while minimizing adverse events (intravenous injection of lipid nanoparticles produced extremely bad immune reactions of the “cytokine storm” variety for example). For the mRNA vaccines, intramuscular injections with lipid nanoparticles within a specific size range are needed to maximize uptake and presentation by antigen producing cells and other cell types important for robust antibody response.
Biodistribution studies were not required for FDA EUA of any of the current covid vaccines. For moderna and Pfizer, the FDA reviewed some published reports with a gfp reporter in a similar mRNA lipid nanoparticles injected intramuscularly in mice. These studies showed that most expression was in the immediate vicinity of the injection cite, followed by the adjacent lymph node, then liver. I believe the Janssen vaccine relied on data from their ebola vaccine studies which employ the same adenovirus technology. There is some concern that expression by other cell types beyond APCs and DCs may be pathological in some contexts (ie vaccine associated thrombocytopenia), so yes biodistribution can be important for 1) proper immune activation 2) limiting cytokine activation and 3) minimizing other adverse events.
When the Japanese data leaked, showing that biodistribution studies were done but not released, I think this angered many people who felt that this was tantamount to hiding data that might have negatively impacted safety decisions (or perhaps triggered a requirement for additional studies to assess potential cytotoxicity).
MikeP
Jul 26 2021 at 5:11pm
The font of all these troubles is likely a single problem — the scientific monopoly claimed by the FDA, the CDC, et al.
When a government agency takes upon itself the mantle of scientific truth, several results are sure to arise:
Their position will be slow to come out due to bureaucracy and risk aversion
People who do not trust the government will not trust the position
The position will become politicized
These all compound each other, and politicians and agency leaders make all of them worse. If government were not involved, we would likely see better understanding both of what science really is and of the COVID vaccine risk-reward tradeoff.
What is needed is some way to facilitate actual science — i.e., the questioning of experts rather than the canonization of experts — even in the presence of such government positions. This should be the role of the media, but the media has completely forgotten their purpose here and instead has gleefully led the campaign to canonize their favorite priests and be the mouthpieces of their favorite governments.
Brian
Jul 26 2021 at 5:33pm
Mixing is not just in trials it appears to be part of the policy in Canada. CTV News in Canada reported on July 6, “NACI went further on June 17, when it said getting an mRNA vaccine after AstraZeneca was the preferred option.”
Rajat
Jul 26 2021 at 5:33pm
This is quite depressing. It’s unfortunate that the decisions and advice of agencies like the FDA are coloured by inappropriate criteria, etc, but the more subtle Dube-type issues are an order of magnitude less important than the most basic point, which is that in the US, everyone should be vaccinated with something ASAP especially those who work with sick Covid patients! It doesn’t seem like more education can directly overcome this type of problem. No matter how many years of schooling people have, they can’t seem to weigh relative risks. Another point in favour of spending less on schooling and allowing kids who wish to undertake vocational training or take jobs when they’re 15.
zeke5123
Jul 26 2021 at 9:46pm
It is far from obvious that people who already have had COVID need to be vaccinated. I’d wager people who work with COVID patients probably already have gotten COVID.
Mark Brophy
Jul 27 2021 at 6:53am
It’s far from obvious that people under 40 should be vaccinated because the virus is not dangerous to them but early signs from the experimental vaccines show that those beta stage products might be very dangerous. Similarly, people in the 40-65 age group who are not obese face no danger from the virus, either. The legitimate market for the vaccines is small so the drug makers have captured the regulatory apparatus of the government to promote their products and increase their profits.
Scott Sumner
Jul 27 2021 at 12:19pm
Rajat, Good points.
Frank
Jul 26 2021 at 5:45pm
Healthy young people have about a one in one thousand chance of dying from Covid. They have personal experience over more than a year, so their understanding of that risk is pretty good. We must accept that people have different degrees of risk aversion.
In a regime of voluntary vaccination it is best for the rest of us to pay the unvaccinated to get vaccinated if we are worried about the residual risk after being vaccinated ourselves.
Andre
Jul 26 2021 at 9:03pm
“Healthy young people have about a one in one thousand chance of dying from Covid.”
Speaking of Bayesian priors. This is off by 1.5-2 orders of magnitude, if we’re talking about everyone under 20, not just the healthy.
I ran the numbers the other day. There have been about 500 deaths in a cohort of 80 million. And odds are pretty good that most of those who died were not healthy (and they skewed closer to 0 and 20 in age).
Frank
Jul 26 2021 at 9:06pm
We merely mean different things by “young”. 🙂
Andre
Jul 27 2021 at 6:58am
🙂 Fair enough. It’s why I added the qualifier! 🙂
JFA
Jul 27 2021 at 7:36am
For those aged 18-50, the probability of dying from Covid since last March was about 1 in 5000. Some studies have shown that acquiring immunity through infection may not provide as much protection as immunity acquired through vaccination (though I think the effect size is not well estimated, so the marginal benefit of vaccine immunity over naturally-acquired immunity may be small).
But *believing* one has had Covid doesn’t seem to be a strong reason to not get vaccinated (how would you know… because you got sick? There are tons of viruses that can give you similar symptoms to covid). The probability of being hospitalized or dying due to Covid are orders of magnitude higher than from getting vaccinated (especially for health young people). Just from a self-interested point of view, it would make sense to get vaccinated. And you can also feel good in knowing that you are much less likely to spread the disease if you encounter it. This should be a large consideration for medical staff, and strangely enough the vast majority (an estimated 88% or higher) of nurses, doctors, pharmacists, and nurse practitioners and physicians assistants get the flu shot (https://www.cdc.gov/flu/professionals/healthcareworkers.htm). Why not for Covid?
zeke5123
Jul 27 2021 at 4:24pm
How funny. You have a group 18-50 and think there is a single risk ratio for that group. There is a very big difference between an 18 year old’s risk and a 50 year old’s risk.
JFA
Jul 27 2021 at 8:21pm
Since I didn’t know what Frank meant by young, I did what I could. For those in their 18-29, the probability of dying from covid since last March is around 1 in 20,000 (with the probability of being hospitalized even higher). Still a clear winner to get a vaccine. I’m guessing the doctors and nurses quoted are not in their 20s.
zeke5123
Jul 27 2021 at 9:43pm
Okay. Now let’s say you are 20 (once again 18-29 is large, though not nearly as large as 18-50). Let’s also say you are otherwise healthy (e.g., not fat, not immuno compromised). Now what is the risk? It is a lot lower than 1 out of 20K.
JFA
Jul 28 2021 at 6:17am
Sure, risks are lower for a 20-year-old than a 29-year-old, but the CDC doesn’t break down Covid deaths by single year ages. But are you also requiring the risk assessments for vaccines be based on single year ages? Or is this more of a double standard for evidential rigor. Why don’t you tell me the risk of vaccination for a perfectly healthy 20 year old and then do the adjustment for potentially unknown underlying conditions?
Here are a few considerations: the risk of death in 2019 for 20-year-olds was 77.6 per 100,000, with the leading causes as accidents, suicide, and homicide with respective rates of 31, 14.4, and 13.8 per 100,000. There were a reported 21 deaths from flu, a rate of 0.5 per 100,000 (goes up to 47 deaths from flu for those aged 29 and the risk starts increasing at around age 25 or 26). If the age structure for deaths from Covid follows that of the flu (definitely a strong assumption but an infectious respiratory virus seems like the appropriate comparison), then we would expect to see about 150 20-year-olds die of Covid. That’s on par with cancer (which comes in at #4 for leading causes of deaths for 20-year-olds), with a rate of 3.4 per 100,000 (or about 1 in 30,000)). That would be a 4% increase in the risk of death (holding all else constant). See the CDC Wonder database for all the data.
And again, this was all relating back to the post, which was discussing how medical professionals were viewing and giving advice on vaccines. Those people are not 20.
Jon Murphy
Jul 26 2021 at 6:29pm
The market for expert advice is just like any other market: the ability to say “no” is crucial.
Phil H
Jul 26 2021 at 7:48pm
While I agree that the FDA’s position is a problem, I just wanted to comment on this:
“the people at the FDA…I suspect that many of them privately agree with Dube, but don’t feel free to state that opinion publicly.”
If true, this is not a bad thing. The FDA is supposed to be a conservative organisation. Their goal is not to say what is likely to be right, or is probably correct, or even what is almost certain. Their organisational goal is to tell the public what is *known*. Obviously that means they lag behind the cutting edge of science and perhaps shouldn’t be the poster boys for science in urgent cases like Covid. But the gap between what individuals believe and what the FDA says doesn’t seem to me to indicate dysfunction.
Jon Murphy
Jul 26 2021 at 8:46pm
If they were merely an advisory body (that is to say, their EUA were standard fare) rather than the agency that decides how people are treated for medical issues, then such a conservative attitude would be ok. But given their regulatory power, which you admit is useless in times of emergency, then their conservative attitude does indicate dysfunction.
For the many people who die (or suffer needlessly) because of the FDA’s conservative attitude, I bet they’d disagree with your conclusion.
MikeP
Jul 26 2021 at 9:11pm
Their organisational goal is to tell the public what is *known*.
What was known as early as April 2020 was that an 80-year-old’s chance of dying from COVID was far greater than their chance of dying from a vaccination.
Yet the FDA made it illegal for an 80-year-old to get a vaccination.
The FDA is directly responsible for hundreds of thousands of deaths.
It may not be dysfunction when measured against certain metrics that favor conservatism. But the FDA abrogates the rights of individuals, with demonstrably disastrous consequences. The bar for not being dysfunctional must be very high indeed.
john hare
Jul 27 2021 at 3:25am
It seems you would like to change the verbiage on some of the FDA actions to reflect certain realities.
Stage one approval of a drug is called decriminalize, especially in the case of the vaccines.
Stage two approval is to offer limited press release type support with caveats.
Several stages later is government financial support.
Scott Sumner
Jul 27 2021 at 12:24pm
MikeP, You said:
“What was known as early as April 2020 was that an 80-year-old’s chance of dying from COVID was far greater than their chance of dying from a vaccination.
Yet the FDA made it illegal for an 80-year-old to get a vaccination.
The FDA is directly responsible for hundreds of thousands of deaths.”
Most people would be shocked by this, but there’s some truth in what you say. Particularly if you replace “FDA” with “government medical regulatory apparatus”, including our dysfunctional tort system.
MikeP
Jul 27 2021 at 2:40pm
Yes, your broader base of blame is good.
Back in the summer of 2020 I was blaming “the FDA, or at least Congress and the Food and Drug Act,” because I did not know how much the FDA’s hands were tied.
But then the FDA issued Emergency Use Authorizations, tailored very specifically, notably by age, and I realized they could have been letting doctors and patients in high risk categories use the vaccine all along — and collecting that data too for their use and others’.
So simple for a reasonable FDA: There are clearly people who could benefit greatly from this new treatment. While we investigate its safety and efficacy, we need to allow those at risk to avail themselves of it and add their experiences to our investigation.
BC
Jul 27 2021 at 1:49am
It’s not so much that the FDA’s job is to “tell the public what is known”. After all, that a given treatment is likely, but not certain, to be best is part of “what is known”. Rather, as a government body, the FDA must follow certain processes and procedures. Government’s sole (or even main) purpose is not to disseminate knowledge. Government processes are also designed to avoid abuse of power, provide institutional consistency (get roughly similar results regardless of which specific people are in charge), allow for many voices and inputs, provide checks and balances, etc. For example, a judge in a criminal trial can’t just blurt out that he thinks the defendant is guilty even if the judge sincerely believes that to be the case based on evidence presented; the defendant is entitled to due process.
But, that supports Scott’s point. FDA officials cannot just give real time updates of their opinions about various vaccine regimens given their expertise and the available scientific evidence. They are constrained by their institutional roles. Further, those institutional constraints are there for a reason. In turn, that means that the best expert scientific opinions can arise elsewhere.
Frank
Jul 26 2021 at 9:50pm
“Trust but verify” was said by Ronald Reagan.
“Trust is good, but control is better” was said by Joseph Stalin.
Alan Goldhammer
Jul 27 2021 at 9:55am
Leaving politics and conspiracy theories aside, the FDA has one basic job to do which is to evaluate a vaccine for safety and efficacy. It is not their job to make pronouncements on vaccine policy, that’s the job of others such as the CDC and political leaders.
Most of the comments I’ve read above reflect little or no understanding of what goes into a regulatory review. Most of the public is totally unaware that there already have been large safety studies on vaccines finished and still ongoing. Adverse reactions to vaccines are constantly reported to the VAERs system and those of us who have done pharmacoepidemiology for a living know about this and how to access data.
Wacko information is spewed forth with great regularity and is difficult to counter which is why you see stupid statements from those who should know better. Had this type of behavior existed in the 1950s, we would not have conquered polio (and even then there was a massive failure of contamination by one vaccine manufacturer which didn’t seem to impact the take up of vaccine by Americans).
The libertarian approach that ‘it’s my choice to be vaxxed’ is a failure to think about how this virus can be controlled.
I will respond directly to this one bizarre comment from Mike P (I hope this isn’t former VP Pence):
There was no vaccine available in April 2020! Trials had just started and it was not clear that a totally new vaccine platform would work or be safe.
zeke5123
Jul 27 2021 at 9:53pm
Let’s just read what you wrote:
Emphasis added.
Now, let’s read what MikeP wrote (that you quoted!):
So, MikeP makes the elementary (but important) point that there was a vaccine that was created by April 2020 and that given the rate of death amongst the old it may be reasonable to allow the old to use the untested but promising vaccine.
Your incredulous response is that “no vaccine was available.” But that statement is only true if you think like a bureaucrat. Your statement would be actually true (not just true in bureaucrat land) if you added one word to your sentence: “legally.” That is, “no vaccine was legally available.” The fact that you think telling Mike P that “no vaccine was available” was some kind of winning argument misunderstands entirely Mike P’s point; he thinks there shouldn’t have been a legal restriction to the vaccine that had been created (i.e., that was physically available) for the very old because the rewards outweighed the risk.
Nothing in your posts argues with the merit of Mike P’s position (i.e., given the death rate for the very old the risk was worth the reward) yet you still call his position bizarre and then make “captain obvious” statements.
Michael Rulle
Jul 27 2021 at 10:00am
Statistics are not required in schools. Statistics are often counterintuitive. But a person of average intelligence can learn its basic logic. But like with much math, we focus more on formulas and getting the specific answers, when for the normal person it is better to teach how to understand the issues.
A friend of mine has two masters—-one in physics and one in Mathematics. Straight A from Columbia. He told me that about a year after he graduated he discovered that the sine of a triangle was simply a ratio of (hypotenuse to opposite?) —-the point being he did not know it was a ratio of two sides of a triangle.
This angered him so much he started a tutoring business—-his point was he was taught the mechanics of calculation rather than understanding.
Ken P
Jul 27 2021 at 11:26pm
Michael, I like your example. I’ve used the definition of sine or the a^2 + b^2 = c^2 hundreds of times in my life for practical reasons. What length board I’m going to need for something I can’t measure at the moment, designing rafters for a shed.
Floccina
Jul 27 2021 at 5:00pm
Should Government and insurance companies refuse to pay for unvaccinated people hospitalized due to covid?
Yaakov
Jul 27 2021 at 5:47pm
Of course. Insurance companies should also not pay expenses for people who were in a car accident due to speeding, or that got injured due to not using a seat belt. Payment should only be offered after the injured proves, beyond any doubt that they were at no fault to the occurance of the injury.
robc
Jul 27 2021 at 6:38pm
Actually, it depends what the terms of the contract are.
Insurance companies should be allowed to offer both types. One policy type would be way more expensive.
Jens
Jul 28 2021 at 9:35am
Robc is right when he points out that there could be different types of contracts with different conditions.
I also think the phrase “beyond any doubt” is relatively strong. Most contracts will imply rules on the burden of proof that have some relation to the expectations and probabilities of usual cases in the field. Proof “beyond any doubt” can be very, very difficult, even with facts and processes that are actually very simple (e.g. “beyond reasonable doubt” is a different phrase).
In addition, to decide questions of legal proofs – even with completely free contractual partners – the service of a free and independent jurisdiction is necessary (One could imagine that there are contractual constellations in which both parties only pay and comply completely voluntarily. But I do not know that there is such a thing in insurance constellations. In the event of a claim, the insured person is usually in a more difficult situation than the insurer in the event of a premium loss, especially if there is also no enforceable obligation to settle claims).
And what is also another topic: In traffic accidents it happens relatively often that there are several causers and it is not at all clear who is responsible for what share of the blame. One was driving too fast, the other was a little drunk. This can then – together with completely individual contract designs – become quite confusing (and also expensive).
To come back to the Corona issue again .. Who should pay if someone who has been vaccinated infects an immunosuppressed person that goes to ER? (possibly also in cases in which this cannot be determined)
Ken P
Jul 27 2021 at 11:54pm
I have no problem with you making biological arguments, Scott. I’m not really impressed with credentialism and it’s easy to game. Scientists often don’t agree so if you want to lean on an expert it is easy to find one that confirms what you want to believe.
My opinion on vaccine hesitancy is that institutional trust is at an extreme low and guides decisions of groups that trust institutions the least. The J&J pause was meant to signal caution but it actually signaled lack of confidence. But also, people know their risk to some extent which is why more older people got vaccinated than younger people. Based on the low death rate in the face of a high case rate, I would say people are probably close to estimating their risk.
I think we would have had a higher vaccination rate a year ago had the FDA approved the vaccine then. As others have said, earlier approval would have saved a lot of lives.
Scott Sumner
Jul 28 2021 at 1:46am
You said: “Based on the low death rate in the face of a high case rate, I would say people are probably close to estimating their risk.”
Low? Almost 2000 Americans died of Covid in just the past week. Almost all cases were easily preventable. Not sure what you would consider a high death rate. (Next weeks figures will be even higher.)
And of course the cost of Covid goes far beyond just deaths.
I agree that earlier FDA approval would have been better. No FDA regulation at all would have been even better.
Zeke5123
Jul 28 2021 at 8:16am
Loose language. We have no clue how many people died of covid; instead we know how many died with covid (assuming the cycle was set properly).
Given some data coming out of the UK (while acknowledging different background vaccination statuses) it wouldn’t be surprising if many people are being hospitalized for reason X and then contracting covid in the hospital.
Scott Sumner
Jul 28 2021 at 11:36am
“We have no clue how many people died of covid”
Sorry, but this is just being silly.
zeke5123
Jul 28 2021 at 2:31pm
Pithy response lacking in substance.
You might not be familiar but data out of the UK suggests more than half of the recent COVID cases were developed in the hospital. The fact that these people were already in the hospital suggests that they were already in a not great space and it is unclear whether COVID did anything to cause the death.
Are you suggesting that the you think the vast majority of recorded COVID deaths are caused by COVID? Or that it is impossible to know and so just make the assumption?
Kenneth P
Jul 29 2021 at 9:35pm
Deaths are the lowest they’ve been since the pandemic began despite having highest case load since May. Out of 2,000 deaths 20 would have been vaccinated and those 2,000 deaths are 4% of all cause deaths.
Personally, I don’t think insinuating people as irresponsible, idiots, etc. is going to encourage them to trot down to the pharmacy to admit they aren’t vaccinated. I know that you aren’t saying that, but that is the way it is being framed in press and I think it reduces vaccination rates.
I agree with you that no regulation would have been even better.
Philo
Jul 28 2021 at 12:08pm
“I suspect that many of them [people at the FDA] privately agree with Dube, but don’t feel free to state that opinion publicly.” That is not exactly conspiracy theorizing on your part, but it is something similar. Yet, it is quite reasonable: even genuine conspiracy theorizing cannot be dismissed out of hand (at least, not simply on the grounds that it is conspiracy theorizing).
I suppose it has always been challenging to make one’s broad-scale empirical judgments rationally, but the challenge has been highlighted by the rise of social media (including Econlog).
Michael Sandifer
Jul 29 2021 at 11:49pm
Nurses don’t actually practice medicine, unless they’re nurse practitioners. They aren’t medical experts. They’re technicians/caregivers. AS degrees don’t provide much in the way of understanding immunology, for example.
Comments are closed.