4 ms·
It's surprising to me that we don't have better mechanisms to green-light the combination of factors where (a) a drug company has a history of successfully deli
by btown 3y ago
It's surprising to me that we don't have better mechanisms to green-light the combination of factors where (a) a drug company has a history of successfully delivering treatments with full FDA approval, (b) the patient has only months to live, (c) multiple doctors agree that the treatment is superior to any other option for them, and (d) the drug company is prohibited from any kind of marketing for the treatment.
Certainly there are edge cases and loopholes, but there should be much more of a culture of informed consent for terminally ill patients, with common-sense ways to ensure that "quack" drug companies don't take advantage of them.
(Ah, but as I type this, of course there is a party that might not consent to this: the insurer. That's a tough set of incentives to crack, especially with the fact that the treatment may have unknown side effects, and thus cause the patient to fall outside of actuarial expectations. But we've solved harder problems than this before.)
- science4sail 3y agoIsn't it a problem of incentives? No one gets penalized if a lifesaving drug gets delayed, but heads will roll if an experimental drug turns out to have horrible side effects and/or financial costs - especially if the test subjects disproportionately belong to a politically-sensitive demographic. Pandemics are an edge case: it's socially acceptable to violate political and ethical norms during an emergency.
- atahanacar 3y ago>problem of incentives I don't see the problem here. In med school, the first thing we're taught is "primum non nocere". Of course it makes sense to penalize even if no harm is done to patients, if the methodology of testing is wrong or unethical. > it's socially acceptable to violate ... ethical norms during an emergency Not exactly. You aren't violating ethical norms, the ethical norms themselves allow or even "force" you to change priorities in emergencies. I would say "It's ethically acceptable to violate social norms during an emergency" fits better.
- huytersd 3y agoWho really cares about anything when you have 2 months to live. You should be allowed to try anything on a willing participant at that point.
- bhhaskin 3y agoSome places allow you to. I believe it's called right to try.
- atahanacar 3y agoThis is medical ethics 101. I don't have the time right now to explain it, but I will leave some keywords if anyone is interested in reading about it: therapeutic misconception, vulnerable groups, medical vulnerability. Related to your point (c): clinical equipoise.