Public Health

Flu Vaccination for Kids: a Moral Obligation?

Written by Ben Bambery and Julian Savulescu

Rosie Anderson, aged 8, died from influenza infection last Friday the 15th of September. Her tragic death followed the recent death of young father, Ben Ihlow, aged 30, who died suddenly on Father’s Day this year, also from influenza infection.

Contrary to public perception, “the flu” is a deadly disease. In Victoria this year, at least 97 people have lost their lives to influenza. The majority of these deaths are amongst the elderly, who are particularly vulnerable to severe disease, but as made painfully clear by Rosie and Ben’s deaths, the flu kills young people too. Continue reading

Does Female Genital Mutilation Have Health Benefits? The Problem with Medicalizing Morality

Does Female Genital Mutilation Have Health Benefits? The Problem with Medicalizing Morality

By Brian D. Earp (@briandavidearp)

Please note: this piece was originally published in Quillette Magazine.

 

Four members of the Dawoodi Bohra sect of Islam living in Detroit, Michigan have recently been indicted on charges of female genital mutilation (FGM). This is the first time the US government has prosecuted an “FGM” case since a federal law was passed in 1996. The world is watching to see how the case turns out.

A lot is at stake here. Multiculturalism, religious freedom, the limits of tolerance; the scope of children’s—and minority group—rights; the credibility of scientific research; even the very concept of “harm.”

To see how these pieces fit together, I need to describe the alleged crime.

Continue reading

Can We Trust Research in Science and Medicine?

By Brian D. Earp  (@briandavidearp)

Readers of the Practical Ethics Blog might be interested in this series of short videos in which I discuss some of the major ongoing problems with research ethics and publication integrity in science and medicine. How much of the published literature is trustworthy? Why is peer review such a poor quality control mechanism? How can we judge whether someone is really an expert in a scientific area? What happens when empirical research gets polarized? Most of these are short – just a few minutes. Links below:

Why most published research probably is false

The politicization of science and the problem of expertise

Science’s publication bias problem – why negative results are important

Getting beyond accusations of being either “pro-science” or “anti-science”

Are we all scientific experts now? When to be skeptical about scientific claims, and when to defer to experts

Predatory open access publishers and why peer review is broken

The future of scientific peer review

Sloppy science going on at the CDC and WHO

Dogmas in science – how do they form?

Please note: this post will be cross-published with the Journal of Medical Ethics Blog.

Damages and communitarianism

By Charles Foster

The Lord Chancellor recently announced that the discount rate under the Damages Act 1996 would be decreased from 2.5% to minus 0.75%. This sounds dull. In fact it is financially tectonic, and raises some important ethical questions.

In the law of tort, damages are intended to put a claimant in the position that she would have been in had the tort not occurred. A claimant who, as result of negligence on the part of a defendant, suffers personal injury, will be entitled to, inter alia, damages representing future loss of earnings, the future cost of care and, often, private medical and other treatment.

Where damages are awarded as a lump sum, there is a risk of over-compensating a claimant. Suppose that the claimant is 10 years old at the time of the award, and will live for 70 years, and the future care costs are £1000 a year for life. Should the sum awarded be £1000 x 70 years = £70,000? (70, here, is what lawyers call the ‘multiplier’). It depends on the assumption one makes about what the claimant will do with the lump sum. If she invests it in equities that give her (say) an annual 5% return, £70,000 would over-compensate her.

In the case of Wells v Wells1, the House of Lords decided that, to avoid the risk of under-compensation, claimants should be treated as risk-averse investors. It should be assumed, said the House, that the discount rate should be fixed by reference to the return on index-linked gilts – Government securities. The rate was 2.5% from 2001 until February of this year. The reasons for the change to minus 0.75% are hereContinue reading

Invited Guest Post: Healthcare professionals need empathy too!

Written by Angeliki Kerasidou & Ruth Horn, The Ethox Centre, Nuffield Department of Population Health, University of Oxford

 

Recently, a number of media reports and personal testimonies have drawn attention to the intense physical and emotional stress to which doctors and nurses working in the NHS are exposed on a daily basis. Medical professionals are increasingly reporting feelings of exhaustion, depression, and even suicidal thoughts. Long working hours, decreasing numbers of staff, budget cuts and the lack of time to address patients’ needs are mentioned as some of the contributing factors (Campbell, 2015; The Guardian, 2016). Such factors have been linked with loss of empathy towards patients and, in some cases, with gross failures in their care (Francis, 2013). Continue reading

In praise of ambivalence—“young” feminism, gender identity, and free speech

By Brian D. Earp (@briandavidearp)

* Note: this article was first published online at Quillette magazine.

Introduction

Alice Dreger, the historian of science, sex researcher, activist, and author of a much-discussed book of last year, has recently called attention to the loss of ambivalence as an acceptable attitude in contemporary politics and beyond. “Once upon a time,” she writes, “we were allowed to feel ambivalent about people. We were allowed to say, ‘I like what they did here, but that bit over there doesn’t thrill me so much.’ Those days are gone. Today the rule is that if someone—a scientist, a writer, a broadcaster, a politician—does one thing we don’t like, they’re dead to us.”

I’m going to suggest that this development leads to another kind of loss: the loss of our ability to work together, or better, learn from each other, despite intense disagreement over certain issues. Whether it’s because our opponent hails from a different political party, or voted differently on a key referendum, or thinks about economics or gun control or immigration or social values—or whatever—in a way we struggle to comprehend, our collective habit of shouting at each other with fingers stuffed in our ears has reached a breaking point.

It’s time to bring ambivalence back. Continue reading

Video Series: Tom Douglas on Asbestos, a Serious Public Health Threat

Asbestos kills more people per year than excessive sun exposure, yet it receives much less attention. Tom Douglas (Oxford Uehiro Centre for Practical Ethics) explains why asbestos is still a serious public health threat and what steps should be undertaken to reduce this threat. And yes, the snow in The Wizard of Oz was asbestos!

Alcohol, pregnancy, experts, and evidence

In the United States, the Centers for Disease Control recently released a new advisory regarding the use of alcohol during or around pregnancy. According to the CDC, any drinking by women ‘who are pregnant or might be pregnant’ constitutes ‘drinking too much.’ The primary reason for the label is the risk of a fetus developing Fetal Alcohol Syndrome, although Sudden Infant Death Syndrome (SIDS) and miscarriage were listed as well. The range of the recommendation is rather wide – the CDC targeted any woman who might be or become pregnant (so, any sexually active woman capable of becoming pregnant). The recommendation has been widely criticized.
 
A number of commentators noted the shaky evidential basis for the advisory. Regarding Fetal Alcohol Syndrome, for example, there is a lot we do not know regarding the amounts of alcohol that are dangerous, and it has been suggested that genetics might play a role in propensity to develop the Syndrome. Regarding SIDS, some evidence suggests the link between alcohol and SIDS is moderated by parents co-sleeping with infants after abusing alcohol – but the advice offered by the CDC did not flag this indirect (potential causal) link.
 
Writing in the LA Times, the philosopher Rebecca Kukla also emphasized the contributions such messages make to creating a culture of shame surrounding women and pregnancy (here). Writing for Time, Darlena Cunha argued that the CDC advice is overly paternalistic, and discriminates against women (here).
 
I do not wish to justify the CDC. I rolled my eyes like many others when I first heard of the recommendations. But here’s a question: why might the CDC release such an advisory? I could imagine someone thinking like this. Well, there should be higher awareness of potential damages of alcohol on a developing fetus. The CDC has the function of alerting the US public to various health risks, and is something of a trusted source as it fulfills this function. But people will not base their decision on the CDC alone. They will be biased in their assessment of evidence, and they may also rely on the first bit of pseudoscience to pop up on Google. So we should come out forcefully, in the hopes that our voice will count for more than a more moderate recommendation might. This way, perhaps we will do more good. (Imagine trying to convince your kids not to run out into the road. You might scare them out of such a behavior by emphasizing the very unlikely but goriest possible outcome.)
 
Of course, I have no idea how the CDC reasoned nor what led to the nature of the advisory they released. What I want to ask is whether institutions we trust to deliver evidence-based advice ought to reason in this way.
Arguably, they should not. We want our experts to be experts, not to be another source of bloviating rhetoric in the public sphere. Evidence-based experts have the credibility they do because they know the evidence. It seems plausible, then, that our experts should fulfill their function in a certain way. They should pay attention to the way their messages are framed. Their messages should be framed in a way that respects people’s autonomy over their own health choices, and that treats decision-makers as reasonable individuals capable of weighing relevant evidence. Doing so would presumably lead to a more moderate message – one that, in this case, emphasized the potential links between alcohol use and fetal alcohol syndrome, that admitted just how much we do not know regarding this question, and that stressed potential reasonable responses to the existing evidence. Importantly, this can be done without overstating the case, without ignoring the nature of the risk (as seems to have happened regarding the alcohol-SIDS link), and without ignoring the amount of risk associated (as seems to have happened regarding the alcohol-Fetal Alcohol Syndrome link).

The unbearable asymmetry of bullshit

By Brian D. Earp (@briandavidearp)

* Note: this article was first published online at Quillette magazine. The official version is forthcoming in the HealthWatch Newsletter; see http://www.healthwatch-uk.org/.

Introduction

Science and medicine have done a lot for the world. Diseases have been eradicated, rockets have been sent to the moon, and convincing, causal explanations have been given for a whole range of formerly inscrutable phenomena. Notwithstanding recent concerns about sloppy research, small sample sizes, and challenges in replicating major findings—concerns I share and which I have written about at length — I still believe that the scientific method is the best available tool for getting at empirical truth. Or to put it a slightly different way (if I may paraphrase Winston Churchill’s famous remark about democracy): it is perhaps the worst tool, except for all the rest.

Scientists are people too

In other words, science is flawed. And scientists are people too. While it is true that most scientists — at least the ones I know and work with — are hell-bent on getting things right, they are not therefore immune from human foibles. If they want to keep their jobs, at least, they must contend with a perverse “publish or perish” incentive structure that tends to reward flashy findings and high-volume “productivity” over painstaking, reliable research. On top of that, they have reputations to defend, egos to protect, and grants to pursue. They get tired. They get overwhelmed. They don’t always check their references, or even read what they cite. They have cognitive and emotional limitations, not to mention biases, like everyone else.

At the same time, as the psychologist Gary Marcus has recently put it, “it is facile to dismiss science itself. The most careful scientists, and the best science journalists, realize that all science is provisional. There will always be things that we haven’t figured out yet, and even some that we get wrong.” But science is not just about conclusions, he argues, which are occasionally (or even frequently) incorrect. Instead, “It’s about a methodology for investigation, which includes, at its core, a relentless drive towards questioning that which came before.” You can both “love science,” he concludes, “and question it.”

I agree with Marcus. In fact, I agree with him so much that I would like to go a step further: if you love science, you had better question it, and question it well, so it can live up to its potential.

And it is with that in mind that I bring up the subject of bullshit.

Continue reading

Podcast: Steve Hyman, Loebel Lecturer 2015, on categorising mental disorders

Oxford Loebel Lecturer 2015, Prof. Steve E. Hyman (Broad Institute at Harvard/MIT), discusses the challenges surrounding the categorisation of mental disorder and the widely-used DSM-V on Philosophy Bites.

 

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