By Brian D. Earp See Brian’s most recent previous post by clicking here. See all of Brian’s previous posts by clicking here. Follow Brian on Twitter by clicking here. UPDATED as of 27 May, 2013. See the bottom of the post. The AAP report on circumcision: Bad science + bad ethics = bad medicine For… Read More »The AAP report on circumcision: Bad science + bad ethics = bad medicine
It is hardly a keen insight to note that there are a lot of problems in the world today, and that there are also lots of suggested solutions. Often these can be classified under three different labels:
In this view, it is tremendously good news that scientists are getting closer to producing artificial organs. If this goal is achieved, it will be a technological solution to the problem of transplant organ shortages – and technological solutions tend to be better than institutional solutions, which are generally much better than “good guy” solutions. The “good guy” solution to organ donation was to count on people to volunteer to donate when they died. Better institutions (such as an opt-out system where you have to make a special effort not to be a donor, rather than a special effort to be a donor) have resulted in much improved donation rates. But cheap artificial organs would really be the ultimate solution.
Of course I don’t denigrate the use of getting people on your side, nor the motivations of those who sincerely want to change things. But changes to people’s attitudes only tend to stick around as long term solutions if this is translated into actual institutional or technological changes.
Take slavery, for instance. Read More »Artificial organs: “good guys” finish last to technology
Love drugs and science reporting in the media: Setting the record straight
By Brian D. Earp, Julian Savulescu, and Anders Sandberg
Love. It makes the world go round. It is the reason we have survived as a species. It is the subject of our art, literature, and music—and it is largely the product of chemical reactions within the brain.
No wonder science is starting to unravel the ways in which we can influence it, and perhaps even control it.
Just as Darwin’s finding that we are descended from apes shocked people in the nineteenth century, so people will be shocked to find that our most lofty social ideal is something we share with our mammalian cousins and which is the subject of scientific scrutiny and even chemistry-book manipulation.
In 2008, two of us (Julian Savulescu and Anders Sandberg) published an article in the journal Neuroethics on the topic of “love drugs” – a term we use to refer to pharmacological interventions based on existing and future bio-technologies that could work to strengthen the bond between romantic partners. All three of us have an article just published in the journal Philosophy & Technology in which we build upon that earlier work. Interested readers will take the time to study those papers in full, but we have a feeling that much of the population will stop at a handful of media reports that have recently summarized our ideas, including at least one article that we think has the potential to mislead. Let us set the record straight.
Read More »Should you take ecstasy to improve your marriage? Not so fast …
* Note: this article has been re-posted at various other sites, sometimes with minor edits. This is the original and should be referred to in case of any discrepancies.
A fatal irony: Why the “circumcision solution” to the AIDS epidemic in Africa may increase transmission of HIV
1. Experimental doubts
A handful of circumcision advocates have recently begun haranguing the global health community to adopt widespread foreskin-removal as a way to fight AIDS. Their recommendations follow the publication of three [1] randomized controlled trials (RCTs) conducted in Africa between 2005 and 2007.
These studies have generated a lot of media attention. In part this is because they claim to show that circumcision reduces HIV transmission by about 60%, a figure that (interpreted out of context) is ripe for misunderstanding, as we’ll see. Nevertheless, as one editorial [2] concluded: “The proven efficacy of MC [male circumcision] and its high cost-effectiveness in the face of a persistent heterosexual HIV epidemic argues overwhelmingly for its immediate and rapid adoption.”
Well, hold your horses. The “randomized controlled trials” upon which these recommendations are based are not without their flaws. Their data have been harnessed to support public health recommendations on a massive scale whose implementation, it has been argued, may have the opposite of the claimed effect, with fatal consequences. As Gregory Boyle and George Hill explain in their extensive analysis of the RCTs:
Suppose that a despotic political regime is keeping its citizens in cramped and unhygenic labour camps. The survival and and economic productivity of the incarcerated individuals is sustained only through the widespread administration of antibiotics which helps to prevent epidemics. It is difficult for international organisations to do anything about these work camps, but one thing they could do is cut off the supply of antibiotics. This would risk the lives of thousands of inmates in the short term, but can also be expected to put an end to the work-camp system in the longer term, since it would render the camps uneconomic.
Should the international organisations cut-off the supply of antibiotics? It is doubtful whether they should.
But now suppose we replace the work-camps with chicken houses and sow stalls, and the citzens with farm animals. Many farm animals held under cramped and unhygenic conditions are kept alive, and economically productive, only through the widespread administration of antibiotics. Restricting access to these antibiotics would force the agricultural industry to reform these practices. In this case it seems more plausible that antibiotic use should be restricted. At least, this is what Robert S. Lawrence writes in The Atlantic.
By Julian Savulescu and Bennett Foddy
Former Brazilian President, Fernando Henrique Cardoso, has argued that the war on drugs has failed and cannabis should be decriminalised. He argued that the hardline approach has brought “disastrous” consequences for Latin America. Having just returned from Rio, one can only agree. One of us was staying with an eminent professor of philosophy. We were returning to her house with her 11 year old daughter, only to have our way blocked by police with machine guns. They were hunting a drug lord in the local favela – this road was the only escape route and they were preparing for possible altercation.
Cardoso highlights the practical failure of a zero-tolerance approach. A zero tolerance approach to a crime like taking drugs must always fail, in the same way as a zero-tolerance approach to alcohol, prostitution or drugs in sport will always fail. Paradoxically, the worst thing you could do to the drug lords in Rio is not to wage a war on them, but to decriminalise cocaine and marijuana. They would be out of business in one day. Supplies could be monitored, controlled and regulated – the harm to users and third parties significantly reduced.
The case for legalizing drugs has been made often, most recently by Cardoso and by Australia’s foreign minister, Bob Carr, who this week co-signed a report declaring that ‘the war on drugs has failed’. The argument is nearly always put forward in terms of the burdens that the drug war has imposed on us in terms of crime and public health. And it is true that these things give us good reason to abandon Nixon’s war on drugs. But we so rarely hear a moral argument in favour of liberalizing drug laws. This is a mistake. Although experts have told us time and time again that things would be better without the drug war, politicians have ignored the expert advice because voters do not want drugs laws to be loosened. And voters feel this way not because they think they know better than the experts, but because they have moral objections to drug use. There is a hidden moral debate driving the war on drugs that we never seem to bring out in the open.
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.
Read More »Nudge Drugs: should the social side-effects of medications weigh into public health?
By: Prof. Kenneth Boyd, Revd Professor Emeritus of Medical Ethics, Associate Editor, JME
Coming up to me at a meeting the other day, an ethics colleague waved a paper at me. “Have you seen this ?” she asked, “It’s unbelievable!” The paper was ‘After-birth abortion: why should the baby live?” by two philosophers writing from Australia, Alberto Giubilini and Francesca Minerva.
Well yes, I agreed, I had seen it: in fact I had been the editor responsible for deciding that it should be published in the Journal of Medical Ethics; and no, I didn’t think it was unbelievable, since I know that arguing strongly for a position with which many people will disagree and some even find offensive, is something that philosophers are often willing, and may even feel they have a duty, to do, in order that their arguments may be tested in the crucible of debate with other philosophers who are equally willing to argue strongly against them.
Of course for that debate to take place in the Journal of Medical Ethics, many of whose readers, doctors and health care workers as well as philosophers, may well disagree, perhaps strongly, with the paper’s arguments, we needed first to make sure that the paper, like any other submitted to the Journal, was of sufficient academic quality for us to publish; and the normal way in which we determine this is to invite academics in relevant disciplines to review the paper critically for us, so that we can eventually make an informed decision about whether or not to publish it, either in its original or (as in this case) a form revised in the light of the reviewers’ reports.
Read More »Handling Editor Defends Decision: After – Birth Abortion
By Brian Earp
See Brian’s most recent previous post by clicking here.
See all of Brian’s previous posts by clicking here.
Follow Brian on Twitter by clicking here.
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
Professor Paul Keim, who chairs the US National Science Advisory Board for Biosecurity, recently recommended the censoring of research that described the mutations which led to the transformation of the H5N1 bird-flu virus into a form that can be transmitted between humans through droplets in breath (in ferrets, the number of mutations required is frighteningly… Read More »H5N1: Why Open the Stable Door?
