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Medical ethics are ridiculous

Medical ethics are ridiculous

In a blistering letter in the current issue of the British Medical Journal, Miran Epstein identifies some of the factors we should consider in assessing the claims of so-called ‘evidence-based medicine’.[1] Nobody rationally disagrees with the suggestion that medicine should have an evidence base, and everybody should agree that in order for medicine to be based on reliable evidence, it should be free of the following ‘polluters’:

  •  financial conflicts of interest
  •  inadequately rigorous selection criteria, outcome measures and criteria of statistical significance
  • the practice of testing products against placebo or no treatment (rather than current treatment), and then shouting ‘Eureka!’
  • recruiting subjects using financial incentives that introduce outcome bias
  • marketing campaigns masquerading as research

Compromising with Racism

Over at Slate, Tanner Colby has a critique of liberal US school busing policies that’s well worth reading.  Some historical context: in the wake of Brown v. Board’s 1954 mandate to integrate school districts, a pattern of ‘white flight’ emerged – white parents moving from city centers to the suburbs to avoid having to send their children to racially integrated schools.  School busing was a court-enforced reaction to this movement, designed to force the children of those who had fled to the suburbs to integrate by busing students in the whiter suburbs to more minority-dominated schools and vice-versa.  Busing has more recently been rolled back by various courts and local governments, much to the chagrin of liberals – but Colby argues the policy was actually a massive failure to begin with.  He makes some important points concerning a central goal of integration (to get students of different races to truly socialize and interact, not merely sit in the same classrooms and cafeterias) that busing did not achieve, and towards the end offers a glimpse of an alternative Colby thinks is superior.  This alternative essentially involves compromising with racism by having blacks be bused to predominantly white schools, but (acceding to the racially-motivated demands of white parents) not vice-versa.  Yet despite the allegedly good consequences of the compromise, there are inherent problems with it.  These problems, I submit, give us strong reason to reject compromising with racism in this instance.Read More »Compromising with Racism

Difficulties in assessing the risks of hydraulic fracturing and shale gas extraction: new study shows correlation between birth defects and proximity to gas wells in Colorado.

Natural gas extraction is associated with several known teratogens. A study published in the journal Environmental Health Perspectives on January 28th by researchers from the Colorado School of Public Health and the Department of Epidemiology of Brown University, USA, finds that for those babies born of mothers living with greater density of natural gas wells within a ten mile radius of their residence, there was an increase in congenital heart defects, and a possible link with increase in neural tube defects. 1
This is significant for current debates about the future of methods to extract shale gas inland in the UK, including the use of hydraulic fracturing (or fracking as it is more commonly known). Fracking involves a method for extracting natural gas from impermeable rocks deep within the earth by deep drilling, firstly vertically, then horizontally, and the injection of a mixture of water, sand and chemicals at high pressure into the wells to cause fissures into the rock (hydraulic fracturing) through which natural gas can escape up to the surface. The aim is that the fracturing will take place beneath the water table so that the water supply is not polluted by the mix of chemicals, methane gas and rock that are produced. The water sand and chemical mix that had been injected into the well is then partially recovered (it is never possible to recover all of it) and this waste fracking fluids, complete with fragments of rock from deep in the earth, must be disposed of. The technology requires that large numbers of wells are drilled in order to extract the gas, and requires the transportation of millions of gallons of water and chemicals to the drill, as well as some method of disposal of the waste. (The precise method of disposal for proposed UK fracking is not yet clear: in the States, evaporation pits are often used, but these are, for good reason, illegal in the EU.)
The debate about the safety of fracking is complex and it is important to tease apart some of the many points that may possibly muddy the debate. One of the difficulties is collating and assessing evidence of harm; another difficulty is in assessing how we extrapolate data of risks and benefits from one situation to another, when there may be variations in geography, geology, techniques used, chemicals used, regulations, and law. There is much to consider, so here I just discuss a couple of points to indicate how complex the debate is. One main lesson should be that simplistic assurances of lack of risk from fracking should be listened to with caution.

Read More »Difficulties in assessing the risks of hydraulic fracturing and shale gas extraction: new study shows correlation between birth defects and proximity to gas wells in Colorado.

Assisted Suicide in Scotland

Kevin McKenna offers a spirited critique (http://www.theguardian.com/commentisfree/2014/feb/01/assisted-suicide-bill-scotland) of Margo MacDonald’s bill on assisted suicide, proposed recently to the Scottish Parliament.

 Behind the rhetorical references to the ‘culture of death’ MacDonald is seeking to introduce in Scotland, and her ‘deathly obsession’, there are some old arguments, which remain as weak as ever.Read More »Assisted Suicide in Scotland

Time to stop the abominable illegality of kidney markets

Do you like the ambiguous title? No, I don’t think illegal kidney markets are intrinsically abominable. Insofar as they are abominable in various respects it is entirely a further consequence of the abominality of making them illegal. The abominable politicians who passed the law and sustain the law are to blame for thousands of deaths every year.

A fundamental argument for a market in kidneys is that they’re my kidneys and it’s up to me what I do with them, so keep your nose out of it. I would also direct you to an earlier argument of mine based on the ultimatum game, in which I show that if it is true that the offers in that game should be fair, then failing to pay donors for kidneys is unfair. But perhaps you’d prefer an argument based on better consequences. Let me give you one:Read More »Time to stop the abominable illegality of kidney markets

“One cup of joe and your brain is ready to go”? – Caffeine as memory enhancer

The first systematic study investigating the effects of caffeine on human performance – sponsored by Coca-Cola – has been published about 100 years ago. Since then, thousands of other studies have been looking at if and in which ways caffeine improves cognitive performance. This question is still debated in science, but there is general consensus that caffeine can be seen as an enhancer for specific functions like mood, attention, concentration and reaction time. These enhancement effects have been shown in studies with the general set-up that participants first took caffeine and then did a performance task. This matches our everyday representation of “wise” caffeine use: if I wanted to enhance my performance with caffeine, I’d take it immediately before the “critical situation”, for example an exam.

Read More »“One cup of joe and your brain is ready to go”? – Caffeine as memory enhancer

Do we have a right to drink? On Australian thugs and French hedonists

It has been an interesting week awaiting the announced reforms on the alcohol laws in New South Wales, Australia. After another incident with alcohol fuelled violence where a young boy died due to an unprovoked single punch, the family of this young man, Thomas Kelly, submitted a petition asking for intoxication to be taken into account in sentencing as a mandatory aggravating factor, rather than a mitigating factor, which is now sometimes the case. While the government reflected on what to do about alcohol induced violence, the discussion in the media sparked up high.

1. Should intoxication be an aggravating or mitigating factor?

Read More »Do we have a right to drink? On Australian thugs and French hedonists

Marathon mice, enhancement and the will to work out

In his article in the Pacific Standard last week, author Bruce Grierson discusses the emerging scientific evidence that the ‘will to work out’ might be genetically determined. Grierson describes a ‘marathon mouse’, the descendant of a long line of mice bred for their love of exercise, and a 94-year-old woman called Olga, who is an athletic anomaly. Both the mouse and Olga love to work out. The mouse goes straight to his wheel when he wakes up, running kilometers at a time and Olga – a track and field amateur – still competes in 11 different events. Grierson suggests that cracking the code for intrinsic motivation to exercise would lead to the possibility of synthesizing its biochemical signature: ‘Why not a pill that would make us want to work out?’, he asks. Such a possibility adds an interesting dimension to the debate about enhancement in sport, and to enhancement debates more generally.Read More »Marathon mice, enhancement and the will to work out

The Texan flautist and the fetus

Imagine that when you woke up this morning, you found yourself lying next to an unconscious stranger. The stranger has a rare life-threatening illness, and unbeknownst to you he was plugged in to your organs during the night. You are now stuck to the stranger. If you disconnect the life support he will die. If, though, you remain connected to him for most of the next year his illness will have recovered, and he can safely ben unplugged. What should you do? Are you obliged to stay attached to the stranger? It might be generous of you to give up your body, and good if you choose to do so, but should we require you to remain connected?

Read More »The Texan flautist and the fetus

The incoherence of Obama’s position on marijuana

           U.S. President Barack Obama’s recent interview in the New Yorker was surprisingly interesting.  While some have noted his disapproval towards a (hypothetical) son playing pro football out of concussion concerns, the more remarkable comments concern marijuana:  he says it’s “not very different from…cigarettes” and “I don’t think it’s more dangerous than alcohol.”  He did not come out in favour of legalisation, however, and this makes his views (and, to a certain extent, the position of the executive branch charged with carrying out federal law) incoherent – by which I mean, his various positions taken together are inconsistent.  Obama may well ‘evolve’ further as he did with gay marriage, but any such evolution will likely come too late in his term to lead to an effective, permanent change in policy. Read More »The incoherence of Obama’s position on marijuana