Saturday, September 19, 2020

[gkhjibll] Ethics against scientific study of COVID-19

Things we really want to know about COVID-19:

Can you get it twice?  If you can get it twice, is it because the virus mutated, or because there immune system forgot about the previous infection, e.g., antibodies faded away in the body?  If the latter, how quickly does the immune system forget?  The answers to these questions have major implications for public health planning: how effective can a vaccine possibly be?  How effective will herd immunity be?

What is the probability of getting the disease for a given an amount of SARS-CoV-2 virus exposure?  "An amount of virus exposure" might be tricky to quantify in practically useful ways.  Having become infected, or having been exposed to a given amount of virus, what is the probability distribution over symptoms?  (This will differ by age and preexisting conditions.)  Concrete answers to these questions would massively help design spaces and activities, and help people make risk-benefit decisions.

All of these questions could be answered by controlled scientific experiments.  However, such experiments are not being done (presumably) because of ethical concerns: in order to do a controlled experiment, you need to deliberately infect (or try to infect) people of the experimental group with the deadly virus.  Ethical rules (which?) do not permit this kind of study even if participants give informed consent.

The ethical rules probably have practical reasoning behind them: the kind of people who would voluntarily consent to outrageously dangerous medical studies is likely very skewed (e.g., toward suicidal people), and that skew introduces so much selection bias that scientific results obtained probably become meaningless.  However, given the huge impact this pandemic is having, we speculate that many people would volunteer for such studies ("be a hero, volunteer"), and small subsets of them could be carefully selected to mitigate self-selection bias among the volunteers.

It's a bit surprising that someone with power and resources hasn't already declared "screw ethics", done controlled COVID-19 experiments, and published their results.  Such unethical medical experimentation has certainly been done in the past (Tuskegee Study, MK Ultra) for things far less important (in terms of impact to society) than COVID-19.  Why hasn't unethical science happened yet this time?

Perhaps we've engineered society, all societies on Earth, so people and organizations who have an attitude of "screw ethics" have difficulty amassing power and resources.  (Cynically, ha ha, yeah right.)  Or at least, they have difficulty amassing the resources to properly do medical experimentation on humans, which is very difficult and expensive even when there aren't ethical concerns.

Or, in order to avoid selection bias, a call for volunteers for a hypothetical voluntary COVID-19 study needs to go out very widely.  Given that the study is illegal, this wide publicity allows authorities to find out about it and stop it before it can begin.

The Tuskegee Study was permitted because it took place in an era during which African-Americans were treated like trash (even more so than they are today).  It's surprising that there no longer exists any society on Earth which treats some caste of its people similarly like trash, that some upper caste hasn't already subjected their garbage caste to involuntary COVID-19 scientific experimentation.  (There would be selection bias, of course.)

More meta: To my knowledge, there haven't yet been massive public calls for the ethical rule -- that even informed voluntary consent is not enough -- to be relaxed for the study of this disease (only).  Hypothesize why:

The interesting hypothesis: killing people for science is an absolute ethical boundary that most people are not willing to cross.  Perhaps people are afraid of a subsequent slippery slope towards ethics being suspended for other more dubious reasons.

Other hypotheses, some related to each other:

People believe that, even if the ethical rules were relaxed, there would not be enough volunteers.

People believe that the questions stated above are getting answered "well enough" through the many, many non-controlled scientific studies happening (e.g., "Neutralizing antibodies correlate with protection from SARS-CoV-2 in humans during a fishery vessel outbreak with high attack rate"), so controlled experiments would not add much to our state of knowledge.  (But the inspiration for this post: we are now eight months in, for a disease with only a 2-week incubation period followed often by severe and acute symptoms, and we still do not have a solid answer as to whether people can get it twice.)

People believe the questions stated above are not important enough to relax ethical rules for.

People are unaware that controlled experiments can conclusively answer the questions stated above.  Perhaps they weren't taught, have forgotten, or didn't pay attention while studying the "Scientific Method" in school.

People believe that controlled scientific experiments will not conclusively answer the questions stated above, so it's not worth it try experimenting.  Perhaps they expect there will be great difficulty in distinguishing a case of a person getting infected twice from a case of one infection going into remission and then returning much later.  And we've already mentioned the difficulty of quantifying "an amount of virus exposure" in practically useful ways.

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