Making Decisions in a COVID-19 World

Baruch Fischoff
JAMA. 2020;324(2):139-140.
doi:10.1001/jama.2020.10178

Here are two excerpts:

Individuals must answer complementary questions. When is it safe enough to visit a physician’s office, get a dental check-up, shop for clothing, ride the bus, visit an aging or incarcerated relative, or go to the gym? What does it mean that some places are open but not others and in one state, but not in a bordering one? How do individuals make sense of conflicting advice about face masks, fomites, and foodstuffs?

Risk analysis translates technical knowledge into terms that people can use. Done to a publication standard, risk analysis requires advanced training and substantial resources. However, even back-of-the-envelope calculations can help individuals make sense of otherwise bewildering choices. Combined with behavioral research, risk analysis can help explain why reasonable people sometimes make different decisions. Why do some people wear face masks and crowd on the beach, while others do not? Do they perceive the risks differently or are they concerned about different risks?

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Second, risk analyses are needed to apply that knowledge. However solid the science on basic physical, biological, and behavioral processes, applying it requires knowledge of specific settings. How do air and people circulate? What objects and surfaces do people and viruses touch? How sustainable are physical barriers and behavioral practices? Risk analysts derive such estimates by consulting with scientists who know the processes and decision makers who know the settings.3 Boundary organizations are needed to bring the relevant parties together in each sector (medicine, sports, schools, movie production, etc) to produce estimates informed by the science and by people who know how that sector works.

The info is here.

The Public’s Distrust of Biotech Is Deepening. Commercialization May Be to Blame.

Jim Kozubek
undark.org
Originally published November 3, 2017

Here is an excerpt:

The high profile patent battle over the CRISPR-Cas9 gene editing tool, often valued commercially at a billion dollars, and the FDA approval of the first genetically modified medicine for $475,000 — a sale price that is 19 times the cost to manufacture it — have displayed the capacity for turning taxpayer-funded research into an aggressive money-making enterprise. More personally, genetics are being used to typify people for cancer risk and age-related diseases, schizophrenia, autism, and intelligence, none of which truly belong to diagnostic categories.

It is therefore no surprise that parents may want to protect their newborns from becoming targets of commercialization.

In truth, genome sequencing is an extension of earlier commercial sequencing tests and standard newborn screening tests. BabySeq has expanded these to 166 genes, which can theoretically predict thousands of disorders and identify several genetic risk variants. For instance, it has identified a dozen newborns to have a genetic variant associated with biotinidase deficiency, which can impact cognition, and be fixed by taking a simple vitamin. Casie Genetti, a researcher at Boston Children’s Hospital, noted researchers found 109 of 125 babies had at least one, and up to six, genetic variants for an autosomal recessive disorder, meaning that if they went on to have children with a partner who had a corresponding gene compromised in a similar way, it could be damaging or life-threatening for their own baby.

Part of the problem is that we all have some measure of genetic variation, and that can be either dangerous or advantageous depending on the cell type or genetic background or environment.

The article is here.

No Child Left Alone: Moral Judgments about Parents Affect Estimates of Risk to Children

Thomas, A. J., Stanford, P. K., & Sarnecka, B. W. (2016).
Collabra, 2(1), 10.

Abstract

In recent decades, Americans have adopted a parenting norm in which every child is expected to be under constant direct adult supervision. Parents who violate this norm by allowing their children to be alone, even for short periods of time, often face harsh criticism and even legal action. This is true despite the fact that children are much more likely to be hurt, for example, in car accidents. Why then do bystanders call 911 when they see children playing in parks, but not when they see children riding in cars? Here, we present results from six studies indicating that moral judgments play a role: The less morally acceptable a parent’s reason for leaving a child alone, the more danger people think the child is in. This suggests that people’s estimates of danger to unsupervised children are affected by an intuition that parents who leave their children alone have done something morally wrong.

Here is part of the discussion:

The most important conclusion we draw from this set of experiments is the following: People don’t only think that leaving children alone is dangerous and therefore immoral. They also think it is immoral and therefore dangerous. That is, people overestimate the actual danger to children who are left alone by their parents, in order to better support or justify their moral condemnation of parents who do so.

This brings us back to our opening question: How can we explain the recent hysteria about unsupervised children, often wildly out of proportion to the actual risks posed by the situation? Our findings suggest that once a moralized norm of ‘No child left alone’ was generated, people began to feel morally outraged by parents who violated that norm. The need (or opportunity) to better support or justify this outrage then elevated people’s estimates of the actual dangers faced by children. These elevated risk estimates, in turn, may have led to even stronger moral condemnation of parents and so on, in a self-reinforcing feedback loop.

The article is here.

Informed Consent and Standard of Care: What Must Be Disclosed

Ruth Macklin & Lois Shepherd
The American Journal of Bioethics
Volume 13, Issue 12, 2013

Abstract

The Office for Human Research Protections (OHRP) was correct in determining that the consent forms for the National Institutes of Health (NIH)-sponsored SUPPORT study were seriously flawed. Several articles defended the consent forms and criticized the OHRP's actions. Disagreement focuses on three central issues: (1) how risks and benefits should be described in informed consent documents; (2) the meaning and application of the concept of “standard of care” in the context of research; and (3) the proper role of OHRP. Examination of the consent forms reveals that they failed to disclose the reasonably foreseeable risks of the experimental interventions in the study, as well as the potential for differences in the degree of risk between these interventions. Although the concept of “standard of care” may be helpful in determining the ethical acceptability of other aspects of research, such as clinical equipoise, it is not helpful in discussing consent requirements.

The entire article is here.