I didn’t pay much attention the Wakefield MMR paper when it first started generating controversy: I wasn’t bothered whether its conclusions were correct or not, because I figured that it’s in the nature of science for certain putative discoveries later to be debunked.  But the years passed, and as I paid a bit more attention, it began to be clear that there was more to the story than a disagreement about how to interpret data.  Over at Ministry of Truth, Unity provides a nice little account of just what was wrong not just with Wakefield’s research findings, but with the research wholesale: I won’t reproduce the litany of problems that have been raised, but it’s worth remembering that, notwithstanding GMC censure and the retraction of his paper, he’s still working at a clinic in Texas seemingly funded by anti-vaccination campaigners… which brings me nicely to this little gem, reported in last week’s New York Times, from Jim Moody.  Moody speaks on behalf of an organisation that promotes the supposed link between the MMR vaccination and autism, and he thinks that “the retraction would strengthen Dr. Wakefield’s credibility with many parents.” more…

Someone once told me that, if you want a paper to be heard by a large, fractious audience, make sure it’s about circumcision.  Peter Breibart considers it over at The Freethinker, and he’s not a happy bunny.

You may have heard that there are medical advantages for circumcision – and it is true that the American Academy of Pediatrics notes a 1 percent drop in urinary tract infections among circumcised boys. Women, however, are 30 times more likely to get UTIs than men, yet no-one in their right mind would suggest the cutting of the labia and clitoral hood in order to improve hygiene and reduce the risk of infection.

Shamefully, the World Health Organisation recommends circumcisions in areas badly affected by HIV, instead of recommending educating the public regarding the use of contraceptives. The idiocy is profound: mutilate a man’s penis instead of leaving it intact and educating him. Cut him instead of teaching him. I have no doubt that the widespread influence of the Catholic Church in AIDS-hit countries has affected the WHO’s decisions about the dodgy fixes they endorse regarding the HIV. We well know the Vatican teaches that condoms don’t prevent HIV (for the Holy See, AIDS might be bad, but condoms are worse.)

I’m not sure about the reliability of the medical facts that Breibart cites here, and there was a short piece on the practice in New Scientist a little while ago suggesting that it halves the risk of HIV infection, possibly because of the changes it forces to the bacterial fauna on the penis - though this isn’t a vindication of circumcision so much as a vindication of targeting antibiotics to alter the fauna.  Any thoughts?

UPDATE: Of course, the JME did a whole symposium on this topic a little while ago; Søren’s introductory editorial can be found here.

Not so long ago, I heard a research scientist talking about the work he was doing and its context in the discipline.  He was looking at a particular set of genes that were implicated in cancer, and was interested in manipulating those genes as a means of controlling tumor formation.  He wanted to work on zebrafish. more…

I know I keep stressing the distinction between ethics and activist - and how it’s usually just before I witter on about something vaguely activistic.  However, I do think it’s worth popping over to look at the 10:23 Campaign, which takes a robust and sceptical attitude to homeopathy.

If you’re not sure about why it’s worth making a fuss, I’d recommend having a look at Martin Robbins’ account of the evidence about homeopathy presented to the House of Commons Science and Technology Select Committee; having a look at xtaldave’s skewering of the “evidence” that homeopaths sometimes cite in their own favour; and having a look at what is probably the most remarkable of the lot: the details of UCLAN’s BSc in homeopathy as reviewed by UCL’s David Colquhoun, which is of particular interest from an ethicist’s point of view, referring as it does to to code of ethics of the Society of Homeopaths.

Have fun!  But don’t forget to dilute it…

UPDATE: Oh, all right.  Have some Tim Minchin, in what is probably the best jazz-poetry take-down of this nonsense you’re likely to see today.  Well worth ten minutes of your time.

One of the objections to the HPV vaccine was that it might encourage promiscuity, and so should not be administered.  There was a number of reasons why the objection failed. more…

This looks like it could be interesting…

Department of Philosophy, University of Bristol

This is an informal workshop on topics in the philosophy of medicine.

Everyone is welcome.

•09.45–11.00 Kevin Brosnan (Cambridge) “Does nothing in medicine make sense except in light of evolution?”
•11.15–12.30 Jeremy Howick (UCL) “Defining a role for mechanistic reasoning in EBM”
•13.30–14.45 Havi Carel (UWE) “Phenomenology and its application in clinical medicine”
•15.00–16.15 Alex Broadbent (Cambridge) “Inferring causation in epidemiology: mechanisms, black boxes, and contrasts”

The workshop will take place in the Common Room, Ground Floor, Department of Philosophy, 9 Woodland Road.

There is no need to register—it will be fine if you just turn up on the day. (If you do know that you are coming, it may be helpful to let us know, to ensure that we have a large enough room.) If you have any questions, please contact Alexander.Bird {AT} bristol.ac.uk.

Stem cells have been in the news rather a lot lately.  President Obama has, it’s currently being widely reported, lifted Dubya’s restrictions on human embryonic stem-cell research, much to the chagrin of some, and the delight of others.  (Interestingly enough, among the worriers we find a surprisingly large number of British commentators who point out that scientists might be tempted to head back to the US to do their research after having come here in the past few years.)

The other hESC story of late has been the “breakthrough” that allows the “ethical” production of stem cells - that is, stem cells without the “embryonic” bit.

I ought no longer to be dissapointed by the flippant use of the word “ethical” in this sort of story - as if hESC researchers have been utterly devoid of any moral support for what they’ve been doing (because clearly finding cures for diseases has nothing in its defence…) - but, well, ho-hum.  Let’s allow for the sake of the argument that the word “unethical” means something substantial, and that hESC research is in some sense unethical.

Would that mean that new methods that allow us to reprogramme cells and thereby avoid hESC research is in some sense (again, allowing that the predicate is meaningful) “ethical”?  Not necessarily.  I’m reminded here of a paper given at the IAB conference in September by Katrien Devolder, which is currently in reviewerland, in which the point was made that foresaking hESCs now still implies complicity in past hESC research, since the technology relies on hESC research.  (I’ll leave aside debates about the scientific advantages of one technique compared to the other.)  So if you’re worried about dirty hands, you ought to be worried about the new technologies.  That is to say: if hESC research is morally tainted, then so is research into induced pluripoent stem-cells or other such technologies, since iPSCs are only possible thanks to hESC research.

For those who want the benefits of stem-cell research, but who would prefer minimal loss of embryonic life - and that group ought really to cover everyone who doesn’t have a pathological hatred of embryos, I suppose - then the way forward seems to be at most to accept iPSCs with a rueful smile.  But if we’re prepared to do that, then why not cut to the chase and embrace hESC research?

Some of you may be aware that the National Research Ethics Service has been trialling a Fast-Track system for dealling rapidly with applications that present “no material ethical issues”. They have recently published a report on this trial which can be found here: Developing NRES.

more…

Here’s a handful of moral statements that, I guess, many people would take to be trivially true: We ought to save lives where possible; Saving more lives is better than saving fewer; It is a good thing to save lives as efficiently as possible; Saving lives is more important than improving tolerable lives.  Nothing too controversial there, I don’t expect.  (OK - there may be rough edges, but this is a blog, not a peer-reviewed paper, dammit…)

I mention these because I’ve just been reading Rose George’s The Big Necessity: Adventures in the World of Human Waste.  It’s as much of an eye-opener as it as a nose-closer.  Take this, for example, from the introduction:

2.6 billion people don’t have sanitation [...] Four in ten people have no access to any latrine, toilet, bucket or box.  Nothing.  Instead, they defecate by train tracks and in forests.  The do it in plastic bags and fling them through the air in narrow slum alleyways.  If they are women, they get up at 4 a.m. to be able to do their business under cover of darkness for reasons of modesty, risking rape and snakebites  Four in ten people live in situations where they are surrounded by human excrement, because it is in the bushes outside the village, or in their city yards, left by children outside the back door.  it is tramped back in on their feet, carried on fingers onto clothes, food and drinking water

The disease toll of this is stunning.  A gram of faeces can contain 10 million viruses, 1 million bacteria, 1000 parasite cysts, and 100 worm eggs. [...] Poor sanitation, bad hygiene and unsafe water - usually unsafe because it has faecal particles in it - cause one in ten of the world’s illnesses.  Children suffer most.  Diarrhoea [...] kills a child every fifteen seconds. [...] Public health professionals talk about water-related diseases, but that is a euphemism for the truth.  These are shit-related diseases.

Now go back to the moral claims with which I started this post.  If you think that they’re at least in the vicinity of correct, then it seems that there would be some hard questions to answer about our health priorities. more…

It would appear that games like Tetris may help in the treatment of PTSD - there’s apparently a six-hour period in which traumatic memories become consolidated, so something like Tetris, in effect, allows the brain to be distracted for a time, thus reducing the consolidation.  Hence

[p]laying “Tetris” after viewing traumatic material reduces unwanted, involuntary memory flashbacks to that traumatic film, leaving deliberate memory recall of the event intact.

There’s a bit more on this via the BBC.  And, reliably, posters to the b3ta community have been quick off the block doing intelligent and witty stuff with the story.  This one is by Bela Lugosi’s Dad.