7 ms·

Interesting point of view, but where would you set the threshold: a challenge trial for a cancer drug by injecting a carcinogen to cause tumor growth? What abo

by folli 6y ago

Interesting point of view, but where would you set the threshold: a challenge trial for a cancer drug by injecting a carcinogen to cause tumor growth? What about viral diseases that are much more devastating, e.g. a challenge study for an ebola vaccine?

waterhouse 6y ago
There are no ethical issues when the subjects are fully willing volunteers who have had the risks properly explained and emphasized to them. As some have mentioned, if people can volunteer to risk their own life for the army, then why not for this? (The experiment must, of course, fully quarantine the volunteers who are given an infectious disease (cancer is not infectious, ebola is) until they're recovered (or dead); otherwise they'd be risking more than just the volunteers' lives.)
- refurb 6y ago
  There are ethical issues. You’re just not aware of them. Do you compensate the participants for their time? If not, can you find enough people to run the trial? If you do compensate them are they truly consenting freely? Or do they just need the money? Consent is a very complicated issue and you’re hand waving all the nuances away.
  - waterhouse 6y ago
    I do think it's a silly argument that paying someone to do something means they're not freely consenting to do the thing. As long as it's not your fault that they're in a bad economic situation, all you're doing is offering them an option that they, by accepting it, believe to be an improvement over their current situation. People who don't like sweatshops should be removing all barriers to the setting up of more sweatshops, so that they will compete for workers and eventually have to improve working conditions or raise wages. However, in this case, I suspect offering a monetary incentive wouldn't be necessary. Everyone knows about the terrible disease; just make a patriotic appeal and I expect you'd have plenty of unpaid volunteers.
    - refurb 6y ago
      Accounting for financial aspects is not silly. People who are desperately poor will do desperate things for money that they would consent to otherwise. Taking advantage of that is unethical. And I’m not sure if you’d have a ton of unpaid volunteers or at least enough to power a trial. It’s not a simple “lets get a shot” it’s having to travel to a clinic several times over a period of time. It’s a serious commitment of time, that’s why trials are normally compensated. Otherwise your entire pool of patients are just upper class mid-white collar career who can work from home and skip work in the middle of the day.
      - waterhouse 6y ago
        > Accounting for financial aspects is not silly. People who are desperately poor will do desperate things for money that they would consent to otherwise. Taking advantage of that is unethical. Why? The desperately poor person seems to think the money is worth it. Who are you to tell them it's bad for them to take it? The very stigma against "exploiting" such a person makes it less likely that other people will make them less-bad offers. > And I’m not sure if you’d have a ton of unpaid volunteers or at least enough to power a trial. In this thread, we have someone saying "I have signed up" and someone replying "thanks for taking a risk to help out the human race". It is patriotic, it is (or can easily be made) prestigious. (To make it visible, give out a hat, a button, a jacket, whatever.) I expect some guys would do it because it seems exciting or meaningful, others because they think it'll help them impress the ladies.
- mattkrause 6y ago
  When, specifically (i.e., as of what date?), do you think the risks of COVID were well-understood enough to be properly explained and emphasizes?
  - waterhouse 6y ago
    Well, to be responsible, all you have to do is not understate the risks. In fact, it's probably best to err on the side of making it seem scary. If you said "N people have died, M people are known to have gotten it and recovered, so you should not assume your survival chances are better than M / (N+M)", with N being at least, say, 100 for sample-sizing purposes, I think that would be reasonable—so one could have said that probably back in February 2020. That would have yielded overestimates—probably 1-10% IIRC—but you could probably find some people willing to risk even those odds for the sake of their country or the world (or bragging rights).
gamegoblin 6y ago
I think an obvious first-pass at a threshold would be a global pandemic with a clearly established non-trivial mortality rate and in which it is clear to epidemiologists that -- unless a vaccine is developed -- essentially everyone is going to get the virus at some point. It's much more murky territory for more containable viruses such as ebola. But a deadly pandemic that spreads across the globe in weeks? Seems like it would be hard to argue against challenge trials with informed consent. I think the strongest argument against it is that setting any such bar only makes it possible to lower the bar in the future.

by folli 6y ago

waterhouse 6y ago

There are no ethical issues when the subjects are fully willing volunteers who have had the risks properly explained and emphasized to them. As some have mentioned, if people can volunteer to risk their own life for the army, then why not for this? (The experiment must, of course, fully quarantine the volunteers who are given an infectious disease (cancer is not infectious, ebola is) until they're recovered (or dead); otherwise they'd be risking more than just the volunteers' lives.)

refurb 6y ago
There are ethical issues. You’re just not aware of them. Do you compensate the participants for their time? If not, can you find enough people to run the trial? If you do compensate them are they truly consenting freely? Or do they just need the money? Consent is a very complicated issue and you’re hand waving all the nuances away.
- waterhouse 6y ago
  I do think it's a silly argument that paying someone to do something means they're not freely consenting to do the thing. As long as it's not your fault that they're in a bad economic situation, all you're doing is offering them an option that they, by accepting it, believe to be an improvement over their current situation. People who don't like sweatshops should be removing all barriers to the setting up of more sweatshops, so that they will compete for workers and eventually have to improve working conditions or raise wages. However, in this case, I suspect offering a monetary incentive wouldn't be necessary. Everyone knows about the terrible disease; just make a patriotic appeal and I expect you'd have plenty of unpaid volunteers.
  - refurb 6y ago
    Accounting for financial aspects is not silly. People who are desperately poor will do desperate things for money that they would consent to otherwise. Taking advantage of that is unethical. And I’m not sure if you’d have a ton of unpaid volunteers or at least enough to power a trial. It’s not a simple “lets get a shot” it’s having to travel to a clinic several times over a period of time. It’s a serious commitment of time, that’s why trials are normally compensated. Otherwise your entire pool of patients are just upper class mid-white collar career who can work from home and skip work in the middle of the day.
    - waterhouse 6y ago
      > Accounting for financial aspects is not silly. People who are desperately poor will do desperate things for money that they would consent to otherwise. Taking advantage of that is unethical. Why? The desperately poor person seems to think the money is worth it. Who are you to tell them it's bad for them to take it? The very stigma against "exploiting" such a person makes it less likely that other people will make them less-bad offers. > And I’m not sure if you’d have a ton of unpaid volunteers or at least enough to power a trial. In this thread, we have someone saying "I have signed up" and someone replying "thanks for taking a risk to help out the human race". It is patriotic, it is (or can easily be made) prestigious. (To make it visible, give out a hat, a button, a jacket, whatever.) I expect some guys would do it because it seems exciting or meaningful, others because they think it'll help them impress the ladies.
mattkrause 6y ago
When, specifically (i.e., as of what date?), do you think the risks of COVID were well-understood enough to be properly explained and emphasizes?
- waterhouse 6y ago
  Well, to be responsible, all you have to do is not understate the risks. In fact, it's probably best to err on the side of making it seem scary. If you said "N people have died, M people are known to have gotten it and recovered, so you should not assume your survival chances are better than M / (N+M)", with N being at least, say, 100 for sample-sizing purposes, I think that would be reasonable—so one could have said that probably back in February 2020. That would have yielded overestimates—probably 1-10% IIRC—but you could probably find some people willing to risk even those odds for the sake of their country or the world (or bragging rights).

gamegoblin 6y ago

I think an obvious first-pass at a threshold would be a global pandemic with a clearly established non-trivial mortality rate and in which it is clear to epidemiologists that -- unless a vaccine is developed -- essentially everyone is going to get the virus at some point. It's much more murky territory for more containable viruses such as ebola. But a deadly pandemic that spreads across the globe in weeks? Seems like it would be hard to argue against challenge trials with informed consent. I think the strongest argument against it is that setting any such bar only makes it possible to lower the bar in the future.