Smokers' and alcoholics' health care costs

More and more doctors in the UK's NHS believe that those subjecting themselves to unnecessarily high health risks by means of smoking, drinking or eating a lot ought to cover the costs for their health care (as far as their illness is related to their lifestyle choices) themselves. The Guardian reports that 4 out of 10 NHS doctors believe smokers who need heart bypasses and alcoholics who need liver transplants should not get them free of charge through the NHS.
33% believe that procedures such as IVF should be covered by patients themselves.
Here are the details.

Initiation ceremonies - the butchery continues

It's that time of the year again. As in every good year young men die in South Africa as a consequence of 'initiation ceremonies' - supposedly marking their coming into being as adults. Well, a short-lived adulthood it was for one boy who was successfully starved to death by his local traditional healer. Amusingly, the provincial health departmental spokesman in the Eastern Cape (the province notorious even in the country for this sort of thing) describes the bloke as someone 'posing' as a traditional healer, as if there was such a thing as a bona fide professional traditional healer.
Anyway, check out this link to the BBC news website for the full story, especially the 'See also' links, reporting deaths in July 2003 and May 2004, as the summer butchery going under the euphemism of 'initiation ceremony' continues.
One wonders what the cultural relativism crowd's stance on this issue would be like.

Philosophers’ Summer Jobs and Food Ethics

Had a pleasant flight back from Canada to the UK tonight. I managed to have a stimulating conversation with a female flight attendant. – No, not that kind of conversation... – Initially we tried in vain to figure out the time difference between St John’s (Canada) and London (UK), and eventually she managed to explain that ‘I’m a philosopher’, clearly suggesting that philosophers quite possibly can’t do maths all that well. I usually use that excuse when I fail to fix flat tyres and the like. In any case, inquiring whether she was serious (not about the maths claim but about her studies), I learned that she is reading philosophy at McGill University, and that she is working for that airline the name of which we shall not speak, during her semester breaks. She is currently fascinated with Gadamer’s work – Gadamer, of all philosophers. I think it is an encouraging sign if young people wanting to become philosophers, do not by default venture into the 'sexy' bits of philosophy.
Just finished reading the New York Times (June 27, 2006). It carries a review of Peter Singer’s most recent book. The ever reliable campaigner, he has co-authored a book looking at the ethical implications of the choices we make with regard to food stuffs we consume. He argues that we should not eat meat and other animal products generated by causing animal suffering, and suggests that we ought to consume ideally organic produce.
Now, here is an interesting challenge: Each time I go to my local supermarket, invariably I end up having to choose between organic OR fair-trade produce. So, it seems (at least on Glaswegian supermarket choices) I either support the environment or the developing world. I tend to settle usually for the fair-trade bananas instead of the organic ones. I am quite certain the supermarket managers deliberately set us customers up for these sort of choices in order to train our ethical critical decision-making skills. It has to be one big conspiracy of ethics teachers and supermarket chains. - Why else, I wonder, would a chain with massive purchasing power buy either fair-trade or organic produce instead of requiring its buyers to purchase produce that satisfies both requirements. You know if you buy organic, the developing world originating produce won’t have been bought at decent prices from the producers. Equally, you know that the fair-trade stuff isn’t truly environmentally friendly.
A Kingston (Canada) neighbourhood festival I bumped into proposed that we ought to buy only produce from local farmers. It all seemed very politically correct, and certainly makes sense in environmental terms (eg the produce is fresh, it doesn’t have to be shipped around the globe etc), but I wonder what farmers in Puerto Rico, Mexico and places like that will make of this kind of protectionism, and how they would survive if their products would no longer be bought by us in … yes, our much maligned local supermarkets?

Margaret Somerville gets an honorary doctorate

Margaret Somerville, a pharmacist cum lawyer at McGill University was awarded an honorary doctorate by Toronto's Ryerson University. In case you don't know Professor Somerville, in a nutshell, imagine the most conservative view someone could reasonably express in bioethics, and you have a fair idea what her position would be like. She is frequently billed as an 'ethicist' (eg here) yet the reality is that Professor Somerville doesn't seem to have any formal training in ethics. She seems to be one of the many lawyers expressing her policy oriented views under the label of 'ethics', making it look a bit more professional than to say 'this is my daily rant'.
In any case, from what I gather, Ryerson seems to have a kind of 'progressive' reputation in Canada and protests started against her receiving the award. Main bone of contention seems to be her stance against 'gay marriage'. Indeed, Professor Somerville has issued a paper arguing against gay marriage - as she claims - on purely secular grounds. The paper basically goes on worrying about the importance of marriage as a potentially procreative instituition and that it must be protected, because for all we know society as we know it would come to an end if suddenly same-sex kinda folks could also get married. Mr Wolfenden sez hello.
Professor Somerville also stresses that she is all in favour of legal recognition of same sex partnerships and against discrimination based on sexual orientation (except, it seems, when it comes to marriage and artificial insemination for lesbians).
Ryerson's award committee said that had it known about her views on the matter it might not have offered the award to her - kinda worrisome, because they seem to be a tad bit sloppy to have missed her high-profile opinion on this issue. During the award ceremony, it seems, there were some protests including professors turning their back at her. This I find a bit unprofessional to be honest. Somerville certainly is a very conservative professional, and her influence within bioethics is negligible to non-existent (after all, she isn't an ethicists in the first place), but she is entitled to her views. Her stance on same sex partnership recognition doesn't make her a raging homophobe either. Of course, she doesn't like artificial insemination for lesbians either, so while she might not be a raging homophobe, she probably is a homophobe - religious, secular, wo cares, outcomes not motives matter.
Having said that, I am bemused by her lack of critical thinking skills on this one. As a conservative she should have recognised that gay folks wanting to get married (ie gay folks wanting a straightjacket - pun intended) are her natural allies. Instead of recognising that marriage as we know it is a failing institution, they campaign for more of the same instead of thinking creatively about alternative regulatory models for longterm committed relationships between one or more people of the same or opposite sex. Mind you, some gay folks in Canada have realised this.

Different rules in different places

Have you ever noticed that there seem to be a number of key events - when visiting new places - that tell you a bit about local culture? One is the behaviour of drivers (car drivers that is). In places like Johannesburg you can be certain that if you as a pedestrian cross a road, some driver invariably will enjoy accelerating madly towards you. In other places drivers automatically slow down and stop. Halifax seems to be in the latter category. I just crossed an interchange when a car came towards me. I started running to save my sorry little life, much to the amusement of the driver wo slowed down to let me pass (smiling at that). In Johannesburg my life would have likely ended, the driver cursing the dead body for bloodying his SUV. - Different places, different rules.
But hey, not all is rosy. Small as Halifax is, during my morning stroll down a street lined with shopfronts I encountered no less than 5 beggars. Not subscribing to the idea that it is sensible to provide hand-outs to beggars in societies with functioning welfare systems I politely declined. Surprisingly, 2 of em cursed me (including using the f*** word). This I never encountered in Glasgow, which in many respects is a rougher kinda place. - Different places, different rules.
Hey, and before you tell me off for using anecdotal evidence to make a point about different places, different cultures. I know, but thanks for reminding me anyway :).

Pharmaceutical industry's bitter pills

According to Richard Gold, a law professor at McGill University in Montreal, the US pharmaceutical company Bristol-Myers Squibb is holding Canadian colorectal cancer patients hostage. The company refuses to sell its colorectal cancer drug Erbitux in Canada because the country's independent Medicine Prices Review Board considered the price the company charged too high by international comparison.
Gold argues that the government has a moral obligation to the citizens it represents to threaten the company with issuing a compulsory license for its product in order to ensure a fair price to the company and to Canadians.
Quite remarkable that BMS should try to hold a whole patient population hostage in order to achieve its profit objectives in a particular market.
[Globe and Mail, June 21, 2006, A17]

Going places

This won't be strictly speaking an ethics posting, probably it's merely an observation about things going wrong. I travelled from Glasgow to Halifax (Canada) today, and have just arrived to splendid weather. Anyway, on the plane was a group of about 20 or 30 Arab men, all dressed neatly in black suits, tie, the lot. I guess, by the suits alone everyone would have wondered who these guys are, even if they had not been Arabs. Them being clearly Arabs led to an amazing amount of gossip and speculation among the other passengers, including the Swedish woman next to me referring to them as 'terrorists' (tongue in cheek tho). To cut a long story short, the blokes were on their way from Oman to Halifax to participate in a band competition (that's what I understood). They're actually an army band. - Kind of sad what the 'war on terror' and terrorism have done to us, when the next person on a plane (a musician of all people) is suddenly put in the same box as some fanatics just because of their ethnicity...

On a lighter note, Air Canada, my preferred Star Alliance airline, punished us suckers in economy class with bags of junk food as the second meal of the intercontinental flight ('would you like doritos or chips sir?'). Quite remarkable, in this day and age, what passes as food on airlines, especially in cattle class.

Journalism and Reporting of Health Issues

Last weekend one of the local Scottish papers had a first page (ie cover page) article on the first face transplant in UK history. Quite sensibly it pointed out how this procedure had the potential to benefit those whose face has been severely disfigured due to accident or illness. It also indicated that there remain serious problems such as patients rejecting the graft. No doubt this procedure will benefit only a very small number of patients in the country.
The to my mind much bigger story, affecting the much large numbers of clinically depressed Scots, was that psychotherapy is not available to many (most?) Scots suffering from clinical depressions. Surely the overall amount of suffering this omission to provide proper psychotherapy causes (simply by way of looking at the number of people affected) is very much higher than the amount of suffering alleviated by face transplants. So, here is my question: why wasn't the issue of depression and lack of services flagged by the paper? The newspaper in question relegated this issue to a smallish news item inside the paper.

Punishing 'blasphemy' in Bavaria

Edmund Stoiber (picture to the left) the leader of the CSU party in Bavaria and the state's first minister has announced an initiative aimed at increasing penalties for 'severe blasphemy' (or Gotteslaesterung in German). I have always wondered how one could possibly be blaspheming something the very existence of which remains uncertain...
Mr Stoiber proposes to increase penalties for blaspheming religions, religious views etc to up to 3 years in prison, depending on how seriously the religious views of religious people have been hurt. If this was the yardstick, it would follow that the same type of blasphemy could lead to different types of penalties, subject to the severity of the 'injury' protested by the recipient of the blasphemy. Say, if I would make a derogatory remark about Judaism to a secular Jewish person that person would less likely take offense than an orthodox Jewish person (substitute Jewish for any other religion if you wish), or if that person would take offense he or she would likely be less seriously offended than a more orthodox believer.

Who speaks for Muslims?

This week's ECONOMIST published an interesting little article confirming my concerns about a multitude of Muslims popping up on TV news programmes. It is clear that the various talking heads we are regularly subjected to on primetime TV are supposed to tell us (ie the viewing public) what 'the' Muslims' stance is on eg the police raid in Forest Gate. By definition they cannot ever achieve this objective as there is no democratic mode of representation ensuring that Muslims all over the UK would be able to elect a spokesperson.

The multitude of Muslim umbrella organisations operating in the country, all vying for their 5 seconds of fame on national TV and membership in government advisory bodies has been compared by one Muslim (no doubt speaking for himself - it's usually a himself, but that should not surprise a great deal, given the nature of this particular ideology) to the nuttish sects fans of the Python's Life of Brian will no doubt remember.

Pharmaceutical companies and the public good

Not too unusual story in today's GUARDIAN newspaper. A pharmaceutical company tries to prevent access to a cancer medication it has invented. Ophthalmologists all over the world, according to the paper, noticed that if the company's colon cancer drug is injected into the eyes of patients going blind, remarkable successes can be achieved. The company since has investigated the matter, undertaken clinical trials and wants to prevent doctors from using its cheap cancer drug for non invented for purposes. Instead it wants doctors to prescribe the same drug under a different name and dosage to prevent blindness, at a 100% increased price.

Ein Schelm were boeses dabei denkt...

Flu- and other bugs

Just in time for an upcoming overseas trip I picked up the flu - mind you, from my partner. This reminds me of a piece, John Harris published in 1995. The argument, as I recall it, was that we should not do things like fly long distance whenever we have the flu, for no other reason then to protect our fellow human beings from harm. Couldn't agree more.

BIOETHICS ISI ranking

Funny this impact factor business, particularly as far as humanities and arts journals are concerned. In any case, BIOETHICS, one of the journals I co-edit, has dramatically improved its ISI ranking and is now in 2nd place in the medical ethics category and 3rd place in the ethics category. Me thinks, we are doing really well.

Glasgow's Ethics Reading Group

Ken McPhail who's professor of ethical and social accounting at Glasgow Uni and I have decided to start a Glasgowe wide ethics reading/discussion group. The first meeting will be held at 5:30 pm today at Uisage Beatha. Feel free to join us!

Conscience clauses

South African legislation allows doctors to opt out of providing certain services (such as abortions) if their 'conscience' does not permit them to do so. In Michigan there's currently a proposal in front of their legislature using the same conscience nonsense to push thru legislation designed to allow doctors not to treat whole groups of patients (eg gays, blacks, muslims etc). All this based on the nebulous 'conscience' thing... Check it out
Addendum: I have published in January 2006 in the Journal of medical ethics an Editorial arguing that non-professional issues (incl religious symbols) should be kept out of doctors' rooms. You can read this Editorial here.

South Africa's Blood Bank's Racial Profiling

The local blood bank (SANBS), like other such national services aims to keeps its blood supply as safe as is feasible. As you will know, the prevalence of all sorts of STIs is quite different in different groups of peoples. Say, among gay white males in the US of A HIV has probably a higher prevalence then among lesbians. So, it is SOP of many blood banks to discriminate actively against such donors. Usually the forms will state something like 'if you're a gay male and you have had sex during the last five years... please go away and watch a movie, but don't donate blood'. You'd probably argue that it would be better to ascertain what type of sex such a guy had, after all, he might have engaged in mutual masturbation with a few zillion others. In reality, this doesn't seem to have worked properly ever, hence all gay men are prohibited from donating blood if they're sexually active. By that means you reduce the likelihood that an HIV infected donation slips through. Of course, blood services test for HIV, but tend to use more often than not tests that don't pick up an infection during the 3 months window period after infection. Consequently you have a policy in place that also is in the best interest of gay male recipients of transfusion units, because they're less likely to get an infection while being transfused.

Of course, this being the new South Africa, 'race' is a big big thing, and someone discovered that the local blood banks don't use blood donated by black South Africans for transfusion purposes (albeit for other blood products that allow the heating of donated blood to the point where the virus would get killed). Main reason is that the HIV prevalence is substantially higher amongst black folks than among indian or white folks (or coloured's, another uniquely local contribution to racial classification -carried over from apartheid South Africa into the 'new' South Africa). Our health minister, has discovered that this, of course, amounts to racism and the usual evilness of 'them' out there (them being an amorphous mass of folks whose skin coloration is lighter than her's). Being (unfortunately) in charge as she is, she demands that this policy be stopped and the blood of Black donors utilised for transfusion purposes. The blood bank countered that this would result into a minimum of 100 additional recipients of infected transfusion units per year. What is particularly galling about her charge of racism is that her policy would mostly affect black patients, because the majority of recipients of transfusions, obviously, happen to be black.

Seems they could get around this issue by adding another test that is claimed to be able to pick up infections during the window period. Cost about another 90 million Rand p/a. This in a place where patients die preventable deaths, for instance because of a lack of sufficient ventilators in public sector hospitals.

Here's an interview I gave to the local broadcaster SABC. And here's a piece from the CAPE ARGUS newspaper.

Udo Schuklenk's Ethx Blog

Udo Schuklenk's Ethx Blog