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International/ Global Health

Is it criminal not to breastfeed?

by Rebecca Roache

The Brazilian
model Gisele Bundchen recently—and controversially—claimed that mothers should
be required by law to breastfeed their babies for the first six months of their
lives. 
A few days later, she partially retracted the claim on her blog, insisting that her talk of a breastfeeding law should
not be taken literally.  It was simply a way of expressing her belief in the
importance of doing the best for her child. 
After all, legally enforcing breastfeeding would be madness, right?

Not
according to the Indonesian government. 
It recently passed a law giving babies the right to six months of
exclusive breastfeeding,
except in cases where medical problems prevent their mothers from breastfeeding.  Mothers who do not comply face a year in
prison or a fine of 100,000,000 Rupiahs (around £7,100), and those who prevent
mothers from fulfilling their breastfeeding obligations also face punishments.  Scientists and health professionals generally
agree that breastfeeding is healthier for babies than the alternatives (see,
for example, here),
that not enough mothers do it (see here),
and governments around the world invest huge sums trying to get mothers to
breastfeed.  But is criminalising non-breastfeeding mothers a good idea?

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The ethics of prescribing antibiotics

Antibiotics are overprescribed. That is, they are given out in many cases where they will achieve little or nothing for the patient. On its own, this would merely be wasteful, but usage of antibiotics increases the development of antibiotic resistant organisms and this is bad for everyone. Today's Guardian has an article suggesting that antibiotic resistance could become a *very* big problem, with all major antibiotics becoming ineffective within a couple of generations (see also the original research in the Lancet). This leads to some very interesting questions concerning the ethics of prescribing antibiotics.

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Why pander to the pandas?

Chris Packham has recently (and not for the first time) suggested that we should stop trying to save the panda — an expensive exercise — and instead put our efforts and resources to ‘better use.’ This suggestion is worth some unpacking.

His argument is a familiar one about cost-effectiveness and resource allocation: we should use our resources so as to maximise their beneficial effects. This kind of argument relies, of course, on an estimation of the value of pandas (and so the disvalue of their extinction) with the cost-effectiveness of saving them being this value divided by the cost of doing so. This is then compared to the value and cost-effectiveness of other environmental concerns like protecting “biodiversity hotspots”.

Importantly there is a range of ways of valuing pandas and biodiversity that each may give different answers to the question of what we should do. It is instructive to consider a number of combinations of these to see how they might pan out and affect Packham’s claims.

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Pandemic ethics: Party to the flu (or vigilante vaccination)

A public health expert has warned yesterday against the idea of swine-flu parties, arguing that it may undermine the fight against the emerging pandemic. But others, including James Delingpole in the Telegraph have embraced the idea, hoping that mild influenza now will protect against more serious illness later. Exposure parties might be thought of as a form of vigilante vaccination against influenza.

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The flu paradox: is the WHO focusing too little on flu?

The WHO is in the news these days thanks to the H1N1 epidemic (alias the swine flu, or the Colbert flu), and it is doing an admirable job coordinating various national agencies in fighting a pandemic. Historically it has been at the forefront of fighting epidemic disease, whether tuberculosis or AIDS. However, since Gro Harlem Brundtland's director-generalship 1998-2003 there has been an increased emphasis on public health, in particular fighting alcohol and tobacco use but also traffic accidents. Has the WHO aimed at the right or wrong problems?

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Pandemic ethics: The boy who cried ‘flu’!

The headlines in the last week have been dramatic. California has declared a state of emergency. The World Health Organisation has raised its pandemic alert status to level 5 – its second highest level. The UK government is about to post leaflets to every household providing information on how to reduce spread of an outbreak of H1N1 influenza (swine flu).

It is not clear whether the threatened pandemic will eventuate. But the response to a possible or to a real pandemic raises a number of ethical questions. This blog will hopefully address some of those questions in the coming days. But here is one to start with. How ought the government to respond to the threat of pandemic influenza?

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The root cause

On April 16 2007  a solitary gunman, Cho Seung-Hui, killed 32 of his fellow students at Virginia Tech, and injured many more http://www.cnn.com/2007/US/04/18/vtech.shooting/index.html .  This came to mind again as I was listening to Radio 4’s Any Questions last Friday, when a questioner referring to the terrorist attacks in Mumbai asked whether we could ever put a stop to extremist violence.  In the subsequent debate difference of opinion began to appear between the panellists who spoke about the need for security and intelligence gathering and military operation, and Caroline Lucas of the Green Party who insisted that terrorism could never be ended by these means, and said several times that we needed to get to the root cause of the problem.  In starting to identify these root causes she mentioned the Palestinian situation, and the widespread feeling among Muslims that the so-called war on terror was really a war of the West against Islam.  (You can check the detail by going to the BBC i-player: http://www.bbc.co.uk/iplayer/ .)

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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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The world’s failure to fulfill its goals

The Guardian reports that the world is not on track for meeting the UN Millennium Development Goal to halt and reverse the increase in Malaria by 2015. While the funding for malaria prevention has increased up to $1 bn per annum, this is not enough to meet the declared goal. Indeed, while the figure sounds high, it is only $1 per person at risk or 0.002% of world GDP, which is not much for one of the UN’s major poverty reduction targets. Scientists at the Kenya Medical Research Institute estimate that 50% to 450% more funding is required to make the target. Sadly this situation with the malaria target is not unusual: the current estimates are that we will fail to meet every single one of the Millennium Development Goals (MDGs).

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Reverse Prostitution: cognitive biases and conditional cash transfers

Stuart Rennie writes a thoughtful blog on bioethics.net, Can
you buy changes in health behaviours? on how the World Bank backs an anti-AIDS experiment paying
young people to not contract sexually transmitted infections. The basic idea is not new, conditional cash transfer
programs in poor countries have had successes in improving health and education but applying it to sexual health moves it into more
controversial territory. Is there anything wrong with “reverse prostitution”?

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