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You're assuming that pulling or not pulling the lever is morally irrelevant, which may not be the case. To take it to the extreme, it's the difference between k

You're assuming that pulling or not pulling the lever is morally irrelevant, which may not be the case. To take it to the extreme, it's the difference between killing three people or waiting for three people to die so you can study them. In the former case, you're definitely causing excess infections (some of which might die, directly due to you).

martincmartin 6y ago
What if it's killing 3 people, vs waiting for 3,000 to die? What if it's having a small but non-zero probability of killing 1 person, who understands and accepts the risk, vs waiting for thousands to die who really don't want to?
- StavrosK 6y ago
  Indeed, and apparently ethics boards find it preferable to wait for hundreds of thousands to die rather than kill one, but it's not entirely unreasonable. Also, I think the number of total deaths in both branches are about the same, as they're only waiting for 100ish people to get infected on either arm.
  - xyzzyz 6y ago
    It was entirely unreasonable, though. Also, I think the number of total deaths in both branches are about the same, as they're only waiting for 100ish people to get infected on either arm. When you (entirely unreasonably) restrict your analysis only to the experiment subjects, it is true. However, the vaccine trials cannot be analyzed in a vacuum: the whole reason why these are even a thing is the raging pandemic that kills thousands of people every single day. To put it in a trolley analogy, the decision is not between high speed and low speed trolley that will end up rolling over the same number of people. Instead, in the other branch, in addition to one slow speed trolley, there are also thousands of extra trolleys that you just aren’t explicitly aware of, but they will roll over their victims nonetheless.
    - bawolff 6y ago
      That seems to be torturing the trolly metaphor quite a bit when the original works perfectly fine (actually better) for this situation.
    - bluGill 6y ago
      There is more than that though. Sure with a challenge trial you know that the vaccine works much faster. However you still need to vaccinate tens of thousands and then watch them for a few months to ensure that nothing else bad happens. At least one covid vaccine trails has already failed because the vaccine wasn't safe (in the case I know of because you show up HIV+ even months latter which makes those tests worthless - the vaccine might have worked against Covid for all I know). There have been a lot of other vaccines trials over the years that have failed for safety reasons.
      - xyzzyz 6y ago
        > At least one covid vaccine trails has already failed because the vaccine wasn't safe (in the case I know of because you show up HIV+ even months latter which makes those tests worthless - the vaccine might have worked against Covid for all I know). That may be a good enough to nix development for common cold vaccine, but how can one argue that it’s serious enough problem to cancel vaccine for disease that kills thousands of people every single day? This is another example of how “safety” and “ethics” regulations have little to do, and in fact are counterproductive to achieve safety and ethics in real world.
        mattkrause 6y ago
        It was clear at the time that other vaccine candidates were working at least as well: Pfizer/Bio-NTech got its EUA the same week AND didn’t mess up HIV tests. Seems like a pretty straightforward decision to me. https://www.nature.com/articles/d41586-020-03570-0 https://www.nature.com/articles/d41586-020-03570-0
- bluGill 6y ago
  What if the 3000 don't die though. At any time covid could hit some sort of natural limit and stop spreading (as happened to SARS before it). At anytime we could discover a miracle cure that means Covid isn't a problem (as antibiotics did for infections). Since you don't know about those unknowns it is hard to say in advance if you killed 3 so 2997 could live, or killed 3 people for nothing.
waterhouse 6y ago
But it's not you that's killing the test subjects; they're doing it to themselves. (Well, it depends on the experimental setup, but it can be easily arranged that way: you could leave a spray bottle on the table and tell them "This contains the coronavirus. If you spray your face with it, you will help our experiment, but risk death. You are also free to just go home and face no consequences.") I don't understand the argument for moral relevance.
- statstutor 6y ago
  Edited: "This contains the coronavirus. If you spray your face with it, we will give you money enough to pay a month or two's rent and living expenses, but you risk your death. You are also free to just leave."
esotericn 6y ago
Taking a top-level view though, we've pulled about a billion different levers. In the UK we've restricted the activity of healthy individuals for about 11 months now - the latest episode being an approximately 3 month period within which it's illegal to meet anyone else within your own home. Psychological trials, even trivial things like filling in surveys or taking reaction speed tests are carefully monitored for ethical concerns, lockdown we just went all in on with no cost-benefit analysis. It seems bizarre to me that in that context we should be worrying about the ethics of a challenge study with a few hundred or few thousand volunteers. Loads of people I know have _already_ volunteered themselves for it in the outside world with no compensation and with no benefit to science because they're not able to mentally handle indefinite restrictions.

martincmartin 6y ago

What if it's killing 3 people, vs waiting for 3,000 to die? What if it's having a small but non-zero probability of killing 1 person, who understands and accepts the risk, vs waiting for thousands to die who really don't want to?

StavrosK 6y ago
Indeed, and apparently ethics boards find it preferable to wait for hundreds of thousands to die rather than kill one, but it's not entirely unreasonable. Also, I think the number of total deaths in both branches are about the same, as they're only waiting for 100ish people to get infected on either arm.
- xyzzyz 6y ago
  It was entirely unreasonable, though. Also, I think the number of total deaths in both branches are about the same, as they're only waiting for 100ish people to get infected on either arm. When you (entirely unreasonably) restrict your analysis only to the experiment subjects, it is true. However, the vaccine trials cannot be analyzed in a vacuum: the whole reason why these are even a thing is the raging pandemic that kills thousands of people every single day. To put it in a trolley analogy, the decision is not between high speed and low speed trolley that will end up rolling over the same number of people. Instead, in the other branch, in addition to one slow speed trolley, there are also thousands of extra trolleys that you just aren’t explicitly aware of, but they will roll over their victims nonetheless.
  - bawolff 6y ago
    That seems to be torturing the trolly metaphor quite a bit when the original works perfectly fine (actually better) for this situation.
  - bluGill 6y ago
    There is more than that though. Sure with a challenge trial you know that the vaccine works much faster. However you still need to vaccinate tens of thousands and then watch them for a few months to ensure that nothing else bad happens. At least one covid vaccine trails has already failed because the vaccine wasn't safe (in the case I know of because you show up HIV+ even months latter which makes those tests worthless - the vaccine might have worked against Covid for all I know). There have been a lot of other vaccines trials over the years that have failed for safety reasons.
    - xyzzyz 6y ago
      > At least one covid vaccine trails has already failed because the vaccine wasn't safe (in the case I know of because you show up HIV+ even months latter which makes those tests worthless - the vaccine might have worked against Covid for all I know). That may be a good enough to nix development for common cold vaccine, but how can one argue that it’s serious enough problem to cancel vaccine for disease that kills thousands of people every single day? This is another example of how “safety” and “ethics” regulations have little to do, and in fact are counterproductive to achieve safety and ethics in real world.
      - mattkrause 6y ago
        It was clear at the time that other vaccine candidates were working at least as well: Pfizer/Bio-NTech got its EUA the same week AND didn’t mess up HIV tests. Seems like a pretty straightforward decision to me. https://www.nature.com/articles/d41586-020-03570-0 https://www.nature.com/articles/d41586-020-03570-0
bluGill 6y ago
What if the 3000 don't die though. At any time covid could hit some sort of natural limit and stop spreading (as happened to SARS before it). At anytime we could discover a miracle cure that means Covid isn't a problem (as antibiotics did for infections). Since you don't know about those unknowns it is hard to say in advance if you killed 3 so 2997 could live, or killed 3 people for nothing.

waterhouse 6y ago

But it's not you that's killing the test subjects; they're doing it to themselves. (Well, it depends on the experimental setup, but it can be easily arranged that way: you could leave a spray bottle on the table and tell them "This contains the coronavirus. If you spray your face with it, you will help our experiment, but risk death. You are also free to just go home and face no consequences.") I don't understand the argument for moral relevance.

statstutor 6y ago
Edited: "This contains the coronavirus. If you spray your face with it, we will give you money enough to pay a month or two's rent and living expenses, but you risk your death. You are also free to just leave."

esotericn 6y ago

Taking a top-level view though, we've pulled about a billion different levers. In the UK we've restricted the activity of healthy individuals for about 11 months now - the latest episode being an approximately 3 month period within which it's illegal to meet anyone else within your own home. Psychological trials, even trivial things like filling in surveys or taking reaction speed tests are carefully monitored for ethical concerns, lockdown we just went all in on with no cost-benefit analysis. It seems bizarre to me that in that context we should be worrying about the ethics of a challenge study with a few hundred or few thousand volunteers. Loads of people I know have _already_ volunteered themselves for it in the outside world with no compensation and with no benefit to science because they're not able to mentally handle indefinite restrictions.