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Public Health

I Don’t Care Too Much for Money, Money Can’t Buy Me Lungs

Is it true that “everyone’s a winner”, as Julian Savulescu suggested recently on this blog , if we price life and body parts? Let’s accept that if there is a valid objection to buying and selling body parts, it must be grounded in the recognition of a harm that would come to some person or group of people. Consider, then, Savulescu’s suggestion that we should price body parts, and engage in buying and selling of them. We could categorize the potential harms that it might generate under the following headings:

(1) Harm to the participants in the transactions: donors, recipients, or facilitators

(2) Harm to specific third parties

(3) Harm to society at large

Read More »I Don’t Care Too Much for Money, Money Can’t Buy Me Lungs

Eugenics or ‘reprogenetics’? Call it what you will, but let’s do it

As The
Times recently
reports:

 

“British couples are to be offered a groundbreaking genetic test that
would virtually eliminate their chances of having a baby with one of more than
100 inherited diseases. The simple saliva test, which identifies whether
prospective parents carry genetic mutations that could cause life-threatening
disorders such as cystic fibrosis, spinal muscular atrophy or sickle-cell
anaemia in their children, is to be launched within weeks in Britain… If the
procedure, which will cost about £400 per person or £700 for a couple, is
widely adopted, it could dramatically reduce the incidence of 109 serious
inherited conditions that collectively affect one in every 280 births.”

 

Surely we should be delighted at such great news?
Surprisingly, not everyone agrees. Some experts object that the test, devised
by the Californian company
Councyl, could lead to “back door eugenics”.
They also argue that the
diseases it detects are too rare for most people to need screening, and that it
will cause needless alarm. Finally, they fear that it will raise demand for
embryo screening and abortion.

 

Read More »Eugenics or ‘reprogenetics’? Call it what you will, but let’s do it

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

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

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

Longer life, more trouble?

An article in the Times argues that life extension will bring us problems: long-lived people will bankrupt the NHS, pensions would become expensive, the pension age would need to be changed, there would be a pressure for resources and life would become meaningless. It is a surprisingly common criticism that would never be levelled at… Read More »Longer life, more trouble?

How not to criticize the NHS

The British National Health Service (the NHS) has been in news a lot recently. First it was the Investor's Business Daily in the US, which claimed that:

'People such as scientist Stephen Hawking wouldn’t have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.'

This is a particularly ridiculous claim as Stephen Hawking of course has lived in the UK all of his life! He responded saying:

Read More »How not to criticize the NHS

Pandemic Vaccination: Who to Vaccinate?

Fears of the spread of pandemic influenza in the UK continue to grow. Three apparently previously healthy patients have died here. There are now plans for widespread immunisation later in the year – though initially this is likely to be restricted to those at highest risk, and those in 'vital' professions.

Who should be vaccinated? This is a question of distributive justice.

Read More »Pandemic Vaccination: Who to Vaccinate?