There is another article about the adrenaline (epinephrine in non-Commonwealth countries) vs. placebo in cardiac arrest trial that is about to start in England. Media sites no longer seem to want to spend money to get valid information on science or ethics. Forbes provides another example of the writer completely missing the obvious.
It’s one thing to treat an incapacitated emergency patient without consent, when you’re administering a standard therapy already proven to be beneficial.
Nobody is being deprived of anything that has been adequately tested on humans. Why assume that the untested and unknown standard treatment is beneficial?
The active drug (adrenaline) is an unknown. There is no good evidence that adrenaline improves outcomes.
If you disagree, provide some evidence that shows that adrenaline is better than placebo at anything that matters.
Adrenaline is an unknown because it has never been adequately studied. The only study that has tried to compare it to placebo was limited by politicians and the media – the people who know the least about how science works.
This is like being told that you will be put in a room with either a killer or a mannequin. Which one do you want. Except that we do not know if adrenaline is a killer. We do not have enough information. The only way to find out is to study it.
The research so far is negative. Is that because the adrenaline is given too late? Is that because too much adrenaline is given? Is that because we give it to everyone still dead after a few minutes?
We do not know.
We treat adrenaline like snake oil – Able to cure all kinds of cardiac arrest. Step right up and get your magic elixir. Cures baldness, too!
When the sales pitch is that the drug fixes everything, we should be very suspicious.
Cardiac arrest due to blood loss? Give adrenaline.
Cardiac arrest due to slow heart rate? Give adrenaline.
Cardiac arrest due to fast heart rate? Give adrenaline.
Cardiac arrest due to irritated heart? Give adrenaline.
Cardiac arrest due to not enough stimulus to the heart? Give adrenaline.
Cardiac arrest due to drug over-dose? Give adrenaline.
Cardiac arrest due to drug under-dose? Give adrenaline.
Cardiac arrest due to diabetes problem? Give adrenaline.
Cardiac arrest due to infectious disease? Give adrenaline.
Cardiac arrest due to lightning strike? Give adrenaline.
Cardiac arrest due to drowning? Give adrenaline.
Cardiac arrest due to asthma? Give adrenaline.
Cardiac arrest due to stroke? Give adrenaline.
Cardiac arrest due to cancer? Give adrenaline.
Cardiac arrest due to adrenaline overdose? Give adrenaline.
We do not discriminate. We just give adrenaline. All of the other drugs have failed to produce a benefit, but we still believe in adrenaline without good evidence. We have been using adrenaline for over half a century on unsuspecting people and we still have no evidence that it works.
However, the more important issue is what you as a patient think. Should scientists be able to enroll you in a life-or-death medical experiment without your consent?
Adrenaline has worked in laboratory animals, but every drug that is tested in humans is supposed to have worked in animals. Why doesn’t adrenaline work in humans? If it does work, where is the evidence?
The standard of care is an experiment that is not controlled and not even acknowledged. The guidelines clearly state that we do not know what works and that we should only consider adrenaline, but that we do not have any good evidence that adrenaline improves outcomes for anyone.
The ethical failure is that we have failed to find out if what we are giving is harmful.
We have only improved outcomes when we have ignored the drugs and paid attention to chest compressions and defibrillation.
We are lying to patients when we tell them that we know what works in cardiac arrest.
How much worse than placebo is adrenaline? We don’t know. Failing to find out is what is unethical.