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Comment by bruce343434 | Hacker News Reader

Imagine being the head of the FDA. Given the variance in human bodies and how they respond to drugs, you really are bound to kill people. Even if you minimize it, there's still a "baseline" of deaths that you can not drive to 0.

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This thing is not "0 deaths"... it's "be conscious of every death you're responsible of and do your best to minimize it". That's why resignation is not really an option: some humans could be better than you, other will be worst, but the plot is that someone will have to face this reality. And this reality will have to be shared with everybody on C-SPAN.

And what about, something like, say, the measles vaccine? Before the vaccine, everyone caught measles and 1 in a thousand died from it; after the vaccine, almost nobody catches measles, but 1 in a million die from reactions to the vaccine. I guess not approving the vaccine means the FDA director has to kill 1000 puppies, and approving the vaccine means the FDA director only has to kill one?

> but 1 in a million die from reactions to the vaccine.

That... seems high?

I couldn't find any more info with a quick search as the results were polluted with articles about measles deaths, which also mentioned vaccination. Do you have any links to hand with decent stats for that, or a good set of search terms I could use to find out more myself?

The "1 in a million" number I believe got directly from the CDC website a number of years ago. I couldn't find a specific number there there now, but you can look at the statistics from the National Vaccine Injury Compensation Program (VICP). At a quick glance, it looks like they have criteria [1] for when they'll automatically pay out; this includes, for example, having anaphylaxis within 4 hours of receiving the vaccine.

According to the stats [2], there were 134 million MMR vaccines administered between 2006 and 2022, and 28 "compensable concession" claims -- where the Department of Health and Human Services determined that compensation was warranted; and an additional 124 claims where they ended up paying but don't necessarily admit that it was warranted (either ordered by a court or settled out of court). That's about 1 in 1 million for claims paid out, and 1 in 4 million for "concession" claims.

There's no indication in [2] of exactly what the claims were for; looking at [1] it could be anything from death from anaphylactic shock to even include things like "Shoulder Injury Related to Vaccine Administration".

This page has some investigation about deaths related to various vaccines, including the MMR vaccines [3]. A lot of the deaths were related to children with a compromised immune system or unsanitary conditions; the report says that there was evidence that MMR sometimes causes anaphylaxis, and that anaphylaxis can be fatal, but that they didn't have any actual instances of MMR causing fatal anaphylaxis.

Regarding the original point though: even if deaths are due to unsanitary conditions or compromised immune systems, and even if modern medicine can often successfully intervene to prevent death in the case of anaphylaxis, the fact is that injecting things into the body has an inherent risk, no matter how small. But the risk of not doing the injection is far higher. We'd like there to be an "always safe" option, but that's not the world we live in.

[1] https://www.hrsa.gov/sites/default/files/hrsa/vicp/vaccine-i... page 2

[2] https://www.hrsa.gov/sites/default/files/hrsa/vicp/vicp-stat... page 3

[3] https://www.ncbi.nlm.nih.gov/books/NBK236284/

Yeah that's literally the trolley problem -- do you kill the 1-in-a-million person (due to adverse reactions to vacine) to save the 1-in-a-thousand people (who didn't catch measles due to vaccine)?

Of course you do, at least you do if you're the head of a public institution (who should be treating lives equally). But that's probably what GP meant by "bound to kill people".

The trolley problem is just a fun/meme way to visualize the choices influential people have to make daily. [And, FWIW, like the trolley problem, the choices get harder if you have a non-"neutral" agenda, i.e. when you can't just tally the number of lives impacted and abandon the group with less lives involved.]

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