Re:Strep A kills half a million per year; why don't we have ...
by jimbob45 on Saturday October 19, 2024 @12:15AM
(#41885592)
Drug companies have been unwilling to take financial risks when they can’t be sure there’ll be a market for a strep A vaccine in wealthy countries
Did they not poll anyone on this? I struggle greatly to believe the greater public wouldn’t sprint to their nearest pharmacy for such a vaccine. I wanted to fund such a thing before the article was over - I simply never knew such a thing was on the table.
Re:Strep A kills half a million per year; why don't we have ...
by Molitor5901 on Saturday October 19, 2024 @12:29AM
(#41885642)
Vaccine makers could lobby the government to make the vaccine mandatory, thereby guaranteeing a revenue stream for the vaccine to reduce the financial risk.
Re:Strep A kills half a million per year; why don't we have ...
by fshbbdssbbgdd on Saturday October 19, 2024 @01:12AM
(#41885782)
I wonder if people downvoted this because they took it as some kind of political point about COVID-19. Maybe it was, but I agree with it as a serious proposal. Even if the government is not confident in its ability to get people to accept vaccinations, it should commit to pay for the doses either way, to incentivize the development of the vaccine. In general, a contest or prize is a smart way to fund a public good. Among left and right economists, this is one thing most would agree on.
Re:Strep A kills half a million per year; why don't we have ...
by kelnos on Saturday October 19, 2024 @02:52AM
(#41886136)
And yet we still have many successful mandatory vaccination campaigns. Certainly they've been hurt by all the antivax garbage going around since the pandemic, but that doesn't make them not worthwhile.
Re:Strep A kills half a million per year; why don't we have ...
by pfdietz on Saturday October 19, 2024 @12:36AM
(#41885672)
The concern with any Strep vaccine is stimulating autoimmune reactions. Rheumatic fever is just such a reaction associated with strep infection, and it can be very damaging, even deadly.
Re:Strep A kills half a million per year; why don't we have ...
by fny on Saturday October 19, 2024 @12:39AM
(#41885685)
First, there are cheap alternatives (antibiotics) which limit the total market size.
Second, it’s almost tautological. If there was enough profit to justify the development time and cost, drug companies would pursue a vaccine. Since they’re not pursuing a vaccine, you can assume there’s not enough estimated profit compared to other research ventures.
The second point includes considerations of difficulty. There are many strep strains. Strep can trigger autoimmune diseases. Will the costs of surmounting these challenges be rewarded above other pursuits?
Re:Strep A kills half a million per year; why don't we have ...
by dragonwriter on Saturday October 19, 2024 @02:03AM
(#41885943)
> Second, it’s almost tautological. If there was enough profit to justify the development time and cost, drug companies would pursue a vaccine.
No, that's not "almost tautological". In fact, it is a form of the appeal to tradition fallacy. (LIt is tautological -- as are many applications of that fallacy -- if you take the assumptions underpinning rational choice theory as axioms, but it stops being such once you drop the perfect information assumption.)
Your reframing of it in the next sentence subtly acknowledges this, when you shift from "if there was enough profit" to "there’s not enough estimated profit", despite that you are responding to a post that explicitly is arguing that the estimate made of the profit is dubious.
Re:Strep A kills half a million per year; why don't we have ...
by maxbond on Saturday October 19, 2024 @01:40AM
(#41885867)
GP is correct that the argument contains an informal fallacy[1], and people often express this criticism by saying "your argument is tautological," and you are correct that a tautology is a statement which is always true [2].
Re:Strep A kills half a million per year; why don't we have ...
by pdonis on Saturday October 19, 2024 @07:37PM
(#41891683)
> GP is correct that the argument contains an informal fallacy
The GP didn't say that.
As for which informal fallacy the GGP's argument contained, I would say it was more like a false dilemma. And the GGP did say "almost tautological", which implicitly recognizes that there might be other possibilities.
> people often express this criticism by saying "your argument is tautological,"
I have never seen this (nonsensical) way of expressing the criticism that an argument is false by saying that it is tautological (and therefore true).
Re:Strep A kills half a million per year; why don't we have ...
by zaptrem on Saturday October 19, 2024 @04:49AM
(#41886570)
Even with antibiotics strep really sucks for kids (painful!) and parents (kid needs to stay home from school). Seems like there would be obvious demand. The article says the FDA banned testing for like 40 years due to a tiny issue during a trial in the late 20th century.
Re:Strep A kills half a million per year; why don't we have ...
by slillibri on Saturday October 19, 2024 @01:50AM
(#41885898)
Probably because a half million a year is a rounding error in global mortality. It sounds like a lot but the daily global mortality rate, when last I checked, was something like 170,000 per day.
Re:Strep A kills half a million per year; why don't we have ...
by Fomite on Saturday October 19, 2024 @02:23AM
(#41886007)
Achieving the equivalent of "What if no one died for three days?" every year is a massive achievement on the same scale of the wildest dreams of most of the people on this site.
Re:Strep A kills half a million per year; why don't we have ...
by zaptrem on Saturday October 19, 2024 @04:27AM
(#41886485)
This isn’t true in any way we could reasonably reach. The world has an insane amount of potential food output. A huge portion of the food the US produces goes directly in the trash instead of being used.
Re:Strep A kills half a million per year; why don't we have ...
by naveen99 on Saturday October 19, 2024 @08:32AM
(#41887441)
Do you have numbers ? There used to be famines. And countries still fight over water. what is the carrying capacity in terms of food production on earth ? 10 billion, 100 billion ? At a trillion, the world would be at Singapore’s population density I think.
Re:Strep A kills half a million per year; why don't we have ...
by pfdietz on Monday October 21, 2024 @08:56AM
(#41903667)
It's highly dependent on assumptions.
The limit is ultimately set by thermodynamics and the need to dissipate waste heat to space. This limit is around 1 trillion people, but this likely requires food be artificially synthesized. Using conventional agriculture, a global limit of 150 billion was set (in a 1979 study referenced in the 1985 book "The Global Possible", page 217), or 47 billion with a US-like diet. Nitrous oxide emission from agriculture is likely to be a long term concern, as this powerful greenhouse gas accumulates.
As always, please do not interpret these statements as advocacy of these outcomes.
Re:Strep A kills half a million per year; why don't we have ...
by pfdietz on Tuesday October 22, 2024 @11:44AM
(#41915468)
It's because I have constantly seen that misinterpretation. People seem to think that if I say "X is true" or "X is possible" then I'm saying "I find X desirable". This is a weird non sequitur and seems to be closely related to wishful thinking, that is the non sequitur of thinking that something is true because its truth would be desirable.
Re:Strep A kills half a million per year; why don't we have ...
by slillibri on Saturday October 19, 2024 @02:34AM
(#41886054)
Cancer kills over 9 million people per year, or 18x strep A. Tuberculosis kills nearly 1.5 million people per year, or 3x. Over 9 million people die from hunger related causes, which while not a disease is 18x strep A. It's not to demean the people who die from strep A, because to each of their families it's a tragedy, but the scale and the fact that it can be treated with common antibiotics means that we can put the effort and resources that would be spent on a vaccine to better use elsewhere.
Re:Strep A kills half a million per year; why don't we have ...
by fallous on Saturday October 19, 2024 @03:34AM
(#41886281)
Nearly all hunger-related deaths are due to the political environment they live in (including wars). Of course such environments also disproportionately include those who cannot gain access to antibiotics as well.
You could argue that vaccines would be hampered by the same environmental issues, but the window of stability necessary to vaccinate a person for life is much smaller and easier than the repeated stability moments required to gain access to antibiotics in a timely fashion for those infected with Strep A.
The question of prioritization of resources is not merely dependent upon the number of those affected, the creation of an effective vaccine is unpredictable. You're better off taking a broad approach in order to maximize the likelihood of success.
Re:Strep A kills half a million per year; why don't we have ...
by kelnos on Saturday October 19, 2024 @02:42AM
(#41886100)
> Cancer kills over 9 million people per year
"Cancer" isn't one disease though, it's hundreds, and many of them require completely different approaches to treat.
> Tuberculosis kills nearly 1.5 million people per year, or 3x
So in other words, yes, it would be "worth it" to develop a vaccine for strep A. It would also be worth it to develop a vaccine for tuberculosis. Let's do both.
> Over 9 million people die from hunger related causes, which while not a disease is 18x strep A
Not really relevant. The people who have expertise in developing vaccines and the people who have expertise in "fixing hunger" are not the same people.
> the scale and the fact that it can be treated with common antibiotics means that we can put the effort and resources that would be spent on a vaccine to better use elsewhere
That's not a good way to evaluate where to put resources. To borrow your example, maybe it will take 10x more time and 5x the cost to develop a vaccine for tuberculosis vs. strep A. Then working on strep A sounds like a good allocation of resources.
Just offering that as an example; I of course don't know the relative resource requirements here. But things are not so simple. (Though going back to your cancer example: I feel pretty safe in guessing it would take way more than 18x the resources and effort to cure all forms of cancer than to develop a strep A vaccine.)
And regardless, resources are usually not allocated in the most simple, efficient way. People work on things because they want to, and can find someone to fund them. Funders might want to fund something because they have a personal connection to the thing they're funding. Certainly government grants are given with a bit more rigor than that, but there's a lot of disease-fighting out there that comes from a variety of sources. And that's ok.
Re:Strep A kills half a million per year; why don't we have ...
by konschubert on Saturday October 19, 2024 @03:41AM
(#41886310)
Considering that strep A deaths are probably 100x easier to prevent than cancer deaths, this means that’s we should focus on Strep A at least as much as on cancer.
Re:Strep A kills half a million per year; why don't we have ...
by alt227 on Saturday October 19, 2024 @04:00AM
(#41886381)
We shouldnt be trying to erradicate diseases which keep population numbers in check. The world will run out of food fast and there will be widespread famine and starvation like the world has never seen before.
Re:Strep A kills half a million per year; why don't we have ...
by pfdietz on Monday October 21, 2024 @09:00AM
(#41903697)
Your comments there have no connection to reality. The major population issue facing the world going forward is intractable decline in birth rates leading to population collapse.
Re:Strep A kills half a million per year; why don't we have ...
by kelnos on Saturday October 19, 2024 @02:47AM
(#41886117)
And yet a half million people still get it and die. Doesn't sound "solved" to me ("technically" or otherwise). I'm not sure if mass vaccination campaigns would be more effective than hoping people see a doctor when they get sick (seems like a lot don't) and hoping they are able to pay for a full course of antibiotics (seems like a lot can't), and hoping they actually stick with it and take the full course (many people in general don't).
At least with vaccinations, it's usually one shot every $DECENTLY_NOT_SHORT_INTERVAL, and that's it.
Granted, crazy stupid antivax sentiment is on the rise...
Re:Strep A kills half a million per year; why don't we have ...
by lqstuart on Saturday October 19, 2024 @02:09AM
(#41885960)
> Although the penicillin family of antibiotics is highly effective against strep A, many Ugandan families instead visit traditional healers, whose treatments include scraping tonsils with a spoon or a sharp piece of wood until they bleed. If parents do seek out antibiotics, they might just buy two pills of penicillin, not the full course necessary to clear an infection.
Think this is the problem they should be solving before trying to immunize people against bacteria that lives literally everywhere
Re:Strep A kills half a million per year; why don't we have ...
by isodev on Saturday October 19, 2024 @03:01AM
(#41886171)
I think the opposite... instead of going through the trouble of making people change their ways (which we know is hard and takes generations) instead we eliminate the root cause. Sounds efficient to me.
Re:Strep A kills half a million per year; why don't we have ...
by Fomite on Saturday October 19, 2024 @02:24AM
(#41886012)
Public health tends to prefer the Swiss cheese model of prevention - increased access to antibiotics, trust building in communities, and promoting access to healthcare all occur simultaneously.
Re:Strep A kills half a million per year; why don't we have ...
by carlmr on Tuesday October 22, 2024 @03:17AM
(#41911965)
Enough is obviously good, there's plenty of stuff where you need antibiotics to heal. Enough can be bad if abused, since some doctors overprescribe antibiotics for cases where it's not warranted, e.g. a cold. Most colds are viral in any case, so all you're doing is weakening the patient even more. Aside from that there may be severe side-effects, so it's best only to use antibiotics if you know you have a bacterial issue that can be solved with them.
None is preferable to partial treatments, since a partial treatment will create resistant strains and not much else.
Re:Strep A kills half a million per year; why don't we have ...
by more_corn on Saturday October 19, 2024 @08:18PM
(#41891892)
My mother was educated. She bought into some misinformation and fear-mongering about modern medicine and rejected it entirely. No vaccines no doctors. Mostly it was fine till it wasn’t.
I took myself to a doctor as a teen with bad strep. Not our doctor we didn’t have one. just a doctor. No insurance. They could see I was in rough shape. They just diagnosed me with strep (although I already knew that’s what it was) and sent me away with a prescription. I didn’t even realize how weird that was till much later. (That they saw me with no insurance and no previous relationship and no payment)
My sister was in town once years later and my younger brother was in such bad shape she took him to a doctor. She swears to this day he would have died. Again strep.
Misinformation is a big problem. People who buy into it put their kids at risk. When we allow purveyors of nonsense to thrive because “freedoms” we do everyone a disservice.
Re:Strep A kills half a million per year; why don't we have ...
by jart on Saturday October 19, 2024 @03:16PM
(#41889952)
They still do. They think it's a magic salve that cures everything, even cancer. Which is sad because for many of them it's probably the only health care they have access to. The way the media reacts to this stuff only makes things sadder.
Re:Strep A kills half a million per year; why don't we have ...
by tim333 on Sunday October 20, 2024 @05:37AM
(#41894212)
There was a bit of an odd phenomenon in the US where a lot of people went anti vax during covid and in those groups they tended to support using ivermectin instead to treat covid, in spite of the evidence being that vaccines were quite effective at reducing harm and ivermectin wasn't. They tended to be the right wing anti government types, while the dems were mostly in favour of getting everyone to be vaccinated. Most of the ivermectin lot were Trump voters although I don't think he suggested it - he recommended vaccination and in the early days suggested hydroxychloroquine when people still thought that might work.
I'm not american and found it all a bit odd. I mean you'd think with medication you'd follow the scientific evidence for what works rather than political stuff. Maybe social media is to blame?
Re:Strep A kills half a million per year; why don't we have ...
by hypercube33 on Saturday October 19, 2024 @02:20AM
(#41885992)
What about bacteria phages for strep? If I'm not mistaken and I really could be but I thought we use them to keep some meats fresh? I didn't dig into this further many years ago but I also haven't seen anything new either beyond a paper suggesting their research.
Antibiotics come up here a lot and other places in discussion due to their (possibly) bad side effects or immunity with excessive use.
I think someone else here pointed out that it's tricky to make an immune response have the desired outcome and no undesired ones so a vaccine may not be the right hammer for this nail.
Re:Strep A kills half a million per year; why don't we have ...
by Fomite on Saturday October 19, 2024 @02:25AM
(#41886019)
HN tends to love phage, but for this application, it's not a great one, because the infrastructure required to safely do phage prep greatly exceeds what you need even for complex vaccines.
Re:Strep A kills half a million per year; why don't we have ...
by OutOfHere on Monday October 21, 2024 @01:24PM
(#41906272)
The development of phages has thus far made more sense for resistant infections. Perhaps phages could also help patients with chronic lung infections. For strep there isn't much motivation even if it's theoretically desirable.
Re:Strep A kills half a million per year; why don't we have ...
by karim79 on Saturday October 19, 2024 @03:41AM
(#41886303)
I had this, in 2011. I was in another country, attending job interviews I had been invited to.
It was the single worst experience of my life. I was in a hotel, a fever crept in. Then my throat was so swollen I could barely talk. I was sweating so much that my delirious brain decided it would be a good idea to lay out all the clothes in my suitcase onto the bed. I had a fever dream that my brother had called an ambulance to save me.
I then woke up to realise I was still actually in hell. I managed to muster up the strength to go down to the hotel lobby and ask the hotel receptionist to direct me to the nearest pharmacy. I almost couldn't speak because my throat was almost swollen shut. Sweat was literally pouring down my face and I sounded, let's say, incompetent.
I eventually arrived at the pharmacy and I honestly credit the lovely lady there for saving my life. She gave me fever reducers and a concentrated iodine-based throat gargle.
It took around five days to recover from this, I had missed my flight and had to book a new one back. When I arrived back home, the first comment I received was "there is no colour in your face, you're white as a sheet".
I've had many of the nasty viruses several times (covid, you-name-it flu, measles even, please do not ask).
Re:Strep A kills half a million per year; why don't we have ...
by hyperman1 on Saturday October 19, 2024 @05:38AM
(#41886752)
Not a strep, but I remember getting sick with something. Go to docter, go to apothecary. All the while grumbling I had work to do and this really was messing with my schedule.
Walking home, with pills in hand, I somehow got really sick very fast. That's when I realized this might have easily killed me 70 years ago, and the antibiotics I was holding were a small miracle. All that grumbling was first world problems.
Did they not poll anyone on this? I struggle greatly to believe the greater public wouldn’t sprint to their nearest pharmacy for such a vaccine. I wanted to fund such a thing before the article was over - I simply never knew such a thing was on the table.
(1) TotallyGenuine drug company realizes that they can still get paid giving out fake shots.
(2) NotEvil drug company buys up it's smaller competitors and stops improving vaccines.
(3) KeyboardScientist makes a viral post that the government is sterilizing people of a particular ethnicity.
With a bit of googling, you can find events very close to all these three.
Second, it’s almost tautological. If there was enough profit to justify the development time and cost, drug companies would pursue a vaccine. Since they’re not pursuing a vaccine, you can assume there’s not enough estimated profit compared to other research ventures.
The second point includes considerations of difficulty. There are many strep strains. Strep can trigger autoimmune diseases. Will the costs of surmounting these challenges be rewarded above other pursuits?
No, that's not "almost tautological". In fact, it is a form of the appeal to tradition fallacy. (LIt is tautological -- as are many applications of that fallacy -- if you take the assumptions underpinning rational choice theory as axioms, but it stops being such once you drop the perfect information assumption.)
Your reframing of it in the next sentence subtly acknowledges this, when you shift from "if there was enough profit" to "there’s not enough estimated profit", despite that you are responding to a post that explicitly is arguing that the estimate made of the profit is dubious.
Those aren't logical fallacies; they're just not very useful.
[1] https://en.wikipedia.org/wiki/Begging_the_question
[2] https://en.wikipedia.org/wiki/Tautology_(logic)
The GP didn't say that.
As for which informal fallacy the GGP's argument contained, I would say it was more like a false dilemma. And the GGP did say "almost tautological", which implicitly recognizes that there might be other possibilities.
> people often express this criticism by saying "your argument is tautological,"
I have never seen this (nonsensical) way of expressing the criticism that an argument is false by saying that it is tautological (and therefore true).
If you wish to see usages like I described, have a look here.
https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...
https://xkcd.com/703/
One dose and very little strep for the rest of your life is different than an annual regimine.
But you can't know how it will do before a lot of spending.
The world would get massively overpopulated very quickly.
Diseases maintain the balance of us with nature, if we eliminate them we are going to run out of food fast.
The limit is ultimately set by thermodynamics and the need to dissipate waste heat to space. This limit is around 1 trillion people, but this likely requires food be artificially synthesized. Using conventional agriculture, a global limit of 150 billion was set (in a 1979 study referenced in the 1985 book "The Global Possible", page 217), or 47 billion with a US-like diet. Nitrous oxide emission from agriculture is likely to be a long term concern, as this powerful greenhouse gas accumulates.
As always, please do not interpret these statements as advocacy of these outcomes.
This is where ai currently falls down. It can’t do new analysis.
You could argue that vaccines would be hampered by the same environmental issues, but the window of stability necessary to vaccinate a person for life is much smaller and easier than the repeated stability moments required to gain access to antibiotics in a timely fashion for those infected with Strep A.
The question of prioritization of resources is not merely dependent upon the number of those affected, the creation of an effective vaccine is unpredictable. You're better off taking a broad approach in order to maximize the likelihood of success.
"Cancer" isn't one disease though, it's hundreds, and many of them require completely different approaches to treat.
> Tuberculosis kills nearly 1.5 million people per year, or 3x
So in other words, yes, it would be "worth it" to develop a vaccine for strep A. It would also be worth it to develop a vaccine for tuberculosis. Let's do both.
> Over 9 million people die from hunger related causes, which while not a disease is 18x strep A
Not really relevant. The people who have expertise in developing vaccines and the people who have expertise in "fixing hunger" are not the same people.
> the scale and the fact that it can be treated with common antibiotics means that we can put the effort and resources that would be spent on a vaccine to better use elsewhere
That's not a good way to evaluate where to put resources. To borrow your example, maybe it will take 10x more time and 5x the cost to develop a vaccine for tuberculosis vs. strep A. Then working on strep A sounds like a good allocation of resources.
Just offering that as an example; I of course don't know the relative resource requirements here. But things are not so simple. (Though going back to your cancer example: I feel pretty safe in guessing it would take way more than 18x the resources and effort to cure all forms of cancer than to develop a strep A vaccine.)
And regardless, resources are usually not allocated in the most simple, efficient way. People work on things because they want to, and can find someone to fund them. Funders might want to fund something because they have a personal connection to the thing they're funding. Certainly government grants are given with a bit more rigor than that, but there's a lot of disease-fighting out there that comes from a variety of sources. And that's ok.
Strep A is technically solved due to being easily treatable with common antibiotics.
At least with vaccinations, it's usually one shot every $DECENTLY_NOT_SHORT_INTERVAL, and that's it.
Granted, crazy stupid antivax sentiment is on the rise...
Think this is the problem they should be solving before trying to immunize people against bacteria that lives literally everywhere
But vaccines are very effective.
None is preferable to partial treatments, since a partial treatment will create resistant strains and not much else.
The inappropriate use of antibiotics is too high, and simultaneously there are very real issues of access.
Has there been a vaccine like that?
https://www.nature.com/articles/s41541-023-00609-x
Plenty of wealthy people are taking horse deworming medicine for political purposes.
That people in the US choose to be ignorant despite having an education happens, but it's rarer than where there is no education.
My sister was in town once years later and my younger brother was in such bad shape she took him to a doctor. She swears to this day he would have died. Again strep.
Misinformation is a big problem. People who buy into it put their kids at risk. When we allow purveyors of nonsense to thrive because “freedoms” we do everyone a disservice.
Don’t understand this
Though that was a bit 2020. Not sure it still goes on.
Think of the folks who think RFK Jr is some sort of breath of fresh air. Or the people into Gwyneth Paltrow faux “wellness” nonsense and homeopathy.
On the more reactionary side, you have people who idolize the cowboy myth, the 1950s, or interpret freedom as meaning “I don’t pay taxes”.
It’s the same psychological feature, realized through different perceptions.
I'm not american and found it all a bit odd. I mean you'd think with medication you'd follow the scientific evidence for what works rather than political stuff. Maybe social media is to blame?
They estimate about 319,000 more people died in the US that would have happened if everyone just got vaccinated when it was recommended (https://www.npr.org/sections/health-shots/2022/05/13/1098071...)
Antibiotics come up here a lot and other places in discussion due to their (possibly) bad side effects or immunity with excessive use.
I think someone else here pointed out that it's tricky to make an immune response have the desired outcome and no undesired ones so a vaccine may not be the right hammer for this nail.
It was the single worst experience of my life. I was in a hotel, a fever crept in. Then my throat was so swollen I could barely talk. I was sweating so much that my delirious brain decided it would be a good idea to lay out all the clothes in my suitcase onto the bed. I had a fever dream that my brother had called an ambulance to save me.
I then woke up to realise I was still actually in hell. I managed to muster up the strength to go down to the hotel lobby and ask the hotel receptionist to direct me to the nearest pharmacy. I almost couldn't speak because my throat was almost swollen shut. Sweat was literally pouring down my face and I sounded, let's say, incompetent.
I eventually arrived at the pharmacy and I honestly credit the lovely lady there for saving my life. She gave me fever reducers and a concentrated iodine-based throat gargle.
It took around five days to recover from this, I had missed my flight and had to book a new one back. When I arrived back home, the first comment I received was "there is no colour in your face, you're white as a sheet".
I've had many of the nasty viruses several times (covid, you-name-it flu, measles even, please do not ask).
This was by far the worst illness I can remember.
Reminds me of this, people imagining a helping person or spirit in a dire situation: https://en.wikipedia.org/wiki/Third_man_factor
Walking home, with pills in hand, I somehow got really sick very fast. That's when I realized this might have easily killed me 70 years ago, and the antibiotics I was holding were a small miracle. All that grumbling was first world problems.