Yesterday I spoke with my doctor about skirting around the FDA’s not having approved of a drug that may be approved in Europe first (it may be approved in the US first). I explained that one first-world safety organization’s imprimatur is good enough for me until the FDA gives a verdict, and that harm from taking a medicine is not qualitatively different than harm from not taking a medicine.
We also discussed a clinical trial of a new drug, and I had to beat him with a stick until he abandoned “I have absolutely no idea at all if it will be better for you or not”. I explained that abstractly, a 50% chance of being on a placebo and a 50% chance of being on a medicine with a 50% chance of working was better than assuredly taking a medicine with a 20% chance of working, and that he was able to give a best guess about the chances of it working.
In practice, there are other factors involved, in this case it’s better to try the established medicine first and just see if it works or not, as part of exploration before exploitation.
We also discussed a clinical trial of a new drug, and I had to beat him with a stick until he abandoned “I have absolutely no idea at all if it will be better for you or not”. I explained that abstractly, a 50% chance of being on a placebo and a 50% chance of being on a medicine with a 50% chance of working was better than assuredly taking a medicine with a 20% chance of working, and that he was able to give a best guess about the chances of it working.
Better yet, if you aren’t feeling like being altruistic you go on the trial then test the drug you are given to see if it is the active substance. If not you tell the trial folks that placebos are for pussies and go ahead and find either an alternate source of the drug or the next best thing you can get your hands on. It isn’t your responsibility to be a control subject unless you choose to be!
Downvoted for encouraging people to screw over other people by backing out of their agreements… What would happen to tests if every trial patient tested their medicine to see if it’s a placebo? Don’t you believe there’s value in having control groups in medical testing?
Lessdazed is describing quite a messy situation. Let me split out various subcases.
First is the situation with only one approval authority running randomised controlled trials on medicines. These trials are usually in three phases. Phase I on healthy volunteers to check for toxicity and metabolites. Phase II on sufferers to get an idea of the dose needed to affect the course of the illness. Phase III to prove that the therapeutic protocol established in Phase II actually works.
I have health problems of my own and have fancied joining a Phase III trial for early access to the latest drugs. Reading around for example it seems to be routine for drugs to fail in Phase III. Outcomes seem to be vaguely along the lines of three in ten are harmful, six in ten are useless, one in ten is beneficial. So the odds that a new drug will help, given that it was the one out of ten that passed Phase III, are good, while the odds that a new drug will help, given that it is about to start on Phase III are bad.
Joining a Phase III trial is a genuinely altruistic act by which the joiner accepts bad odds for himself to help discover valuable information for the greater good.
I was confused by the idea of joining a Phase III trial and unblinding it by testing the pill to see whether one had been assigned to the treatment arm of the study or the control arm. Since the drug is more likely to be harmful than to be beneficial, making sure that you get it is playing against the odds!
Second, Lessdazed seemed to be considering the situation in which EMA has approved a drug and the FDA is blocking it in America, simply as a bureaucratic measure to defend its home turf. If it were really as simple as that, I would say that cheating to get round the bureaucratic obstacles is justified.
However the great event of my lifetime was man landing on the Moon. NASA was brilliant and later became rubbish. I attribute the change to the Russians dropping out of the space race. In the 1960′s NASA couldn’t afford to take bad decisions for political reasons, for fear that the Russians would take the good decision themselves and win the race. The wider moral that I have drawn is that big organisations depend on their rivals to keep them honest and functioning.
Third: split decisions with the FDA and the EMA disagreeing, followed by a treat-off to see who was right, strike me as essential. I dread the thought of a single, global medicine agency that could prohibit a drug world wide and never be shown up by approval and successful use in a different jurisdiction.
Hmm, my comment is losing focus. My main point is that joining a Phase III trial is, on average, a sacrifice for the common good.
Downvoted for encouraging people to screw over other people by backing out of their agreements… What would happen to tests if every trial patient tested their medicine to see if it’s a placebo? Don’t you believe there’s value in having control groups in medical testing?
Downvoted for actively polluting the epistemic belief pool for the purpose of a shaming attempt. I here refer especially (but not only) to the rhetorical question:
Don’t you believe there’s value in having control groups in medical testing?
I obviously believe there’s a value in having control groups. Not only is that an obvious belief but it is actually conveyed by my comment. It is a required premise for the assertion of altruism to make sense.
My comment observes that sacrificing one’s own (expected) health for the furthering of human knowledge is an act of altruism. Your comment actively and directly sabotages human knowledge for your own political ends. The latter I consider inexcusable and the former is both true and necessary if you wish to encourage people who are actually capable of strategic thinking on their own to be altruistic.
You don’t persuade rationalists to conform to your will by telling them A is made of fire or by trying to fool them into believing A, B and C don’t even exist. That’s how you persuade suckers.
Your comment actively and directly sabotages human knowledge for your own political ends.
OK, see, I thought this might happen. I love your first comment, much more than ArisKatsaris’, but despite it having some problems ArisKatsaris is referring to, not because it is perfect. I only upvoted his comment so I could honestly declare that I had upvoted both of your comments, as I thought that might diffuse the situation—to say I appreciated both replies.
Don’t get me wrong—I don’t really mind ArisKatsaris’ comment and I don’t think it’s as harmful as you seem to, but I upvoted it for the honesty reason.
You just committed an escalation of the same order of magnitude that he did, or more, as his statements were phrased as questions and were far less accusatory. I thought you might handle this situation like this and I mildly disapprove of being this aggressive with this tone this soon in the conversation.
A very slightly harmful instance of a phenomenon that is moderately bad when done on things that matter.
I thought you might handle this situation like this and I mildly disapprove of being this aggressive with this tone this soon in the conversation.
Where ‘this soon’ means the end. There is nothing more to say, at in this context. (As a secondary consideration my general policy is that conversations which begin with shaming terminate with an error condition immediately.) I do, however, now have inspiration for a post on the purely practical downsides of suppression of consideration of rational alternatives in situations similar to that discussed by the post.
EDIT: No, not post. It is an open thread comment by yourself that could have been a discussion post!
I obviously believe there’s a value in having control groups Not only is that obvious but it is actually conveyed by my comment. It is a required premise for the assertion of altruism to make sense.
Not so, there exists altruism that is worthless or even of negative value. An all-altrustic CooperateBot is what allows DefectBots to thrive. Someone can altruistically spend all his time praying to imaginary deities for the salvation of mankind, and his prayers would still be useless. To think that altruism is about value is a map-territory confusion.
My comment observes that sacrificing one’s own (expected) health for the furthering of human knowledge is an act of altruism.
Your comment doesn’t just say it’s altruistic. It also tells him that if he doesn’t feel like being an altruist, that he should tell people that “placebos are for pussies”. Perhaps you were just joking when you effectively told him to insult altruists, and I didn’t get it.
Either way, if he defected in this manner, not just he’d be partially sabotaging the experiment he signed up for, he’d probably be sabotaging his future chances of being accepted in any other trial. I know that if I was a doctor, I would be less likely to accept you in a medical trial.
Your comment actively and directly sabotages human knowledge for your own political ends.
Um, what? I don’t understand. What deceit do you believe I committed in my above comment?
Wedrifid made a strategic observation that if a person cares more about their own health then the integrity of the trial it makes sense to find out whether they are on placebo and, if they are, leave the trial and seek other solutions. He did this with somewhat characteristic colorful language.
You then voted him down for expressing values you disagree with. This is a use of downvoting that a lot of people here frown on, myself included (though I don’t downvote people for explaining their reasons for downvoting, even if those reasons are bad). Even if wedrifid thought people should screw up controlled trials for their own benefit his comment was still clever, immoral or not.
Of course, he wasn’t actually recommending the sabotage of controlled trials—though his first comment was sufficiently ambiguous that I wouldn’t fault someone for not getting it. Luckily, he clarified this point for you in his reply. Now that you know wedrifid actually likes keeping promises and maintaining the integrity of controlled trials what are you arguing about?
Wedrifid made a strategic observation that if a person cares more about their own health then the integrity of the trial it makes sense to find out whether they are on placebo and, if they are, leave the trial and seek other solutions.
To me it didn’t feel like an observation, it felt like a very strong recommendation, given phrases like “Better yet”, “tell them placebos are for pussies”, “It isn’t your responsibility!”, etc
Even if wedrifid thought people should screw up controlled trials for their own benefit his comment was still clever, immoral or not.
Eh, not really. It seemed shortsighted—it doesn’t really give an alternate way of procuring this medicine, it has the possibilty to slightly delay the actual medicine from going on the market (e.g. if other test subjects follow the example of seeking to learn if they’re on a placebo and also abandon the testing, that forcing the thing to be restarted from scratch), and if a future medicine goes on trial, what doctor will accept test subjects that are known to have defected in this way?
Now that you know wedrifid actually likes keeping promises and maintaining the integrity of controlled trials what are you arguing about?
Primarily I fail to understand what deceit he’s accusing me of when he compares my own attitude to claiming that “A is made of fire” (in context meaning effectively that I said defectors will be punished posthumously go to hell; that I somehow lied about the repercussions of defections).
He attacks me for committing a crime against knowledge—when of course that was what I thought he was committing, when I thought he was seeking to encourage control subjects to find out if they’re a placebo and quit the testing. Because you know—testing = search for knowledge, sabotaging testing = crime against knowledge.
Basically I can understand how I may have misunderstood him—but I don’t understand in what way he is misunderstanding me.
Yesterday I spoke with my doctor about skirting around the FDA’s not having approved of a drug that may be approved in Europe first (it may be approved in the US first). I explained that one first-world safety organization’s imprimatur is good enough for me until the FDA gives a verdict, and that harm from taking a medicine is not qualitatively different than harm from not taking a medicine.
We also discussed a clinical trial of a new drug, and I had to beat him with a stick until he abandoned “I have absolutely no idea at all if it will be better for you or not”. I explained that abstractly, a 50% chance of being on a placebo and a 50% chance of being on a medicine with a 50% chance of working was better than assuredly taking a medicine with a 20% chance of working, and that he was able to give a best guess about the chances of it working.
In practice, there are other factors involved, in this case it’s better to try the established medicine first and just see if it works or not, as part of exploration before exploitation.
This is serious stuff.
Better yet, if you aren’t feeling like being altruistic you go on the trial then test the drug you are given to see if it is the active substance. If not you tell the trial folks that placebos are for pussies and go ahead and find either an alternate source of the drug or the next best thing you can get your hands on. It isn’t your responsibility to be a control subject unless you choose to be!
Downvoted for encouraging people to screw over other people by backing out of their agreements… What would happen to tests if every trial patient tested their medicine to see if it’s a placebo? Don’t you believe there’s value in having control groups in medical testing?
Lessdazed is describing quite a messy situation. Let me split out various subcases.
First is the situation with only one approval authority running randomised controlled trials on medicines. These trials are usually in three phases. Phase I on healthy volunteers to check for toxicity and metabolites. Phase II on sufferers to get an idea of the dose needed to affect the course of the illness. Phase III to prove that the therapeutic protocol established in Phase II actually works.
I have health problems of my own and have fancied joining a Phase III trial for early access to the latest drugs. Reading around for example it seems to be routine for drugs to fail in Phase III. Outcomes seem to be vaguely along the lines of three in ten are harmful, six in ten are useless, one in ten is beneficial. So the odds that a new drug will help, given that it was the one out of ten that passed Phase III, are good, while the odds that a new drug will help, given that it is about to start on Phase III are bad.
Joining a Phase III trial is a genuinely altruistic act by which the joiner accepts bad odds for himself to help discover valuable information for the greater good.
I was confused by the idea of joining a Phase III trial and unblinding it by testing the pill to see whether one had been assigned to the treatment arm of the study or the control arm. Since the drug is more likely to be harmful than to be beneficial, making sure that you get it is playing against the odds!
Second, Lessdazed seemed to be considering the situation in which EMA has approved a drug and the FDA is blocking it in America, simply as a bureaucratic measure to defend its home turf. If it were really as simple as that, I would say that cheating to get round the bureaucratic obstacles is justified.
However the great event of my lifetime was man landing on the Moon. NASA was brilliant and later became rubbish. I attribute the change to the Russians dropping out of the space race. In the 1960′s NASA couldn’t afford to take bad decisions for political reasons, for fear that the Russians would take the good decision themselves and win the race. The wider moral that I have drawn is that big organisations depend on their rivals to keep them honest and functioning.
Third: split decisions with the FDA and the EMA disagreeing, followed by a treat-off to see who was right, strike me as essential. I dread the thought of a single, global medicine agency that could prohibit a drug world wide and never be shown up by approval and successful use in a different jurisdiction.
Hmm, my comment is losing focus. My main point is that joining a Phase III trial is, on average, a sacrifice for the common good.
It’s in Phase III.
Downvoted for actively polluting the epistemic belief pool for the purpose of a shaming attempt. I here refer especially (but not only) to the rhetorical question:
I obviously believe there’s a value in having control groups. Not only is that an obvious belief but it is actually conveyed by my comment. It is a required premise for the assertion of altruism to make sense.
My comment observes that sacrificing one’s own (expected) health for the furthering of human knowledge is an act of altruism. Your comment actively and directly sabotages human knowledge for your own political ends. The latter I consider inexcusable and the former is both true and necessary if you wish to encourage people who are actually capable of strategic thinking on their own to be altruistic.
You don’t persuade rationalists to conform to your will by telling them A is made of fire or by trying to fool them into believing A, B and C don’t even exist. That’s how you persuade suckers.
OK, see, I thought this might happen. I love your first comment, much more than ArisKatsaris’, but despite it having some problems ArisKatsaris is referring to, not because it is perfect. I only upvoted his comment so I could honestly declare that I had upvoted both of your comments, as I thought that might diffuse the situation—to say I appreciated both replies.
Don’t get me wrong—I don’t really mind ArisKatsaris’ comment and I don’t think it’s as harmful as you seem to, but I upvoted it for the honesty reason.
You just committed an escalation of the same order of magnitude that he did, or more, as his statements were phrased as questions and were far less accusatory. I thought you might handle this situation like this and I mildly disapprove of being this aggressive with this tone this soon in the conversation.
A very slightly harmful instance of a phenomenon that is moderately bad when done on things that matter.
Where ‘this soon’ means the end. There is nothing more to say, at in this context. (As a secondary consideration my general policy is that conversations which begin with shaming terminate with an error condition immediately.) I do, however, now have inspiration for a post on the purely practical downsides of suppression of consideration of rational alternatives in situations similar to that discussed by the post.
EDIT: No, not post. It is an open thread comment by yourself that could have been a discussion post!
I’m not unsympathetic.
Compare and contrast my(September 7th, 2011) approach to yours(September 7th, 2011), I guess.
ADBOC, it didn’t have to be.
It sort of soon became one.
Not so, there exists altruism that is worthless or even of negative value. An all-altrustic CooperateBot is what allows DefectBots to thrive. Someone can altruistically spend all his time praying to imaginary deities for the salvation of mankind, and his prayers would still be useless. To think that altruism is about value is a map-territory confusion.
Your comment doesn’t just say it’s altruistic. It also tells him that if he doesn’t feel like being an altruist, that he should tell people that “placebos are for pussies”. Perhaps you were just joking when you effectively told him to insult altruists, and I didn’t get it.
Either way, if he defected in this manner, not just he’d be partially sabotaging the experiment he signed up for, he’d probably be sabotaging his future chances of being accepted in any other trial. I know that if I was a doctor, I would be less likely to accept you in a medical trial.
Um, what? I don’t understand. What deceit do you believe I committed in my above comment?
Let me see if I can summarize this thread:
Wedrifid made a strategic observation that if a person cares more about their own health then the integrity of the trial it makes sense to find out whether they are on placebo and, if they are, leave the trial and seek other solutions. He did this with somewhat characteristic colorful language.
You then voted him down for expressing values you disagree with. This is a use of downvoting that a lot of people here frown on, myself included (though I don’t downvote people for explaining their reasons for downvoting, even if those reasons are bad). Even if wedrifid thought people should screw up controlled trials for their own benefit his comment was still clever, immoral or not.
Of course, he wasn’t actually recommending the sabotage of controlled trials—though his first comment was sufficiently ambiguous that I wouldn’t fault someone for not getting it. Luckily, he clarified this point for you in his reply. Now that you know wedrifid actually likes keeping promises and maintaining the integrity of controlled trials what are you arguing about?
To me it didn’t feel like an observation, it felt like a very strong recommendation, given phrases like “Better yet”, “tell them placebos are for pussies”, “It isn’t your responsibility!”, etc
Eh, not really. It seemed shortsighted—it doesn’t really give an alternate way of procuring this medicine, it has the possibilty to slightly delay the actual medicine from going on the market (e.g. if other test subjects follow the example of seeking to learn if they’re on a placebo and also abandon the testing, that forcing the thing to be restarted from scratch), and if a future medicine goes on trial, what doctor will accept test subjects that are known to have defected in this way?
Primarily I fail to understand what deceit he’s accusing me of when he compares my own attitude to claiming that “A is made of fire” (in context meaning effectively that I said defectors will be punished posthumously go to hell; that I somehow lied about the repercussions of defections).
He attacks me for committing a crime against knowledge—when of course that was what I thought he was committing, when I thought he was seeking to encourage control subjects to find out if they’re a placebo and quit the testing. Because you know—testing = search for knowledge, sabotaging testing = crime against knowledge.
Basically I can understand how I may have misunderstood him—but I don’t understand in what way he is misunderstanding me.
Upvoted comment and parent.