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this post was submitted on 16 Oct 2023
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Medicine
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This was actually a big topic during the AIDS epidemic back in the '80s. However, I don't remember how they resolved that.
I think I've heard one semi solution is:
You end the study before people die/get permanent damage. You should have enough data at that point to show efficacy.
Then you offer All placebo people the treatment if they want it (after the study)
You are correct that this is still done in studies where efficacy is very clear.
In fact, this just happened a few days ago in a new trial of semaglutide to treat kidney disease in diabetics. With diabetes being one of the two major causes of the need for dialysis (the other being hypertension), the drug was so successful at improving kidney function that it would have been unethical to withhold it from placebo recipients.
https://www.fiercepharma.com/pharma/novo-nordisks-unstoppable-semaglutide-ends-kidney-disease-trial-early-positive-efficacy
In studies where efficacy is more marginal or harder to demonstrate, then drugs are sometimes given for "compassionate use" to people who are almost guaranteed to die otherwise, so providing an unproven treatment that may work or may harm them is less ethically fraught. That was the basis for a lot of AIDS treatments being distributed back in the day, and in fact AIDS activists were crucial to getting compassionate use rules liberalized.