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TWiV 157 Letters

Robert writes:

The reason you can't do an ethical placebo test for vaccines is that it is considered unethical to withhold the current standard of care. {see the Helsinki Declaration} "Alternative medicine" promoters complain fairly frequently that testing of their favorite remedy for <insert anything here> failed its testing because it was tested in conjunction with the current standard of care vs just the current standard of care. Direct testing of anything against placebo when there is a standard of care and any risk to the patient/subject almost never gets past an legally constructed IRB. It happens infrequently, but one thing that is a red flag that an IRB is ineffective (or fraudulent) is repeat approval of placebo controlled trials contrary to an established standard of care.

I'm sure that there is a member of an easy to contact IRB at your university that could explain things much better where I probably just caused confusion.

Thanks for producing something that lets me put my insomnia to productive use, though writing this in the morning might have made it clearer.

Nick writes:

I must say I was pretty excited to see some of my work on TWIV this week (I never thought that would happen). I was one of the authors of the Lancet ID paper on flu vaccine effectiveness. I really enjoyed the discussion and the jokes about meta-analysis. I wish we could have done a tighter meta-analysis by age, vaccine, risk factors, etc but there was not enough data to do that.

I wanted to follow up regarding some of the points for LAIV. It was noted that the LAIV seems to be a much better vaccine. I would agree for children it would be preferred, as you guys noted. However for adults, it’s a much more complicated story. We did find three studies for adults, but they were not significant . LAIV was licensed on non-specific outcomes for adults, which is why that study was not included in our analysis. It could make for a very interesting discussion on TWIV about why LAIV works so well in kids but poorly in adults. Dr. Arnold Monto and his group at Michigan have done a lot of work on this and have some great ideas on why this is the case. Those ideas are encapsulated in this press release (

With warm regards,

Nick Kelley, PhD


Ricardo writes:

Hello TWIV members.

This time I have a question. It is related to the flu vaccine efficacy.

What is the reason for the lack of efficacy?

The fact that the vaccine misses the antigens of the virus that is affecting the person (wrong antibodies), which would involve vaccine production tuning (faster), broader antigen coverage, better antigen targets...

(If this is the case then the all family would be at risk in case of a low efficacy vaccine)

or differences in triggering the immune response in different people, which would require better routes of delivery, more reactive target choices and probably more adjuvant research...

In this case family members would have different levels of protection.

Once again thank you for the show, it really brights my day and my enthusiasm for microbiology (all of it).

R i c a r d o M a g a l h ã e s

P r o f e s s o r A s s o c i a d o

U n i v e r s i d a d e F e r n a n d o P e s s o a

Peter writes:

Headline reads -

Horse euthanased with Hendra virus

So they inject a horse with Hendra because it had a broken leg or something?????

Man, I was taught not to write like that when I was like 8. No wonder the netizens hold the old press in such contempt.



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