Practical Ethics

Cold and Calculating NICE

Yesterday's Daily Mail online contains an opinion piece bemoaning the decision by NICE - the UK body responsible for rationing healthcare resources - to decline funding for four new treatments for Kidney Cancer. The Mail complains:

...what does NICE offer by way of explanation? A cold, calculating statement that, while the drugs work for many of those with advanced kidney cancer, they are not 'cost-effective'.

What a clinical way to assess whether a person should be afforded precious extra months and years of life, or consigned to a 'death sentence'.

I don't want to defend NICE's decision in this particular case, but the Mail's attack on NICE's "clinical" decision-making process is clearly unjustified.

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.

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?

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.

Genetic discrimination and the future of health insurance

The US Congress today passed legislation banning the use of genetic information by insurance companies, unions and employers. As Dominic Wilkinson noted in his post on 26 April, this legislation might have interesting implications for professional sport. The reform also raises questions about the future of insurance markets.

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.

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.

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?

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.

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.