The unethical side of the ethics committee

If you ever were involved in research on human subjects or animals, you know about the giant hurdle you have to jump. While funding, performing the experiments, evaluating the data and publication might be difficult and time consuming, the greatest barrier to research usually is to get your study past the local ethics board (and in case of a multi-centre trial past all of the ethics boards involved).

The reasons, why these ethics boards were installed are noble and worthwhile -never again should scientist be able to perform unethical experiments on humans as it had happened in the German concentration camps or the Japanese prison camps. Therefore experiments have to be useful, be performed on consenting adults and must not harm the participants. If you want to transgress these boundaries (e.g. experiment on children on patients with dementia) you have to take additional measures (and fill in a lot of additional forms), IF you get permission to perform your experiments at all.
Everybody can see the good intentions, so where is the problem?

First of all, it requires a lot of work to fill in all these forms, print them out (once if you’re lucky, 12 to 20 times if not) bring them to the ethics board on the specified date and reply to all additional requests (“the date in the patient information sheet differs from the one given on the consent form – please correct your forms and send us the corrected versions in 12 copies”). All this work has to be repeated for each study: So if your study involved a harmless procedure (e.g. taking the blood pressure or an MRI scan) in one group of patient, and you want to make a second study in a slightly different disease, you usually have to start all over again. Therefore young researchers often spend several weeks each year just with these forms and the ethics board instead of doing actual research.

Second, the ethics board takes it’s time to evaluate all the applications – a delay of 6 month is not unusual. So if you have a new treatment that might save 100 lives each year (let’s say a new antibiotic), the additional delay from the ethics board might cause 50 unnecessary deaths. Of course these 50 deaths will not appear in any statistic (as usual, the problem is not on the seen, but on the unseen side of the coin). So ask yourself: when did you last hear of a researcher that killed 50 participants (when one volunteer in a gene therapy trial dies, this makes worldwide headlines)? and how many people are we killing each year just to prevent these visible deaths?

In addition, many trials will never be performed, just to avoid these problems. This is the reason, why almost no medication is tried on children or pregnant women. Of course we avoid dead children in a drug trial. But pediatricians are giving medications to children based on anecdotal evidence, which were only tested in adults. And children are often receiving medications that have been in use for decades, instead of newer and possibly better treatments, as the latter were not tried out by desperate pediatricians yet and no anecdotal evidence is available. So ethical limitations on trials might protect many children from researchers, but it will inevitably harm children as well.

While nobody can really calculate the net effect, I have the (non evidence based) feeling, that the net negative effects are greater than the benefits. If you want to read more about it, have a look at Michael Brooks excellent book “free radicals”, where he shows many medical breakthroughs (e.g. cardiac catheters) that involved overstepping the boundaries and working outside the regulatory framework. And many famous studies, like the Milgram experiment would not pass todays ethics committees – or if they do, it is in a watered down format, where the experiment is stopped before the critical phase (“would they still be willing to kill somebody on a simple order?”).

So maybe we should start to discuss again how to prevent unethical research – and how we prevent unethical prevention of research by the ethics committee.

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Why college might not be the best idea – at least not for everyone

Recently this video appeared in the iTunes feed of TED talks, and everybody seems to be impressed by the novel approach of studio schooling.

The idea, that you can improve schooling with a hands-on approach and much more practical training is convincing – certainly not for every child, but at least for the large majority, who will not end up in an academic career. But I was baffled, that this should be a novel idea. At least in Germany and Switzerland, most of the professions will be learned with training on the Job. So a youth after leaving primary school (at the age of 14 to 16), who wants to be e.g. a mechanic, will start an organized training program (called “Lehre”) at a mechanic’s workshop. During this training period, which lasts between 2 and 4 years, depending on the profession, he will be introduced to the practical side of the craft. On one or two days per week, he will also go to a special school, to complete his training. After this training period, he either can start working in his profession, continue further training while working (to become a master or “Meister”) or continue a secondary education. There are even specialized colleges for people with more practical inclinations (“Fachhochschulen”). This practical education was for a long time the standard career path for most of the population across a wide variety of fields, from the traditional crafts up to salesmen or accountants. The college or university degree, on the other hand, was limited to the small number of people, who actually wanted to pursue an academic career.

However, this practical training, despite it’s structure, is not a formal college degree and is therefore not accepted in the international education rankings. So while a lot of people got an education, that was perfect for their needs, it limited the number of “educated people” in the international rankings. A good example is a nurse, who will get a practical degree in Germany, but will study at a university in most other European countries – both will perform similar tasks in the end. To overcome this lack of college graduates, and to keep up with the level of university graduates, Germany increasingly sends students to university for tasks, that might better be trained on the job: only 20 years ago, the normal bank teller would have spent 10 years in school and then gone through practical training at the bank, and would have been able to earn a living at the age of 20. Today, a significant amount of bank tellers, went through 12 years of school, studied economics for another 4 years but will still require another year of practical training on the job, to get the experience with actual work at a bank.
So it is nice, that at least someone else starts to see the advantages of a practical education. Maybe it is not too late, and we can learn something from the “old” training system in Germany before it is completely replaced by higher education with limited value.

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Riot Clean Up – an emergent phenomenon

It is only a small step from order to chaos in an unstable society, and I will not comment on the proximate causes of the UK riots (even if I have some thoughts on the ultimate cause) as the difference betweens stability and riot can depend on one single person. It a curious coincidence, last weeks “little atoms” with Duncan Watts talked exactly about this fact and about the ignorance of the pundits who try to explain everything after the facts.

What I rather wanted to do is, to praise everybody involved in the “Riot Clean Up” campaign. If you have not heard of them yet, they are the best example that Hobbes was wrong and that societies will organize themselves if left alone.
That this cleanup was organized in just a few hours is not only a sign of modern communication, but rather an excellent example of emergent order. So if you despair about the images on TV, look at this picture and enjoy the bright side of humanity.

Clean Up London\’s Photo on Lockerz

And follow them on twitter @riotcleanup or #riotcleanup

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Geek nation

Angela Saini is an excellent writer, a charming talk show guest (listen to her here and here) and the author of the new book “Geek nation”.

I will not delve deep into the content – just go and get it and read it yourself. It is worth the time and money. But I wanted to point out one important remark she made on technological development in India (and this is also true for African or East Asian countries): We should not expect them to take the same route to innovation, that we did. And we must not expect, that they develop the same technologies, that we do. Because the history, culture and society in these countries is different from ours.
One example she mentions, is spoken internet over mobile phone (no smartphones, just standard cheap mobile phones) used in rural indian villages to communicate about farming and local politics. The initial configuration had only a limited set of functions. But in a short time the local farmers developed their own comment sections, chat rooms and the spoken version of facebook (a family leaving the sound of their children on a message board). Something similar developed in the recent years throughout Africa, where mobile phones and text messages are used to replace the non-existent banking system.
So we might not get the next tablet PC out of India (although we can never be certain about this) but there might be a lot of modern inventions in the making, that none of us ever thought about or even thought they would be necessary.

Or as Adam Smith used to say “he is in this, as in many other cases, led by an invisible hand to promote an end which was no part of his intention”

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An optimist talks about the future

Mark Stevenson is a clever and funny man, so he became a comedian. But he is also a curious man with an open mind and a positive attitude towards new things, and so he toured the world and wrote a book about it: An Optimist’s Tour of the Future.
As every writer has to promote his books on tour, so does Mark (and you can follow him @Optimistontour). Monday night he spent at London Skeptics in the Pub. The talk he gave was excellent and inspiring and all of you, who could not be there, should listen to it via the pod delusion.

During the talk Stevenson made one excellent point, that can not be stated enough, especially in the skeptical community: We do not only need technical improvements, but we also need experimentation and improvements in the way our government works. Unfortunately he did not have much time to elaborate on examples, but you can find a lot more in his book.

One excellent example of how government regulations can cause more harm than good is the US “Corporate Average Fuel Economy” program established in the 1970s. It was intended to reduce fuel consumption from private cars. To avoid problems for small business, the milage restrictions were limited to cars, while light trucks were exempt. As usual, the regulatory body could not anticipate human creativity, including the creativity of car manufacturers, who invented the SUV. An SUV is above the size limits of the light truck and therefore not considered a car, and consequently not included in the CAFE restrictions. So it is quite probable, that the current wave of gaz-guzzling SUV in the US is a direct (although unintended) consequence of the good idea, to reduce fuel consumption.
The same goes for the current EU program to add 10% of ethanol to all fuels. To achieve this goal, oil companies have to buy ethanol- which is either produced on fields originally covered with food crop – and therefore raising food prices all over the world, including poor countries. Alternatively ethanol can be produced from sugar cane grown on land that was covered by rainforest. But you can’t have both – large amounts of ethanol in your fuel in short time or large areas of rainforest. It is quite possible, that new technologies using bacteria and algae will be able to produce the ethanol we need in the near future – but nobody knows the exact answer by now and the idea, that a government can tell us how to achieve this goal, is simply arrogant, or as FA Hayek would put it – a fatal conceit.

My last example is from the field of modern medicine. Mark Stevenson showed us many new medications and promising results on the way of personalized medicine. But he made the mistake to think, that this might reduce the cost – when pharmaceutical companies do only have to evaluate selected medications for small groups and not a large range of medications to find the one that will suit for the general populations, this really will reduce costs per medication. Unfortunatly the regulatory reality is, that every medication has to undergo an extensive testing marathon, no matter if it was produced for a large market with several million patients or for a small individualized market (drugs for so called orphan diseases are somewhat exempt), and the cost of this marathon are fixed. So if you develop a drug that will help a small fraction of all women with breast cancer, your fixed costs are not much lower compared to the development of a drug that might help all women with breast cancer. But as a lot less doses of this drug will be sold (due to the smaller market), the price of each treatment will skyrocket. We already have the situation, that new cancer drugs will not be tested or prescribed, as they are too expensive. So unless we change the way drug development is regulated, new personalized medications will not reach the patients as they can not jump the regulatory hurdle.

Still I am optimistic about the future, and I hope that writers like Mark Stevenson might open the eyes of some people on the left side of the skeptical movement, to the fact that government is often not the solution but the root of the problems we have. And than we can work in the league of pragmatic optimists to achieve better solutions.

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Adam Curtis and Ayn Rand

The simultaneous appearance on Derren Brown’s Svengali blog and in the new little atoms podcast raised my interest in the new documentary series by Adam Curtis on BBC 2 „All watched over by machines of loving grace, love and power“.

Having watched the first episode, I am rather disappointed. I can see the underlying idea, that the combination of self-centred philosophy based on Ayn Rand and the illusion of control by machines caused the financial disasters in the last few decades. But the treatment of the subject by Curtis was rather superficial, and most of the time uncritical – as blaming the financial sector, big business and government can not be considered critical thinking nowadays.

While there were a lot of loose ends to tie (and I might come back to them in a later post), I will concentrate for this time on Curtis portrayal of Ayn Rand. During most of the film Rand was pictured as an original thinker, constructing a whole new philosophy, which is rather far from the truth. Most of Rand’s ideas were already formulated by her initial mentor Isabel Paterson, an almost forgotten American writer and editor, before they reached Rand, as Jeff Riggenbach demonstrates in this podcast.

The remaining ideas, especially her insisting on complete self-reliance of man and lack of empathy for others, are at least flawed, if not completely false. Humans are social creatures (although not created) and this social ability is necessary to create any useful society. If Rand had for example read more of Adam Smith, she might have noticed that apart from the “invisible hand”, which by the way is only mentioned once in the Wealth of Nations, Smith wrote extensively on the emergence of structure in society. Some thinkers consider Smith’s Theory of Moral Sentiments to be his most important work, while the Wealth of Nations is the practical applications of these ideas in the political sphere. Absolute egoism will on the other hand prevent the appearance of useful and productive structures: If I insist on only my own advantage, I will not perform acts, that might not profit myself but shape the whole of society. That these actions lay the groundwork for cooperation and might profit myself again in unknown ways in the future, can not be foreseen, at the moment when I refuse to perform these acts in the first place. And as I can not be certain whether my neighbour will be as virtuous as I hopefully am, and as I can not rely on help from others in case of an attack (because everybody just looks after himself) trust will never build up. Ayn Rand’s objectivism might be perfect for a society of angels, but in human reality, it is bound to fail.

This whole section on Rand and selfishness culminated in the statement, that Alan Greenspan was the most loyal of all disciples of Rand. Nothing could be further from the truth. It might be, that Greenspan called himself loyal and praised Rand all his lifetime, but his actions defied his words. If Atlas Shrugged is Rands philosophy in form of a novel, than Greenspan would clearly be part of the dark side. The main characteristic of the heroes in Atlas Shrugged is the refusal to cooperate with government structures, which are depicted as corrupt and rotten to the root. Every character in the novel supporting the government is either weak or outright evil. Alan Greenspan on the other hand was during most of his career a firm supporter of the US government, as head of the Fed he even printed the money to support all of its evil doing. If Rand had written a textbook on American History of the 20th century, Greenspan would have certainly been painted as one of the villains. So while he might have been a vocal supporter of Rand in the last days of her self afflicted isolation (by rejecting every supporter), he never adhered to her philosophy or her ideas, and I am quite certain that Rand herself would have considered this to be the worse choice.

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MMR scare – what’s the harm?

Today’s NZZ (New Zurich Newspaper) had another report on the increase of measles in Switzerland. Since December 445 Cases of measles were reported in Switzerland, mainly in the regions of Geneva (173 cases), Vaud (93 cases) and Basle (62 cases). In April alone there were infected.
Especially in Basle, the outbreak occurred in a group of vaccination deniers. These were mainly parents with children at the anthroposophic Rudolf-Steiner school as well as attendants of a sermon by Ivo Sasek, a preacher who regularily condemns vaccinations.
To get to the core of the problem: 87% of adults that were infected refused to get vaccinated, 7% only had insufficient vaccination.

And what’s the harm? 32 patients had to be hospitalized, 18 had an additional pneumonia.

So up to now nobody has been killed yet – but if the anti-vaccination crowd continues to grow, it is only a question of time.

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