> 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
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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
"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.
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.
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.
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.
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...
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.
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.
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 it before the article was over - I simply never knew such a thing was on the table.
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?
> 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.
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.
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].
> 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).
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.
Vaccine makers could lobby the government to make the vaccine mandatory, thereby guaranteeing a revenue stream for the vaccine to reduce the financial risk.
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.
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.
> 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
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.
That’s because you don’t understand what group A strep is or what it means to eliminate it
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.
But vaccines are very effective.
Vaccines are sometimes very effective. But against "over 200 known types of strep A, distinguished by their unique M proteins"?
Has there been a vaccine like that?
There’s lots of multi-valent vaccines, the HPV vaccine being a good example. There’s also potential non-M protein targets.
https://www.nature.com/articles/s41541-023-00609-x
Public health tends to take the view that access to antibiotics is already too high, not too low.
Working as an infectious disease epidemiologist in global health, that’s not the take.
The inappropriate use of antibiotics is too high, and simultaneously there are very real issues of access.
Not in the example given there.
It is, it's preferable to have no antibiotics than not enough antibiotics. This only creates resistant strains and doesn't heal people.
Is it preferable to have none or enough?
In other words, poverty is the real problem.
Ignorance is the problem.
Plenty of wealthy people are taking horse deworming medicine for political purposes.
A mix of both, the poverty creates some of this ignorance by lack of access to education.
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 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.
> Plenty of wealthy people are taking horse deworming medicine for political purposes.
Don’t understand this
This I think https://www.independent.co.uk/news/world/americas/covid-iver...
Though that was a bit 2020. Not sure it still goes on.
Interesting. It won the Nobel prize for human applications long before it was considered a veterinary drug so I am still puzzled.
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.
The “they” being wealthy people? I am skeptical. I know many of them.
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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).
This was by far the worst illness I can remember.
>I had a fever dream that my brother had called an ambulance to save me.
Reminds me of this, people imagining a helping person or spirit in a dire situation: https://en.wikipedia.org/wiki/Third_man_factor
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.
Strep is a bacterial infection, and I'm glad you recovered without antibiotics.
Thank you. Had I been smarter I would have just called an ambulance, like what my brother did in my fever dream.
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.
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.
> What if no one died for three days?
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.
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.
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.
In terms of difficulty, perhaps. In terms of significance, it's an achievement on the same scale as sleeping late on the weekend.
I think it's weird (and a bit callous) that you'd so casually dismiss the idea that saving 500,000 lives a year is something significant.
That's easy to say, but not productive. What are the diseases that kill the most people we should be working on?
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.
> 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.
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.
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.
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.
Cardiovascular diseases, cancers, respiratory infects.
Strep A is technically solved due to being easily treatable with common antibiotics.
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...
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.
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.
Especially for diseases that can be cured with regular antibiotics, but aren't due to different reasons
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 it before the article was over - I simply never knew such a thing was on the table.
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?
> 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.
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.
You realize tautology is a logical fallacy, right?
It's like saying "A beginner is new to a subject." That's tautological since the definition of beginner implies being new to a subject.
Those aren't logical fallacies; they're just not very useful.
Huh? A tautology is a statement that is automatically true by the laws of logic.
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].
[1] https://en.wikipedia.org/wiki/Begging_the_question
[2] https://en.wikipedia.org/wiki/Tautology_(logic)
> 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).
The point is that it's an overloaded term, which makes it easy to talk past each other.
If you wish to see usages like I described, have a look here.
https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...
It is not. It is actually quite the opposite.
It sounds somewhat comparable to the Hepatitis A vaccine and I'm not sure many are sprinting to the pharmacies although it is moderately successful.
It would depend on the efficacy and the length of time its effective.
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 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.
And the wealthy country here just means United States. It is the only country where pharmaceutical companies could sell their products at any price.
Vaccine makers could lobby the government to make the vaccine mandatory, thereby guaranteeing a revenue stream for the vaccine to reduce the financial risk.
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.
Okay suppose the government commits to pay for it and keeps coercing people to take it. What happens when:
(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.
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.
We have also had many successful wars. Doesn't mean wars are the best way to solve issues.
I was actually thinking of Gardasil but yes, it could be applied to anything. It was not meant to be political.
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