Great article for discussing the production of scientific knowledge, shared knowledge, and also the new knowledge and technology theme.
Scientific Cooperation Knows No Boundaries—Fortunately
Infectious diseases, it is commonly said, know no borders, and neither does the knowledge needed to fight them. Scientists around the world routinely share information and collaborate across borders. The current pandemic has scientists working together on platforms such as Slack, and using new tools, such as machine learning, to rapidly detect the novel coronavirus in tests that use large amounts data from multiple sources. This outbreak has demonstrated in real time how scientific understanding can indeed be a global public good.
This article gets into a lot of the relevant issues of medical ethics and uses appropriate ethical language in the discussion. I’m working with this in my class today (remotely). Here’s the worksheet I’m using today.
“The criteria for access to intensive therapy in cases of emergency must include age of less than 80 or a score on the Charlson comorbidity Index [which indicates how many other medical conditions the patient has] of less than 5.”
The ability of the patient to recover from resuscitation will also be considered.
One doctor said: “[Who lives and who dies] is decided by age and by the [patient’s] health conditions. This is how it is in a war.”
How do we make better use of this piecemeal information? Computers are great at spotting patterns—but that’s just correlation. In the last few years, computer scientists have invented a handful of algorithms that can identify causal relations within single data sets. But focusing on single data sets is like looking through keyholes. What’s needed is a way to take in the whole view.
“That is also the case for other health professionals whose practice is based on science, like qualified dietitians, physiotherapists, occupational therapists and psychologists. Guidelines are revised, advice is reversed — on blood pressure, diet, hormone replacement, opioid prescribing. This can be immensely frustrating for patients, even though it is what we must do to provide the best possible treatment.”
“It’s a fact that all studies are biased and flawed in their own unique ways. The truth usually lies somewhere in a flurry of research on the same question. This means real insights don’t come by way of miraculous, one-off findings or divinely ordained eureka moments; they happen after a long, plodding process of vetting and repeating tests, and peer-to-peer discussion. The aim is to make sure findings are accurate and not the result of a quirk in one experiment or the biased crusade of a lone researcher.”
“We tend to think of medicine as a science, but for most of human history it has been scientific-ish at best. In the first episode of a three-part series, we look at the grotesque mistakes produced by centuries of trial-and-error, and ask whether the new era of evidence-based medicine is the solution.”
“How do so many ineffective and even dangerous drugs make it to market? One reason is that clinical trials are often run on “dream patients” who aren’t representative of a larger population. On the other hand, sometimes the only thing worse than being excluded from a drug trial is being included.”
Book about medical reaseach, common fallacies and problems, and what makes good science when it comes to medicine. Worth reading just for the introduction.
“Medicine shouldn’t be about authority, and the most important question anyone can ask on any claim is simple: ‘how do you know?’ This book is about the answer to that question. There has been a huge shift in the way that people who work in medicine relate to patients. In the distant past, ‘communications skills training’, such as it was, consisted of how not to tell your patient they were dying of cancer. Today we teach students – and this is a direct quote from the hand-outs – how to ‘work collaboratively with the patient towards an optimum health outcome’. Today, if they wish, at medicine’s best, patients are involved in discussing and choosing their own treatments. For this to happen, it’s vital that everyone understands how we know if a treatment works, how we know if it has harms, and how we weigh benefits against harms to determine the risk. Sadly doctors can fall short on this, as much as anybody else. Even more sadly, there is a vast army out there, queuing up to mislead us”
“We are trying to teach children that stories are usually an unreliable basis for assessing the effect of treatments,” Nsangi explained, adding that stories amount to anecdotal evidence. The kids are also learning to watch out for the perverting effects of conflicts of interest, and to recognize that all treatments carry both harms and benefits and that large, dramatic effects from a treatment are really, really rare.