Risk versus Benefit
Janet Liljestrand, M.D., M.A.
Whether we realize it or not, we weigh the benefit versus the risk of most decisions, large and small. When making medical decisions, physicians will sometimes refer to the risk/benefit ratio. A math problem with numbers? Unfortunately not, but a clinical judgment seeking to determine if the benefit that this particular patient is likely to receive is greater or lesser than the risks the patient will be assuming with the procedure or medication.
Childhood immunizations risks are often stated to be less than one in a million. With such a low risk, the benefits are great by comparison. ...read more
A Tale of Two Data Scientists
Neil Ferguson, Ph.D. Infamous Graph Youyang Gu
D. Joy Riley, M.D., M.A. Executive Director
It was a long year ago (March 2020) that a dire prediction was issued by a group at Imperial College London (UK) regarding the possible effects of the novel coronavirus, SARS-CoV-2. The model predicted more than 500,000 UK deaths, and >2.2 million deaths in the U.S. by summer if no action were taken. One of the data scientists issuing that proclamation was Neil Ferguson, Ph.D. He and his group advised the government that “in the UK and US context, suppression will minimally require a combination of social distancing of the entire ...read more
Is It Science or Scientism?
Joyce Shelton, Ph.D. Professor of Biology, Trinity International University Guest Column
In the climate of fear, uncertainty and urgency engendered by the COVID-19 pandemic, it is often difficult to know what to do or whom to trust. Public policy makers are daily making decisions and enacting rules that affect our lives and dictate our actions in the name of protection. They lend authority and justification to their decisions by claiming that they are following the science, implying that this appeal to a trusted, rational voice should be enough to calm our concerns and guarantee our compliance. But the elevation of science to the ...read more
A Project for Our Time
D. Joy Riley, M.D., M.A. Executive Director
The responses to the COVID-19 pandemic have been by turns dramatic and disconcerting, and, at times, draconian. I read about Steve Reiter’s deplorable experience and his new project in a BreakPoint commentary in July, and he was kind enough to speak with me by telephone on 24 July.
Steve’s beloved wife, Elizabeth, had diagnoses of lupus and pulmonary hypertension, among other difficulties. She had had a lengthy hospitalization in 2014, but had recovered. Steve attributes her recovery to excellent medical care and the 24/7 presence of her family. She had a Hickman line placed, and Steve ...read more
When Breath Is (Not Enough) Air: Let’s Talk about Ventilators
There has been much public discussion about ventilators amidst the COVID-19 pandemic. It is humbling to consider that we, or someone we love, might require one. Most people know something about the benefit of a ventilator when needed; but how well do we really understand the functions and risks of mechanical ventilation? The pandemic presents an opportune time to learn about this. So I posed a series of questions about these machines and the processes involved in using them to a physician, who is a specialist in using ventilators to treat very ill patients. Those questions, and her answers, follow.
1) ...read moreWhen the Foundations Are Wobbling, Part II
Death Certificates and COVID-19
D. Joy Riley, M.D., M.A. Executive Director
One of the tasks assigned to physicians is the completion of death certificates—at least, the portion of death certificates that list cause of death (COD). I learned the importance of accuracy of death certificate completion as a pathology student fellow, an extra year of pathology training in the middle of my medical school career. We were instructed never to use the mechanism of death, such as cardiac or respiratory arrest, as a cause of death. Additionally, the use of terms like “probable” or “suspected” were not allowed. After all, the goal of ...read more
