Curse You Medical Ethics!!!

[Cruel2BKind]

Trying to read a section of my textbook on the difference between theoretical and clinical equipoise... How ethical it is to clinically test two differing medications against each other if evidence shows that one is worse then the other. My head is about to explode.

The next papers I have to read are on stem cell research and abortion and the lines of similarity between the two... That will be more interesting at least.

 

[Safe_Bet]

Trying to read a section of my textbook on the difference between theoretical and clinical equipoise... How ethical it is to clinically test two differing medications against each other if evidence shows that one is worse then the other. My head is about to explode.

The next papers I have to read are on stem cell research and abortion and the lines of similarity between the two... That will be more interesting at least.

Really? You see, I'd find the "medication" thing to be more interesting because of its impact on real people. The "stem cell" and abortion issues aren't as big of a deal to me because stem cells and zygotes aren't sentient.

 

[lance gt]

One thing you have to consider, Cruel, is that ethics and pharmacutical companies don't go together. They don't care what the medication does, as long as they can make money off of it. They weigh the law suits against the profits and decide what the acceptable losses are.

 

[Cruel2BKind]

It's a philosophy course. Professor Cooke is very clear to us how scummy the pharmaceutical companies are.

Equipoise is the idea that it's unethical to offer an inferior treatment in a clinical trial if you KNOW that it's inferior, like a clinical trial where you have ten women with breast cancer, half get chemotherapy, half get aromatherapy. That's easily unethical

Equipoise is supposedly necessary for the investigators of the trial to have. It's a state of honestly not knowing which treatment is better. It sort of makes sense in certain cases, but in cases where you are testing multiple factors, it can get complicated.

One example that he gave us was lets say there is an illness that can be treated very effectively with one pill, but has horrible painful side effects. You have a second treatment that is less effective, but has no side effects.

That sort of thing happens all the time, but the need for equipoise makes things difficult.

 

[lance gt]

It stiil comes down to money in the end. Side effects are present in EVERY single pill, from aspirin up. The ethics of giving one pill vs. another, comes down to acceptable losses or complications.

The decision to approve a medication to a patient never lies in the patient's choice, only the pharma's and the FDA they bought off. To be equipoise in giving one pill over another, should lie with the patient to decide, not a doctor. A doctor should explain the effects and side effects of both and let the patient decide, but it never happens that way. Invariably, the doctor is told that the medication is the best thing on the market for dealing with the symtoms, but not one, repeat, not one, deals with the cause.

The reason, no money in curing an illness, just prolong it and make as much money as possible, before the patient dies. Discuss the equipoise of that issue.

 

[Cruel2BKind]

It stiil comes down to money in the end. Side effects are present in EVERY single pill, from aspirin up. The ethics of giving one pill vs. another, comes down to acceptable losses or complications.

The decision to approve a medication to a patient never lies in the patient's choice, only the pharma's and the FDA they bought off. To be equipoise in giving one pill over another, should lie with the patient to decide, not a doctor. A doctor should explain the effects and side effects of both and let the patient decide, but it never happens that way. Invariably, the doctor is told that the medication is the best thing on the market for dealing with the symtoms, but not one, repeat, not one, deals with the cause.

The reason, no money in curing an illness, just prolong it and make as much money as possible, before the patient dies. Discuss the equipoise of that issue.

I personally think that except for in some of the most obvious cases, equipoise is a crock of shit. It prevents doctors from testing medicine against placebos a lot of the time. It makes it harder to test medications.

But I gotta read about it, finals in two weeks

 

[mynameisben]

One example that he gave us was lets say there is an illness that can be treated very effectively with one pill, but has horrible painful side effects. You have a second treatment that is less effective, but has no side effects.

That's why we have doctors, not just spreadsheets and pharmacies. A doctor relies on experience, training, physical examination data, and medical histories to choose which medication is appropriate for each patient on a case by case basis. Sometimes the health risk of taking a highly effective acne medication with "horrible and painful side effects" is more than a frail, little old granny can bear. A twenty-year-old Olympic Decathlete, however, stands a much better chance of surviving a turbo-charged acne cream that would lay waste to lesser men.

My point is, "inferior" is not an absolute. Inferior depends. And as long as it depends, there is value in offering both types of medications: The more effective with bad juju, and the less effective that's more easily tolerated.

 

[Cruel2BKind]

And that is why I hate this class. Since it is focused on 'ethics' we talk less about what makes sense, and more about how we can make solid arguments that reflect the truth better then the equally solid arguments that prompt us to do horrible things.

The beginning of this class was more like math than anything.

To do action Y, you must first do X
X is illegal
Therefore anyone doing action Y must be wrong.

And so forth.

It was really interesting seeing some arguments that have been used in the past that were reasonable then, but not now. For instance..

Man is intelligent.
Woman is not man
Therefore, women are not intelligent.

For centuries, that was considered a valid argument. As budding ethicists (though most of us are just taking the class because it wipes out 3 gen eds at once...) We can't just criticize the obviously false conclusion, we have to find the problem with the REASONING.

In this case, the problem is that they changed the meaning of the word 'man' from the first point to the second.

I think the hardest part about this class is trying to find how arguments are unsound when you either violently disagree or strongly agree with the conclusion.

 

[mynameisben]

And that is why I hate this class. Since it is focused on 'ethics' we talk less about what makes sense, and more about how we can make solid arguments that reflect the truth better then the equally solid arguments that prompt us to do horrible things.

The beginning of this class was more like math than anything.

To do action Y, you must first do X
X is illegal
Therefore anyone doing action Y must be wrong.

And so forth.

It was really interesting seeing some arguments that have been used in the past that were reasonable then, but not now. For instance..

Man is intelligent.
Woman is not man
Therefore, women are not intelligent.

For centuries, that was considered a valid argument. As budding ethicists (though most of us are just taking the class because it wipes out 3 gen eds at once...) We can't just criticize the obviously false conclusion, we have to find the problem with the REASONING.

In this case, the problem is that they changed the meaning of the word 'man' from the first point to the second.

I think the hardest part about this class is trying to find how arguments are unsound when you either violently disagree or strongly agree with the conclusion.

There's more to ethics than boolean algebra. You are right to focus on "what makes sense." Much of ethics can be distilled to a simple, yet powerful ideal: let your conscience be your guide. Tell your ethics professor to stick that in his modus ponens.

 

[PennLady]

I think the hardest part about this class is trying to find how arguments are unsound when you either violently disagree or strongly agree with the conclusion.

Yeah, that critical thinking can be a bear.

 

[Cruel2BKind]

There's more to ethics than boolean algebra. You are right to focus on "what makes sense." Much of ethics can be distilled to a simple, yet powerful ideal: let your conscience be your guide. Tell your ethics professor to stick that in his modus ponens.

My professor is awesome!

It's the material that can be a bitch... He still has to teach us to think narrowly.

 

[mynameisben]

My professor is awesome!

It's the material that can be a bitch... He still has to teach us to think narrowly.

Eh. Just do what I did. Staple a couple of benjamins to your final exam blue book before you turn it in, and you'll do just fine.

 

[Cruel2BKind]

Eh. Just do what I did. Staple a couple of benjamins to your final exam blue book before you turn it in, and you'll do just fine.

I wish I had the benjamins!

He's an ethic's teacher, you cad! The most ethical person I know!

 

[Safe_Bet]

Yeah, that critical thinking can be a bear.

So can that superior, condescension thing!

 

[PennLady]

So can that superior, condescension thing!

It's called teasing. And I'll be honest, I wish I'd had a teacher like that when I was in college.

 

[Cruel2BKind]

Ugh.... That last article I had to read made me physically ill.

It was a Roman Catholic arguing why abortion is immoral, even when the mother is in danger. To paraphrase the article...

'The fetus and the mother are both persons, so no special status should be given to the mother. If the conditions of BOTH the mother and the fetus are so low that one or the other can be saved by harming the other, it can only be done if the chances of one surviving are HIGHER then the chances of the two living combined.'

What a dick. Throughout the article he had this subtle snotty undertone towards women, as if everything about abortion was entirely our fault. He even ruled rape-abortions immoral because the child is innocent of the father's crimes.

The entire article was him treating women like wayward containers. I hope the next article is a little easier to swallow.

 

[Derroreaper]

Ugh.... That last article I had to read made me physically ill.

It was a Roman Catholic arguing why abortion is immoral, even when the mother is in danger. To paraphrase the article...

'The fetus and the mother are both persons, so no special status should be given to the mother. If the conditions of BOTH the mother and the fetus are so low that one or the other can be saved by harming the other, it can only be done if the chances of one surviving are HIGHER then the chances of the two living combined.'

What a dick. Throughout the article he had this subtle snotty undertone towards women, as if everything about abortion was entirely our fault. He even ruled rape-abortions immoral because the child is innocent of the father's crimes.

The entire article was him treating women like wayward containers. I hope the next article is a little easier to swallow.

Of course they hate abortion, (Born and raised Catholic, hard core charismatic I might add) but once you look at the political machine that is Catholicism, it starts making sense. "How dare you not give birth, and we'll even explain why God wants you to give us that baby you don't want.

We have thousands of wealthy Catholics that want your baby, and they will give us tons of cash to get it. They will be forever in our debt and continue to pay us seven percent of their income for EVER!"

A bitter Atheist as you can see

 

[jomar]

Any delving into double blind experiments?

 

[Zeb_Carter]

Any delving into double blind experiments?

Yeah, let's get a bunch of really sick people together and give half the medicine that could cure them while the other half get sugar pills. Loved (he says sarcastically) those studies. But, I guess giving a sick person sugar pills does no harm to the patient...I mean their sick already and giving them sugar won't make them sicker, so the doctor is covered as to his oath.

Of course, half the study group dies, but they knew what the results would be anyway.

 

[Cruel2BKind]

There is theoretical equipoise, which insists that the moment you have any information saying that treatment A is better then treatment B, the trial should cease. The problem with TE, is that this could include the preliminary studies done in order to even start the trial.

Clinical equipoise is where you agree to continue the test until there is enough data from the controlled experiment that the board that approved the experiment approve of either one treatment or the other.

Double-blind is used whenever possible in all clinical trials, to avoid the investigating physicians from developing a bias.

 

[PayDay]

That's why we have doctors, not just spreadsheets and pharmacies. A doctor relies on experience, training, physical examination data, and medical histories to choose which medication is appropriate for each patient on a case by case basis.

Not every doctor is an A student, and not every doctor took the job with only the intention of helping people.

Ethics is not a 'makes sense' issue, it is personal and emotional and based on an individual's point of view. That's why Ethics is a pain in the ass, because there are lots and lots of individuals.

I think a person who practices medicine is subject to the ethics of a healer. Their job would be to 'do no harm' so to speak, or do as little harm as possible under the circumstances.

Now as far as clinical research goes, I believe that they are not subject to the same rules, to the point that they should not be allowed to intentionally do harm with the intent to do harm (like testing a supervirus on an uninformed patient) or violate the desires of the ethical majority (which are not static).

It is research, sometimes things go wrong, and this has to be taken into account. If the person they are testing on is well aware of the potential side effects along with the potential benefits, and agree to be a part of the testing, than anything goes in my opinion as long as the ethical majority agrees.

Just think of how many people would be unharmed or alive if they 'clinically tested' DDT pesticide first? But at the same time, someone was still going to have to take the side effects during the testing so on one hand, it is ethically wrong, but on the other, it is ethically right.

Something can be more than one thing, but majority rules in Ethics and Democracy.

(Here's some changing definitions of the same word, it's all about intent)

In your case of one medication vs. the other not as good medication, it is the responsibilty of a medical researcher to find out if the projected 'better' medication really is better. That is their job, regardless of the side effects they may cause a person intentionally, as the researcher's intention is still 'to do no harm' to a majority of patients. So ethically, in the end, their intention is still to do the right thing. If this is not the case, then it would fall under the rules of equipoise.

Now one medication vs a placebo would only be hindered by equipoise if the placebo would intentionally do harm to the person being tested. I think a medical professional should have to take the time to keep a patient from dying, but that's just me.

At the same time, I think people cannot have a problem with medicine being commercial, as a free market increases advances.

I say, instead, have a problem with greed and manipulation.

 

[Verdad]

It was really interesting seeing some arguments that have been used in the past that were reasonable then, but not now. For instance..

Man is intelligent.
Woman is not man
Therefore, women are not intelligent.

For centuries, that was considered a valid argument.

I would have sworn that was fallacious in any century.

Illicit major

 

[jomar]

Yeah, let's get a bunch of really sick people together and give half the medicine that could cure them while the other half get sugar pills. Loved (he says sarcastically) those studies. But, I guess giving a sick person sugar pills does no harm to the patient...I mean their sick already and giving them sugar won't make them sicker, so the doctor is covered as to his oath.

Of course, half the study group dies, but they knew what the results would be anyway.

I feel ya, but if not double blinds, how would you suggest to test for efficacy and discriminate between best treatment options?

 

[JAMESBJOHNSON]

It's a philosophy course. Professor Cooke is very clear to us how scummy the pharmaceutical companies are.

Equipoise is the idea that it's unethical to offer an inferior treatment in a clinical trial if you KNOW that it's inferior, like a clinical trial where you have ten women with breast cancer, half get chemotherapy, half get aromatherapy. That's easily unethical

Equipoise is supposedly necessary for the investigators of the trial to have. It's a state of honestly not knowing which treatment is better. It sort of makes sense in certain cases, but in cases where you are testing multiple factors, it can get complicated.

One example that he gave us was lets say there is an illness that can be treated very effectively with one pill, but has horrible painful side effects. You have a second treatment that is less effective, but has no side effects.

That sort of thing happens all the time, but the need for equipoise makes things difficult.

The answer is: Use two groups of Niggaz and dont charge them for the meds.

 

[Cruel2BKind]

The answer is: Use two groups of Niggaz and dont charge them for the meds.

As ridiculous and racist as you are, the US pharmaceutical companies stumble over themselves to prove that they are even more ridiculous, and even more racist.

They like to do clinical trials of AID's research in Uganda. They have found a treatment for pregnant women with AID's that gives the newborns an increased probability of being born without the mother's disease. They justify giving one section of the trial subjects placebos on the grounds that the women are getting more care then they would without the study.

So they justify giving the test subjects placebos on the grounds that they are giving the women meals and some non-related health care that they never would have gotten in the first place.

It's basically pharmaceutical outsourcing. They go after groups of people that will undertake more risks for less pay because they are desperate. Namely, US homeless, AID's-positive mothers in Uganda, and US prisoners.

JAMES, you made a valid point. I might just die of shock.