Terrific article from @strauss_matt.
“In the absence of experiment, my bias will remain towards a minimalist approach.” This seems a very close match for “First, do no harm,” and also for the Precautionary Principle. (a thread, 1/10)
spectator.co.uk/article/ventil…
“In the absence of experiment, my bias will remain towards a minimalist approach.” This seems a very close match for “First, do no harm,” and also for the Precautionary Principle. (a thread, 1/10)
spectator.co.uk/article/ventil…
Both @strauss_matt’s and Dr. Kyle-Sidell’s critiques of treating COVID-19 patients with ventilators contain, so far as I (not a medical doctor) can tell, at least two distinct branches:
1.Are ventilators appropriate to treat ARDS?
2.Is this ARDS? 2/
1.Are ventilators appropriate to treat ARDS?
2.Is this ARDS? 2/
The second question itself raises further questions, including: Is ARDS (Acute Respiratory Distress Syndrome) a single syndrome, with one set of symptoms and causes, or is it a “catch-all” category of respiratory ailments, which may or may not have a common etiology? 3/
IF ARDS is a “good category,"
AND ventilators are an effective treatment against ARDS,
AND Covid-19 causes ARDS,
THEN what to do is straightforward.
But that’s a lot of contingencies, most of which are neither straightforward nor settled. 4/
AND ventilators are an effective treatment against ARDS,
AND Covid-19 causes ARDS,
THEN what to do is straightforward.
But that’s a lot of contingencies, most of which are neither straightforward nor settled. 4/
That said, I would not demand randomised control trials as proof of efficacy while the pandemic rages. Just as, the U.S. Constitution affords special rights, which border on authoritarian, to the government under times of national duress, which includes public health crises…. 5/
So too should medical professionals and systems be not just allowed but *expected* to make risky, high-stakes decisions now, which they would be discouraged from making under normal conditions. Our rules and standards cannot be one-moment-in-time-fits-all. 6/
Extraordinary times call for extraordinary measures, as they say.
But this pithy saying may miss the larger point of @strauss_matt’s article. The larger point may be: extraordinary times call for *greater skepticism than ever* towards generic, status quo solutions. 7/
But this pithy saying may miss the larger point of @strauss_matt’s article. The larger point may be: extraordinary times call for *greater skepticism than ever* towards generic, status quo solutions. 7/
Further, when status quo solutions, like using ventilators to treat acute respiratory distress, turn out to have been untested even under normal circumstances, they should definitely not become the go-to solution. 8/
This situation points, once again, to failures of systems that most people assumed were wholly functional, humming along just fine and out of view. But it turns out it’s not just the making of laws and sausages that don’t hold up well under scrutiny. 9/
We all need to pay more attention to that man behind the curtain. /end
