News outlets have been discussing a call to require health warnings on alcoholic drinks comparable to those placed on cigarette packets. Amongst other recommendations, the All Party Parliamentary Group (APPG) on Alcohol Misuse has called on political parties to include a health warning on all alcohol labels, and to deliver a government-funded national public awareness campaign on alcohol-related health issues.
If this proposal is to be implemented, it is important to note that there is an important disanalogy with placing health warnings on cigarette packaging. Whilst cigarettes always damage health to some degree, a large body of evidence suggests that moderate drinking is not only non-harmful to health but may in fact promote it. Continue reading
Epigenetics and Blaming Pregnant Women: Hasty Conclusions, Control, and Simplified Burden of Responsibility
In a recent (13.8.2014) article in Nature , Sarah S. Richardson and colleagues maintain that careless discussion of epigenetic research on how early life affects health across generations could harm women.
Authors discuss the extensive history of placing the burden of responsibility of a child’s health on the lifestyle of the pregnant mother – and the means for controlling women’s behavior. Authors describe how, for example, evidence of any fetal harm easily lead to zero-tolerance regulatory frameworks and severe informal and formal consequences (e.g. social condemnation for an occasional sip of alcohol despite the ambiguous evidence that very moderate and occasional drinking should harm the fetus), and how the “lack of emotional warmth” of the “refrigerator mothers ” was considered to be the reason to child autism as late as the 1970s. Going even more backwards in the history, various defects were attributed, for example, to the company the mother kept during pregnancy.
When Are Objections ‘Religious’ Objections?: Hobby Lobby, Wheaton College, and Contraceptive Coverage
On June 30th, the Supreme Court of the United States handed down its decision in Burwell vs. Hobby Lobby. The case required the court to consider whether closely held for-profit companies owned by individuals with sincere religious objections to abortion should receive a special exemption from providing healthcare coverage for contraceptives that may act after fertilisation but before implantation of an egg. Coverage of twenty types of contraceptives – including the four specific types that the owners consider to be abortifacients – is otherwise legally required as part of the employer-sponsored health insurance mandated by the Patient Protection and Affordable Care Act 2010 (ACA). For a more in depth overview of the facts of the Hobby Lobby case and the key questions before the court, see my previous post on this blog. Continue reading
Suppose that the government is proposing a new policy regarding buildings of historical significance. Rather than simply banning the destruction of ‘listed’ buildings, the new policy would allow their destruction, provided that whoever destroys the building agrees to construct, somewhere nearby, a new building of a similar size, in a similar style, exhibiting a similar range of architectural innovations, and of a similar level of beauty. Blenheim Palace could be flattened and built over with a shopping mall and carpark, provided that mall developers agreed to construct a replica of the palace somewhere nearby.
Most would be disturbed by such a policy. Part of the reason that they would be disturbed, I presume, is that it seems to manifest a failure to recognise the true value of historical buildings. Not all of the value of historical buildings consists in their possession of generic properties like ‘being beautiful’, ‘being in the baroque style’ or ‘using space to dramatic effect’. Some of their value is value that they have as particular objects, and that could thus not be realised in any other object. Part of the value of Blenheim Palace derives from it’s being the birthplace of Winston Churchill. This value could not be realised in a replica of the palace built 5 miles down the road.
Of course, no-one is proposing a policy of sort I’ve just outlined. I bring it up because I think reflecting on this kind of case may throw some light on recent discussion regarding biodiversity offsetting (see, for example, here, here and here). Continue reading
The National Institute for Health and Care Excellence (NICE) recently recommended that the NHS should learn from commercial weight loss programmes such as Weight Watchers, Rosemary Conley and Slimming World. The NICE guidelines suggested that doctors should take a “respectful” and “non-judgemental” tone when helping patients to lose weight. As well as this, GPs were encouraged to continue to identify overweight patients for referral to state-funded commercial weight loss schemes, run by companies such as Weight Watchers, with obese adults being given priority.
The plan is estimated to cost hundreds of millions of pounds, but is also likely to save the NHS vast amounts in the long run, if successful in reducing obesity. Approximately 1 in 4 adults in the UK are obese, a condition that is linked with other ailments such as diabetes, heart disease and some cancers. The costs to the NHS attributable to people being overweight and obese are projected to reach £9.7 billion by 2050. Figures show that Weight Watchers and similar schemes manage to reduce participant’s body weight by 3 per cent, and NICE believe that even this small amount will help in the long term. Is it right, therefore, that the NHS subsidise the cost of these commercially run weight loss schemes?
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
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 today. According 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.
This week, a landmark ruling from the European Court of Justice held that a Directive of the European Parliament entailed that Internet search engines could, in some circumstances, be legally required (on request) to remove links to personal data that have become irrelevant or inadequate. The justification underlying this decision has been dubbed the ‘right to be forgotten’.
The ruling came in response to a case in which a Spanish gentleman (I was about to write his name but then realized that to do so would be against the spirit of the ruling) brought a complaint against Google. He objected to the fact that if people searched for his name in Google Search, the list of results displayed links to information about his house being repossessed in recovery of social security debts that he owed. The man requested that Google Spain or Google Inc. be required to remove or conceal the personal data relating to him so that the data no longer appeared in the search results. His principal argument was that the attachment proceedings concerning him had been fully resolved for a number of years and that reference to them was now entirely irrelevant. Continue reading
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
“Whoa though, does it ever burn” – Why the consumer market for brain stimulation devices will be a good thing, as long as it is regulated
In many places around the world, there are people connecting electrodes to their heads to electrically stimulate their brains. Their intentions are often to boost various aspect of mental performance for skill development, gaming or just to see what happens. With the emergence of a more accessible market for glossy, well-branded brain stimulation devices it is likely that more and more people will consider trying them out.
Transcranial direct current stimulation (tDCS) is a brain stimulation technique which involves passing a small electrical current between two or more electrodes positioned on the left and right side of the scalp. The current excites the neurons, increasing their spontaneous activity. Although the first whole-unit devices are being marketed primarily for gamers, there is a well-established DIY tDCS community, members of which have been using the principles of tDCS to experiment with home-built devices which they use for purposes ranging from self-treatment of depression to improvement of memory, alertness, motor skills and reaction times.
Until now, non-clinical tDCS has been the preserve of those willing to invest time and nerve into researching which components to buy, how to attach wires to batteries and electrodes to wires, and how best to avoid burnt scalps, headaches, visual disturbances and even passing out. The tDCS Reddit forum currently has 3,763 subscribed readers who swap stories about best techniques, bad experiences and apparent successes. Many seem to be relying on other posters to answer technical questions and to seek reassurance about which side effects are ‘normal’. Worryingly, the answers they receive are often conflicting. Continue reading