[extropy-chat] Fwd: Are vaccinations useless? was Re: Failure of low-fat diet

[Rafal Smigrodzki]

On 3/10/06, Robin Hanson <rhanson at gmu.edu> wrote:
> At 05:05 PM 3/10/2006, Rafal Smigrodzki  wrote:
> >>On 3/6/06, Robin Hanson <rhanson at gmu.edu> wrote about the impact of
> >>vaccination on the prevalence of smallpox:
> >> > To answer your exact  question I'd guess 1 to 10% of the reduction is
> >> > attributable to vaccination.
> >To avoid misunderstanding, are you saying that even without
> >vaccinations against smallpox, the lifetime prevalence of that
> >particular disease today would be only about 1% to 10% of the lifetime
> >prevalence observed in the years 1500 - 1700 in Europe?
>
> Regarding the United States, yes, that is my rough estimate.
>
> >This would
> >mean a reduction of an estimated lifetime prevalence from close to 90%
> >down to, say 1%, solely from the collateral effects of affluence.
> >If you indeed believe this, then you would need to explain how a 100%
> >reduction of the prevalence of smallpox occurred in all those
> >countries which did not achieve affluence, or even experienced
> >worsening of their economic circumstances, including Afganistan, China
> >of the Great Leap Forward period, and others.
>
> In response to my saying that the data suggests medicine only contributed
> a small fraction to the reduction in mortality over the last few
> centuries, I was
> asked what did it.  I said I was very unsure.  When I was asked to at least
> give an example of what might be plausible, I offered the
> stress-wealth theory.
> I was not intending to offer a grand theory making precise predictions
> about the rates of each disease in each nation at each time, and to then
> challenge others to present data to prove me wrong.
>
> I don't know the details of smallpox in poor counties - perhaps that is an
> area where medicine had a larger than usual effect.

### Very good, you agree then that a specific form of medical
intervention, namely smallpox vaccination, had a "larger than usual
effect" on morbidity in poor countries.

Now to the next step - above you postulate that in the US there was no
significant effect of smallpox vaccination on morbidity, simply
because US citizens are too rich to get smallpox. Are you saying that
the biology of smallpox is radically different for rich people and
poor people? You are talking about a 99% difference in lifetime
prevalence of the disease. At what per capita income does this
biological effect manifest itself? Can you point to research observing
a 99% drop in smallpox infection rate in unvaccinated humans who meet
this economic criterion?

I expect that you will be unable to point me to any such research,
since if it existed, I would have have heard about it.

What is more, I hope you are familiar with estimates of material
wealth in rich countries in the 1850s. At that time even the citizens
of Great Britain were hardly wealthier than Maoist Chinese were twenty
years ago, and yet rates of smallpox were dropping precipitously in
inverse relationship with vaccination rates.

As Damien Sullivan noted in another post, other infectious conditions
that can be vaccinated against have also exhibited significant
declines, while infectious conditions that cannot be vaccinated
against are still rampant in the same populations. I hope you do not
hypothesize that wealth changes only the biology of smallpox, polio,
and tetanus, while having no impact on herpes, or HIV.

I think I need to ask you again about the basis for your belief that
vaccinations in rich countries are 99% useless. Extensive
interventional as well as correlative data indicate that this is not
the case. Even the Bunker et al. reference you mentioned previously in
this thread does not claim that vaccinations are useless (subsequently
you disparage their research). Is your opinion based exclusively on
analysis of aggregate longevity data versus aggregate healthcare
spending?

I am glad that you assign the confidence level "very unsure" to the
economic explanation of dropping prevalence of certain infectious
conditions. Leaving aside the question of mechanism for a while, what
is your confidence level for the prediction that absence of
vaccinations would have only minor, if any, effect on morbidity in
this country?

Rafal