Skip to content

Health

Ending It, in Paternia

In the Republic of Paternia there has, of late, been a vigorous debate on the question of whether the law should change to permit marital separation in some circumstances. Some desperate Paternian couples have been illegally travelling abroad to engage in marital separations in Switterland (where they are permitted for now, though the Switts are becoming uncomfortable with their country’s renown for so-called “separation tourism”). Some of these couples have been dragged through the Paternian courts on their return. Sympathetic juries have often chosen to acquit, recognizing that their situations had become unbearable, that they had separated consensually, and that legal enforcement of their cohabiting marital relationship would only have prolonged their suffering. Moreover, prosecutors in Paternia have for a long time only selectively prosecuted cases of marital separation that illegally took place abroad.

Read More »Ending It, in Paternia

Renaming a Disorder

What’s in a name? Quite a lot, considering the huge commotion over proposed revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM). Almost a thousand pages long, this psychiatric bible is
used all over the world to classify and diagnose mental patients – it’s
the definitive authority on that nebulous concept known as “normal”.
The implications of any revisions are tremendous, and the American Psychiatric Association, publisher of the manual, has attracted support as well as harsh criticism.
Could these revisions actually cause more harm than good? I’m not sure,
but I want to explore the implications of just one of the proposed
revisions – that concerning EDNOS, or “Eating Disorders Not Otherwise Specified.”

Read More »Renaming a Disorder

The worth of a life and a life worth living

There has been a lot of discussion about health care rationing in the North American media over the last year, much of it hysterical and barely coherent. A number of respected ethicists have tried to make the case for rationing, including Peter Singer in the New York Times last year, and recently John Freeman.

This week Newsweek Science Editor Sharon Begley asked ‘What is a Life Worth?’ drawing on a recent study presented at the American Society for Maternal-Fetal Medicine meeting. Begley noted

“This is the kind of news that unleashes hysteria about "death panels" and "health-care rationing," but here goes: an analysis of genetic screening for an incurable, untreatable disease called spinal muscular atrophy shows that it would cost $4.7 million to catch and avert one case, compared with $260,000 to provide lifetime care for a child born with it. So here's the question: do we say, "Damn the cost; it is worth any price to spare a single child the misery of being unable to crawl, walk, swallow, or move his head and neck"—or do we, as a society, put on the green eyeshades and say, "No, sorry, we can't afford routine screening"?”

Read More »The worth of a life and a life worth living

Obesity and Responsibility

There has been a good deal of discussion about obesity recently, since the Royal College of Surgeons criticized access to weight loss operations in the UK as a ‘postcode lottery’: http://www.guardian.co.uk/commentisfree/2010/jan/21/morbid-obesity-gastric-bands-nhs-costs

One common response – for example by Catherine Bennett in The Observer (  http://www.guardian.co.uk/commentisfree/2010/jan/24/homeopathy-obesity-gastric-bands ) has been that the question of unfairness shouldn’t be permitted to arise in the first place. Obesity, since it is self-inflicted, should not be treated by the NHS at all. Rather, the money should be spent on treatments for involuntary ailments, such as cataract operations or hip replacements.

Against this, it could be argued that interventions to cause weight loss, such as gastric bands, are in fact a highly effective use of NHS resources, since (a) they tend to work pretty well and (b) they save the costs of further treatment down the line for conditions which would otherwise have been caused by the obesity. This argument, however, fails to deal with the original deflection of responsibility for obesity onto the sufferers themselves. If they bring obesity on themselves, which then gives rise to further medical problems, then plausibly they have brought those problems on themselves as well. The NHS should refrain from treatment throughout.

Read More »Obesity and Responsibility

The Disease Industry

In a recent article, “Sure, It’s Treatable. But Is It a Disorder?” the New York Times warns its readers to “brace yourselves for P.E. – shorthand for premature ejaculation”. If the pharmaceutical industry is to be believed, that may not be bad advice, since according them, “One in three men actually have the condition.” But the advice is not meant to be taken literally. What the reporter really meant was, “brace yourselves for ‘P.E.’ – shorthand for ‘premature ejaculation’”. According to the article, just as the makers of Viagra have in recent years introduced into the popular lexicon the name of a “modern man’s malady” and it’s acronym – ‘erectile dysfunction’, or ‘E.D.’, we can expect a similar effect as a result of the development and marketing of Priligy: a new pill for “men who ejaculate before copulating or within seconds of beginning.”Read More »The Disease Industry

Second-hand and second-class organs. Should the patient know?

In a urology journal this month American
surgeons describe transplanting kidneys that would previously have been
rejected as unsuitable. In each case the donor kidneys had been found to
contain a solitary mass during the transplant work-up that was potentially
cancerous. Rather than cancelling the donation the surgeons removed the kidney,
cut out the tumour, and then transplanted the tumour-free organ. This follows
reports from a couple of weeks ago that surgeons are increasingly using ‘risky’
organs from donors who are elderly or who have other serious illnesses.

Read More »Second-hand and second-class organs. Should the patient know?

Diluted evidence: is there anything special with homeopathy?

Last week I participated in the Royal Society MP-Scientist Pairing Scheme where I got a chance to see Westminster from the inside. I was lucky to end up listening to a hearing in the Parliamentary Science and Technology Select Committee about whether the government was really pursuing evidence based medicine when it funds homepathic medicine through NHS and makes MHRA decisions for homeopathy pills. Ben Goldacre was there and has of course written eloquently about the whole thing. While Booths at least admitted they selling the remedies because they made money from them, the proponents tried both to claim clear results in their favor, that statistical measurement methods did not work and that placebo had nothing to do with what they are doing. A particular howler was how one speaker argued that homeopathy should be respected for its 200-year long history, yet it was "still early days" for explaining how or if it worked.

Read More »Diluted evidence: is there anything special with homeopathy?

A Controversial Use of Taxpayer Funds

The health care reform bill currently being debated in the United States has re-ignited controversy there over abortion, and in particular over the availability of federal government funding to pay for the procedure. Earlier this month, the House of Representatives version of the health care bill passed narrowly, and with a last minute amendment that will restrict provision of abortions. The so-called “Stupak amendment” says that no health care plans receiving any subsidy from the federal government may offer abortions, except in the case where abortion is the result of rape, incest, or to save the woman’s life, and it maintains this restriction even if the government subsidies are kept separate from the private payments made into the plans, and no government subsidy is ever used to pay for abortions. The Stupak amendment represents a tightening over existing policy, according to which the federal government is prohibited from directly funding the provision of abortions, but may provide funds for hospitals, for example, that also provide abortions – so long as the hospitals pay for the abortions themselves by some other means.

The argument for Stupak’s additional restrictions on abortion funding is supposed to be that since money is fungible, the old prohibition does not really work to prevent federal funds indirectly playing a role in providing for abortions. Whatever the merits of this argument, it’s worth noting that many of its proponents in congress make it hypocritically; they are more than willing to accept generous campaign contributions drawn from the profits of health insurance companies that provide insurance for abortions as a component of their plans. But I want to focus here on the question of having any restriction of this kind at all. Can the federal government legitimately be prohibited from funding abortion?

Read More »A Controversial Use of Taxpayer Funds

Are some ethicists really really ethical?

In this blog recently Simon Rippon discussed the empirical evidence collected by Eric Schwitzgebel that suggests that perhaps ethicists are no more ethical in their behaviour than non-ethicists. A survey of academics in the US reveals that philosophers do not think that their peers specialising in ethics behave any better than those who do not study ethics. Self-described ethicists condemn meat-eating more than their peers, but their actual eating behaviour appears similar to non-ethicists. And, paradoxically, more ethics textbooks appear to go missing from libraries than non-ethics books.

As Simon noted, there are some reasons to avoid jumping from this evidence to the conclusion that the study of normative ethics is of no help in the living of a virtuous and ethical life. But even if we accept that on average ethicists are no better citizens than anyone else, it seems that at least in some cases deliberation about ethical issues leads individuals to make decisions that are highly laudable.

Read More »Are some ethicists really really ethical?