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Regulation

How to Win the War on Drugs in Sport

Drug scandals again tarnish the Tour de France. Last week three riders, Spaniards Manuel Beltrain and Moises Duenas and Italian climber Riccardo Ricco, winner of two mountain stages, failed tests for the banned performance enhancer EPO. This year has seen fewer spectacular expulsions, but of course the game is not over.

Does this mean the drug testers are winning the war on drugs? It might. But it might also mean that cyclists and their doctors are getting better at evading testing. A recent BBC investigation supports the latter conclusion. WADA labs have been proven to fail to pick up positive results. There are 80 copy-cat drugs, produced in China, India and Cuba, which are difficult to detect. And labs apparently collude with doctors to “exchange knowledge” on testing procedures. Expert Professor Bengt Saltin, a leading anti-doping expert and a former winner of the IOC Olympic Prize, the highest honour in sports science, said

"I would think that most of the medal winners and many in the finals of endurance events – there is a big risk for them having used EPO."

So despite the numbers of athletes being prosecuted for EPO declining by two-thirds between 2003 and 2006, Professor Saltin concluded this was due to evasion, not a reduction in use.

"The reason that I am still a little bit upset with the whole situation is that I have seen too many suspicious samples that are clearly abnormal. Athletes are getting away with it. Look how many have been caught for EPO misuse recently."

The response is predictable: widen testing critieria. Experts have suggested that urine samples should be tested for any evidence of naturally produced EPO. If there is none, it should be classed as suspicious because the use of artificial EPO for doping causes the body’s own production to shut down. These experts also call for testing of blood profiles as well as the urine. An analysis of the number of young red blood cells can also indicate doping.

Is this a solution? No. It will simply escalate the war to the next level. History has proven the ability of athletes and their doctors to ingeniously evade detection. We will never win the war on doping.

Read More »How to Win the War on Drugs in Sport

Unpopular policy and public rationality

The BBC
reports that the Japanese
town of Kamikatsu
has become the first ‘zero waste’ town. Residents
compost all of their food waste, and must sort the rest of their rubbish into
34 different categories—all of which they must take to public waste centres,
since there are no rubbish collections from people’s homes. It seems that the inhabitants of the town are
generally enthusiastic about the scheme, which offers small financial rewards
for recycling, and has encouraged people to make an effort to reduce the
rubbish they produce.

This is one
of those relatively rare, uplifting stories about a scheme designed to reduce
environmental damage that is not only successful, but supported by the
community. Could something similar work
in the UK? Recently, many UK councils reduced domestic refuse
collections from once-weekly to once-fortnightly, with recyclable waste being
collected in the intervening weeks. Whilst this has boosted the amount of rubbish being recycled,
some news reports
reveal that the new measures are unpopular, and some councils have bowed to
public pressure by re-introducing weekly collections. Given the environmental impact of adding to
landfill waste sites, ought the government to placate the public by relaxing
measures designed to reduce waste, or should unpopular measures be enforced
regardless of public opinion?

Read More »Unpopular policy and public rationality

Paying to top up NHS treatment

The BBC has this week published a story on co-payment in the UK’s National Health Service. Sue Matthews, a Buckinghamshire woman with terminal bowel cancer, would like to top up her NHS care by paying for a £30,000 course of cetuximab – a drug which could extend her life, but which is not funded by her NHS trust. However, if she does so, she may also have to pick up the tab for her standard NHS treatment. That’s because the NHS guidelines advise against allowing such co-payments: they require that a given instance of treatment be either fully privately funded, or fully publicly funded.

Should co-payments be banned?

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“Reanimation” and Taking Organs from Living People

One of the greatest fears associated with organ transplantation is that the person from whom organs are taken is not really dead.

That nightmare was almost realised in France last week when a French patient “came back to life” after 30 minutes of unsuccessfully heart massage. In 2007, in order to address the shortage of organs for transplantation, French authorities allowed the trial of using people whose hearts have stopped beating, but who have not met brain death criteria for being dead, as organ donors. These are called Non-Heart Beating Donors. Organs can also be taken from such donors in the UK. Such patients’ hearts have stopped beating but they have not met brainstem criteria for death.

Read More »“Reanimation” and Taking Organs from Living People

My Genes, not a Doctor’s

California has sent cease-and-desist letters to firms offering Web gene tests to consumers. The legal reason is that California law requires a licenced physician to order any lab tests. This follows from a similar crackdown in New York. Wired responds by top 10 reasons that regulators should not hinder genetic testing. Is there any good reason to limit public access to genetic testing besides protecting incumbents and gatekeepers?

Read More »My Genes, not a Doctor’s

Setting a Minimum Price for the Sale of Organs

Professor Maqsood Noorani, a leading surgeon made the headlines asking for legalisation of the sale of organs to prevent the exploitation that exists in the black market. Yet his comments show that he is uneasy with the concept of a market in organs. He believes that the sale of organs in richer nations would ‘tarnish the process’, and suggests that even in poorer countries accommodation or education should be offered in exchange instead of cash. 

When two people want to freely exchange some good or service, we need good reasons in a free market to prevent the exchange. Moreover, when it comes to a market in organs, the good in question is life saving. Why then should we prevent such exchanges when there are willing buyers and sellers?

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Is there a duty to execute prisoners humanely?

An article published this week in PLoS Medicine discusses the ethics of research on US lethal objection protocols. The authors conclude:

While lethal injection and the death penalty present a host of ethical questions, the specific, pressing issue now faced by 36 US states, the federal government, and the 3,350 prisoners on death row is the movement to amend lethal injection protocols to comport with Eighth Amendment requirements and to minimize the potential for pain and suffering, in itself a commendable goal. As jurists demand lethal injection protocol changes, however, corrections officials, governors, and their medical collaborators are left in a legal and ethical quandary. In order to comply with the law and carry out their duties, they are employing the tools and methods of biomedical inquiry without its ethical safeguards. Given the current guidelines for human experimentation, it is difficult to conceive of circumstances in which lethal injection research activities could be carried out in a fashion consistent with these ethical norms, and yet those engaged in such research would seem to be required to do so.

This passage raises many questions. Is is the movement to amend lethal injection protocols really the pressing issue? Can a movement to execute prisoners more humanely really be commendable? But let’s focus on the authors main claim: namely that the states in question face a legal and ethical quandary since, (i) they are under "duties", as well as legal requirements, to execute more humanely, but (ii) they cannot do so without breaching the ethical and legal requirements.

The authors devote most of their attention to the second claim, (ii), but arguably (i) is more problematic.

Read More »Is there a duty to execute prisoners humanely?

Abortion for Fetal Abnormality?

Abortion remains a crime for most Australians. Laws are inconsistent between states. In contrast, long ago the UK Abortion Act 1967 repealed and replaced its antiquated legal statutes on which much of Australian abortion law is still based.

The government in the state of Victoria asked the Law Reform Commission to provide legislative options to decriminalize abortion. Law reform is expected later this year.

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HFEA and Regulating Reproduction:Triumph for Rationality and Victory for Secular Ethics

MPs voted on Tuesday on two of the most controversial issues surrounding reproduction- the provision of IVF treatment, and the availability of legal abortion. Under the new laws, IVF clinics will no longer have a legal requirement to consider the need for a father, but will instead be asked to ensure provision of ‘supportive parenting’, removing any barrier to single women and lesbian couples conceiving through the treatment. In a separate amendment, MPs were asked to consider the legal time limit on abortion, which currently stands at 24 weeks. Given the option to reduce this limit to 22, 20 or even just 12 weeks, MPs voted by a comfortable majority to stick with the status quo. 

The UK is now at the forefront of rational reform to legislation governing reproduction and research. The Human Fertilisation and Embryology Bill has now approved the creation of human admixed embryos, with important implications for scientific advance.

Blog on Admixed Embryos
Savulescu, J., The Case for Creating Human -Non Human Cell Lines, Bioethics Forum
Human Enhancement papers, media and other resources for free download

It has also reformed the regulation of reproduction in a thoroughly sensible manner.

Read More »HFEA and Regulating Reproduction:Triumph for Rationality and Victory for Secular Ethics

The new asbestos?

Carbon nanotubes are tiny man-made fibers with an incredibly high tensile strength. They are one of the most promising nanotechnological developments with many potential applications in electronics, medicine and futuristic materials. However, a new study by a group of scientists from the US and the UK suggests that carbon nanotubes may cause health problems similar to those of asbestos. The problem comes from their similar shapes: both nanotubes and asbestos consist of hard microscopic fibers that can cause significant damage to the lining of the lungs. The study involved exposing mice to nanotubes and found that nanotubes of a certain size caused asbestos-like inflammations and lesions.

Read More »The new asbestos?