__blockcipher__

Honestly I don't think it's that they identify as entrepreneurs or business owners, I think it's just that they identify as progressives, and there is an incredibly prominent pro-censorship current in modern progressive ideology. I say this because I've definitely interacted with many people in real life who are not the "entrepreneur" or "pro corporate" types yet happily cheer on the censorship being practiced by big tech and the like

I mean it’s an implicit negotiation of sorts. If you can routinely leave work early and not get penalized for it, you’ve basically “negotiated” that arrangement.

This all comes back to the fact that everyone should be protective of their time. I’m single but regularly run errands, exercise, go grocery shopping etc in the “middle of the workday”. I get my work done. Nobody complains.

It’s just a matter of knowing and recognizing your own value.

JFYI comments like these are very likely to trigger flame wars and the like

I think most people would have expected it to. Whether that's a reasonable expectation or not is up for debate. But yeah, many if not most people in the US were convinced that COVID was a threat so severe that it warranted completely uprooting life as we knew it. A sizeable minority of people are convinced that COVID vaccination is so important that people should be coerced into it by almost any means necessary. So I think understanding that we don't have a single randomized controlled trial that actually shows a reduction in all-cause mortality when given this intervention is pretty important.

It's a general principle of medicine (or at least, it used to be) that the important outcomes are the actually clinically relevant outcomes. Did people die less? Did they achieve a better quality of life? When you get into proxy metrics you get to this weird place where you can show that something is insanely effective for proxy metric X, and yet it makes no difference (or is even deleterious) in thing-you-actually-care-about Y.

[meta: this was supposed to be a quick response and then I ended up getting real longwinded]

Glad you got some value out of my comment!

Thanks for the feedback on my tone. In particular the references to specific examples was very helpful to me. I’ll [try to] be mindful of its effect in the future.

Not that it's necessary but just because it's kind of interesting to psychoanalyze, I think some of the tone comes as a [maladaptive] response to past times on HN where I'd go really deep into analyzing certain studies, etc and then would get downvoted or even flagged because the conclusion was that lockdowns were deleterious or that mandates are a bad idea, etc.

The binary thinkers comment specifically (you're right that it will tend to put people off btw) was because in general (not just on HN) it happens all the time that if I point out, say, how we don't even have an RCT that shows a reduction in all-cause mortality from getting COVID-vaccinated, very often I'll get a response to the tune of "Ivermectin doesn't even work you dummy" because most people seem to only have two boxes to put people in (you're either team trump or team biden, team vaccine or team ivermectin, etc). But obviously even if I had done it in a more diplomatic way, making reference to people being binary thinkers is only going to distract from the actual points being made.

I am curious of your mentioning of being offput by "to quote the great...". Did it sound like I was being sarcastic, or was it something else about it? Because I intended it in the literal sense, i.e. indicating my respect for Stegenga and his work.

---

Back to the actual study:

> One possible reason for this surprising result is that only a small fraction of people - even in the placebo group - caught COVID at all. I'm not sure how to account for possible missed infections but Figure 2 of the main text indicates that 0.08% of the placebo group became CASES (which I think means something like "person felt bad enough to see a medical professional, who then diagnosed them with COVID"), and the table in Figure 2 indicates that there were 1034 "occurrences" out of ~22,000 people in the placebo group (which I read as "~5% confirmed infections").

Yes. I suspect that this is partially due to the fact that they actually take some steps to confirm that it really is COVID, whereas in the real world (at least in 2020, but probably still now) they'd run a PCR test with an absurdly high cycle threshold cutoff and then call that COVID even if you were completely asymptomatic (which as an aside is an oxymoron because COVID is supposed to stand for "Coronavirus Infectious Disease", and yet an asymptomatic individual is not diseased (nor are they very infectious btw)). So one interpretation is that when care is taken to actually be somewhat careful about calling something a COVID case, that the prevalence of COVID infection ends up being quite low. Whereas when that care is not taken (whether due to negligence or institutional incentives to drum up case counts / fear in general) you end up with much higher apparent case counts.

This is quite speculative, I know. I'd really like to look at a chart of reported COVID cases in the US versus the rate of cases in this trial. I'd be curious if they are similar shape / relative magnitude, or if there's dramatically more cases in the US in general than the laboratory-confirmed cases in the trial.

I couldn't actually find an actual case definition (maybe it's in the supplement?) but I found this under the Efficacy subheading in the main text:

> BNT162b2 efficacy against laboratory-confirmed COVID-19 with onset ≥7 days post-dose 2 was assessed descriptively in participants without serological or virological evidence of SARS- CoV-2 infection ≤7 days post-dose 2, and in participants with and without evidence of prior infection. Efficacy against severe COVID-19 was also assessed.

So I think that means when calculating their overall VE number, they don't "start counting" lab-confirmed COVID-19 until it's been at least a week post second dose. I do know in general in these trials they like to play that game (ignoring infections before the "fully vaccinated" cutoff to get a better-looking VE number). Although Figure 2 seems to provide numbers starting immediately after dose #1 so I suppose those numbers tell us that while VE is quite bad immediately after the first dose, its expected value doesn't seem to be negative (at least in this cohort)

As an aside, I'd note that they blew up the control arm after 6 months, so this is basically the only clean data we're ever going to get. Which should be very concerning to people considering the enormous push to mandate vaccination for an intervention that has never been shown to reduce all-cause mortality in the studied populations.

> So, it's possible that the beneficial effect of the vaccine is still hidden in the statistical noise since there have been so few infections in the placebo group. It's also possible that some people _were_ harmed by receiving the vaccine (see table S4 [2]), so there's a fixed harm upfront to the vaccine group, which may eventually be surpassed once more of the placebo group gets infected.

Unless the data is doctored or has some flaw that I'm not seeing, I agree that a much higher base rate of COVID infection would probably have shown a positive effect on mortality. Which brings us back to #1 of the 3 possible explanations I gave in my original comment. I find it very interesting that actual COVID mortality (or even bad outcomes) were so rare in this cohort of >44,000 people, that a well-over-90-percent-effective-in-reducing-COVID-mortality intervention literally did not make a detectable effect on net mortality. I think from a societal perspective it's quite interesting because during the time this trial was running, people were (and still are btw) getting bombarded by fearmongering, giant red eternally-incrementing "live" death tickers, etc.

It doesn't take some grand conspiracy to see why that might be, but I think it's something interesting to reflect on. It's a large part of why COVID took me from kind of libertarian leaning to full-blown anarchocapitalist, because I am personally so disgusted by what the media, the public health "authorities", and "polite society" at large did in terms of catalyzing such tremendous suffering on a worldwide scale (via the hysteria, global supply chain disruption, missed medical appointments, cancelled elective surgeries, and outright authoritarian/totalitarian public policy), for something that for most people, they would literally never notice if not bombarded about its existence.

Thanks for that context. I learned a bit about something new :)

Fun fact: the trial you referenced failed to show any benefit of COVID vaccination in reducing all-cause mortality in the population they studied:

https://www.medrxiv.org/content/10.1101/2021.07.28.21261159v...

> During the blinded, controlled period, 15 BNT162b2 and 14 placebo recipients died; during the open-label period, 3 BNT162b2 and 2 original placebo recipients who received BNT162b2 after unblinding died. None of these deaths were considered related to BNT162b2 by investigators.

There was actually one more death in the experimental group, albeit that's not significantly significant.

So some combination of the following must be true:

(1) The vaccination is effective at reducing COVID mortality, but COVID mortality for people in the trial was such a joke that eliminating 95% of COVID mortality doesn't actually change one's risk of dying in a non-negligible manner

(2) The vaccination is effective at reducing COVID mortality, which does spare lives, but it ends up killing just as many from adverse events / side effects

(3) The vaccine isn't effective and they doctored the numbers.

My money is mostly on (1) with a sprinkling of (2), personally.

---

And since people like to be binary thinkers, this is where I mention that I'm not an Ivermectin shill and as a medical nihilist I'm strongly skeptical of treatments in general. And while I haven't looked at the IVM data very much at all, what I have seen is incredibly weak evidence at best, as well as a bunch of really crappy associative arguments from the IVM crowd ("Africa uses IVM and Africa has less COVID mortality than the US!" as if that proves anything)

To quote (slightly paraphrased) the great Jacob Stegenga:

> If we consider the ubiquity of small effect sizes in medicine, the extent of misleading evidence in medical research, the thin theoretical basis of many interventions, and the malleability of empirical methods, then our confidence in medical interventions ought to be low.

I think this is very unlikely to significantly explain what we’ve seen. It’s much more likely just the natural result of artificial immunity waning much more rapidly than naturally acquired. As well as the fact that natural immunity involves exposure to the whole virus and therefore much broader types of epitopes for the immune system to “learn”.

Just out of curiosity- they used to be a christian scientist and now they’re not and go by xe/zir style pronouns? That’s quite a journey if so.

As for J&J, yes it’s generally the fact that it’s one and done so it feels less risky to people that didn’t want to get vaccinated. Then there’s the whole mRNA thing as well.

Sunlight exposure causes nitric oxide release (which itself will have downstream effects on neurotransmitters). That's probably what you're feeling if I had to guess.

FWIW the best way to get a feeling for what serotonin feels like is doing MDMA since it dumps massive amounts of serotonin out. It dumps plenty of dopamine too - it wouldn't be nearly as fun without that - but the unique "rolly" feeling is very attributable to serotonin.

Not advising people take MDMA just to figure out what serotonin feels like, but for those who have it's very helpful to sort of "recognize" what different neurotransmitters feel like

I don't think the article touched on it, but an interesting point is that dopamine is not just the reward but also the anticipation / prediction of reward. And there's some interesting literature basically showing that the reward system of the brain is a prediction network of sorts and that the magnitude of error in its prediction correlates with how rewarding something is; that is to say, that how rewarding something is is as much a function of the expectations going into it as it is of the activity itself. (I don't mean expectation in the sense of the high-level ego's expectation of an event but rather of the lower level reward processing system's expectation)

Here's a reference on dopamine wrt reward prediction error: https://www.frontiersin.org/articles/10.3389/fpsyg.2017.0024...

And here's one that kind of builds on that theory and proposes a sensory prediction error. Haven't read this paper yet: https://royalsocietypublishing.org/doi/10.1098/rspb.2018.164...

---

Anyway as far as the article itself, the point that dopamine is oversimplified is very important but I felt the author did a frankly terrible job making that point. And they tied in a bunch of irrelevant stuff ("dopamine is a vasoconstrictor"...true but it's a bit of an implicit strawman to act as if the people talking about dopamine addiction think that its ONLY purpose is as a reward chemical)

Your priors are messed up then.

BTW the feeling of being sick is literally the feeling of your immune system doing its thing. No immune response = no sickness symptoms (until huge swaths of your body have been destroyed by the pathogen)

It’s definitely theoretically possible but having been pretty involved in the scene I’ve only ever seen LSD, shrooms, and other classic psychs bring out psychosis/schizophrenia in people who were probably going to develop it anyway (or at least were pre disposed). This was around college age when schizophrenia usually emerges. In general they don’t seem to cause mental illness in people who weren’t already pre disposed. (Obviously this does not mean psychs should not be treated with enormous respect)

I’ve seen a lot of people get low-grade cognitive dysfunction from mdma abuse (neurotoxicity due to “doing it wrong” ie overheating/overdosing), and while not in the class of drugs we’ve been discussing I’ve seen xanax ruin more lives than any other drug by far

Something like 10% of MDMA is converted to MDA on average (this varies heavily based on genetics) so it’s not super surprising. I totally agree it’s not talked about nearly enough though. I haven’t had visual hallucinations (assuming we’re talking actual hallucinations not “visuals” like tracers) but have definitely had auditory hallucinations where it sounded like people were talking just outside the car my friend and I were cuddling in.

Even with pure MDMA a lot of the time 100mg - while an amazing time - isn’t really the “fun dose”. Ideal for me is 250 across a night (maybe 125 then 75 then 50) if it’s like a full on music festival. In a mellower context (camping or a house roll or something) I’d recommend one 100mg dose and no more though

Just out of curiosity, did you get COVID first and then decided to get the vaccine later on? Or was it the other way around? I'm guessing the former - I've had friends who had COVID and their doctors still advised them to get the vaccine - and find it quite troubling if so. We've known for so long now how robust natural immunity is - and before we "knew for sure" any sane person's priors would still assume natural immunity works the way it does for any other respiratory pathogen - yet there was a concerted institutional/media push to act as if immunity literally didn't exist, or the more subtle form that immunity might exist but that vaccine immunity is "better".

Not that it's super relevant but the friends I mentioned were mid 20's and in fine health, no weird immune disorders or anything, so the fact that their doc advised the vaccine was frankly just negligence in my book.

The study you linked does not prove what you think it does. Check out the inclusion criteria:

> Inclusion criteria were a first COVID-19 diagnosis during the April 1, 2020 - March 31, 2021 time period, with an outpatient visit 1 month to 2 years before, and another 6 months to 2 years before that

To actually compare fairly against vaccination, you need to compare the infection myocarditis rate, not the case myocarditis rate. (Technically you should really compare infection myocarditis rate * chance of actually getting infected w/ SARS-2 [while very slightly adjusting for time decay], but let's ignore that especially since the chance of getting COVID over a 2-3 year window is quite high)

So the study you linked will give an unfairly high estimate of the rate of myocarditis. This is the same principle as the fact that looking at hospitalized COVID-19 patients will show much worse effects than looking at rates of bad effects for all PCR+ individuals, and even moreso if extrapolating from serology.

The efficacy is “recovering” because the vaccinated are acquiring natural immunity. The way you / sailorrooscout present it obscures that simple fact.

What happens if they don’t pay the fees?

Sorry if I wasn’t clear enough. It’s being used in places like Biden’s federal mandate that will (when they announce the actual OSHA rule) slap private companies with massive fees if they have unvaccinated employees

> Israel has some great data on the combination of various number of doses and natural immunity, and the combo is very strong.

https://pastebin.com/8yR3y5NA

The best study on this actually found no significant difference when giving a single shot to those who were naturally immune. Which makes sense because the chance of reinfection is so incredibly tiny that even if the shot completely eliminated the chance of getting COVID, the absolute size of the effect is still going to be quite small.

> Additionally, the spike protein is the least likely mutation to enable escaping, as it both has to modify to be different enough from the original, plus somehow still be able to attach onto our cells with similar level of infectiousness.

But you don't have to choose just one part. You could have an inactivated whole virus vaccine. That avoids the whole issue.

FWIW we are already seeing point mutations on the spike developing. That's probably why Delta is so damn good at spreading, right? The Israel data suggests a VE of ~39% against Delta. I personally don't believe Pfizer's original 95% VE number, but if you do, that's a startling drop.

Sorry, where are you getting that quote? I couldn't find your quote on the page. Anyway, that quote doesn't disprove the points I made whatsoever. The number needed to treat is enormous, and there's no detectable benefit on either hospitalizations or missed days of work:

> Injected influenza vaccines probably have a small protective effect against influenza and ILI (moderate-certainty evidence), as 71 people would need to be vaccinated to avoid one influenza case, and 29 would need to be vaccinated to avoid one case of ILI. Vaccination may have little or no appreciable effect on hospitalisations (low-certainty evidence) or number of working days lost.

That's literally the spitting definition of "barely better than placebo" in my book.

> Sure it does. You will get COVID. You'll either be vaccinated at the time or you won't be.

That may be true, but it's another non-sequitur. You need to show that the acute and long-term risks of me receiving the moderna or the pfizer or the j&j, is lower than the risks to my health from getting COVID-19 while unvaccinated. And first you need to know whether I've already had COVID, because that's highly relevant to that calculation.

---

I think you're missing the general principle here, so let me see if this hypothetical helps you. Imagine a hypothetical virus that spreads just like SARS-2 but has a 0% IFR, no symptoms, and no complications whatsoever, whether short or medium or long term.

Imagine a vaccine that is 100% effective at preventing this hypothetical 0% IFR virus from infecting me. Imagine that in 99.9999% of people, the vaccine causes no harm, but in that .0001% of people, it causes harm.

Which is more dangerous to me, getting infected with the hypothetical virus, or getting vaccinated?

Well personally I'm an ancap so I consider all laws/executive orders to be implicitly (and often explicitly) backed by the police power of the state. You can say that the government requiring employees to be vaccinated isn't violent police power because they're not holding them down and injecting them, but what exactly will the state do if the employer doesn't comply? They'll send in the guys with guns to enforce.

Really it's such a small thing to be splitting hairs over though. If you prefer, just read what I wrote and mentally s/violent police power/coercion

Oh dear. I really don't care what Fox News does. It is very sad to me that this passes as an argument for you. I don't care to speculate on the motivations of a giant corporation. It's also not even true that Fox is "anti vax" - you can find videos of Sean Hannity and the like imploring their audience to get vaccinated. Fox, like all media, makes an enormous portion of its ad revenue from pharmaceutical companies. So you're not even right on your characterization of Fox's stance. Fox is largely pro-vaccine. Trump is pro-vaccine. All the mainstream republicans are pro-vaccine. And none of this is at all relevant, so why are we wasting time talking about it?

I already said (in the comment you directly replied to) why I personally am not getting vaccinated against COVID. I don't understand where your rambling diatribe about Fox News comes from. I gather that you might be a binary thinker that thinks that everyone fits into a red or blue, left or right, democrat or republican, etc box?

> People are opposed to being vaccinated because of a coordinated media campaign put out by elements in the mainstream media

This is an unfounded assertion. And also simply not true BTW, at least for all of the unvaccinated people (myself included) that I know in my personal life.

> Your risk from the vaccine is lower than your risk from Covid

You don't have the necessary information about my demographic and medical history to be able to make this claim. The following statement of yours is a non-sequitur because it in no way proves the claim of yours that I am at greater risk from SARS-2 infection than I am of a COVID vaccine:

> because you know the Covid disease creates fully functional viruses whereas the vaccine only incorporates a small subset that cannot reproduce. Why you would want the fully functional version is beyond me.

> Why people choose to deviate from a very clear dominating strategy is simply not necessary for me to understand or research.

It's very important for you to understand if you hope to impact the behavior of people who don't share your beliefs. Or am I misunderstanding and you live in a universe where you can wave a magic wand? If so, I'd recommend just using that aforementioned wand to eliminate all mortality :P

> Its from understanding the science of vaccines and the exponential mathematic of pandemics.

It's logistic, not exponential, because the exponential growth tapers off as the proportion of immunity increases. This might seem like a nitpick*, but it's very indicative of the inability of those in your camp to foresee higher order effects. From a purely societal perspective, these vaccines do not offer anywhere near enough protection to actually avoid the propagation of the virus. All they've done is create a rich population of SARS-2-naive vaccinated individuals who provided perfect substrate for a variant like Delta, which possess point mutations on the spike, to rip through the vaccinated (given that, insofar as the vaccines were reasonably effective against "alpha", they prevented the vaccinated from acquiring natural immunity). It is no coincidence that a strain that largely-but-not-entirely bypasses vaccine immunity is now by far the most dominant strain here in the US.

* granted you could counter-nitpick me here by pointing out that the pandemic phase is specifically the exponential part of the epidemic curve

> But in the meantime, people like kids, the especially vulnerable, and those who cannot medically take the vaccine are put at risk.

Kids are not at serious risk of COVID-19. How can you claim to "understand the science" if you won't even admit this very basic fact? The infection fatality rate of COVID-19 is dramatically lower than Influenza, and we never pulled kids out of in-person schooling for two years straight when presented with pandemic Influenza. (Yet if we applied COVID risk standards, we would have)

Note that this is usually where people come in and make a bunch of unfounded assertions about long COVID and how the kids will be crippled for life. I hope you're not going to take that route :)

> the especially vulnerable, and those who cannot medically take the vaccine are put at risk.

Ignoring the ethical issue of how much responsibility someone has to ingest a pharmaceutical product with no manufacturer liability, I think a much more accurate statement is that those individuals are put at risk by those who have not acquired natural immunity. Briefly:

The difference between a SARS-2-naive vaccinated individual and a SARS-2-naive unvaccinated individual is real, but quite minor in the context of Delta in terms of infection & transmission. The difference between a SARS-2-recovered unvaccinated individual and a SARS-2-naive vaccinated individual is absolutely massive. (https://pastebin.com/8yR3y5NA to avoid cluttering this comment)

So, while ethically I don't accept the notion of assigning blame to transmission of highly infectious endemic respiratory viruses, if we're gonna assign blame, the relevant criteria is "previous exposure to SARS-2", not vaccination status.

> Because we know for sure that Covid infection causes significant long term damage in at least 10% of cases.

Where are you getting your information? Your mayoclinic link doesn't make this 10% claim, nor did you provide any citation for it. I'm genuinely shocked by how divorced from the clinical reality your claims are.

SARS-1, which is SARS-2's less infectious but much more deadly older brother, didn't even cause long-term damage in 10% of cases. And you're trying to claim it for SARS-2, which is a virus where many who are infected will never even know they had it (if they don't get tested)?

Your claims are unfounded and, quite frankly, simply false. There's nowhere near 10% occurrence of "brain damage", scarred lungs, or "some other organ malfunction". (The vagueness of your terminology betrays you, btw)

Since you almost certainly haven't read any literature, let me provide you some reading material. I'll stick to just the lung issues subclaim. Some of these are on the older side but they're still relevant:

["Follow-up Chest CT findings from discharged patients with severe COVID-19: an 83-day observational study"](https://www.researchsquare.com/article/rs-27359/v1) - First Submitted May 4 2020, Published online May 12 2020

> Radiological abnormalities in patients of severe COVID-19 could be completely absorbed with no residual lung injury in more than two months’ follow-up.

^ note this is severe COVID-19, so that's from a population selected for severity of symptoms and they're still recovered by 2 months.

https://onlinelibrary.wiley.com/doi/full/10.1046/j.1440-1843... (SARS-1 pathology)

> Preliminary evidence suggests that these lung function abnormalities will improve over time

> 99.2%

I would use 99.7% as a fairly conservative number, frankly: https://www.who.int/bulletin/volumes/99/1/20-265892.pdf

Anyway, the other point is that that number is the overall IFR. If, like me, you know you're in a category that has almost no risk from COVID, then it's even more of a no-brainer. That's why it's completely absurd that the GP tried to tell me that I'm at less risk from the vaccine from the disease, when they don't know my age, # of comorbidities, metabolic health, past SARS-2 infection status, past non-SARS-circulating-hCoV infection status, etc. They simply don't know what they're talking about.

> Across the entire spectrum you're at less risk from the vaccine than you are from the disease.

You don't know me or my medical history, so you can't make that statement honestly. I am in a population where I am at borderline negligible risk from SARS-2 infection. The mere 24+ hours of post-second-shot acute inflammatory cascade, which is almost guaranteed, already eclipses the expected value of COVID symptoms I would experience if infected. (Perhaps you aren't aware of how stratified the risk is based off age and comorbidities?)

You doubly so cannot make such a statement when you don't know whether I've already had COVID previously. Someone who has had SARS-2 naturally and recovered is almost completely insulated from COVID risk. And this, by the way, is much moreso than compared to an unexposed-yet-vaccinated individual. And the effect size is massive, we're not talking about natural immunity being "20% better", we're talking like 800% better. Source: https://pastebin.com/8yR3y5NA

> That's so weird, all the data seems to indicate that in areas with high vaccination rates nobody gets sick and dies.

How closely have you been looking at the Israeli data? It is simply false that nobody gets sick and dies. The vaccines very significantly reduce the personal risk of hospitalization or death, but as I've already told you, my risk from SARS-2 is almost nonexistent, so that confers exactly zero benefit for me. The reason you and others are so concerned about vaccination is - I hope - the purported societal benefit of vaccination, and I've already hinted at the very predictable phenomenom that vaccinating against only the spike protein is just going to lead to antigenic drift and immune escape and will just end up spinning our wheels at best, and at worst it will actually lead to increased pathogenicity in the unvaccinated (https://journals.plos.org/plosbiology/article?id=10.1371/jou...)