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Curios

Who’s the SilLIer?

30 Mar, 14 | by Iain Brassington

It’s funny how things come together sometimes.  A few months ago, I mentioned a slightly strange JAMA paper that suggested that non-compliance with treatment regimes should be treated as a treatable condition in its own right.  The subtext there was fairly clear: that there’s potential scope for what we might term “psychiatric mission-creep”, whereby behaviour gets seen as pathological just if it’s undesirable and can be changed with drugs.  I was reminded of this by a couple of things I found last weekend.

I was avoiding work by pootling away on the internet, and stumbled across a couple of things.  This - an article about American politics that notes the use of psychiatry as a means of social control – was one of them:

[In 1980] an increasingly authoritarian American Psychiatric Association added to their diagnostic bible (then the DSM-III) disruptive mental disorders for children and teenagers such as the increasingly popular “oppositional defiant disorder” (ODD). The official symptoms of ODD include “often actively defies or refuses to comply with adult requests or rules,” “often argues with adults,” and “often deliberately does things to annoy other people.”

Many of America’s greatest activists including Saul Alinsky [...] would today certainly be diagnosed with ODD and other disruptive disorders. Recalling his childhood, Alinsky said, “I never thought of walking on the grass until I saw a sign saying ‘Keep off the grass.’ Then I would stomp all over it.” Heavily tranquilizing antipsychotic drugs (e.g. Zyprexa and Risperdal) are now the highest grossing class of medication in the United States ($16 billion in 2010); a major reason for this, according to the Journal of the American Medical Association in 2010, is that many children receiving antipsychotic drugs have nonpsychotic diagnoses such as ODD or some other disruptive disorder (this especially true of Medicaid-covered pediatric patients).

For some reason, I had foxes on my mind as well, and so I entered the word “Fox” into google; and I should have known that it’d provide lots of hits for the US TV conglomerate.  One story that came up on the search had to do with a twitter account called @LIPartyStories.  This was apparently a feed that would repost pictures sent from its teenage followers of themselves in various states of intoxication and déshabillé.  So far, so straightforward: the day that teenagers stop getting drunk and doing stupid things at parties is the day that the world will stop turning.  Granted, when I was young, we didn’t post stuff online – but if the internet had been around, we probably would have.  Kids do daft stuff; they sometimes regret it; then they grow up, and do daft stuff less.

Keith Albow, a Fox pundit, doesn’t see it quite like that: more…

So THAT’s where I’ve been going wrong…

7 Nov, 13 | by Iain Brassington

Blogging here has been a little sparse for the last few months; I’d like to be able to blame it all on the pressures of work, but this post suggests that it might be otherwise: some combination of not getting up at the crack of dawn, and not smoking, seems to be a factor:

Apparently, Kant had formulated the maxim for himself that he would smoke only one pipe, but it is reported that the bowls of his pipes increased considerably in size as the years went on.

Nietzsche was fond of tea and long walks, which is just another reason to like him.  I’m going to try using that as a reason not to go to meetings: “Sorry: optimal REF performance demands that I go to the edge of a glacier”.  Bound to work, that.

(Via @PsychEthics and @SynFutures on twitter – with some potential irony, given the damage that the internet has done to productivity…)

Under-Treatment, Treated.

29 Aug, 13 | by Iain Brassington

Right: file this paper from the JAMA under “Properly Odd”.  It’s a proposal that nonadherence to a treatment regime be classed as a treatable medical condition in its own right.

No, really.  Look at the title: “Medication Nonadherence: A Diagnosable and Treatable Medical Condition”.

Starting from the fairly straightforward premise that non-adherence to treatment regimes is “a common and costly problem”, Marcum et al move at the end of their opening paragraph to have medication nonadherence recognised “as a diagnosable and treatable medical condition”.  The authors allow that, as a precursor to treatment, there must be an accurate diagnosis.  However,

for undetected and under-treated conditions such as medication nonadherence, one way to identify the population of interest is to conduct screening. The 1968 World Health Organization principles on screening tests have clear application to medication non-adherence. For example, the condition is an important problem, there are suitable tests available, and there are acceptable treatments for those with this problem.

Well, OK; but it hasn’t yet been shown that nonadherence is a condition, and so it’s too early to say that it’s a condition for which tests and treatments are available.  It shouldn’t be hard to see what’s gone wrong here: the fact that treatable medical conditions are serious problems that are (or could in principle be) reversible doesn’t entitle us to say that any serious problem that is (or could be) reversible is a treatable medical condition.  The authors appear to have got things – to use the vernacular – arse about tit.

So is there any evidence offered in the paper for non-adherence being a medical condition in its own right?  The paper is short, but even so, it’s not something I want to reproduce here; all the same, there’s nothing that leaps out.  The main planks of the argument are simply that it’s a problem, that it’s a problem that has something to do with health, and that it’s therefore a health problem properly understood.

The authors continue:

Using previously established methods and instruments, screening to diagnose medication nonadherence among adults across care settings should be routine. A number of screening tools or instruments are currently available to determine the underlying behavior(s) of interest.  This approach illustrates how clinicians and researchers can begin conceptualizing the diagnosis and treatment of medication nonadherence.  [...] Also, given the proposal to routinely screen for medication non-adherence in adults, the next step is to match the identified barriers to a proven treatment for the condition.

Well – if I can interrupt for a moment – they can begin diagnosis and treatment of the condition so long as the condition is actually a thing.  Which it isn’t.

I have a horrible feeling that I know what’s going on here; there’s a couple of telltale signs:

Inclusion of medication adherence data in the electronic health record will allow for sharing among health care professionals and insurers, establishing trends over time as well as benchmarking for quality improvement purposes. Moreover, it is paramount that patient-reported medication adherence information (eg, medication beliefs and values) is incorporated into such documentation.

And this makes me think that it’s got something to do with the role of private insurance in the US medical system.  If you can get non-aherence accepted as a condition, then it’s something that insurers’d have to cover, which would mean…

Eh?

… Actually, no.  I’ve no idea.  I mean, it wouldn’t actually make it a condition.  You can’t just define a condition into existence because it’d suit some purpose.

In the current health care climate, there is a strong demand for improving the quality of care delivered, including medication adherence.

Hmm.  That’s not really helping.

 

How Magic can help Teach Students about Medical Ethics

24 Aug, 13 | by Iain Brassington

Guest post by Daniel Sokol, KCL

For some time, I have been interested in the relationship between magic and medical ethics.  Five years ago, I gave a talk in Prague on how to use magic in medical ethics education.  More recently, I held a workshop on Magic for Anaesthetists, which touched on ethical issues in anaesthesia.  My latest ‘guest’ lecture is entitled Magic, Medicine and Medical Ethics and examines the ways in which the work of professional magicians can shed light on the art and ethics of medicine.

This blog is for those who teach medical ethics.  It explains how a magical effect can help convey ideas in a memorable and thought-provoking way.  I am grateful to Gerry Griffin, a fantastic card magician from the United States, for permission to use one of his effects.  I respectfully ask readers to keep the secret to themselves.

more…

Not in any Way Topical.

22 Jul, 13 | by Iain Brassington

I know, I know.  I keep banging on about the irrelevance of genetics when it comes to families – about why parenthood isn’t a genetic thing.  But, actually, now I think about it – Duchess of Cambridge blah blah baby blah… I wonder what, if any, constitutional implications there’d be if the heir to the throne were infertile and adopted?

Yeah, I know that it’s doubtless happened before without anyone knowing – but just suppose that the new third in line to the throne were, say, an adopted Cambodian orphan instead of a (close) genetic relation to William and Kate.  I can’t think of any moral objection to that being a barrier to succession.  A child raised in those circumstances would, I think, have just as much right to ascend as would a child related by blood; there’s no reason to suppose that he or she wouldn’t be a part of the family in the fullest sense.

Unless, of course, we think that the word “family” in “Royal family” doesn’t mean quite the same as the word “family” in other contexts.  But then, what would it mean?  Why would genes be important in this circumstance?

And just suppose that the people of late mediaeval and early modern England had had the same obsessions about genes.  That’s something that’s been keeping the Abstruse Goose awake.

AG

Readably big version here.

UPDATE: OK, that’s odd.  The site on which the cartoon appears is currently listed as a virus threat.  I have no idea why.

UPDATE 2: Hmmm.  Seems to work on my home computer.  It might just be the UoM servers being twitchy, then.  Oh, I don’t know.

Winston Churchill and the Spirochaetes

29 May, 13 | by Iain Brassington

Did you hear the programme about syphilis on Radio 3 on Sunday?  If not, you can catch up on it here – and I’d thoroughly recommend doing so: it was superb.

One bit in particular caught my attention; it had to do with the use of penicillin to treat the illness during World War II.  (It’s from about 38:40 on the iplayer version.)  Astonishingly, in 1942, more men were out of action in North Africa because of syphilis than because of battlefield wounds.  Obviously, penicillin would be of immense help to both groups; but the problem was that there was not enough of the drug to meet both demands.  Giving it to the wounded obviously had some moral gravity… but so did giving it to the syphilitic: after all, they’d be cured and battle-ready very quickly, whereas the wounded might never be battle-ready again.

You can doubtless see why this might be problematic: more…

A bit more on Circumcision

28 Mar, 13 | by Iain Brassington

Maybe he should have been invited to contribute to the special edition: Somegreybloke seems to have the debate wrapped up perfectly…

Italian Pop Music’s Role in Bioethical Debate

12 Feb, 13 | by Iain Brassington

Sadly, the list entitled “Great Moments in Italian Pop” is short; but the entry that must surely be at the top is probably very near the top of the list entitled “Great Moments in All Pop”.  It’s a 1972 song by Adriano Celentano.

Prisencolinensinainciusol.

It’s pure gibberish – a parody of what anglophone pop sounds like to people who don’t speak English.

I mention it here for a couple of reasons.  The first is that it’s great.  The second is that it’s a nice way of talking about people who appear to be going through the motions of thinking about ethical matters, but who just get it wrong, and are actually talking gibberish.

Via Dominic Wilkinson, this gem from BioEdge is a lovely example of bioethical prisencolinensinainciusol.  On the face of it, it’s a plea for consistency when it comes to policymaking.

[I]n the Australian state of Queensland [...], the police union has argued that pregnant women who abuse alcohol should be forced to live in safe houses. “Those [unborn] children also deserve a right to full life and health and should not be disadvantaged simply because of the actions or inaction of their birth mother,” said Union president Ian Leavers.

Obviously this is a controversial issue, but I can’t understand how one can both defend access to legal abortion and lock up women who might harm their children.

The link provided is to The Australian, which is behind a paywall, so not something I can access.  However, News.com.au carries the story, too, reporting Union president Levers to have said that the state should be able to intervene in cases where children are at risk of foetal alcohol syndrome and drug addictions.

“Those children also deserve the right to a full life and health and should not be disadvantaged simply because of the actions or inaction of their birth mother.  The state must have the ability to intervene and protect the unborn child when its mother refuses, or is incapable or unwilling to do so.”

Mr Leavers said tougher laws would complement the criminal code, which provides for a charge of killing an unborn child or grievous bodily harm for any person who violently kills or harms an unborn child.

This is a bit odd, all told.  I mean: it might be easy enough to agree that pregnant women probably ought to reduce, or even eliminate, certain behaviours.  But the idea that that might be a matter for the law is very strange indeed.  What would the sanction be?  Is the idea that it’d be better for pregnant women to be in prison?  Fined?  And what about the plausible claim that alcohol or drug abuse is itself a health problem?  Or the distinct possibility that women who do drink or use drugs are much less likely to seek any medical advice at all during their pregnancy if they think that the state might punish them for their behaviour, thereby making a suboptimal situation even worse?  Legal intervention of the sort indicated would be both cack-handed and unjust.

But what about BioEdge‘s plea for consistency?  From what I can see, there’s a fairly obvious set of rejoinders.  First, the police union can say what it likes about what the law should be, but the role of the police is to enforce the law as it stands.  So not interfering with a woman’s legal right to abortion is not the same as defending it.  Likewise, mooting the idea that women might be sanctioned for risking the health of the foetus is not the same as locking women up.  BioEdge seems to have got the difference between voicing an idea, and enforcing a policy, utterly the wrong way around.  BioEdge‘s writer makes it sound like a moral argument is being made; but, really, it isn’t.  Second, that it’s odd to defend abortion but advocate sanctions against risky behaviour in pregnant women may be true – I mean, it’s not a crazy suggestion – but it doesn’t follow from that that one ought to change one’s mind about abortion (which is, I think, given BioEdge‘s commitments generally, what the implication is): all else being equal, and given a whole truckload of secondary arguments about the moral status of the foetus and the moral status of the mother, it’s at least prima facie more likely that it’s the risky behaviour claim that’s off.  Third, that the representative of a policing union has made a statement about what the law should be is in no way an indication that that statement should be taken seriously.

Come on, BioEdge.  Fair play to you: you look like you’re doing the job… but… Prisencolinensinainciusol.

Maybe there’ll be richer pickings from the other story behind the link.  In Tasmania,

the premier and deputy premier have released a long report on legalised euthanasia. They insist that there is no “sound evidence” of potential elder abuse. However, rates of child abuse are nearly 60% higher there than in other Australian states. Isn’t that a bit inconsistent? The kind of people who abuse children probably won’t mind abusing grannies.

Ummm… wait a sec: What?

Gay Conversion “Therapy”: Might the CMF have a point?

5 Feb, 13 | by Iain Brassington

Spoiler alert: Almost certainly not.  But hear me out for a bit.

The Christian Medical Fellowship blog had an article posted yesterday about what it praised as a balanced documentary concerning “sexual orientation change efforts” – gay conversion therapy to you and me – on Radio 4 on Sunday.  Actually, it wasn’t a documentary – it was a short article on Sunday, the station’s religious-affairs-quota-filling hour (go to about 30:50 here), and it’s no more a documentary than is the sports bulletin - and the balance is “BBC balance”, which means giving equal airtime to the fireman and the fire.  But anyway, that’s not what struck me.

Neither am I particularly bothered for the sake of this post about whether or not psychotherapy can make any difference to sexual orientation.  I’ll simply allow, for the sake of the argument, that it can at the very least make a difference to sexual behaviour, and maybe to orientation tout court.

What struck me was a couple of things that Peter Saunders says on his CMF blog post about the use of such “therapies”.  One of the striking things was this: more…

6 Dec, 12 | by Iain Brassington

via the Philosopher Shaming tumblr:

*narrows eyes*

 

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