Practical Ethics

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.”

The interesting thing about drugs like these is that the condition that they address may not be recognized as a “disease” or “medical disorder” until the drug companies set out to market a “cure” for it. And medicalizing the issue is an essential part of the drug marketing strategy.

Nice People Take Drugs (Too)

The drug and human rights charity *Release* recently launched an advertising campaign in which the slogan ‘Nice People Take Drugs’ was displayed on the sides of London buses. Their aim was to encourage society to face up to the reality that a huge proportion of the population does at least experiment with drugs and to combat the popular assumption, which underlies a good deal of political rhetoric and media coverage, that since drugs are simply ‘evil’ there is no point in seriously debating drug policy. Those ads are now being withdrawn by the company that booked the space, after advice from the Committee of Advertising Practice: http://www.guardian.co.uk/media/2009/jun/09/nice-people-drugs-ads-pulled

Apparently, Release has been told that their strap-line would be more acceptable if it included the word ‘too’. This suggests that the CAP may have felt that the public would read the original claim as equivalent to ‘All those who take drugs are nice people’. But even adding the word ‘too’ may not be enough. For the new sentence might be read as: ‘All nice people take drugs, along with other things (such as holidays when they can, advice when they need it, offence when people are rude to them, etc.).’ Of course, no one would have understood either the new or the old sentence in these ways. But in fact, though it should be up to Release how they word their strap-line (the censorship charge they have made doesn’t seem far-fetched), adding ‘too’ does bring out more clearly what they want to say: that we should stop demonizing drug-takers and have an open, impartial, and well-informed debate.

Publishing Negative Research Results

Ben Goldacre, in the Guardian this weekend, noticed the range of headlines on health and health risks that are to be found in the media. He mentions, among others, the rise of ‘manorexia’, the failure of water to induce weight loss and the dangers of antibiotics to prevent premature birth. I found a couple more: It turns out that dark chocolate can reduce the risk of heart attacks, vegetable rich diets and in particular vegetables like broccoli reduce the chance of heart disease and stroke and turmeric, the spice that makes curries yellow, can reduce the size of hemorrhagic stroke.

It’s quite striking what research is done!

A Nasty Dilemma for NICE

After a prolonged disagreement with patient groups, the NHS's funding guidance body, NICE, has approved the £10,000-an-eye blindness treatment, Lucentis. The drug has been shown to halt the progression of wet age-related macular degeneration (AMD), the most common cause of blindness in developed countries. But as the BBC  note, in approving it, NICE may have unwittingly deprived the NHS of a much cheaper alternative.

Brain Boosting and Cheating in Exams: Four Responses

A report by the Academy of Medical Sciences looking at different aspects of drug use and mental health has identified a growing trend for off-label use of drugs intended for the treatment of diseases including narcolepsy, ADHD and Alzheimer’s. The use of such drugs by a healthy individual can improve memory, alertness and concentration. While the report does not condemn the practice, it raises a number of potential concerns over safety, and fairness. Professor Les Iversen, report co-author, highlighted concerns that the use of enhancement in exams would unfairly advantage wealthier students, and suggested that the use of such drugs could be considered cheating. The report recommends that legislation is prepared to tackle the misuse of such drugs, including the potential for urine testing in schools and universities.

Below are responses from Julian Savulescu, Nick Bostrom, Anders Sandberg and Mark Sheehan on the effects of cognitive enhancing drugs, and the issue of cheating

Academic Integrity and Vioxx

Drug company Merck and its product Vioxx are in the news again. An article in the Journal of the American Medical Association (JAMA) has examined the documents from the legal proceedings against Merck in connection with the withdrawal of Vioxx from the market in 2004. From their analysis, a significant number of journal articles – mostly review articles rather than articles reporting clinical trials – were written in-house and senior academics were brought in late to be lead named author. At least one of these academics has disputed the accusations made in the JAMA article.