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I am reminded of this story of a medical reversal: https://www.badscience.net/2011/03/when-ethics-committees-kill/ https://www.badscience.net/2011/03/when-ethic

by J-dawg 7y ago

I am reminded of this story of a medical reversal: https://www.badscience.net/2011/03/when-ethics-committees-kill/ https://www.badscience.net/2011/03/when-ethics-committees-ki... > This is not an abstract problem. Here is one example. For years in A&E, patients with serious head injury were often treated with steroids, in the reasonable belief that this would reduce swelling, and so reduce crushing damage to the brain, inside the fixed-volume box of your skull. > Researchers wanted to randomise unconscious patients to receive steroids, or no steroids, instantly in A&E, to find out which was best. This was called the CRASH trial, and it was a famously hard fought battle with ethics committees, even though both treatments – steroids, or no steroids – were in widespread, routine use. Finally, when approval was granted, it turned out that steroids were killing patients. > This was an extraordinary piece of work. At the end of the trial, where the head injuries were pretty bad (a quarter of the people died), it turned out there were two and a half extra deaths for every one hundred people treated with steroids.

e40 7y ago
in the reasonable belief that this would reduce swelling It's amazing to me that they wouldn't track this from the beginning, and do the experiment, to vet the idea. I mean, they went all in on it, why not give it to 50% of the head injuries and see?
- e40 7y ago
  It seems like part of the world is going in the direction of verify don't assume, and the other half has decided that their gut always has the right answer. It's a strange time to be alive.
  - AstralStorm 7y ago
    Except some of those won't be. We're taking life or death decisions here. (Or at least productive years of life.) There is always a cost and this cost did come to bite you sooner or later. The highest standard for decision making is definitely not "going with your gut". I wonder if anyone is actually claiming this or you just like to build strawmen. Typical reasons to adopt a practice is politics and marketing, then legacy, only then followed by effectiveness...
- kbenson 7y ago
  Possibly because if you make an experiment out of is, then there's ethical concerns that you might have to consider (or worry about other people throwing in your face), where as if you just do it because of your stated belief it would help, then that specific problem is no longer a concern. It's impossible to rationally consider all the myriad decisions we must make in the modern day, so people rely on rules-of-thumb that work in most cases (or we hope they work in most cases). For example, "don't perform medical experiments on people that may cause them more hard than not experimenting". Unfortunately, we often start relying on the rule-of-thumb as the reason instead of the heuristic that helps us short-circuit a rigorous rational reasoning, and then we end up with people using those rules of thumb why to deny, or criticize, actions where it makes no sense.

by J-dawg 7y ago

e40 7y ago

in the reasonable belief that this would reduce swelling It's amazing to me that they wouldn't track this from the beginning, and do the experiment, to vet the idea. I mean, they went all in on it, why not give it to 50% of the head injuries and see?

e40 7y ago
It seems like part of the world is going in the direction of verify don't assume, and the other half has decided that their gut always has the right answer. It's a strange time to be alive.
- AstralStorm 7y ago
  Except some of those won't be. We're taking life or death decisions here. (Or at least productive years of life.) There is always a cost and this cost did come to bite you sooner or later. The highest standard for decision making is definitely not "going with your gut". I wonder if anyone is actually claiming this or you just like to build strawmen. Typical reasons to adopt a practice is politics and marketing, then legacy, only then followed by effectiveness...
kbenson 7y ago
Possibly because if you make an experiment out of is, then there's ethical concerns that you might have to consider (or worry about other people throwing in your face), where as if you just do it because of your stated belief it would help, then that specific problem is no longer a concern. It's impossible to rationally consider all the myriad decisions we must make in the modern day, so people rely on rules-of-thumb that work in most cases (or we hope they work in most cases). For example, "don't perform medical experiments on people that may cause them more hard than not experimenting". Unfortunately, we often start relying on the rule-of-thumb as the reason instead of the heuristic that helps us short-circuit a rigorous rational reasoning, and then we end up with people using those rules of thumb why to deny, or criticize, actions where it makes no sense.