“A policy of letting the unvaccinated foot the bill for their COVID-related hospitalizations is only partly about wielding a financial stick to push reluctant people into vaccination. It’s also about not expecting others to pay for your decisions. Standing up for your beliefs means being willing to bear the consequences. Otherwise, it’s just cheap talk.”
There are a pair of big problems with this approach, the two problems being intertwined.
The first problem is that the true ‘full cost’ of medical care is difficult to determine. And in economic theory, properly so, because marginal costs of producing goods or services vary according to quantity and context. If a facility buys an expensive piece of equipment, let’s say it’s an MRI machine, then there was a fixed cost at purchase, but they recover their cost according to how much they use it and how much they charge patients. What is the ‘right’, justifiable cost per use? That is negotiated between insurance carriers and providers. And what percentage of the charge per usage goes toward ‘overhead’, the cost of keeping the heating and lights jn in the hospital, and of paying the custodial staff.
While there may be cost analysts on both sides of the negotiation, there isn’t a magical correct number. The facility takes payments from various different insurance plans, and it settles for different prices from different plans.
And then there are the uninsured. Yes, there are uninsured, of various sorts for various reasons. And since individual patients don’t have agreements in advance how much they will pay fore different services, the facility bills them for ‘full price’, but then in many cases there is not way that the patient will ever be able to pay back that ‘full price’,and the facility can’t get blood out of a turnip, so ultimately the bill gets negotiated down to some amount they believe they can collect.
Put together thesec two issues, the impossibility of identifying a true ‘full cost’, and the impossibility of collecting whatever is that ‘full cost’ from an impoverished patient, and it just doesn’t work. And Ii have a relative whose family are uninsured and unvaccinated. But if they get sick, the hospital has to treat them, and it will eventually settle the bill for whatever he can be made to pay.
The proposition works in an Objectivist world in which hospitals can turn away patients. Whatever else may be crazy about American health care financing, it’s not heartless like that.
I follow what you are saying. In fact I agree with your reply entirely. However it only seems tangentially related to the topic.
ie: Those who choose to take on more risk should expect to pay more from those they wish to insure them against that risk. I’ll grant that in a country that demands a person be insured the details can be murkier. But overall the central premise is not just sound, but obvious.
You choose risky choices, you should accept those who insure you against that risk will charge you more.
This is a better argument than most in relation to vaccine hesitancy. However, in the universal healthcare systems of the West we don’t make people who weigh over thirty stone pay for the special fire service equipment or beds required, or for their endemically higher risk of diabetes, amputations, and other related medical costs, so it would set a precedent for other behaviour related sanctions and exclusions (apart from smoking, where taxes and less likelihood of reaching the high cost period of life, in terms of social care, medical costs and public pensions actually works out much better for non-smokers in terms of the resources vs. taxes freed up to be spent on them).
In private systems, there are also the uninsured and many of the vaccine hesitant groups in the US, for example, are far more likely to fall into the uninsured category.
Does that imply that when the vaccines turn out to have bad long term effects that cause hospitalization their hospital costs will be paid by the people that took the decision to get vaccinated?
I happily, vocally, and vigorously support the burden of consequences befalling those who make choices. Hence I am all over vax passports that confer privileges (not rights) to those who are vaxxed, and withhold those privileges from those who are not. Bring it on.
However, I have 2 issues with the concept of self pay for medical care for those unvaxxed who develop COVID illness. First, I believe basic and life saving medical care is a right. It is not something we demand payment for prior to its delivery. I don’t think such essential care should be denied based on inability to pay.
And second, we care for people who make all manner of idiotic and moronic choices, from which medical consequences arise, yet still don’t deny their insurability. Smokers. Alcohol and drug misusers. You might argue addiction is itself a medical condition, and hence not entirely a choice. But drunk drivers injuring themselves. People doing things without helmets. Idiots making stupid choices that bite them. We currently insure all these people for their care now. I don’t know that the unvaxxed are in principle doing anything more egregious than any of those other cohorts. (I suppose the difference, it could be argued, is that this particular group of idiots is endangering others, which the other groups do not….but we still have to contend with second hand smoke, drunk drivers who injure others…so it seems a bit less cut and dried).
I assume that people with HIV and sexually transmitted diseases fall into this category, as do the obese, substance abusers, people who want the public to pay for their sex change operations and the like.
I’m on board with the idea of graduated health insurance payments and social perks based on one’s BMI and overall level of fitness. But is that really what Claire wants or is there some special pleading going from an Aussie who doesn’t happen to live in Western Australia.
I saw this on Tucker Carlson the other night.
I think Carlson goes a bit overboard with the idea of the supposed American affection for Aussies and the totalitarian streak in Australians was clear in one of my favorite Aussie films, “Children of the Revolution."
Wow, that must break the record for Carlson’s distortions of facts & that’s really saying something given his record. But it’s fine because hiding behind ‘opinion’ journalism is above board even though he knows that his millions of gullible viewers don’t perceive his steady stream of propaganda that way.
The great irony of Carlson’s & and many American’s conception of freedom is that any amount of lying qualifies as freedom when it ultimately only serves to restrict it.
There is some precedent for charging users of harmful substances up-front, partly to deter such usage and also to help pay for their (on average) increased need for medical care in the future: taxes on alcoholic drinks and tobacco products, both of which are carcinogens and harmful in other ways.
Let’s assume, for the sake of the argument, that the principle might be extended to other behaviours which, on average, cause harm to the self and so require high costs of medical care in the future - which in Australia are largely or entirely borne by taxpayers.
Claire, do you or your family ever expose yourself to the UV-B radiation in high-elevation sunlight, not through glass, with some of your skin unprotected by clothing or sunscreen? If so, while there are no-doubt some benefits from being outdoors and perhaps from the UV-B, UV-A and visible light skin exposure, you are certainly raising your risks of skin cancer. Are you proposing the government assess such behaviours and bill citizens accordingly. A similar problem affects the eyes: The Sun, UV Light and Your Eyes - American Academy of Ophthalmology .
Do you know your 25-hydroxyvitamin D level, as measured in blood tests? I am not suggesting you or anyone else needs to have it tested, as long as you either get lots of UV-B unprotected skin exposure all year round (which raises the risk of skin cancer and requires special lamps and protective eyeglasses in winter) or if you properly supplement D3: for 70kg bodyweight, about 0.125mg (5000IU) D3 a day, or 7 x this per week. (Vitamin D3 supplemental intake as a ratio of bodyweight) Such D3 supplementation will generally raise 25-hydroxyvitamin D levels safely above 50ng/ml 125nmol/L (one part in 20,000,000 by mass) after several months.
Most MDs think that 20ng/ml or 30ng/ml is adequate, but they are relying on Institute of Medicine and Endocrine Society guidelines which are wrong, because they were developed primarily and largely (respectively) to ensure sufficient 25-hydroxyvitamin D levels for the kidneys to maintain the stable and very-much lower level of circulating, and so hormonal, 1,25-dihydroxyvitamin D which regulates calcium-bone metabolism. Neither of these guidelines, which form the basis of most countries vitamin D supplementation recommendations, were set according to the needs of the immune system.
Worse still, most countries’ D3 supplementation recommendations are based on the IOM’s completely mistaken recommendation for adults, of 0.02mg 800IU/day. This was flawed partly by their low 20ng/ml 25-hydroxyvitamin D target, but especially by their completely fluffed RDA (recommended daily allowance) calculation, which was based on the variance of the average of several studies rather than the variance of the individual subjects in all those studies: Heaney et al. 2015 Letter to Veugelers, P.J. and Ekwaru, J.P., A Statistical Error in the Estimation of the Recommended Dietary Allowance for Vitamin D. Nutrients 2014, 6, 4472–4475; doi:10.3390/nu6104472 . A proper quantity would have been about 0.175mg 7000IU a day. However, I argue that the whole RDA concept is flawed given wide variations in “adult” bodyweight and in 25-hydroxyvitamin D levels in response to D3 intakes: Vitamin D3 supplemental intake as a ratio of bodyweight which is why D3 intakes as ratios of bodyweight are a better approach. I cite two such systems in that page, and derive my own ratios from Ekwaru et al. 2014, with separate ratios for those suffering from obesity, since I couldn’t find such an approach in any peer-reviewed articles.
Since 2008, 48 MDs and other researchers have been calling for 40 to 60ng/ml 25-hydroxyvitamin D to be the standard of repletion. You can see from the articles cited at What every MD should know about vitamin D and the immune system, COVID-19, sepsis, Kawasaki disease, Multisystem Inflammatory Syndrome etc. - however, very few know these things that immune cells need 50ng/ml or more 25-hydroxyvitamin D to work properly - to provide strong innate and adaptive responses and to reduce the risk of self-destructive, (cytokine storm), dysregulated inflammatory responses, which cause severe COVID-19, sepsis, Kawasaki disease and Multisystem Inflammatory Syndrome. Don’t take my word for any of this - I am an electronic technician and computer programmer. Read the research articles yourself and make up your own mind - or get your doctor to read them and advise you.
Please refer to this graph of the risks of hospital-acquired and surgical site infections according to 25-hydroxyvitamin D levels, from Quraishi et al. 2014 https://jamanetwork.com/journals/jamasurgery/fullarticle/1782085 . This is from ~700 patients in a Boston hospital after undergoing the same surgery.
You can see straight-out immune system failure resulting from levels below 50ng/ml, since this is the only significant cause of the greatly increased risks above the 2.5% risk which results from 50ng/ml or more 25-hydroxyvitamin D. If you haven’t been having lots of UV-B unprotected skin exposure (which is good) and you haven’t been substantially supplementing D3 (there is very little in food or multivitamins) then your 25-hydroxyvitamin D levels could easily be 20ng/ml. This results in weakened innate and adaptive (antibodies and macrophages etc. which destroy whatever antibodies attach to) which in the Quraishi et al. post-operative patients raised their risks of both kinds of infection to about 22%. Those ~700 patients were morbidly obese and had just undergone the same Roux-en-Y gastric bypass surgery for weight loss. However, there’s no reason to believe that these patients immune cells had significantly higher needs for 25-hydroxyvitamin D than those of people who are not suffering from obesity.
Weakened innate and adaptive and hyper-inflammatory immune responses are all very strong risk factors for numerous diseases, especially severe COVID-19. Would you support government monitoring of either 25-hydroxyvitamin D levels - or food and supplement usage and UV-B exposure as a proxy for these - and adjusting income tax rates accordingly? See these risks. Refs at https://aminotheory.com/cv19/#vc
I don’t support these measures, but let’s say you do, which would be consistent with your argument, as best I understand it, that the government should apply additional taxes or fees for all people above some age who do not accept “full vaccination” against COVID-19, with whatever vaccines the government makes available. This means that as the definition of “fully vaccinated” changes, everyone would need to get booster injections to avoid paying the extra taxes.
In Israel first and second boosters (3rd and 4th injections) are already being implemented, and the whole vaccination campaign began less than a year ago.
There might be some justification for your argument if these vaccines were very safe (their real safety is surely less than what many people in the West have been lead to believe, but that is a long series of arguments for another day) and highly effective. They are generally effective at reducing the chance of severe symptoms, which is very important - but even then, if this is a long-lasting benefit, why are Israel and other countries introducing booster injections so urgently?
Their protection against transmission (reducing the rate of viral shedding for those infected and/or the risk of infection for any given viral insult) fades over months. Otherwise, why would so many countries be keen to introduce booster injections? There’s no hope of vaccines alone achieving herd immunity, as you can ascertain from the 2021-08-10 evidence of Prof Andrew Pollard to the UK Parliament’s All-Party Group on Coronavirus. The video link and transcript is at: https://nutritionmatters.substack.com/p/vitamin-d-and-early-treatment-vs . Prof Pollard is Director of the Oxford Vaccine Group, co-developers of the AstraZeneca COVID-19 vaccine.
“The one thing that vaccines might do - just like wearing masks and so on - they may slow the process down a bit about transmission. . . . And in fact, mild infection in someone who is vaccinated will boost their immunity. It will likely broaden their immunity to future variants as well as the current ones, and will increase the amount of immunity they have. So as long as you are vaccinated and are fortunate to get mild infection, then you are protected.”
So the current vaccines do substantially protect against severe symptoms (in the current timeframe, and there are indications that this may not last). This is an important benefit - and a relatively safe passage to broad-based, much stronger, likely to last decades (as best we know from SARS-CoV research) immunity, once the fully vaccinated person is infected.
Why do you advocate forcing vaccination on those who have already been infected? There is no possible argument for this, since rates of vaccine complications are likely to be higher for such people (no space here to go into this) and they already have far better immunity than those who have not been infected and who are fully vaccinated.
Your focus on vaccines as the fix for the pandemic seems fully in line with the extraordinary acceptance of this by many in the West, especially those with left-leaning political sensibilities: Update: American Public Opinion and Vaccination Requirements . Yet in some non-Western settings, COVID-19 infection, hospitalisation and death rates have been kept very low with low rates of vaccination, through early treatment, including with ivermectin. For instance, the Indian state of Uttar Pradesh, with ~230 million people: India's Ivermectin Blackout - Part V: The Secret Revealed
In supporting government efforts to force people to accept these vaccinations, and to penalise those who don’t, you are apparently not aware of several profound arguments against this approach:
1 - These same governments - and the MDs and citizens who support, with sometimes religious / existential fervour, what amounts to the global COVID-19 vaccinophile cult - are actively suppressing discussion of and access to multiple early treatments which are perfectly good ways of dealing with COVID-19 infection, especially if started immediately after diagnosis or presumed infection. There’s no room to discuss these here, but melatonin and ivermectin are perfectly good, safe, effective early antiviral treatments. Calcifediol (which is 25-hydroxyvitamin D) is an even better early treatment for the great majority of people whose 25-hydroxyvitamin D levels are a half or less of the 50ng/ml their immune system needs. See the Castillo and Wimalawansa links at https://vitamindstopscovid.info/05-mds/ . Research regarding early treatments is listed at the sites pointed by https://c19early.com .
2 - These same governments are insisting that their generally vitamin D deficient populations take the expensive, slow (the more weeks before the 2nd injection the better) invasive medical intervention of mRNA / adenovirus vector vaccination when it would be much better, faster, safe and less expensive to recommend and encourage proper D3 supplementation for all. This would strongly suppress transmission and disease severity. This should be a national priority, starting with those in hospital, care homes and prisons (and the staff there), the elderly, those suffering from obesity and all those with melanin rich skin. For instance, the median 25OHD level of Arab - Muslim - women in sunny Israel is about 10ng/ml: https://aminotheory.com/cv19/#2020-Israel
So governments are choosing to enforce the 3rd best approach to COVID-19 on their populations (D3 supplementation is the 1st and early treatment, including bolus D3 or ideally calcifediol is the 2nd). The current vaccines work by programming our cells to produce viral spike proteins, which project from their cell membranes, for the express purpose of giving our immune system target practice: raising antibodies to these spike proteins (alone, not the viral nucleocapsid and other proteins) primarily in our arms (rather than in the nasal mucosa, where the best such immunity could be developed). Once the antibodies are created, they attach to the spike proteins on our cells so that macrophages and other mechanisms destroy those cells. This can happen to cells all over the body - not just in our arms. Also, the spike proteins can float free and cause trouble anywhere in the body. What could go wrong?
You are supporting extra taxation for those (above a certain age - and those below this age keep getting born and can transmit and be harmed by COVID-19, especially with their typically low vitamin D status) who refuse to accept one of several government mandated vaccines, one of which (AstraZeneca) has killed 8 Australians and hospitalised another 133 Early detection, treatment behind lower rate of mortality from rare AstraZeneca-related clots - ABC News from 11.3 million doses. So this is 141 harmed or dead people from (I guess) about 6 or 7 million people who have had one or both doses.
I think your proposal is hugely mistaken.
More vitamin D blah blah blah.
PIck whatever endpoint you want. Do an RCT, enrolling people with vitamin D levels below whatever threshold you propose. Supplement half of these people with whatever formulation you desire, up to whatever vitamin D level grabs your fancy. THen see what happens with those endpoints. Then we can stop all your dreary navel-gazing and fan-boy-ing of the stuff, or have causative proof that it does something. Either result beats what you’re doing here.
Do the same for vitamin D and COVID.
It’s time to do it, or get off the pot.
I don’t use any medication or drug beyond whatever is in a small quantity of not-dark chocolate. Care to divulge your caffeine intake?
What do you think of McGregor et al. https://www.biorxiv.org/content/10.1101/2020.07.18.210161v1 ? (Summary: ICU resources for COVID-19 .) Don’t you think it would be best if Th1 lymphocytes had enough 25-hydroxyvitamin D so their autocrine signaling system works - so they could properly transition from their pro-inflammatory start-up program to their anti-inflammatory shutdown program?
What about Quraishi et al? Do you think it is healthy for most people (without proper D3 or UV-B exposure) to have 5 to 25ng/ml 25-hydroxyvitamin D when it is clear they need 50ng/ml for properly strong innate and adaptive immune responses.
What about Castillo et al. Mathematical analysis of Córdoba calcifediol trial suggests strong role for Vitamin D in reducing ICU admissions of hospitalized COVID-19 patients | medRxiv reducing ICU admissions from 50% to 2% and deaths from 8% to zero, with a single oral dose of 0.532mg calcifediol?
I guess you are going to complain some more about how you want to see two or more highly positive meta analyses, each with a bevy of shiny RCTs in tow, served up to you in the manner to which you have become accustomed.
There’s a global crisis with 10 people dying every minute. The responses imperil democracy, as Vinay Prasad writes:
You should take a greater interest in what is actually happening in immune cells due to inadequate 25-hydroxyvitamin D rather than giving yourself airs regarding the supposedly virtuous position of expecting every possible item of evidence being perfectly laid out in front of you before you would consider changing your understanding of biology.
Doesn’t matter what i think would be best. Most certainly does not matter what you think would be best. What matters is what can be proven to be, if not “best”, then at least “better”. You’re mired in the endless loop that is on par with cleaning navel lint.
Yup, I want to see proof of causation. Everything else is just sheisters selling supplements. I’m old fashioned that way.
“In theory there is no difference between theory and practice. In practice, there is”
(you can attribute this to Albert Einstein, or Benjamin Brewster. Either way, you need to go away and come to grips with the concept they are referring to).
What is lacking regarding proof of causation in McGregor et al.? It is a complete mechanistic description of how inadequate 25-hydroxyvitamin D leads to failure of autocrine signaling in Th1 regulatory lymphocytes which causes them to remain pro-inflammatory indefinitely, instead of switching to their anti-inflammatory shutdown program.
Quraishi et al. https://jamanetwork.com/journals/jamasurgery/fullarticle/1782085 showed that pre-operative 25-hydroxyvitamin D levels strongly anti-correlate with the rates of post-operative infections. Why do you think this does not show beyond reasonable doubt (for practical purposes “proves”, though proof is not part of Popperian science) that the immune system failure which allows these infections to spread is caused by 25-hydroxyvitamin D levels being below 50ng/ml. This is the first graph in my message 4 messages above.
What about causality in the multiple observational studies (2nd diagram) cited at: https://aminotheory.com/cv19/#vc ?
What about causality in the Castillo et al. RCT in which 0.532mg calcifediol (and half this on days 3, 7, 14 etc.) reduced ICU admissions from 50% to 2% and deaths to zero?.
You are the one on an endless loop, avoiding reading and discussing the research, and pretending you are wiser, better informed or whatever than I am or than anyone who has read the research and considers it good evidence that people should supplement D3 to raise their 25-hydroxyvitamin D levels from typical unsupplemented (and with little UV-B skin exposure) levels of 5 to 25ng/ml, to attain 50ng/ml or so, such as the average 46ng/ml Luxwolda et al. 2012 found in traditionally living East African Maasai herders and Hadzabe hunter gatherers: Traditionally living populations in East Africa have a mean serum 25-hydroxyvitamin D concentration of 115 nmol/l - PubMed.
I’ve acknowledged long ago about the “biological plausibility” that repletion of vitamin D in people who are vitamin D “deficient” (however defined) COULD have benefits. What you have shown is simply yet more biologic plausibility. But at some point, that biologic plausibility “rubber” needs to meet the “meaningful clinical outcome benefit” “road”. And for that you are no further along, still, after however long you’ve been shilling for vitamin D.
Do you know when you finally get there? Here’s a hint: you will no longer need to use phrases like:
That’s right, Sherlock. When you graduate from “correlation” to “causation”, you will know you have arrived. When you can show that vitamin D supplementation CAUSES a drop in post-op infections, then you will have gotten somewhere. That would be important information, and wake me up when you get some. Until then, you’re just another snake oil salesman.
@S.Cheung, the post-operative infections could not have caused the pre-operative low 25-hydroxyvitamin D levels. So the lower then 50ng/ml pre-operative 25-hydroxyvitamin D levels either directly and wholly, or at least partially caused the immune system weaknesses which are reasonably assumed to have enabled the infections to proliferate, OR such low levels were strongly correlated with one or more so-far unidentified circumstances which wholly or partially caused the weakened responses.
Since D3 supplementation raises 25-hydroxyvitamin D levels (slowly, use a bolus dose to do it in a few days, or ~1mg calcifediol for 55 to 85kg bodyweight to do this in 4 hours) one doesn’t need RCTs to establish that such perfectly safe interventions will reduce or eliminate the weakened immune responses. See https://vitamindstopscovid.info/02-autocrine/ for research on the mechanisms by which immune cells rely on good levels of 25-hydroxyvitmin D so they can individually respond to their changing circumstances. It is no mystery about the mechanisms by which low 25-hydroxyvitamin D levels cause weakened and dysregulated overly-inflammatory immune responses.
There is a general principle regarding not feeding things which jump out from under bridges making snapping and growling noises. I will apply that principle here. In order to protect the signal to noise ratio of this discussion thread, I request that anyone - including you - who wants to argue that this principle doesn’t apply here do so by private message or better still email to email@example.com .
…directly…wholly…or at least partially…OR correlated to something which wholly or partially caused something else…pal, pick a lane, which is it? By now, it should be crystal clear as to why you can’t even come up with one consistent argument on the basis of the “evidence” you’ve examined so far. Think about it. Take your time.
Meanwhile, wake me up when you can say with scientific justification that for people with vitamin D below serum level of X, who are supplemented with vitamin D preparation Y using a dosing interval Z, they are less likely to have post-op infections, or contract COVID, with a number needed to treat of A1, at a P value of less than 0.05. That I would actually like to see.
In the meantime, I’ve listened to your drivel about vitamin D enough times in the past, and finally applied the principle of “see something, say something”. Working well so far.