An alternative approach that feels less gameable:Every time a plea bargain is reached, there is a small chance (1 in 1000?) that we randomly select the case for review. The defendant is imprisoned as per the terms of the plea bargain, but then we also bring the case to trial (federally funding a defense).If the review trial finds the defendant guilty of the charges they pled to, we say 'okay, seems like the plea bargain was fair, the defendant would have been found guilty anyway'.
If the review trial finds the defendant innocent, we release them and publicize this fact. If multiple reviews under the same prosecutor exonerate the defendant, it starts to look like that prosecutor is threatening charges to coerce defendants into unfavorable plea bargains.
A 1 in 1000 chance means that the cost of this should not grow too excessive compared to existing costs of the legal system, but also means that a prosecutor who is habitually coercing defendants into taking unfavorable plea deals is very likely to get caught.
Without commenting on the rest of your point, this part:
If my quality is, say, a 7/10, my level of success should be somewhere in that ballpark. Maybe the market would be inefficient and I'd only reach a 5/10 or a 4/10. Or maybe I'd be lucky and reach an 8/10 or 9/10.
is something I don't think you should necessarily have expected from a market to begin with. Assuming that your startup was in a scalable field (e.g. a software company as opposed to a restaurant) with an efficient market, what you expect to happen is that quality 7/10 should lead to success 0/10 - there is no reason that anyone would buy from you when they could instead buy from a 10/10.
In reality there are lots of reasons this isn't quite the case. Maybe your product is 7/10 overall but genuinely the best in the world for certain specific users/use cases. (C++ and Python both continue to exist). Maybe the market just isn't very efficient and some people end up buying inferior products. (PHP also continues to exist). But on the whole expecting a 7/10 product to experience a 7/10 success is not actually what you should expect to see.
Numerical cost-benefit analysis.
Your hyperlink currently includes a period at the end of the link URL and so doesn't work right.
I do think that packing five separate questions into one paper is too much, but also going through those questions one at a time:
(a) What is the difference between practice and research?
This question seems...obviously stupid? It might be intended as a Socratic lead-in of some sort, I suppose.
(b) What is the relationship between research ethics and clinical ethics?
This question seems extremely vague. I can imagine related sub-questions that could be meaningful: e.g. 'does research need to use different ethical standards than clinical ethics' (like (d) below), 'does research need separate ethical regulations from clinical treatment, or can it use the same ones', 'should clinicians be worried about the ethics of researchers who give them treatments/vice versa', but in the absence of a more specific question I'm not clear on what this means or what an answer would be.
(c) What is the ethical relevance of the principle of clinical equipoise?
I hadn't heard of this. Per Christian's answer above it might be a reasonable question, although it seems a bit tautological asking for the ethical relevance of a principle if the principle itself is an ethical principle. Still willing to accept it as a probably-okay question.
(d) Does participation in research require a higher standard of informed consent than the practice of medicine?
This is a good question. If it were the only question in the paper I would like it.
(e) What ethical principle should take precedence in medicine?
We take a kind of abrupt turn here into a very high-level meta-question. It's weird to combine this with a bunch of lower-level questions, and even weirder to put it at the end - surely if you need to decide what ethical principle to use that needs to be the first thing you do?
So I think we've got either 2 or 3 reasonable questions muddled together into one paper along with some silly/poorly defined ones. Then, looking at the ending, the main thrust of their conclusion appears to be 'our approach is useless for thinking about these questions':
It can be concluded that [our approach] has not provided us with conceptual instruments that would resolve the ethical debate between proponents of the segregation and integration models... ...[our approach] also does nothing to resolve the problem of a researcher's clinical obligation. Rather, it creates a new source of moral obligation: a health‐care system. Next, [our approach] seems not to resolve the controversy over the concept of clinical equipoise.
It can be concluded that [our approach] has not provided us with conceptual instruments that would resolve the ethical debate between proponents of the segregation and integration models...
...[our approach] also does nothing to resolve the problem of a researcher's clinical obligation. Rather, it creates a new source of moral obligation: a health‐care system. Next, [our approach] seems not to resolve the controversy over the concept of clinical equipoise.
I am overall not very impressed by this paper. I don't think it sounds actively evil or anything, I just think it sounds like a waste of (a great deal of) paper.
I'll agree that I worded it pretty harshly, but I do think I'll stand by it not being a useful paper. Imagine a science paper that claimed to be about the following list of questions:
a) What is the difference between iron and xenon? b) What is the relationship between solid matter and gaseous matter? c) What is the practical relevance of the principle of least action? d) Does investigating radioactive materials require different experimental procedures than investigating other physics? e) What kind of statistics should be used in physics papers?
Many of these are rather hard to read. The following are my even-more-slimmed down summaries based on skimming just those few paragraphs. Some may be in error, if you disagree with any let me know:
1. Argues in favor of more bioenhancement and against refusing to do bioenhancement for reasons of 'egalitarianism', though in a somewhat wishy-washy way 'we endorse a cautious proposal'.
2. Not really related to bioethics - argues in favor of pseudonymous publishing.
3. Argues in favor of 'nudging' patients to obtain consent for treatments.
4. Argues that if you favor assisted suicide when doctors do it, you should also favor it when for-profit entities do it.
5. Argues that all newborns should be screened for critical congenital heart diseases, without exemption for parental religious beliefs.
6. Tells the story of a patient who demanded his doctors do something really stupid and refused to budge. Unclear what moral, if any, they want to draw.
7. A weirdly meta paper that evaluates methods for evaluating ethics. I have no idea what this means.
8. Frets about off-label use of ketamine being worrying, recommends formal research into it combined with stricter regulation of off-label uses.
9. I have no idea what this paper is about. It tells the story of a kid called James, but I don't know what it wants to draw from it.
10. Argues against 'nudging' people to register as organ donors.
11. Argues that traditional consent is inadequate for a 'biobank' (which stores biological samples of people?) and that you should use something called a 'Participation Pact' instead.
12. Argues that bioethicists should pay attention to neuroscience?
13. Agrees with someone called Lee that bioethics and environmental ethics should be linked, but disagrees that his idea of 'public health ethics' is a good way of doing it.
14. Asks about how to allocate limited supply of a drug called nusinersen for spinal muscular atrophy patients.
15. Argues that consent to organ donation is 'vague' in harmful ways.
16. Talks about 'right-to-try' trials where terminally ill patients try untested drugs. Some waffling, I'm unclear if they approve or not.
17. Argues that diversity in researchers will help make research better.
18. Talks about what to do if your patient's relatives try to fix him with prayer and magic. Appears to argue that you should support the relatives as well as the patient.
19. Argues that conscientious objection to abortion should not keep you from being sued if your refusal causes injury.
20. Proposes a different standard for how to evaluate parent's decisions re. medical care for their children. Unclear how it differs.
21. Argues that standards for resolving e.g. disagreement between doctors and family members on what to do with an incapacitated patient should be simpler.
22. Argues that all children should get measles vaccination. Claims that this paper's conclusions 'reframe the dialog on measles vaccination...from a framework of what is owed to parents...[to] the framework of what is owed to children'. Unclear why that wasn't the framework we were in already.
23. References Gattaca, then argues (against some other bioethicist) that bioenhancement can be good if regulated.
24. Argues that 'professional guinea pigs' who participate in trials for money are being exploited by capitalism.
25. Argues that palliative care for children is currently in a very bad state, and that we should do research into it and make it better.
26. I have no idea what this paper is about. I don't think the authors do either. (EDIT: second opinion is that I'm being uncharitable here, see Kaj below).
27. Declares that a 2010 study on premature babies called SUPPORT was unethical, arguing that it placed one of its treatment groups at higher risk than they would have been without the study.
28. Talks about how to handle decision-making for unrepresented patients. Unclear what they think you should do.
29. Argues that the HEC-C program (a healthcare certification program of some kind) is good.
30. Argues that the HEC-C program (again!) should be more diverse - what they seem to mean by this is not the standard concept of 'diversity' but that it should cover a more diverse set of medical situations.
31. Argues that informed consent is 'nonsense' because people sometimes believe multiple different things.
32. Argues (against some other bioethicists) that you do not need consent from a patient to test whether they are brain-dead.
33. Book review of a book arguing that medical ethics 'cannot be regarded as an extension of common morality' and must be treated as a completely different thing.
I agree that the export ban is not cooperative policy, but I'm unclear if it has an effect. If the US is banning exports of vaccines, but also paying more for vaccines than the EU, it seems unlikely that vaccines will be exported from the US to the EU anyway?
Update: Metaculus published a document explaining their scoring rule, which seems to say something similar. The key quote is probably this:
Our positive sum Scoring Rule — in which for a given question the total points awarded across users is generally positive — encourages broader participation on more questions by not penalizing forecasters who participate in more questions
Presumably the relevant question for vaccine rollout is 'are these places running their own vaccine distribution program, or are they covered under the umbrella of the UK's program.' My guess would be the latter, leaving a total of four distinct vaccination programs of which one is fairly large, two are medium-sized and one is tiny (the UK, Israel, the UAE and Seychelles) as ones that outperform the US.