First, Do No Harm

Speaker A: 00:00:00

Hello and welcome to the Cognitive Engineering Podcast produced by me, Fraser McGruer, for Aleph Insights. In this series of podcasts we take a look at interesting topics and discuss what we think they tell us about analysis and decision making. I'm here with Chris Wragg and Nick Hare of Aleph Insights and this week we're going to start by discussing the side effects of the AstraZeneca vaccine. So actually to interrupt our own podcast just before it started, me and Nick, this is just me and you, we're actually recording this after we recorded the episode you were about

Speaker B: 00:00:36

to hear. Nick, why are we doing that? What's going on? Well, during the episode which listeners are about to hear, we discuss the issue of the potential risk of dying from blood clot related deaths if you're vaccinated with the AstraZeneca vaccine, which as you know, has been in the news as a cause for concern. And during the podcast when we're discussing it, I think I just sort of completely dismissed it as a concern. So we're just generally quite dismissive, aren't we? Yeah, I think we sort of said that we're all convinced that this is now. And then it was only afterwards that when I was mulling it over that I thought, you know, that's a bit uncharacteristic, or at least it may not be uncharacteristic, but it's below the level I aspire to in that I feel like I should have checked the numbers instead of just, you know, going with authoritative sources, which is more or less what I was doing. So I went back to check the numbers. Okay.

Speaker A: 00:01:30

To make sure that we have to be massively worried about blood clots. Wrong, actually. So I had to

Speaker B: 00:01:35

look at the European Medicines Agency press release, which essentially says that they're aware of 25 cases where people had got blood clots after being vaccinated with the AstraZeneca. No, absolutely no indication of any causality here, right? Purely the cases they're aware of. Yeah, where, you know, someone got vaccinated, then died of a blood clot. Yeah. So you got about 25 deaths out of 20 million people vaccinated. Now, if we then compare that with the mortality rates from COVID, they are substantially higher, the risks of dying from COVID is substantially higher, even if you're, you know, well outside the kind of key risk groups. So for example, the 30 year old has a 7.4 out of 100,000 risk of dying from COVID. If they contracted, obviously, which is compared with 0.125. Even if we assume the blood clots are actually directly related to the vaccine, the risk of dying of COVID is about 30 times higher. If you contract, and that's for a relatively low risk group, and that's for a low risk group, you know, and we're not even we're not even vaccinating those people anyway, as soon as you get, you know, 40 year old, 50 year old, six year old, it's hundreds of times more likely that you'll die of COVID if you contract it than that you die of a blood clot after getting vaccinated. And that's even assuming being as generous as possible, assuming which we absolutely do not know that there's some connection between the vaccine and the, and the blood clots. So anyway, the gist is we were right to dismiss it, but for the wrong reason in that I hadn't actually checked and now I have. Well, you had checked but you hadn't just checked the actual numbers. I hadn't gone back to the sources. Yeah. And it's always, you know, the thing is, I definitely don't trust narratives. And I don't, I don't trust news stories, even ones that support, I think in this case, is it, you know, because it sort of supports my, my, my, you know, existing presumptions. I think there was a bit of confirmation bias going on there that I was inclined to believe it anyway. But I, you know, I always want to check the figures. And that's what I've done. So, you know, on with the show. There we go. The data is clear. Enjoy the show, everyone.

Speaker A: 00:03:55

Chris, there's not a head growing out of your shoulder there or purple boils, is it or something? Tell us, tell us about, yeah, lead us in. AstraZeneca side effects. Yeah, well, so, so far,

Speaker C: 00:04:07

I haven't had any because I had my vaccine on Sunday, so sort of five days ago. And at the time at which I, so I got a text message, you know, telling me to book my, you know, appointment to go in for the jab and so on. And at that point, you know, the great blood clot panic was was breaking and everybody was was talking about that. Lots of countries, you know, I think Thailand was was the one that that popped up. Obviously, lots of European countries, you know, postponed or. Yeah, we're reluctant to officially endorse the AstraZeneca vaccine and so on and so forth. So I was sort of I received this text message right. You immediately

Speaker A: 00:05:02

leapt on Facebook and and in four caps. Yeah. Yeah. And thought, what does Gwyneth Paltrow

Speaker C: 00:05:09

think about this? So so yeah. So I so I had this issue of contemplating, you know, momentarily what what to do about accepting this this appointment and going and getting myself my my vaccination or not. And it made me think basically about the whole concept of, you know, whether whether or not by vaccines are a particularly good example of this, but whether we're going to do something you are causing, you know, you're risking you're causing harm to yourself or whether actually, you know, you're going to get more benefit by by doing the thing that is that is active to yourself. So, yeah. And as I said, once I once I'd had the the vaccine that that evening, I was a bit a bit poorly, but got the kind of chills, woke up the next morning, was OK. And then the following evening was a was a bit poorly as well. But after that have have been fine and happy to report no no blood clots thus far. And yet you appear to be alive, you know. Yes, quite. Yeah. Yeah. I mean, it was quite it was quite interesting, because I was a little bit nervous and not related to blood clots, but I'd spoken to quite a lot of people that week, you know, at least, I don't know, four or five people that week who were older than me and had their jabs who had said they felt really quite quite poorly. So I had I had a cluster of people, you know, who said, oh, yeah, I had my jab. It was, you know, I was wiped out for a couple of days or something. So I was saying

Speaker B: 00:07:02

they say that all of the blood in their body had turned into one black. That's right. It was just

Speaker C: 00:07:06

it was just a coagulated lump of giant scab. Barely a person anymore. Just just a huge blood

Speaker B: 00:07:13

clot. Yeah. Is it worth saying that the this blood clot thing is a total load of crap?

Speaker C: 00:07:19

Hmm. I think it's I think it's worth saying that the evidence at the moment is clearly that that's not not the case. But yeah, I mean, it's it's it's interesting because clearly we don't you know, it's a new vaccine. It's obviously gone through relatively quickly, but it will have received a massive amount of scrutiny because, you know, of what they're proposing. But it is it is different to normal vaccinations in that, you know, the circumstances of it, both the potential gains and the speed at which it's been developed are are unusually, you know, impactful on our lives.

Speaker B: 00:08:01

So, yeah, I think it's fair and it's and it's fair enough to be to be concerned about side effects. I mean, it's you know, we the amount of role the number of people getting it is huge compared to the number of you know, the amount of time we've had to do any testing or anything like

Speaker A: 00:08:17

that. So. So look, there's two things. This has come at a brilliant time because coincidentally or not really coincidentally, but at the time of recording, I am due to receive my vaccine, my vaccination tomorrow. So depending on how this conversation goes, you know, it's going to dictate whether I go there and. Yeah, exactly. Or start posting ranty stuff on Facebook. And first, second, what we want to talk about here is is what is, you know, is first do no harm. Is that is that a sound principle or not? I mean, we're talking about hesitancy, aren't we? What

Speaker C: 00:08:53

we really want to get it. Yeah, well, that that was that was what occurred to me basically was, you know, is the kind of I won't say anti-vaccination, but the the people who are, you know, reluctant to receive a vaccine are operating on the principle or, you know, the overriding drive behind them is I don't want to do any damage to myself that that, you know, primum non nocia, you know, the first do no harm principle. Primum non nocere. You can tell you didn't have a private education. I didn't. Yeah. Yeah. A hard C, clearly. Yeah.

Speaker B: 00:09:33

Well, that's all the rage these days. Nocere. Yeah. Yeah. But then we don't say,

Speaker C: 00:09:39

you know, I mean, the Latin stem of sincere and we don't say sincere, do we?

Speaker B: 00:09:44

Quite right. I think in is it in Goodbye, Mr. Chips, where I think he's is he called Chips? Yeah, Mr. Well, yeah, Mr. Chips. I can't remember what his full name is. But and he says something like, oh, it's he's when he's old, he's moaning about all the fact that these days they want us to call Cicero kicker row. And, you know, it's all this new trendy,

Speaker C: 00:10:06

trendy people who say Barthelona. I'm going to Barthelona. That's nice. Okay. Anyway,

Speaker A: 00:10:12

yeah. Sorry, because I remember university, a classics person saying to me, yeah, that her teacher is always on about how it's got to be kicker. So. So. So, yeah. What is it? Is it

Speaker C: 00:10:22

Cicero or kicker? Well, if you said kicker row, you would get a kicker row from me.

Speaker B: 00:10:27

Yeah, I think I think the the latest state of scholarship is that the Romans used a hard C.

Speaker A: 00:10:34

So far as we can tell. Sounds like. And by the way, not even in Spain. Yeah, Barthelona. English people talk about Barthelona. But also even in Spain, often in many parts of Spain, they wouldn't say Barthelona. They would just say Barcelona. But here's the question. As an English speaker, should you be saying chorizo? I mean, should you go? This is a slider, right? Should you be saying chorizo? Should you be going right at the other end of the scale and saying chorizo? Or somewhere in the middle chorizo? What was the. Anyway, I was just going to.

Speaker B: 00:11:07

That's a topic for another another podcast. I know. I'll tell you that my desire for authenticity. In other words, my desire to want to say in an English way is is I'm afraid trumped by my desire to look like one of the middle class cognoscente. And so and so I always get it wrong and say and say something like chorizo, I think, which sort of slightly sits on the fence a bit. But yeah, but it is it's a thorny problem. I think it's fine if if it's a food that we've had for ages long enough for there to be an anglicization. Yeah, but this is not just

Speaker A: 00:11:48

really great. It's in my ears. And let's not even get into the whole bruschetta debate. Anyway, I feel that we've gone off at a tangent. That's good. Yeah. So that was that. That was that

Speaker C: 00:12:02

podcast. What were we talking about? Should we stick to the English anyway? The first do no harm. Yes, there we go. I mean, the point the point is right. Well, Hippocrates wasn't Latin anyway, was he? He was Greek. So you know, there you go. And and in fact, he never he never said that. And in the original, you mean Hippocrates? Yeah, that guy. But yeah, he it wasn't actually in the in the in the original Hippocratic oath. Anyway, it was in his of epidemics, I believe. But there we go. That's all an aside. The point is, is it a sensible thing to to opt for to say, OK, well, you know, let's before we do anything else, let's not damage our let's not damage ourselves before we worry about the, you know, the potential benefit for something. And to me, as a pure as a pure principle, that's obviously utter nonsense. I mean, not only is it utter nonsense, like no medicine would be able to or very little medicine would

Speaker B: 00:13:13

be able to be you wouldn't be able to do any surgery. Yeah. You know, which is stabbing

Speaker C: 00:13:18

people to life quite and and an injection itself. Right. Any any injection stabs you in the arm first, you know, that bit's going to hurt, you know, never mind what the side effects are. So. So, yes. But but, you know, is there something is the spirit of something to it that that principle

Speaker B: 00:13:43

sensible? Nick? Yeah, it might be worth trying to define what we mean by this. I think so the way in my mind now, I don't know. I mean, some people might think there's a distinction. But in my mind, what we're talking about here is what's usually called the precautionary principle, which is that you should not take a course of action or you should presume against taking a course of action that might do harm if you could just leave things alone. Right. So in other words, if by doing something, you might lead to some irreversible side effect, then you should be pretty sure that that what you're doing is the right thing before you go ahead and do it. That's broadly, I think, a statement of the precautionary principle. Don't do it. Look before you leap, essentially, you know, and we're in a situation where, you know, the ground you're on might be on fire, but you should still look before you leap in case you're leaping off a cliff kind of thing. I think that's that's the gist of it. The reason why I'm being expressing it in a slightly hand-wavy, vague type way is because actually it is quite hard to formulate this in a way that makes sense from a decision theory point of view. So it's very hard to sort of formalise what exactly this is getting at. So it enshrines an idea which is called the acts and omissions doctrine, which a guy called Jonathan Glover, a philosopher, wrote quite a lot about in a book called Causing Death and Saving Lives, which is a really fantastic work of philosophy, which I highly recommend. But the acts and omissions doctrine says that there's a relevant difference between acting and failing to act. So, you know, it says that if you, you know, if you take the trolley problem, you know, classic five people on one line, train's going to hit them. Do you press a button and make the train go in a different direction? That you are in some sense culpable for the death of that one person might be justifiable, but that by pressing that button, you're culpable for the death of that one person, which you did to try and save those five people in a way that you wouldn't be if, for example, you know, you were standing on the button and the train was going to divert anyway, but you didn't do anything. You know, even if you could, you could have lifted your foot off the pedal, but you didn't. That would be an omission, right? So, or more, perhaps more kind of dramatically, if you, you know, there's not really a difference between drowning someone, pushing someone into the water and letting them drown and not saving someone if you could from drowning. So the idea is that there is a distinction. That's what the acts and omissions doctrine says, right? It says that there's a difference between acting and failing to act. The problem is it's really, really hard to try and make this work consistently to try and say that there's such a thing as an act. So in this context, in the context of COVID, we want to say that the act is vaccinating people and the omission is not doing it right. And the thing you're worried about by doing the act, which is, well, maybe we're giving people blood clots. That's the harm that we're doing. We're going to look at the cost of that and we're not going to worry too much about the cost of not doing it, right? Because our presumption is let's not do it because vaccinating, unless we can be sure that vaccinating isn't in any way harmful and the omission is not doing it right. And it says that there's a distinction there. It says that there's a moral difference between in one, you know, you do the vaccine, some people get blood clots, it's your fault. But if you don't act, now we know that a whole bunch of other people will get COVID, right? Maybe die. But that's not your fault anymore. That's what the act and omissions doctrine says. It says it's not your fault, because you didn't, you're not the one who gave them COVID. But you would be the one who gave them a blood clot if you vaccinated them. And the problem is, like, there's not really any moral frameworks where that distinction actually makes any sense. I mean, I mean, if you know, not giving someone a vaccine when you could, is not, is no more or less of an action, you know, what you could, you could sort of, you can arbitrarily reframe it and flip it around and say, well, I'll tell you what, we're going to give all these people exposure to COVID, right? They're all hiding at home, but we're going to push them out into the streets and let them get COVID, unless you explicitly stop that happening, and give them a vaccine. So you just flip it, flip it round, you know, and say, and turn the act into an omission. And, and hey, presto, you know, in theory, if the act and omissions doctrine is correct, you've sort of reversed the moral calculus, even if the consequences are the same. So I think that's the, that's the point is that it's really hard to make the precautionary principle make sense, certainly from a sort of consequentialist point of view. What we should be doing is saying, look, these are A and B, vaccinate, some people get blood clots, maybe, and, you know, a lot more people don't get COVID. B, fewer blood clots, more, a lot more COVID. That's, and you don't care about labelling one of them an act and one of them a failure to act. You just say, which one of the two options? Yeah, yeah, that's, that's what modern decision theory would say. The idea of the precautionary principle, drawing a distinction between something you've done and something you haven't done, is a very old fashioned approach to ethics that can't really be made to make much sense. Having said all that, I'm about to defend it, but I wonder if there's

Speaker A: 00:19:26

other, Chris might have a... Just, Chris, before you come in, I just don't know if this is relevant or not, but to what extent does that get affected by contact with the real world and quality of information and perception of information? If people start making decisions on, on faulty information or poor perception of information, is that relevant or not? Either, you can either address that or Chris, go on,

Speaker C: 00:19:53

whatever you're going to say, I don't know. Well, I suppose picking up on that a little bit, because I think, you know, I mean, any, any decision, you know, the decision not to act, as Nick pointed out, is a, is a decision, right, in its, in its own right. And, you know, we've all, all, most always got imperfect, imperfect information. So, you know, and, and we have to make those decisions on that, on that basis. I think for whatever reason, there is an element of human nature, which, which feels reluctant to, to take, take an action to, to check or to change the status quo when uncertainty exists, like that, that there seems more inertia against that than there does just letting things go as they are, even if that, you know, is equally uncertain and potentially dangerous. But I think looking at, you know, the, the practical reasons as to why this might exist as a, as a central tenet of, of kind of medical ethics, you know, I, I think part of it is probably about, about professional credibility. And if you look at the, if you look at the history of, of kind of quackery, right, you know, within the medical profession, you know, and Hippocrates himself, for example, was a, was a proponent of the, of the four humors theory, right, which, you know, arguably led to lots of questionable medical practice, albeit, you know, he was, he was a pretty kind of hands off, you know, his, his, his treatments were generally quite non-interventionist, you know, let people kind of sit around and relax and enjoy sunlight and things. But, but, but nevertheless, he will have been practicing, you know, conducting medical practice, which nowadays would be viewed as being harmful, you know, that's, that's almost certain. But if you look back over, you know, the history of medicine, you've had, you know, all sorts of things like the, the, the, you know, the practice of bleeding and use of leeches and, you know, the use of cocaine in, in medicine, you know, Dr. Pepper, hasn't mercury been used for mercury? Yeah, yeah. Dr. Pepper was initially, you know, sort of launched as a, a kind of, you know, medicinal sort of tonic, you know, I think they called it liquid, liquid sunlight. And then, you know, you obviously had Donald Trump recently with, you know, hydroxychloroquine. And, you know, so, so there, there are lots of...

Speaker B: 00:22:45

Doctors recommending camel cigarettes to help your, help with your sore throat.

Speaker C: 00:22:49

That's, that's right. Yeah, yeah. And, and, you know, the, the, the, the Guinness prescription, you know, that is widely sort of talked about. So yeah, so there are lots of examples of practices which have subsequently been found to be harmful. And the impact of that on the medical profession is, is sort of loss of trust in their, their competence and their ability to understand what's, you know, diagnosed and prescribed the right treatment. And that in itself is probably, you know, the erosion of their kind of professional capital is arguably, you know, a worse thing for society. If people didn't, you know, people didn't do what doctors did, suggested, you know, look at the gains we've had from modern medicine, if, and we are in an age of doubt at the moment, right, about, you know, science and, and medical practices. And so the, you know, every, every time a doctor, you know, or conventional medical wisdom is found to, you know, be reversed, that, that has a much more damaging effect than the, you know, 99% of stuff that they get right all the time and help save our lives. So I think, I think that's what kind of underpins it from a practical perspective.

Speaker B: 00:24:18

e of the biggest ones, fenfen: 1990

Speaker A: 00:29:46

and below that you're not. That sounds like a conclusion. So we do need to stop soonish. I don't really have any questions. But Chris, is there anything you look like you're going to say

Speaker C: 00:29:58

Yeah, no, I was just gonna say, I mean, the the other thing that, you know, applies to medicine in particular, is that, you know, the the human body, by and large is a self healing system, right? You know, I mean, you have a you have an immune system, tissues, mend. And so there is a, you know, there is a kind of another rationale for why you wouldn't, you know, a bit like Nick was talking about Chesterton's fence, you know, it's, it's a, it's a system which, you know, which has a certain ability to repair itself. And so you kind of know, in general, leaving it alone, things will will get better. And not if you have lung cancer, not if you have lung cancer. Exactly. Yeah. So if you have lung cancer, the fruit smoothies are not going to do anything for you, I'm afraid. But, but, but, you know, there is, you know, lots of lots of things that do go wrong with the human body do eventually sort themselves out,

Speaker A: 00:31:06

you know, you know, like COVID. So I'm gonna, I hear what you're saying loud and clear. I'm not going to take that vaccine. Got it? Yeah, no, that wasn't what I was saying.

Speaker B: 00:31:19

But yeah, your body is going to cure itself of COVID. Yeah. And that we should get some healing chakras and crystals to help it along. I gotta Yeah. Thank you for listening to the

Speaker A: 00:31:30

Cognitive Edge. And that is our scientific recommendation. But I mean, one of the things we're sort of getting into there actually is I'd be interested to know if let's say we just took the extreme anti vaxxers, for example, I wonder what percentage of those of those individuals would have done things like smoked cigarettes, for example, drunk alcohol, or even cross the road, I was about to say across the road, you know, or, you know, get in a car and drive. I mean, I mean, it's Yeah, I mean, it's, I guess it's sort of obvious where it's a whole

Speaker B: 00:32:05

basket of things, anti vaxxers. And it's definitely a podcast on its own. Yeah, needless to say, I think it's fair to say, I don't think we have an official company policy. But you know, the costs, the benefits of getting a vaccine are vastly, vastly outweigh the costs.

Speaker A: 00:32:24

And so you should do it. Yeah, yeah, quite. Anything we want to say? Or are we good to stop there? Are you going to get your jab? Yeah, I'm gonna get my jab. Yeah. Actually, I also I laid out the groundwork really well, which was I said to my boss, who had his jab in the US a few weeks back, and he was very poorly afterwards. So I laid mine out nicely saying, Yeah, I'm getting jabbed this weekend. I hope I'm going to be fine. And

Speaker C: 00:32:50

yeah, I'll be able to work. I might have to miss a couple of weeks of work. Yeah, yeah. Well,

Speaker A: 00:32:54

I didn't I didn't say that. But I left it, you know, anyone could, you know, yeah, you also

Speaker C: 00:32:59

get a sticker as well. So do you? Yeah, brilliant. lollipop? No lollipop. Well,

Speaker B: 00:33:05

they rot your teeth, apparently. All right. Yeah. Yeah. Well, it's been nice listening to you oldies go on about your vaccines. I've got a while to wait. Yeah. Yeah. Yeah. How old? How old are

Speaker A: 00:33:14

you? Chris? 46. Right. So I'm 47. So yeah, I'm very excited. Also, it was great. It was a nice bit of it caused a nice bit of domestic tension. Because my wife, who's only a year younger than me had not received her notification. And so she was very upset by this. And which I think there's only one word which could describe my attitude, which was gloating. So but she has since gone on to receive the notification. But yeah, no, I'm looking forward to it and be able to sort of participate fully in society once more. Sort of, yeah. Society will be breathing a sigh of relief. Yeah. And good luck to you making it through however long it might take before they're ready for young whippersnappers like like you and I hope you you know, you're still alive at that point. I'll do my best. Yeah, good. Okay, we'll stop there. As always, thanks for listening. And if you have any thoughts or suggestions for topics, you can email us at podcast.alefinsights.com. We'd love to hear from you. If you've enjoyed the podcast, what should people do, Nick?

Speaker B: 00:34:13

They should give the like button its daily dose of being smashed.

Speaker A: 00:34:20

Indeed. And also follow us on your chosen streaming service. Thanks as always for listening to the Cognitive Engineering Podcast. I'm Fraser McGruer. We've been here with Chris Wragg and Nick of Aleph Insights. Until next time, goodbye.