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‘Reasonable steps’ to prevent gambling

The BBC
reports today
that a compulsive gambler has failed in a High Court bid to make
the bookmaker William Hill repay £2 million of his gambling losses. The gambler, Graham Calvert, claimed that the
bookmaker failed in its ‘duty of care’ by allowing him to continue to place
bets after he had asked the company to close his account. The judge recognised that William Hill failed
to take ‘reasonable steps’ to prevent Calvert from gambling, but said that it
was probable that Calvert would have continued to gamble even had such steps
been taken, meaning that William Hill is not responsible for his losses.

Does a
bookmaker have a duty of care towards its customers? The judge in the case thought not, so let us
pose a far more modest question: ought a bookmaker to take ‘reasonable steps’
to prevent its customers from gambling in certain cases? Answering ‘yes’ to the latter question raises
a number of puzzling questions. For
example, what counts as a reasonable step, and under what circumstances ought
such a step to be taken? Consider the
reasons we might believe that pathological gambling is bad: I suggest that
three important reasons are (1) that it is irrational, in that the gambling
behaviour of pathological gamblers is highly unlikely to help realise their goal
of winning money and is highly likely to frustrate this goal; (2) that
pathological gamblers gamble often, and gamble more money than they can afford
to lose; and (3) because of (1) and (2), pathological gamblers are likely to
suffer large financial losses, which can disrupt other aspects of their lives,
such as their personal relationships, health, and career. 

Read More »‘Reasonable steps’ to prevent gambling

The Transparency of Clinical Trials

An article in the current issue of Science examines the extent to which new policies regarding the governance of clinical trials promote transparency. It goes on to suggest further issues that remain unaddressed and require attention. The authors suggest that recent policy changes have improved the extent of public access to clinical trial data. In particular, they suggest that Section 801 of the FDA Amendments Act “should go a long way in ensuring that all patients and all data are publicly accounted for.” However, with the Editor-in-Chief of the New England Journal of Medicine, they do worry that some patients “are left on the cutting room floor to make a drug look better than it really is.”

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Doublethink and double effect; donation after cardiac death

In California a transplant surgeon has been charged with a felony in relation to the death in intensive care of a young disabled man (Ruben Navarro). (See also Matthew Liao’s blog from yesterday). Ruben had a severe degenerative disorder of the nervous system known as adrenoleukodystrophy, and had then suffered further brain damage after a respiratory arrest. The surgeon is accused of administering drugs to hasten Ruben’s death so that his organs could be used for transplantation. In the event Ruben’s death took some 8 hours after removal of life support, and none of the organs could be used.

What happened after Ruben Navarro’s life support was removed remains unclear. However this case highlights some of the problems of conflicting intentions when patients are allowed to die.

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Stairlifts, wheelchairs, and radium-powered toasters

The BBC has
reported plans by the government to
ensure that all new homes are built to accommodate the needs of an ageing
population. Under these plans, new homes
would need to include features such as stairs wide enough to fit a stairlift,
downstairs bathrooms, and room for wheelchairs to turn. The plans are, reportedly, part of a wider
initiative to make entire neighbourhoods more old-people-friendly, through—for
example—building better pavements and kerbs, improving street lighting,
thoughtfully positioning bus stops, and ensuring access to amenities such as
toilets.

The plans
have been welcomed by organisations such as Help the Aged and Age Concern, who
believe that such measures will enable old people to live independently for as
long as possible. A spokesman for Help
the Aged is quoted as saying, ‘We live in an ageing population and our housing
must meet the needs of older people, both now and in the future’.

Read More »Stairlifts, wheelchairs, and radium-powered toasters

The Rogue Senator and the Protection of Genetic Information

The editors of Nature have today called for the US Senate to bypass Senator Tom Coburn’s (Republican, Oklahoma ) ‘hold’ the Genetic Information Non-discrimination Bill. The Bill, if enacted “would protect people from being discriminated against by health insurers or employers on the basis of their genetic information” but Senator Coburn has used a procedural manoeuvre called a “hold” to prevent it from coming to a vote in the Senate. In their editorial the editors suggest that by putting a hold on this Bill, the senator from Oklahoma is preventing the enormous research and clinical progress from continuing and further developing the era of personalised medicine.

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Earache for teenagers

The BBC today
reported
calls to scrap an acoustic device designed to disperse crowds of
troublesome teenagers. There are 3,500
such ‘Mosquito’ devices in use in England, which work by emitting a
sound normally audible only to those under the age of 25. The sound is turned on for 20 seconds at a
time, and becomes irritating after around 15 seconds, causing those who can
hear it to move away. Typically, the
devices are installed in areas where groups of teenagers gather, such as
shopping precincts.

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Hybrid Embryos and Dying Children

The BBC yesterday reported that the government is looking into calls to remove the ban on creating human-animal hybrid embryos using cells from dying children. As things stand the Human Fertilisation and Embryology (HFE) Bill being considered in parliament would forbid such research without the consent of the child. In a letter to health minister Lord Darzi, a group led by the Genetic Interest Group (GIG) has argued that the Bill as it stands “imposes a barrier to one of the most potent tools for research into the most severe childhood diseases.” Our understanding of diseases such as Tay Sachs and Spinal Muscular Atrophy stands to be greatly enhanced by the use of stem cells obtained from such hybrid embryos.

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Funding cuts for homoeopathy

The Guardian, Times and BBC are today reporting that National Heath Service funding for homoeopathy is on the decline. A survey conducted by Pulse has found that only 37% percent of the UK’s primary care trusts are still funding homoeopathy services, with more than 25% having reduced funding to homoeopathy in the last two years.

The real news, I would argue, is that more than a third of the UK’s funding bodies are still funding the alternative medicine.

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I won’t be coming to work today – I’d rather go back to sleep

The BBC
reported yesterday
that the inability of
some people to get out of bed in the morning is genetically determined. A study at the University of Zurich
found that individual cells have ‘clocks’, which regulate body processes. The schedule of these clocks determines whether one is better suited to early mornings or late nights.

When a pattern of behaviour is found to be
biologically based, those who exhibit it often find themselves excused from
responsibility for it, particularly if it is correctable. It is not the fault of dyslexics that they
make mistakes reading and spelling, and it is not the fault of Tourette
syndrome sufferers that they make offensive remarks. As a result, medical help is provided for
sufferers of these conditions. Sometimes, however, the view that those who exhibit undesirable,
biologically-determined behaviour should be excused from responsibility for it,
and their behaviour medically corrected, is controversial. For example, many view the widespread
prescription of Ritalin to treat attention-deficit hyperactivity disorder
(ADHD) in children as suspect, in part because it encourages the view that
unruly but normal children are diseased, and therefore excuses those children
and their parents from applying discipline to reign in the offending behaviour.

Read More »I won’t be coming to work today – I’d rather go back to sleep