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Nudge Drugs: should the social side-effects of medications weigh into public health?

You are a public health official responsible for the purchasing of medications for the hospitals within your catchment area in the NHS. Your policies significantly affect which, out of the serpentine lists of heart disease medications, for example, are available to your patients. Today, you must choose between purchasing one of three heart disease medications: Drug A, Drug B, and Drug C. They are pretty similar in efficacy, and all three have been being used for many years. Drug B is slightly less expensive than Drug A and Drug C, but there is emerging evidence that it increases the likelihood that patients will take “bad bets,” i.e. make large gambles when the chance of winning is low (and thus might contribute to large social costs). Drug C costs a tiny bit more than Drug A, but there is some evidence that Drug C may help decrease implicit racial bias. You have been briefed on the research suggesting that implicit racial bias can lead to people making choices that consistently and unintentionally limit the opportunities of certain groups, even when all the involved parties show explicit commitments to social equality.  Finally, there is emerging evidence that drug A both helps people abstain from alcohol and dissociates negative emotional content from memories.

Which drug should you purchase?

 

Let us begin to think about this question through the lens of the idea of the “Nudge,” which has exploded onto the public sphere (and blogosphere) since Thaler and Sunstein’s published their book, “Nudge: improving decisions about health, wealth, and happiness.”   (see the blog here). I briefly and incompletely introduce nudges here, in hopes that we may soon move on to discuss the kind of “nudge drugs” our thought experiment considers.

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Love and other drugs, or why parents should chemically enhance their marriages

By Brian Earp

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Love and other drugs, or why parents should chemically enhance their marriages

Valentine’s day has passed, and along with it the usual rush of articles on “the neuroscience of love” – such as this one from Parade magazine. The penner of this particular piece, Judith Newman, sums up the relevant research like this:

It turns out that love truly is a chemical reaction. Researchers using MRIs to look at the brain activity of the smitten have found that an interplay of hormones and neurotransmitters create the state we call love.

My humble reckoning is that there’s more to “the state we call love” than hormones and neurotransmitters, but it’s true that brain chemistry is heavily involved in shaping our experience of amour. In fact, we’re beginning to understand quite a bit about the cerebral circuitry involved in love, lust, and human attachment—so much so that a couple of Oxford philosophers have been inspired to suggest something pretty radical.

They think that it’s time we shifted from merely describing this circuitry, and actually intervened in it directly—by altering our brains pharmacologically, through the use of what they call “love drugs.”

Read More »Love and other drugs, or why parents should chemically enhance their marriages

Is Drug Addiction a Lifestyle Choice?

According to BBC News this week, the brains of some people “may be wired for addiction.” A study has come out in the journal Science that presents evidence of abnormal brain structures that were found in drug addicts and their non-addicted siblings. The lead researcher, Dr Karen Ersche, was quoted by the BBC as saying that the study “shows that drug addiction is not a choice of lifestyle, it is a disorder of the brain and we need to recognize this.”

Has the Ersche et al study in fact shown that drug addiction is not a lifestyle choice? Has it proven that drug addicts should be treated as innocent patients with medical problems rather than being subject to moral censure for their failure to exert self-control, and for their irresponsible and often deeply anti-social behaviour? No! In fact, it is likely that no possible neuroscientific evidence could show such a thing.

Health warning: You may find brain scan images like these confusing!

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10-year-old gets a tattoo, mother gets arrested

By Brian Earp

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See Brian’s most recent prior post on this blog here.

See a list of all of Brian’s previous posts here.

 

Inking arms, piercing ears, and removing foreskins: The inconsistency of parental consent laws in the State of Georgia 

Gaquan Napier watched his older brother die in Acworth, Georgia after being hit by a speeding car. He was with him in those numbing final moments. And now Gaquan wants to keep his brother close to his own heart as he picks up the pieces and moves through life: in the form of a tattoo on his upper arm. Malik (that’s his brother’s name) plus the numbers from Malik’s old basketball jersey. Rest in peace. A memorial to his sibling and best friend, whose life was cut tragically short.

Gaquan is ten years old. So he asked his mother, Chuntera Napier, about the tattoo. She was moved by the request, by the sincerity and maturity of her son’s motivations. She assented. She took Gaquan to have the remembrance he wanted etched into his arm in ink.

Now stop the presses. Chuntera was arrested last week under child cruelty laws and for being party to a crime. Someone at Gaquan’s school had seen his tattoo and tattled to the authorities. But what was the offense?

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The cost of living and the cost of dying

X, a patient with reliably diagnosed PVS, lies in a hospital bed for years, fed via a nasogastric tube. He has not, and by definition never will have, any capacity for pain, pleasure or any sort of sensation. Devoted family members come each day to sit by his bedside, but he has no idea that they are devoted, or that they exist.
It is expensive to keep him alive. He occupies a bed and consumes a good deal of nursing time.
The NHS Trust responsible for his care has a limited budget. It decides that the money spent on maintaining his merely biological life would be better spent on dialysis machines. It can, and does, justify its decision in purely utilitarian terms. It writes in the minutes of the relevant committee meeting: ‘For the money we spend keeping X alive, we can save the lives of 10 kidney patients, each of whom will have a good quality of life for many years. The QALY arithmetic makes X’s continued existence nonsensical.’Read More »The cost of living and the cost of dying

Are Dopers better Sports(wo-)men?

by Roman Gaehwiler The crusade against artificial performance enhancement in sports is varicoloured and almost exhaustively debated. Nevertheless, there are still several approaches from the athlete’s perspective which are worth to consider. On the one hand, there is the noble and doubtlessly essential pedagogic approach fostering the educative aspect implying that the misapplication of pharmaceuticals… Read More »Are Dopers better Sports(wo-)men?

Legalize heroin

By Brian Earp

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Forget about “medical marijuana.” Isn’t it time to legalize heroin in the United States? Recreational cocaine? Ecstasy? LSD? How about the whole nefarious basketful of so-called ‘harder’ drugs?

Yes, it is, says Ron Paul, a fourteen-term libertarian congressman and obstetrician from the state of Texas. It’s a view shared by virtually none of his Republican colleagues, nor, for that matter, very many Democrats. Nor really anyone in the “mainstream” of American politics. But in this post, I’ll argue that he’s right.

Paul—who is currently making his third bid for President of the United States—offered his perspective to comedian and Daily Show host Jon Stewart in an interview earlier this week:

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Is a child a blessing?

By Charles Foster

Three years ago Ana Mejia bore a son, Bryan Santana. To her surprise he had no arms and only one leg. I should have been warned about this, she recently told a Florida court. It was negligent not to warn me. Had I been warned, I would have had an abortion. She asked the court for $9 million compensation. The jury gave her $4.5 million.

The disability rights lobby is predictably outraged. Why, they say, should it be presumed (as it clearly is), that a disabled person’s life isn’t worth living?

If that is Ana Mejia’s presumption, then (at least in relation to a child as relatively mildly disabled as Bryan) it is plainly reprehensible. I don’t know her motivation, but I doubt that she saw it that way. Many parents in her situation (and this is a very common issue in medico-legal practice) don’t make their decisions on the basis of their child’s quality of life at all. A much commoner thought is: ‘A disabled child will disrupt my own life. One of the purposes of pre-natal screening is to enable me to decline to bring into the world a child who does not fit with my ideas about how I should be living my life.’ I will call this thought the ‘pre-natal screening default thought’ (PNSD).Read More »Is a child a blessing?

Why Pro-Life Counsellors Ought to Lie

Those who are pro-choice often get frustrated by anti-abortion advocates, who are seen as using underhanded and immoral tactics to decrease numbers of abortions. These include presenting misleading information about abortions at their advice centres.
For example, it is claimed that some abortion counsellors show pictures of late-stage abortions when discussing early-stage abortions, exaggerate the trauma felt by people who have had abortions and assert that foetuses feel pain earlier than scientists believe they do. A large part of the opposition to the amendment proposed by Nadine Dorries , which would have prevented bodies which carry out abortions from counselling women, was that this might mean that more women would be counselled by anti-abortion groups who cannot be trusted to provide accurate information about abortion. I’m going to suggest that it is a mistake to think that anti-abortion advisors are failing morally by providing misleading information about abortions. Indeed, they might be failing morally if they did not do so.Read More »Why Pro-Life Counsellors Ought to Lie