Bioethics, healthcare policy, and related issues.
Dawn Eden has a weird tendency to quote her own, personal feelings about any issue as evidence of the truth of factual claims she makes – often about other people’s feelings on that same issue. She thinks not merely that how she feels should dictate other people’s behavior (that’s just right wing politics in a nutshell), or even that how she feels should dictate actual facts about the world (right-wing science in a nutshell). Eden has expanded the shell of her nuttiness to include the apparent belief that her feelings both give her epistemological access to, and serve as a norm for, other people’s beliefs and values. She is constantly describing the mental contents, and emotional states, of people she clearly doesn’t understand on issues she can barely discuss coherently, and then relying on her own delusional descriptions as factual evidence for moral conclusions about those people and the topic at hand.
That’s . . . odd. (And let me say that, aside from the sheer reality-defying oddness of it, the emotional states of a woman who bursts into tears in church and sobs continuously through half the service because . . . someone making announcements talked too fast . . . are an especially dubious source of moral or epistemological norms. I hope she doesn’t get around to reading my mind, because I’d hate to suddenly find myself behaving like that.)
The LA Times reports that 20% of licensed heart, lung, or liver transplant centers in the US do not meet federal guidelines, and that they show higher-than-average death rates. This is a very serious matter, but I think there is reason to suspect that the paper is misinterpreting or over-reacting to the data.
Roman Catholic Cardinal Alfonso Trujillo has announced that anyone who participates in research that involves the destruction of an embryo – specifically, stem-cell researchers – is liable to excommunication from the Catholic church. This is apparently an expansion of existing Catholic doctrine regarding abortion providers. (Trujillo, you may recall, is the clown who released a lengthy report, quickly demonstrated to be scientifically false in almost every respect, concluding that condoms do not help prevent AIDS.)How much impact the excommunication policy will have remains to be seen. Trujillo’s justification for it, however, is more worrisome.
Stateline.org, from the Pew Research Center, has an excellent roundup of abortion laws and abortion access state-by-state. It covers much more than merely restrictive laws, but a variety of other issues, such as professional licensing, that also impact women’s access to reproductive healthcare. This is a vital resource; check it out.
Hat tip: bioethics.net
I attended an interesting conference session today on the relationship between bioethicists and the media. Most of the discussion focused on the ways the media distorts or simply does a bad job reporting controversial issues, especially on difficult or abstract subjects such as arise in bioethics. The question was pitched as “How should bioethicists relate to the media?”
I’m off to a conference. Little to no blogging until next week. I’m sure you’ll get along somehow. (I notice my traffic seems to vary almost directly with the energy I put in blogging and commenting on other blogs. I wonder if I can get it all the way to zero this week?)
The “Vital Signs Blog” earns the just-established “Stegosaurus of the Week” award with this post noting that the Mayo Clinic Web site explains (in response to a reader’s question) that there is no scientifiically verifiable link between abortion and risk of later breast cancer. This perpetual fantasy being a mainstay of right-wing propaganda, Vital Signs is concerned, weighs the issues . . . and concludes that the Mayo Clinic is wrong. Because, after all, what do they know about medicine or anything?
Am[az/us]ingly, they pounce on the Clinic’s citation of the definitive study of the issue by the National Cancer Insitute (hacks! – like they’re some sort of experts on cancer!), on the grounds that “the organization has come under fire as politically charged”. (I.e., rightwingers complain that the NCI doesn’t accept their pretend science, which in turn is grounds for dismissal of the NCI by rightwingers, because it has been the focus of complaints.)
So, congratulations Vital Signs Blog. For judging the Mayo Clinic’s knowledge of medicine by your standards, and for regarding a refusal to believe the truth by people who agree with you as evidence supporting your own refusal to believe that same truth, you are officially the Stegosaurus of the Week. Next time try thinking with the cerebral ganglion, not the sacral one.
Our lovely “Stegosaurus of the Week” Award GIF:
Official Winners may feel free to add it to their Web sites.
I have commented previously on the right wing’s penchant for dressing up their particular aversions in pseudo-medical language and imputing some sort of bogus pathology to people who have simply refused to behave as they were told. I was not aware of the ways in which that temptation has invaded the so-called “men’s rights” and “fathers’ rights” movements, however.
I just came across a comment on another blog, to the effect that today’s medical students were not even born when the AIDS epidemic was officially recognized in 1981.
Wow.
Michael Bloomberg, the Republican, but reasonably decent, mayor of New York City, has been aggressive in promoting healthful lifestyles and a healthier public environment in the City, especially through the use of the law-making and regulatory powers of government to prohibit or discourage harmful practices. Recently he spoke to a national convention on public health, advocating the use of the law to its maximal extent to promote the same goals nationwide.There is no doubt some of his initiatives here in New York have been outstandingly beneficial – none more so than the smoking ban in restaurants and bars. But each such policy raises the question of the limits of and justification for government intrusion into private behavior, especially on the frankly paternalistic grounds of improving the citizen’s own health.
Bioethics Discussion Blog has an interesting post about the new AMA guidelines for physician participation in law enforcement or intelligence interrogation practices. The AMA apparently feels they are taking a strong stand, but I’m not sure that they are. The relevant policy is quoted below:
The Global Bioethics Blog has two interesting posts recently, touching on the relations between first-world and third-world healthcare systems and patients. They raise some interesting questions about the obligations the medical haves bear towards the have-nots, and the extent to which the pursuit of our own interests in a globalized medical marketplace dooms others in far reaches of the world.
A lot of attention has been given to the recent court decision regarding the firing of a Wal-Mart pharmacist for refusing to fill birth-control prescriptions. When he refused to perform his job to even minimal standards – not only not providing medication, but refusing to refer patients to other pharmacists as he was contractually obligated to do – and was then released, he sued on grounds of “religious discrimination”. What has gotten little attention is the unbelievably unprofessional, and at times simply bizarre, behavior that this clown and his supporters contend was justified under the “conscience clause” that releases him from his obligations as a supposed professional.
Amazingly, I forgot to note the official one-year anniversary of Sufficient Scruples, less than two weeks ago. Sufficient Scruples officially went “live” June 1, 2005. Hard to believe it was that recently, or that long ago, both!
Since then, there’ve been thousands of visitors (the Sitemeter counter in the left column was initiated only a few months ago, so it does not reflect the entire total for the past year), and easily dozens of commenters. My one ongoing worry with this blog – as both regular readers already know – is lack of traffic. To those of you who have been coming by, thanks so much! To our newest visitors, welcome, and stick around! Better, bring a friend!
I’m pleased with what the blog’s become, and am inclined to continue in the same vein. But as I have said before, I want it to be responsive to the needs and interests of the vast untapped public that I am sure awaits – which would be easier if I knew who they were and what their needs and interests are. Feel free to drop me a line. In particular: Sufficient Scruples podcasts – an idea whose time has come, or a much needed void waiting to be filled? You decide.
Thanks again for a great year, and the enthusiasm for a better one to come!
This blog has been inundated with a huge traffic increase for the past two days – certainly a very welcome phenomenon, but an unusual one. Virtually all the new traffic comes from “StumbleUpon” – a Web service that feeds random Web pages matching selection criteria that you choose (it lets you “stumble upon” pages that refer to things you’re interested in). Somehow, this page is coming up a whole lot for StumbleUpon users, though, if anything, even less than usual for all the other readers.
So, first of all, of course – Welcome, Stumblers! Thanks for dropping by! (Though I see you share the universal aversion to leaving comments.) Please come back often.
However, I’m a little puzzled. Does anybody know why this page is getting so much StumbleUpon traffic suddenly? Is it a fluke, or are there a lot of users who are interested in bioethics? Am I doing something right that I should keep doing?
As always, feedback, comments, and visits are much welcomed.
Online Beeb has an interesting article on the debate over euthanasia in the UK. They quote Len Doyal as coming out in favor of active euthanasia, which their headline bills as some sort of shocker (readers of medical ethics literature will know this is not a new or even especially rare position to take – it has just been backburnered in the public debate on end-of-life care). The real point of interest to me was the breadth of opinion now being openly bandied about. Another interesting point is my recognition that some parts of that range of opinion are new, at least on the public stage, and some people or organizations that uphold what were once radical positions have been forced into opposing others who are now going further than those so-called radicals feel comfortable with.
All of which is by way of saying that there may be something to this slippery-slope business after all.
Martin at Health Policy and Research has exactly the right take on malpractice trial optimality:
[T]he data on medical malpractice is incredibly murky. It is not at all clear that the sensitivity and specificity of malpractice lawsuits is where it should be, but that is a very different question than if, from a policy perspective, we should put caps on malpractice awards.
The data probably are murky, but they’re not that bad. And I am not sure how “incredibly murky” data support a conclusion that “something must be done!“, as the tort “reformers” keep insisting. Normally, inability to produce convincing evidence is considered tantamount to admission that your position is insupportable – but somehow, the burden is always on the other side to disprove any conservative claim, no matter how groundless.
At any rate, what impresses me about Martin’s post is that, even while seemingly critical of the tort system, he manages to identify the correct decision-making criteria: the sensitivity and specificity of malpractice trials (i.e., the likelihood of “true positives” – correct awards for well-grounded accusations of malpractice – and the likelihood of “true negatives” – correct rejections of false malpractice claims – respectively) as means of adjudicating claims of wrongdoing. As with any test or evaluative procedure, there will be a certain percentage of Type I (false positive) and Type II (false negative) errors. The question is not whether malpractice trials are a perfect way of adjudicating accusations, but whether they are better than any available alternative. (A recent study, often cited in support of the call for “tort reform”, actually suggests that the sensitivity of malpractice trials is quite high.) There is also the question whether whatever level of benefits (if any) we might derive from abandoning or changing the tort system is worth eviscerating the Constitutional role of civil trials in settling disputes of this type.
Whatever we decide to do, we must evaluate the tort system as we would any other method of decision-making and problem-solving. Medical science, in particular, gives us the tools for evaluation of medical testing procedures – which malpractice trials, in a certain way, are. What we want for the malpractice adjudication system (aside from the question of the method of actually setting compensation in proven cases) is what we want from any medical test: the highest possible sensitivity and specificity commensurate with available technology and resources. Viewed in that light, the mere fact that awards are made – virtually the only evidence typically offered against the current system – has no significance. The burden not only remains on “reformers” to prove their case – they have not essayed that burden at all so far.
Saw the X-Men movie this past week, and was struck by how explicitly the “biological deviance” theme was brought out in the plot. Of course, that is the main driver of plot tension throughout the three movies (and to some degree in the original comic books, I gather, though I haven’t read them). But, even more so than in the first two movies, the third installment delves into the bio-politics of “normalcy” and prejudice, in interesting, though somewhat complicated, ways.
It’s a juicy subject for a worthwhile discussion, and a welcome sign in these days of otherwise unbridled bigotry and repression.
