Robin Hanson has a been a strong proponent of this idea. If you're curious about this subject, this post is a must read:
http://www.overcomingbias.com/2020/03/variolation-may-cut-co...
http://www.overcomingbias.com/2020/03/variolation-may-cut-co...
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.
https://docs.google.com/document/d/1x91Ef7G6xbm77DcRDvjAXbFm...
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?
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.
Though vaccine trials aren't quite as safe for the public as variolation. If a vaccine doesn't work, the person can spread the disease. If variolation doesn't work, then it has the same mortality as natural infection, but afterwards the person is immune and can't spread the disease.
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).
>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.
Of the 79 infected, 19 died. E block (where the index patient was), had 53 infections and 15 deaths for a mortality rate of 28%. Other units had 26 infections and 4 deaths, for a mortality rate of 15%. The death rate of patients in E7 (closest to the index patient and with the highest viral load) was 70%. That's more than 4x difference in mortality based on viral load!
It would be very surprising if low doses of SARS-CoV-2 caused higher mortality. Therefore should allow researchers and volunteers to experiment with low dose deliberate infection. It could save hundreds of thousands of lives.
If there was, no one would consider variolation.
I'm working on just such a public proposal [1] and have been in correspondence with Hanson but haven't heard of any registered.
[1] "SARS-CoV2 Live Virus Skin Vaccine" - https://tinyurl.com/y8ujrcze
Do we really? I don't keep up with the news, did we already dismiss those reports about re-infection? Does it last long enough to be globally useful?
> The main risk is to the volunteer, not to others.
The main risk, sure, but the volunteer will become infectious. Vaccines constrain the risk to volunteers a lot better.
It seems to be extremely rare, and it's hard to know how many of those cases are due to incorrect initial diagnosis or people with odd immune systems. Immunity seems to be much greater than that conveyed by vaccines (which protect 85-95% of recipients).
> The main risk, sure, but the volunteer will become infectious. Vaccines constrain the risk to volunteers a lot better.
In vaccine challenge trials, people are exposed to the virus and kept quarantined until after the incubation period. Those who aren't protected by the vaccine must remain quarantined until their immune system defeats the disease. It would be the same for deliberate infection. Volunteers wouldn't be allowed to leave until the virus is no longer detectable. Hanson makes this clear in his blog post (linked to at the top of this thread).
That said, most vaccine trials are not challenge trials. Researchers give patients the vaccine and wait a while to see how many of them naturally contract the disease. During that time, the patients may or may not have immunity and can potentially infect others.
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.
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.
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.
How else can one describe fraud?
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.)
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.
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.
Losing money in a prediction market does not count as a proportional penalty for the damage that he might be causing to others.
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?
Again: How?
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.
> He's suggesting a program of trained medical professionals, isolation, observation (...) he just ought to go off and infect himself
Yes, that is the point! He is suggesting something that medical experts already consider dangerous and unethical, otherwise it would already be done. He wants medical experts give some veneer of science to something completely immoral just by seeking higher financial compensation to those that might be affected.
So what he is "proposing" involving everyone else taking a lot more risk, without any real consequence for him. This is no display of SITG, quite the opposite. He just sees it as a game of "Heads some might lose their life, but tails we might win a little, so let's find the price point where this is even".
By asking if he is willing to infect himself to do it, it is not a matter of doing it for the science or the economics of betting. It is just a pure ethical filter: "So far your words only risk the lives of others, but if you really think this is the best course of action then you need to demonstrate you are willing to put your ass on the line. Can you?"
You demonstrate utter failure to understand the idea. A controlled, known, small viral load is the idea. Controlled: not from a random walk through a hospital, but administered under controlled conditions. Known: a measured quantity, not an unknown quantity from a random walk through a hospital, of a known viral strain. Small: maybe 1/50th the kind of load you would get if you were exposed in a busy hospital and someone sneezed on you.
You so spectacularly missed all these points that it's clearly not worth continuing this conversation further.
Let me try again: there is a reason that no one is doing "small, controlled, small virus load experiments": it is because they are illegal, unethical and potentially bring more harm than benefit. If they are supposed to be done properly, they should be done with the same standards that are adopted for those that want to develop vaccines and other medicines.
What Hanson is proposing requires doctors and scientists to drop already established ethical principles and adopt practices that have unknown risks and can be potentially catastrophic.
He puts it as the whole "we already test vaccines on humans, and vaccines are made from the virus itself, so why not just test the actual virus" was just an issue of testing on dosage/response. He wants to argue that the risk people take is just proportional to the amount of contact they have to the virus.
It is not. Just as an example: suppose that inoculation by a weak version of the virus does not help our immune system to create antibodies and just instead make us more susceptible to a future, more lethal mutation of another Coronavirus? This is a very-tiny-but-plausible possibility, and that alone should stop us from abandoning current safe practices for research.
He wants you and I and other doctors to just squint our eyes and pretend it is okay to do what he is proposing if the participants take a little bit more risk (compared to drug trials conducted ethically) and that just by compensating them properly, it would be fair and ethical.
It is not. Trials for drugs and vaccines go through a bunch of other steps before to try to determine its safety on humans. He sidesteps the whole thing and wants medical practices to go back centuries in time for no good reason other than "economic theory"
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So, we have this guy who is trying to convince others to take risks of unknown magnitude and to break traditional practices with unknown benefit. We have this guy who is willing to play fast and loose with the rules without ever facing any consequence of the potential downside of these measures.
What do you do with it? What I am saying is that anything he is defending should not have any weight until he shows willingness to face the consequences of his risky proposal. And given that we do not know the behavior of the virus and we do not know what are the "safe" parameters for it, the only way that he can show SITG is by facing the highest possible risk.
This is why I say I don't particularly care about the practicality of it all. There is no way to quantify the risk anyone is being exposed to it, so whoever is asking others to take the risks should give the example by taking the maximum risk possible. And it is not that he is making himself "more right" or "less wrong" (pun intended) if he does show SITG. It is just that I am just allowing myself to take any risky proposal into consideration when those doing the proposal are also facing the risks. It is a simple filter.
I hope at least now I could make myself clearer. Thanks for the discussion anyway.
Agreed.
I didn't read his post as saying that the payment had anything to do with the ethics of it, and we routinely pay participants in clinical trials for their time. I don't see the idea as something that's impossible to do ethically, and you do, but apart from that we are in agreement. Thanks to you too.
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.
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.
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?
(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.