He calls 200 days too quick? While the pathologic markers take some time, 200 days seems like plenty to deteriorate. In fact, the protective effect of vaccines deteriorates over time - like even by 5 years. As we know, the pathologic markers aren’t completely predictive of symptoms.
200 days of reduced inflammation in the brain would seem like enough ttime to notice a difference.
The transcript is full of mistakes in just grammar and word choice. He mentions a paper in JAMA and we are supposed to guess which one? Gemini says that are 100s.
Not real science. Influencer trying to make coin. Doesn’t mean he doesn’t have some good points but the level of evidence he brings is very low.
Looks like but doesn’t reach significance until later. Until significance is reached, it is noise.
And I’m sure you realize avoiding disease isn’t making you any smarter😄
The benefit would be there at first dose likely with just getting a bit stronger with the second. I don’t know the numbers but often, 50-70% of people might get protection from 1 dose of vaccine but we get a second to get to 90+%. So the effect for a majority probably starts with 1 dose and may not get any better with 20 doses.
At some point, this joker isn’t changing anything except lining his pocketbook with YouTube views. I am not sure of any rational person not getting a shingles vaccine in 2026 at age 50 - at least in the US where it is free. Shingles sucks so why even worry about it whether it helps dementia or not.
Personally, the anti-expert trend is unquestionably damaging to the public health of the US. Those who are smart and take advantage of this to make money are some of the most repugnant people in history. Being dogmatic about RCTs is not helpful. As a surgeon, we practice almost entirely without RCTs. Should we stop? Hmm - it seems like hemorrhage kills but we haven’t ever tried a RCT - so how do we know???
Full disclosure - my number one investment is in memory care facilities so I’ll make more money if people listen to this guy.
Both the Wales and the UK study were well powered and the analytic method (regression discontinuity) is the most appropriate tool for analyzing a time-shifted naturalistic experimental and control group. Several differences in the populations have been discussed as potential explanations for the disparate findings. One that caught my eye was the difference in classification criteria for dementia. The Wales study rested on the judgment of personal physicians who, by nature of the culture, were often close to the patient and might be among the “first to know,” The UK study rested on impersonal hospital admission classifications where we might expect to see a threshold requiring more advanced cases. This is not determinative but I think a good read of the two studies will not produce reasons to discount the Welsch study.
Agreed on the “anti-expert, anti-science” subculture. We might see the immediate damage more in health but the problem is widespread. Climate. Oceanography. Air and water pollution.
The point of all this is not to affirm or attack any participant in the discussion, but to look for ways to remove possibly faulty hypothesis in the Popperian sense. If we posit some alluring thesis, such as “vaccines reduce dementia”, we should first and foremost look for ways to falsify that thesis. The natural tendency we see, especially by influencers, but also many scientists, is to generate a thesis and then spend all one’s efforts in finding ways to support it, instead of pulling back and saying “let me first find good reasons why it might not be true, and only if I find none, to elevate the hypothesis status”. This is where critics come in. They can assist in the process you yourself should already be engaged in. Prasad is a skilled and trenchant critic of this thesis? Great! Fantastic! Because if I can withstand his critique, I am already a step closer to validating the thesis.
Nobody has a monopoly on truth and anybody can be wrong, including you, me or Vijay Prasad. But I for one appreciate the opportunity Prasad gives me to test my favored thesis and my possible hidden biases.
More discussion is better, but there is a caveat. The participants should bring arguments and evidence of sufficient rigor, otherwise endless low value flamewars of anti-vaxx flat earth type tussles are a pointless waste of time. I value Prasad not because I necessarily agree with him (I certainly don’t on some issues), but because he argues with a degree of rigor that rewards engagement, and that is both very valuable and in my experience relatively rare.
In that spirit - providing maximum opportunity for examining this complex issue - here’s a pop-sci article that’s actually pretty good, replete with studies mentioned which you can then chase down, including ones Prasad mentioned and including extensive quotes from researchers. More kindle for the fire - hopefully more light for all that heat!
What should be done in the meanwhile as RCT’s are underway? The answer is in the middle. Shingles can be prevented, and there’s a chance that it will reduce the risk of dementia. There’s not enough evidence for Shingrix to be given as a prescription drug to prevent dementia. If that evidence is important, the research speed can be sped up so we don’t have to wait until 2037 for results. If there’s a will and money there’s a way.
Rejecting RCT’s as a necessary method in favor of observational studies is foolish, as all of the failed and even harmful vitamin trials have shown. Likewise rejecting some types of observational studies is on an equal footing, as it takes time and it’s expensive for them to be superseded, they aren’t a data request and some statistics.
Even in the best case scenario there’s a 1/5 reduction in risk of dementia, that’s still 4/5 risk on the table and shouldn’t cause complacency.
Dr. Simpson said exactly what I wanted to say just more succinctly and elegant.
The coincidence being that he is a bariatric surgeon like myself. The number of full time bariatric surgeons in the US is around 1000. It isn’t published but that is the typical number thrown around.
Which goes back to the point that we all our products of our professional backgrounds. Some more than others of course and I suspect surgeons are particularly impacted by their careers.
I appreciate the debate and the other point of view - as much as I can truly do that.
There is a big side issue here that probably gets me emotional and we know what that does to clear thinking. Only 35% of US adults over 50 have had the shingles vaccine. Only about 60% get the annual flu shot. The flu shot actually has RCTs with reduction in cardiac events and ACM. Yet the uptake is terrible.
The amount of needless suffering, probably dementia and death from the anti-science viewpoint is staggering. A quick back of the napkin number is 65,000 avoidable dementia cases diagnosed per year in the US for an intervention that is free and easy.
That is based on relatively short study follow ups with 18-20% reduction. The potential reduction for a population that starts fighting neuroinflammation at age 50 is likely much higher.
Measles is quick to notice and easily tracked. But there are far greater impacts from this attitude that are harder to see.
Little side anecdote, a flu vaccine RCT in 1999 showed reduced work absence by about 50%. More recently (2020) an observational study showed the exact same thing - 50%. Total biased observational group with no attempt to correct because they were looking at cost. Obvious bias does not always change the conclusion.
Prasad is not anti-science but he also profits by pandering to that viewpoint. Science is not advanced by youtube views. And the general public doesn’t have the skill set to interpret the studies. Look at the headline of this thread - no one here thinks that is correct. Having doubt is fine but saying there is no effect is not the same thing at all.
As someone who has spend a good portion of his life thinking about conceptualization, design, and methodology problems, I have a healthy respect for the value of the RCT in medicine. With this in mind, the RCT is a stage-appropriate design not suitable for early or even most mid-exploratory inquiries. Why? A full answer appeals to a lot of detail. A summary is that designing a workable RCT almost always entails gaining precision at the expense of verisimilitude or realism. Moreover, if you step back to look at the full corpus of scientific knowledge, you see that very little of it was derived from RCTs.
There being a possible causal relationship between the shingles vaccine and slowing or even preventing manifest dementia adds little to the rationale for taking the vaccine. The vaccine does a good job of preventing a disease that can be life threatening and is almost surely life shortening. What these investigations can and will likely do is expand our understanding of the nature and progression of dementias and how to prevent them. Much of this understanding is likely to come from research designs other than RCTs.
