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…

It’s been a while since the last post, and there’s a couple of serious entries on the way – but they’ve been displaced by a bit of silliness from Oklahoma.  State Senator Ralph Shortey (or SHortey, if you follow his Facebook style) has introduced a Bill demanding that

[n]o person or entity shall manufacture or knowingly sell food or any other product intended for human consumption which contains aborted human fetuses in the ingredients or which used aborted human fetuses in the research or development of any of the ingredients.

Robin Marty elaborates:

The Republican has proposed a bill that will ban the use of “aborted human fetuses in food,” despite his admission that he doesn’t know of any companies that actually…well..use them.

So where did Sen. Shortey get this idea?  According to him, from the internet.

The “internet research” Shortey is referring to likely is an ongoing anti-choice crusade that began months ago, when an activist group began demanding a boycott of PepsiCo, which works with a research and development company that uses a line of embryonic kidney stem cells created in the 1970′s to test “flavor enhancers.” The boycotters, led by a group called Children of God for Life, say that’s the same as using aborted fetuses.

Ah: teh interwebz.  I see.  (For the record, the LA Times reports that “[a] U.S. Food and Drug Administration spokeswoman told the Associated Press that the agency has never gotten any reports of fetuses being used in food production.”)

Since there’s never likely to be a better excuse to link to [SPOILER ALERT] the final scene of Soylent Green on this blog, that’s precisely what I’ll do; I only wish I could get the clip to embed.

But there’s more to this than lampooning a typographically-challenged Senator, because the Bill, in its brutal simplicity, is brutally simplistic. more…

You can tell libertarians from the sound they make: it’s the faint rattle of a tiny intellect untethered in an otherwise empty mind.  Cheap and all-too-easy insults aside, though, I’d been wondering how long it’d be, in the wake of the BMA’s recommendation that smoking be banned from cars, before we got a response from the libertarians.  The answer, it seems, is a couple of days.  The Libertarian Alliance, for example, has had a go (it’s a totalitarian tax ruse, I tells ya!  Thank goodness tax is low on tinfoil hats…); but the example that really caught my attention – by which I mean rendered me slack-jawed in amazement – was this piece by Rob Lyons in Spiked, the online journal of choice of the bewildered. 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…

I like the idea of free-at-the-point-of-use healthcare, and if you want to call that a right, that’s fine with me, too.  In the world of Tea Party-affliated Republican senator Rand Paul, that means I’m the sort of person who’d support turning up at a physician’s door with the police, and forcing that physician (and all the necessary support staff) to work for free.  Which means I support slavery.

Don’t believe me?  Watch him in action here…*

I particularly like the look on the face of the person sitting behind him; she seems to be trying to work out whether she’s dozed off and is dreaming all that.

In all seriousness, though: if there’re any American readers of this blog, could you let me know something?  I understand that there’re arguments to be made against public health care, or even the watered-down Obamacare stuff.  (Let’s not worry about whether they’re good arguments for the moment: it’s enough that there are arguments at all.)  But how is it that this kind of preposterous claim can be made, apparently with a straight face, by the opponents of a public option?  Is it a kind of political kamikaze?  I mean: Paul can’t expect to be believed… can he?

*One day, I’ll work out how to embed videos into this thing.  It’s only 80 seconds or so, though.  H/T ThinkProgress.

James Wilson (UCL) and I recently wrote a briefing paper for the Nuffield Council on Bioethics on the ethical issues surrounding hyper-expensive treatments – that is treatments which exceed NICEs usual cut off point of £30000 per quality adjusted life year (qualy). One factor that we kept coming back to was the need to consider the opportunity cost of funding relatively inefficient medicines (which has implications for example for Cameron’s Cancer Drug Fund).

I thought it was apt today to reflect on the opportunity costs involved in the tax payer footing the bill for part of the royal wedding – namely the security costs. These have been estimated now at twenty million pounds.

Hence if this public expenditure was instead used on health care, using NICEs cut off point we could at least save 666 quality adjusted life years – and of course it could be much more since many treatments cost less than £30000 per qualy.

Now of course things aren’t this clear cut, we have to factor in the probable tourist income due to the wedding, the tax income from people buying bunting and flags from the pound store and so on as well as the impact of all the good will and cheer the papers are nattering on about. And to counter balance this we need to consider any further tax earnings from the 666 Qualys generated, the economic costs of an additional public holiday and so on.

Nonetheless it is at least a sobering thought – there may well have been a public good based argument for the royal couple eloping…

Lord knows why, but I keep going back to Secondhand Smoke, the pro-life, global-warmin’-denyin’, public-healthcare-hatin’, intelligent-design-lovin’,  Daily-Mail-quotin’ blog written by Discovery Institute affiliated lawyer Wesley Smith.  I try to stay away, but like a child peeping between his fingers while hiding his eyes, I’m just fascinated by it.

A recent post concerns a Kiwi woman whose doctors removed her life-support machine in the belief that it was futile.  This was contrary to the wishes of her parents, who are acupuncturists who “had drawn on specialist acupuncture and traditional Chinese medicine practitioners for support during the critical period when life support was withdrawn”.  She survived.

In Smith’s telling of the story, the doctors “forced” the patient off the machine – which, to be honest, can’t have been all that hard given that she was unconscious.  He goes on:

This is a warning.  Doctors don’t know everything.  Hospitals are not always right.

Well, yeah.  But that doesn’t mean that they oughtn’t to have made the decision that they made.  Isn’t it obvious that medics don’t have perfect foresight?  Isn’t it obvious that there’s always going to be the odd (very odd) recoveries from miserable situations?  That doesn’t mean that it’s illegitimate to make decisions about futility, or that it’s illegitimate to act on them.  It doesn’t mean that it’s wrong to make decisions based on medical judgement.  Couldn’t we equally well say that recovery was evidence that the life-support machine wasn’t necessary anyway, and ought to have been withdrawn a lot sooner (and perhaps not used at all)?  After all, if you’re going to play on medical fallibility, you can’t pick and choose between mistakes.

Is Smith saying that it’s always impermissible to remove treatment based on judgement short of godlike omniscience?  Strange.

I’ve set my RSS to receive updates from Secondhand Smoke, which is one of the blogs at First Things.  It’s written by Wesley Smith, who is affiliated to the Discovery Institute, the creationist thinktank in Seattle: that gives you an indication of the sort of position he occupies – not just on bioethics, but also on global warming, socialised medicine and probably a lot else – so it’s no surprise that I disagree with a lot of what he posts.

I mention this now because I’m currently thinking about the way that euthanasia, and medical killing more generally, get represented in the media, and I’m interested in how the blogosphere handles it.  My general hypothesis is that a lot of the coverage is distorting, and is so in a way that harms public debate, and causes unnecessary fear among vulnerable groups.  (I mentioned my suspicion here a while ago.  For the record, I don’t think that the anti-euthanasia lobby is uniquely open to criticism here, either: the defenders also sometimes seem to have a habit of focusing on isolation, indignity and so on as being inescapably the overwhelming and plainly undesirable characteristics of certain lives, particularly among the old and disabled, such that not considering death is seen as bizarre.  Though I’m sympathetic to the legalisation of euthanasia, I think it’s possible to overplay a good moral hand.)

A recent post by Smith is a nice illustration of what I mean (and suspect).   more…

The Centre for Policy Studies has recently published a report on euthanasia, authored by Cristina Odone.  It’s available to download here, though it would seem that you can also buy a paper version for a tenner.  It’s amazing for the sheer poverty of the argument; I might never have thought that so much specious nonsense could be crammed into 60 pages had I not seen it.  Indeed, there’s a good part of me that finds the whole thing hilarious – and it would be, were it not so dispiriting.

There’s barely a paragraph that doesn’t have some objection; but I’m aware that I sometimes go on a bit, so I’m going to limit myself to highlighting a few particular highlights.  But, really, if you’ve a spare moment, it shouldn’t be hard to find other howlers. more…

Someone’s just asked me if it’d be possible to design a virus specifically to kill people with a certain given genetic signature.  I have a feeling that the South African security services tried to cook up an ethnically specific biological agent in the ’80s, but am not sure whether this is an urban myth.  Any suggestions?

Similarly, would it be possible to engineer a virus to deliver some kind of gene therapy for this or that condition, and then release it into the wild?  (I’ll ignore the moral problems of treatment without consent – I’m just interested in the possibility at the moment.)  Has there been anything published on this theme?*

*I’m sure there has.  What I actually meant was, “Could someone give me a reference or two?”.