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Mini: Placebo Controls for Vaccines · Why We Do What We Do

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  Speaker 1: You're listening to Why we do what we do? Welcome
• 0:15
  Speaker 1: to why we do what we do. I am your host, Abraham,
• 0:19
  Speaker 1: and I'm your Shane, and I should have said why
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  Speaker 1: we do what we do? MANI, because this is a
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  Speaker 1: small episode, and by small I mean short, fun size,
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  Speaker 1: require a huge deep dive, although in most of these
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  Speaker 1: could do a big, like thorough investigative expose on it,
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  Speaker 1: that we feel like we can manage in like ten
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  Speaker 1: to fifteen minutes and then let you go about your day.
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  Speaker 2: Yes, and so today we are going to talk about
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  Speaker 2: placebo controls, but specifically in the context of vaccines. And
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  Speaker 2: we were talking about vaccines because apparently we're having another
• 0:55
  Speaker 2: debate about weather vaccines cause autism and all that nonsense.
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  Speaker 2: I'm so tired of saying the word vaccine having to
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  Speaker 2: justify y vaccines are important to people.
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  Speaker 1: Yeah, and it's kind of silly. So anyway, we are
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  Speaker 1: I'll talk more about that at the end of this discussion.
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  Speaker 1: If you're joining us for the first time, welcome. We're
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  Speaker 1: glad that you are here. We hope that you enjoy
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  Speaker 1: what you listen into this today and walk away with something,
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  Speaker 1: hopefully a little bit valuable, which is like an argument
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  Speaker 1: as to why we should not It's like, this is
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  Speaker 1: actually why we shouldn't do some things. Yeah, maybe instead
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  Speaker 1: of why we do what we do. Yeah, but yeah,
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  Speaker 1: I think we're ready to dive in.
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  Speaker 2: Yeah, I think we could do that.
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  Speaker 1: Let's go ahead, all right. Now, we have talked about
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  Speaker 1: placebos in the past, so you might go check out
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  Speaker 1: some of our earlier episodes where we've talked about placebos,
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  Speaker 1: and so we're not really going to dive into that
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  Speaker 1: necessarily here, but placebos are often used in science to
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  Speaker 1: create an experimental arrangement that is very rigorous and that
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  Speaker 1: can essentially distill the important variables in a really highly
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  Speaker 1: controlled setting so you can understand how things work. So
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  Speaker 1: the idea is that you might test some new substance,
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  Speaker 1: often we're talking about medicine here, and you're going to
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  Speaker 1: test that against an inert version of that substance and
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  Speaker 1: see if there's any difference between how they sort of
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  Speaker 1: play out. So that's sort of the general placebo control arrangement.
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  Speaker 2: Yeah, So sometimes we think about this and we're like, well,
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  Speaker 2: maybe we should do it when we're testing new vaccines, right,
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  Speaker 2: we should use placebos to in vaccine research to see
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  Speaker 2: if it has an effect.
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  Speaker 1: Well, at least that's the.
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  Speaker 2: Proposal from the dumbest jackass to ever work in the
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  Speaker 2: federal government, RFK Junior. So again, you know, we're talking
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  Speaker 2: about somebody who is vehemently nonscience, Yeah, proposing that he
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  Speaker 2: slightly understands how the scientific method works, but then also
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  Speaker 2: completely debunks the fact that he has any knowledge about
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  Speaker 2: anything at all. So we're gonna talk about why we
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  Speaker 2: should not do placebos in vaccine research.
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  Speaker 1: Here, right, So we'll start by talking about how placebos work,
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  Speaker 1: and again, just a brief sort of reoverview here recap
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  Speaker 1: if you will. So let's create a hypothetical example. Let's
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  Speaker 1: say that you're testing, or someone's testing new medication for headaches,
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  Speaker 1: and they want to try that medication against just a
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  Speaker 1: basic sugar pill, and the sugar pill has no known
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  Speaker 1: medicinal properties or any reason to believe it should have
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  Speaker 1: any way of impacting headaches, and so what you might
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  Speaker 1: do is is you want to give some group of
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  Speaker 1: people the new medicine and some group of people the placebo.
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  Speaker 1: And if the new medication performs just as well as
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  Speaker 1: the placebo does in terms of people reporting their headaches
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  Speaker 1: going away, then it likely isn't very effective because we
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  Speaker 1: don't think that the sugar pill should have had any effect.
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  Speaker 1: So if the if the new medication only works that well,
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  Speaker 1: then we would assume like it probably doesn't really have
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  Speaker 1: an effect aside from people believing that there is an effect. However,
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  Speaker 1: if the new medication has greater effect on reducing headaches
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  Speaker 1: than that placebo, then we might then interpret that to
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  Speaker 1: mean that that medication is pretty effective at helping reduce headaches,
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  Speaker 1: because at least compared to something that should not reduce headaches,
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  Speaker 1: it seems to be doing a better job. And that's
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  Speaker 1: sort of the general idea of a placebo control right now.
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  Speaker 2: Typically, we will also separate people into two groups, one
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  Speaker 2: who will receive the real medicine versus someone who will
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  Speaker 2: receive the placebo. And that way we can see if
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  Speaker 2: the group that got the medicine does better than the
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  Speaker 2: group that got the fake medicine. Like, we want to
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  Speaker 2: compare and contrast the results.
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  Speaker 1: And you know, in the placebo episode that we did,
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  Speaker 1: we talked about the fact that a lot of times
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  Speaker 1: placebos will still have an effect, but a actual medication
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  Speaker 1: should have a much more powerful effect, right, And so
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  Speaker 1: if you're interested in that, go check that out. And so, yeah,
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  Speaker 1: there's this's the idea. So shouldn't we want to do
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  Speaker 1: this placebo control with all medicines and all medication? Sure? No, actually, okay,
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  Speaker 1: but hold on, sorry, let me rephrase that a little bit. No, yeah,
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  Speaker 1: is actually the real answer there, ridiculous. So let's let's
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  Speaker 1: explain this.
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  Speaker 2: Let's unpack this a little bit. Right. Imagine you, dear listener,
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  Speaker 2: I have been diagnosed with cancer. Fortunately, we have a
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  Speaker 2: treatment that is about ninety to ninety five percent effective
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  Speaker 2: at treating this cancer. However, we have a new medication
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  Speaker 2: that might be even better, or may be just as
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  Speaker 2: good but cheaper or whatever. It doesn't matter. It's new
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  Speaker 2: and we want to test it.
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  Speaker 1: You have this disease that sucks, and this is a
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  Speaker 1: disease that will definitely kill you if untreated, but you
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  Speaker 1: can you can enroll in this study. So you might
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  Speaker 1: be in the group who gets the new medicine, or
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  Speaker 1: you might be in the group that gets the placebo
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  Speaker 1: that we know doesn't work, because that's why we chose
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  Speaker 1: as the placebo. And we can see that if you're
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  Speaker 1: in the group that lives or the group that dies, right,
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  Speaker 1: or both groups die if the new medicine doesn't work
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  Speaker 1: in the way that we hoped. But like that's it.
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  Speaker 1: It's like we're going to say, like we know that
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  Speaker 1: we can treat this cancer, but instead of giving you that,
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  Speaker 1: we're going to put you into one of two groups,
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  Speaker 1: one of which will do nothing that we know will
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  Speaker 1: do nothing, and one of which might work. And that's
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  Speaker 1: how we're going to test it. Right, are you going
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  Speaker 1: to sign up for that study? Hope not?
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  Speaker 2: I certainly hope not. I certainly wouldn't. Sometimes two what
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  Speaker 2: will happen is like the people will get put in
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  Speaker 2: a third group. So you've got like the group that
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  Speaker 2: gets the medicine, you've got the group that doesn't get
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  Speaker 2: the medicine, and you get the group that gets ads. Okay,
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  Speaker 2: so we're talking about placebos in medicine and how sometimes
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  Speaker 2: we shouldn't do it. And when we have an effective
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  Speaker 2: treatment and we have a deadly disease or maybe a
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  Speaker 2: highly incapacitating disease or something that puts somebody at significant risk,
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  Speaker 2: we probably don't want to have a placebo in place.
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  Speaker 2: And vaccines are very similar in that regard. We cannot
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  Speaker 2: ethically give some people a placebo against a disease that
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  Speaker 2: may make somebody extremely sick, permanently disabled, or possibly even dead,
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  Speaker 2: if we have an effective against that disease. Like, we
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  Speaker 2: can't just say, like we know, we could stop this,
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  Speaker 2: but we shouldn't. I mean, that's what happened with every
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  Speaker 2: siphilist study that happened early on, right, that's the Tuskegee Airmen.
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  Speaker 2: It was like, we had a viable treatment available and
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  Speaker 2: we chose not to give it to these folks for decades,
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  Speaker 2: and look what happened. It was a very terrible, terrible situation.
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  Speaker 1: Yeah, actually that was one of the specific if you
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  Speaker 1: look this up in one of the sources we used.
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  Speaker 1: Side of the fact that like we've kind of done
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  Speaker 1: this in history and it's like really bad, don't do it.
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  Speaker 2: Yeah, it has changed the way we do ethics.
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  Speaker 1: Yeah, it actually really has, like it has set new
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  Speaker 1: standards for how we approach these because that was such
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  Speaker 1: a gross misstep that they took. So instead, what we'll
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  Speaker 1: do when we have situations like this, where we have
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  Speaker 1: effective prevention or we have effective treatments, whatever the situation is.
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  Speaker 1: In this case, we're talking about like prevention, we're talking
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  Speaker 1: about vaccines. We test those vaccines against existing vaccines to
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  Speaker 1: see if they perform as well or better than those
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  Speaker 1: like the flu shot that comes out every year. And
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  Speaker 1: this year we're probably not going to get an effective
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  Speaker 1: one because RFK has blocked their ability to share research
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  Speaker 1: with one another, and the manufacturers are now going to
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  Speaker 1: lose money on this because they might not even be
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  Speaker 1: able to get one to market, and if they do,
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  Speaker 1: they won't have any ability to speak to how well
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  Speaker 1: it works because of RFK Junior, who is trying to
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  Speaker 1: kill as many people as possible, specifically children, but as
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  Speaker 1: many as he can get his hands on, right anyway,
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  Speaker 1: One of the ways that they test this when you
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  Speaker 1: have a situation where you have something that you know
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  Speaker 1: is an effective treatment or prevention, is you then compare
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  Speaker 1: that with people who then get the other actual effective
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  Speaker 1: treatment or prevention, as I was mentioning, like flu shots,
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  Speaker 1: Like oftentimes their efficacy is like let's just say seventy
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  Speaker 1: percent or something like that. Well, if they test against
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  Speaker 1: the news train that they are a new vaccine, they
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  Speaker 1: believe it is even more effective. What if that gets
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  Speaker 1: up to like ninety five percent or something. Sure, so,
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  Speaker 1: like they will have obviously gone through several steps up
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  Speaker 1: to the point where they're confident in the safety of this,
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  Speaker 1: and now they're essentially measuring it for efficacy and how
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  Speaker 1: effective it is. But like, you don't want to be
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  Speaker 1: measuring that against like nothing where you know that they
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  Speaker 1: might they have an actual real risk of like contacting
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  Speaker 1: a disease and again becoming extremely sick or permanently disabled
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  Speaker 1: or dead.
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  Speaker 2: Right, So it's really not very complicated. We don't want
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  Speaker 2: to expose people to unnecessary risk or harm, especially especially
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  Speaker 2: in research, Like that's the last thing we want to
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  Speaker 2: really take steps to make sure that people are not
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  Speaker 2: exposed to risks or harms for undue reasons. You wouldn't
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  Speaker 2: want yourself, for a loved one to be a guinea
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  Speaker 2: pig in a situation in which there is a fifty
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  Speaker 2: percent chance and you will get completely ineffective medication against
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  Speaker 2: an illness that.
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  Speaker 1: May kill you.
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  Speaker 2: There are ways of doing good science without placebo controls,
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  Speaker 2: and we have been doing them for decades decades. We
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  Speaker 2: have examples of how we can do this without having
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  Speaker 2: to implement placebo controls.
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  Speaker 1: And I do want to say, like there are conditions
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  Speaker 1: under which you and basic scigennce and medicine placebos make
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  Speaker 1: a lot of sense. And then like very low stake
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  Speaker 1: situations with things such as headaches, for example, the outcome
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  Speaker 1: of that medication failing is not you being extremely sick, disabled,
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  Speaker 1: or dead. So like it's low stakes enough that that
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  Speaker 1: might be an appropriate place to do a placebo control.
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  Speaker 1: So it's not like there's no place for placebos at
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  Speaker 1: all and medical research, but when we're talking about high
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  Speaker 1: stake situations that are life and death, like those are
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  Speaker 1: places where if we have an effective treatment, start with
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  Speaker 1: that right and then like compare our new treatment against
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  Speaker 1: those We're not going to then put people in the
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  Speaker 1: risk of harm that we know we could have otherwise
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  Speaker 1: prevented or at least somewhat mitigated. And part of why
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  Speaker 1: we're talking about this is that there is like a
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  Speaker 1: new mandate that vaccines go through placebo control trials, and
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  Speaker 1: this is so wrongheaded. It is going to slow down
• 10:45
  Speaker 1: the process of vetting vaccines, it's going to cost more
• 10:47
  Speaker 1: money to vet vaccines, and it is going to be
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  Speaker 1: unethical and cause people to suffer unnecessarily. It will cause
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  Speaker 1: undue harm, it will introduce more bureaucracy, take longer, cost
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  Speaker 1: more money, and hurt more peace people. So in RFK
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  Speaker 1: Junior's world, that's a win win win win yep.
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  Speaker 2: Exactly. Now, conditions under which placebos may be appropriate, specifically
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  Speaker 2: when it comes to vaccines, would be one developing a
• 11:11
  Speaker 2: locally affordable vaccine, two evaluating the local safety and efficacy
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  Speaker 2: of an existing vaccine, three testing a new vaccine when
• 11:19
  Speaker 2: an existing vaccine is considered inappropriate for local use, like
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  Speaker 2: based on epidemiological or demographic factors, or four determining the
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  Speaker 2: local burden of the disease like Those are conditions in
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  Speaker 2: which a placebo might be effective, or it might.
• 11:33
  Speaker 1: Be an appropriate it might what I mean, yeah, and
• 11:35
  Speaker 1: like a vaccine and a placebo control. Sorry because you
• 11:39
  Speaker 1: mentioned placebos in in an experimental study evaluating a vaccine,
• 11:43
  Speaker 1: having a placebo might be appropriate under those conditions. And
• 11:46
  Speaker 1: this is one of those like the exception proves the
• 11:49
  Speaker 1: rule type things where it's like if we had to
• 11:52
  Speaker 1: dig and search and scrounge around to like come up
• 11:55
  Speaker 1: with conditions under which that could be appropriate, that highlights
• 11:59
  Speaker 1: the fact that it is generally speaking, very inappropriate, Like
• 12:04
  Speaker 1: we do not use placebo controls for vaccines when we
• 12:07
  Speaker 1: have effective vaccines already now. And I do think there
• 12:09
  Speaker 1: are conditions and that's actually in the four that they listed.
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  Speaker 1: There are conditions in which there is no existing vaccine.
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  Speaker 1: So testing a vaccine against a placebo makes perfect sense
• 12:19
  Speaker 1: because like we don't have an effective vaccine to compare
• 12:22
  Speaker 1: it against. Like let's take the recent bird flu that
• 12:25
  Speaker 1: has been passing around and is probably one of the
• 12:28
  Speaker 1: top contenders to be the next pandemic. We don't really
• 12:31
  Speaker 1: have something that we're that sure about as far as vaccines,
• 12:34
  Speaker 1: at least at the time of us recording this, And
• 12:37
  Speaker 1: so a placibo control might actually be a reasonable strategy
• 12:41
  Speaker 1: for something like that particular disease, because like what else
• 12:44
  Speaker 1: would we use, So it's not like it doesn't exist.
• 12:47
  Speaker 1: But again we consider all the factors here in the
• 12:49
  Speaker 1: information that we have, and generally speaking, if we have
• 12:52
  Speaker 1: existing effective treatment and prevention, we don't use placebos because
• 12:57
  Speaker 1: that's wildly unethical and again introduces more bureaucuracy, slows down
• 13:01
  Speaker 1: the process, and causes undue suffering. So that's why we
• 13:05
  Speaker 1: don't do and don't advocate for placebo controls with vaccines,
• 13:09
  Speaker 1: particularly established ones.
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  Speaker 2: Yep, exactly one hundred percent.
• 13:13
  Speaker 1: All right, Well, that is what a mini sounds like.
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• 14:00
  Speaker 1: so much to my team of people without whom I
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  Speaker 1: could not make this show, And thank you all for listening.
• 14:04
  Speaker 1: Thank you for recording with me today.
• 14:05
  Speaker 2: Shane anytime?
• 14:06
  Speaker 1: All right? I said a bunch of thank you is Is
• 14:08
  Speaker 1: there anything that I forgot that you would like to
• 14:10
  Speaker 1: add before we kick this mini off to the published world.
• 14:13
  Speaker 1: Go out and vote.
• 14:14
  Speaker 2: This is what happens when you don't.
• 14:16
  Speaker 1: Very good points. Yeah, go out and vote against the
• 14:19
  Speaker 1: anti vaxxers. Yes, all right, thank you. This is Abraham,
• 14:22
  Speaker 1: this is Shane. Why we Do what we Do mini
• 14:25
  Speaker 1: is out. Bye. You've been listening to Why We Do
• 14:29
  Speaker 1: What We Do.
• 14:30
  Speaker 2: You can learn more about this and other episodes by
• 14:32
  Speaker 2: going to wwdwwdpodcast dot com. Thanks for listening, and we
• 14:38
  Speaker 2: hope you have an awesome day.