Practical Ethics

The bread of life: should we enhance our food?

A new study from the US suggests that folic acid supplements may substantially reduce the risk of premature birth. This has reinforced calls for the fortification of flour with folic acid. Although this reported effect on preterm births is new, there are well documented public health benefits of folic acid.(1) The food standards agency in the UK finally decided in May last year that folic acid would be added to either flour or bread, after years of lobbying.

Supplementing bread and flour is an effective way of providing health supplements on a population level. But how much should we add to food staples in the name of public health? Should additives be limited to those that prevent serious disease, or if available, should we add things to food that enhance health?

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.

I won't be coming to work today - I'd rather go back to sleep

The BBC reported yesterday that the inability of some people to get out of bed in the morning is genetically determined. A study at the University of Zurich found that individual cells have ‘clocks’, which regulate body processes. The schedule of these clocks determines whether one is better suited to early mornings or late nights.

When a pattern of behaviour is found to be biologically based, those who exhibit it often find themselves excused from responsibility for it, particularly if it is correctable. It is not the fault of dyslexics that they make mistakes reading and spelling, and it is not the fault of Tourette syndrome sufferers that they make offensive remarks. As a result, medical help is provided for sufferers of these conditions. Sometimes, however, the view that those who exhibit undesirable, biologically-determined behaviour should be excused from responsibility for it, and their behaviour medically corrected, is controversial. For example, many view the widespread prescription of Ritalin to treat attention-deficit hyperactivity disorder (ADHD) in children as suspect, in part because it encourages the view that unruly but normal children are diseased, and therefore excuses those children and their parents from applying discipline to reign in the offending behaviour.

Synthetic life

      Last Friday’s issue of Science contained a paper announcing the creation of a synthetic chromosome by a team of scientists headed up by the biologist and entrepreneur Craig Venter. Venter is a very controversial figure. He was described as the ‘bête noire of the scientific establishment’ by Colin Blakemore in an article that appeared in The Observer on Sunday. Blakemore calls for a public debate to establish a regulatory framework for research on synthetic life. He suggests that in the absence of such a debate we may see legitimate concerns about the risks of synthetic life hijacked by religious organisations, such as the Catholic Church, who worry about scientists ‘playing God’. And religious organisations are not the only organisations that have had an emotional response to synthetic life. The Canadian biotechnology lobby organisation, the ETC group, who call for a moratorium on the release and commercialisation of synthetic life forms have a comic strip, prominently displayed on their website, which ends with the birth of Synthia, a ‘new species of bacterium with entirely human-made DNA’, replete with an evil-looking face and little horns on its head.

Paying for better health: Should patients be able to pay for expensive cancer drugs?

In the last month there have been a number of cases of patients with terminal cancer appealing for access to novel drugs that are not currently funded under the NHS. In Scotland yesterday a man with terminal bowel cancer succeeded in his battle to get NHS funding for a new and expensive drug cetuximab. This follows the recent publicity over two patients with breast cancer who have been fighting to be allowed to pay privately for another new drug bevacizumab.

These drugs are genetically engineered antibodies developed by a US biotech company to target growth factors commonly found in tumour cells. The drugs have been shown to improve survival of patients with some cancers, but evidence is lacking in other types of cancer.

This sort of dilemma is not unique to the UK. There is similar debate about access to bevacizumab in Canada and Australia. Some of the debate is about the science, and whether or not the drugs have been conclusively proven to be of benefit. However there are also ethical questions about the rationing of expensive treatments in public health care systems. It is generally accepted that there are finite resources available for healthcare, and that not all treatments can be afforded. But if public funding isn’t available for health treatment should patients be able to pay privately to access them?

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.

Objective Research Funding? An Approach to quantify the Value of Experiments

The distribution of research funds is clearly not based on purely objective criteria. Most countries have different ways of how to deal with this issue – all face different, but serious problems. Bruce Knuteson (MIT) has developed a formula of which he claims is able to estimate the scientific merit that a proposed experiment will give back per monetary unit before we actually perform it. Knuteson’s formula estimates the gain to be obtained by a proposed experiment in terms of the reduction in information entropy the experiment is expected to provide. This is a seductive concept: Large scientific projects, think of ITER at Cadarache or the Large Hadron Collider at CERN – cost the public a lot of money. The ‘right’ distribution of research money is thus not only of interest to promote the future success of scientific research, but also of larger societal interest. The Swiss newspaper Neue Zürcher Zeitung (NZZ) reports on Knuteson’s formula. Can it really help to provide objective and rational criteria for funding the right type of research?

I'm Not a Number; I'm a Human Being: RFID Tags and Our Personas

Swedish athletes Carolina Klüft and Stefan Holm (currently reigning Olympic champions in the heptathlon and high-jump events) recently suggested that elite athletes might have an obligation to implant chips or carry GPS transmitters in order to allow anti-doping organisations to track them. Meanwhile medical researchers debate whether patients should be tagged implanted chips for identification purposes. While such suggestions almost universally provoke a shudder and remarks about Orwell's 1984 other people voluntarily chip themselves: some to access nightclubs, others to "hack" themselves. We might resist some privacy invasions, but eagerly invite others. Should we just get it over with and let the government tag us all?