Tyrone on clinical trials and how to keep them up and running

Tyrone — my evil twin brother — received so much hate and love mail from his recent pronouncements about QAnon that he felt emboldened to offer additional opinions.  As you might expect, he prefers to spew his hateful bile on matters of life and death.  In particular, he has been following the debates about Covid and whether new treatments should be accelerated in their availability.  Anyway, I told him I was willing to pass along another of his letters, as a kind of experiment (not quite a clinical trial) whether Tyler or Tyrone is a more beloved writer on MR.  I am sure you readers — and especially commentators — stand ready to defend my honor!

So here is his (as usual) fallacy-ridden missive:

Tyler, I don’t see why you let the defenders of FDA stalling get away with their dawdling.  They all end up with the same argument — if we let wonderful, salt of the earth Americans take beneficial medicines, treatments, and vaccines, we will not be able to set up informative clinical trials.  Why partake in the trial when you can just get the stuff through normal means?

That is so lame!  First, they could simply pay people to partake in those trials.  Isn’t that in essence what the NBA did with its Covid testing in the bubble?  If the value of those clinical trials truly is so high, it should be possible to internalize enough of those benefits to encourage participation.  If institutional barriers stand in the way there, let’s obsess over fixing those.

Why should we force so many Americans to be sacrificial lambs, just to subsidize the trial costs?  Let those costs be taken out of grant overhead!  (And admin. salaries, if need be.)

If the current medical establishment is not as able as the NBA, well OK, can’t they just admit it and plead patheticness?  We can send them to take care of Major League Baseball, and put Adam Silver and Lebron James in charge of our health care.

Second, there is another way to keep the trial up and running.  Approve use of the treatment, but allow the suppliers to charge very high prices!  Better yet, use the law to make them charge high prices and if need be forbid insurance coverage.

“What will it be sucker? Fifty percent chance of the placebo, or 100k for those monoclonal antibodies?”

I assure you Tyler that will restore a separating equilibrium.  Furthermore, in the meantime only the most meritocratic of wealthy men will get the treatment outside of the trial, all for the better.  If need be, you can pull away the price floor when the clinical trial is complete, in the meantime you have satisfied the Pareto principle.

And what about the Hippocratic Oath ?  “Do no harm”?  Is that not invoked so selectively by the public health commentators?  Surely you realize they court public opinion and high status by taking sins of commission far more seriously than the far less visible sins of omission?

Is it not harm to deny patients ready accessibility to a treatment with positive expected value?

Is it really such a great rejoinder to insist “We can’t let those patients improve their lot by raising pecuniary costs for the medical professionals running their trials!  That is true Hippocratic harm and must be avoided at all costs, because in fact we medical people would be too feckless to overcome that problem…”

Sigh.  At that point I had to stop reading and transcribing.  I am sorry readers, I didn’t know that Tyrone in his spare time was studying economics and indeed some logic as well.  Maybe he has even been reading MR.  That makes him less interesting, less funny, and maybe a bit too much like Tyler.  That is not why you come to read Tyrone, and indeed you might as well be reading Tyler.

What can I do to make Tyrone better and more eccentric again?  Perhaps try to get him premature access to some of those special treatments?  Stay tuned….