Faster Human Trials
In 1986, AZT (AIDS treatment) showed 1/145 deaths compared to the placebo’s 16/137. 6,000 AIDS patients were offered AZT, helping it get to the public much faster.
Different rules apply in a pandemic. If the treatment is sufficiently promising, we should skip to human clinical trials. Covid-19 has a lower fatality rate than AIDS, which set a precedent. 3,000 altruists have even offered to deliberately expose themselves to covid-19!
COVID-19 vaccines started to be distributed in December 2020. So about one year out. By vaccine standards, that was pretty fast.
Resource Allocation
“Triage” was originally a references to sorting coffee beans, and then its usage slipped into sorting different kinds of war casualties.
My introduction to “triage” was at work. When a bug is filed on Azure Dev Ops, it is set to triage, where an engineer (usually a lead) categorizes it as P1 (highest), P2, or P3 (lowest). TIL of the word’s etymology.
Triage in a hospital setting refers to deciding which patients get access to a limited set of resources, e.g. ventilators. One may triage in a way that prioritizes acute needs first, e.g. ERs treating heart attacks before fevers. One may also triage from a utilitarian (doing most good) perspective, e.g. maximizing years of life in a bombing aftermath where the more likely to survive are treated first. #utilitarianism
Wartime films frequently feature “mercy killings” of soldiers who’ve sustained fatal injuries in the field . Charges of homicides (undue euthanasia) were brought against some health care workers (most notably Dr. Anna Pou), but no one was indicted.
Baltimore held public debates with residents to discuss how to ration health resources. Even though factors like gender, race, socioeconomic status, citizenship, occupation, criminal history, etc., were deemed out of bounds by the discussion leaders, they still cropping up in the group discussions. Isn’t expected lifetime, which is a proxy for age, a form of discrimination?
TIL about CMU’s Program for Deliberative Democracy. It involves: recruiting a diverse group of participants; providing basic information and a balanced view of various perspectives on issues; moderated small-group discussions; Q&A with experts; small-group discussions to reflect on Q & A; exit survey.
Although Baltimore participants were comfortable making utilitarian choices, e.g., person X should get the ventilator because they’re going to benefit the greater good, they rejected alternative formulations, e.g., person X deserves the ventilator more because their life has more value. Taking ventilators from patients who did not appear to be improving was very contentious amongst the participants, but it’d be hard for any system to work without reallocation.
Some states have published guidelines for allocating scarce resources during emergencies, e.g., WA’s DoH’s EMS and Trauma Care Clinical Guidelines .
References
- Experimental AIDS Drug to Be Given to Half of Patients. Marlene Cimons. www.latimes.com . Sep 20, 1986.
- The case for vaccine experiments on human volunteers. Peter Singer; Richard Yetter Chappell. www.washingtonpost.com . Apr 27, 2020.
- Can Progressives Be Convinced That Genetics Matters? Gideon Lewis-Kraus. www.newyorker.com . Sep 6, 2021. Accessed Sep 7, 2021.
- Playing God. Sheri Fink; Gina Isbell; Simon Adler; Annie McEwen. radiolab.org . Aug 21, 2016.
- Film / Mercy Kill - TV Tropes. tvtropes.org . Accessed Oct 8, 2022.
- Memorial Medical Center and Hurricane Katrina. en.wikipedia.org . Accessed Oct 8, 2022.
- Whose Lives Should Be Saved? Researchers Ask the Public. Sheri Fink. www.nytimes.com . web.archive.org . Aug 21, 2016. Accessed Aug 31, 2022.
- Program for Deliberative Democracy. www.cmu.edu . Accessed Oct 8, 2022.
Harden, a liberal behavior geneticist, is publishing a book, “The Genetic Lottery: Why DNA Matters for Social Equality”. Watch this space as it casts doubt on prevailing social justice thesis that environmental factors, and not genetics, influence behavior or social outcomes.
Check back in Sept 2022 (one year from now).