I’m not hurling an insult at you. I’m saying the language you used is unwelcoming and problematic. Which it is. I’ve had people point that kind of thing out to me before, when I’ve made mistakes like that. And rather than get defensive about it, I reflected on how I’d messed up, I read about things, and worked to be better. And if I didn’t understand exactly how I screwed up, I realized that was on me to learn about it if I wanted to not be engaging in whatever kind of -ist or -phobia I’d inadvertently stumbled into. So as a cisgender person, I honestly don’t care if your feelings are hurt by someone pointing out your anti-trans language and frankly just unnecessary comment. Everyone has blind spots, but your willful attachment to yours, again makes this a clearly unwelcoming place for some diabetics.
Except again, we know female individuals have stronger reactions to all vaccines, both because dosing tends to be based on male bodies and also because of stronger average immune responses (potentially requiring only half the dose of influenza vaccine to be effective, for example). Medicine routinely causes harm by ignoring female-specific issues–this is a recurring problem that often only gets addressed once disproportionate adverse effects are observed. See also Ambien dosing as another example outside of vaccines or how cumulative side effects of polypharmacy can result in sudden death more readily in female patients because of sex-based differences in cardiac function.
There are whole books on the topic of sex-based medical negligence, see Dr. Alyson MacGregor’s book “Sex Matters: How Male-Centric Medicine Endangers Women’s Health and What We Can Do about It” or “Doing Harm” by Maya Dusenbery.
Oh, also, the greater lifespan isn’t a factor here, nor with the AstraZeneca concerns, since these responses are occurring in younger (18-48 years old) people anyway. So that’s irrelevant.
By “dosing” I take it you mean the amount (my apologies if you didn’t), yet my understanding is that vaccine dosages are not based on body weight or body type, rather they are sufficient to generate an immune reaction and to guarantee that the vaccine itself hasn’t degraded to a point where it doesn’t exist.
Other drugs maybe, yet quite honestly I have yet to experience a doctor other than ones treating a-pancreatics that take body weight into consideration when prescribing. I do know that “child” doses are typically smaller, but it still strikes me as arbitrary. Dang, this is another Frederick.
The rest of what you say demands more attention; I’ve been thinking about it for 12 hours now and I will try to respond because it concerns an issue that matters to me a lot, statistics. Your points are certainly valid, my inclination is to challenge the context, but I have to think about that.
What makes you think there aren’t dose effects for vaccines? The flu vaccine is dosed in higher amounts for older people because they have a reduced immune response and need a stronger dose. Current COVID vaccine trials for children are testing doses a fraction of adult doses, at varying strengths, such as half doses, to try to figure out how that will work best. And we know that women have more reactions to vaccines in general, and sure enough, research shows that half the typical dose seems effective in females, likely due to smaller body size and/or (and I suspect this is the more significant factor) greater immune response, but we don’t see dosing recommendations arising from that.
But that’s not uncommon really–plenty of medical things are given in a one size dose fits all just because thaqt is what has been studied and done, not because different doses have been studied or optimized, and things that adversely affect women seem particularly prone to being ignored. Birth control pills are a great example–they are much less effective in people who are obese (and maybe even overweight–can’t remember the exact cut off when it drops, but it’s not that high), but birth control pills are never dosed by weight even though fat tissue has a major effect on hormone metabolism.
I think you need to quote sources at this point.
Whether dosage matters differs per vaccine. The flu shot is a one size fits all vaccine in my country. Children and adults are all given the same dose.
Looking at the thread, I’m guessing this is where the breakdown happened. I’m guessing that for those of us who are not close to this issue, this could seem like an objective observational statement. And I’m guessing that for those of us close to this issue, this is a transphobic statement.
When I was in a friend’s wedding a few years ago, one of the bridesmaids elected to wear the “male” bridal party outfit rather than the bridesmaid dress selected. I was sitting with her on the bridal party bus chatting as we went to different photography locations before the wedding. She said that she would have been fine to wear the dress if her wife had not traveled with her to the wedding. But when she had tried on the dress in front of her wife, her wife said, “Nope. That’s just too weird. I can’t get past that.” So the bridesmaid elected to wear the “male” outfit while being a bridesmaid.
When she told me that story on the bus (she brought it up and explained why she was wearing what she was wearing…I never asked bc it did not matter to me at all), I responded, “Oh, really. That’s super interesting.” I thought I communicated it with interest and sincerity. The way that it evidently landed was quite different. The bridesmaid said, “My wife’s NOT trying to change me. It’s NOT like that.” And then she abruptly changed the subject. Having just met this woman, I didn’t know what to say or if there was anything to say to more clearly communicate that it just never occurred to me that style of dress would be a factor in a marriage…but maybe I just seemed too interested? Or too surprised? Or maybe it touched a nerve in her about something that I would have no idea about? I thought I had been welcoming and supportive by engaging with them and their kids all day prior to photos, but I don’t know where I went wrong. There was a vibe throughout the wedding events that the married gay couples in the wedding party were sticking together and rolling their eyes at the rest of the wedding party like we weren’t getting how hickish we all were. But at the same time, I never saw anything other than fun, happy and normal interactions. So I don’t know what to think about it. I would hate to think that I hurt someone’s feelings. But I also felt like it all happened so fast and that door was closed without explanation that there was nothing that I could do about it to make it better.
I hope everyone feels welcome here. And I hope that if I say something unknowingly offensive, that people will educate me about where I went wrong.
One suggestion in this thread is that there may be better results, i.e., significantly fewer side-effects with no significant loss of protection, if the dosage were in fact varied based on gender or body weight. But to do so would seem to require expensive clinical studies to prove the safety and effectiveness of each dosing strategy, and the drug companies see no reason to pay that cost if they can get approval for a uniform—but perhaps significantly sub-optimal—dose.
I wasn’t denying that??
This entire thread is an excellent illustration of the fact that true communication is really difficult. It was not my intention to impute a denial to your statement. Merely to reiterate and elaborate that vaccination dosing is constrained towards uniform strategies by the cost of clinical studies, and I can see a highly-credible possibility that some classes of people could get a better result from a smaller dose. But we won’t know that because the manufacturers will not pay to run the experiment.
You’re right, I misunderstood your comment. Thanks for your kind response.
Well the older adults is just the vaccine that is 4x as strong of a dose that is commonly commercially available in the US and recommended for older people, if you google it: High-dose flu vaccines: How are they different from other flu vaccines? - Mayo Clinic.
Re the sex based findings, here are just a few sources (including some findings from the most influential science journals) demonstrating flu vaccines are more effective in females:
https://www.pnas.org/content/115/49/12477
https://academic.oup.com/ofid/article/5/9/ofy211/5090299
@Sam, if you want people to feel like it’s worth it engaging with you more directly about concerns, then you should make more effort to seem open to feedback about being thoughtful about these issues. If you are, great, my mistake. Then my suggestion is, when it’s suggested you said something transphobic, next time ask, can you explain? I would like to learn, vs that’s ridiculous!, so someone can tell you you’re phrasing “reporting whatever gender they identify with these days” is ■■■■■■ because it implies that someone trans reporting gender is somehow not just, you know, stating their real gender like everyone else (which is it, and if you don’t agree, well, then you are a transphobe). It also is ignorant because it misses many key points about why you’re wrong that I listed above, though I care more about the disrespect (again, whether intended or not, it’s baked into that phrasing and you should reflect on that) than the ignorance.
But you should know, your past dismissiveness and lack of sensitivity or reflection around topics like this is in part of why it’s just hard to believe that you come to this in good faith. It would be great if my wariness were wrong and you are far more open-minded than you’ve ever indicated before. I genuinely hope that’s true—would love to be wrong in this respect.
Also, sometimes being a member of a community as well as having literal expertise in working with a community means someone is the relative expert on the topic. So too bad that you don’t like that, but sometimes being a white cis straight man means you should sit back and listen about things you don’t understand.
Making a lot of assumptions about me there aren’t we? I can’t even imagine the outrage if I had just said something comparable to you…
Anyway, moving on.
I went back to the original CDC sources. The Sanofi vaccine has three adjustments that I count; it’s a live vaccine, it has an adjutant that promotes the immune reaction and it has a four times dose. So I take exception to the word that you use just - it’s not just that.
I referred back to the CDC justifications for what they recommended I I found this chilling statement:
Studies published in the Journal of Infectious Diseases conducted during the 2017-2018external icon and 2018-2019external icon flu seasons among Medicare beneficiaries aged 65 years and older found that Fluzone High-Dose and FLUAD provided greater protection against flu-related hospitalizations than standard-dose, egg based vaccines in both seasons, while Flucelvax provided greater protection during the 2017-2018 season only.
[The ‘external icon[s]’ are links to the sources the CDC itself quotes.]
So a vaccine with the adjutant was not discriminated against one which had both the adjutant and the 4x dose.
I cannot find any sources that suggest that increasing the dose itself helps.