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Tattoos and taboos: making end of life preferences known when it matters

A 79 year old euthanasia campaigner in New Zealand has attracted local and international publicity after having the words ‘Do Not Resuscitate’ tattooed across her chest. Although this seems unlikely to be widely emulated her action highlights the problem that at the time when it might be most important to make one’s views known, patients are often unconscious or incompetent.

Read More »Tattoos and taboos: making end of life preferences known when it matters

Universal AIDS testing: should we save the many at the cost of harm to the few?

In a paper published in the Lancet yesterday, a group of WHO scientists
have suggested that a radical change to HIV testing would be necessary
to combat the epidemic. The authors published details of a mathematical
model of “universal voluntary testing” and early drug treatment of all
those found to have HIV in a country with HIV levels similar to those
present in Southern Africa. They present striking and provocative
evidence that this approach could reduce dramatically the incidence and
mortality from HIV within a fairly short period. The major ethical
question raised in response to their proposal is whether such a
strategy would violate the rights of individuals, and impose harms on
them in order to secure greater benefits for others.

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Status quo bias and presumed consent for organ donation

Yesterday the UK organ donation taskforce released its report on a
presumed consent (opt-out) system for organ donation. To the
consternation of the chief medical officer and the Prime Minister the
taskforce advised against the introduction into the UK of such a system.

In an editorial in today’s Guardian, it was observed that both the low
rates of consent in the UK – and the taskforce’s response to the
question of presumed consent may represent an irrational preference for
the default position. They may both be examples of the status quo bias.

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Travelling for Treatment

A BBC report today suggests that “many” UK couples are going overseas to choose the sex of their children. What seems most odd about this is that in some cases they go to places where sex selection is illegal.

What is interesting here is the fascination with what people do when they go overseas or why they go overseas. There are a whole range of stories about Britons going overseas to get things that they cannot get in the UK – or cannot get in the UK as cheaply. The obvious examples are sex selection, assisted suicide or treatments not available on the NHS.

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If evolution grinds to a halt, we move on

According to professor Steve Jones human evolution is grinding to a halt. The reason is, at least in the developed world, we have so good living standards and hence low mortality that we are not suffering any selection. He also argues that the mutation rate has been reduced because changes in reproduction and the larger gene pool. He concludes: "So, if you are worried about what utopia is going to be like, don’t;
at least in the developed world, and at least for the time being, you
are living in it now." As I see it, he has a very modest view of utopia. More seriously, do we have some kind of obligation to evolve?

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Knowledge may be power, but is it healing?

The
explosion of medical information on the internet is a good thing,
right?  Patients worried that their condition
is not being taken seriously, those who want a second opinion but are worried
about upsetting their GP by asking for it, and those with symptoms too trifling
or embarrassing to take to a doctor—all these people who, fifteen years ago, may
have felt at a dead end with the medical profession can now use
the internet to research their conditions from the comfort of their own homes.

Read More »Knowledge may be power, but is it healing?

The price of ignorance: the Durham study and research ethics

Ben Goldacre (who seems to be one of this blog’s favorite
sources) tears into the Durham fish oil trial. A while ago Durham County together with the company Equazen decided
to test whether giving omega-3 supplements would improve the GCSE scores of
children. Unfortunately there were clear problems with the trial design. In the
face of criticism the organisations involved refused to give out information on
the experimental setup and even claimed not to be running it as a trial (despite numerous statements to the
press). GCSE scores did not generally increase. Despite this, now positive results are claimed – largely because what is measured has been changed to suit
the data. The most vexing thing about the whole affair is that the
trial could have been done in a proper manner for the same amount of money.

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Publishing Negative Research Results

Ben Goldacre, in the Guardian this weekend, noticed the range of headlines on health and health risks that are to be found in the media. He mentions, among others, the rise of ‘manorexia’, the failure of water to induce weight loss and the dangers of antibiotics to prevent premature birth. I found a couple more: It turns out that dark chocolate can reduce the risk of heart attacks, vegetable rich diets and in particular vegetables like broccoli reduce the chance of heart disease and stroke and turmeric, the spice that makes curries yellow, can reduce the size of hemorrhagic stroke.

It’s quite striking what research is done!

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A Nasty Dilemma for NICE

After a prolonged disagreement with patient groups, the NHS’s funding guidance body, NICE, has approved the £10,000-an-eye blindness treatment, Lucentis. The drug has been shown to halt the progression of wet age-related macular degeneration (AMD), the most common cause of blindness in developed countries. But as the BBC  note, in approving it, NICE may have unwittingly deprived the NHS of a much cheaper alternative.

Read More »A Nasty Dilemma for NICE