This man is claiming that staying at home increases deaths... He's also claiming a vaccine could be years away.
I also see zero evidence as to why he should be considered a credible source for effective covid treatments. The man is an economist at a university. Am I looking at the wrong Robin Hanson?
The key argument is that there is lots of uncertainty, but variolation is probably worth trying. And if volunteers can be found, why not? One shouldn't need to be a virologist to credibly make that argument.
Well, for one, orthopoxviruses cause skin lesions, replicate in keratinocytes, dermal fibroblasts and other skin cells and evoke strong immune responses there. Coronaviruses don't.
I'm not a medicine professional, so I'm just curious here.
Since variolation has basically the same principle as vaccination, it's hardly an alternative to vaccination. Is it really worth trying?
To me (with my very crude understanding), proposing variolation as an alternative to vaccination is akin to proposing knife without a handle as an alternative to a regular knife.
Is there any case where vaccination fails to work, while variolation succeed?
>is it suggested to just deploy [variolation] without testing?
Yes: the blog post by economist Robin Hanson suggested deploying it without waiting for the results of testing. (Of course, it would be good to test as fast and as much as possible concurrent with the deployment.)
"deploying it": making available to the public a variolation service or procedure designed by medical experts.
The reason a vaccine is months or years away is only because we are testing whether it is safe enough to give to billions of people.
The reason we do that is because a virus can cause disease both directly but also in unexpected ways (e.g. by immune over-reaction to some of the viral RNA in some individuals).
Variolation as a public policy would have to go through the same safety testing for the same reasons (as it is a form of vaccination with un-weakened virus).
You would also still have to produce doses of the variolate, both in terms of replicating the virus and bottling it.
There is no real time advantage to variolation. Anybody making the case for variolation without validation would be better off making the case for vaccination with one or several of the 30 vaccine candidates under study for SARS-Cov-2 right now (a case could be made... allow volunteers to be given the candidate vaccine of their choice in larger numbers than normal clinical trials, scaling up as the risk profile of each candidate vaccine is known).
I am not an expert (but neither are you, I am guessing).
>Anybody making the case for variolation without validation would be better off making the case for vaccination with one or several of the 30 vaccine candidates under study for SARS-Cov-2 right now
The advantage variolation has over the 30 vaccine candidates, I am guessing if the question is what to do before the results of testing are available is that most of those 30 candidates will turn out after being tested to fail to confer significant immunity.
I believe that the fate of most vaccine candidates for any disease is that testing reveals that the candidate fails to confer immunity to most or all of the people it is given to. Also I believe that it usually takes at least a year to produce enough of a vaccine to test, then test, then analyze the results of the testing.
There are 30 candidate vaccines (probably a lot more by now). 32 if you include the two that are non-weakened forms of virus that are being proposed for variolation.
Having "candidate vaccines" is very different from having a "vaccine". Variolation is a reasonable alternative to the lack of a known, effective vaccine.
You have to test variolation too. There are dozens of vaccine candidates, if we are willing to ignore safety and efficacy testing we can start vaccinating people today.
Just to clarify further - the man cites nothing but his own blog articles but makes sweeping statements as though they are fact. This is speculation on medical approaches for an understudied virus by a man totally unqualified who feels it unnecessary to inform his audience as such.
He's an economist, sure, and is proposing an idea that others can consider and, perhaps, study. I am not looking to this blog post as a source of treatment ideas but instead as a source of ideas.
I've been reading about the importance of the viral load in survival against this disease. His proposed variolation approach is one I've personally considered. Much like families of old had chicken pox parties for their kids, the idea of just getting this over with as safely as possible has some appeal.
Yet it is an approach out of favor for good reason. For most diseases the risk can be significant and historically we've been able to improve survival via quarantine and treatment. This disease is apparently harder to quarantine due to a long latency period and asymptomatic cases. And we have no effective treatment for the worst cases.
It is interesting however to consider that for patients inoculated with preliminary vaccine, it is considered unethical to give a "challenge dose" of virus, while this guy proposes doing so for those with no protection whatsoever. I can't get past that, and am too risk averse to try his idea even in a carefully controlled setting. I'll keep wearing my mask, washing hands and wait it out for now.
There is hope that we will discover a variant of this disease which is less dangerous. In that case I think the approach he recommends is more reasonable.
As you said, Pox parties and all weren't exactly a brilliant solution - now your kid would be carrying the chickenpox virus amd have a risk of shingles later, and using things like saliva from lollipops means that your kids are also now at risk if getting all sorts of fun diseases like hepatitis. There's a reason we use vaccines. We dont know the long term risks of covid (case in point, recently it's become clear that it can trigger blood clots and strokes in otherwise low risk individuals, and the inflammatory syndrome in children is highly concerning). That's why we dont do challenge doses.
There are companies deliberately breeding strains that are less dangerous (attenuated strains) for use as a vaccine, so people are working on that actively. It's not one of the approaches further along in trials though.
He is not a credible source on this, or pretty much anything else. He has some utterly reprehensible views, and is part of a very questionable cult of self-important people.
Meh. I have never heard of him before, but he has a clearly expressed idea which isn't completely unreasonable. I evaluated the idea on its own merits, and that's where I found it lacking. The man matters nothing to me, only his idea.
I submit that this is the only reasonable way of evaluating ideas. We can't all be perfect for all time in history.
Edit. Having now read your link, I am less interested in following his blog, but my analysis of his proposal is unchanged knowing more about him.
One thing to point out is that, as the wikipedia article makes clear, variolation refers explicitly to inoculation with smallpox. What he is proposing is literally just a really mediocre vaccine. Instead of killing or weakening the virus, or expressing subunits to build immunity against, hes suggesting just vaccinating with the normal live virus. And by exposing to a very low dose, it might not even be enough to trigger a strong enough immune response to generate long term memory against the virus, since we're already seeing people with little or no antibody response after getting sick. So of course wed need a rigorous, well run trial to evaluate this, at which point what's the advantage compared to a well made vaccine again? You don't get to have lower standards for your vaccination approach because you call it something else incorrectly.
When he shows any semblance of Skin in the Game and gets inoculated with the virus, then I will think about listening to him.
There is no amount of money that can be paid to someone where there is non-zero risk of dying or having long-lasting damages to your brain, heart or lungs.
> There is no amount of money that can be paid to someone where there is non-zero risk of dying or having long-lasting damages to your brain, heart or lungs
This is trivially false, as people accept money for health risk every day (see: working in medicine, transportation, mining, leaving your house, etc.)
The risks you mentioned are in no way a direct consequence of the actions people take. No one goes to work in medicine with the purpose of getting infected.
Do not think this rhetorical BS trap is believable for a second. This is the kind of crappy thinking and morality that economists and Robin Hanson proponents defend and pat themselves in the back for sounding oh-so-smart.
Regardless of whether death is a direct consequence or an outside risk from the action you’re still just as dead. It might matter for the court system assigning blame but it doesn’t matter from an economic perspective.
> It might matter for the court system assigning blame but it doesn’t matter from an economic perspective.
Right. To which I say that anyone that only looks at things from the economic perspective is an immoral hack that should never be listened to.
Every larger issue, dear to either conservatives or progressives alike, can find its roots in and be justified by some moron looking for solutions exclusively via an economic perspective. It's a danger to society, plain and simple.
It's a global pandemic. We all have skin in the game whether we want to or not. Unless you're suggesting that before writing a blog post, he should do some amateur virology and variolate himself, I'm not sure what point you're trying to make. If you're trying to say Robin Hanson would see this implemented and then not be among the first volunteers, I think you don't know Robin Hanson.
I'm guessing he isn't doing it himself because he's 61 years old. His odds of dying are maybe 10-100x higher than the perfectly healthy twentysomethings that he's proposing for an initial trial.
Well, he is the one that is arguing that there is some linearity between cost-benefit of such a research. So following his own reasoning, as long as he gets 10x-100x bigger payment compared to a twentysomething, all is good and clean.
There are moral considerations to be done before proposing something ridiculous like what he is doing, and yet he is trying to reduce all ethical considerations into a "simple" matter of economics. Life can not be reduced to spherical cows and trolley problems.
I mean "Skin in the Game" in the Talebian sense, so yes, I am saying that he may write anything he wants, but I will only give any credit to his ideas if he actually follows through himself, or at the very very least if he accepts responsibility for any damage that he's done and is penalized accordingly.
Losing money in a prediction market does not count as a proportional penalty for the damage that he might be causing to others.
I know very well what you meant, and yet I still struggle to see what you're actually suggesting that he should have done, besides what he did, which was write a blog post about an interesting idea.
Can you actually make a concrete suggestion or are you just blathering because you don't like the guy? The only concrete thing I can see in your comment is that you won't "give any credit to his ideas" unless he, presumably, tries it himself first (how?).
And what exactly is this terrible damage that he might be causing to others by raising awareness of this idea? Are we afraid of infection from blog posts now?
He would be showing a modicum of Skin in the Game if he actually went to infect himself and those close to him with the virus before encouraging others to normalize such a risky experiment.
> Are we afraid of infection from blog posts now?
He is not just "raising awareness" of the idea of variolation. His writing was already trying to argue that government could try a program where volunteers would get paid to be infected.
When asked "if you think this is a good idea, why don't you do it yourself?" he responded with something along the lines of "there is no counterparty to bet with me on it, so what is the point?" Isn't that the answer of someone completely oblivious to the idea of SITG?
He's suggesting a program of trained medical professionals, isolation, observation, and you think he just ought to go off and infect himself in uncontrolled conditions without any medical training or control group? One of the two of you hasn't thought this through, and I'm pretty sure it's you.
> There is no amount of money that can be paid to someone where there is non-zero risk of dying or having long-lasting damages to your brain, heart or lungs.
Hard disagree based on experience. The clinical testing of many drug classes are entirely dependent on many people being too uneducated or desperate to consider those types of risks.
The fact that something is possible or economically advantageous does not make it moral.
In the crazy scenario that I had to participate in drug trials, I would instate a pretty simple rule: I would only accept those substances if everyone involved in the drug creation and test taking had themselves participated in the trial.
> "In the crazy scenario that I had to participate in drug trials, I would instate a pretty simple rule: I would only accept those substances if everyone involved in the drug creation and test taking had themselves participated in the trial."
That's a simple rule, but it's ridiculous. The costs and benefits of taking a new drug are heterogeneous. Do you think people who develop anti-psychotics should be required to take anti-psychotic medications they have no need for?
No. I do not think that. It does not make my statement invalid. Does it?
(Come to think of it, it is interesting to see how the US is so addicted to pills and the opiate epidemic. The doctors are free to prescribe willingly, receive incentives from pharma companies and there is almost zero downside paid by them for those that get addicted. Don't you think this would be a much smaller problem if there was a way to get Skin in the Game from the doctors and companies and make them pay for cases of opiate abuse?)
Anyway, I was thinking of drugs that may affect anyone, like treatments for common diseases. For those, the idea is that I would like to have some sense of symmetry in the risk taking for all parties.
As perhaps a better way illustrate what I mean: whenever I had to take my kids to the pediatrician, I would listen to the doctor's recommendations and would ask "If it was your kid, would you still do the same you are telling me?"
Here in Germany the practices are way more conservative and less pill-happy in the US, so I can't recall any time where the doctor would propose something that was not willing to apply to one of her own. In Brazil, however, I do remember in 2017 during an outbreak of Yellow Fever when I everyone was rushing to the hospitals to get a vaccine. I talked to a nurse who basically said "If it was my kid, I wouldn't give it. The side-effects are too strong and it is only sensible if you live really close to the Forest." The doctor later confirmed, and we walked out.
I also see zero evidence as to why he should be considered a credible source for effective covid treatments. The man is an economist at a university. Am I looking at the wrong Robin Hanson?