TigerDoc

Yeah, that’s a good way to put it. The frustrating part is that once people are primed to see “spin”, even legitimate clarification can look like word games. Probably why it helps to keep things as concrete as possible (e.g. what’s the claim, over what timeframe, and what does it actually imply vs. what’s being inferred, etc.) Applies to the OP and honestly a lot of stuff that blows up online.

quote:

---

No. I’m not arguing for the OP. I’m arguing for exactly the kind of education you’re giving your patients.

---

I think we’re actually pretty aligned on the standard then - clear, balanced explanation of risks/benefits and letting people make their own decision.

Where I’d maybe add a layer is that kind of communication gets harder when people are getting very selectively framed versions of real data ahead of time like in OP. Not saying that’s the only problem, and I don’t think it means doctors should just push harder - if anything it makes good, transparent communication more important.

The tricky part (and this isn’t unique to health) is how often a true slice of information gets presented in a way that implies more than it actually shows. That seems to be what people react to, whether it’s medical stuff or anything else that blows up online (e.g. the Owens/Kirk mess I've seen you care about recently).

So I’d still come back to the same standard you’re pointing to - just applied in a world where people are often walking in with those frames already in place.

I agree with you about pharmaceutical advertising. we would be better off with less of it. But we should evaluate this independently of the safety and effectiveness of the interventions themselves.

quote:

---

That’s intentional

---

I will agree with you when you start doing things like investigate the credibility of Kirsch and his subtweeter, but that's another level of analysis that I've found is harder to get people to see here, so I start with the science communication itself, but you're not wrong.

What are the credibility problems you see?

Sure. If a patient said that to me, I wouldn’t push back with “you’re wrong.” I’d be more like “you’re right that there’s a value judgment in how we weigh outcomes. Some people care mostly about whether they get shingles at all. Others care more about how bad it could be if they do.

Would it be helpful if I walk through what the worse outcomes actually look like?”

If they’re open, I’d add (to reiterate a previous post), “in older people, shingles isn’t just a rash - it can mean weeks of significant pain, and in some cases persistent nerve pain that can last months or longer and really affect sleep and day-to-day functioning.

The vaccine’s strongest effect is in reducing those complications, not just the total number of cases. It also reduces things like eye involvement (which can threaten vision) and hospitalizations, though those are less common.”

Then I’d bring it back to them with something like “Some people hear that and think "worth it", and others still say "I’ll take my chances." Both are reasonable & my role is to make sure you know what you’re trading off.”

Should we go into why that's better than OP?

quote:

---

I wonder if the shot might boost the immune response of someone who currently suffers from Shingles.

---

Good question. The shingles shot isn’t used to treat an active case - it’s used to prevent future episodes and especially the worse complications. If someone has shingles now, treatment is antivirals + pain control. The vaccine comes after, to reduce the chances of it happening again and to lower the risk of long-lasting nerve pain.

It doesn’t have to give perfect (sterilizing) immunity to be useful - it’s about shifting the odds and severity in your favor, not making you invincible (unfortunately).

You cited person-years. Per 1,000 person-years means per year on average - not just total. So this isn’t simply 8 fewer cases ever. It’s an annualized benefit being compared to a 21-day transient risk window.

I think people on this thread are right to point out how drones are changing the game and the way the information space has changed will likely be inflammatory. The American people will see very graphic videos of our soldiers drone-hunted and the same for the enemy and I don't think they're prepared for this. It could create a momentum for getting into another in a long line of long quagmire wars we have a hard time avoiding for some reason.

That makes sense to me—and I can see how capitated systems in particular would be more attentive to those kinds of metrics. I think the distinction I’m still trying to get clear on is between:

-the system tracking and trying to influence something and
-how much that actually changes behavior in practice

Especially when it’s one item among a large bundle of metrics, and sitting alongside things like standard of care and patient expectations (so they were going to vaccinate anyway.

For your local example, do you have a sense of whether groups like that actually see meaningful differences in vaccination rates compared to less tightly managed settings, or is it more of a marginal effect?

That seems fair - at least that someone designing the system probably thinks incentives might nudge behavior at the margins.

I guess where I’m less clear is how much weight they actually carry in practice relative to everything else (standard of care, guidelines, patient expectations, etc). Like, there’s a difference between “this is included in a broader incentive structure” and “this meaningfully drives physician behavior”, and I’m not sure those always line up.

Part of why I was asking is I’m curious whether people on the ground have actually seen vaccination rates move in response to compensation changes, or if it’s more of a theoretical lever than a dominant one.