Sunday, December 15, 2013

'Tradition' doesn't constitute an argument in ethical conflicts

This weekend's column in the Kingston Whig-Standard.

I don’t know whether you had a chance to watch the musical Fiddler on the Roof. Tevye, the main character of the musical, tries to explain tradition in the opening song. And so it goes, “You may ask: How did this tradition get started? I’ll tell you. I don’t know. But it’s a tradition. And because of our traditions everyone of us knows who he is, and what God expects him to do.”

Traditions -- we come across them all the time, those time-honoured arguments for continuing along a well-worn path. Catholic bishops in the United States tell us that euthanasia is wrong, because, among other reasons, it violates medical tradition. Even the Canadian Medical Association, in a booklet published on the issue in 1993 traces some beliefs that are held strongly by some medical doctors on euthanasia back to tradition. It doesn’t take opponents of assisted dying very long to hark back to the unfortunate Hippocratic Oath that most medical school graduates are forced to take in grand ceremonies in some form or shape. These ceremonies are really quasi-religious activities where senior doctors (typically the medical schools’ professors) demonstrate their faith in their students’ ability to carry on the medical tradition. In turn, and because it is tradition, the students make wild and quite frankly oftentimes silly public promises including not to participate in what we would describe today as surgery.

Not a big surprise really, considering that this Oath got started some 2,500 years ago, likely by a Pythagorean cult. Since then the oath has been issued in revised and modernised versions by various medical associations and other interested groups. Some of the original content of the oath survived though, namely content including prohibitions on abortion and euthanasia. As it is with such documents, no reason for this is given, beyond the exhortation on doctors not to provide such services to patients.

Of course, the oath really was a reflection of particular values held by a smallish cult in Greece a very long time ago. Why in today’s day and age medical doctors who are not Pythagorean (i.e. pretty much all of them) should abide by such values is unclear. This is particularly true for Christian students, if the history of battles between Christians and Pythagoreans is true, where reportedly Christians eventually burned the Pythagorean temple to the ground and destroyed the cult for good. It is also unclear why students who wish to practice medicine should have to take any such oaths to begin with.

A colleague of mine who teaches in a medical school introduced to his students a whole range of competing ethics codes for medical graduates and then asked them to pick the one they would be most comfortable taking their oath on. Not unexpectedly the whole gamut of ethical convictions unfolded. The students in that particular medical school hailed from all corners of the world, and so were the choice of oath they picked. At least they believed that there is value in taking such oaths to begin with. It’s probably a traditional thing. Today these oaths are frequently used by medical doctors to pick and choose ‘traditions’ they like and traditions they dislike. Surgery they might do, abortion – not so much, you get the drift. The randomness of it all is reason for concern, because their decisions are not actually derived from their traditional oath, but from other value systems that are then projected into the bits and pieces of the oath that are wheeled out to ‘justify’ this, such as the stance on abortion, euthanasia, IVF and any number of other ethically controversial medical issues. It turns out tradition isn’t even a justification for anything.

Exactly the same phenomenon crops up in debates on marriage equality. There is even a Facebook group ‘1,000,000 for traditional marriage’ which garnered support from less than 50,000 people worldwide. Traditionally marriage was a one-man-one-woman thing, ergo, so goes the argument, this is how it should be like today. Well, it doesn’t take much to realise that there is no ergo justifiable here either. Nothing follows at all from the fact that we do certain things today, or from the fact that we did certain things in certain ways in the past, for how we should do things from today onward. The point I am making here is that arguments from tradition have zero substance as arguments. They are non-arguments. Each time someone tells you that you should do a certain thing because of tradition, it’s best to tell them to go away and get a life. They merely describe what we have always done or what we have done over extensive periods of our history. If that was sufficient, we could justify slavery. After all, if we bought and sold other people for such a long time, surely it’s a tradition of sorts. The fact that there was such a tradition doesn’t provide us with any moral guidance with regard to what we should do in the future.

Now, to be fair, conservative thinkers like Edmund Burke pointed out why traditions might be valuable. He claimed that traditions provide societal stability and security. Clearly there is some usefulness in societal stability and security. That argument then isn’t any longer about whether there is a good reason to keep some tradition going. That argument simply warns us of ominous consequences if we don’t keep traditions going. The truth is, of course, that even conservatives need societal progress to occur, lest their societies would otherwise be frozen in time, eventually losing out to more agile competitors on the global stage. So they are back to square one so to speak. Even they need reasons to justify particular traditions if someone clamours for particular changes to how society goes about doing business, or how doctors go about doing medicine, etc. Unless there is a good reason beyond the fact that something is a tradition we should probably be prepared to abandon traditions more frequently if we are given good reasons for doing so.

Udo Schuklenk teaches ethics at Queen’s University, he tweets @schuklenk

Saturday, December 07, 2013

What to do about science denialists

This week's column from the Kingston Whig-Standard.

One of the privileges that comes with being an academic is that one is comparably mobile, the world really is one’s job oyster.
I chose to work between 2000 and 2005 in a medical school in Johannesburg, South Africa. Sub-saharan Africa at the time was the world’s region worst hit by HIV and AIDS. At a time when HIV infected people in the West got used to the idea of living to old age, people around me literally were dropping like flies. Talk about culture shock! In the condo-complex where I lived, several of our staff members died preventable AIDS-related deaths. One of my staff member’s life-partner died from AIDS, too. He had just matriculated from college.

Many of our students were infected and discussions began in the university whether we had a responsibility to sponsor medical insurance to ensure their survival while they were enrolled with us. To the outsider this might look like an issue best understood as people in the developing world being unable to afford access to life-preserving medication. And, to be fair, the price tags of essential medicines in many developing countries remain unacceptably high. However, this is not what actually caused in excess of 360,000 entirely preventable HIV-related deaths in South Africa.
The country’s president at the time, Thabo Mbeki, and his health minister, Manto Tshabalala-Msimang subscribed to wild conspiracy theories involving Western agencies wanting to crush African people’s aspirations. In their paranoid world AIDS medicines were a means to poison Africans. HIV was not the cause of AIDS, and AIDS didn’t quite exist as a new disease. They duly found a high-profile, ironically white, United States academic and a few of his, ironically white, allies to confirm their worst fears. Being the country’s president, Mbeki quickly set up a presidential expert panel involving mainstream scientists and a bunch of denialists. A funny idea to create a sparring match between discredited academics and mainstream academics and encourage them to entertain your paranoia. Mbeki clearly thought that a scientific consensus is reached not by evidence but by discussion and some kind of compromise (as if HIV could cause AIDS just a little bit, depending on the compromise reached).

Well, Mbeki and his side-kick Tshabalala-Msimang enforced policies aimed at keeping as many impoverished South African AIDS patients away from life-preserving medicines as was possible. HIV infected pregnant women were not given access to medicines proven to drastically reduce the risk for their newborns to be HIV infected. Thousands and thousands of HIV infected newborns came into this world as a result of these crazy policies. A Harvard University study estimated that in excess of 360,000 South Africans died preventable AIDS deaths during Mbeki’s reign. Some of the medical doctors in public sector hospitals who prescribed and provided AIDS drugs to their infected patients were disciplined by hospital managers carrying out the health minister’s orders.
Ask yourself how the world would have responded if such genocidal policies had been implemented by the apartheid regime preceding the ANC government that’s running the country today. No doubt international bodies would have busily prepared genocide charges. No doubt international campaigns would have got off the ground blaming the racist government for the preventable deaths of such a large number of South Africans. A black politician with liberation credentials presiding over what could demonstrably be described as genocide barely led to people batting their eyelids. Human lives clearly remain cheaper even today in that part of the world than elsewhere. Another, even crazier, head of state, Gambia’s president Yahya Jammeh insists that a herbal concoction he invented cures AIDS. Foreign aid workers disbelieving the story end up being kicked out of the country, and any Gambian criticizing his take on this medical problem end up in jail. Meanwhile Jammeh instructed HIV infected people to stop taking AIDS drugs.

What bothers me greatly is that government policies leading demonstrably to large numbers of preventable deaths remain unpunished. It is one thing if Mbeki had said that his government decided not to provide AIDS drugs due to their high cost. If you don’t have the resources to treat everyone it is fair game to allocate resources. But denying access to life-preserving medicine to large numbers of impoverished South African public sector patients because of truly crazy ideas about Western conspiracies is surely something else. Yet Mbeki walked away, enjoying today his generous retirement pay-out. His alcohol guzzling health ministerial side-kick died eventually of liver cirrhosis. Even there she remained true to her unethical form by jumping the queue toward a donor liver.

Well, enough on AIDS. This week United States talk show host Katie Couric used her show on national TV to peddle nonsense about the HPV vaccine. In Mbeki style she juxtaposed scientific mainstream views with anecdotes supplied by vaccine critics. The impression created was that there is a genuine debate, that there are genuinely two sides to this vaccine, when patently there are no two sides. While some of the stories presented were genuine human interest stories, they showed nothing relevant at all with regard to the safety and efficacy of this vaccine. It was clearly irresponsible of Couric to give a high-profile stage to quacks promoting their anti-science agendas. Almost certainly as a result of her action people who would clinically benefit from getting vaccinated won’t get vaccinated. Some of these women will eventually go on to develop cervical cancer. Is it acceptable, for the sake of ratings to promote quacks’ views on national television? I doubt it.

To be fair, Couric’s case is different to Mbeki’s actions. Women choosing not to get vaccinated did it on bad information they received through her TV show. Arguably women making such important health care choices would do better than to listen to anecdotes on a talk show when making important health care related choices affecting themselves. Let the buyer beware, as the old Romans said. On the other hand, the impoverished HIV infected South Africans depended on the national health care system to deliver life-preserving medicines. They did not have the luxury of choice to begin with. So, while the blame for bad choices in Couric’s cases arguably should be shared between those who act on anecdotes heard on her talk show and those who produced the show, the blame in South Africa falls squarely on Mr. Mbeki’s shoulders. Remarkably until today he was neither prosecuted nor did he ever utter an apology for the genocidal policies he presided over.

Udo Schuklenk teaches bioethics at Queen’s University, he tweets @schuklenk.

Saturday, November 30, 2013

Why Animals Matter More Than We Think

This week's column in the Kingston Whig-Standard

It is the silly season of the year again. The president of the United States seemed to have nothing better to do this week than to ‘pardon’ one (well, two) turkeys, based on a popular vote that took place down south. Worldwide wall-to-wall media coverage ensured that actual animals capable of suffering and living a good life were both assigned idiotic names such as ‘popcorn,’ I kid you not, and then ‘pardoned.’ There’s something truly macabre about this kind of nonsense, given that millions of turkeys were reared in miserable circumstances for that one purpose only, to be slaughtered in equally dreadful circumstances around Thanksgiving.
We, of course, had our turkey slaughtering season a few weeks back.
In any case, this event brought home to me again how badly we treat animals that – like us – are capable of suffering and living a better or worse life. Given that most of us would agree that it is better to live in a world where there is overall less suffering than living in a world where there is more suffering, it is a bit puzzling why we rear and slaughter so many animals when we could well survive without consuming them at all.
There are actually a number of good ethical reasons for why we should begin to change how we perceive and treat non-human animals. I mentioned one already. If you think that suffering is usually a bad thing, you should aim in your daily life to reduce the suffering that could afflict you as well as anyone around you who might suffer as a result of your actions.
It turns out, we are pretty good at ensuring that we suffer as little as is feasible throughout our lives, and we do hold it against folks who make us suffer. When it comes to us inflicting pain on others, most of us have at least a guilty conscience, feelings of remorse or regret. Those who do not we call psychopaths.
Strangely when it comes to non-human animals who can also suffer, we don’t care that much anymore. That does not seem to be a terribly consistent way of dealing with the issue at hand. It doesn’t take much more than this to realize that animals matter significantly more than we typically give them credit for. If we did, would we manufacture them on an industrial scale as if they were comparable to other things we produce? Would we manipulate them genetically into growing fat faster so that we can slaughter them sooner? Would we really buy those concentration camp eggs we get at the supermarket because they are the cheapest?
It doesn’t seem all right to essentially torture these animals throughout their lives and then slaughter them, just to satisfy our demand for meat. Like us they also have only this one life. And yes, they might look different, and they might not use computers, but still their one life is all that they have. Very much like us.
Often ignored is another reason that should encourage those of us who don’t care a great deal about animals but who do care about our fellow humans, to consider reducing their meat consumption. This other reason is that it takes a huge amount of energy to actually produce the meat. We use massive amounts of fertile land to produce the animal feed necessary to grow animals (in addition to all sorts of unhealthy growth hormones, antibiotics and the list goes on). To produce 1kg of meat we roughly require between 5 and 10 kg of grain. Some have argued that world hunger would not exist if we all lived a vegetarian lifestyle and if we used the fertile land globally to produce only vegetarian food products.
Think about it, by 2050 the global population is estimated to be 50% larger than what it was just 10 years ago. Global grain demand is likely to double. This estimate is based on the conservative assumption that average income globally will also rise and so more people will be able to afford meat products. The reality is that meat production on current per capita consumption in the Western world for such a large number of people is environmentally unsustainable. If we fail to act on this issue we will see social instability on a global scale increase. This planet’s ecosystem cannot survive on its current growth trajectory.
So, whether you care about suffering or the future of your offspring, we have very good reasons to look again at our eating habits. Do I think we all simply should become vegetarians? In an ideal world that is what would happen. In the real world I’m not a vegetarian myself. I have been for some 15 years and then it lapsed for all sorts of personal reasons. What I manage to do today is to consciously limit my consumption of animals significantly. If there is a halfway digestible vegetarian meal in the restaurant, that’s what I order. Do not get me started on the incompetence of the average restaurateur to offer a decent-tasting vegetarian meal. It can’t be that difficult! In case there’s no choice of vegetarian food at all I tend to go for the animal that’s lowest in terms of its development (say, chicken instead of pork, prawn instead of chicken). I always purchase eggs in the supermarket that are from free-range chicken. That doesn’t do away with the production of chicken for the purpose of egg production, but it’s a compromise in my books that’s better than buying battery hen eggs. Similarly, I force myself to purchase meat products from local farmers who do not mass-produce livestock.
All of this, of course, is expensive. Well, that’s another good reason to limit the consumption of animal products.
I should say that all these efforts count for nothing in the eyes of animal liberation activists. Equally, many if not most of my colleagues in ethics are vegetarians or even vegans (i.e. they also refuse to consume milk or eggs). They are more consistent in their conduct than I am. What I am suggesting though, is that many animals, our environment and future generations of humans inhabiting this planet would be better off if more of us consciously reduced their consumption of mass-produced animal-based food products significantly. The nature of capitalism is such that demand would decrease and ever fewer animals would be reared in such appalling circumstances.
Perhaps that is a more realistic aim than to insist that we all become vegetarians.
Udo Schuklenk teaches bioethics at Queen’s University, he tweets @schuklenk.

Sunday, November 24, 2013

Reportedly Margaret Somerville is at it again in the Globe and Mail, celebrating her scholarship

Ha, an odd weekend this has been. Instead of completing a book chapter that's due next weekend I spent most of the time emptying the basement to prepare it for a major remodelling job. Hard labour probably feels a bit like that.

In any case, over the weekend a whole bunch of people have written to me about Margaret Somerville who seemingly had yet another Somerville-on-soapbox-with-megaphone piece in the Globe and Mail newspaper. An opinion piece in which she reportedly whinges about being judged by others based on her religious convictions and not her ideas.

It is so so tempting, of course, to contact the paper and ask for the opportunity to reply to this utter nonsense. Alas, I have sworn to myself not to read its Opinion pages (I don't access them on the internet either) while it keeps in its employ a columnist who is a known plagiarist. The lack of editorial integrity that goes with such misguided policies should have some consequences, one being my 'don't read, don't contribute' policy.

I'm note saying that the Globe and Mail isn't worth reading. It has many fine journalists and writers working for it, but for better or worse it is seriously tainted by its editorial decision to keep said plagiarist writing for it. You can't take a broadsheet quite seriously that operates like that.

So, I've got to be clear here, I am responding to what has been reported to me about said article (that I won't link to either). Ms Somerville seems essentially to be complaining about people judging her by her religious beliefs and not by her ideas.

Ms Somerville's views are not seriously discussed in bioethics, despite her hard work at selling herself as a bona fide bioethicist in her newspaper and other appearances. She doesn't publish in serious, mainstream bioethics outlets or serious mainstream international academic publishing houses. On her website there is zero evidence that she has any academic qualifications in biomedical ethics. For years she has been marketing herself as the founding director of some bioethics outfit at McGill University. Really Ms Somerville? Bragging about having founded something many years ago as evidence of current-day academic competence?

Despite Ms Somerville's reported protestations (in said article) to the contrary,  this empress is really naked. The reason why virtually nobody seriously engaged academically with her is that there is little academic professional output to engage with. She pontificates mostly in newspapers, and it's always predictably Catholic output. To give you just three examples: Catholic Church: Assisted Dying = bad. Ms Somerville: Assisted Dying = bad. Catholic Church: marriage equality = bad. Ms Somerville: marriage equality = bad. Catholic Church: abortion = bad. Ms Somerville: abortion = bad.

Ms Somerville - to give credit where probably it isn't actually due - has tried hard over the years to cover her Catholic agitprop in bioethics language. Among her favourite covers is 'human dignity'. As far as she is concerned, assisted dying violates human dignity. Human dignity here simply stands for a Catholic understanding of what it is to be human and what it is to live a dignified human life. There's nothing else Ms Somerville has actually to offer. There are no ideas to engage with.

I do encourage you to check out Ms Somerville's Wikipedia entry. It seems to be a hard-fought-over entry. There are ongoing debates about her being turned down as an expert witness by US Courts. The entry tries hard - at the time of writing - to persuade us that Ms Somerville is a serious academic by showing off two article in the first volume of an unknown journal propagating Christian family values. It is all a bit of a joke, to put it mildly. An anti-gay campaign outlet masquerading as an academic journal, not affiliated with any serious international publisher. The Table of Contents downloads as MS Word documents. Hilarity all around here.

Perhaps, Ms Somerville, you would be better off stopping crying in public that nobody takes you quite seriously in the academy. It is you, after all, who has given professionals working in the field that you unjustifiably claim as your own so very little reason to engage you as an intellectual. If I wanted to engage thoughtful Catholic bioethicists, there are plenty of them. We do argue with each other. The key phrase here is that we 'argue'. Ms Somerville doesn't argue, she pontificates.

Saturday, November 23, 2013

Against taxpayer funded access to IVF services

This weekend's column in the Kingston Whig-Standard, on IVF funding and adoption.

More than a few of my friends, colleagues and even family members think I am wrong on the issue of in vitro fertilization (IVF) funding for infertile couples.
For the life of me I cannot see what interest the state should have in paying significant amounts of money to satisfy some people’s interest in having their own genetically-linked children. I do understand that some people want to have a child that is biologically linked to them. I think the desire is irrational, but evolutionary pressures probably explain this drive to get hold of their ‘own’ child as opposed to opting for an adoptive kid.
My objection to IVF is not religiously motivated. Regular readers of this column will know that I am as secular in approaching ethical issues as they come. So I don’t care strongly about how babies are made, whether it’s by sexual intercourse, IVF, or any number of other means, including reproductive human cloning when that comes eventually about. My argument is not about prohibiting access to IVF. I am concerned about ongoing discussions – even court cases – aimed at getting taxpayers to pay for this sort of thing through our public health care system. In Canada, health care being a provincial matter, we see very different approaches. Wealthier provinces such as Quebec – just kidding – pay for IVF treatment cycles while poorer provinces such as Ontario have chosen not to. Well, who is right?
Given that the question is whether the public health care system ought to provide free-to-user IVF treatment cycles, it’s worth asking: is infertility a disease? I guess it depends on how you define disease. Some infertile people campaigning for taxpayer-funded access to IVF compare their infertility to cancer and other serious illnesses. You might want to ask someone struggling with life-threatening cancer what they make of that kind of comparison. Clearly, infertile people can live perfectly healthy lives very much like other people who choose not to reproduce. The latter choose not to reproduce, the former cannot, but both are able to live healthy lives. If you think that not being able to reproduce biologically is a sign of illness justifiably demanding tax monies to be thrown at it you will obviously disagree. At a minimum though it isn’t self-evident that infertility is an illness. It is also unclear whether we could find a sensible cut-off-point for IVF treatments that ought not to be funded. The oldest woman carrying an IVF caused pregnancy to term was a 74 years old. The sky is the limit and profit maximization is the name of the game for the fertility industry. Unsurprisingly the fertility industry is keen to see IVF treatment cycles paid for by taxpayers as that would increase its income.
Even if infertility was uncontroversially an illness it still wouldn’t follow that tax monies ought to be expended on it. We make resource allocation decisions in health care systems (public and private) all the time. More needs to be said to justify public expense than merely ‘I want my own genetically-linked child, so you pay for my IVF treatment cycles.’ Some cash-strapped parents-to-be argued that it truly is unfair of society to expect of them to pay the $15,000-$20,000 for IVF treatment cycles. I do think to describe this as unfortunate would be correct, that it is unfair is far from self-evident. Indeed, some went so far as to say that they would not have been able to have children if it hadn’t been for someone else paying the bill for the IVF treatment. Here’s my problem with this line of reasoning: The cost of raising a child to the age of 18 currently is in the average about $250,000 in Canada. You can’t tell me that a down payment of $15,000-$20,000 is beyond anyone considering that kind of overall expenditure. If it were, perhaps that would be a good reason to reconsider your spending priorities in life, or better even, your life-plan.
An expert panel working on behalf the last Liberal government in Ontario recommended that IVF treatment cycles be provided free of charge through the public health care system. It noted that some people who rely on their own funds to pay for the treatment, implant too many embryos to ensure a pregnancy. This leads to costly complications in some cases. My response to this argument would be that folks engaging in such risk-taking ought to be required to take out insurance to cover any health care cost their irresponsible behavior requires.
Be that as it may, my broader objection to IVF goes beyond merely bickering about scarce health care resources being wasted on people’s preferences for biologically linked children over – say – adoptive children. I think it’s actually a morally problematic choice to produce more children by costly artificial means while children in need of adoptive parents exist in the country. Yes, I’m not talking Madonna-style purchases of babies in the developing world, but needy children in our own backyard.
At the moment tens of thousands of children in Canada are in need of adoptive parents. They are still looking for a family to call their own. Most of these kids were biologically conceived by people unable to look after them. It remains true that it is for most of us a tad bit easier to make children than to look after them. To my mind it would be decadent of any public health care system to subsidize IVF procedures while in its jurisdiction large numbers of children are in need of permanent homes. It just does not make sense to me. I readily acknowledge that the non-commercial adoption system in this country is far from perfect, but I doubt – given what’s at stake – that there can be a perfect system.
Udo Schuklenk holds the Ontario Research Chair in Bioethics and Public Policy at Queen’s, he tweets @schuklenk

Friday, November 15, 2013

There is no 'War on Christmas'

Here's a link to this weekend's column in the Kingston Whig-Standard.

It’s that time of the year again where books need to be sold and the alleged atheists’ war on Christmas needs to be fought again at all cost.
Failed U.S. vice-presidential candidate Sarah Palin is currently busily hawking her book on the topic, Fox ‘News’ has also started its annual War-on-Christmas campaign, lest we forget that Christmas is coming. For better or worse, being connected to that part of the world courtesy of the Internet and cable TV, even Canadians can’t quite escape the manufactured outrage by assorted business minded Christians like Ms Palin.
So, quick reality check: do us atheists fight a war on Christmas, and presumably elsewhere holy wars on Eid, Diwali and whatnot else that is celebrated by our religious brethren? Do we celebrate anything spiritual at all or is our life really one of eternal boredom stripped of anything deep and meaningful? Our kids, are they really robbed of Santa Claus when all the other kids dress for the occasion?
Well, brace yourselves, most atheists in the West are actually known to celebrate Christmas. It is true that we do not treat Christmas as a time of religious worship, but hey, that puts us in the same boat as the vast majority of Canadian Christians. The latter cannot quite be bothered to trek down to their local church and listen to a preacher’s sermon even during their supposedly most holy of religious events. Incidentally, in addition to Christians we have a hell of a lot of Canadians who worship competing invisible friends in the sky, so they also don’t do Christmas as the Christian churches want us to do. The odds are that the majority of Canadians do not actually treat Christmas as a time of worship but a time of public holidays, gift shopping and literally any number of other things that have zilch to do with the God-related activity that Christmas historically was all about. Most of us have kind of grown out of the religious appendage attached to Christmas. That doesn’t stop us from giving gifts to our kids and each other. It’s also that time of the year where many of us feel sufficiently guilty about not having donated a great deal of money to charitable causes, so it’s the cashing-in time of the year for charities. The spirit of giving isn’t quite dead yet, but it is by and large stripped of its religious meaning.
Atheists would do more or less the same thing in majority-Muslim countries around Eid, and in majority-Hindu countries around Diwali. There is even that peculiar Mexican Dia de Muertos, its Day of the Dead. It is probably fair to say that most Mexicans today will not subscribe to the ancient Aztec beliefs that gave rise to the Day of the Dead. One also can’t help but wonder how many the Muslims enjoying their Eid al-Adha celebrations would be willing to sacrifice their sons to their God, because Eid celebrations are actually celebrating a father’s willingness to sacrifice his son to demonstrate obedience to Allah – it goes without saying that the Bible offers similarly disconcerting stories of human sacrifice in the name of the Lord.
Typically atheists in those countries will simply join in the festivities and get on with their lives. We certainly don’t think it’s worth celebrating someone’s willingness to kill their children for the sake of making their respective God happy. It’s just not how we roll.
Richard Dawkins, one of the better known atheists these days, makes no secret out of his love for Christmas carols, and being an Englishman, the pulling of crackers, the smell of the Christmas tree and so on and so forth. Surely there’s nothing wrong with this. After all, the practice of gift giving around Dec. 25 turns out to be a practice pre-dating Christianity. It can easily be traced back to pagan celebrations of the northern hemisphere’s winter solstice.
What’s more difficult to accept, however, is that public holidays are inflicted upon us around Christmas time. Don’t get me wrong, I enjoy holidays as much as the next guy, but there’s something inequitable about how we prioritize Christian religious events over similar events celebrated by other religions. This matters, to my mind, because, as I mentioned earlier, Christmas has been stripped of its religious significance for most of us. So, why should we continue to have public holidays around Christmas instead of Eid, or international human rights day, or whatever else? Why not add a number of holidays to our annual leave budget and leave it to us when we would like to take them.
This surely would not stop Christians – and anyone else wanting to join in their celebrations – from enjoying Christmas. Those of us subscribing to different religious views – or none – would then be free to continue going to the gym, going shopping, being at the office, instead of being shut down for a few days while Christianity is at its celebratory activities. As it stands we unfairly prioritize these traditions over other religious traditions, and the ‘nones’, like me. That is patently unfair.
The state surely would do well to remain neutral in religious affairs. Inflicting religious holidays on everyone isn’t quite what neutrality looks like.
You could call this a war on Christmas if you wish, but at best it’s a war against Christmas holidays. I call it a campaign for fairness toward the majority of Canadians to whom Christmas is merely a cultural event, an event stripped of religious meaning altogether. You could rightly point out that the majority of Canadians are still Christians. That is true, on paper anyway. I guess my case is based on the fact that the vast majority of Canadian Christians can’t even be bothered to visit their houses of worship during this most significant time in their calendar, because – like everyone else – they are too busy gift shopping, visiting friends, and whatnot else. So, an important cultural event it arguably is, a religious event demanding a public holiday, not really.
Udo Schuklenk teaches at Queen’s University, with Russell Blackford he is author of 50 Great Myths About Atheism (Wiley 2013), he tweets @schuklenk

Thursday, November 14, 2013

Against the use of non-certified health 'remedies' in resource poor countries

My Editorial from the December issues of Developing World Bioethics.
Homeopathy organisations have taken to the skies to help sick people in resource poor countries as well as disaster zones. The thing about homeopathy is, of course, that there is zero evidence that homeopathic concoctions have any effect beyond that of other placebos.[1]Governments such as the UK's have clamped down on the quack therapy degrees that flourished for a good number of years in parts of its university sector. In 2007 a whopping 5 BSc degrees in homeopathy were offered; today there is none.[2]
While one could appreciate these homeopaths' good intentions, it is deeply unsettling that people without proper medical training use donations provided by their supporters to travel to developing countries and essentially apply their unproven concoctions on sick and dying people. During Haiti's recent cholera epidemic, on their own account they provided ‘remedies’ to cholera patients.[3] The term ‘remedy’ is probably carefully chosen by these people who show up in impoverished Haitian communities in medical-doctor-like white coats,[4] clearly giving the impression to the undereducated local populace that they are health care professionals. This masks to the uninitiated observer as well as to the local patients that their remedies are precisely that, concoctions that have no proven medicinal value. They are not medicines. The homeopathic emperor really is naked. I didn't say it first, but it is still true.
David Shaw, writing in the British Medical Journal, reports that training’ programs have been set up that ‘train’ locals in homeopathy. He writes, ‘the creation of homeopathic pharmacies increases the likelihood that Haitians will not obtain effective treatments for future illnesses. Training 38 people as homeopaths simply compounds the unethical effects of Homeopaths Without Borders' presence in Haiti, as does the attempt at legitimisation represented by their attempt to obtain official licences.’[5]
A different example: other activists reportedly traveled from the USA to virulently anti-gay Jamaica to ‘heal’ gay Jamaicans and turn them into heterosexuals.[6] Vulnerable Jamaicans were subjected to treatments that are known not to work. What is by now illegal in many jurisdictions, namely offering and providing treatments for homosexuality, is now exported to resource-poor countries. Damage is predictably done to the psychological well-being of perfectly healthy gay Jamaicans.
It appears to be the case that the developing world has become a playground for the vaguely health-related activities of activists that have been thoroughly discredited in the wealthier and better educated parts of the world. These are shocking developments.
It is an interesting question how one should approach an ethical critique of these sorts of activities, namely of well-heeled Westerners abusing their privileged situation to inflict at best unproven medical concoctions and treatments on vulnerable populations in resource poor countries. If they were professionals (say in the Jamaican case if they were psychologists or psychiatrists, or in the Haitian case medical doctors or nurses) one could report them to their professional regulatory bodies. Unfortunately, these people are not professionals, hence appeals to ethical professionalism or professional bodies fail. Appeals to common sense are also likely to fail, because who other than a fanatic would want to travel to other countries to spread the word about concoctions that they know are not taken seriously by specialist professionals in their home countries?
Ethically, all that's left to say for the Haitian situation is that it is harmful to use such unproven concoctions and therapies on patients seeking help. It is also unacceptable to present oneself as a health care professional when one is not. For actual health care professionals providing homeopathic concoctions, the charge would be that they are acting unprofessionally by not providing standard, proven medical care. Cholera cannot be addressed with unproven homeopathic remedies. People will inevitably get hurt. For the Jamaican case, the harm to perfectly healthy people is again what is at issue. It will be distressing to these people both to undergo whatever ‘therapy’ is visited upon them, and it should be just as distressing to note that they failed, given the prevalent anti-gay sentiments in the country.
Harm is also done to impoverished communities by the fundraising activities of these organisations. Gullible donors will waste valuable financial resources that could go to actual sensible health care or development goals and that will instead be diverted toward the establishment and dissemination of quack therapies and treatments in resource poor environments.
To my mind governments in the West should police these activities in the same manner that they police the activities of sex tourists who travel to resource poor countries to exploit children. Equally, governments in Haiti, Jamaica and elsewhere should not permit their most vulnerable citizens to be abused by representatives of such organizations.

Monday, November 11, 2013

AIDS activism commuted death sentences but its spirit is lost

Here's a piece I had over at The Conversation.

For those of us who were around when the HIV pandemic started in the west, How to Survive a Plague, a newly released film about AIDS activism in the US and the fight for more research is an especially difficult, if not distressing documentary to watch. People in this group will recall how friends in their early 20s and 30s died horrible deaths and there was just nothing anyone could do about it.
American AIDS activism taught us a number of important lessons – lessons that go far beyond the treatments we now have for AIDS. These activists, many of whom were HIV positive, knew that they would be consigned to the same terrible deaths that they had watched happen to friends and loved ones go through unless they were able to get their hands on medication to keep the virus that was killing them in check. On the other side were intransigent governments unwilling to fund clinical research aimed at finding a cure, or at least a treatment that would keep HIV under control.
Two successive Republican presidents, Ronald Reagan and George H. W. Bush, really couldn’t have cared less about gay men dying of an infectious disease. As Bush, his that time best mate, Republican Senator Jesse Helms, and the Roman Catholic Church put it, it was just a matter of us changing our “lifestyles” and everything would be hunky dory again.

Death focuses the mind

The film follows the ACT UP movement in New York City, which demanded large-scale and concerted research into AIDS. Its activism in those days fought first and foremost the clinical trials and drug approval system. Trial designs all too often were unconcerned about trial participants’ survival. If your only way to access promising experimental anti-HIV drugs was by participating in a clinical trial, randomised trials that asked you to accept a 50:50 chance of getting a placebo weren’t good enough.
While this might have been a sound research method, try telling someone who is dying that they have a 50% chance of ending up with a sugar pill. AIDS activists didn’t accept this lying down. They were also not prepared to wait for years for AIDS drugs to make their way through the drug approval system, because that bureaucratic course was itself a death sentence. AIDS activists, supported by a growing number of scientists, made themselves highly knowledgeable about scientific matters as well as regulatory issues to make the drug research and development system one that served their survival interests. Knowledge is power.
What’s missing in the film is that this led to interesting alliances. Old school Republican Pat Buchanan, for instance, is shown in an old CNN clip agreeing with ACT UP’s Peter Staley that people with AIDS should be able to access experimental drugs. But what we don’t see in the film is that pharmaceutical companies began bankrolling some of these activist groups because they were also interested in getting their drugs to the market quicker. AIDS made for some fascinating coalitions.
While political AIDS activism undoubtedly changed the system for the better, I’m not sure that much of this is actually replicable when you think about patient activism today. AIDS was unique in that it hit a population that was used to political activism. Gay people in those days were already accustomed to fighting for recognition of our basic civil rights and it was a been-there-done-that type thing for many AIDS activists. Many were also very well educated, fairly young, and had little to lose. Death focuses the mind as they say.

Public spectacle and political act

Any film about AIDS in the 1980s and 1990s will inevitably be about death and dying. And Survive A Plague is harrowing to watch as over the course of the film we watch some of the protagonists wither away and eventually die. Others who actually did survive spoke at the time very matter of factly that they couldn’t imagine surviving AIDS.
Dying became a public spectacle. And it became a political act. The annual events that went into creating the AIDS Quilt were huge. The quilt, which began in 1987 to carry a message of remembrance and hope, now has over 48,000 individual panels that each commemorate a life lost to AIDS and sewn together by friends and loved ones.
Adding to the AIDS Quilt in 1992. Elvert Barnes

Today our deaths have again become private acts. I sometimes wonder whether as societies we can learn something from the way death was celebrated as much as mourned in those communities in the 1980s and 1990s.

A sad indictment

Little is said in the film about survivor guilt among those who made it to the other side. Lives were also destroyed because people were unable to actually make sensible life plans. If you think you’re going to die within a few months or years, a career and pension are not what’s foremost on your mind.
The most tragic thing, to my mind, is that the advent of powerful AIDS drugs that have permitted people to live healthy lives again have basically ended AIDS activism in the west. In some places in the west, HIV infection rates are still high among gay men. But, as is all too briefly flagged in the film, millions die preventable deaths from HIV because they cannot afford access to life-preserving HIV medications in the developing world.
It is a sad indictment of Western AIDS activism that it pretty much ended as a politically powerful movement once its figureheads’ problems at home were solved. There are a few notable exceptions to this, but as a general rule, I’m afraid this is what it is. We are left today with professionalised AIDS bureaucracies that more or less go through the motions. This isn’t radical activism any longer but well-paid senior management types in upmarket office digs.
It would have been nice, in the context of the film, to hear something about the battles for survival that millions of HIV infected people in developing countries face today. South Africa’s former president Thabo Mbeki joined western HIV denialists, people who today still insist that HIV is not the cause of AIDS, with the result that more than 365,000 South Africans are estimated to have died premature deaths during his presidency because of a deliberate act of omission (namely by refusing to provide AIDS drugs through the public health care system).
No doubt, if this had happened during the apartheid years, AIDS activists would have rallied to this cause, but it didn’t cause much excitement among Western AIDS activists. HIV infected Africans struggling to survive the pandemic is a seemingly less important cause than fighting for the same cause in their own backyard.
What the US AIDS activists did was to radically change AIDS from being a death sentence to something that could be managed. For all those thrown sideways by the appearance of a such a terrible illness and who suffered the loss of loved ones, it was no mean feat. But we still need that spirit of activism and that determination to make sure others, however far away, get access to the same drugs we readily have now.

Friday, November 08, 2013

Time to legalize cannabis use in Canada

Here's this weekend's column in the Kingston Whig-Standard.

The Harper government’s general approach to policy seems to be: ensure that it isn’t based on scientific evidence. Since our great leader’s rise to power scores of government scientists have variously been muzzled or fired. Nothing is surely worse than evidence coming in the way of implementing sacred-cow conservative policies!

I had no idea that medical cannabis was high on our dear leader’s agenda, but it turns out that it is. Let me be clear about my take on cannabis. It’s as close to a no brainer as it gets that adult access to it ought to be legal. While there are health consequences if you inhale it, they are nowhere as bad as those caused by alcohol, a drug much more likely to lead to dependency. No wonder the Editor of the top medical journal The Lancet opined, ‘cannabis per se is not a hazard to society but driving it further underground may well be.’ Unlike with alcohol, you can’t overdose on cannabis. Perhaps that’s why our government is selling alcohol directly to us, while it forces us to head to illegal dealers to access a comparably much safer drug. We have discovered recently that one of Mr. Harper’s best mates, Toronto mayor Rob Ford, tends to get so hammered from his use of alcohol that he even forgets that he’s smoking crack on the odd occasion. Trust me, there is nobody who is that severely affected from smoking a joint at the weekend.  Interestingly, Mr Ford insists that he doesn’t have a drug problem, most likely because he doesn’t conceive of alcohol as a drug. It’s here where our classification system has it all backward. Surely whether an addictive substance is a drug or not cannot be a question of its legal status. Honesty demands that we acknowledge also that the prohibition of drugs of any kind has been an utter failure.  Saying this, I’m not the odd guy out. The view that the war on drugs has been an abysmal failure is shared by 68% of Canadians, according to a 2012 representative survey. I am not a great fan of cannabis myself. I tried it once or twice – who hasn’t? – and truly I don’t know what the fuss is all about. Unlike Mr Ford I can’t get my head around inhaling smoke. I cough immediately like there is no tomorrow. From what I gather, that kind of defeats the purpose.

It turns out that there is another reason to legalize adult access to cannabis. That reason came to the fore this week. There are tens of thousands of Canadians who use medical cannabis for various ailments ranging from glaucoma to pain management to asthma – in case you want to know: for the latter it isn’t inhaled but drunk as tea. There is quite a bit of clinical evidence to support the claim by medical cannabis users that cannabis has beneficial effects. Still, cannabis isn’t actually an approved medication for most or possibly all of these and other conditions. So, here’s the bizarre system Mr Harper is foisting upon these patients. Obviously his major issue is with cannabis itself, that damn hippie drug. He can’t stand it, or, more likely, his conservative base can’t stand it. So his health minister developed a nefarious scheme to remove access to cannabis effectively from legitimate medical users.

Currently registered medical users are able to access cannabis legally, even grow it legally for their own purposes, provided they meet certain clinical conditions, and provided a doctor certifies that they meet these conditions. Yes, you heard correctly, our current system asks doctors to write quasi scripts for cannabis. That’s a bit odd, because cannabis is not actually an approved drug to treat any of the conditions currently on Health Canada’s list of approved clinical conditions. Thank our legal system for this mess. Many doctors are rightly annoyed about being dragged into this medical cannabis business at all. Some doctors tried and quickly discovered that their rooms were overrun by healthy folks who really just wanted to get legal access to cannabis. Their neighbors weren’t terribly excited about their doctors’ new ‘patients’ either. In any case, while the current system wasn’t perfect, it permitted legitimate access to bona fide medical cannabis users. Those who chose not to grow their own supply could buy it from a government facility. Within the overall unjust context of the ongoing criminalization of adult access to cannabis, this system worked, up to a point.

Mr Harper’s health minister cooked up a scheme to subvert the current status quo. Combine that with Harper’s love for private entrepreneurship and voila you get the new system, coming your way in 2014. Clearly the Harper government’s main concern was to limit medical cannabis users’ access. This is achieved by first eliminating their current ability to grow their own affordable supply in a controlled manner. Then remove the government production facility and open the field to cannabis entrepreneurs. Give licenses to these medical cannabis entrepreneurs and permit them to charge the living hell out of current medical cannabis users. Many patients have done their budgets already and discovered that their annual bills will go up from several hundred dollars to tens of thousands of dollars. There is, of course, that minor constitutional issue of equal access. Harper has created a system whereby only the wealthiest of medical cannabis users will be able to afford continuing access, but nobody else. One company, CanniMed is currently pricing medical cannabis at between $9 and $12 per gram. Compare that to just cents per gram for homegrown cannabis. Many medical cannabis users will almost certainly resort to buying cannabis illegally on the street. No surprise the CBC’s The National managed to find a masked illegal cannabis dealer celebrating the new legislation and the financial windfall it means for his business. That’s how our federal government effectively criminalizes medical users of cannabis while permitting at the same time clever business people to make a fortune on the backs of desperate patients.  Well played Mr Harper, no doubt the victims of your legislative efforts will see you in court.

On the good news front, on federal level both the NDP as well as the Liberal Party support the decriminalization and legalization of cannabis use respectively. They are in line with the close to 60% of Canadians supportive of legal, controlled adult access to cannabis. However, don’t hold your breath hoping for government support on that front. Being out of touch with the majority of Canadians on important matters of public policy is a hallmark of this government. To be fair to Mr Harper, he doesn’t have to care. After all, he was elected to an absolute majority government on the basis of just a 39.62% share of the popular vote, courtesy of our first-past-the-post way of doing democracy. 

Udo Schuklenk holds the Ontario Research Chair in Bioethics and Public Policy, he tweets @schuklenk