I've said this before here and got downvoted for it, but bioethicists as a profession are responsible for more death than pretty much anything else I can quickly think of.
People are dying from heart disease all the time, very often in predictable conditions. Literally millions every year. Statistically this means we should hear about such failed procedures many many more times than we do now - there is literally no downside from doing this much more often, and a strict upside: a chance to live longer and a definite advance in medicine leading to other lives saved. Sure, it may mean more stress for a dying patient, but quite a few would prefer their death have some meaning. But they can't chose this because it's not "ethical".
Moderna had the mRNA vaccine for Covid ready in about 3 weeks. This means the tech was already there - I'd really like to see an argument where we had three major companies create mRNA vaccines, only one failed (harmlessly!) but we shouldn't have used this technology a few years early. mRNA tech is incredibly versatile - it should have applications from curing cold to curing cancer. But no, we needed a pandemic and 10 months of testing to start using it, because it wasn't "ethical".
We knew from month 1 that the young and healthy are not hit hard by Covid. Mortality in those groups was always comparable to flu, more or less. But we didn't do challenge trials. We wasted ... I have to take a break from typing, tbh, I'm overwhelmed. We wasted almost a year while literal millions died while wondering if Covid is transmitted by touch, aerosols or airborne when we could have fixed this in two weeks with a bunch of 25 year olds. We spent half a year before even realizing masks help, and we still don't know for sure how much and what's the difference between each kind. We had Omicron - we knew it was different, we had good reason to think it's not significantly worse from the start, but we still had a _lot_ of questions. But two years from the start of the pandemic we STILL didn't put a bunch of healthy volunteers through a completely harmless study to find out things early. Because it wouldn't have been "ethical".
This isn't ethics we're talking about. It's pure and unadulterated cowardice. We as a society shy away from doing things which we _know_ would save more lives in the aggregate because we'd have to risk causing much less harm, but harm which we'd be directly responsible for. Joe from the street would be excused from making these decisions, but when you deal with the people directly charged by the society from making these decision, it's just failure to do their job. And in a supermajority of case we're dealing with volunteers anyways.
100% agree. I think the unsolved meta problem here is large-scale game theoretic stalemates where we all lose in grand ways, and yet nobody can bust out of their local incentives.
To do so successfully would require thousands of unacquainted people to coordinate changes (against their backdrop of incentives) simultaneously.
Governments are made for this but after a certain size and complexity, their people get stuck in the same frontier of stuck incentives.
They (CureVac) failed because they started trials too late, and by then the Delta variant was going around and caused the numbers to not look as good as Pfizer and Moderna's.
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If you look back, it's a real shame, because Pfizer's and Moderna's Delta numbers are no better than CureVac's.
[Also, speaking completely anecdotally, but I'm in that clinical trial and thus a recipient of 2 CureVac shots and 2 Moderna shots. I have yet to catch Covid despite taking nearly zero precautions and a lot of high risk contacts. And yes, I get tested constantly. There might be something more interesting yet to discover about this.]
Ethical protocols are useful to have to prevent genuinely bad stuff from happening but they are indeed over used to instead limit legal and political liability; which is not the type of "bad stuff" most people would care about but which is something that gets expensive quickly if you are a multi billion dollar corporation in the business of converting government funding into profit (aka. a Pharmaceutical company). The only bad outcome they really care about is of a financial nature.
When ethics devolves into morals and religion, it gets worse because in that case the "bad stuff" is somebody feeling offended/insulted and when that conflicts with potentially life saving new treatments; that in itself might be considered a bad thing (unethical?). Ethics has this way of contradicting itself.
When you weigh two bad outcomes, the rational thing to do (the least bad thing) might not be the ethical thing to do but some people (me) would still consider that the right thing to do. When letting people die that want to live (an important caveat) is more ethical than doing something to prevent that, something is very wrong. Also letting them die when they actually want to is considered unethical by some.
When people don't feel they are equals in society, the whole "for the benefit of all" sounds pretty cynical.
Also, some governments have a poor record for taking responsibility (e.g. looking after veterans), or making others take responsibility (DuPont), so the people who do come off worse don't necessarily expect to be taken care of.
I respectfully disagree. It is patient's right to refuse any medical procedure.
A mere suspicion, impression that doctors are not treating life and health of this particular patient with all sainctity will do a lot more harm than good.
I mean, life is precious, doctors should know this best and act like it is. Recklessness even in words will do a lot of harm. A lot of credit will be lost if standards slip even a little bit.
I know this very well because people around me are not vaccinated yet because they are suspicious of Sputnik-V. Yes, this is reality where I live. People are suspicious and refusing a life-saving procedure.
The patients who don't get the experimental treatment didn't refuse the experimental treatment -- they were never offered it at all which is the problem.
The ethics and regulatory red tape kills any hope for such a treatment before patient consent is even a question.
This is risking another rant, but I'll hold. Keeping things short - authorities lied their asses off for the whole pandemic, and this is what (legitimately) destroyed trust. People are a lot less stupid than usually given credit for - sure, they can't always do the research themselves, but they do know to look around and orient them in complex situations. And it got pretty obvious pretty soon that the official message was not about the truth, but about getting the "correct" response. Which turned out to be a lot less precise and correct in practice. So yeah, now you get people mistrusting vaccines because you can't get them to trust anything.
>Moderna had the mRNA vaccine for Covid ready in about 3 weeks. This means the tech was already there
Not quite. While this line of research has been occurring for some time, it wasn't quite at that point yet. It wasn't developed and not being used because testing them would be considered unethical. It was developing technology, and Covid came at an opportune time in that things were close enough for researchers to rush things along.
>But no, we needed a pandemic and 10 months of testing to start using it, because it wasn't "ethical".
Yes, we did need testing before we started using it. It could make everyone sick for all we know. Or perhaps only a select few populations. Testing also allows guidance to be developed on what expect, and what doctors need to look out for. If it were to cause bleeding in people with a certain blood type, for example, then just giving it out would result in huge numbers of people rushing to already overworked ER rooms. Which could just worsen the health crisis we were trying to avoid. There are many good reasons to test treatments even when time is limited
>We as a society shy away from doing things which we _know_ would save more lives in the aggregate because we'd have to risk causing much less harm, but harm which we'd be directly responsible for.
Y
I'll take this logic further and say why not do some DNA alteration experiments on babies? We may have to destroy the specimens after, but so what? A finite number of lives can lead to saving countless lives in the future. Think of the things we could learn about rare diseases, removing harmful genes, improving human health, etc. The millions, even billions of lives we could save and enrich. It's immoral NOT to do that, when the rewards are so great.
That's the line of thinking that doctors try to avoid, hence "do no harm". It doesn't matter how common sense it seems, some lines you just don't cross. Because if people do cross those lines, eventually some might use it to justify doing immoral things. There's certainly a lot of rigorous debate about medical ethics, but these decisions are the results of groups of doctors and ethicicts. I'm of the belief that the alternatives have indeed been considered in most cases and the best choice has been made.
I follow your arguments, but I just find them incredibly weak.
We're not talking about slippery slope here and "may have beens", we're talking about already having a soft form of worst case scenario, and _still_ not bringing out the big guns. Not doing challenge trials for Covid is just stupid, no matter how you try to push it.
"DNA alteration experiments on babies" - we do that, actually, and I'm seriously considering waiting on having a family until they become mainstream. It's a pretty cool tech, they had the first designer baby out last year. Just putting the scariest form you can think of in writing isn't an argument in itself, you know. You also have to say why it's a bad idea. Otherwise, no offense and please don't take it personally, but it's purely equivalent of somebody saying 200 years ago: "what's the next step, feeding MOLD to BABIES?". Turns out yes, feeding mold to babies is exactly what we're supposed to do. It's just progress - it looks weird until it's in the kitchen cabinet.
The mRNA vaccine not being ready - it's just incredibly improbable that you had three major corporations being able to "rush things along" and finish exactly at the same time. It's 10x to 100x more probable that they were already finished and stuck at some regulatory step.
And a final thought - please don't interpret my comments to say testing and regulation in general is bad. FDA is bad, and probably should be destroyed outright and something else, something much leaner, built instead. But some regulation and a lot of testing are of course necessary. It's just that currently 1. they've gone waaaay beyond what's needed and into pure bureaucracy and 2. the system is such that it ignores major slices of reality and focuses only on what's in front of their eyes, i.e. they don't do challenge trials because it's not ethical for the volunteers, but if they lead to 1% less death overall this means tens to hundreds of thousands saved - which they ignore.
People are dying from heart disease all the time, very often in predictable conditions. Literally millions every year. Statistically this means we should hear about such failed procedures many many more times than we do now - there is literally no downside from doing this much more often, and a strict upside: a chance to live longer and a definite advance in medicine leading to other lives saved. Sure, it may mean more stress for a dying patient, but quite a few would prefer their death have some meaning. But they can't chose this because it's not "ethical".
Moderna had the mRNA vaccine for Covid ready in about 3 weeks. This means the tech was already there - I'd really like to see an argument where we had three major companies create mRNA vaccines, only one failed (harmlessly!) but we shouldn't have used this technology a few years early. mRNA tech is incredibly versatile - it should have applications from curing cold to curing cancer. But no, we needed a pandemic and 10 months of testing to start using it, because it wasn't "ethical".
We knew from month 1 that the young and healthy are not hit hard by Covid. Mortality in those groups was always comparable to flu, more or less. But we didn't do challenge trials. We wasted ... I have to take a break from typing, tbh, I'm overwhelmed. We wasted almost a year while literal millions died while wondering if Covid is transmitted by touch, aerosols or airborne when we could have fixed this in two weeks with a bunch of 25 year olds. We spent half a year before even realizing masks help, and we still don't know for sure how much and what's the difference between each kind. We had Omicron - we knew it was different, we had good reason to think it's not significantly worse from the start, but we still had a _lot_ of questions. But two years from the start of the pandemic we STILL didn't put a bunch of healthy volunteers through a completely harmless study to find out things early. Because it wouldn't have been "ethical".
This isn't ethics we're talking about. It's pure and unadulterated cowardice. We as a society shy away from doing things which we _know_ would save more lives in the aggregate because we'd have to risk causing much less harm, but harm which we'd be directly responsible for. Joe from the street would be excused from making these decisions, but when you deal with the people directly charged by the society from making these decision, it's just failure to do their job. And in a supermajority of case we're dealing with volunteers anyways.
If you feel like reading more about how stupid the whole system is: https://slatestarcodex.com/2017/08/29/my-irb-nightmare/