Rich Winkel writes:
> According to Stathis Papaioannou: > >Why would you not include the well-known fact that driving at high > >speed is more likely to kill someone as "evidence"? If the driver > >honestly did not know this, say due to having an intellectual > >disability, then he would have diminished responsibility for the > >accident. > > I don't know how you're using the term "responsibility", but in any > case the issue is whether a driver is willing to slow down despite > not seeing any obvious hazards. Evidence isn't always obvious. Past experience shows that there might be hazards around even though you can't see them, and you are being irresponsible if you ignore this fact. The only excuse is if you genuinely are unaware of this, in which case you have no reason to slow down if you see no hazards. > >Astronomy does not really have an ethical dimension to it, but most > >other sciences do. Discovering that cyanide kills people is science; > >deciding to poison your spouse with cyanide to collect on the > >insurance is intimately tied up with the science, but it is not > >itself in the domain of science. > > Precisely. Good medical research is science, but medical practice > often involves matters of expedience, cultural bias, conflicts of > interest and habit. OK, but for the purposes of this discussion we should try to separate the purely scientific facts from the rest. If the scientific evidence shows that cyanide is good for headaches, and people die as a result, then perhaps the scientists have been negligent, incompetent, or deceitful. > >As for doing nothing often being the best course of action, that's > >certainly true, and it *is* a question that can be analysed > >scientifically, which is the point of placebo controlled drug trials. > > But of course if the research is never done or never sees the light of > day, something other than science is going on. Right, but we're getting away from the subject of epistemology and onto the specifics of particular treatments and the evidence supporting them. Personally, I have experience of several situations where I believed that a new treatment would be helpful on the basis of the published evidence but subsequently found, either through my own experience or through new evidence coming to light maybe years later, that it caused more harm than good. There is at least one example of a harmful drug side-effect (olanzapine causing diabetes) that was so obvious to me that it crossed my mind that adverse research findings may have been supressed; on the other hand, I also have experience of treatments with well-documented adverse effects which I never seem to encounter, and I don't surmise that in those cases the data has been faked to make the drug look bad. > >You are suggesting that certain treatments believed to be helpful > >for mental illness by the medical profession are not in fact helpful. > >You may be right, because the history of medicine is full of > >enthusiastically promoted treatments that we now know are useless > >or harmful. However, this is no argument against the scientific > >method in medicine or any other field: we can only go on our best > >evidence. > > I'm not arguing against the scientific method. I only wish medical > science practiced it more often. It is unscientific to equate > absence of evidence with evidence of absence. Yes, and everyone is acutely aware that a new treatment may still be harmful even though the present best evidence suggests that it isn't. This needs to be taken into account in any risk-benefit analysis: that is, the "risks" equation should include not only the weighted probability of known adverse events, but also the weighted probability of as yet unrecognised adverse events. It is difficult to quantify this latter variable, but it does play a part in making clinical decisions, perhaps not always obviously so. For example, new treatments are generally used more cautiously than older treatments: in the more severely ill, in cases where the older treatments have failed, in lower dosages. As more experience is gained, it becomes clearer whether the new treatment is in fact better and safer than the old one, or better than no treatment at all, and it is used more widely and more confidently. It would be interesting to retrospectively analyse the incidence and severity of adverse effects of medical treatments not suspected at the time of their initial clinical use, allowing a quantitative estimate of the abovementioned weighted probability for use in clinical decision-making. I don't know if this has ever been attempted. Stathis Papaioannou _________________________________________________________________ Be one of the first to try Windows Live Mail. http://ideas.live.com/programpage.aspx?versionId=5d21c51a-b161-4314-9b0e-4911fb2b2e6d --~--~---------~--~----~------------~-------~--~----~ You received this message because you are subscribed to the Google Groups "Everything List" group. To post to this group, send email to everything-list@googlegroups.com To unsubscribe from this group, send email to [EMAIL PROTECTED] For more options, visit this group at http://groups.google.com/group/everything-list -~----------~----~----~----~------~----~------~--~---
