Last week I took another dive into the world of triage- specifically focusing on some common questions and sticking points that were raised in RadioLab podcast entitled “Playing God.” As was mentioned in the previous blog post, we don’t think triage is really about playing god, rather about facing limited resources and making decisions. Last week we talked mostly about the value implications of such discussions of who lives and who dies. This week we’ll touch upon two other points. First, the reaction to not want to make triage decisions, and the second is the multitude of ways to triage and therefore the importance of RCTs in knowing which way is best in a given situation.
The Radiolab podcast from WNYC Studios is as close to appointment listening as we have in 2016. One of the show’s recent episodes, entitled “Playing God,” takes up a topic directly in the A2J Lab’s wheelhouse: triage. In a stark bit of commentary, the host characterizes the practice not as deciding how to allocate scarce resources; rather he described it as an “inhuman act which humans are trying to do.”
Feel confident walking into that interview! Raise your hands up, hold your chest high, and, whatever you do, don’t cross your arms as you wait. You want to make sure the pose you’re striking inspires confidence and communicates that confidence to your (hopefully) future employer.
First, a confession: flossing and I enjoy a complicated relationship. I do it, but not as consistently as four out of five dentists might prefer. Yet, using several other dental hygiene implements, I somehow emerge from biannual checkups with pretty solid marks. And it seems I have (the absence of consistent) science on my side!
How helpful is that Head Start?
Education reform is tricky no matter the level or issue targeted. But one area of reform subject to fairly constant momentum is Head Start, especially under the Obama Administration. This program, established in 1965, addresses some of the early developmental and school readiness gaps for low-income children, from birth to age five. The million-dollar question (for a many million-dollar program) is: does it work?
Beyond the extraordinary “Why RCTs?” examples
If you’ve been following our “Why RCTs?” series, you’ve read about some drastic examples across several fields of study- many in the medical field- where RCTs have turned common knowledge and practices upside down. These examples are meant to be shocking; they show us the very real and serious implications that can follow from not testing interventions at all or with non-randomized interventions. The accounts I’ve highlighted in the series illustrate several things:
Greetings from Indianapolis and the National Legal Aid and Defender Association (NLADA) annual conference! The proceedings have gathered many of the best minds and providers in the legal services field. There is real momentum for collecting data, making use of promising technologies, and implementing evidence-based practices. All great news for the A2J Lab.
Triage and Justice for All, Pt. 2
As Erika discussed in a previous blog post, triage is integral to the delivery of legal services, and yet there is no research that demonstrates how to triage well in law. Triage is always important (because resources are always finite). But it is absolutely critical when resources are scare and stakes are high. Decades ago, James F. Childress, in the provocatively titled “Who shall live when not all can live,” laid out the moral and logical arguments for different conceptualizations of triage.
Learning and Changing in Response to RCTs… Challenges Remain
Mastectomies have become more and more openly discussed over the past decade, as celebrities have spoken about their experiences and more women are screened for breast cancer. During their lifetimes, 12% of women in the U.S. will develop invasive breast cancer, and the rate of women choosing mastectomies after a positive diagnosis rose from 2% in 1998 to 11% in 2011. Recently the number of women who have opted for double mastectomies has increased despite recent research showing that the procedure does not improve one’s chances of survival or quality of life.
Mastectomies and Rigorous Evaluations
“In terms of reliable information about what works and what does not, United States law in 2016 is roughly where United States medicine was in the late 1930s, i.e., in the Dark Ages.”