Skip to content

Tom Douglas’ Posts

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?

Read More »Paying to top up NHS treatment

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?

Trading on Testosterone: Doping and the Financial Markets

Two cambridge researchers have found that  found that the amount of money a male financial trader makes in a day is correlated with his testosterone level. The pair – John Coates and Joe Herbert – also found that a trader’s testosterone at the beginning of a day is strongly predictive of his success that day, suggesting that testosterone causes improved stock market performance, rather than the reverse.

Read More »Trading on Testosterone: Doping and the Financial Markets

PatientsLikeMe.com

The New York Times recently published a feature article on a website called PatientsLikeMe. This is an online community like facebook or MySpace, but with a medical twist. The members have serious medical conditions, like Parkinson’s disease, multiple sclerosis, or HIV, and they use site to post quantitative information about their treatment and symptoms. The site then presents this information for all to see. For example, users can search the website for a drug and then view bar graphs illustrating reasons that members take the drug, the distribution of dosages, length of treatment, reasons for stopping treatment, and patient ratings of the treatment. Individual profiles also show line graphs plotting disease progression and showing major treatment events. The aim is to offer patients the information required to better tailor their own treatment.

It’s easy to think of both risks and benefits of this sort of website.

Read More »PatientsLikeMe.com

Remembering what happened vs. remembering what it meant

An upcoming issue of the Psychological Bulletin will
include a review suggesting that the memories of children may be more reliable
– at least for evidential legal purposes – than the memories of adults.

The review conducted by Valerie Reyna and Chuck
Brainerd assesses over thirty studies sparked by their own earlier research on what they call the Fuzzy Trace Theory. According to that theory, people store
two different kinds of memory of experiences: memory of what happened (verbatim memory), and
memory of the meaning of what happened (gist memory). Reyna and Brainerd hypothesised that
children rely more on the former, and adults rely more on the later, and they presented results indicating that this makes adults more prone to certain sorts of ‘false
memory’, since what an event meant to someone may be inconsistent with what
actually happened. In the upcoming review, Reyna and Brainerd will claim that the slough of publications triggered
by their initial research backs up these hypotheses.

Suppose that Reyna and Brainerd are right. What
would follow?

Read More »Remembering what happened vs. remembering what it meant

Neuro-babble

A study
published in this week’s issue of the Journal of Cognitive Neuroscience finds
that including irrelevant neuroscientific information in an explanation can
make people more likely to believe that explanation.

Three
groups of subjects – neuroscience ‘novices’, neuroscience students, and neuroscience
experts – were given descriptions of psychological phenomena followed by one of
the following types of explanation:

I. A
good explanation excluding irrelevant neuroscientific information

II. A
good explanation including irrelevant information

III. A
bad explanation excluding irrelevant neuroscientific information

IV. A
bad explanation including irrelevant information.

Novices
rated bad explanations to be more satisfying when they contained neuroscientific
information (i.e. IV > III) while students rated both good and bad
explanations more satisfying when the contained irrelevant neuroscientific
information (i.e. IV > III and II > I). No similar effect was found for
experts, who in fact rated good explanations to be less satisfying when they
included irrelevant neuroscientific information (i.e. I > II).

That neuroscientific
novices may be persuaded by neuro-babble is, of course, troubling.

Read More »Neuro-babble

Funding cuts for homoeopathy

The Guardian, Times and BBC are today reporting that National Heath Service funding for homoeopathy is on the decline. A survey conducted by Pulse has found that only 37% percent of the UK’s primary care trusts are still funding homoeopathy services, with more than 25% having reduced funding to homoeopathy in the last two years.

The real news, I would argue, is that more than a third of the UK’s funding bodies are still funding the alternative medicine.

Read More »Funding cuts for homoeopathy

A presumed consent system for organ donation

Earlier this month, Gordon Brown, writing in the Sunday Telegraph, voiced his support for a presumed consent system for post-death organ donation in the UK. At present, organs may be procured from a dead body without the family’s consent if the deceased had actively opted-on to a national organ donation register. Under a presumed consent system, all would be included on the register unless they had actively ‘opted out’.

Objecting to Brown’s proposal, the economist and journalist Irwin Stelzer writes in the Telegraph this week:

90 per cent of us favour organ donation, but only 25 per cent make advance arrangements to become donors. From that, the opt-out advocates conclude that most of the non-donors are merely negligent: they forget to register. Really?

It is equally plausible that non-participants have no objection to the procedure, but simply do not want to participate, just as many (most) people have no objection to elections, but choose not to participate, for reasons sufficient unto themselves.

This objection strikes me as unpersuasive.

Read More »A presumed consent system for organ donation

Feeling good about the failure of others

The journal Science last week published a study indicating that the reward centres in our brains are highly sensitive to the success of others. In the study, 19 pairs of subjects were presented with a task involving the estimation of the number of dots on a screen, and were then provided with feedback about their perfromance and about a monetary payment that they would receive. They were also provided with the same information about the other member of the pair. Functional magnetic resonance imaging (fMRI) was used to ascertain the effects of this feedback on blood flow in the midbrain-striatal and midbrain-prefrontal dopaminergic projections – parts of the brain implicated in generating subjective rewards, such as positive feelings, in response to achievement. The researchers analysed the cases in which both members of the pair were successful on the task and found that, in such cases, the reward centres activated more strongly in response to a given payment when the other member of the pair received a lower payment than when the other received an identical or higher payment.

The main conclusion that the authors draw from this finding is that it supports the widely held view that subjective rewards are sensitive to the success of others, at least where success is measured in financial terms. Existing studies claiming to support this view have faced difficulties in, among other things, measuring subjective rewards, but the authors of the Science article suggest they they can avoid this difficulty by using activation of the reward centres as an objective proxy for subjective feelings.

Read More »Feeling good about the failure of others