Medical ethics? (model this)

Steven Joffe, MD, MPH, a medical ethicist at the University of Pennsylvania, said he doesn’t believe clinicians “should be lowering our standards of evidence because we’re in a pandemic.”

Link here.  That sentence is a good litmus test for whether you think clearly about trade-offs, statistical and speed trade-offs included, procedures vs. final ends of value (e.g., human lives), and how obsessed you are with mood affiliation (can you see through his question-begging invocation of “lowering our standards”?).  It is stunning to me that a top researcher at an Ivy League school literally cannot think properly about his subject area at all, and furthermore has no compunction admitting this publicly.  As Alex wrote just earlier today: “Waiting for more data isn’t “science,” it’s sometimes an excuse for an unscientific status-quo bias.”

To be clear, we should run more and better RCT trials of Ivermectin, the topic at hand for Joffe (and in fact Fast Grants is helping to fund exactly that).  But of course the “let’s go ahead and actually do this” decision should be different in a pandemic, just as the “just how much of a hurry are we in here anyway?” calculus should differ as well.  I do not know enough to judge whether Ivermectin should be in hospital treatment protocols, as it is in many countries, but I do not condemn this simply on the grounds of it representing a “lower standard.”  It might instead reflect a “higher standard” of concern for human lives, and you will note the drug is not considered harmful as it is being administered.

If you apply the standards of Joffe’s earlier work, we should not be proceeding with these RCTs, including presumably vaccine RCTs, until we have assured that all of the participants truly understand the difference between “research” and “treatment” as part of the informed consent protocols.  No “therapeutic misconception” should be allowed.  Really?

If the pandemic has changed my mind about anything, it is the nature of expertise.



Add Comment