A blog from the Centre for Research Ethics & Bioethics (CRB)

Month: December 2024

Columbo in Athens

One of the most timeless TV crime series is probably Columbo. Peter Falk plays an inquisitive police lieutenant who sometimes seems so far beyond ordinary time reckoning that he can make Los Angeles resemble ancient Athens, where an equally inquisitive philosopher cared just as little about his appearance.

I hope you have seen a few Columbo episodes. I also take the liberty of opening this post by revealing why I want to write about him. Because he not only exposes the murderers but at the same time frees them from living entangled in their own brilliant plans. You might remember the unusual disposition of the episodes, that we immediately learn who the perpetrator is. The murderers in the series are distinguished not only by their high social and economic status, but also by their high intelligence (and their overconfidence in it). Before the murder takes place, we get to follow how ingeniously the killer plans the deed. The purpose is to give the appearance of having a watertight alibi, to avoid leaving unintended clues at the murder scene, and to leave those clues that clearly point to someone else. Everything is perfectly thought out: BANG! In the next act, Columbo enters the scene of the murder in his worn coat and with a cigar that has usually gone out. In one episode he arrives with a boiled egg in his pocket which he cracks against the murder weapon when he has not had time to eat breakfast.

The murder was just the prelude. Now the episode begins for real, the interaction between the absent-minded Columbo and the shrewd murderer who planned everything in detail and now feels invincible. Especially considering that the police lieutenant leading the investigation is clearly just a confused poor thing constantly fumbling for his notepad and pencil and asking irrelevant questions. I have soon dealt with this fellow, the killer thinks.

Columbo often immediately knows who the murderer is. He can reveal this in a final conversation with the murderer where both can unexpectedly find each other and speak openly, almost like old friends. Soon even the murderer begins to understand that Columbo knows, even though the lieutenant’s absent-minded demeanor at first made this unlikely. Usually, however, the murderer’s confidence is not shaken by knowing that Columbo knows, for everything is perfectly thought out: Columbo “knows” without being able to prove anything! Columbo spends many sleepless nights wondering about the murderer’s alibi and motive, or about seemingly irrelevant details at the murder scene: the “loose ends” that Columbo often talks about, without the murderer understanding why. They seem too trivial to touch the ingenious plan! The murderer almost seems to enjoy watching Columbo rack his brain with immaterial details that cannot possibly prove what both already “know.” Little does the killer know that Columbo’s uncertainty will soon bear fruit.

Finally, Columbo manages to tie up the loose ends that the murderer did not see the point of (they looked so plain compared to the elegant plan). When Columbo reveals how the alibi was only apparent, how the all-too-obvious clues were deliberately placed at the murder scene, and the murderer’s cheap selfish motive, the murderer expects to be arrested by Columbo. “No, others will come and arrest you later,” says Columbo, who suddenly seems uninterested in the whole matter. Columbo seems to have only wanted to expose the illusory reality the killer created to mislead everyone. The murderer is the one who walks into the trap first. To make everything look real, the murderer must live strictly according to the insidious plan from the very first act. Maybe that is why the murderer often seems to breathe a sigh of relief in the final act. Columbo not only exposes the criminal, but also frees the criminal mind from constantly living trapped in its own calculations.

In the conversation at the end, the otherwise active killer seems numbed by Columbo, calm and without a winning smile. Even the murderer is for the first time happily absent-minded.

How does Columbo manage to uncover the insidious plan? We like to think that Columbo succeeds in exposing the murderer because Columbo is even smarter. If Columbo switched sides and planned crimes, no one could expose him! He would be a super-intelligence that could satisfy every wish, like the genie in the lamp. Sometimes even the murderer seems to think along these lines and offers Columbo employment and a brilliant career. With Columbo as accomplice, the murderer would be invincible. But Columbo does not seem to care more about his future than about his appearance: “No, never, I couldn’t do that.” He loves his work, he explains, but hardly gives the impression of being a police lieutenant, but is sometimes mistaken for a vagrant who is kindly asked to remove himself from the scene of the murder. Nuns can offer him food and clothes. Is Columbo the one actually creating the false appearance? Is he the one with the most cunning plan? Is his absent-mindedness just a form of ironic pretense to lure the murderer into the trap?

Columbo probably benefits from his disarming simplicity and absent-minded demeanor. But although we sometimes see him setting traps for the killer, we never see him disguise himself as a vagrant. When his wife has given him a nicer coat, he seems genuinely bothered by it, as if he were dressed up. Is Columbo’s confusion sincere after all? Is it the confusion he loves about his work? Is it perhaps the confusion that eventually reveals the murderer’s watertight plan?

Columbo’s colleagues are not confused. They follow the rules of the game and soon have exactly the conviction the murderer planned for them according to the manual: the murderer has no motive, has a watertight alibi, and cannot be tied to the scene of the murder. Technical evidence, on the contrary, clearly points in a different direction. If the colleagues were leading the investigation, the murderer would have already been removed from the list of suspects. This is how a colleague complains when he feels that Columbo is slowing down the investigation by not following the plan of the criminal mastermind:

Sergeant Hoffman: Now what do you think Lieutenant, do you really think that Deschler didn’t shoot Galesko in the leg?

Columbo: I’ll tell you something, Sergeant, I don’t know what to think.

The injured Galesko is in fact the murderer. He shot himself in the leg after killing Deschler, to make the killing look like self-defense against “his wife’s kidnapper.” Galseko has already murdered his wife, having staged the kidnapping and planted the clues that point to Deschler. Why did Galesko murder his wife? Because he felt she was obscuring his bright future. The murderers in the TV series not only plan their deeds, but also their lives. Without ideas of bright futures, they would lack motive to plan murder.

Neither the killer nor the colleague suffers from uncertainty, they both sleep well. Only Columbo is awake: “I don’t know what to think.” Therefore, he tries to tie up loose ends. Like the philosopher Socrates in ancient Athens, Columbo knows that he does not know. Therefore, he torments the murderer (and the colleagues) with vexing questions that do not belong to the game, but rather revolve around it. Now you probably want to direct Columbo’s most famous line at me: “Oh, just one more thing!” For did I not say that Columbo immediately knows who the murderer is? Yes, I did. Columbo already “knows” who the murderer is. How? Does he know it through his superior intelligence that reveals the whole case in a flash? No, but because the murderer does not react like someone who does not know. When informed of the murder, the killer reacts strangely: like someone who already knows. Lack of confusion is the hallmark of the murderer.

When Columbo reveals the tangle of thoughts that already in the first act ensnared the murderer, the perpetrator goes to prison without complaint. Handcuffs are redundant when the self-made ones are finally unlocked. Columbo has calmed the criminal mind. The culprit is free from the murder plan that would secure the future plan. Suddenly everything is real, just real.

Just one more thing: Merry Christmas and do not plan too much!

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

The dialogue between Hoffman and Columbo is from the episode Negative Reaction (1974). Columbo’s response to the career offer is from The Bye-Bye Sky-High I.Q. Murder Case (1977).

The image is AI-generated in Microsoft Designer by Ashkan Atry.

This post in Swedish

Thinking about thinking

Were many clinical trials during the COVID-19 pandemic unethical?

It is understandable if the COVID-19 pandemic spurred many researchers to conduct their own studies on patients with the disease. They wanted to help in a difficult situation by doing what they were competent to do, namely research. The question is whether the good will sometimes had problematic consequences in terms of research ethics.

For a clinical trial to have scientific and social value, a large number of participants is required. This is in order to be able to compare groups that are treated differently and with a sufficiently high probability demonstrate real connections between treatment and outcome. 20 years ago, small so-called underpowered trials were common, but the pandemic made them flourish again. Some COVID-19 studies had fewer than 50 participants.

Is it then not good that researchers do what they can in a difficult situation, even if it means that they do research on the smaller patient groups that they manage to recruit? The problem is that underpowered clinical trials do not provide valid scientific knowledge. Thus, they have hardly any value for society and it becomes doubtful whether the researchers are really doing what they feel they are doing, namely helping in a difficult situation.

You can read about this in a commentary in the Journal of the Royal Society of Medicine, written by Rafael Dal-Ré, Stefan Eriksson and Stephen Latham. They point out that researchers sometimes defend underpowered clinical trials with the argument that smaller studies are easier to complete and that data from small trials around the world can be pooled to achieve the required statistical power. This is correct if the studies used sufficiently similar research methods to make the data comparable, the authors comment. This is often not the case, but requires that researchers plan from the outset to pool data from their respective studies. Another problem is that underpowered clinical trials more often have negative results and that such studies are less often published. Pooled data from underpowered studies published in journals are therefore not representative. Data from such studies would therefore need to be posted on freely accessible platforms, the authors argue.

Exposing patients to the risks and inconveniences involved in participating in a clinical trial is unethical if the study cannot be judged to provide scientifically valid knowledge with social value. The authors’ conclusion is therefore that research ethics committees that review planned research must very carefully assess that the studies have a sufficiently large number of participants to achieve valid and useful knowledge. If underpowered studies are nevertheless planned, participants must be informed that the results may not be scientifically valid in themselves, but that they will be pooled with results from similar studies in order to achieve statistical power. If there is no agreement with other researchers to pool results, underpowered studies should not be approved by research ethics committees, the three authors conclude. Not even during a pandemic.

Read the commentary here: Underpowered trials at trial start and informed consent: action is needed beyond the COVID-19 pandemic.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Dal-Ré R, Eriksson S, Latham SR. Underpowered trials at trial start and informed consent: action is needed beyond the COVID-19 pandemic. Journal of the Royal Society of Medicine. 2024;0(0). doi:10.1177/01410768241290075

This post in Swedish

We want solid foundations

AI is the answer! But what is the question?

Many projects are underway in Sweden regarding AI systems in healthcare. The testing of AI solutions is in full swing. But many systems do not seem to be implemented and used. Why? Often it is a matter of poor preparatory work. Without a carefully considered strategy and clear goals, we risk scaling up AI systems that cannot cope with the complexity of healthcare.

The atmosphere around many AI ​​ventures can almost be a little religious. You must not be negative or ask critical questions. Then you are quickly branded as a cynic who slows down development and does not understand the signs of the times. You almost have to blind yourself to potential pitfalls and speak and act like a true believer. Many justify the eager testing of AI by saying that we must dare to try and then see which solutions turn out to be successful. It is fascinating how willingly we apply AI to all sorts of tasks. But are we doing it the right way, or do we risk rushing on without giving ourselves time to think?

There are indeed economical and practical challenges in healthcare. It is not only about a lack of financial resources, but also about a lack of personnel and specialists. Before we can allow technologies like AI to become part of our everyday lives, we need to ask ourselves some important questions: What problems are we trying to solve? How do our solutions affect the people involved? We may also need to clarify whether the purpose of the AI ​​system is to almost take over an entire work task or rather to facilitate our work in certain well-defined respects. The development of AI products should also pay extra attention to socially created categories of ethnicity and gender to avoid reinforcing existing inequalities through biased data selection. Ethically well-considered AI implementations probably lead to better clinical outcomes and more efficient care. It is easy to make hasty decisions that soon turn out to be wrong: accuracy should always be a priority. It is better to think right and slow than fast and wrong. Clinical studies should be conducted even on seemingly not so advanced AI products. In radiology, this tradition is well established, but it is not as common in primary care. If a way of working is to be changed with the help of AI, one should evaluate what effects it can have.

We must therefore not neglect three things: We must first of all define the need for an AI solution. We must then consider that the AI ​​tool is not trained with biased data. Finally, we need to evaluate the AI ​​solution before implementing it.

With the rapid data collection that apps and digital tools allow today, it is important not to get carried away, but to carefully consider the ethics of designing and implementing AI. Unfortunately, the mantra has become: “If we have data, we should develop an AI.” And that mantra makes anyone who asks “Why?” seem suspicious. But the question must be asked. It does not hinder the development of AI solutions, but contributes to it. Careful ethical considerations improve the quality of the AI ​​product and strengthens the credibility of the implementation.

I therefore want to warn against being seduced by the idea of ​​AI solutions for all sorts of tasks. Before we say AI is the answer, we need to ask ourselves: What is the question? Only if we can define a real issue or challenge can we ensure that the technology becomes a helping hand instead of a burden. We do not want to periodically end up in the situation where we suddenly have to pull the emergency brake, as in a recent major Swedish investment in AI in healthcare, called Millennium. We must not get stuck in the mindset that everything can be done faster and easier with AI. We must also not be driven by the fear of falling behind if we do not immediately introduce AI. Only a carefully considered evaluation of the need and the design of an AI solution can ensure appropriate care that is also effective. To get correct answers quickly, we must first give ourselves time to think.

Written by…

Jennifer Viberg Johansson, who is an Associate Professor in Medical Ethics at the Centre for Research Ethics & Bioethics.

This post in Swedish

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