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Public Health

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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Doctors or Resource Allocators?

A recent survey by Myeloma UK, and reported on the BBC website, suggests that many doctors do not tell patients about drugs that may be beneficial and which are licensed in the UK. The trouble is that the drugs have not yet been approved by NICE and so may be difficult to obtain on the NHS. This seems to suggest that something is wrong with the way in which NICE functions with respect to licensing and that doctors are in some way complicit.

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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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Testing alternative therapies

The journal Science is today reporting on a controversial plan by the US National Institute of Mental Health (NIMH) to test an alternative treatment for autism on children. The treatment, known as chelation therapy, involves the use of drugs that remove heavy metals from the blood. It’s based on a the theory – unsupported by conventional science – that mercury in vaccines triggers autism.

Chelation therapy is widely used, but its benefits and effects are not well understood. The NIMH have therefore argued that there is a "public health imperative" to test the drug. But opponents claim that any such study would be unethical, since the quality of the trial is likely to be poor, and any results – especially negative ones – would be unlikely to alter the behaviour of parents who support the therapy.

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Care for the Dying and Cost-effectiveness

Yesterday’s news reports the launch of the Government’s End of Life Care Strategy for England. This strategy will dedicate in excess of £250 million allowing patients who are dying to decide, as the Times puts it, “where and how to die.” This is part of a programme to provide better care for the dying. According to the BBC, only one in five deaths takes place at home despite a comfortable majority expressing a preference for such familiar surroundings. This prioritisation raises some interesting ethical issues particularly in the light of cost-effectiveness considerations.

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Preventing Polka-Dot Problems: Should Measles Vaccination be Compulsory?

Jim Todd reports about his measles experience at BBC News. A number of years back such a report about how a case of adult measles feels would have been absurd, since so many had suffered it. A few years back it would have been absurd because measles was rare thanks to vaccination. But now, due to a reduction in vaccinations, the risk of measles is rising. Health chiefs in London are stepping up the vaccination program to try to stave off the rising number of cases. The key problem is that in many areas of London only 62% of toddlers
have been immunised, compared to the 95% that is needed to achieve herd immunity.
Vaccinated people act as firebreaks: if enough people are immune to a
disease long chains of infection become improbable, and epidemics do
not occur. Given this, should measles vaccination be compulsory?

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Hunger is the best spice

Ghrelin is a hormone produced in the stomach that
appears to stimulate appetite. A recent paper in Cell Metabolism shows that
giving ghrelin to volunteers made their brains respond more strongly to food
images, reward systems in the brain became more active and they rated their
level of hunger higher. An immediate reaction in the blogosphere
was to consider the practical applications: Stomach hormone turns hungry people
into junkies (New Scientist), Fast Food Joints Add
Hormone to Food That Makes You Want to Eat More (Io9). Are we moving towards a future where
food will be literally addictive?

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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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