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> It's important that someone control the medical procedures and control that the effectively work. It's valuable to have a impartial observer who can quantify

by Gormo 14y ago

> It's important that someone control the medical procedures and control that the effectively work. It's valuable to have a impartial observer who can quantify the characteristics of a new drug or technique in a valid and useful way, and if an unbiased organization were to produce histograms of likely consequences of using each drug/procedure, and supply them to patients as an input into their decision-making, I'm certain that it would be universally lauded. But that's just supplying the data. Determining whether something is "safe" or "effective" isn't just about quantifying data; it's fundamentally a value judgment. Whether a drug is "safe" depends on how much risk the patient is willing to bear. Whether it's "effective" depends on what results the patient finds satisfactory. These are deeply intimate and personal judgments that are rightly the patient's to make. The problem with the FDA is that it doesn't actually supply the data in a way accessible to patients at all; instead it usurps their inherent right to make their own value judgments regarding their health, and simply allows or denies everyone access to the drug/procedure according to its own criteria. > A similar case, with less emotional charge, is the need of regulation of airplanes. Well, no, this isn't similar at all. It's far, far easier to generalize the risk/reward tradeoffs of flying in an airplane: people want to arrive at their intended destination on time, without being killed or injured in the process. A plane trip lasts a few hours, and has essentially no lasting consequences for a passenger once he disembarks; unlike medicine, flying on a plane doesn't have vast consequences for the quality and quantity of one's subsequent life. Plane trips, like hard drives, are both commodity goods for which the intended results and acceptable risks can be assumed in advance. Medicine is not.

gus_massa 14y ago
>> It's important that someone control the medical procedures and control that the effectively work. In most proposed treatments the discussion is not if they are more or less "effective", the problem is that they don't work, and some of them even have side effects. Terminal ill people are often desperate and would try whatever is trendy: http://theincidentaleconomist.com/wordpress/the-rise-and-fall-of-bone-marrow-transplantation-for-breast-cancer-a-tragic-success-story/ http://theincidentaleconomist.com/wordpress/the-rise-and-fal... This was a very expensive, dangerous and ineffective treatment.
- Gormo 14y ago
  > In most proposed treatments the discussion is not if they are more or less "effective", the problem is that they don't work, and some of them even have side effects. Well, in this context, whether treatments work or "don't work" is the definition of effectiveness, and whether or not they have deleterious side effects is the definition of safety. But apart from that, I'll again point out that whether or not a treatment works is determined by what results the patient considers satisfactory, and whether or not something is safe depends on what risks the patient is willing to bear; generalizations simply don't suffice here. If the unlikeliness of a procedure's success and the nature of the possible side-effects are known, then they can be communicated to the patient so that he can decide whether the higher probability of side effects is justified by the lower probability of relief according to his own hierarchy of values. If how well the treatment works and the nature of its side effects aren't known, then no one has the relevant knowledge to make an informed decision, and it still remains up to the patient to weigh the unquantifiable possibility of relief against the equally unquantifiable risk of a bad outcome. There's simply no way around the fact that the question always boils down to a deeply personal value judgement that no third party has the right to usurp. > Terminal ill people are often desperate and would try whatever is trendy Right. They're desperate because they're terminally ill. They're going to die if they don't get cured, so their risk calculation is probably entirely skewed to the "reward" side of the equation, no matter how remote it is. They've literally got nothing to lose, so it's unconscionable to forcibly deny them the right to "lose" it, third parties' objections to "trendiness" being entirely immaterial. > http://theincidentaleconomist.com/wordpress/the-rise-and-fall-of-bone-marrow-transplantation-for-breast-cancer-a-tragic-success-story/ http://theincidentaleconomist.com/wordpress/the-rise-and-fal... Perhaps this was an ineffective treatment, but the question of whether it should be paid for by insurance is entirely unrelated to the question of whether people should be forbidden from choosing to undergo the procedure at all. The FDA has nothing to do with the former question, and everything to do with the latter; in the article itself, there's no indication that anyone actually tried to forcibly prohibit the ABMT procedure. Doctors simply stopped recommending it after it was demonstrated not to be of much value. If, in some specific case in the future, patient and doctor agree that the ABMT procedure might be worth trying, no third party is going to actively overrule their judgment. But, unfortunately, this isn't the case for certain other procedures.

by Gormo 14y ago

gus_massa 14y ago

>> It's important that someone control the medical procedures and control that the effectively work. In most proposed treatments the discussion is not if they are more or less "effective", the problem is that they don't work, and some of them even have side effects. Terminal ill people are often desperate and would try whatever is trendy: http://theincidentaleconomist.com/wordpress/the-rise-and-fall-of-bone-marrow-transplantation-for-breast-cancer-a-tragic-success-story/ http://theincidentaleconomist.com/wordpress/the-rise-and-fal... This was a very expensive, dangerous and ineffective treatment.

Gormo 14y ago
> In most proposed treatments the discussion is not if they are more or less "effective", the problem is that they don't work, and some of them even have side effects. Well, in this context, whether treatments work or "don't work" is the definition of effectiveness, and whether or not they have deleterious side effects is the definition of safety. But apart from that, I'll again point out that whether or not a treatment works is determined by what results the patient considers satisfactory, and whether or not something is safe depends on what risks the patient is willing to bear; generalizations simply don't suffice here. If the unlikeliness of a procedure's success and the nature of the possible side-effects are known, then they can be communicated to the patient so that he can decide whether the higher probability of side effects is justified by the lower probability of relief according to his own hierarchy of values. If how well the treatment works and the nature of its side effects aren't known, then no one has the relevant knowledge to make an informed decision, and it still remains up to the patient to weigh the unquantifiable possibility of relief against the equally unquantifiable risk of a bad outcome. There's simply no way around the fact that the question always boils down to a deeply personal value judgement that no third party has the right to usurp. > Terminal ill people are often desperate and would try whatever is trendy Right. They're desperate because they're terminally ill. They're going to die if they don't get cured, so their risk calculation is probably entirely skewed to the "reward" side of the equation, no matter how remote it is. They've literally got nothing to lose, so it's unconscionable to forcibly deny them the right to "lose" it, third parties' objections to "trendiness" being entirely immaterial. > http://theincidentaleconomist.com/wordpress/the-rise-and-fall-of-bone-marrow-transplantation-for-breast-cancer-a-tragic-success-story/ http://theincidentaleconomist.com/wordpress/the-rise-and-fal... Perhaps this was an ineffective treatment, but the question of whether it should be paid for by insurance is entirely unrelated to the question of whether people should be forbidden from choosing to undergo the procedure at all. The FDA has nothing to do with the former question, and everything to do with the latter; in the article itself, there's no indication that anyone actually tried to forcibly prohibit the ABMT procedure. Doctors simply stopped recommending it after it was demonstrated not to be of much value. If, in some specific case in the future, patient and doctor agree that the ABMT procedure might be worth trying, no third party is going to actively overrule their judgment. But, unfortunately, this isn't the case for certain other procedures.