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Today's Ethics conundrum - one for StevieB?

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Today's Ethics conundrum - one for StevieB?

Postby RogerS » 08 Jan 2021, 10:41

And talking of jabs, here is todays ethics conundrum.

So if someone is on a vaccine trial (me on Novavax, for example) and got offered the Pfizer one, wouldn’t that compromise their trial efficacy ? So if I rang up the trial people and asked the question ‘Should I have the Pfizer jab’, surely there is no chance of them saying “We recommend against it” ? Just wondering.
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Re: Today's Ethics conundrum - one for StevieB?

Postby sunnybob » 08 Jan 2021, 11:11

The only people who can answer that are the ones you need to telephone. Do it now before you get a hundred "I'm not a doctor but" replies. :shock:
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Re: Today's Ethics conundrum - one for StevieB?

Postby sunnybob » 08 Jan 2021, 11:12

Unless of course youre bored silly and actually DO want a 100 unrealistic answers? :lol: :lol: :lol:
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Re: Today's Ethics conundrum - one for StevieB?

Postby sunnybob » 08 Jan 2021, 11:13

OR.... has Rogers email been hacked by a chat bot? :o :eusa-whistle:
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Re: Today's Ethics conundrum - one for StevieB?

Postby Lurker » 08 Jan 2021, 11:20

Presumably, there is a 50% likelihood that you are currently on a placebo at the present.
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Re: Today's Ethics conundrum - one for StevieB?

Postby RogerS » 08 Jan 2021, 11:21

Lurker wrote:Presumably, there is a 50% likelihood that you are currently on a placebo at the present.


Spot on, Lurker.
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Re: Today's Ethics conundrum - one for StevieB?

Postby RogerS » 08 Jan 2021, 11:22

sunnybob wrote:The only people who can answer that are the ones you need to telephone. Do it now before you get a hundred "I'm not a doctor but" replies. :shock:


Perhaps my OP was too subtle, Bob, as I fear you've completely missed the point. It's about ethics.
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Re: Today's Ethics conundrum - one for StevieB?

Postby billw » 08 Jan 2021, 11:37

I would turn it down because of the possibility it might, even in a very small way, affect the trial results.
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Re: Today's Ethics conundrum - one for StevieB?

Postby sunnybob » 08 Jan 2021, 12:02

Nope, read it all again, dont get the ethics question. Nobody can accuse me of subtlety. :lol:
50% chance of placebo is irrelevant except to a gambler.
if you take the second shot, it will either work, or not work, but you will never know if it worked because you took the second shot, or because you were immune in the first place, or if it didnt work because one cancelled out the other, or because the DNA changing one mutated the non DNA one.
That way lies madness 8-) .
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Re: Today's Ethics conundrum - one for StevieB?

Postby TrimTheKing » 08 Jan 2021, 12:07

Roger is talking about the ethics of the trial runners and whether they would prioritise their trial over Rogers' health.

He's not had a first shot, he's on a separate trial pre-vaccine.
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Re: Today's Ethics conundrum - one for StevieB?

Postby Lee Elms » 08 Jan 2021, 12:26

The rules relating to being in a vaccine trial normally allow you to request that you are told whether or not you have been given the vaccine or a placebo if you have a chance of being vaccinated.

But I agree, as this removes you from the trial, there is still an ethical question as to whether you should take up this option.
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Re: Today's Ethics conundrum - one for StevieB?

Postby RogerS » 08 Jan 2021, 12:44

billw wrote:I would turn it down because of the possibility it might, even in a very small way, affect the trial results.



Mmm..an interesting point. As Lee Elms has said one can ask to be unblinded. If one has had the placebo then not an issue. But if one has had their vaccine then the ethics works both ways.

Would they be ethical in saying "Don't take the Pfizer vaccine because it will mess up our trial."

Would I be ethical in saying "I'll take the Pfizer vaccine as no-one knows how good your vaccine is". Should I run the risk of increasing my chances of catching Covid if theirs does not work ? This is Phase 3, after all...the testing of the efficacy.

They are between a rock and a hard place since a large proportion of their triallists are in the 65+ demographic and so a high likelihood that a lot will be offered another vaccine. So they are going to be under a lot of pressure to dissuade triallists from taking another vaccine.
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Re: Today's Ethics conundrum - one for StevieB?

Postby billw » 08 Jan 2021, 12:59

RogerS wrote:
billw wrote:I would turn it down because of the possibility it might, even in a very small way, affect the trial results.



Mmm..an interesting point. As Lee Elms has said one can ask to be unblinded. If one has had the placebo then not an issue. But if one has had their vaccine then the ethics works both ways.

Would they be ethical in saying "Don't take the Pfizer vaccine because it will mess up our trial."

Would I be ethical in saying "I'll take the Pfizer vaccine as no-one knows how good your vaccine is". Should I run the risk of increasing my chances of catching Covid if theirs does not work ? This is Phase 3, after all...the testing of the efficacy.

They are between a rock and a hard place since a large proportion of their triallists are in the 65+ demographic and so a high likelihood that a lot will be offered another vaccine. So they are going to be under a lot of pressure to dissuade triallists from taking another vaccine.


Well, my answer was from the POV of someone in a less high-risk group, so I accept there's a difference.

I see the point about their side. Yes it's a tough call and obviously when the trial started they weren't to know that this new strain would go on a nationwide rampage. On one hand there's already two approved vaccines available in the western market that look as if they have the supply capability to handle the vast majority of the population. On the other it doesn't hurt to have a third option but by the time it reaches the end of the trial will there be much short term demand? Indeed, once the initial rush is over and the current vaccines have more efficacy data then maybe governments will stick with what they know.

Your viewpoint surely has a similar ethical dilemma? You presumably volunteered knowing you'd be expected to see the trial through, but also you didn't know about the increased risks of the current time.

If they said no to you taking another vaccine, would you ignore them?
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Re: Today's Ethics conundrum - one for StevieB?

Postby Cabinetman » 08 Jan 2021, 13:00

I see your point Roger, they are in a sticky place, and even stickier I’m afraid to say, if you weren’t on the placebo so had their drug injected, and you then have a Pfizer inoculation let’s hope it doesn’t react with the first one.
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Re: Today's Ethics conundrum - one for StevieB?

Postby StevieB » 08 Jan 2021, 13:24

Very quick response because I am dashing between online lectures at the moment!

You have two choices - inform them and let them decide what your course of action should be; or withdraw from the trial and take the approved vaccine for your own safety. I am not suggesting you would, but you should not take the approved vaccine and not inform the trial you are currently in.

They will have a protocol for this, and while it may result in patient withdrawal, this would simply lower the age demographic of the trial you are in. This is not your concern, whether the trial is valid or not will come from the data, and then ultimately from MHRA approval when they scrutinise that data.
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Re: Today's Ethics conundrum - one for StevieB?

Postby novocaine » 08 Jan 2021, 13:54

Roger you are statistically insignificant. if you withdraw you will make bugger all difference. the bigger risk is that you are 1 of many who withdraw in order to take the new vaccine. this is partially the reason that vaccines are being developed in separate nations to prevent cross contamination of the sample and also why the pzier and AZ vaccinations had to be tested and released so close together (AZ not being able to conduct further studies because the pool is now contaminated)

If the AZ and Phizer vaccines weren't as effective as they are I'd say you would have more an ethical issue on your hands (could the trail you are in be more effective) but with 90-95% being the current figure Id say all the trial you are on is doing is providing another company the opportunity market a drug rather than save more lives (obviously this is a very naïve answer which is not based on all the evidence and excludes other benefits such as lower allergy rates, quicker and simple admission etc).

you are not being selfish if you back out and take the known vaccine.

ethical debate over, go get jabbed and become one of the new race of super humans with your little chips and mind control. :D
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Re: Today's Ethics conundrum - one for StevieB?

Postby Lurker » 09 Jan 2021, 10:26

novocaine wrote:Roger you are statistically insignificant. if you withdraw you will make bugger all difference. the bigger risk is that you are 1 of many who withdraw in order to take the new vaccine. this is partially the reason that vaccines are being developed in separate nations to prevent cross contamination of the sample and also why the pzier and AZ vaccinations had to be tested and released so close together (AZ not being able to conduct further studies because the pool is now contaminated)

If the AZ and Phizer vaccines weren't as effective as they are I'd say you would have more an ethical issue on your hands (could the trail you are in be more effective) but with 90-95% being the current figure Id say all the trial you are on is doing is providing another company the opportunity market a drug rather than save more lives (obviously this is a very naïve answer which is not based on all the evidence and excludes other benefits such as lower allergy rates, quicker and simple admission etc).

you are not being selfish if you back out and take the known vaccine.

ethical debate over, go get jabbed and become one of the new race of super humans with your little chips and mind control. :D


Yeh but...........If others on Rogers trial backed out then the trial is shot. Certainly a dilemma as it sounds like there are significant 65+ on the trial and these are soon to be at the front of the queue for the approved vaccines.
As a matter of interest what vaccine are you trialling Roger..... Or can't you say?
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Re: Today's Ethics conundrum - one for StevieB?

Postby novocaine » 09 Jan 2021, 10:55

I know. Thats what the whole rhetoric is about and how its so important for seperate test pools for just that reason. :D
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Re: Today's Ethics conundrum - one for StevieB?

Postby RogerS » 09 Jan 2021, 11:06

Lurker wrote:.....
As a matter of interest what vaccine are you trialling Roger..... Or can't you say?


Novavax
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Re: Today's Ethics conundrum - one for StevieB?

Postby Lurker » 09 Jan 2021, 11:20

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Re: Today's Ethics conundrum - one for StevieB?

Postby RogerS » 09 Jan 2021, 11:29

Lurker wrote:This discusses the issues

https://www.nature.com/articles/d41586-021-00015-0


Thanks Lurker. Interesting read. I think I shall go with my statisticians advice aka. Novocaine :D
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