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Julian Sheather

Julian Sheather on why we must retain the Human Rights Act

12 Dec, 16 | by BMJ

julian_sheatherWhen we sicken in the UK most of us turn to the NHS for care. The majority of doctors here have also been trained in the NHS. Medicine in the UK is therefore deeply involved with the state. Modern developed states are both powerful and, to an extent, impersonal. They can be an enormous force for the good—think of the contribution of the NHS to our welfare—but when they fail they present two kinds of threat: intrusiveness and negligence. There is a danger that powerful states can strip us of our liberty; they can also fail in their obligations to support and protect us. By taking people into its care, and limiting their ability to provide for themselves, the state accrues obligations—at the very least, to provide for the basics: food, water, safety. Tragically, there have been times where, for complex reasons, this hasn’t happened. Consider also the provision of compulsory treatment under mental health legislation. Uniquely, the state, and the doctors who represent it, can override the competent decision of an adult and, if certain conditions are met, provide treatment in their interests without consent. Fundamental rights are engaged here.  more…

Julian Sheather: Extremity piled upon extremity—where next for medical neutrality?

8 Mar, 16 | by BMJ

julian_sheatherIn times of war, said Cicero, the law falls silent. Afghanistan. Iraq. Syria. Yemen. Somalia. Ukraine. Libya. Chad. An irregular patchwork of violent conflict lies across great swathes of the globe. Many of these are new kinds of conflict. The clash of opposing armies has given way. Splinter groups, proxies, irregular forces, insurgents, paramilitaries. It is the language of indistinctness and blurred identity. The theatres of war have also shifted. They are increasingly urban and densely populated—places of deep human settlement. Here the force of modern weaponry is unleashed to catastrophic and indiscriminate effect. The unrestrained savagery of so much of this conflict, its blindness to any moral restraint, recall Thucydides and the Athenian generals on Melos. Their words are still cited by those who hold that there is no place for morality in war. “There is no justice between the weak and the strong: the strong take what they can, and the weak bear what they must.” Every playground bully and every one of his—or her—victims knows the part of truth in this. more…

Julian Sheather: Forty years of the Declaration of Tokyo

1 Jul, 15 | by BMJ

julian_sheatherMedical involvement in torture looks like a category error. Medicine has to do with the healing of bodies and minds; torture with their destruction. It is now forty years since the World Medical Association (WMA) adopted the Declaration of Tokyo on Guidelines for Physicians Concerning Torture. It was necessary then. The tragedy is how necessary it remains. more…

Julian Sheather: Shaping the ends of our lives

27 Apr, 15 | by BMJ

julian_sheatherVery difficult to know how we will approach our death until we are in the shadow of it. Will we hold to the ideals we formed when we were healthy, or will fear, or pain, or desperate hope overturn them? There is an interesting blog touching on this theme over at the New York Times. The author’s father was a doctor, a specialist in infectious diseases. In robust professional life he refused to treat opportunistic infections in dying patients. Where death is inevitable, often as not infection is the door that lets it in. For his father, aggressively treating patients in these circumstances was “inhuman…morally wrong… and professionally bankrupt.” more…

Julian Sheather: Will the confluence of big data and the genomics revolution lead to a transformation in personalized healthcare?

9 Feb, 15 | by BMJ

julian_sheatherWill the confluence of big data and the genomics revolution lead to a transformation in personalized healthcare, or are the emperors’ clothes looking a little threadbare? This was the theme of the Astellas Innovation Debate for 2015, held in the Royal Institution’s lovely raking lecture theatre in Albermarle Street. George Freeman, Minister for Life Sciences, gave an upbeat, we’re clearly in the run-up-to the election, opener. This was visionary stuff. The i-Gene revolution had bought us to the threshold of a great leap forward. Precision healthcare, personalized to our individual genomes, will strip old health of its inefficiencies, side-effects, and randomness. Healthcare costs will plummet. Outcomes will go through the roof. The NHS will become the first publicly funded health system to offer genomics as routine treatment. Smartphones will become medical sensors, providing real time data about our health status, transforming self-care and bringing relief to an overstretched health system. Freeman summoned the ghosts of the great dead: Bevan, he told us, would have championed the i-Gene revolution. Nor does the good news end there. Access to all that rich data locked away in NHS databases—duly anonymized—will unleash the life science industries, giving fresh impetus to the UK’s economic recovery. The future is bright, the future is i-genetic. more…

Julian Sheather: Torture, medicine, and the need for an independent eye

26 Jun, 14 | by BMJ

julian_sheatherIn August 2012, Claudia was woken at 3:00 in the morning when soldiers burst into her home in Veracruz City, Mexico. They tied her hands and blindfolded her. They took her to the local naval base where they tortured her: they subjected her to repeated electric shocks, then they wrapped her in plastic, and beat her—the plastic was to disguise the marks. She was accused of being a gang member, something she vehemently denied.

The next day she was forced to sign a statement unread. In court a week later, she retracted it and testified to the abuse she had suffered. All but one of the charges against her were dropped, and the judge ordered the federal attorney general’s office to investigate. This was nearly two years ago. Nobody has yet been held to account, and in all that time she has received no specialist medical and psychological assessment. more…

Julian Sheather: The man whose mind exploded

13 Jun, 14 | by BMJ

julian_sheatherDrako Oho Zarhazar has anterograde amnesia, a rare brain disorder that has left him unable to form new memories. The distant past—episodes from before the traumas that disabled his mind: a motorcycle accident; his car crushed beneath the wheels of a monster truck—remains to some degree with him, but he can hold almost no memory of anything that came after. He lives in a more or less permanent present, moving in a single interval of time, ghosted by his own slowly withdrawing past.

A former dancer, bohemian, drug dealer, fetishist, and one time muse to Salvador Dali, Drako is in his seventies and, it’s fair to say, he is slightly more than unusual. He strides into his documentary, caped like a magi, walking with his staff down the pebbled foreshore of Brighton beach. He is bald, pierced, crazily (almost childishly) made up, his upper lip horned with a black waxed Dali-esque moustache. Naked on the beach, his nipples are pierced, and a rather lovely tattoo of an ithyphallic ram wraps around his back and leaps down his flank. more…

Julian Sheather: Public health and social power

29 May, 14 | by BMJ

julian_sheatherIt’s hard not to brood from time to time on some of the intractable public health problems that entangle us. Take obesity. Swimming with my boys over the weekend, I was again struck by how much the food that should sustain us is killing us. It’s hard as well not to wonder where change might come from. We know that obesity arises at the juncture between appetite and environment, between private choices and systems that constrain and encourage, between our evolved appetites, the supermarket shelves, and our all too wavering wills. We champion individual and commercial freedoms—freedoms to buy, freedoms to sell—but the private exercise of our liberties is everywhere undoing us.

We know that change will somehow have to address both the regulation of our desires, and also the great social playgrounds in which our desires roam. Partly it is a private issue—what I eat is my business—and partly it is a public one, as cumulative private choices can become big social problems. Although for thousands of years we approached the problem of appetites via the virtues, we now quail at any public suggestion of moralism, preferring the quaint and neutral fiction that we are all rational economic actors and that we can be entirely taxed into good health.


Julian Sheather: Time to debate the ethics of robot care?

17 Apr, 14 | by BMJ

We take it for granted that compassion is at the heart of good care. But what if the hand that reaches out to yours is a robot’s? What if the last face you see on earth is a facsimile? The use of robotics is well established in parts of medicine. Surgery involving remote manipulation of robotic arms is now commonplace. Some have even predicted that surgery will cease to leave a scar: introduced via orifices, robots will travel to the afflicted area, self-assemble and do their robotic thing. But by and large these remain an extension of ordinary human tools—just better. Fully-autonomous robots, our companions and servants—even our nemeses—have not made it far from the pages of science fiction. As an editorial in The Economist has it, set aside car manufacturing and vacuum cleaning, robots have been more successful at parsing our anxieties about technology than delivering real world promise.  But things might be changing. Scientists at Ohio State University have developed an algorithm that enables computers to read human emotions. Google and Amazon are both investing heavily in robots. Big data, cloud computing and the ever-growing crunching power of ever-shrinking processors suggest that robotics may be about to take an automated leap forward. more…

Julian Sheather: Ugandan anti-homosexuality legislation: bad law, bad science

25 Feb, 14 | by BMJ

For all the fanfare that headline science can generate, it is usually quiet science that arouses my sympathies. Carefully uncovered facts can settle like welcome oil, stilling the troubled waters of moral panic and vengeful politics. I am more drawn to the Victorian naturalists who posted songbirds to each other, carefully mapping variation, than to their bullish champions, the Huxleys, and, more latterly, the Dawkins’, who would batter the world’s opinions into quiescence. Disappointing morning then when I return from a week in Norfolk and find that President Yoweri Museveni of Uganda has signed into force draconian anti-homosexuality laws, attaching a life sentence to “aggravated homosexuality.” Even more disappointing to learn that he has done so on the basis of advice from fourteen Ugandan medical “experts.” The clincher, according to these “experts,” is that homosexuality is not genetic behaviour, but learned—not a “natural” occurrence, but a social pathology. more…

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