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Homeopathy, Blacklisting, and the Misuse of Choice

15 Nov, 15 | by Iain Brassington

It seems that homeopathy might at last be facing some serious opposition from within the NHS, with the prospect of its being blacklisted being considered.

There’s any number of people who’ll be entirely on board with that. Homeopathy doesn’t work.  Of course, a lot of medicines turn out not to work, or not to work well.  But the difference between homeopathy and unsuccessful drugs is that the latter are at least more likely to have a plausible mechanism – roughly, one of throwing molecules at other molecules, or coaxing the body to throw molecules at molecules.  Homeopathy doesn’t even have that.  It relies on water having a memory.

At the very best, it contributes nothing. But it does cost money – not much, but more than none, and in the end, the taxpayer has to pony up for it.  Money is being wasted every time the NHS pays for homeopathic treatment, and that looks to be unjust.  (It’s not the most unjust thing in the world, but that’s neither here nor there.  Wrongs are wrongs, even if harms might vary.)

It might even get in the way of effective treatments, if patients use it rather than them.  That might mean that they’re worse off than they could otherwise be.  At the outside, it might mean that they’re a danger to others – they might be spreading illness by dint of not getting treated properly for it.

To that extent, Simon Singh strikes me as being bang on the money: more…

Should Doctors Strike?

9 Nov, 15 | by bearp


Should doctors strike?

Is it ethical for doctors to go on strike, potentially putting their patients at risk of getting inadequate treatment?

As the BBC reports, ministers and junior doctors are currently “locked in a dispute.” One possible outcome of this disagreement is a physicians’ strike, which raises a number of tricky ethical questions. But before we get into those questions, it might be helpful to take a look at a quick sketch of what the problem is all about (from the BBC article):

Junior doctors’ leaders are objecting to the prospect of a new contract. The government has described the current arrangements as ‘outdated’ and ‘unfair,’ pointing out they were introduced in the 1990s. Ministers drew up plans to change the contract in 2012, but talks broke down last year. The government has indicated it will impose the new contract next year in England. The BMA has responded by initiating the industrial action process. …

The latest information provided by the government, which is the most detailed so far, includes an 11% rise in basic pay for doctors. But that comes at a price. Other elements of the pay package are being curbed.

The prospect of a strike appears to be firmly on the table: “Doctors can take strike action but only if it affects non-emergency care. The last time this happened was during [a] pensions dispute in 2012, but that was the first time such action had been taken for almost 40 years. Doctors still attend work – so they are ready for urgent and emergency cases.”

The Journal of Medical Ethics has tackled this issue before. Writing for the journal in 2013, John Park and Scott Murray gave an analysis of the 2012 “pensions dispute” just mentioned.

Last year in June, British doctors went on strike for the first time since 1975. Amidst a global economic downturn and with many health systems struggling with reduced finances, around the world the issue of public health workers going on strike is a very real one. Almost all doctors will agree that we should always follow the law, but often the law is unclear or does not cover a particular case. Here we must appeal to ethical discussion.

The General Medical Council, in its key guidance document for practising doctors … claims that ‘Good doctors make the care of their patients their first concern.’ Is this true? And if so, how is this relevant to the issue of striking? One year on since the events, we carefully reflect and argue whether it was right for doctors to pursue strike action, and call for greater discussion of ethical issues such as the recent strikes, particularly among younger members of the profession.

In light of the current turmoil, the Journal of Medical Ethics welcomes submissions on the ethics of physicians striking, including papers which build on, critique, or respond to the work of Park and Murray. Their 2013 paper can be accessed here. As Associate Editor Dominic Wilkinson stated in an interview:

In their submissions, authors should focus on ethical questions and put their discussion in the context of ongoing international debate and existing literature. Possible questions include, for example: what is a fair level of remuneration for public sector healthcare workers, including doctors? Should all doctors be paid equally? Should antisocial hours be rewarded financially? In a financially constrained environment, should doctors’ pay go down in order to protect funding for health care provision?

Papers can be submitted to the Journal of Medical Ethics here. Author instructions are here.

The Journal of Medical Ethics remains the top-ranked journal in bioethics for 2015 according to Google Scholar Metrics, with an impact factor of 1.511 and an h5-index of 28. We look forward to seeing your submissions.

Check out the current issue by clicking here.

Journal of Medical Ethics Now Accepting Longer Papers

26 Oct, 15 | by bearp


The Journal of Medical Ethics is pleased to announce the addition of a new article type – Extended Essays – that will allow authors up to 7,000 words to provide an in-depth analysis of their chosen topic.

In an interview, Associate Editor Tom Douglas said the new category was created “in recognition of the fact that some topics warrant sustained and nuanced analysis of a sort that can’t be laid out in less than 3,500 words.”

He went on to say that at the Journal of Medical Ethics “we don’t want to miss out on the best papers in medical ethics, many of which currently get sent elsewhere simply because of our strict word limits.”

However, he emphasized that “we still expect arguments to be as concise as possible and that the great majority of our papers will still be under 3,500 words.”

For more information on this new article type, see the Instructions for Authors page. The information is also copied below:

Original Article Papers – Extended Essays

This category is for original research papers which employ in-depth philosophical analysis in order to address an important policy- or practice-related normative question. The main criteria for acceptance are originality, rigour, accessibility, philosophical sophistication, and interest to a wide audience. The standards for being sent for review, and for eventual acceptance, are substantially higher than for ordinary papers. We expect to publish at most two such papers in any issue.

Purely or predominantly empirical papers will not be considered in this category and should instead be submitted as Brief Reports or, if they also include substantive ethical analysis, Papers.

  • Word count: up to 7000 words
  • Abstract: up to 250 words
  • Tables/Illustrations: up to 5, any more at editorial discretion
  • References: up to 50

The Journal of Medical Ethics remains the top-ranked journal in bioethics for 2015 according to Google Scholar Metrics, with an impact factor of 1.511 and an h5-index of 28.

We look forward to seeing your submissions.

Check out the current issue by clicking here.

Stop What You’re Doing: This is Important.

14 Oct, 15 | by Iain Brassington

I’d not realised it, but the latest iteration of the erstwhile Medical Innovation Bill – colloquially known as the Saatchi Bill – is up for debate in the Commons on Friday.  This is it in its latest form: to all intents and purposes, though, it’s the same thing about which I’ve blogged before.

In a nutshell, the Bill does nothing except remove protections from patients who would (under the current law) be able to sue for negligence in the event that their doctor’s “innovative” treatment is ill-founded.

Much more articulate summaries of what’s wrong with the Bill can be found here and here, with academic commentary here (mirrored here on SSRN for those without insitutional access).  There have been amendments to the Bill that make the version to be discussed on Friday slightly different from that analysed – but they are only cosmetic; the important parts remain.

Ranged against the Bill are the Medical professional bodies, the personal injuries profession, patient bodies, and research charities.  In favour of the Bill are the Daily Telegraph, a few people in the Lords who should know better (Lord Woolf, Lady Butler-Sloss: this means you), and Commons MPs who – understandably – don’t want to be seen as the one who voted against the cure for cancer.

Gloriously, Christ Heaton-Harris, who introduced the Bill, did so only after winning the ballot for Private Members’ Bills.  In a nutshell, he was allotted Parliamentary time, and then began the process of wondering what to do with it – which suggests that even the Bill’s sponsor doesn’t have a burning commitment to the cause – or, at least, didn’t when he took it on.

Still, the Bill has the support of Government; as it stands, there’s a good chance that it’ll pass.

SO: Take a few minutes to look up your MP’s email address – you can do that by following this link – and drop him/ her a line to encourage them to vote against the Bill.

Do it.

1 in 4 Women: How the Latest Sexual Assault Statistics Were Turned into Click Bait by the New York Times

1 Oct, 15 | by bearp

by Brian D. Earp / (@briandavidearp)

* Note: this article was originally published at the Huffington Post.


As someone who has worked on college campuses to educate men and women about sexual assault and consent, I have seen the barriers to raising awareness and changing attitudes. Chief among them, in my experience, is a sense of skepticism–especially among college-aged men–that sexual assault is even all that dire of a problem to begin with.

“1 in 4? 1 in 5? Come on, it can’t be that high. That’s just feminist propaganda!”

A lot of the statistics that get thrown around in this area (they seem to think) have more to do with politics and ideology than with careful, dispassionate science. So they often wave away the issue of sexual assault–and won’t engage on issues like affirmative consent.

In my view, these are the men we really need to reach.

A new statistic

So enter the headline from last week’s New York Times coverage of the latest college campus sexual assault survey:

1 in 4 Women Experience Sex Assault on Campus.”

But that’s not what the survey showed. And you don’t have to read all 288 pages of the published report to figure this out (although I did that today just to be sure). The executive summary is all you need.


Flibanserin and Regulatory Failure

25 Sep, 15 | by Iain Brassington

Guest Post by Adriane Fugh-Berman

On August 18th, 2015, the FDA approved flibanserin (brand name Addyi), a purported aphrodisiac that can drop blood pressure so precipitously that users sometimes pass out and require medical intervention to regain consciousness.  The labelling for flibanserin indicates that it is for:

the treatment of premenopausal women with acquired, generalized hypoactive sexual desire disorder (HSDD), as characterized by low sexual desire that causes marked distress or interpersonal difficulty and is NOT due to:

• A co-existing medical or psychiatric condition,

• Problems within the relationship, or

• The effects of a medication or other drug substance.

Focus for a moment on “Low sexual desire that causes marked distress or interpersonal difficulty”.  So a woman upset by a belittling spouse who wants sex more often than she does is eligible for a prescription drug?  It gives a whole new meaning to the term “drugs of abuse.”  Note that even if the putative patient isn’t distressed, she is still eligible for being drugged if her partner is creating interpersonal difficulty.  Here’s a thought – why not sedate him instead?

Not every partner is a jerk, and there are certainly women distressed by loss of libido, but flibanserin isn’t the answer for these women either.  As an aphrodisiac, it’s no great shakes; its predominant mechanism may simply be sedation.  Flibanserin increased “sexually satisfying events” by less than one event a month (the event, by the way, need include neither an orgasm nor a partner).

The labeling of flibanserin reveals the absurdity of this “disease” and its treatment. more…

Assisted Dying’s Conscience Claws

11 Sep, 15 | by Iain Brassington

Aaaaaaaand so the latest attempt to get assisted dying of some sort onto the statute books in the UK has bitten the dust.  I can’t say I’m surprised.  Watching the debate in the Commons – I didn’t watch it all, but I did watch a fair chunk of it – it was striking just how familiar the arguments produced by both sides were.  It’s hard to shake the feeling that, just as is the case with the journals, the public debate on assisted dying has become a war of attrition: noone has much new to say, and in the absence of that, it’s simply a matter of building up the numbers (or grinding down the opposition).  The Nos didn’t win today’s Parliamentary debate because of any dazzling insight; the Ayes didn’t lose it because their speakers were measurably less impressive than their opponents’.  If the law does change in the UK, I’d wager that it’ll be because of demographic brute force rather than intellectual fireworks.

(Every now and again I hear a rumour of someone having come up with a new approach to assisted dying debates… but every now and again I hear all kinds of rumours.  I live in hope/ fear: delete as applicable.)

Still, I think it’s worth spending a little time on one of the objections that’s been raised over the last couple of days to this Bill in particular; it’s an objection that was raised by Canon Peter Holliday, the Chief Executive of a hospice in Lichfield:

In an interview with the Church of England, Canon Holliday said: “If there is no possibility within the final legislation for hospices to opt out of being a part of what is effectively assisted suicide, then there is nervousness about where our funding might be found in the future. Would the public continue to support us and indeed would the NHS continue to give us grants under contract?”

Canon Holliday said the Assisted Dying Bill also contains no opt out for organisations opposed to assisted suicide in spite of high levels of opposition to a change in the law amongst palliative care doctors. Where hospices did permit assisted suicide the potential frictions amongst staff could be ‘enormous’ with possible difficulties in recruiting doctors willing to participate, he said.

“The National Health Service requires us, in our contracts, to comply with the requirements of the NHS. Now if the NHS is going to be required to offer assisted dying there is of course the possibility that it would require us or an organisation contracting with the NHS also to offer assisted dying. If we as an organisation were able, and at the moment under the terms of the bill there is no indication we would be able, but if we were able to say that assisted dying was not something that would happen on our premises, would that prejudice our funding from the NHS ?”

Is this worry well-founded? more…

Psychology Is not in Crisis? Depends on What You Mean by “Crisis”

3 Sep, 15 | by bearp

By Brian D. Earp

*Note that this article was originally published at the Huffington Post.


In the New York Times yesterday, psychologist Lisa Feldman Barrett argues that “Psychology Is Not in Crisis.” She is responding to the results of a large-scale initiative called the Reproducibility Project, published in Science magazine, which appeared to show that the findings from over 60 percent of a sample of 100 psychology studies did not hold up when independent labs attempted to replicate them.

She argues that “the failure to replicate is not a cause for alarm; in fact, it is a normal part of how science works.” To illustrate this point, she gives us the following scenario:

Suppose you have two well-designed, carefully run studies, A and B, that investigate the same phenomenon. They perform what appear to be identical experiments, and yet they reach opposite conclusions. Study A produces the predicted phenomenon, whereas Study B does not. We have a failure to replicate.

Does this mean that the phenomenon in question is necessarily illusory? Absolutely not. If the studies were well designed and executed, it is more likely that the phenomenon from Study A is true only under certain conditions. The scientist’s job now is to figure out what those conditions are, in order to form new and better hypotheses to test.

She’s making a pretty big assumption here, which is that the studies we’re interested in are “well-designed” and “carefully run.” But a major reason for the so-called “crisis” in psychology — and I’ll come back to the question of just what kind of crisis we’re really talking about (see my title) — is the fact that a very large number of not-well-designed, and not-carefully-run studies have been making it through peer review for decades.

Small sample sizes, sketchy statistical procedures, incomplete reporting of experiments, and so on, have been pretty convincingly shown to be widespread in the field of psychology (and in other fields as well), leading to the publication of a resource-wastingly large percentage of “false positives” (read: statistical noise that happens to look like a real result) in the literature.


Putting a Price on Empathy

12 Aug, 15 | by BMJ

Guest Post by Sarah Carter

My paper is another to add to the ever-increasing number of articles about moral (bio)enhancement – but why is this issue so important?  To take a cynical view: if we had a pill or injection that could make people more moral, less prone to harming others, and so on, it would likely be very attractive to governments (perhaps because of real concerns that we’re headed for disaster unless such steps are taken, or simply because it would save on policing and military bills).  So it’s very important to try to get our heads around this subject while it’s still something that’s merely an idea, rather than waiting until it’s something in our medicine cabinets.  This means thinking about and discussing everything from what moral enhancement would actually involve, right through to questioning how it should be distributed, regulated, and even – as my paper addresses – promoted to the public.

Writers such as Persson and Savulescu argue that there is a need to undertake moral bioenhancement as a means to avoid mankind wandering down the path of ultimate harm, but they concede that many people (especially those we might say to be most in need of moral bioenhancement) would be unlikely to undergo it willingly.  In 2014, Vojin Rakic suggested that incentives such as tax breaks, retirement benefits, schooling allowances, and affirmative action policies, should be used as a way to encourage people to undergo moral bioenhancement.  I think that Rakic’s idea, while prima facie sensible and reasonable, simply will not work. This is not due to issues of coercion or social justice that we would normally associate with the use of incentives, but rather because likely public perceptions of moral bioenhancement mean that the use of incentives for this purpose may present a taboo trade-off. more…

Galileo’s Middle Finger: Book Review

5 Aug, 15 | by David Hunter

I recently finished reading Galileo’s Middle Finger by Alice Dreger a medical historian and ethicist (although she may deny the title) and since I found it both thought provoking, terrifying and inspiring I thought I would share a few thoughts and hopefully convince you to read it, since I think some of its content is a must read for bioethicists and people who view themselves as in some way trying to make the world a better place.


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