Child slavery in Africa

Excellent article in today's New York Times on child slavery in Africa and other developing countries. It highlights the issue also from the perspective of families frequently selling their children into slavery in order to survive.

Germany plans to punish cancer patients who failed to undergo timely screening

The BMJ reports that Germany plans to penalise cancer patients who failed to undergo regular screening. That's very much in line with the country's policy to charge dental patients higher rates who failed to have regular check-ups.
The argument is obviously that these patients had a good chance to prevent getting seriously ill, yet they chose not to do so by omitting to undergo screening. Timely detection of early stage cancer and early intervention dramatically reduce serious illness and death.
Invariably such a drastic policy has its critics. Hazel Thornton writes on BMJ.com that such a policy 'intrudes on an individual`s right to refuse an imperfect intervention that can result in false negative and false positive diagnoses; can lead to gross over-treatment; to psychological harm and false categorisation as `cancer patient`.'
Thornton's argument misses the obvious point that the harmful effects of some false negative and false positive diagnoses are by far outweighed by the majority of correct diagnoses resulting into early treatment. Of course, patients are entitled to refuse such testing, but surely if they do, it is not unreasonable to ask them to compensate other tax payers for the additional cost their behaviour is causing.

post scriptum: Given that this blog has no discussion forum, I have decided to post the below reply to this blog (with permission by the person posting it).

Udo,

Your post on screening seem to imply that it is always cost-effective. Yet I haven't seen any numbers from you other than vague statements of how risks can justify the benefits. Have you done any calculations? You have to factor in that

1) cost of screening of millions of people

2) cost of false positives and invasive tests

3) cost of overdiagnosis - i.e. cost of treatment of people whose cancer wouldn't have caused any problems in their lifetime

4) cost of longer treatment for aggressive cases that are not helped by the treatment other than increase the time after diagnosis (at the expense of time before) (read up on lead-time bias if you don't understand what I am talking about here).

Do you know statistics at least a little bit? Do you understand the difference between relative risk and absolute risk reduction? Do you have a clue about how many people need to be tested for one person to benefit? Do you know that for every person whose life is prolonged, several are treated unnecessarily and may have life shortened as a result?

Do you know that you have a higher chance of being diagnised with some cancers if you are screened? Are you aware that because of false positives and overdiagnosis lots of popular screenings are not even remotely cost-effective because cost of screening+cost of treatment for overdiagnosed cases+ cost of false positives is significantly greater than the savings on less treatment for few?

You can take mammograms as one example and do your math. You can use numbers from this article ( http://www.bmj.com/cgi/content/abstract/330/7497/936) which many consider overly optimistic - the mortality reduction listed in this article is way higher that what USPSTF used and about 4 times more optimistic than more recent Cochrane review (from October this year). If German government is using cost to justify their plans - they are way off. Insurance companies had to be forced to pay for screening because unlike German government they can do their math.

The balance of benefit and harm for most screening tests is not as clear cut as you think it is. Few peolple benefit tremendously from it, but some are hurt. It'd be nice to have some proof of cost effectiveness before you start penalizing people for not doing it.

M

More on 'gay sheep' research

I have finally made a decision re PETA's request to support their quest to have 'gay sheep' research at Oregon State University stopped. Here's the background of the story. On October 19, 2006 I wrote this letter to the Principal of the institution...

Dear Dr Ray:

PETA contacted me some time ago with regard to research undertaken by your Dr Roselli and colleagues. This, I assume, is primarily due to
the fact that I am reasonably well-known in the field of bioethics and
also perhaps due to my outspoken views on biological research on
sexual orientation.

I have since contacted Dr Roselli with questions pertaining to his
research. He chose not to respond. Assuming that his mail bag has
grown a bit since PETA's campaign, I won't fault him for that.

Having said that, based on my understanding of his research, he seems
interested in questions pertaining to the sexual orientation (and
their alterability) of higher mammals, with the main focus of his
research being sheep.

I should be honest, unless I misunderstand the research in question, I
think Dr Roselli's serves no health related purpose. Once his
questions have been answered one way or another, there are no health
benefits flowing either to sheep or any other higher mammals,
including humans. I do think that it is highly ethically questionable
whether it is acceptable to subject higher mammals to pain and
suffering in the course of research the outcome of which has not the
well-being and health of higher mammals in mind.

Equally, while I do not subscribe to the view that Dr Roselli himself
is driven by any kind of homophobic agenda, I cannot see how any
research results he might come up with would not be seized upon by
people with precisely such an agenda.

This brings me to the question of whether or not such research ought
to be undertaken. For better or worse, I have spend five years
working in a leading Southern African medical school. Considering the
health problems the world is facing, it seems remarkable to me that a
leading scientist such as Dr Roselli should concern himself with
frankly irrelevant questions. That the pursuit of these research
questions should result into pain, suffering and death for higher
mammals makes his endeavour all the more questionable.

Sincerely,

Sack Manto - What a Brilliant Idea

What a brilliant idea! South Africa'sMinister for Health (Prevention), Manto Tshabalala-Msimang, has finally got her own fan club, a website calling for her to be sacked ASAP. Tshabalala-Msimang, dutifully carrying out the painfully idiotic views of her boss, the country's President, Thabo Mbeki (who thinks HIV is not the cause of AIDS, and that there is no AIDS epidemic in his country), should have been sacked a long time ago, along with Thabo Mbeki.
So, make sure to leave your vote and support the campaign to get Tshabalala-Msimang sacked.

Faith schools - another anachronism

Alan Johnson, the Education Secretary, went on public record demanding that faith schools become less exclusive and take in up to 25% pupils coming from other faiths or none. Funny man he is. Can't he see that the whole point of faith schools is segregation and the fostering of secterianism. Otherwise we would have only public schools in which all pupils received the same education. Faith at best entered the school by way of explaining what faiths are out there to adopt by those inclined to believe in a good omniscient 'God', 'Allah' or some creation like em.
Faith schools primary objective is to indoctrinate kids to ensure they stick with a particular religious ideology throughout their lives, thereby guaranteeing to the leaders of these religions influence in public life that they wouldn't have if they had to rely on the power of their arguments.
It is somewhat amusing that we have at this point in time a big debate about Muslim teachers wearing the Ninja turtle outfit during class, while the much larger moral evil is the very existence of faith schools. They clearly are designed to rob future generations of the opportunity to enter the world of adulthood without having been indoctrinated for many many years. A good colleague of mine calls this 'child abuse'.

madonna's children

So it's 'amtlich', Madonna is trying to adopt a boy in Malawi. Should she be allowed to do so? A whole bunch of professional do-gooders believe she shouldn't. Mostly children's charities operating in Malawi and the perhaps inescapable church groups. They're currently going to court in Malawai to prevent the adoption from going ahead.

This leads to various interesting questions, chief among them whether Madonna's course of action was the best she could have taken under the circumstances. This question is being asked by lots of commentators and the opinion of most is that Madonna is doing something wrong. Their main rationale is that she could help more orphans in Malawai if she sponsored instead schools or sponsored a much larger number of children thru a charity.

The critics clearly have a point here. However, that taking legal action in order to prevent the adoption from going ahead is the right response is doubtful. Imagine if it became a universal rule that unless you undertook a particular course of altruistic action some charity or other would sue you and demand that you do what it believes is the best thing (usually probably sponsor the charity and its staff...). In Madonna's case, it seems somewhat clear that everyone is better off (the child will have a fairly comfortable upbringing together with Madonna's other pampered off-spring; Madonna got the additional child that she wanted, the kid's biological father is supportive because he doesn't have to worry anylonger abbout the child's welfare).

So, while we're probably entitled to snigger at Madonna's action, clearly the actual outcome is desireable. There certainly is no reason to take legal action to prevent the adoption from going ahead.

A second question that puzzles me a bit is this: If the charities are really so concerned about children in need, is it acceptable to put a lot of stress on a little child in order to pursue a legal (and, let's face it, political) case against Madonna. After all, while the kid is getting used to seeing Madonna and her other half as his parents, there are these children's charities trying to bring this process to an end. How would the kid feel if they succeeded? Surely it's not better off returning to an impoverished African orphanage. The point I am trying to make is that the legal case is surely not in the child's best interest, quite to the contrary.

This, again, makes me wonder about the charities' motives.

I can't help thinking that this adoption is also a fairly powerfulstatement against racism...

Crime in South Africa

While I whinge (just below) about my stolen bike... one should never forget, that everything in this regard is relative. JUst check out the most recent (official, as in: not entirely credible) crime stats from the rainbow nation (aka South Africa).
Here's Cape Town's ex Archbishop Desmond Tutu's take on this matter.

Stolen Bikes and People

Check it out ... I got myself a new bike... yet again. It's the white Diamondback. The black Trek 4300 is the most recently stolen one. Beautiful bike... had it less than a year. - There is something odd about the UK and my bikes. I have lived over the years in quite a number of different countries, some of which with a substantially higher crime rate than the UK (think Joburg, South Africa). Thing is though, I have nowhere lost as many bicycles to theft as I have in the UK. It's truly belief defying. I guess during the last 18 months or so I lost bikes worth close to 2000 GBP to theft.
What particulary irks me is that there doesn't seem to be any culture of watching out for one's neighbours in this country. Most recently I had a bike stolen outside Tesco's in Argyle street. Now, that's an innercity food store. There's is substantial 24 hour pedestrian traffic. Yet, someone cutting thru my chain in order to steal the bike while I did my food shopping, didn't motivate any of the passers-by to call the police or even the security guard responsible for ensuring nobody steals Tesco's yoghurts. Not that the company seems to care about the perils its customers vehicles are in while their owners are shopping at Tesco's.

Organ 'donations' Chinese style

There have long been rumours that the organs of executed prisoners in the PR of China are available for sale to the highest foreign bidder. The UK's BBC managed to provide evidence for this. Its undercover journalist went into one of the largest organ transplant specialist hospitals in the PR of China and posed as a buyer (supposedly looking to buy an organ for his father). A doctor and a special marketing person from the hospital explained the deal to him (all on the tape from the hidden camera). Interesting anecdote on the side, the doctor advised that this is a particularly good time to buy organs as they have a surplus of executed prisoners' organs due to the fact that there is a wave of executions prior to an upcoming national holiday... nuff said, check the story out here According to news reports the country executed approximately 1770 people in 2005.

Researching 'gay' sheep

Weird story. I received a message from PETA asking whether I would support their campaign to have research involving 'gay' sheep at Oregon Health and Science's University stopped. From what I gather researchers there investigate the question of what leads some male-oriented rams to be male-oriented as opposed to female-oriented. They also experimented with changing hormone levels in sheep fetuses. The ethical questions with re to this research are really two fold: one certainly is whether this research interest is ethically justifiable, seeing that some animal suffering and death is involved (given that once the answer is found, there would be no health benefits for either sheep or humans or any other higher mammals), the other is whether this type of research ought to be undertaken in homophobic societies?
It will be interesting to see how these scientists will respond to public criticism of their work.

Why do we admire people doing silly and risky things?

It's kinda weird, a few weeks ago this Australian guy died who had a habit of fighting with crocodiles in front of cameras. He died in a freak accident, swimming too close to a sting ray. The frightened sting ray stung him with its tail in his heart. He died nearly instantly. Big drama in Down Under, the PM giving a speech celebrating the dead guy, stuff like one would expect in that part of the world.
Last night a presenter on a show usually propagating highly expensive, outrageously oversized gaz guzzling cars nearly killed himself while trying to set a new land speed record while riding a rocket driven vehicle. He crashed at something like 280-300 MPH. Since then the UK is in crisis mode much like Down Under for its hero.
The UK NHS is, of course, paid for by our taxes. I'm truly surprised that not more people are really upset that massive resources are spent on keeping this rocket car riding TV presenter alive. Why should we spent money to cover him for follies that he committed? To my mind, such people ought to be forced to take out private health insurance that is covering such risk behaviour. Thereby the general public (not usually prone to engage in similarly nonsensical activities!) can focus on spending its health care tax monies in other areas.

Burning the Pope's image

So, there we go again, someone criticises Islam and a few hours later the speaker's effigy is burned all over the Islamic world. There's something slightly contradictory about this peace loving ideology and too many of its proponents and 'representatives'. Particularly ironic is that the Pope (a rightwing ideologue by most people's standards) agrees with those currently burning his effigy on just about everything from opposition to reproductive health rights to gay equality to funny ideas about evolution. Putting these natural allies noses out of joint is kinda intriguing.
Here's what he had to say (quoting an obscure Christian character who died hundreds of years back): 'Show me just what Muhammad brought that was new and there you will find things only evil and inhuman, such as his command to spread by the sword the faith he preached.' Invariably accusations form those burning the effigy suggest that the Pope got it all wrong, yet their very reaction makes one wonder (one being someone like me who is not a scholar on anything Muhammad or Jesus or Dianetics).
What irritates me so very much about this affair is that these people don't seem to realise that their convictions are all man-made. They are chosen by their adherents in a manner similar to other ideologies. It is entirely unclear why their leaders think that somehow they should be above criticism and ridicule anymore then, say, the Labour Party in the UK or the Rpublicans in the US. My gut feeling is that they know about the inellectual poverty of their enterprise. It is probably in direct response to their inability to defend their ideology that they quickly resort to the silencing of critics by various civilised and uncivilised means.

Proper role of Applied Ethics

There has been some argument in recent years about the proper role of Applied Ethics. Should the types of questions people in Applied Ethics confront be determined by the number of sentient beings currently (or potentially in future) affected by a given problem? Or should we aim to resolve particularly theoretically challenging questions, even if the answers to these questions would, if implemented, affect only very few sentient beings? Well... I have argued in a number of articles and editorials for an affirmative stance on the first as opposed to the latter proposition. Surely there is little utility in calling something applied ethics if it isn't applied to a real-world practical problem. What are your views?

Test picture: Scottish Highlands

Picture 165
Originally uploaded by udo schuklenk.

Just testing whether Flickr gamma and blogger beta talk to each other. Ignore this posting and/or enjoy the picture :).
udo

Consciousness in PVS - Bollocks...

The Scotsman reports in today's edition that some people in persistent vegetative state might be conscious to a certain extent and capable of responding for instance to sentences spoken to them. Steve Miles, MD, a bioethicist at the University of Minnesota comments: '1. This woman had suffered a traumatic, not ischemic, brain injury five months before the testing. 2. The MRI showed that the frontal cortex was damaged from the trauma and post accident surgery but that the cortex and white matter were essential intact.
3. The PVS was diagnosed with the Royal College of Physicians 2003 guidelines. http://www.rcplondon.ac.uk/pubs/wp_vegetativestate.pdf However, those guidelines do not allow the diagnosis of post traumatic PVS until one year after the trauma because of the 20% prognosis for recovery in such persons. The clinical exam at 11.5 months showed recovery to Minimal Conscious State thus moving her outside the diagnosis of PVS as defined by the Royal College. 4. She was asked to imagine herself touring her house and playing tennis and appropriate areas of the brain showed metabolic activity. The researchers interpreted this as intentional cooperation rather than as word association responsiveness. She was not given a neutral stimulus such as “tennis” to test this difference.'

Go Zoe Go!

Zoe Williams comments in today's GUARDIAN newspaper that we all should take a much stronger stance against what she describes as 'deranged opponents of a vaccine against cervical cancer'. The main thing about a cervical cancer vaccine is that for it to act successfully against the HPV (which causes cervical cancer) it must be administered before women start having sex (with men). Once you got the bug, the vaccine can't help you.
Unsurprisingly, perhaps, the Christian Right is busily agitating against the vaccine saying that it would encourage young girls to have sex before they should. Of course, they are also quietly saying that girls should only have sex in marriage. Knowing, however, that this doesn't go down too well in modern societies they aim to prevent young girls from access to this potentially life saving vaccine.
Read Zoe Williams fairly sharp but to the point analysis is here.

Good news on the organ transplantion front

Today at midnight new regulations will come into effect in the UK. On current estimates they will prevent approximately 1200 unnecessary deaths p/a. Under the current regime relatives of a deceased person can prevent the NHS from utilising the deceased's organs for transplantation purposes. This results every year into what I would call unnecessary deaths of people on transplant waiting lists who are unable to access life-preserving donor organs in time. Under the new regime the relatives won't be able to stop this process. In other words, the state assumes as of midnight today that a deceased person would want to preserve a fellow citizen's life by means of permitting her organs to be utilised for transplantation purposes. Anyone objecting to this can carry on him a note saying that in case of death he would not wish to see his organs utilised in such a manner. The result of this policy changes is estimated to prevent 1200 premature deaths per year.
Good news indeed.

UK National Health Service IVF rules criticised

The British Fertility Sociey has issued a document arguing that obese women (and others where the expensive, tax payer funded IVF treatment that is provided free of charge, is less likely to be successful) should be denied access to fertility treatment within the NHS.
I think, if the objective of providing free IVF treatment is to maximise the number of new babies born per GBP invested, this probably is a very sensible policy. Indeed, the Society argues that healthy singles and lesbian couples should not be discriminated against in terms of IVF access.
This is all very sensible if one accepts a fairly questionable premise, namely the idea that people are somehow entitled for other taxpayers to pay so that their urges to have a genetically linked child are satisfied. About this I have serious doubts. Our planet remains seriously overpopulated, a couple of hours flying time away hundred thousands of children have become orphans due to the ravages of HIV/AIDS, yet in this country tax monies are being wasted so that people can have their 'own' children instead of taking care of any number of children in need of parents that they could also care for.

Mad Bob

  

AIDS babble

Stephen Lewis (picture to the left), a left-liberal Canadian AIDS activist, and currently the UN special envoy to AIDS, is a good man. A good man simply by virtue of the fact that the South African government wanted him removed for his trenchant criticisms of its genozidal policies on AIDS. The country's health minister Manto Tshabalala-Msimang is these days widely referred to as DR Beetroot due to her continuing insistence that people with HIV/AIDS should take to African remedies such as beet root, garlic and other goodies instead of anti-retroviral medicines.
In any case, Lewis, in a clear sign of succumbing to that sometimes dreadful illness of political correctness suggested in his parting speech to the World AIDS Congress (a large inconsequential talkfest attracting in excess of 10,000 AIDS activists, reporters and a few scientists), suggested that the next AIDS special envoy on AIDS should be a black woman.
Seeing that blackness and biological gender seem to be his only selection criteria, one wonders whether Manto is going to throw her hat in the ring, seeing that at home there is a growing campaign of civil disobedience by people with HIV/AIDS against her continuing tenure.