Bryan, thanks for this post. I’m near the end of my career as an internal medicine doctor (first few years) and an anesthesiologist (last three decades). Safety-ism does indeed pervade the profession. It’s a weird combination of paternalism, innumeracy, and some fear of malpractice litigation, though that’s more often used as a post-hoc justification for lazy thinking and for the other silly things we do.
It’s odd; paternalism is officially “out“. We are these days supposed to offer patients our advice, and let them choose (which is often absurd, given the massive knowledge gap), yet we are still paternalistic about the least important stuff. And don’t forget that a number of our specialty societies (looking at you, pediatricians) have decided that their brief is social activism dressed up as “advocating for our patients”.
The massive knowledge gap should mean that patients have an ever greater need for a trusted intermediary. Yet we don’t seem to selecting for that characteristic.
And is it possible that the safetyism can be (at least partially) attributed to measuring “physician quality” based on population level outcomes vs the actual treatment of the actually presenting patient? With the vast majority of physicians being “employed” vs owners of their own practice - loyalty is at best divided between the employer (paycheck) and the patient (mannequin on which to employ “best practices”).
- given you are exposed to tetanus and unvaccinated, you will experience uncomfortable/painful symptoms even if you don’t die
- a vaccinated person when exposed to tetanus will not experience symptoms
- given they don’t experience symptoms, the medical system will have no knowledge of this, so those cases are underreported
your argument seems to hinge on the cost of a bad day from vaccination outweighing statistical seconds of lifespan, but doesn’t take into account benefit of preventing symptoms even if you don’t die
presumably you agree there is a mechanism by which tetanus can harm you and that there is a mechanism by which the vaccine prevents that harm. if you’re taking the outside view and looking at some stats, then i think the stats would likely not adequately capture the harms
I was about to make this point too: Bryan is comparing the (low) risk of death to the unpleasantness of the shot. Why not factor in the unpleasantness of getting a non-lethal case of tetanus? That said, it's likely you still made the correct call. But let's not settle for anything less than full numeracy.
hm actually maybe issue with my reading comprehension. your gripe is specifically with the booster. and apparently someone fully vaccinated for tetanus as a child doesn’t need a booster.
i guess my question for you would be do you think those that weren’t “fully vaccinated as children” need the booster? or do you think even in that case they should reject it?
Yeah for us old guys we've noticed the CDC and WHO are fighting a really slow, and successful, fight to get rid of tetanus boosters. It used to be in the 60s "every time you were deep cut" (got 3 boosters in a single year when I was a rural kid) and then every five years and now every ten. I think this is a rare case where the CDC actually agrees and knows the booster is pointless and has for a long time, but also understand change is generational so is pushing it out at a glacial pace to avoid politics. And it's being successful as it really has no affect on doctors income whereas mammograms, dental X-rays/cleanings, etc all have cottage industries around them.
Yes, as a recently retired doc, my understanding in recent years was that the booster was pointless in those previously vaccinated, with tetanus (rare as it is) effectively never occurring in people who were vaccinated at some point in their life, no matter how long ago.
However, the recommendations were lagging. As you say, it went from “when you have an open wound, give a tetanus booster unless absolutely sure you had one in the last five years (which meant pretty well everyone got one every time, because nobody seemed to remember when their last shot was given)” to “give every five years” to “give every ten years”.
With the rise of guidelines-driven medicine, tetanus vaccine got onto the checklists of things that were often forgotten but possibly should be done, so it became routine to ask about, recommend, and give the vaccine, in order to check a box on a form. I know that in Nova Scotia, where I worked, they introduced a “chronic disease management” incentive fee, applicable to diabetes, etc., and one of the criteria was “vaccines up to date”. At that point, not only were you paid for giving the shot, but you also got an incentive for the chronic disease management (assuming you met the other targets as well).
So, combination of medical practice not keeping up with best evidence, guidelines creating tick boxes and the imperative to do unnecessary things, and financial incentives that don’t make sense.
Yeah it’s an extremely uncomfortable disease, to put it mildly. You also have to factor in the morbidity acquired from being on a ventilator for 6 weeks. Not saying that’s enough to change the decision, but only putting potential death in the negative columns misses the broad spectrum of bad outcomes. This is what makes disease risk difficult to quantify.
> given you are exposed to tetanus and unvaccinated, you will experience uncomfortable/painful symptoms even if you don’t die
This shows the same problem as the community note - it isn't true that the lack of American deaths from tetanus is primarily due to widespread vaccination.
It's primarily due to a lack of exposure to tetanus. As was already noted, tetanus isn't contagious. You have to be doing something weird, like running around barefoot in an area full of metal debris, to get it. (The paradigm case for catching tetanus is someone who steps on a rusty nail; the nail or other metal will have to break the skin.)
The tetanus vaccine isn't like the practice of cooking your food before you eat it, where the world is constantly assaulting you with serious dangers and you need a barrier to hold them off. It's like the practice of filming sharks from within a steel cage. The cage is a good idea, if you're committed to being near sharks, but the threat doesn't exist unless you want it to. My no-cage approach to shark safety is a lot safer than a filming crew's yes-cage approach, with the bonus of a much lower risk of suffocation.
i have no numbers, so it’s just anecdote vs anecdote, but the analogy to shark/cage feels disingenuous. i have never seen a shark in person in my life. i have been inches away from ostensibly rusty metal countless times. on multiple occasions i have cut or punctured my skin with ostensibly rusty metal. i am not some person that works with metal all the time. there is just a lot of metal everywhere and it’s not uncommon for it to rust.
in any case i understand that the outside view is trying to do some very rational analysis on the incidence of tetanus vs the exposure rate vs whatever, but i’m just not sure that’s the approach we should use. it feels blasphemous to say that, but if i put my midwit hat on then it seems ok. i’m surrounded by metal. some of it is rusty. i’ve even punctured my skin with metal. wounds from rusty metal can cause tetanus. tetanus is unpleasant
with that said, i think none of the above is relevant. bryan caplan is making a more nuanced point very specifically about the tetanus booster (not the tetanus vaccine in general). i don’t think i disagree. when i google if the booster is required many sources say no. so now i don’t understand why anyone cares about this topic.
my understanding at this point is that bryan’s doctor suggested the booster when it’s likely this isn’t necessary, bryan tweeted something that is very easy to misinterpet, the internet misinterpreted it, and bryan misinterpreted the internet’s reaction
For what it's worth, the Community Note still exists, but enough people followed up in rating it 'Not Helpful' that it was moved back to neutral status again - where only people who have signed up to do community notes can see it.
Actually an example of Community Notes working reasonably well. There is no central authority you can appeal to to remove them so far as I know, but in this case enough participants saw the issue that they collectively reversed the initial judgment.
I have never experienced any sort of numerical precision with medical professionals. If there's any risk at all, it is lumped together as "there's a risk." And guess what? There's a non 0 risk of anything. So you always get a generic risk disclaimer for everything and learn nothing that directs decision making.
Yeah courts really need to start looking harder at informed consent all around but especially in the medical, legal, and adjacent fields. Informed means "internalize and understand", not "here is a 40 page information dump".
Last year my three-year-old stepped on a nail. TV tells you this is really bad, so we called the pediatrician. He said that since our son had only had one of the two tetanus shots we should take him to the ER immediately to get a shot. When we got there, they only had adult shots, but insisted they give it to him anyway. It wasn't til we got home that I looked it up myself. What a waste of time, a waste of worry, a waste of $ (it ended up costing over $800). And who knows if the adult-sized dose was truly safe for my son. I got a new pediatrician, but I'm still annoyed about it.
To be fair, it's not like doctors are uniquely innumerate. Almost no one I interact with in my day-to-day life understands basic risk tradeoffs, ROI, or other simple numerical arguments. The rare exceptions are people in professions that succeed or fail on the results of those numbers.
The malpractice and tort environment definitely drives a lot of "defensive medicine" but I'd suggest the possibility that the professions, having a defined career pathway and generally more stability than a lot of careers, might have some self-selection for risk averse people. Consider how much of people's reactions to the covid "crisis," or health topics more generally, can be explained using a 2x2 matrix of numeracy vs risk tolerance.
Ideally, I would like to compare the expected negative value of getting tetanus (given I skipped the shot) to the expected negative value of receiving a vaccine injury (or getting tetanus in spite of taking the shot, presumably very unlikely).
Of course, this makes the numbers more subjective, since they depend on how you evaluate the various negative outcomes (death or suffering resulting from either choice). Sticklers for objectivity might want to compare the more observable risks of getting tetanus versus the risk of vaccine injury. For me at least, the needle poke itself is not worth putting in the calculation.
I think you and I put a *massively* different price on the unpleasantness of receiving vaccines. To me, there is some value in getting a vaccine just to prove my manly ability to endure pain. Especially if others know. I like others thinking I'm tough and manly. I like thinking others think I'm tough and manly. I like thinking I'm tough and manly. I remember hwhen I got my CoVid shot that a (male!) friend said he was so distressed by needles, that he needed to relax in a quiet room on a bed after. (Vaccine sites had this setup, apparently, for people like him.) I kinda liked the feeling of smug superiority that I didn't need this. There were only two guys in our friend group (me and him). And about 5 girls. I kinda liked the feeling of being the "alpha male". It's kinda like hwhy people eat hot sauce and watch horror movies, I think. Even if they're not inherently pleasant (I don't think Carolina Reaper adds much flavouring, tbh, and a lot of slasher films are hella boring), there's a certain pride in manliness in showing you can stand this. This, in itself, would almost make me pay about $10 to get a useless vaccine. I would pay more, perhaps, if I wasn't married. Even more if I knew that it would impress a particular chick that I'm interested in or even just other people that I'm trying to impress.
* That being said, yea, I don't particularly enjoy the pain of vaccines. Slightly more than I enjoy the pride of getting one. So, let's say I would pay $15 to avoid the pain of a useless vaccine.
* That being said, there is a low but non-zero risk of vaccine injury from any vaccine due to blood clots, air in the syringe, tetanus from the rusty needle (how ironic!), allergies, etc. I honestly didn't know the numbers before I checked. But here we go: https://www.hrsa.gov/sites/default/files/hrsa/vicp/vicp-stats-07-01-22.pdf
Using the grand totals on page 3, including even the dismissed claims, I find the risk of vaccine injury about 2.25 per million.
Looking at the total awards. I see about $4.8 Billion total paid. That's a little over half a million dollars per claim. If I were to put a value on my own life, I would say about $2 Million USD (current 2024 dollars). But most of these injuries probably aren't deaths. So let's say $1 Million for an unspecified vaccine injury. I suspect a lot of reported vaccine injuries are BS, since a lot of things happen to someone other than the vaccine, so its difficult to say that the vaccine is truly the culprit. But, whatever...
So, $1 MILLION DOLLARS... divided by 4 Billion doses. That's hwhat? .03 cents per dose. Meh, "rounding error". But, tbh, I had actually estimated the risk of vaccine injury at a lot higher before I looked into it for the purpose of this comment. And I'm not even an anti-vaxxer.
There is a small risk of receiving an extra dose of a vaccine, before one is scheduled for it. Like knowingly getting another dose of a Tetanus vaccine within less than 10 years.
Also, the risk of getting in trouble by the medical system. Actually, having a written record of this makes me nervous. But perhaps I am being "innumerate" about that.
If one of y'all were to meet me in person, though, and pay me cash and keep no written records of the transaction, I would probably do it for $10 CAD. Far less than your hundreds of dollars. In the paying people to receive unnecessary vaccines market, I would totally out-compete you, sir!
Also, you travel, right? I think you should also consider your risks in other countries. I can tell you that hwhen a cut my hand on a piece of rusty metal, in the Philippines, I looked up and saw that I had my last tetanus shot less than 10 years ago. So, I didn't have to rush to the hospital and was able to keep my dental appointment. I asked the dentist for rubbing alcohol and gauze, tho. The stress of wondering "hwhat if?" has a cost. And "peace of mind" has a value. That "peace of mind" was worth over 500 pesos to me. (Over $10 CAD).
Now, if I actually had to pay for the vaccine, that's a different story. My initial strategy when I arrived in the Philippines was not to let any stray dog even TOUCH me. That boundary was broken hwhen a hungry pregnant or nursing dog "kissed" me: touched me with her snout. I panicked and rushed to the clinic. They put me as low priority but still gave me my first doses. (Including the Immuno goblin.) And scheduled the subsequent doses. I can't remember the exact cost. But it was about 2300 pesos per dose. I paid for the first one but as I waited, I was able to do more research. The risk of getting rabies from saliva contact with rabies-positive animal without being bitten is less than one in a million. I didn't return for the subsequent doses. There have been some rare cases of rabies remaining dormant for years. But most cases show symptoms within three months. It's been over 2 years now. I'm fine.
Getting rabies PrEP is even dumber! The normal course for PEP (Post Exposure Prophylaxis) is like 4 doses, including a vaccine within 24 hours of the bite. Plus the immuno goblin. PrEP is two doses. But you STILL need another two doses if you're actually bitten. Including on day zero! So you STILL need to rush to the hospital. Now, you don't need the immuno goblin. So that saves you a few pesos. So, you pay 4600 pesos now to save a few pesos on the immuno goblin IF you get bitten! Ridiculous!
So many travel medicine clinics will try to sell you on rabies vaccines. And they're even MORE expensive in the US and Canada. (And not covered by Medicare of most private insurance in Canada!)
Absolutely ridiculous money grab! The only time it might make sense to get rabies PrEP is IF you're going somewhere hwhere you know you can make it to a hospital with the rabies vaccine but NOT the immuno goblin within 24 hours. If you can't get to a hospital with the rabies vaccine within 24 hours, you're screwed, either way! Even if you got PrEP. But hwhat kind of hospital would have the rabies vaccine but not the Immuno goblin. Rare indeed! Especially in countries, like the Philippines, where rabies is relatively prevalent.
Are we talking safetyism, or are we talking about physicians who are really technicians and are simply following guidelines handed down from above in a less than critical, objective manner?
I say this because my physician goes over my yearly bloodwork and physical examine using the computer report generated by the company that does these things. This report describes my “health” in terms of a comparison to the rest of the population numbers and includes pretty graphs/diagrams with a 95% confidence interval. If I vary from that, my doctor is sure to say “harrumph” and begin to recommend we “treat the numbers”!
Of course, as an old academic, I challenge him with a simple question: “What will happen if I exceed the 95% CI”? Of course, then the possible “parade of horribles” is brought out and the pathologies are described as best he can. The next question is inevitably: “Let’s test for those pathologies directly.” We do and we so far have “come up empty”. ;-)
I tend to treat vaccinations the same way. I refused Covid as I already had the disease (if County tests are to be believed), but was quite happy to have taken both a pneumonia vax and the new Shingles vax as it came out. BP is not at the “new” recommended standard, but since it was fine under the old standard, I simply ignore the new standard and live life as I had before.
The yearly cost of having the adult public get a booster every ten years is (quick math, there are ~250 million adults):
25 million people per year x (patient time value + cost of vaccine at doctor's or clinic) =
25m x ($15 + $55) = approximately 1.75 billion.
If half the public is keeping tetanus updated, that's about $850 million a year we're spending to save two people. And if it would cost another $850 to save two more.
Seems as though tetanus boosters should be eliminated entirely.
Bryan, thanks for this post. I’m near the end of my career as an internal medicine doctor (first few years) and an anesthesiologist (last three decades). Safety-ism does indeed pervade the profession. It’s a weird combination of paternalism, innumeracy, and some fear of malpractice litigation, though that’s more often used as a post-hoc justification for lazy thinking and for the other silly things we do.
It’s odd; paternalism is officially “out“. We are these days supposed to offer patients our advice, and let them choose (which is often absurd, given the massive knowledge gap), yet we are still paternalistic about the least important stuff. And don’t forget that a number of our specialty societies (looking at you, pediatricians) have decided that their brief is social activism dressed up as “advocating for our patients”.
The massive knowledge gap should mean that patients have an ever greater need for a trusted intermediary. Yet we don’t seem to selecting for that characteristic.
And is it possible that the safetyism can be (at least partially) attributed to measuring “physician quality” based on population level outcomes vs the actual treatment of the actually presenting patient? With the vast majority of physicians being “employed” vs owners of their own practice - loyalty is at best divided between the employer (paycheck) and the patient (mannequin on which to employ “best practices”).
i’m a little confused here. my understanding is:
- tetanus can be treated even if unvaccinated
- given you are exposed to tetanus and unvaccinated, you will experience uncomfortable/painful symptoms even if you don’t die
- a vaccinated person when exposed to tetanus will not experience symptoms
- given they don’t experience symptoms, the medical system will have no knowledge of this, so those cases are underreported
your argument seems to hinge on the cost of a bad day from vaccination outweighing statistical seconds of lifespan, but doesn’t take into account benefit of preventing symptoms even if you don’t die
presumably you agree there is a mechanism by which tetanus can harm you and that there is a mechanism by which the vaccine prevents that harm. if you’re taking the outside view and looking at some stats, then i think the stats would likely not adequately capture the harms
I was about to make this point too: Bryan is comparing the (low) risk of death to the unpleasantness of the shot. Why not factor in the unpleasantness of getting a non-lethal case of tetanus? That said, it's likely you still made the correct call. But let's not settle for anything less than full numeracy.
hm actually maybe issue with my reading comprehension. your gripe is specifically with the booster. and apparently someone fully vaccinated for tetanus as a child doesn’t need a booster.
http://news.ohsu.edu/2020/02/25/adults-dont-need-tetanus-diphtheria-boosters-if-fully-vaccinated-as-children-study-finds
i guess my question for you would be do you think those that weren’t “fully vaccinated as children” need the booster? or do you think even in that case they should reject it?
Yeah for us old guys we've noticed the CDC and WHO are fighting a really slow, and successful, fight to get rid of tetanus boosters. It used to be in the 60s "every time you were deep cut" (got 3 boosters in a single year when I was a rural kid) and then every five years and now every ten. I think this is a rare case where the CDC actually agrees and knows the booster is pointless and has for a long time, but also understand change is generational so is pushing it out at a glacial pace to avoid politics. And it's being successful as it really has no affect on doctors income whereas mammograms, dental X-rays/cleanings, etc all have cottage industries around them.
Yes, as a recently retired doc, my understanding in recent years was that the booster was pointless in those previously vaccinated, with tetanus (rare as it is) effectively never occurring in people who were vaccinated at some point in their life, no matter how long ago.
However, the recommendations were lagging. As you say, it went from “when you have an open wound, give a tetanus booster unless absolutely sure you had one in the last five years (which meant pretty well everyone got one every time, because nobody seemed to remember when their last shot was given)” to “give every five years” to “give every ten years”.
With the rise of guidelines-driven medicine, tetanus vaccine got onto the checklists of things that were often forgotten but possibly should be done, so it became routine to ask about, recommend, and give the vaccine, in order to check a box on a form. I know that in Nova Scotia, where I worked, they introduced a “chronic disease management” incentive fee, applicable to diabetes, etc., and one of the criteria was “vaccines up to date”. At that point, not only were you paid for giving the shot, but you also got an incentive for the chronic disease management (assuming you met the other targets as well).
So, combination of medical practice not keeping up with best evidence, guidelines creating tick boxes and the imperative to do unnecessary things, and financial incentives that don’t make sense.
Yeah it’s an extremely uncomfortable disease, to put it mildly. You also have to factor in the morbidity acquired from being on a ventilator for 6 weeks. Not saying that’s enough to change the decision, but only putting potential death in the negative columns misses the broad spectrum of bad outcomes. This is what makes disease risk difficult to quantify.
> given you are exposed to tetanus and unvaccinated, you will experience uncomfortable/painful symptoms even if you don’t die
This shows the same problem as the community note - it isn't true that the lack of American deaths from tetanus is primarily due to widespread vaccination.
It's primarily due to a lack of exposure to tetanus. As was already noted, tetanus isn't contagious. You have to be doing something weird, like running around barefoot in an area full of metal debris, to get it. (The paradigm case for catching tetanus is someone who steps on a rusty nail; the nail or other metal will have to break the skin.)
The tetanus vaccine isn't like the practice of cooking your food before you eat it, where the world is constantly assaulting you with serious dangers and you need a barrier to hold them off. It's like the practice of filming sharks from within a steel cage. The cage is a good idea, if you're committed to being near sharks, but the threat doesn't exist unless you want it to. My no-cage approach to shark safety is a lot safer than a filming crew's yes-cage approach, with the bonus of a much lower risk of suffocation.
i have no numbers, so it’s just anecdote vs anecdote, but the analogy to shark/cage feels disingenuous. i have never seen a shark in person in my life. i have been inches away from ostensibly rusty metal countless times. on multiple occasions i have cut or punctured my skin with ostensibly rusty metal. i am not some person that works with metal all the time. there is just a lot of metal everywhere and it’s not uncommon for it to rust.
in any case i understand that the outside view is trying to do some very rational analysis on the incidence of tetanus vs the exposure rate vs whatever, but i’m just not sure that’s the approach we should use. it feels blasphemous to say that, but if i put my midwit hat on then it seems ok. i’m surrounded by metal. some of it is rusty. i’ve even punctured my skin with metal. wounds from rusty metal can cause tetanus. tetanus is unpleasant
with that said, i think none of the above is relevant. bryan caplan is making a more nuanced point very specifically about the tetanus booster (not the tetanus vaccine in general). i don’t think i disagree. when i google if the booster is required many sources say no. so now i don’t understand why anyone cares about this topic.
my understanding at this point is that bryan’s doctor suggested the booster when it’s likely this isn’t necessary, bryan tweeted something that is very easy to misinterpet, the internet misinterpreted it, and bryan misinterpreted the internet’s reaction
You should have asked how much the doctor gets to bill for the shot.
For what it's worth, the Community Note still exists, but enough people followed up in rating it 'Not Helpful' that it was moved back to neutral status again - where only people who have signed up to do community notes can see it.
Actually an example of Community Notes working reasonably well. There is no central authority you can appeal to to remove them so far as I know, but in this case enough participants saw the issue that they collectively reversed the initial judgment.
I have never experienced any sort of numerical precision with medical professionals. If there's any risk at all, it is lumped together as "there's a risk." And guess what? There's a non 0 risk of anything. So you always get a generic risk disclaimer for everything and learn nothing that directs decision making.
How in the hell could you get a shot in Feb. 2020?
Medical professionals are not innumerate per se. On the contrary they are looking after their own bottom line.
"Get the jab. I don't care if you die because a) informed consent b) no liability"
Yeah courts really need to start looking harder at informed consent all around but especially in the medical, legal, and adjacent fields. Informed means "internalize and understand", not "here is a 40 page information dump".
Last year my three-year-old stepped on a nail. TV tells you this is really bad, so we called the pediatrician. He said that since our son had only had one of the two tetanus shots we should take him to the ER immediately to get a shot. When we got there, they only had adult shots, but insisted they give it to him anyway. It wasn't til we got home that I looked it up myself. What a waste of time, a waste of worry, a waste of $ (it ended up costing over $800). And who knows if the adult-sized dose was truly safe for my son. I got a new pediatrician, but I'm still annoyed about it.
To be fair, it's not like doctors are uniquely innumerate. Almost no one I interact with in my day-to-day life understands basic risk tradeoffs, ROI, or other simple numerical arguments. The rare exceptions are people in professions that succeed or fail on the results of those numbers.
No, I have worked with docs all my life. They are absolutely uniquely innumerate (relative to IQ).
I think that’s probably true.
The malpractice and tort environment definitely drives a lot of "defensive medicine" but I'd suggest the possibility that the professions, having a defined career pathway and generally more stability than a lot of careers, might have some self-selection for risk averse people. Consider how much of people's reactions to the covid "crisis," or health topics more generally, can be explained using a 2x2 matrix of numeracy vs risk tolerance.
Ideally, I would like to compare the expected negative value of getting tetanus (given I skipped the shot) to the expected negative value of receiving a vaccine injury (or getting tetanus in spite of taking the shot, presumably very unlikely).
Of course, this makes the numbers more subjective, since they depend on how you evaluate the various negative outcomes (death or suffering resulting from either choice). Sticklers for objectivity might want to compare the more observable risks of getting tetanus versus the risk of vaccine injury. For me at least, the needle poke itself is not worth putting in the calculation.
Interesting piece, again, Dr. Caplan.
A few thoughts:
I think you and I put a *massively* different price on the unpleasantness of receiving vaccines. To me, there is some value in getting a vaccine just to prove my manly ability to endure pain. Especially if others know. I like others thinking I'm tough and manly. I like thinking others think I'm tough and manly. I like thinking I'm tough and manly. I remember hwhen I got my CoVid shot that a (male!) friend said he was so distressed by needles, that he needed to relax in a quiet room on a bed after. (Vaccine sites had this setup, apparently, for people like him.) I kinda liked the feeling of smug superiority that I didn't need this. There were only two guys in our friend group (me and him). And about 5 girls. I kinda liked the feeling of being the "alpha male". It's kinda like hwhy people eat hot sauce and watch horror movies, I think. Even if they're not inherently pleasant (I don't think Carolina Reaper adds much flavouring, tbh, and a lot of slasher films are hella boring), there's a certain pride in manliness in showing you can stand this. This, in itself, would almost make me pay about $10 to get a useless vaccine. I would pay more, perhaps, if I wasn't married. Even more if I knew that it would impress a particular chick that I'm interested in or even just other people that I'm trying to impress.
* That being said, yea, I don't particularly enjoy the pain of vaccines. Slightly more than I enjoy the pride of getting one. So, let's say I would pay $15 to avoid the pain of a useless vaccine.
* That being said, there is a low but non-zero risk of vaccine injury from any vaccine due to blood clots, air in the syringe, tetanus from the rusty needle (how ironic!), allergies, etc. I honestly didn't know the numbers before I checked. But here we go: https://www.hrsa.gov/sites/default/files/hrsa/vicp/vicp-stats-07-01-22.pdf
Using the grand totals on page 3, including even the dismissed claims, I find the risk of vaccine injury about 2.25 per million.
Looking at the total awards. I see about $4.8 Billion total paid. That's a little over half a million dollars per claim. If I were to put a value on my own life, I would say about $2 Million USD (current 2024 dollars). But most of these injuries probably aren't deaths. So let's say $1 Million for an unspecified vaccine injury. I suspect a lot of reported vaccine injuries are BS, since a lot of things happen to someone other than the vaccine, so its difficult to say that the vaccine is truly the culprit. But, whatever...
So, $1 MILLION DOLLARS... divided by 4 Billion doses. That's hwhat? .03 cents per dose. Meh, "rounding error". But, tbh, I had actually estimated the risk of vaccine injury at a lot higher before I looked into it for the purpose of this comment. And I'm not even an anti-vaxxer.
There is a small risk of receiving an extra dose of a vaccine, before one is scheduled for it. Like knowingly getting another dose of a Tetanus vaccine within less than 10 years.
Also, the risk of getting in trouble by the medical system. Actually, having a written record of this makes me nervous. But perhaps I am being "innumerate" about that.
If one of y'all were to meet me in person, though, and pay me cash and keep no written records of the transaction, I would probably do it for $10 CAD. Far less than your hundreds of dollars. In the paying people to receive unnecessary vaccines market, I would totally out-compete you, sir!
Also, you travel, right? I think you should also consider your risks in other countries. I can tell you that hwhen a cut my hand on a piece of rusty metal, in the Philippines, I looked up and saw that I had my last tetanus shot less than 10 years ago. So, I didn't have to rush to the hospital and was able to keep my dental appointment. I asked the dentist for rubbing alcohol and gauze, tho. The stress of wondering "hwhat if?" has a cost. And "peace of mind" has a value. That "peace of mind" was worth over 500 pesos to me. (Over $10 CAD).
Now, if I actually had to pay for the vaccine, that's a different story. My initial strategy when I arrived in the Philippines was not to let any stray dog even TOUCH me. That boundary was broken hwhen a hungry pregnant or nursing dog "kissed" me: touched me with her snout. I panicked and rushed to the clinic. They put me as low priority but still gave me my first doses. (Including the Immuno goblin.) And scheduled the subsequent doses. I can't remember the exact cost. But it was about 2300 pesos per dose. I paid for the first one but as I waited, I was able to do more research. The risk of getting rabies from saliva contact with rabies-positive animal without being bitten is less than one in a million. I didn't return for the subsequent doses. There have been some rare cases of rabies remaining dormant for years. But most cases show symptoms within three months. It's been over 2 years now. I'm fine.
Getting rabies PrEP is even dumber! The normal course for PEP (Post Exposure Prophylaxis) is like 4 doses, including a vaccine within 24 hours of the bite. Plus the immuno goblin. PrEP is two doses. But you STILL need another two doses if you're actually bitten. Including on day zero! So you STILL need to rush to the hospital. Now, you don't need the immuno goblin. So that saves you a few pesos. So, you pay 4600 pesos now to save a few pesos on the immuno goblin IF you get bitten! Ridiculous!
So many travel medicine clinics will try to sell you on rabies vaccines. And they're even MORE expensive in the US and Canada. (And not covered by Medicare of most private insurance in Canada!)
Absolutely ridiculous money grab! The only time it might make sense to get rabies PrEP is IF you're going somewhere hwhere you know you can make it to a hospital with the rabies vaccine but NOT the immuno goblin within 24 hours. If you can't get to a hospital with the rabies vaccine within 24 hours, you're screwed, either way! Even if you got PrEP. But hwhat kind of hospital would have the rabies vaccine but not the Immuno goblin. Rare indeed! Especially in countries, like the Philippines, where rabies is relatively prevalent.
Are we talking safetyism, or are we talking about physicians who are really technicians and are simply following guidelines handed down from above in a less than critical, objective manner?
I say this because my physician goes over my yearly bloodwork and physical examine using the computer report generated by the company that does these things. This report describes my “health” in terms of a comparison to the rest of the population numbers and includes pretty graphs/diagrams with a 95% confidence interval. If I vary from that, my doctor is sure to say “harrumph” and begin to recommend we “treat the numbers”!
Of course, as an old academic, I challenge him with a simple question: “What will happen if I exceed the 95% CI”? Of course, then the possible “parade of horribles” is brought out and the pathologies are described as best he can. The next question is inevitably: “Let’s test for those pathologies directly.” We do and we so far have “come up empty”. ;-)
I tend to treat vaccinations the same way. I refused Covid as I already had the disease (if County tests are to be believed), but was quite happy to have taken both a pneumonia vax and the new Shingles vax as it came out. BP is not at the “new” recommended standard, but since it was fine under the old standard, I simply ignore the new standard and live life as I had before.
Thanks for the information.
The yearly cost of having the adult public get a booster every ten years is (quick math, there are ~250 million adults):
25 million people per year x (patient time value + cost of vaccine at doctor's or clinic) =
25m x ($15 + $55) = approximately 1.75 billion.
If half the public is keeping tetanus updated, that's about $850 million a year we're spending to save two people. And if it would cost another $850 to save two more.
Seems as though tetanus boosters should be eliminated entirely.
Feb 2020 has to be 2021, right?
Innumeracy is the opioid of the masses.
Doctors are not much different.