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Thinking Aloud

Resurrectionism at Easter

23 Apr, 14 | by Iain Brassington

There’s a provocative piece in a recent New Scientist about what happens to unclaimed bodies after death – about, specifically, the practice of coopting them for research purposes.

Gareth Jones, who wrote it, points out that the practice has been going on for centuries – but that a consequence of the way it’s done is that it tends to be the poor and disenfranchised whose corpses are used:

[T]he probably unintended and unforeseen result [of most policies] was to make poverty the sole criterion for dissection. [... U]nclaimed bodies are still used in countries including South Africa, Nigeria, Bangladesh, Brazil and India. While their use is far less in North America, they continue to constitute the source of cadavers in around 20 per cent of medical schools in the US and Canada. In some states in the US, unclaimed bodies are passed to state anatomy boards.

For Jones, the practice of cooption ought to be stopped.  His main bone of contention is the lack of consent – it’s a problem that’s made more acute by the fact that the bodies of the disenfranchised are more likely to be unclaimed, but I take it that the basic concern would be there for all.

One question that we might want to ask right from the off is why informed consent is important. more…

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…

What should we Think about Belgium’s Child Euthanasia Law?

15 Feb, 14 | by Iain Brassington

With any luck, the nuts real-world work schedule of the past few months* will begin to ease in a few days, so I should be able to start blogging more frequently soon; but I thought I’d take a moment out from writing jurisprudence lectures to do some thinking out loud about Belgium’s recent change to its euthanasia law, which legalises it for children.  This is partly because it’s interesting in its own right, and partly because I’m debating it on Radio 4’s Sunday programme this week.  I’ve drafted this post before the interview’s recorded, but I’m not publishing it until after (though before the broadcast); let’s see how my thoughts here pan out on air…**

For reference, the text of the law is available here in French, and here in Dutch – thank goodness for A/S levels.  A decent précis provided by AP is hosted here; and Christian Munthe has an unofficial translation here.

OK: so, what should we think about it? more…

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…

From the File Marked “This Can’t End Well”

25 Nov, 13 | by Iain Brassington

… and cross-referenced with the file marked “You Wouldn’t Let It Lie”.

Francesca Minerva has a paper in Bioethics in which she refers – none-too-obliquely – to the furore surrounding The Paper Of Which We Do Not Speak.  Her central claim is that there is a threat to academic freedom posed by modern communications, inasmuch as that a paper in a journal can now attract to the author intimidation and threats.  A case in point would be The Paper.  But, she claims, it’s vital to the academic exercise that people be able to knock ideas around.  This ability is limited by things such as the response to The Paper; academic freedom is therefore threatened.

Yeah, but no.  I think it’s reasonable enough to say that academic progress depends on the free exchange of ideas, and that there should be no sacred cows.  Sometimes conventional ideas turn out to be untenable or flat-out wrong; and we tend to take it as axiomatic that it’s desirable to have fewer wrong ideas.  (I suppose we could imagine a culture that is satisfied with its opinions as they are, and is not bothered by their truth so much as by some other value they might have, such as their ability to promote social cohesion; but I’ll leave such cultures aside for the moment.)  I’d go along with the idea that we shouldn’t back away from controversial claims, on the basis that repugnance is no objection to the truth of a claim; that if a claim’s true, we should accept it as best we can, like it or not; and that if a claim is false, we shouldn’t have cause to fear its articulation, because we can take it that it won’t survive scrutiny.

And I’d agree that some of the responses to the paper – and to Julian’s defence of publication – were indefensible, and that this is so irrespective of the merits or demerits of the paper or the defence.  But not all of them were.  While some were from obvious dingbats and keyboard warriors (Jonolan remains even now the sole occupant of the banned commenters list here – and I rather suspect that he rather enjoys that honour), other responses were from people whom one might think wrong, but whose response was nonetheless worth taking seriously because it was much more considered and at least on the face of it amenable to argument – which is what academic discourse is all about.

Does any of this tell us about threats to academic freedom, though?  I don’t think so. more…

An Attack of the What-Ifs

25 Oct, 13 | by Iain Brassington

Among the comments to the last post, there’s this from Parmenion59:

So…if a cure for lung cancer is found, and the study has been funded through money from a tobacco company…the BMJ won’t publish said study?
Way to go BMJ.

Hmmm.  At least on the face of it, this looks like an important point – one that deserves a bit of unpacking.  We can begin by distinguishing between responses to this particular point, and responses to the general idea behind it.  First things first.

I’m willing to bite the bullet and admit without worrying too much that the policy of not accepting papers funded by the tobacco industry may mean that some research is not publicised.  There’s a small handful of reasons why I’m willing to do that.  One of them – admittedly the weakest of the lot – is based on the idea that it’s not wholly clear that much tobacco money really is directed at finding a cure for lung cancer, rather than firefighting other research about the detrimental properties of tobacco.  But that, as I say, is weak, based on suspicion rather than anything enormously substantial; and even if the hunch is correct, it’s merely empirical rather than anything conceptual.  Still, even if the hunch is wrong, it shouldn’t matter, because there’re stronger reasons.

One is based around the idea that there’s a special providence in the fall of a pipette – or, put another way, you can’t keep a good truth down.  If something is there to be discovered and is worth the effort, then it’ll be discovered sooner or later; if not by Smith, then by Jones.  And, because scientific progress is invariably a matter of the accretion of the work of several teams, all working independently and making minor discoveries, rather than one heroic person who would be solely responsible for The Cure For Cancer ™, the loss of one paper here and there probably won’t make all that much of a difference in the grand scheme of things. If that’s correct, then the idea that we might lose the cure for cancer is not all that compelling – not one about which we should worry too much.

A final reason is that, as I’ve said before elsewhere, I’m not persuaded that research is obligatory: it’s admirable, but not required by duty.  There’s a range of second-order arguments one might present here, but most relevant has to do with the benefits that research might generate.   more…

Smoking out Tobacco Industry-Supported Research

18 Oct, 13 | by Iain Brassington

BMJ Open, along with a couple of other journals, published a statement a couple of days ago saying that they’d no longer accept papers based on research wholly or partially funded by the tobacco industry.  The gloss on the statement is damning:

The tobacco industry, far from advancing knowledge, has used research to deliberately produce ignorance and to advance its ultimate goal of selling its deadly products while shoring up its damaged legitimacy.  We now know, from extensive research drawing on the tobacco industry’s own internal documents, that for decades the industry sought to create both scientific and popular ignorance or “doubt.”  At first this doubt related to the fact that smoking caused lung cancer; later, it related to the harmful effects of secondhand smoke on non-smokers and the true effects of using so called light or reduced tar cigarettes on smokers’ health.  Journals unwittingly played a role in producing and sustaining this ignorance.

Some who work within public health and who buy the notion of “harm reduction” argue that the companies that now produce modified cigarette products and non-cigarette tobacco products, including electronic nicotine delivery devices (e-cigarettes), are different from the tobacco industry of old, or that the tobacco industry has changed. For “hardened” cigarette smokers who can’t or won’t quit cigarettes, the argument goes, new tobacco products could represent potential public health gains, and company sponsored research may be the first to identify those gains.

But one fact remains unassailably true: the same few multinational tobacco companies continue to dominate the market globally and, as smaller companies develop promising products, they are quickly acquired by the larger ones. However promising any other products might be, tobacco companies are still in the business of marketing cigarettes. As US federal court judge Gladys Kessler pointed out in her judgment in the case of US Department of Justice versus Philip Morris et al, the egregious behaviour of these companies is continuing and is likely to continue into the future.  And just this summer documents leaked from one company showed a concerted campaign to “ensure that PP [plain packaging of tobacco products, bearing health warnings but only minimal branding] is not adopted in the UK.”  The tobacco industry has not changed in any fundamental way, and the cigarette—the single most deadly consumer product ever made—remains widely available and aggressively marketed.

What should we make of the policy?

A bad argument against the ban – yeah, I know that that misses some linguistic subtlety, but it’s close enough – is that it’s a violation of free speech: it really is no such thing, for the simple reason that noone is trying to stop the tobacco industry making its case – a right to free speech doesn’t imply a right to a platform.  Of course, if every reputable publisher denies the industry a platform, than this might be a de facto rather than de jure curb on free speech – but that’s just the way it goes: just as noone gets to insist that a particular person gives them a platform, they don’t get to insist that they be provided with one at all.  (Also – though it doesn’t apply in this case – merely to splutter “B…b.. but free speech!” isn’t an argument anyway.)

Still, I guess I am uneasy about a ban. more…

Research Ethics and Ethical Problems

16 Aug, 13 | by Iain Brassington

Noted on Ben Goldacre’s twitter feed a couple of weeks ago was this article in Slate about the recruitment of pregnant women into drug trials.

Essentially, there’s a situation in which there’s a dearth of information about the impact of drugs during pregnancy.  According to the article,

[p]harmaceutical companies are not willing to navigate the legal and ethical minefield of testing drugs on pregnant women, especially because pregnancy lasts only nine months, a short window in which the tests could pay off in additional sales.  As a result, drugs are often prescribed to this population off-label, meaning that they haven’t been specifically approved for pregnant women.

Of course, that doesn’t explain why testing is an ethicco-legal “minefield” to begin with.  Still, it’s not all that hard to come up with at least a skeletal explanation: the whole point of trials is that the effect of a drug is unknown, and this might mean that it’s not safe.  When we’re talking about a volunteer, then it’s important that they know the risks before enrolling; but when a woman is pregnant, another dimension is added: she’s effectively volunteering her unborn child as well.  And it might be problematic to expose another human – even a foetus – to an unknown risk.

But this leaves us with a paradox: 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…

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