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PeterMcCluskey comments on On funding medical research - Effective Altruism Forum

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Comment author: PeterMcCluskey 23 February 2018 11:04:43PM *  1 point [-]

It does seem like there are important areas where medical research is inadequate. I'll suggest that part of the problem is inadequate effort devoted to treatments that aren't protected by patents.

It looks like some unknown fraction of ME/CFS is caused by low thyroid hormone levels. "Subclinical" hypothyroidism has symptoms that are pretty similar to those of ME/CFS. They are usually distinguished by TSH tests. [TSH is the standard measure of thyroid levels; there are a number of other options, none of which are ideal].

Here's speculation that we should distrust TSH results. (There's a more detailed and very verbose version of that speculation here).

There's plenty of confusion about when it's wise to increase a patient's thyroid hormone. E.g. this small RCT study which gave a standard T4 dose, rather than adjusting the dose to achieve some measure of optimal hormone levels. The reported TSH levels of 0.66 in patients receiving T4 suggest that many patients got more than the optimal dose, and/or didn't convert T4 to T3 well.

In contract, two smaller uncontrolled studies (here00014-0/abstract) and here) reported good results from T3 treatment for treatment-resistant depression (H/T Sarah Constantin). Plus there are lots of anecdotal reports of benefits (see mine here).

There are real dangers from overdoses, and it's unclear how well researchers have measured the benefits, so it's easy to imagine that most doctors are erring on the side of inaction.

My intuition says that there's plenty of room for making protocols that more safely determine the optimal dose. I don't have enough expertise to estimate how tractable that is.

Another area where EAs might possibly provide an important benefit is Alzheimer's. There have been some recent claims that there are strategies which substantially prevent Alzheimer's or reverse it in early stages. As far as I can tell, these claims aren't prompting as much research as they deserve.

Some parts of those strategies are backed by small RCTs published in 2013 and 2012, and yet the first Google search result for Alzheimer's is still a page that says Alzheimer's "cannot be prevented, cured or even slowed".

I expect good research about Alzheimer's to be too expensive for EAs to fund directly, but it seem like we should be able to do something to nudge existing research funding into better directions.