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Alex John London Profile picture
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30 Dec 20, 4 tweets, 4 min read
Just out & open access, my new paper “Self-Defeating Codes of Medical Ethics and How to Fix Them: Failures in COVID-19 Response and Beyond.” From @bioethics_net #medicalEthics #bioethics #MedTwitter #epitwitter #researchEthics
tandfonline.com/eprint/DSWJTGJ… Image
Chuffed to have comments from @johnlantos @riekevdgraaf Wouter van Dijk, Sara J. M. Laurijssen, Ewoud Schuit, Diederick E. Grobbe & Martine C. de Vries, Carla Saenz,
@mmcdadden @wrwveit Rebecca Brown @briandavidearp Hugh Desmond, Jerry Menikoff, Sabine Salloch, Ryan Essex
Should be @MMccradden ☝️
Probably not a popular take but the willingness of clinicians to deliver unvalidated interventions outside of clinical trials isn’t surprising when the norms of medical ethics emphasize using individual judgment but are silent about a duty to learn what actually works.

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More from @AlexJohnLondon

Alex John London Profile picture
31 Dec 20
1. I’m not persuaded by this. Some reasons are specific to this case others apply more generally to arguments of the form—if we deviate from practices that are supported by the best evidence we can save even more lives.
2. Right now we are struggling to get vaccine into people’s arms. If we adopt a policy of 1 shot only, we could easily be in a situation in which more vaccine sits unused rather than in a situation in which x doses go into 2x arms.
3. Part of the bottleneck is overcoming the logistics of delivery. If a person has had their first shot, the the probability that we can get them a second and that they will take it is high. We might not be able to get that second dose to someone else who is willing to take it
Read 7 tweets
Alex John London Profile picture
8 Dec 20
I like to give my kids #philosophy problems. My son and I agree: if you were a person in the #StarTrek universe it would be a bad idea to use the teleported. Because once you are disintegrated, your existence ends. But from a second person standpoint, there is no difference.
The version of you that walks off the transporter on the other side thinks they were transported, because they remember getting on the platform and waking up or whatever in the new place. So the version of you that survives has a consciousness contiguous with your past.
So everyone thinks that transporters don’t harm people. But you are not the very of you that walks off the platform. After all, we could copy you and reassemble you in the same room without destroying you. In that case there is a second version of you...
Read 5 tweets
Alex John London Profile picture
8 Dec 20
1. I want to make one more point about #vaccine #RCTs and I’m open to being corrected here by someone like @nataliexdean who has worked on these trials. The point has to with being in a situation in which we have estimates of efficacy so early on in the planned 2 year trials.
2. When these trials were designed it wasn’t a sure thing that we would have efficacy estimates this early. During the #ebola vaccine trials in 2014-15 the outbreak was waning by the time the vaccine trial was underway. If we had a coordinated public health response to #COVID
3. ...then lower rates of transmission at trial sites would have meant a longer time to the relevant number of infections. As I said, I’m open to correction, but having this information so quickly seems unprecedented to me.
Read 4 tweets
Alex John London Profile picture
2 Aug 20
When you make an argument like this, please show your work. Let’s think of the cases

1. So we deploy an investigational vaccine that doesn’t actually confer immunity or strong immunity. If people think it provides protection, & take more risks MORE people get sick and die.
2. Imagine vaccine provides some protection, but a subgroup of people who access it outside of an RCT have a serious adverse reaction. If people think the vaccine is harmful, fewer take it or enroll in trials and MORE people die.
3. Why should we believe that outside access to an investigational vaccine and speed at which a clinical trial completes are independent? If outside access slows accrual in a RCT MORE people could die in the long run since (a) pre-approval production rate will be smaller than...
Read 13 tweets
Alex John London Profile picture
18 Apr 20
1. One of the best parts of my corner of twitter is watching incredibly smart people like @mlipsitch @nataliexdean @trvrb carry our peer review in real time. And as Marc says in this thread, it’s important to remember that spending time critiquing work is a mark of respect....
2. But watching their work, and @CT_Bergstrom as well, has made me even more skeptical of the value of medical preprints. Yes, science often advances through the accumulation of many contributions in which few single studies are definitive. But in the current environment...
3. Preprints making striking claims are almost immediately reported to the wider public prior to the kind of rigorous and thoughtful review in the link above. And at that point, the toothpaste is out of the tube....
Read 5 tweets
Alex John London Profile picture
10 Apr 20
1. I’m going to try to be a better twitter user. And that means bringing a little more charity to this platform than it tends to induce and avoiding snappy tweets that makes people feel like things are worse than they really are. So what to make of these two reports?
2. Here is the conclusion of the NAM report. There are no direct studies of the question at issue. We have to make inferences from the other data They suggest fabric masks might reduce transmission of larger particles but net benefits depend on make and use, so benefit uncertain.
3. The BMJ piece says, “Although good quality evidence is
lacking, some data suggest that cloth masks may be
only marginally (15%) less effective than surgical
masks in blocking emission of particles, and fivefold more effective than not wearing masks.”
Read 6 tweets

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