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.
In the U.K., a Labour plan has recently been in the news and stimulating some interesting debate – mainly about the over-regulation of smoking.
As can be seen on the BBC news website, Labour peers have “tabled an amendment to the Children and Families Bill detailing their proposal for England, which they said was about “protecting children”. Lord Hunt, who supports the motion, has stated
“Some Lords will argue a car is a private space and that we should not legislate for what happens within such a space. But there are more important principles than that… For one for me is the need for child protection. Unlike most adults, children lack the freedom to decide when and how to travel, they lack the authority most adults have to ask people not to smoke in their company. And in those circumstances I think it is right for Parliament to step in to protect children.” Continue reading
‘Between the NHS and social care, there must be total commitment to ensuring that interaction is paperless, and that, with a patient’s consent, their full medical history can follow them around the system seamlessly.‘ So said Jeremy Hunt,the Health Secretary, on 16 January 2013. And NHS England say that: ‘Our vision is for a fully integrated digital patient record across all care settings by 2018’.
It sounds like a good idea. It’s not. Or not in its present form. Many of the concerns that have been expressed relate to privacy/confidentiality. Those concerns are real. But even if they can be satisfactorily addressed, electronic health records have the potential to do great harm. They divert attention from the patient to the screen, and they cause clinical skills to atrophy.
David Loxterkamp recently observed that the computer in the consulting room is a Frankenstein-like creature: ‘….we have created a place in our exam rooms for a computer that needs our care and feeding. It now directs the flow and purpose of an encounter that once unfolded organically according to the particular needs of the patient.’ The electronic servant becomes the master. Continue reading
According to an article in the New England Journal of Medicine (Prabhat & Peto 2014),
Tripling tobacco tax globally would cut smoking by a third, and prevent 200 million premature deaths this century from lung cancer and other diseases. (here)
This should, of course, be instituted immediately. It is almost the perfect public policy: self-interest dressed up as sanctimony. Not only will we make the lives of non-smokers better at the expense of smokers, but we can do so whilst telling smokers we are doing it for their own good! Continue reading
Concussions are prevalent in high-impact and much-beloved sports such as American and Australian football, rugby, and hockey. Concussions are harmful – recent studies link repeated concussions to degraded cognitive performance along a number of measures (Randolph et al. 2013), as well as an increased risk of neurodegenerative conditions such as chronic traumatic encephalopathy (McKee et al. 2013). Concussions are much in the news. Recent events such as the suicide of Dave Duerson and the suicide of Junior Seau have been linked to the long-term effects of repeated concussions, and the governing bodies of many high-impact sports have, of late, been scrambling to address the problems posed by growing awareness of the danger of concussions.
A number of ethical questions arise in connection with this growing awareness. (What should the governing bodies of sports leagues do to protect players? What do teams owe players in such sports? Is the decision to play such a sport, or to continue playing in spite of suffering a concussion, really autonomous? Should fans speak up about player protection, and if not, are they complicit in the harm done to players? And so on.) Here I want to consider one question that has received little attention. It involves the role of parents in fostering participation in high-impact sports. Continue reading
Kyle Edwards, Uehiro Centre for Practical Ethics and The Ethox Centre, University of Oxford
Caroline Huang, The Ethox Centre, University of Oxford
On November 22, in a harshly worded “warning letter,” the US Food and Drug Administration (FDA) informed the direct-to-consumer genetic testing (DTC-GT) company 23andMe that it had 15 working days to discontinue marketing of its services. By December 5, 23andMe had canceled television, radio, and online advertising and stopped selling its $99 ‘spit kit’ DNA test online.
To put it mildly, the FDA and 23andMe have some communication issues to resolve. A working relationship dating back to 2008 appears to have soured after a six-month period of silence from 23andMe, prompting the warning letter and causing many observers to comment on the apparent stupidity and mystifying nature of 23andMe’s communication ”strategy.” While the FDA’s letter is quite clear that 23andMe must communicate better, particularly in reporting the accuracy of its tests, it is not at all clear on how the FDA plans to regulate companies like 23andMe after these accuracy results are in. Moreover, it hints strongly that some tests may be banned even if they are as accurate as the tests you could receive through a physician.
Assuming 23andMe follows through on its promise to cooperate with the FDA, how exactly should these DTC-GT services be regulated to best serve the public?
Next week, thousands of final year medical students will sit a Situational Judgement Test (SJT) as part of the application for their first medical jobs. This will be the second year that the Foundation School Application System (FPAS) has used the SJT, which was developed by the Improving Selection to the Foundation Programme group (ISFP), and replaced the resource-intensive and perceived-unreliable short-answer questionnaires of the previous application process. Continue reading
It was announced last week that a new offence of ‘wilful neglect or mistreatment’ is to be created for NHS hospital staff whose conduct amounts to the deliberate or reckless mistreatment of patients. This offence will be modeled on an existing offence under the Mental Capacity Act which punishes the wilful neglect or ill-treatment of patients lacking capacity. Currently, a medical worker convicted of this offence faces a maximum sentence of five years imprisonment, or an unlimited fine. The sanctions for the proposed new offence are likely to be of a similar severity.
The creation of the offence comes in the wake of the inquiry into the widespread negligence that occurred at Mid Staffordshire hospital. Intended principally to deter healthcare workers from mistreating patients, the new offence has been proposed following review of patient safety. The leader of the review, Professor Don Berwick, emphasized that patient safety must become the top priority and that the measure was needed to target the worst cases of a ‘couldn’t care less’ attitude that led to ‘wilful or reckless neglect or mistreatment’.
Concerns about its impact
Whilst most would agree that patient safety should clearly be a priority, there has been concern that the new criminal sanction could create a ‘climate of fear’ amongst healthcare workers and that individual workers will be penalised for mistakes that are the result of inadequate staffing or simple human error, rather than blameworthy acts of malice. Continue reading
So the US government is likely being shutdown, which will suspend the work of many government agencies, including the Center for Disease Control (CDC). But, fair citizens, I reassure you – in its wisdom, the US Congress has decided that the military’s salaries will be excluded from the shutdown.
With all due respect to military personnel, this is ludicrous. The US military is by far the world’s largest, there is little likelihood of any major war (the last great power war was in 1953), and no sign of minor wars starting, either. Suspended salaries may be bad for morale and long term retention, but they aren’t going to compromise US military power.
Contrast with the CDC’s work. The world’s deadliest war was the second world war, with 60 million dead, over a period of years (other wars get nowhere close to this). The Spanish flu killed 50-100 million on its own, in a single year. Smallpox couldn’t match that yearly rate, but did polish off 300-500 million of us during the 20th century. Bog standard flu kills between a quarter and a half million every year, and if we wanted to go back further, the Black Death wiped out at least a third of the population of Europe. And let’s not forget HIV with its 30 million deaths to date.
No need to belabour the point… Actually there is: infectious diseases are the greatest killers in human history, bar none. If any point needs belabouring, that’s one. And a shutdown would have an immediate negative impact on public health: for instance, the CDC would halt its influenza monitoring program. Now, of course, this year’s flu may not turn out to be pandemic – we can but hope, because that’s all we can do now! And if we have another SARS starting somewhere in the United States, it will be a real disaster.
We’re closing our eyes and hoping that the greatest killer in human history will be considerate enough to not strike while we sort out our politics.