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Current Affairs

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

Paying for better health: Should patients be able to pay for expensive cancer drugs?

In the last month there have been a number of cases of patients with terminal cancer appealing for access to novel drugs that are not currently funded under the NHS. In Scotland yesterday a man with terminal bowel cancer succeeded in his battle to get NHS funding for a new and expensive drug cetuximab. This follows the recent publicity over two patients with breast cancer who have been fighting to be allowed to pay privately for another new drug bevacizumab.

These drugs are genetically engineered antibodies developed by a US biotech company to target growth factors commonly found in tumour cells. The drugs have been shown to improve survival of patients with some cancers, but evidence is lacking in other types of cancer.

This sort of dilemma is not unique to the UK. There is similar debate about access to bevacizumab in Canada and Australia. Some of the debate is about the science, and whether or not the drugs have been conclusively proven to be of benefit. However there are also ethical questions about the rationing of expensive treatments in public health care systems. It is generally accepted that there are finite resources available for healthcare, and that not all treatments can be afforded. But if public funding isn’t available for health treatment should patients be able to pay privately to access them?

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Our Obligations to the Poor

The relationship between the rich and the poor countries of the world has been questioned in a number of ways today. Oxfam have released a report, Investing for Life, which suggests that pharmaceutical companies are missing an important opportunity by not focussing their attention on the large health problems of the poorest countries. At the same time, in the US, apparently significant developments have been made in the production of drought–resistant crops and, in the UK, the government’s chief scientific adviser will call for a rethink on GM crops.

These two issues pull in interestingly different ways. In the first case, the challenging question is how best to balance the value of a market-based research industry with the need to provide assistance to the poorest countries. In the second, the challenge is the price we are prepared to pay for our worries about genetically modified crops. In both cases our obligations to the poor sheds important light on the values of our society.

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