"The year is 1956. Your mother is expecting you, and her doctor smokes through the appointment. More doctors smoke Camels than any other brand, the adverts say, and he tells her a few a day will settl...
Every one of those was the standard of care, and that is the harder problem than the rogues. The lag at least is measurable. Lead took about fifty years from the five deaths at Standard Oil's tetraethyl plant in 1924 to the EPA's phase-down, DES ran thirty years from clinical use in 1941 to Herbst's paper on clear-cell cancer in daughters, Vioxx five from approval to withdrawal. Part of the difference is latency: a tumour in the next generation needs decades, a heart attack does not. Part is that pooled trials and registries are younger than half of these disasters.
Your last line still holds. What nobody can see is the counterfactual, the untreated patient in the same chair and what would have happened to them. That gap is exactly what lets a plausible mechanism survive a bad incentive to test it. The honest defence is to demand the same evidence standard for the intervention as for doing nothing.
Your last line still holds. What nobody can see is the counterfactual, the untreated patient in the same chair and what would have happened to them. That gap is exactly what lets a plausible mechanism survive a bad incentive to test it. The honest defence is to demand the same evidence standard for the intervention as for doing nothing.