There’s an essay by Diego Gracia called “Palliative Care and the Historical Background” that I frequently use in classes about Care ethics, and there’s a passage in it that always gets a fascinating reaction from students.  In this passage, Gracia claims that

the true goal of medicine has always been curing, rather than taking care of the patient. Caring has never been the goal of medicine.

In fact, in the context of palliative care, he takes this one step further:

Thus, if the type of care specific to medicine is curing, then palliative care has nothing to do with medicine…

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In the replies to this thread, The Witch Doctor asks this:

A Scenario:

Apparently there are some sites on the web just now claiming that the world is going to end in 2012. Some teenagers are becoming agitated.

I don’t want to be around when the world ends, so I’m going to drink some poison and present to my local A and E department on Halloween 2011. If conscious I will refuse treatment but ask to be kept pain free and as comfortable as possible while I make a “dignified exit” anticipating the end of the world.

I will also carry an AD in case I become unconscious before arriving at A and E.

If conscious, I will be assumed to be competent until proven otherwise. I will pass the competency test. I do not have a mental health problem. I have just been spending too much time surfing the web.

Should the medical staff allow me to die when the time comes and if not, why not?

It’s a good question - though I’d rephrase it slightly to “if so, why; and if not, why not?” at the end.

I’m curious to know what the readership here thinks.  Since I’ve posted my reply in the old thread, I’ll keep out of it as much as possible.

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…

Doubtless many of you will have heard by now of Kerrie Wooltorton, who, apparently depressed by her fertility problems, drank anti-freeze, called an ambulance, and handed a living will to staff at A&E. Her story is reported by the Telegraph under the headline “Suicide woman allowed to die because doctors feared saving her would be assault” more…

I’m going a bit off-topic with this, I think, but John Coggon’s reply to today’s earlier post has got me thinking.  His reply pointed out that

[i]t might be worth noting that Article 9 of the European Convention on Human Rights (presumably the key right under issue) states:

“Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief, in worship, teaching, practice and observance.”

This has got me thinking about the nature of that supposed right. more…

It wasn’t until I was eight that I first got glasses. This wasn’t because I wasn’t short sighted before then, rather the contrary I was very short sighted I just hadn’t noticed. I thought trees were just blurry green blobs at a distance, I sat at the front of the classroom so I could read the board, I thought the other students just didn’t want to be able to read the black board… In other words I had just adjusted to my condition, such that I didn’t notice it. Getting glasses was a revelation suddenly the world was clear.

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The New Scientist this week is running a series of short articles on how to make the world a better place. One of the suggestions is to legalise drugs – I’ve blogged about why this is a good idea before (and Ben Goldacre has a nice account of why we haven’t done it already). Another is to learn to love genetic engineering – and again, I’m all for that.

But one of the suggestions is that the police should have access to a universal DNA database - and this is not something for which I’m cheering. more…

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…

There’s a short piece in the latest JME about the use of social networking sites by medics that’s got me thinking.  In it, Guseh, Brendel and Brendel suggest that physicians need to be especially careful about accepting, say, a Facebook friend request from patients because of the nature of social networking sites and the possibility that normal privacy rules may be violated.  (For the rest of this post, I’ll talk mainly about Facebook, but that’s just for convenience.  The points will stand in relation to any social networking site.)

I can see something of the motivation for the worry here, but I’m not sure I share it.  The reason for this is that I have yet to be convinced that the online world presents us with any new problems: all it does is re-manifest old ones.  For that reason, there’s nothing about which we need to get all that excited.  Nor is there anything special about physicians, as opposed to anyone else, on FB.

Let’s start with the first area of dispute: is there anything special about online social networking?  more…