It was reported a couple of weeks ago that researchers had found a link between certain forms of assisted conception and an increased risk of birth defects.  The paper, published in the NEJM, suggested that ICSI (intra-cytoplasmic sperm injection) correlated with defets in just about 10% of births.  The base rate is about 5.8%, rising to around a 7.2% defect rate from IVF.

Does this tell us anything of any great moral import?

Several things spring to mind.  One is that, granted the claim that it’s better not to be born with a defect, it’s presumably also better for assisted reproduction not to elevate the risk of defects above the natural level.  There might even be an obligation to do more research into assisted reproduction, so that we can ensure the fewest possible birth defects (and maybe get better at generating healthy babies than nature: even a rate of 5.8% looks a bit slapdash).  Slightly more radically, some might claim that there ought to be a moratorium on certain assisted reproduction procedures – ISCI in particular – for the sake of minimising the number of birth defects.

Let’s deal with the radical claim first (what can be said about that will also speak to the less radical one). more…

Some very strange papers have just appeared in Bioethics regarding homeopathy.  Not so long ago, the journal published a paper by Kevin Smith that advanced the claim that homeopathy is not only ineffective, but ethically problematic.  The position taken was that homeopathy “ought to be actively rejected by healthcare professionals”, and that it is in fact ethically unacceptable, not least because of concerns about it reducing the likelihood that people would seek effective healthcare, and wasting resources.  The analysis is overtly utilitarian, but I don’t see any particular reason why a non-utilitarian theory wouldn’t come to essentially the same conclusions about using homeopathy, especially by public bodies.  (For example, there seems to be a reasonable justice-based claim that could be made on behalf of taxpayers, that it’s wrong to spend their money on stuff that lacks an evidence base: it should either be redirected to stuff that has evidence in its favour, or refunded.  This doesn’t have to be utilitarian in flavour.) 

But while I have no particular dispute with Smith’s paper, neither do I have any dispute with homeopaths getting a right to reply in the same journal.  They should have this right.  Papers could be wrong or need refining, and disinterested argument is a good way to correct errors.

Still: scientifically speaking, homeopaths have their work cut out.  And without the science, the ethics is going to be tricky. more…

Two slightly curious stories about drugs and sex.  Or, rather, two stories about drugs and sex curiously juxtaposed.

First, this story from Sunday’s Independent was inspired by this paper in The Journal of Sexual Medicine.  Quite how much weight we should put on the JSM‘s paper is a moot point – it’s a case study involving one person, rather than a full RTC – but I’m interested in the way that it was represented by the Indy:

Oxytocin, a hormone traditionally used to induce labour, is as sexually arousing to men as Viagra, according to new research.

Studies conducted in the US found that a married man who sniffed a nasal spray containing oxytocin twice daily became more affectionate to friends and colleagues and recorded a marked improvement in his sexual performance.  According to the actual breakdown of results, the man’s libido went from “weak to strong”, while arousal went from “difficult to easy”. Ego certainly wasn’t hurt either: sexual performance, according to feedback from his wife, was classed as “very satisfying”.

Let’s take it at face value, and ignore the leap from the experience of one man to all men, and the post hoc ergo propter hoc fallacy, and all the rest of it: a man who was apparently having some sex-related difficulties was helped by oxytocin.  Bravo for him. Hurrah.  Oxytocin for all!

Or maybe not. more…

BioNews asked me to write something about Matthew Liao, Anders Sandberg and Rebacca Roache’s paper on engineering humanity to minimise global warming.  I’d been meaning to for a while, so this was the prod I needed.  Anyway: my take on their paper is here; but I thought I’d also reproduce it on this blog.  What follows is the version I submitted; it’s substantially the same, save for a few tweaks that BioNews made to conform with their house style.  (They didn’t like the Latin…)  I am massively grateful to the student who made the point about small people taking more steps to get anywhere.  I’d also like to think that the idea of making people smaller led me to Lilliput, thence to Gulliver, thence to the voyage to Laputa.  It didn’t.  I’m not that clever.  Laputa made its appearance quite unbidden.  But – hey, it works.

 *     *     *     *     *

There’s a part of Gulliver’s Travels where Gulliver visits the grand Academy at Lagado, wherein one of the academicians is trying to derive sunbeams from cucumbers.  It’s tempting to wonder at first glance whether there’s something of the Academy to Liao, Sandberg and Roache’s proposed strategy for combating climate change: that we could engineer humanity to be less of a drain on the environment.  Their paper, “Human Engineering and Climate Change” (forthcoming in Ethics, Policy and the Environment, with a pre-publication version here), has already attracted a reasonable amount of media interest, and it’s not hard to see why.  The headline proposal is that we could engineer people to be smaller, on the grounds that smaller people require less food and fuel: a population that is smaller on the whole would have less environmental impact.  (A small part of this – and I’m genuinely fond of this idea – is that heavier people wear out shoes and carpets more quickly, so are more resource-hungry.  On the other hand, as one of my students has pointed out, short people take more steps to get across the room; the carpet might actually suffer more.  Moreover, a small person has a greater surface-to-volume ratio, and so would lose heat more quickly, possibly requiring more central heating and more food.) more…

The BMJ Group journals Sexually Transmitted Infections and Journal of Medical Ethics, in conjunction with academics at the Centre for Social Ethics and Policy (University of Manchester) and the Health Ethics and Law Network (University of Southampton), would like to publish a collection of articles on the criminalization of disease and sexually transmitted infections. We invite article contributions to be published as part of this themed collection.

Funding has also been sought from the ESRC for a seminar series on the same theme and, if successful, authors contributing to this collection may also be invited to present their papers at one of the seminars (which will take place in winter 2012/13 and summer 2013 in Southampton, and winter 2013/14 and summer 2014 in Manchester).

Themes

The use of criminal law to respond to infectious disease transmission has far-reaching implications for law, policy and practice. It presupposes co-operation between clinicians and criminal justice professionals, and that people who infect others can be effectively and fairly identified and brought to justice. There is a potentially difficult relationship between criminal justice and public health bodies, whose priorities do not necessarily coincide. We are interested in receiving papers of broad interest to an international readership of medical ethics scholars and practicing clinicians on any of the following topics:

·      Legislative and policy reform on disease and sexually transmitted infections

·      Health services and the police: privacy, state interference and human rights

·      Evidence and ethics: prosecuting ‘infectious’ personal behaviours

·      Clinicians and the courts: the role of health professionals and criminal justice

·      The aims of criminalization and public health: a compatibility problem?

·      International comparative studies on disease and criminalization: policy, practice and legal issues

More details below the fold. more…

Guest post by Dominic Wilkinson

(Cross-posted from Practical Ethics)

In a provocative article forthcoming in the Journal of Medical Ethics (one of a new series of feature articles in the journal) philosophers Walter Sinnott Armstrong and Franklin Miller ask ‘what makes killing wrong?’ Their simple and intuitively appealing answer is that killing is wrong because it strips an individual of all of their abilities – acting, moving, communicating, thinking and feeling.

So what, you might ask? If this is right, say Sinnot-Armstrong and Miller, it means that it would be just as bad to commit an act that caused someone to be in a permanent vegetative state, as it would to kill them. more…

Comment on “Bedside detection of awareness in the vegetative state: a cohort study” by Damian Cruse, Srivas Chennu, Camille Chatelle, Tristan A Bekinschtein, Davinia Fernández-Espejo, John D Pickard, Steven Laureys, Adrian M Owen

Published in The Lancet, online Nov 10.

Cruse and colleagues founds evidence of some kind of consciousness in 3 out of 16 patients diagnosed as being permanently unconscious. They used an EEG machine, capable of being deployed at the bedside. Is this good news?

This important scientific study raises more ethical questions than it answers.  People who are deeply unconscious don’t suffer.  But are these patients suffering?  How bad is their life?  Do they want to continue in that state?  If they could express a desire, should it be respected?

The important ethical question is not: are they conscious?  It is: in what way are they conscious?  Ethically, we need answers to that.  Life prolonging treatment has been and legally can be withdrawn from patients who are permanently unconsciousness.  We need guidelines for when life-prolonging treatment should be withdrawn in these minimally conscious states.  Paradoxically, it could be worse for some than being permanently unconscious.  And in countries like the Netherlands, we need guidelines on whether and when active euthanasia should be performed.  For some of these patients, consciousness could be the experience of a living hell. more…

Right now, physicists are pondering the fallout from the collision of high-energy particles.  (Probably.)  And I, for my part, am pondering the fallout from the collision of high-energy nonsense.

Having had this brought to my attention, I’m led fairly quickly to this, then this, and, finally, this Mail on Sunday piece.  All the links refer to a story in which a hospital is apparently using £200k or so of Lottery money to fund research into spiritual healing based on Reiki.  I’m willing to bet dollars to doughnuts that the research finds that spiritual “healing” is utterly ineffective, except when it means people don’t avail themselves of real medicine – in which case, it’s very effective and its effects are undesirable.  Spiritual healing is bunk; one could reasonably think that a trial into it is a waste of money.  We oughtn’t to waste money, so, modus ponens, we oughtn’t really to be doing this kind of research.

In fact, there’re likely to be big problems with spiritual healing research of any sort, simply because participants may feel that there’s less need to continue using established treatments, and thereby end up worse off.  And when others continue with conventional treatments, it’s going to be hard to tell which of their outcomes was attributable to which – so the research’ll likely tell us nothing.  Hence I wonder whether the research will yield anything publishable: if not, then the whole thing will have been in vain, and there’s something problematic about enrolling people in trials that stand a chance of being, from a publication point of view, barren.

I’m not actually going to go down that route here, though. more…

How much would I love to have been on the ethics committee that was faced with this?

Researchers at the University of Pennsylvania were interested in a method of treatment for leukaemia that made use of modified versions of white blood cells.  Cells were taken from leukaemia patients and genetically modified in two ways: first, they were adapted to target the cancer cells; second, they were adapted to reproduce like crazy.  This second modification is important, because attempts to make use of the first have hitherto fizzled out as the modified cells died off.  Or, in slightly more scientific language, the New England Journal of Medicine explains that

[f]irst-generation chimeric antigen receptors had limited clinical activity, primarily because in vivo activation of the chimeric antigen receptor T cells induced only transient cell division and suboptimal cytokine production, which failed to produce prolonged T-cell expansion and sustained antitumor effects. These deficiencies were overcome by the addition of a costimulatory signaling domain in second-generation chimeric antigen receptors, which enhanced the proliferation, survival, and development of memory cells — features that appeared to be the hallmarks of successful therapy with EBV-specific T cells and tumor-infiltrating lymphocytes.

And this approach, based on preliminary results, seems to be very promising, having exceeded expectations.  The paper reporting the experiment is available here.

But how do you get the modification into the cells to begin with?  The team

used HIV-derived lentiviral vectors for cancer therapy, an approach that may have some advantages over the use of retroviral vectors.

And that, of course, is where things get interesting. more…

There’s a slightly curious correspondence taking place in the BMJ at the moment that concerns assisted dying.  Des Spence started things moving with this short piece.  For the most part it is (sorry to say) a slightly pedestrian and simplistic overview of the state of the assisted dying debate.  One of the arguments against AD that he cites, for example, rests on the idea that it violates a doctor’s moral duty – which seems to me to be just the teeniest bit question-begging.  The rest of the anti- paragraph is a shopping list of the standards.  The next paragraph tells us that the pro-arguments are also strong, but he makes the mistake of claiming that it’s autonomy that does the work here.  It ain’t.  Not in respect of assistance.  I don’t violate your autonomy by not helping you to die.

So far, so workaday.  But a potentially interesting point is made next:

[A]ssisted dying is happening every day throughout the NHS. The doctrine of double effect means that doctors give large doses of morphine near the end of life. We know that this will hasten death, but we square this moral circle by accepting that we are relieving suffering. Doctors also widely withhold and withdraw treatment knowing that this will hasten death. Isn’t the reality that we are already actively engaged in assisted dying?

There’s an error here, too, I think: but it’s an interesting one.   more…