At 18.07 24/09/2009 +0100, Owen Dempsey wrote:
>Thus: The idea that all views on e.g. use of Tamiflu; [i.e. the competing
>views that either everybody should have Tamiflu (as under the criteria of
>the guidelines) versus the decision/choice that Tamiflu is too risky for a
>given healthy individual and shouldn t be prescribed or taken] are of
>equal moral status, is flawed.
I don't see the them as the only options available. In fact, the options
could be just the opposite: on the community perspective, it would be
better *not* to use antiviral drugs to prevent the emergence of resistance
(possibly at the cost of a few casualities) and of side effects, while
individuals could prefer to have it to reduce the small risk of serious
disease, despite the risks of side effects and of inducing resistance.
> This liberal all views are fine by me stance assumes that everybody has
> equal access to and understanding of the real state of affairs when it
> comes to the risk benefit ratio of this intervention. This is akin to
> pretending that we live in a real democracy (which is of course an
> impossible fiction to attain) instead of an organised democracy where the
> outcomes e.g. of elections are preordained and the people misinformed.
It is the doctor's responsibility to get the best information available and
to pass it to individual patients in a way that they can understand and
decide. And, by the way, this is just what EBM is all about. It is not in
the possibilities of EBM to make politicians or patients to behave
rationally, although it might help to make the choices more explicit.
>
>
>With Tamiflu, the government, health spokesmen and the drug industry with
>the help of the corporate media conspire to mislead the public by
>over-egging the dangers of e.g. Mexican/Swine Flu and overstating (even if
>it is by implication i.e. simply by recommending its use) the benefits of
>Tamiflu.
Politicians (and public health managers are often just that) probably just
anticipate what they expect to be "typical" reaction of the laymen: as Ben
explained, omitting of doing something that could possibly prevent a
serious bad event is often considered more undesirable that having a side
effect, no matter how little is the chance of getting a benefit.
I agree with you that this behavior (of politicians) is incorrect (in fact,
most of the business of "EB-recommendations", as far as it fails to
integrate individual circumstances, is flawed), but I maintain with Neal
that is the patient, the owner of the problem, that has to be informed of
the possible consequences (and uncertainty) of different choices and then
assisted unjudgementally in thinking and deciding which stance to assume.
In this context, both choices are acceptable.
regards,
Piersante Sestini
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