If you look at the comments thread in the post about Kerrie Wooltorton, you’ll see that there’s been an interesting debate between me and someone who calls himself “Dr No”.  I don’t think that No and I will ever see eye-to-eye on quite a lot of stuff, but, then again, I don’t see eye-to-eye on a lot of things with the people whose offices are on the same corridor as mine, so there’s no surprise there.

Anyway - there’s a link to No’s own blog in one of the comments, and it, should you follow it, it’ll take you here.  You know the aphorism about pictures being able to represent a thousand words?  Here’s a picture: more…

This thought hit me over the weekend in Tesco’s car-park; I was still mulling over the reliability, or lack thereof, of science reporting in the media.  I was also thinking about the PCC and how powerless it is, largely because it’s simply a boys’ club for editors.

However, in my finding-a-trolley reverie, it occurred to me that there could be a solution.  There’s already a couple of papers that run debunk columns - the most high profile of these is obviously Ben Goldacre’s “Bad Science” in the The Guardian (with its corresponding blog, to which I’ve linked from here more than is absolutely healthy), but there’s also Tim Harford at the FT whose “Undercover Economist” pieces throw light onto often highly-spun news stories; he also presents Radio 4’s “More or Less”, which does its bit to look behind the headlines.  From the blogosphere, Lay Scientist, Ministry of Truth, and many, many others all provide sterling work evaluating science, the reporting of science, and the integration of science into policy.  (Peter Sinclair’s films on global warming, for example, are wonderful.)  There’s no shortage of people that care about accuracy.

What they have in passion, they lack in organisation.

So here’s the idea: its that there should be convened a panel of independent experts drawn from science, medicine and a few other fields: most importantly, statistics.  Every so often, this panel would meet and give news media a “reliability rating”.  In return for this, each member of the panel would be given a small honorarium - say a couple of grand a year - from a fund supported by the newspapers (rather as they fund the PCC).  Or maybe fewer members would be able to farm out consultancy work to academics.  Whatever - let’s not sweat the details yet.  Newspapers then would be able to print a little logo - say, a test-tube that’s more or less empty - next to their titles, to give readers a sense of the paper’s scientific trustworthiness.  The odd daft story would get through, but over the course of, say, a year, it’d be possible to build a picture of reliability.  The papers themselves would have an incentive to contribute to the scheme, and to be as reliable as possible, because they could use their trustworthiness as a selling point.  Papers that don’t participate in the scheme would, by omission, be flagging their own worthiness for scepticism.  Granted, there’re weaknesses in the picture: my guess is that people buy the Daily Fail for its scientific insight.  But they’d at least have an implicit warning that, if they were going to believe its on-occasion utterly daft health reporting, they’d only have themselves to blame.

There has to be a fatal flaw in this scheme (unless it is, so far, so sketchy right now that there’s nothing in which there could be a flaw).  Tell me what it is.

There’s an illuminating item that’s recently been posted on Enemies of Reason about the way that the press has been handling H1N1, and the way in which the distinction between deaths from and deaths with the illness has been blurred.  And it’s very easy to look at the newspaper stands and laugh at the manner in which they generate health scares from nothing - and the manner in which they then keep them going.  (Need one mention the MMR pseudo-controversy that just seems to keep on running?)

It’s not only in respect of health that journalism gets things wrong or sensationalises the trivial, of course - it happens all the time in science journalism more generally.  There is, the wisdom goes, a terrible lack of understanding about science among journalists and - worse - a perception that they don’t care that they don’t understand.  Ben Goldacre keeps returning to this theme: in the last few days, he has picked up on this particularly egregious example - the same story was noted and demolished by EoR (among others) a little while ago - and PZ Meyers has highlighted another in the recent past.  And, of course, bad science journalism and bad medical journalism come together, since it’s in respect of health that much scientific reserch gets into the papers to begin with.  (It’s either health, dinosaurs or global warming…)

So we can construct an argument about bad journalism.  It’d go something along the lines that lazy or incompetent writing is misleading, and thereby puts people’s health and welbeing in danger.  Parents are not getting their children vaccinated because of HPV and MMR stories that are simply not true, and that’s generating a serious health threat.  Others are making other decisions that have effects ranging from unnecessary anxiety to threats to life based on the way that health stories get reported.  Perhaps this might not be quite so worrisome when we’re talking about the way the mainstream press covers a story about, say, the expression of a gene in zebrafish (assuming that it got any coverage at all), since noone sane is going to change their life on the basis of how that gets reported.  But in respect of matters of health… well, that’s potentially a bit different.  And by “a bit”, I mean “very”.

Or we could construct a rather less consequentialist argument, and say that journalism that distorts the facts is blameable without any appeal to the outcomes at all - it’d still be blameable if it made people do optimific things.

A secondary charge is that the press treats “balance” as demanding equal time for all sides - which means allowing vaccination cranks as much space as people who know of what they speak.  (On which topic, Dara O’Briain is worth a watch…)  Again, this is misleading, and perhaps culpably so.

I’m beginning to wonder whether this is correct, though - or, at least, whether there might be at least a limited case for the defence.  With no small trepidation, here goes… more…

At least the Trolley Problem has been solved.  (Hat-tip to Brian Leiter for the pointer.)

Dependably right-wing blogger Paul “Guido Fawkes” Staines has been circulating the idea that Gordon Brown may be taking anti-depressants - specifically, Monoamine Oxidase Inhibitors - under the touching and understanding heading “Is Brown Bonkers?”  and making some sniggering schoolboy allusions to Malcolm Tucker-like tantrums.  This allegation - and quite why it’s an allegation is beyond me - leads Fawkes to muse that

[i]n the context of all this speculation and his manifest physical unease, surely somebody in the Lobby has to publicly ask the question at the PM’s next monthly briefing: ”Prime Minister, have you been taking medication that may affect your judgement?”

But it’s not just Staines that’s casting doubt on Brown’s mental health: he’s asked me to point out, and I’m happy to clarify, that he’s simply following up a story in the Independent that was saying the same thing, except more speculatively (and coquettishly)

Senior Whitehall bods are reported as noting that [Brown] was recently given a long list of things he absolutely must avoid, and that among these are Chianti and cheese. Both are well-known for causing a violent, even lethal reaction to a specific group of heavy duty antidepressants known as MAOIs (Monoamine Oxidase Inhibitors).

See how it works: there’s a rumour that Brown has been given a list of foods to avoid, a suggestion that this might be because of some medication, and BINGO! he’s a nutcase.  Of course, because his article’s in the Indy, Matthew Norman is careful to add all kinds of “Of course, I’m not saying…” caveats -

[w]hether literally the case or not, however, this rumour carries the kind of psychological truth that tends to be more damaging than fact.

- but only after having demanded disclosure:

You’d have thought that whether our Prime Minister is severely clinically depressed falls loosely under the public interest header, but what can you do? Our political system regards secrecy less as desirable than its raison d’etre.

See?  From “There might be some foods the PM’s avoiding” to “There’s a conspiracy to cover up the fact that he’s bananas” in two easy steps, with a little side-helping of “I’m not saying that… except I am” as a garnish.  Of course, there’s a range of references to One Flew Over the Cuckoo’s Nest, natch, because there was a law passed in 1473 saying that every media story about mental health had to have at least one such citation.  Possibly.

There’s a range of things to question about this story: more…

At risk of flogging a dead horse, there’s still quite a lot being said about the NHS as a comparator for American healthcare.  With that in mind, there’s an interesting little piece on Liberal Conspiracy at the moment comparing the UK and US systems in terms of cost per head.

Do these numbers, and what’s done with them, look plausible?  They do to me, but then I’m statistically hopeless.  Thoughts?

Coming up soon: a post on a different theme.  A serious, philosophical one.  By the end of today, too, if I get my arse into gear.  No, really.

Thom Brooks on facebook has pointed out this hilarious rhetorical fact checking fail from Neo-conservatives debating the public provision of health care in the US:

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This is the first installment of Matazone’s “Floppity MD” series - and it’s well worth spending a couple of minutes looking at more recent installments, too: they provide an all-too-easily forgotten warning about purple, scalpel-carrying, semi-psychopathic cuddly toys.

I believe there may be a Hugh Laurie reference or two in there as well.

Dan Sulmasy has a piece on Bioethics Forum at the moment in which he considers the next 40 years of bioethics.  It’s a curious piece, making six main claims or predictions about the future, to which I’ll return in a minute: but before that, I think it’s worth looking at his scene-setting:

I suggest that bioethics has evolved through three phases: a religious phase in the 1950s and ’60s, a philosophical phase in the ’70s and ’80s, and a political-empirical phase from the ’90s to the present. Much as been written and said about the first two phases, but little about more recent history.

By the late 1980s, just as I was starting serious study in the field, philosophical bioethics had created a standard canon and had begun to rest on its achievements. Physicians, who found the language of philosophers alien but had been taking courses in bioethics, began re-engaging the field (or, in some cases, reclaiming it as their own). 

The general public, policymakers, and many of the new young students entering the field of bioethics by this time also began to complain that philosophy did not supply enough concrete answers to their pressing questions. They wanted solutions to social policy problems such as the distribution of health care resources, cost-containment, and physician-assisted suicide.

I’m interested to know whether this natural history of bioethics is accurate.  On the face of it, I’m not sure.  It - perhaps - describes the genesis of bioethics in the US, but I’m not sure that the subject has followed the same route in Europe, where there simply has not been a religious or political phase.  Bioethics has grown out of a renewed interest in applied ethics, which has grown out of good, old-fashioned, seminar-room ethics.  To the extent that claims are made about what should be done, and what the law should say, bioethics is “political” - but it isn’t political in the strong sense that I think Sulmasy uses the term; it isn’t about activism on behalf of this or that group (and it shouldn’t be, either).  And I’ve already articulated my suspicions of the supposed “empirical turn” in the subject; empirical studies may feed ethical debate, but they oughtn’t to be treated as a substitute.

But back to the six points, which I’ve edited down here.

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For quite a while now, I’ve had the idea that I’d like to write something about the purpose of medicine - it’s something I’ve been adding on job applications for about 5 years, but I’ve not got around to doing all that much about it yet.  The question as I saw it was whether medicine is properly concerned with making us well, or with assisting us in our projects.  The latter may be a condition of the former - indeed, it may be a criterion of the former - but it’s not the same, because we could have all kinds of odd projects that’re only tenuously health-related.  For example, cosmetic surgery - and here I mean potentially quite extreme body modification - might potentially belong to medicine if we go for the latter option.  It might not be the sort of thing that medics should prioritise, but it could still be on their list of concerns.

Where’s this preamble leading?  Well, Alice Dreger has been considering a similar sort of question over on the Hastings Center’s blog.  It’s cosmetic surgery that worries her:

I’m not naïve; as an historian of medicine, I know that medicine has always advanced itself by offering improvements of patients’ social status, primarily by making patients healthier, but also by legitimizing their complaints.

But the noble profession has historically been primarily about something nobler than boob jobs and Botoxing wrinkles. The medical profession’s primary goal, historically speaking, has been prevention and relief of real suffering.

I can’t believe I even have to assert that. If the great men and women of medicine could come back from the dead and watch television today, what would they make of the fact that a large percentage of the medicine that is represented is cosmetic?

They might conclude, reasonably, that this reveals medicine’s success. Only in a world of astonishingly good anesthetics, infection management, and surgical technique would patients dare seek these procedures. But they might also reasonably conclude that something very strange has happened.

There’re some interesting considerations raised in the piece - I do recommend it.  However, there’s also a couple of things with which I’d pick a dispute.  The conclusion doesn’t strike me as powerful, for example.

Let’s just call these practices what they are: barber surgery. That way, when one of my idealistic, smart, principled students hears that the student next to her is going into “cosmetics,” she can just answer, “Really? And here I thought we were in medical school.”

Dreger is fairly clear that she goes along with the first of my options above - that medicine is about wellness - but I’m not sure that that’s right: I don’t think I see wellness as an end in itself.  Rather, I see it as something that’s valuable (and comprehensible) only within the context of a certain set of projects.  So it’s those projects that do the work - in which case, cosmetic medicine (or barber surgery - call it what you will) is, if not exactly back on the menu, at least chalked up on the “Specials of the Day” board.  The “and I thought we were in medical school” retort wouldn’t stick.

And I think that the tone of the article more generally suggests something important and interesting about the cultural background of bioethics as pursued on the other side of the Atlantic. more…