Back to the history of medicine

There are a few angles that have me thinking back to the history of medication and the sort of lessons that might be drawn from it.

Drug discovery

I've mentioned before that what science has looked like throughout history often differs from many in the scientific community seem to think is has. Major journals like The Lancet and Nature only started sending out papers for external peer review in the 1970s for example. The same seems to apply to how some critical drugs were developed:

Fighting pandemics with mandatory masks

One problem noted there - and you might expect with current measures - are questions of just how long the public is likely to be willing to tolerate them.


You may not have heard much about this but it's the precursor to modern vaccinations. It involved deliberately infecting people with a small dose of smallpox in order to significantly improve survivability from the infection. I'd heard of this before, but in the covid19 context it was Robin Hanson that seems one of its early vocal advocates as a possible way to address the current pandemic.

The medical literature consistently finds strong relations, in both animals and humans, between initial virus dose and symptom severity, including death. The most directly relevant data is on SARS and measles, where natural differences in doses were associated with factors of 3 and 14 in death rates, and in smallpox, where in the 1700s low “variolation” doses given on purpose cut death rates by a factor of 10 to 30. For example, variolation saved George Washington’s troops at Valley Forge.

He notes that using lockdowns to try to prevent of a disease may have the effect of increasing the fatality rate from the a disease like the one behind the current pandemic, as being trapped in close confinement could cause an initially infected person spreading the infection to those they live with by in higher (and thus more dangerous) initial doses.

Now I see Scott Gottlieb talking of viral load, pointing to an New York Times article. The author of that article spends much of it talking about the risk which is certainly a legitimate concern. He says this:

It would be unethical to experimentally manipulate viral dose in humans for a pathogen as serious as the coronavirus, but there is evidence that dose also matters for the human coronavirus. During the 2003 SARS coronavirus outbreak in Hong Kong, for instance, one patient infected many others living in the same complex of apartment buildings, resulting in 19 dead.

I keep finding myself thinking to what extent I should buy the arguments of the current medical ethicists though. At the moment it seems that one major reason why the US has failed to respond well to the current pandemic seems to have been concerns by the CDC and the FDA over ethics and safety regulations1.

Here I think Hanson's words are useful - I suggest reading the whole post. It's worth knowing thatthere's not yet adequate data to answer some questions and testing which does legitimately pose a risk would be needed to address them. Controlled infection is one strange way to go about actually "flattening the curve", could help move society closer to herd immunity, and could have savings in lives that might overwhelm any lost.

Of course, if low doses cut death rates by a factor of two or more, variolation volunteers would actually cut their chance of death, perhaps greatly. Yes, the first few thousand volunteers could be less sure of such gains, but they could be compensated for this risk, just as we now consider compensating subjects in vaccine trials using live Covid19 viruses. We could pay variolation volunteers cash, offer their loved ones priority medical care, certify them as safe for work and social gatherings, and honor them like soldiers selected for their elite features who take risks to produce community gains.

It seems to me that often people look at risk as something you either take or you don't rather than looking enough at offsetting one type of risk against another.

  1. It also seems worth asking the question as to whether or not caution by regulators is a cause of a significant slowdown in the development of new drugs ↩︎