> 'One day when I was a junior medical student, a very important Boston surgeon visited the school and delivered a great treatise on a large number of patients who had undergone successful operations for vascular reconstruction.
> At the end of the lecture, a young student at the back of the room timidly asked, “Do you have any controls?” Well, the great surgeon drew himself up to his full height, hit the desk, and said, “Do you mean did I not operate on half the patients?” The hall grew very quiet then. The voice at the back of the room very hesitantly replied, “Yes, that’s what I had in mind.” Then the visitor’s fist really came down as he thundered, “Of course not. That would have doomed half of them to their death.”
> God, it was quiet then, and one could scarcely hear the small voice ask, “Which half?”'
Let's say inmates on death row aren't getting kidney transplants. A normal person might think "Well, that makes sense. There are only a few kidneys available, and if we give one to a death row inmate who we then fry the next day, we've just lost a kidney that could potentially give a dying person decades of healthy life for literally zero gain."
Does it surprise you that there are medical ethicists who are ABSOLUTELY OUTRAGED that death row inmates are not receiving kidney transplants? And this isn't the result of me looking for some outrageous cause to cherry-pick and put in an article. This is the result of me typing "medical ethics" into Wikipedia, clicking on the first name I saw, and seeing the sentence "He has urged that death row inmates be eligible to receive kidney transplants" in the bio.
That's a separate problem. One can be against the death penalty and against giving death row inmates kidneys. Even if all the death row inmates in the world are innocent, giving them kidneys still wastes kidneys. (Since most of them will not be exonerated.)
Everyone has their own "will to power" -- for Atilla the Hun, it's death and mayhem; for a gangsta, it's money and ho's (or whatever, I don't know any gangstas personally); etc.
Ironically, though, priests and therapists and ethicists have their own (whiny) will to power, and get a rush feeling their way of life taking over in the world, just like a warlord gets the same rush with new territory, etc (and I get the same rush with a new script or query).
"Genealogy of Morals" deserves any credit for this idea, not me.
I know that organized randomized studies are what is really needed, but there is a poor-man's substitute : Simply gather the data systematically, and data-mine anonymized records.
Of course, there will be unwanted correlations in the results (Dr X always does steroids), but those can be weeded out statistically (similarly for Hospital Y kills patients). But if the patients are receiving/not-receiving steroids at anything approaching random (as claimed in the article) then good data collection, and good statistics should be able to tease out results.
Many important findings in medicine are due to meta-analysis : whereby multiple trials are aggregated, and answers gathered across the meta-trial (and the questions being answered may even be different from what the trials were originally seeking to answer).
Hmm, I wonder if it's any harder to get the results of these meta-analyses "generally accepted" than if you did your own (equally statistically valid) trials?
In any case, weeding out the extra correlations requires more data, yada yada, people die while you're collecting it.
Protecting ourselves to death. This article's about consent requirements, which for the unconscious can delay treatment hours and worsen prognosis. And also that ethics panel makes trials difficult to organize, so new medicines are delayed.
The article doesn't mention it (since it is about the UK) but it the US the FDA takes unapproved drugs from the sick. For example in the 80's when aids victims brought dextran sulfate back from Japan, the FDA seized it at the border. This didn't stop until 88 when the drug was proven to work (at least up to FDA standards, costing millions of dollars and years after other countries had done).
Everybody wants to ensure medicine is ethically tested and safe, but that means some will die waiting. Mary Ruwart (a doctor and also a leading candidate for the libertarian party's presidential nominee in 2008) has written on this subject: http://www.ruwart.com/Healing/chap6.html.
Looks to me that the meme "Citation please" clearly needs to spread. The irony here is that it applies to the folks on their high horse; i.e. the ethics committee...
In debates over divisive topics, I've found that this two work request very quickly and efficiently isolates and weeds out sloppy thinking faster than any other technique.
There are other similar situations in other fields, as well as medicine; Robin Hanson had a post last Saturday on "Institutional Review Boards" in academia. They are involved in all human research, social as well as medical.
I can see the argument is this case, since it is a treatment that may be applied in the field anyway.
But in general I would actually tighten the restrictions for which research should be allowed very drastically since Doctors have shown a consistent disregard for peoples rights since basically forever. Go read the wikipedia list http://en.wikipedia.org/wiki/Human_experimentation_in_the_Un... it is very instructive in showing just how little many prominent doctors care about their patients. It goes back a long time, but there are some recent entries on that list too (and I bet there are still ongoing trials that will be added in the future)
Some choice quotes:
In 1953, the U.S. Atomic Energy Commission (AEC) ran several studies on the health effects of radioactive iodine in newborns and pregnant women at the University of Iowa. In one study, researchers gave pregnant women from 100 to 200 microcuries of iodine-131, in order to study the women's aborted embryos in an attempt to discover at what stage, and to what extent, radioactive iodine crosses the placental barrier. In another study, they gave 25 newborn babies (who were under 36 hours old and weighed from 5.5 to 8.5 lbs) iodine-131, either by oral administration or through an injection, so that they could measure the amount of iodine in their thyroid glands.[51]
From 1963 to 1973, a leading endocrinologist, Dr. Carl Heller, irradiated the testicles of Oregon and Washington prisoners. In return for their participation, he gave them $5 a month, and $100 when they had to receive a vasectomy upon conclusion of the trial. The surgeon who sterilized the men said that it was necessary to "keep from contaminating the general population with radiation-induced mutants". One of the researchers who had worked with Keller on the experiments, Dr. Joseph Hamilton, said that the experiments "had a little of the Buchenwald touch".[79]
In 1962, twenty-two elderly patients at the Jewish Chronic Disease Hospital in Brooklyn, New York were injected with live cancer cells by Chester M. Southam, who in 1952 had done the same to prisoners at the Ohio State Prison, in order to "discover the secret of how healthy bodies fight the invasion of malignant cells". The administration of the hospital attempted to cover the study up, but the New York State medical licensing board ultimately placed Southam on probation for one year. Two years later, the American Cancer Society elected him as their Vice President.[45]
So no, ethics committtees don't kill. They restrain doctors from going out of control.
> 'One day when I was a junior medical student, a very important Boston surgeon visited the school and delivered a great treatise on a large number of patients who had undergone successful operations for vascular reconstruction.
> At the end of the lecture, a young student at the back of the room timidly asked, “Do you have any controls?” Well, the great surgeon drew himself up to his full height, hit the desk, and said, “Do you mean did I not operate on half the patients?” The hall grew very quiet then. The voice at the back of the room very hesitantly replied, “Yes, that’s what I had in mind.” Then the visitor’s fist really came down as he thundered, “Of course not. That would have doomed half of them to their death.”
> God, it was quiet then, and one could scarcely hear the small voice ask, “Which half?”'
Dr. E. E. Peacock, Jr., quoted in _Medical World News_ (September 1, 1972), p. 45, as quoted in Tufte's 1974 book _Data Analysis for Politics and Policy_; http://www.marginalrevolution.com/marginalrevolution/2010/12...