When does being careful become its own kind of reckless?: Practitioners

The waiting room

I am an ER nurse. I was an ER nurse in January 2021, working twelve-hour shifts in a facility where COVID patients were on gurneys in hallways because the ICU had been full since Thanksgiving. The vaccine existed. We knew it worked. And we could not give it to the eighty-year-old man on the gurney because the paperwork was not done.

I do not have a framework. I have a waiting room.

The precautionary principle people have legitimate points about thalidomide and Vioxx. But thalidomide was 1961, and the people making that argument in December 2020 were making it from offices while I was watching patients die of a disease we had a tool to prevent. The gap between the theory and the gurney is where all three camps lose me.

The action-biased run the QALY numbers. QALYs are a unit that exists in spreadsheets. The man on the gurney is a person whose daughter called every shift to ask if he was still alive, and one night I had to tell her he was not.

The context weighers want dynamic risk assessment. I want a system where the people who see consequences have any input into the speed. Nurses, doctors, pharmacists — we execute decisions, we do not make them. The system that decides how fast a drug moves has no feedback loop from the floor.

I went back to school for public health. I still work shifts. Who exactly does the caution protect when the people it is supposed to protect are dying of the caution?

Where we concede ground: We are not regulators. We do not see the drugs that the process correctly stopped. Our view is biased toward the visible harm.

What would change our mind: A regulatory process that includes frontline input producing demonstrably worse safety outcomes over a decade.

Read the full synthesis: When does being careful become its own kind of reckless?