Alex John London Profile picture
Author of: For the Common Good: Philosophical Foundations of Research Ethics (OUP forthcoming) & Clara L. West Professor of Ethics & Philosophy at CMU.
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
30 Dec 20
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… 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 ☝️
Read 4 tweets
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
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
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
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
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
2 Apr 20
1. I’m not going to lie, I’m still grappling with the fact that 1,049 people died in the US just today from #COVID19. At this rate it will be 2k per day by the weekend. Each one of those people was unique. They were someone’s lover or crush...
2. They were a bearer of someone’s secrets, a witness to someone’s failure and grief, to deep sorrow and merciful joy. They wore glasses and worried about tomorrow and in a drawer or a notebook they had a list of things to do tomorrow, places to go, vacations to take...
3. And most of these people were enmeshed in the warp and woof of other lives, the people whose names were on those lists, whose pictures were on their phones, whose names were on their minds when there was tea to tell.
Read 9 tweets
12 Mar 20
1. I want to share some thoughts about how I’ve been feeling lately, in part because I suspect that many of you are feeling the same way and, for me at least, there is comfort in solidarity. #COVID19 #academic #AcademicChatter #medicine #healthcare
2. This has been a tough week, and I’m afraid that it is only the beginning. We are on spring break and I had a long list of tasks I’ve needed to accomplish but it has been difficult with everything that has been going on.
3. It isn’t just the trip cancelations and the challenge of having to move two highly interactive seminars into some sort of online format. It is the growing recognition that we are in the midst of an outbreak...
Read 20 tweets
18 Jan 20
Today is always a rough day for my family. I’ll probably delete this later, but for some reason I want to talk about a few things. Seven years ago I was in France for a WHO meeting. I was excited to be speaking and to be with some old friends and to meet some new folks.
I had spent the day with @AnantBhan walking around a lake and taking photos. I was in bed and I was about to turn off the ringer on my phone when my wife texted. I had already said good night to her already half an hour before. But something was wrong.
She got a call from her dad. He had come home from work and found her mother on the floor. He didn’t know what was wrong, but he called an ambulance. Something was seriously wrong but we didn’t know what.
Read 26 tweets
13 Dec 19
1. #disinformation is like a computer virus for humans. A #computervirus is a set of instructions that are run on a machine to perform procedures that advance the goals of someone other than the machine’s user.
2. Disinformation is a set of propositions that are introduced into the belief structure of a person in order to bring that person to advance the goals of someone other than that person.
3. If #disinformation is the #virus then #socialmedia is the delivery device. So when people connect to social media, what is the firewall or anti-virus system that protects their belief set? You might say “critical thinking.”....
Read 6 tweets
15 Aug 19
“There is no greater threat to intellectual culture than the thought that when it really counts, when it actually matters to us, we philosophers give up on doing philosophy.” @AgnesCallard on petitions in #philosophy…
For all x, I’m always the last to hear x, so I’m sure this is old news to both of you reading this. As someone who has signed petitions (some of which I later regretted) my heart is with @AgnesCallard in this respect... the end of the day, persuasion on the basis of reasons is the foundation of our discipline and the most respectful means to facilitate change and form the basis of community. Having said that...
Read 14 tweets
15 Jul 19
1. I used to work more actively in #moralpsychology. In particular, I thought that #Aristotle’s moral psychology was more sophisticated than a lot of contemporary models. Part of the reason was his view that emotions and beliefs can change one another.
2. I wrote about implications of this idea for #practicalethics here…. I still like this work. At some point, though, this work requires more than reflection on Aristotle, since it is based largely on empirical claims.
3. When I see a paper like this… my initial reaction is something like “Aristotle was so far ahead of his time...l” then I think “I’m glad to see empirical support for this...” and then I think, “in isolation this is just confirmation bias and I need...
Read 4 tweets
5 Apr 19
1. I’m a supporter of making more efficient use of information. But something about this piece bothers me. Thread. #ai #MachineLearning #medialAI #AIinMedicine

Machine Learning in Medicine | NEJM…
2. “this is the promise of machine learning in medicine: the wisdom contained in the decisions made by nearly all clinicians and the outcomes of billions of patients should inform the care of each patient....”
3. “That is, every diagnosis, management decision, and therapy should be personalized on the basis of all known information about a patient, in real time, incorporating lessons from a collective experience.”
Read 10 tweets