You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our Group site.

Uncategorized

Post Birth Streisand effect?

18 Jul, 14 | by David Hunter

While I am wary on this blog talking about what we commonly refer to as “The paper that shall not be named” for fear of inciting yet more criticism, complaint and work for myself and Iain there is a certain amount of schadenfreude to be had at the impact three years on of the controversy that ignited on the blog regarding that paper about post-birth abortion.

Google Scholar has recently published its 2014 ranking of top journals and in the subcategory of bioethics the Journal of Medical Ethics is tops and at least one person (you know who you are…) has suggested this is because of the post-birth abortion paper.

The impact factor of the Journal of Medical Ethics is 1.4 which implies the average number of citations a paper in the JME is 1.4. The post birth abortion paper has received an astonishing 74 citations thus far. And while I am sure it would have received some citations organically I am also sure that the vast majority of those citations would not have happened without the controversy. This is the academic equivalent of the Streisand effect (the effect whereby trying to hide something makes it much much more well known and readily available).

At the very least there is a lesson here for those who want to shut down particular areas of academic debate, giving these issues oxygen and attention makes them more rather than less likely to succeed. I’m hoping that anyone bothered by this post takes that lesson on board…

Back(wards) to the Future: The ethics of trading present health care for research

19 May, 14 | by David Hunter

Those outside of Australia are probably at best peripherally aware of the furore that the current budget announced by the new government last week is causing – it is in many ways an unsurprising budget for a broadly rightwing socially conservative government and quite reminiscent of the policies the Con-Dems have brought in the UK (attacks on public services, deregulation of higher education) against the background of a similar rhetoric of economic necessity and being all in it together, needing to clean up the mess left behind by the (kinda, almost, nominally) leftwing former government. It has managed thus far to reverse the popularity of the preferred leaders, and political parties so the fall out may be quite significant.

One interesting winkle it introduced was the introduction of a new medical research future fund (we are told ultimately it will be the largest in the world) which the majority of the significant cuts to public expenditure on health care would be channelled into and in particular of the new $7 co-payment that patients would be asked to pay to go to the GP(doctor) $5 would go to this new fund.

Obviously this is at least partially a cynical attempt to force the health cuts through the Senate (since if Labour votes against it as they say they will and succeed in stopping this policy then the Liberals can cast them as wanting the electorate to die of cancer…) sort of the equivalent of what is known as pork barrelling in the US.

And here you go a direct quote from the Minister for Health:
“People should understand that if they don’t want to put money into medical research then they can go down the obstructionist path of Labor and the Greens,”

Nonetheless there is an interesting question of whether this tradeoff is ethically acceptable? I wrote a little something about it here.

Unsurprisingly I think typically it won’t be because the cut backs to public health and new co-payments being imposed disproportionately disadvantage those worst off in society and the benefits will disproportionately accrue to those already well off – due to the cost of entry for new medical treatments, differing life expectancies and the likely focuses of medical research.

If the fund focused on disadvantage, health generally conceived and there was a guarantee that evidence generated would be listened to by government then it could be a force for good, but how likely is that?

Twitter Speaks Truth

4 Apr, 14 | by Iain Brassington

I know I should be concentrating on my marking at the moment, but I’ve just seen this at the top of my twitter feed, and…

Screen shot 2014-04-04 at 16.19.41

I feel that it vindicates my little break.

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…

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…

CONF & CFP: 9th International Conference on Clinical Ethics Consultation

13 Jul, 12 | by Iain Brassington

From Ralf Jox (Munich)

Call for Abstracts: “Clinical ethics: bridging clinical medicine and ethics”.

The Ninth International Conference on Clinical Ethics Consultation (ICCEC) 2013 will take place in Munich, Germany.

The conference’s intention is to strengthen the bridge between clinical medicine and ethics by providing a forum for the exchange of experience and discussions between clinicians, ethicists and ethics consultants.  In particular, the conference will feature
“role model consultations” based on real clinical cases from intensive care, dementia care, and oncology.  In addition, plenary sessions will focus on the needs for
ethics consultation from the perspective of clinicians and connect them to the experience of ethics consultants.  Ample time will also be provided for free oral or poster contributions based on an abstract competition.

All colleagues interested in ethics and medicine from all over the world are invited to
make the ICCEC 2013 a lively experience and a forum for fruitful exchange and helpful information.

The Scientific and Advisory Committees have identified the following four topic areas of interest: more…

After-Birth Abortion: Editorial Comment

28 Feb, 12 | by BMJ

Rev Prof Ken Boyd, Associate Editor, Journal of Medical Ethics, writes:

Coming up to me at a meeting the other day, an ethics colleague waved a paper at me. “Have you seen this ?”she asked,  “It’s unbelievable!” The paper was ‘After-birth abortion: why should the baby live?” by two philosophers writing from Australia, Alberto Giubilini and Francesca Minerva. Well yes, I agreed, I had seen it: in fact I had been the editor responsible for deciding that it should be published in the Journal of Medical Ethics; and no, I didn’t think it was unbelievable, since I know that arguing strongly for a position with which many people will disagree and some even find offensive, is something that philosophers are often willing, and may even feel they have a duty, to do, in order that their arguments may be tested in the crucible of debate with other philosophers who are equally willing to argue strongly against them. Of course for that debate to take place in the Journal of Medical Ethics, many of whose readers, doctors and health care workers as well as philosophers, may well disagree, perhaps strongly, with the paper’s  arguments,  we needed first to make sure that the paper, like any other submitted to the Journal, was of sufficient academic quality for us to publish; and the normal way in which we determine this is to invite academics in relevant disciplines to review the paper critically for us, so that we can eventually make an informed decision about whether or not to publish it, either in its original or (as in this case) a form revised in the light of the reviewers’ reports. Satisfied by the reviewers’ reports and my further editorial review that the paper was of sufficient academic quality to be published in the Journal of Medical Ethics, and being charged with making the decision as an Editor with no conflict of interest in the matter, since unlike my fellow-editors in the relatively small world of international academic medical ethics I have never met the authors, and indeed personally do not agree with the conclusions of their paper, I decided that it was appropriate to publish it in the interest of academic freedom of debate.  It has subsequently been suggested to me that people whose lives might have been ended by ‘after-birth abortion’ were this legal, might be deeply offended by this paper. If that is the case I am sorry, but I am also confident that many of these people are equally capable of mounting a robust academic reply to the paper which, again subject to peer-review, the Journal of Medical Ethics will be very willing to consider for publication.

(IB adds: the paper in question is here; Julian Savulescu defends publication in the next post down.  I’ll add relevant links, both pro and contra, as I find them.)

Blogging hiatus

2 Sep, 11 | by Iain Brassington

Bit quiet around here, isn’t it?

Don’t worry (just in case you were): we’ve not gone away; real life has made a temporary intrusion, and I think the same is true for David.  We’ll be back soon.

MSF Dilemma # 3: Re-Infibulation

4 Mar, 11 | by Iain Brassington

This is the third of the dilemmas considered here.

To allow childbirth, it is necessary to surgically open an infibulation.  After delivery, women (and their husbands) ask for restoration of the infibulation (re-infibulation), which involves re-suturing. MSF opposes re-infibulation and works to ensure that it is not undertaken in its delivery facilities.  Although MSF opposes this practice, not performing re-infibulations risks jeopardising community trust, which could lead to women no longer attending the only safe childbirth service in the region.  Should the staff break MSF’s policy, honour the request of the mother, and avoid the risk of losing community acceptance?

JME blog homepage

Journal of Medical Ethics

Analysis and discussion of developments in the medical ethics field. Visit site

Latest from JME

Latest from JME

Blogs linking here

Blogs linking here