Food packaging matters more than informed consent to treatment

Packets of cigarettes carry pictures showing purchasers what their lungs or their arteries will look like if they carry on smoking. Consumers International and the World Obesity Federation are now suggesting that some foods should bear similar images.

Assume for the sake of argument that the practice would be effective in discouraging the purchase of health-truncating foods. If the images work by telling consumers something about what they are buying that they would not otherwise know, surely there can be no coherent objection to them. Knowledge of that sort is always good – assuming that the consumer has a real choice as to whether to buy the bad product or a better one.

If they work by pushing to the forefronts of consumers’ minds information that their grosser appetites conveniently suppress when they are wandering down the mall, there may be an argument against them. This would presumably be on the broad basis that the images manipulate the person away from being what they authentically are (a fructose-guzzling cardiac-cripple-in-waiting) towards something else. This argument would assert that there’s a sort of ethical imperialism at work: that those would stamp pictures of limbless diabetics on junk sweet packs are tyrannously seeking to impose an arbitrary normative idea of the good life.

I have little sympathy with this second view. If anyone says in a normative voice that it’s good to be diabetic, they’re insane. If anyone says in an empirical voice that it’s better to be diabetic than non-diabetic, they’re misinformed. If anyone says in the voice of a hedonistic utilitarian that the overall pleasure gained by the consumption of lard outweighs the detriments, I’d invite them to get thin, do all the Munros, and then revisit their original judgment. If anyone thinks that they’re more authentically themselves by being ill might have a point once their illness is long-standing and has truly become a defining characteristic. But before the illness is triggered, aren’t they more themselves without clogged arteries or the need to inject insulin five times a day?

If the packaging proposal is adopted, some interesting questions arise. Should good foods be branded with pictures of the condition you’ll be in or the advantages you’ll have if you eat them? Aphrodisiac oysters would display the beaming visages of satisfied sexual partners. Green tea would show lean centenarians on trampolines. Or perhaps those good foods should show the things that they’ll spare you: prostate-preserving tinned tomatoes might show an unoccupied midnight toilet.

Perhaps other, wider concerns should feature. Tins of palm oil should show dead orangutans. Milk should show the mournful face of a calf-less cow alongside the pictures of healthy, non-osteoporotic bone-scans.

While it’s easy to multiply absurdities, the proposal is basically a very good thing. It’s a good thing for at least some of the reasons that the notion of informed consent to medical treatment is endorsed. If you’re keen on informed consent to treatment, a fortiori you’ll be keen on food package images. In fact, I suggest, you should be more keen on those images. They’re more important. Continue reading

Expert workshop on cognitive enhancement device regulation: Are there ‘two worlds’ of devices?

Last week, we held an expert workshop with key stakeholders to discuss our recent Oxford Martin School policy paper. Our policy paper put forward proposals for how we thought cognitive enhancement devices such as brain stimulators should be regulated. At present, if these sorts of devices do not make medical treatment claims (but instead claim to make you smarter, more creative or a better gamer, say) then they are only subject to basic product safety requirements. In our paper we suggested that cognitive enhancement devices should be regulated in the same way as medical devices and discussed how this could be implemented. Indeed, the devices that are being sold for enhancement of cognitive functions use the very same principles as devices approved by medical device regulators for research into the treatment of cognitive impairment or dysfunction associated with stroke, Parkinson’s disease and depression (amongst other conditions). Being the same sorts of devices, acting via similar mechanisms and posing the same sorts of risks, there seemed to be a strong argument for regulation of some form and an equally strong argument for adopting the same regulatory approach for both medical and enhancement devices.

Having published our paper, we were very keen to hear what people more closely involved in making policy and drafting legislation thought of our proposals. Individuals from the Medical and Healthcare Products Regulatory Agency, the EU New and Emerging Technologies Working Group, a medical devices company, the Nuffield Council on Bioethics, and experts on responsible innovation and on brain stimulation joined us. Overall, the response to our recommendations was positive: all participants agreed that some regulatory action should be taken. There was a general consensus that this regulation should protect consumers but not curtail their freedom to use devices, that manufacturers should not be over-burdened by unnecessary regulatory requirements, and that innovation should not be stifled. Continue reading

Does it matter that there’s cocaine in our water supply?

Scientists from the Drinking Water Inspectorate have recently discovered benzoylecgonine in water samples at four test sites, a finding that is thought to be a result of high levels of domestic cocaine consumption. Benzoylecgonine is the metabolised form of cocaine that appears once it has passed through the body, and is the same compound that is tested for in urine-based drug tests for cocaine. It is also an ingredient in a popular muscle-rub, however, so the origins of the compound in our water are somewhat uncertain. Steve Rolles from the drug policy think tank Transform has suggested that the findings are an indication of the scale of the use of cocaine in Britain todayAccording to a 2010 UN report, the United Kingdom is the single largest cocaine market within Europe, followed by Spain.  In contrast to the shrinking cocaine market in North America, the number of cocaine users in European countries has doubled over the last decade, from 2 million in 1998 to 4.1 million in 2007/8. Although the annual cocaine prevalence rate in Europe (1.2%) is lower than North America (2.1%), the UK prevalence rate (3.7% in Scotland and 3.0% in England and Wales) is actually higher than the US (2.6% in 2008). According to the charity DrugScope, cocaine is the second most used illegal substance in the UK after cannabis: there are around 180,000 dependent users of crack cocaine in England, and nearly 700,000 people aged 16-59 are estimated to take cocaine every year. Further, according to the government statistics, in the years 2012-13, cocaine was the only drug to show an increase in use among adults between 16-59. All this does appear to suggest a possible link between the benzoylecgonine found in the water supply and high levels of cocaine use in the UK.

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Complicity and Contraception: Rethinking Hobby Lobby’s Claim of ‘Substantial Burden on the Exercise of Religion’

Within the next month, the United States Supreme Court will decide whether for-profit corporations shall receive an exemption from providing certain types of contraceptives that are otherwise mandated for healthcare coverage by federal law to employees on the basis of the religious objections of the corporations’ owners.  The two cases considered in tandem by the Supreme Court, Sebelius v Hobby Lobby Stores, Inc., and Conestoga Wood Specialties Corporation v Sebelius (Hobby Lobby from here on out), feature a Christian-owned arts and crafts chain and a Mennonite Christian-owned furniture manufacturer, the owners of which object to four specific forms of birth control that they claim cause abortions.

In making their argument for an exemption, the claimants rely mainly on the Religious Freedom Restoration Act (RFRA) passed by Congress in 1993. The RFRA states, “Government shall not substantially burden a person’s exercise of religion…” unless “that application of the burden to the person – 1) is furtherance of a compelling governmental interest; and 2) is the least restrictive means of furthering that compelling governmental interest.” This sets up three tests for judging the permissibility of a government act: the substantial burden test, the compelling interest test, and the least restrictive means test. For the claimants in Hobby Lobby to be successful under the RFRA, the Supreme Court would need to decide first that the government’s ‘contraception mandate’ is indeed a ‘substantial burden’ and second that the provision of contraception is both a compelling government interest and that employer based health insurance is the least restrictive method for securing that interest.

Scholars and journalists have taken various approaches in responding to the range of questions related to these three tests. However, I argue here that Hobby Lobby’s exemption claim can be denied without diving into this spectrum by showing that it fails to meet the first test: the government does not place a substantial burden on the exercise of religion by Hobby Lobby and Conestoga Wood in its ‘contraception mandate.’ Continue reading

Terminal Illness and The Right Not to Know

The parents of a young woman named Vickie Harvey, who tragically died at the age of 24 from acute myeloid leukaemia, have launched a campaign to give patients the right not to know that they are terminally ill.  Eric and Lyn Harvey claim that their daughter lost the will to live when, after her leukaemia returned following a period of remission, doctors told her ‘in graphic detail’ how she would now succumb to her disease. Eric Harvey told the Daily Mail:

After [Vickie was about her prognosis] she changed – and never really got out of bed again. We knew she was dying, but we feel that, if she hadn’t been told that day, she would have lasted longer’. Continue reading

Living near a busy road can kill you

Early April saw some unusually smoggy days across much of Western Europe, resulting in widespread media attention to air pollution.
(See, for example, here, here and here.) On one day, air quality in some parts of London was worse than in Beijing. Further attention has been drawn to the issue by a number of recent official reports, including one from the World Health Organisation, which has declared that air pollution is now the world’s biggest single environmental threat to health.

As has been noted, media coverage can give a misleading picture of the health risks of air pollution. Coverage tends to focus on short-term peaks, such as those seen recently in Western Europe, but the health risks of air pollution are primarily related to long term exposure, and show no ’safe threshold’ effect. Elevated baseline levels of pollution are thus more of a problem than occasional peaks.

There’s another important aspect of air pollution that often goes unnoticed; small geographical differences can have a marked effect on exposure to air pollution and thus on risk of adverse health effects. For example, living near a busy road appears to substantially increase air pollution-related mortality. A study published last year in the Lancet (press summary here) investigated the effects of very local differences in air quality on mortality by pooling 22 European cohort studies. The investigators found that an increase in average annual fine particulate (PM2.5) exposure of 5 µg/m3 was associated with a 7% increase in the risk of dying from all natural causes. This is approximately the difference between living on a busy urban road and living in a traffic-free area. The finding was robust in the face of correction for various possible confounding factors. Continue reading

Is smoking morally wrong?

This week, I’ve been thinking about smoking. Full disclosure: My name is Jim and I am a smoker. I have smoked for nearly a decade now – since around 2005 – and I only smoke menthol cigarettes. I am addicted to the sweet menthol smoke, where that touch of red fire at the end of a white stick seems so perfectly suited to almost any occasion from celebration to commiseration. I give up on average for a month or two a year, every year. I always come back, though. The reason I say this is to highlight that I am by no means one of these dour-faced moralizers, condemning smokers for their ‘filthy habit’. Like a snot-nosed child, it may be filthy, but it’s my filthy habit. Most efforts to encourage people against smoking focus on the idea that smoking is personally damaging: it causes illness and death, it costs a lot of money, it harms others, it litters the environment, and so on. This week, however, I’ve been thinking about whether the real concern is that smoking might be morally wrong. (NB: I’m discussing where whether it is morally wrong, not whether it should be legally banned or whether people should have the ‘right’ to smoke – these are distinct questions). Continue reading

Meat Free Mondays: Having the “right” versus it being “right”.

Some context: “Meat Free Mondays” is an international campaign that encourages people not to eat meat on Mondays to improve both their own health and the health of the planet (also, y’know, not killing sentient beings unnecessarily). Sounds like a good idea, no? Apparently not. Continue reading

Another Surprising Side-Effect of Paracetamol: Causing ADHD?

Taking the popular over-the-counter pain and fever medication paracetamol during pregnancy might affect the unborn child more than we assumed – and hoped for. Recently, research began to link pre-natal exposure of paracetamol (also known as acetominophen) to asthma and poor motor and communication skills in small children. Now, a new study published yesterday suggests that taking paracetamol during pregnancy comes with an increased risk for the baby of developing attention deficit hyperactivity disorder (ADHD) later.

The authors of this study investigated 64,322 Danish children (born 1996-2002) and their mothers. The women were asked whether they have taken paracetamol in computer-assisted telephone interviews three times during their pregnancy and shortly after. To asses ADHD in children, the researchers used different ways: they asked the mothers of 7-year-olds about their child’s behaviour using a standardised ADHD questionnaire. Moreover, they used Danish medical registries to gain information about diagnoses of hyperkinetic disorder, which resembles a severe form of ADHD, and descriptions of ADHD medication to the children.

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Are the reasons why people take illegal drugs relevant to sentencing decisions?

The laws that prohibit possession of certain drugs are ostensibly justified because they protect people from the health risks that are associated with uncontrolled or heavy use. Some have argued that criminalizing possession of small quantities of drugs for personal use is overly paternalistic (people should be free to make potentially risky choices as long as they don’t put others at risk) or even counterproductive (criminalizing drug use fuels a black market, many aspects of which present greater dangers to individual drug users and wider society). I find these arguments intuitively persuasive (although clear evidence would be needed to substantiate the claim that criminalization is in fact counterproductive).

So, if there is a justification for putting controls on personal drug use it seems that it ought to appeal solely to the physical and social harms that would result from a policy of drug liberalization. Such an approach is roughly reflected in the UK drug laws: the graded classification system, which determines the maximum penalty for possessing drugs in each class (A to C), considers only the harmfulness of the drug: punishment is linked to risk to health. Criminalization of drug use thus has nothing to do with a moral evaluation of this drug use.

However, a news story this month raises the question of whether moral considerations are sometimes playing a role in the sentencing of those convicted of possessing illegal drugs. Continue reading