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In the News

Medical Information for Sale?

21 Jan, 14 | by Iain Brassington

Reader Keith emailed me a week or so ago to tip me off about the government’s plans to allow private firms to access medical information.  It’s a story that has subsequently been picked up by  – inter alia – The Guardian.

As with the last post I made here, I’m going to have to cry off from saying much in my own right – I’ve got lectures that need to be written, and I need at least to go through the motions of being competent – but I would draw your attention the Christian Munthe’s take on the matter.

Touch wood, I’ll be able to get back to more frequent blogging soon.

Sex-Selection and Abortion: Is there a Problem?

17 Jan, 14 | by Iain Brassington

This is just a quick post, and it’s mainly to draw your attention to a couple of other posts worth reading elsewhere.

A little background: there’s been a minor fuss* in the media over the last few days concerning sex-specific abortion**, after The Independent reported that

[t]he practice of sex-selective abortion is now so commonplace that it has affected the natural 50:50 balance of boys to girls within some immigrant groups and has led to the “disappearance” of between 1,400 and 4,700 females from the national census records of England and Wales, we can reveal.

Now, there’s something a bit fishy about the article even on its own terms: alarm bells should be got ringing by this:

[O]ur deeper statistical analysis of data from the 2011 National Census has shown widespread discrepancies in the sex ratio of children in some immigrant families, which can only be easily explained by women choosing to abort female foetuses in the hope of becoming quickly pregnant again with a boy.

After all, it does seem to reduce to a claim along the lines that “I can’t think of a better explanation than e for phenomenon p, therefore e obtains” – but that tells us far more about the limits of the speaker’s imagination than about the state of the world.  Besides, while there are good reasons to favour the most simple explanation of p, one ought to keep a distinction between the simple and the simplistic.  Bluntly, an easy explanation isn’t any more likely to be true by dint of being easy.  E=mc2 is simple once you’ve derived it, but its derivation isn’t easy.

But how reliable is the Indy‘s analysis anyway?  I’ve not gone through the data myself, but Unity has, and has a couple of really good posts: the first is here, and the followup is here.

They’re very worth the read – but I recommend that you make yourself a good cup of tea before starting them.  They’re looooooong.  I’d be interested to know what others think, though.

 

UPDATE: There’s even more.  I think Unity’s enjoying himself with this.

 

* Minor in the sense that it’s been eclipsed by things like Oscar nominations.

** Here’s Christina Odone, for example, blaming it all on feminism.  Surprised?  You could knock me down with a bulldozer.

Identity and IVF

11 Jan, 14 | by Iain Brassington

It’s good to see that Stephen Latham is blogging again after a short hiatus; and he’s come back with a really thought-provoking post on IVF and problems of identity.

The background is this: apparently, there is evidence that children conceived by IVF are at an elevated risk of health problems compared to kids conceived naturally:

Compared to spontaneously-conceived singletons, singletons from assisted conception were almost twice as likely to be stillborn, more than twice as likely to be pre-term, almost three times as likely to have very low birth weight, and twice as likely to die within the first four weeks after birth. Outcomes varied by type of assisted conception. Very low and low birth weight, very preterm and preterm birth, and neonatal death were “markedly” more common in births from IVF and, to a lesser degree, in births from ICSI. Use of frozen embryos elminated the risks of ICSI, but not of IVF. But frozen embryos also had increased risk of macrosomia.

This is the paper that Stephen mentions; but it’s not the only one to report potential risks associated with IVF.  A rather kneejerk response to this is to go “Eeeep!  This means that IVF is dangerous, and we’re harming kids by conceiving them by this method”.  (I suspect that there’s an element of that in posts like this – though admittedly if that element is there, it’s being deployed merely as a part of a wider attack on IVF, motivated for different reasons.)  But, of course, kneejerk reactions are rarely all that morally insightful, and the conventional response to concerns about IVF is rather more sanguine.

Borrowing heavily from Parfit, the standard response is this: each of us is reliant on a particular egg and a particular sperm having fused in a particular way.  Had that been different, we would not have come into being.  A month later, and it’d’ve been a different egg; and it could easily have been a different sperm cell.  Any resultant child would be related to us only in the same way as a sibling – except that it wouldn’t be our sibling, because we wouldn’t be there.  This indicates that, if IVF represents a child’s only chance of coming into existence – and it probably is – it is hard to say that the child has been harmed or wronged thereby.  There may be a qualification to add, along the lines that should the child’s life be so bad that non-existence would be preferable, existence may be a harm; but that kind of outcome is probably hyperbolic in practice.  An elevated risk of any congenital characteristic is therefore unlikely to count as a harm.

So, as Stephen points out, we can ask a question: more…

Welcome to Britain.

30 Dec, 13 | by Iain Brassington

It having been a long time since my last post, and this being the season of good-will, I wasn’t going to comment on the government’s new policy of charging migrants for A&E services.  Noone needs that kind of spleen on a dreich Monday; besides: I’ve got a PhD thesis that needs assessing, and a bathroom floor that I’ve been meaning to re-lay all year – all manner of better uses of my time.

Still, there’s a couple of things that merit comment.  First, there’s this, from the Government’s press-release:

We know that some people are abusing the system by coming into the country early enough to have one or more antenatal appointments before giving birth on the NHS – without the intention to pay.

I love a good vague statistic.  “Some” people.  There’s nothing offered about how many that amounts to.  Presumably, it’s more than one, but fewer than everyone.  Beyond that, though… well…  The phrase “some” just isn’t very useful when it comes to making judgements about anything – as waitresses (and diners) can attest.  But still, I’m willing to concede that “some” indicates a positive integer, and that there is therefore some measurable impact on expenditure arising from such people.  This doesn’t tell us whether it’s expenditure at a level that should bother us.  The DoH press release offers some illumination on this point: more…

Some stories, if true,

2 Dec, 13 | by Iain Brassington

just don’t need additional comment:

The Italian woman was sedated and her baby delivered against her will, after Essex social services obtained a court order in August 2012 for the birth “to be enforced by way of caesarean section”.

[...]

After the C-section, the woman, who has two other children and is divorced, was sent back to Italy without her daughter. She returned to Britain in February to request the return of her daughter, who is now 15 months old, but was told at Chelmsford Crown Court that she was to be put up for adoption in case her mother suffered a relapse.

UPDATE: Essex CC has a statement here.  Thanks to Nathan Emmerich for the pointer via twitter.

UPDATE 2: There’s a really good analysis at Pink Tape.

UPDATE 3: The judgement about adoption.

UPDATE 4: And the judgement about the caesarian.

Genes and Confidentiality: Tricky!*

22 Nov, 13 | by Iain Brassington

A couple of weeks ago, the D–ly M–l** asked me to comment on the Personal Genome Project‘s call for 100 000 volunteers who’d be willing to have their DNA sequenced so that it could be correlated with their health records and used as a tool for research.  As it happens, my peals of wisdom never made it into print, but here’s an expanded version of the things I said.

First up, this project is superficially similar to that undertaken by the UK Biobank.  The idea behind both is that, since many illnesses have a genetic component to them, understanding those illnesses fully will require doing genetic research.  Sometimes that will be on cells in a lab; sometimes it’ll be population surveys.  Often, the idea will be to learn as much as we can about individuals’ genomes, and then to keep track of their health over a prolonged period.  If, across the population, we notice a correlation between a given gene and a given illness, the hope would be that we could work out more effective treatments.  Insofar as participating in this project might help with research into things like cancer, it’s tempting to think that it’s admirable – some even argue that participation in medical research is a moral duty (though others disagree: to and fro and to and fro***; cf this and this and this).

However, there are also moral problems to consider. more…

Drug Legalisation in Uruguay: Opening up Pandora’s Box

8 Aug, 13 | by BMJ

Guest post by Melissa Bone, University of Manchester

Uruguay is poised to become the first country in the world to legalise and regulate the sale of cannabis for recreational use.  On the 31st July 2013 a draft bill legalising cannabis was passed by members of Uruguay’s lower house of congress, where 50 out of a possible 96 MPs voted in its favour.  If approved by the senate as is expected then the government will legally control the production, distribution and sale of cannabis.  The bill allows for each Uruguayan household to cultivate up to 6 cannabis plants.  Alternatively, residents could join a co-operative which would be licensed to grow up to 99 plants.  Private firms will be able to produce cannabis as well, but they will be required to sell it to the government, who will in turn sell it to consumers through pharmacies.  Only Uruguayan citizens will be able to purchase cannabis; they can purchase up to 40g per month (minors will be excluded).  Driving while under the influence will remain a crime.

Many commentators recognise that Uruguay has taken this bold step due to the devastation that’s wreaked by the so-called “war on drugs”.  This phrase was first coined by President Nixon in1971, and it is widely employed on both sides of the drug legalisation debate to describe a global position that prohibits the possession, production, and sale of certain psychoactives, all of which are listed in the UN drug conventions.  Advocates of drug reform often use the phrase to expose the aggressive and militant tactics which are used in producer countries especially, in an attempt to restrict the production and trade of illicit substances.  For instance, the Latin American region has the highest murder and drug-related violence rates in the world, drug cartels have infiltrated and corroded various positions of power, infamous aerial fumigation operations have destroyed farmer’s livelihoods, and this along with numerous other human rights abuses provides the backdrop for Uruguay’s brave decision.

Predictably, the International Narcotics Control Board (INCB), a committee tasked with ensuring compliance to the UN drug conventions, doesn’t quite see it this way. more…

Emmerich on Fitness to Practise

30 Jul, 13 | by Iain Brassington

Having asked out loud whether anyone could explain a couple of odd FtP decisions, I got this from Nathan Emmerich, offering sociological pop at an answer… 

Iain wondered if anyone could explain the morality that underlies a couple of recent Fitness to Practise decisions made by the GMC.  Well, more accurately he wondered if anyone could explain the “public perception” or “public confidence” aspect of the GMC’s Fitness to Practice guidelines.  Never one to shirk a challenge, I thought I would give it a go…

The first thing to note is that one has to change, or perhaps expand, the terms of the debate.  As a discipline applied philosophical bioethics tends to focus on “ethics”, “ethical reasoning” and codified rules over what I (and some others) would call “morality”.  For our present purposes the starkest way to express the idea is by appeal to the historical morality of the UK medical profession, which used to be based on the idea of the British gentleman of a certain class and standing (and, obviously, race and gender).

This morality was uncodified – it had no explicit ethics.  Indeed, more than this, it was held to be uncodifiable both in principle and as a matter of morality.  It was thought it would be wrong to codify gentlemanly (medical) morality as to do so would open the way to, first, individuals who merely followed rules rather than being the correct sort of persons or having the right character.  Second, it would lead to people who did not have the right character or standing attempting to second-guess the decisions of medical professionals or gentlemen.  Such a thing was, of course, intolerable.

There is no denying that there was a lot wrong with this ‘moral culture’, and a range of factors has been influential in the modification of medical morality from this historical position to the one we have today.  However, “medical morality” has vanished completely, indeed, it is impossible for it to do so: the medical profession (indeed any profession or cultural group) has some underlying moral ethos.  Some cultures, like modern medicine, may also have explicitly stated ethical codes and guidelines that may be more or less in line with the underlying moral culture.  Nevertheless the moral culture itself is not obviated by these codes.  Indeed it underpins the existence and application of any such formally stated ethics.

The problem here is that no rule contains the principles of for its own application.   more…

Fitness to Practise Revisited

26 Jul, 13 | by Iain Brassington

***UPDATE: Important codicil at the end***

Back in March, I posted something about what I took to be a slightly odd Fitness to Practise decision by the GMC in respect of one Mohammed Al-Byati.  Via the BMJ, here’s another case that seems a bit strange:

A doctor who abducted her six year old daughter from her estranged husband nearly two years ago and took her to Pakistan has been struck off by a panel of the Medical Practitioners Tribunal Service (MPTS).

[...]

The MPTS panel, sitting in Manchester, acknowledged that Dar’s conduct did not relate to her medical practice.  But panel chairman Michael Whitehouse said that misconduct could also involve conduct “of a morally culpable or otherwise disgraceful kind,” which could prejudice the reputation of the profession.

The emphasis is mine, though it’s the stuff about the “reputation of the profession” that intrigues me.  If Dar has breached a court order, or is a kidnapping suspect, then fine – but that’s a matter for the courts.  She perhaps wouldn’t be able to practice if found guilty and imprisoned, but that’s a different matter.  It’s not obviously the GMC’s business.

Now, sometimes a profession might have an interest in disciplining people who misuse their association with it.  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.

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