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WTF?

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…

Under-Treatment, Treated.

29 Aug, 13 | by Iain Brassington

Right: file this paper from the JAMA under “Properly Odd”.  It’s a proposal that nonadherence to a treatment regime be classed as a treatable medical condition in its own right.

No, really.  Look at the title: “Medication Nonadherence: A Diagnosable and Treatable Medical Condition”.

Starting from the fairly straightforward premise that non-adherence to treatment regimes is “a common and costly problem”, Marcum et al move at the end of their opening paragraph to have medication nonadherence recognised “as a diagnosable and treatable medical condition”.  The authors allow that, as a precursor to treatment, there must be an accurate diagnosis.  However,

for undetected and under-treated conditions such as medication nonadherence, one way to identify the population of interest is to conduct screening. The 1968 World Health Organization principles on screening tests have clear application to medication non-adherence. For example, the condition is an important problem, there are suitable tests available, and there are acceptable treatments for those with this problem.

Well, OK; but it hasn’t yet been shown that nonadherence is a condition, and so it’s too early to say that it’s a condition for which tests and treatments are available.  It shouldn’t be hard to see what’s gone wrong here: the fact that treatable medical conditions are serious problems that are (or could in principle be) reversible doesn’t entitle us to say that any serious problem that is (or could be) reversible is a treatable medical condition.  The authors appear to have got things – to use the vernacular – arse about tit.

So is there any evidence offered in the paper for non-adherence being a medical condition in its own right?  The paper is short, but even so, it’s not something I want to reproduce here; all the same, there’s nothing that leaps out.  The main planks of the argument are simply that it’s a problem, that it’s a problem that has something to do with health, and that it’s therefore a health problem properly understood.

The authors continue:

Using previously established methods and instruments, screening to diagnose medication nonadherence among adults across care settings should be routine. A number of screening tools or instruments are currently available to determine the underlying behavior(s) of interest.  This approach illustrates how clinicians and researchers can begin conceptualizing the diagnosis and treatment of medication nonadherence.  […] Also, given the proposal to routinely screen for medication non-adherence in adults, the next step is to match the identified barriers to a proven treatment for the condition.

Well – if I can interrupt for a moment – they can begin diagnosis and treatment of the condition so long as the condition is actually a thing.  Which it isn’t.

I have a horrible feeling that I know what’s going on here; there’s a couple of telltale signs:

Inclusion of medication adherence data in the electronic health record will allow for sharing among health care professionals and insurers, establishing trends over time as well as benchmarking for quality improvement purposes. Moreover, it is paramount that patient-reported medication adherence information (eg, medication beliefs and values) is incorporated into such documentation.

And this makes me think that it’s got something to do with the role of private insurance in the US medical system.  If you can get non-aherence accepted as a condition, then it’s something that insurers’d have to cover, which would mean…

Eh?

… Actually, no.  I’ve no idea.  I mean, it wouldn’t actually make it a condition.  You can’t just define a condition into existence because it’d suit some purpose.

In the current health care climate, there is a strong demand for improving the quality of care delivered, including medication adherence.

Hmm.  That’s not really helping.

 

But that’s not what it says, is it?

25 Jan, 13 | by Iain Brassington

Today’s blast of righteous indignation is directed towards New Mexico.  House Bill 206 says, in essence, that… well, it’s short, so here it is in full:

HOUSE BILL 206

51ST LEGISLATURE – STATE OF NEW MEXICO  FIRST SESSION2013

INTRODUCED BY

Cathrynn N. Brown

AN ACT

RELATING TO CRIMINAL LAW; SPECIFYING PROCURING OF AN ABORTION AS TAMPERING WITH EVIDENCE IN CASES OF CRIMINAL SEXUAL PENETRATION OR INCEST.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

SECTION 1.  Section 30-22-5 NMSA 1978 (being Laws 1963, Chapter 303, Section 22-5, as amended) is amended to read:

“30-22-5.  TAMPERING WITH EVIDENCE.–

A.  Tampering with evidence consists of destroying, changing, hiding, placing or fabricating any physical evidence with intent to prevent the apprehension, prosecution or conviction of any person or to throw suspicion of the commission of a crime upon another.

B.  Tampering with evidence shall include procuring or facilitating an abortion, or compelling or coercing another to obtain an abortion, of a fetus that is the result of criminal sexual penetration or incest with the intent to destroy evidence of the crime.

C.  Whoever commits tampering with evidence shall be punished as follows:

(1)  if the highest crime for which tampering with evidence is committed is a capital or first degree felony or a second degree felony, the person committing tampering with evidence is guilty of a third degree felony;

(2)  if the highest crime for which tampering with evidence is committed is a third degree felony or a fourth degree felony, the person committing tampering with evidence is guilty of a fourth degree felony;

(3)  if the highest crime for which tampering with evidence is committed is a misdemeanor or a petty misdemeanor, the person committing tampering with evidence is guilty of a petty misdemeanor; and

(4)  if the highest crime for which tampering with evidence is committed is indeterminate, the person committing tampering with evidence is guilty of a fourth degree felony.”

SECTION 2.  EFFECTIVE DATE.–The effective date of the provisions of this act is July 1, 2013.

The new bit is section B.

In a statement, the congresswoman who introduced the Bill, one Cathrynn Brown, said that her intention was to punish the person who commits incest or rape and then procures or facilitates an abortion to destroy the evidence of the crime.

Hmmm.  Except that that’s not what it says, is it?  Maybe she should read the text of her own Bill.  It talks about procuring an abortion, as well as compelling or coercing another person to have one.

I think that the second bit is actually fairly unobjectionable.  To compel someone to have a medical procedure, whomever that someone is, and whatever the procedure, is to wrong them; and if you compel them to have the procedure in order to remove evidence of another wrong, then the wrongness is multiplied.  But, y’know… that first bit… um… more…

198!

23 Oct, 12 | by Iain Brassington

Seriously!  Theoretical Medicine and Bioethics has published a paper with a hundred and ninety-eight listed authors!

I’ve always been slightly puzzled by multi-authored papers – by just how many people get to add their names to a piece of work.  A friend of mine who is a proper scientist once tried to explain how it works in the sciences to me – about how you need to give credit to the people who ran the experiment, but also to those who did the titration and general donkey-work.  That seems fair enough.  Having said that, I suspect that there’s often a bunch of people who get credits that shouldn’t be there.  (I remember once seeing a CV from a guy that had 45 pages’ worth of publications listed.  Granted, it was double-spaced… but, still: there must have been the thick end of a thousand papers listed; there’s no way on God’s good Earth that he could have played a significant role in all of them.  So why was he entitled to claim them?  Why did he take the credit?  Apparently, it was because, although not all of the papers referred to work he’d done, they did all refer to work done by other people in a lab he ran.)  Anyway… the Steinhauser et al ad infinitum paper, with its 198 authors, isn’t lab-based, so the credit-where-it’s-due argument wouldn’t work.

(Jozsef Kovacs, writing in a paper currently available as a pre-pub in the JME, is also concerned about authorial inflation, and who should get the credit for a given paper, and how to improve things.  It’s definitely worth a look.)

The author list for the Steinhauser paper seems to have been generated at least in part via the membership of a Facebook group (and one that no longer exists, or at least one that is so private that it doesn’t show up on a search).  That’s just silly, and there’s no way that anyone can successfully marshall so many contributors.  That turns a paper into an open letter.  Indeed: the “authors” seem to think that their paper could be treated as such without loss: more…

Junk food feeders are criminal child abusers? Really?

15 Oct, 12 | by David Hunter

Public Service Announcement: Sensitivity Advisory Sticker – Caution Post contains sarcasm.
In the interests of our more sensitive readers not taking offence I recommend they skip this post on the grounds that it will contain gentle sarcasm, disagreement and a certain amount of me asking “Is that really what they mean to say?”*

Blog Post:
The Oxford Practical Ethics Blog is typically very good, hence when there are posts that seem shall we say not quite as thought through as they might be it seems worth mentioning this and raising some debate. Presently Charles Foster has an interesting post: Should you be prosecuted for feeding junk food to your child?

more…

In Defence of Live Tweeting

4 Oct, 12 | by Iain Brassington

Questions to which the Answer is Eh?  What are you on about?  No, really: what?, part 2: Should people who live-tweet conferences be thrown out and barred from future conferences?

A story in IHE that concerned a debate (well, I say “debate”, but it was clearly a slow news day…) about the rights and wrongs of live-tweeting prompted Brian Leiter to post this:

[A]nyone who live-tweets a conference should be immediately disinvited from the event, and any future ones.

He elaborated later:

The medium of twitter is not suited to discursive reasoning or extended analysis or argument.  But philosophy presentations contain discursive reasoning and extended analysis and argument.  Therefore a twitter version of a talk will necessarily mutilate it.  Since mutilation of someone’s work has no value, people who attend a conference should have the courtesy not to try to tweet the talks.  If they do not have that courtesy, they should be thrown out.   There may be fields where presentations lend themselves to tweeting; on that issue, I’m agnostic.  But philosophy isn’t one of them.

Hmmmm.

Naaaaaah.

The first sentence (I’d call it a premise, but that seems to overrate it) of this is possibly true, but not obviously so.  For sure, you can’t get much into a single tweet, but a succession of tweets is capable of generating serious discussion.  There’s not room for nuance – but that might mean simply that you’re forced to cut to the chase.  Thus, though the second sentence is probably true, the third is false.

The claim about courtesy bears a bit more scrutiny.  more…

How Not to Respond to the Nicklinson Verdict

23 Aug, 12 | by Iain Brassington

Unsurprisingly, the ruling handed down last week in respect of Tony Nicklinson and “Martin” has generated a lot of comment.  A lot of that comment has disagreed with the ruling.  David Allen Green, the Staggers‘ legal correspondent and also known as the blogger Jack of Kent, tweeted that it was a “dreadful court decision… depriving a person of basic dignity“; and in the wake of Nicklinson’s death, added that he thought it was still “entirely open for courts to rule in his favour rather than blame Parliament“.  Over at the Practical Ethics blog, Roger Crisp suggests that the High Court might even have acted unlawfully.

Sympathetic as I am to Nicklinson’s basic moral claim, I think that such responses are mistaken.  Not in the sense of their being in any way disreputable – it’s just that I’d argue for a different conclusion.  But, as such, it’s the possibility of an argument that matters, and there’re arguments to be had either way, some of which will be powerful, and some of which will be less so.  That’s the nature of debate.

There are others, though, whose response seems to me to get things entirely wrong.  I’ll give one example from each side. more…

Oh, and since we’re talking about assisted dying…

18 Jun, 12 | by Iain Brassington

… read this from Current Oncology – “Pereira’s Attack on Legalizing Euthanasia or Assisted Suicide: Smoke and Mirrors” – if you haven’t already.

(via the Bioethics International FB group… and a million others.)

Well, Consider my Jaw Dropped.

2 Jun, 12 | by Iain Brassington

I know it’s not long since I last posted about the Christian Medical Fellowship’s blog, and I would ordinarily leave it a bit longer… but I’m about to go off on one.  Forgive me.  I’ve had a hard week marking exam scripts, and I’m tired and stressed and cranky, and this is just… well…  Look: I hear that ginger is quite a good anti-emetic.  You might want to go and find some.

You will, of course, be aware of the recent killings in Houla: 108 civilians shot at close range or stabbed in what the UN says may amount to a crime against humanity.  You may also have read about the arrest of Mick and Mairead Philpott, suspected of the murder of their six children in a housefire.  Peter Saunders, on the CMF blog, under the title “There are Few Things More Horrifying than the Slaughter of Innocent Children”, writes that

Every child’s death is a tragedy but there are few things more reprehensible than the killing of children by adults. Children are rightly seen as amongst the most vulnerable and defenceless members of society and deserving of special protection.

It is therefore not surprising that Western governments are acting quickly at the highest level to expel Syrian diplomats and impose sanctions and the police are giving high priority to investigating the Derby fire for which the children’s own parents are now suspects.

Whether or it turns out that the Syrian government was directly involved in the latest atrocities, or whether or not the parents are charged with starting the fire, it is nonetheless deeply ingrained in the human psyche that public authorities have a duty to protect the vulnerable and that the strongest advocates for children should be their own parents.

As I read that, I had a horrible feeling about what was going to come next.  I suspect many people reading this now will have the same feeling.  The same creeping nausea.  He’s used the phrase “slaughter of innocent children”.  He’s not going to say… is he?

Reader, he is. more…

Onwards, to the past! Especially when slavery is involved…

15 May, 12 | by Iain Brassington

Wow.

Steve Fouch has, on the Christian Medical Fellowship’s blog, offered advice on how to vote in the BMA ballot on industrial action.  Now, Fouch isn’t the same as the CMF, and I don’t suppose what he writes indicates the CMF’s position any more than what I write here represents the BMJ’s.  Even so, what he suggests is pretty remarkable; and, in keeping with a lot of stuff from the CMF, the general advice is that the solutions to all modern problems can be found in a set of writings edited and selected – highly selected – around 1900 years ago by men with beards.

Notably,

I would lay out the following biblical framework for thinking through the way we approach this dispute:

Firstly, industrial relations:

Col 3:22 ‘Slaves obey your earthly masters in everything’

1 Peter 2:18 ‘Slaves, submit yourselves to your masters with all respect, not only to those who are good and considerate, but also to those who are harsh.’

1 Timothy 6:1 ‘Let all who are under a yoke as slaves regard their own masters as worthy of all honour, so that the name of God and the teachings may not be reviled’.

Philippians 2:14-16 also encourages us to not be grumblers and moaners in the workplace, but to be a positive influence.

It is clear that Paul and Peter, in writing these messages were urging slaves not just to do their jobs, but to be exemplary, going over and above the call of duty, and to have a positive attitude and spirit in so doing. While this is referring to the institution of slavery, the principles apply equally to modern employment.

Do they apply equally to modern employment?  There’s no obvious reason to suppose that they do – not least because modern employment practices don’t generally rely on slavery.  more…

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