

When ethics committees kill - baha_man
http://www.badscience.net/2011/03/when-ethics-committees-kill/

======
gwern
Reminds me of a quote I posted on LessWrong:
[http://lesswrong.com/lw/37k/rationality_quotes_december_2010...](http://lesswrong.com/lw/37k/rationality_quotes_december_2010/35rk)

> '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...](http://www.marginalrevolution.com/marginalrevolution/2010/12/the-
ethics-of-random-clinical-trials.html)

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AngryParsley
"Against medical ethics" is a similar blurb written by a med student:
<http://squid314.livejournal.com/285785.html>

_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._

~~~
ceejayoz
Said ethicists may have noticed that a whole lot of death row inmates seem to
be getting exonerated lately.

~~~
wazoox
And said ethicists may also be of the prevalent opinion among civilised
people, that death penalty is an abomination.

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mdda
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).

~~~
waqf
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.

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tomjen3
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...](http://en.wikipedia.org/wiki/Human_experimentation_in_the_United_States)
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.

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warrenwilkinson
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>.

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hsmyers
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...

~~~
bane
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.

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billswift
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.

<http://www.overcomingbias.com/2011/03/against-irbs.html>

