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Equality and the Clinical Trial Dating Agency

Equality and the Clinical Trial Dating Agency

The first advert for the sale of a clinical trial place offers, for $2 million, the chance to participate as a patient in a trial investigating the Farmington virus (FARV) and its potential efficacy in treating certain forms of brain tumours. Meanwhile, Alexander Masters has written convincingly about his idea for a clinical trial dating agency: matching wealthy but sick donors with scientists who have an idea for a cure but no money for a trial (shorter version also available). In Masters’ idea as in the real life case, the proposal is that the wealthy donor will pay not just for himself or herself, but enough for the trial to go ahead with a full complement of those who could not otherwise afford it, recruited on the same basis as any trial.

Predictably, ethical concerns have been raised, perhaps the main one being equality: “In the UK, the principles in participating in clinical trials include open and equal access for those who chose to participate” (Kate Law, director of clinical and population research at Cancer Research UK, quoted in The Telegraph ).

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Facebook and Apple – Increasing choice and control or creating biased solutions?

Reproductive technologies were in the headlines when Facebook and Apple announced they would offer female employees a $20,000 benefit to freeze their eggs. According to the report, this enables women to delay child bearing for different reasons and gives women more control. The announcement states that egg freezing is a pricey but increasingly popular option for women: The procedure typically costs up to $10,000, with an additional $500 for storage each year. After freezing eggs, in vitro fertilisation (IVF) can be used afterwards.

I wish to start with a disclaimer: I’m totally for increasing control and flexibility with reproductive technologies, I think the possibility as such is great, I cheer if some women genuinely wish to use this option, and I totally recognize that Facebook and Apple are just giving an option. However, there is room for questions. First, individual-level solutions are suggested where the actual issue is likely to be socially constructed, and secondly, IVF is seen merely as a handy option. These two are discussed in the following.Read More »Facebook and Apple – Increasing choice and control or creating biased solutions?

Harsher sentences for murder of a police officer: what are the arguments?

The recent media coverage of the Parole Board’s decision to release Harry Roberts after serving his (minimum) murder sentence has reignited debate over how those convicted of killing a police officer should be punished. The fact that the people Roberts murdered were police officers seems to be of great significance in the outcry about his release: not only did he murder, he murdered police officers.

The current law in England and Wales states that the murder of a police (or prison) officer in the course of duty is a factor indicating a murder of ‘particularly high seriousness’, which must attract a minimum sentence of 30 years. Other factors indicating particularly high seriousness include:Read More »Harsher sentences for murder of a police officer: what are the arguments?

Relaxed about dying?

“Now we must wait, wait. These hours…. The gurgling starts again — but how slowly a man dies! …By noon I am groping on the outer limits of reason. …every gasp lays my heart bare.” Erich Maria Remarque, All Quiet on the Western Front

In Remarque’s novel, the agony of the German soldier, witnessing the slow death of an enemy combatant, is heightened by his own guilt (the narrator had stabbed another soldier in self defense). However, his powerful evocation of distress (and guilt) at witnessing a slow dying is very close to the expressed concerns of parents and clinicians who are watching the death of a child.

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The dappled causal world for psychiatric disorders: implications for psychiatric nosology

On Thursday 16th October, Professor Kenneth Kendler delivered his second (and final) Loebel Lecture, entitled ‘The dappled causal world for psychiatric disorders: implications for psychiatric nosology’. You can view it online here or listen here.

Whilst Kendler’s first lecture – summarised by Roger Crisp here – focused on empirical issues, the second lecture was more philosophical. Kendler’s key question in the second lecture could perhaps be formulated as: Given the complex aetiology of mental disorders, how can we best understand and explain how they arise?Read More »The dappled causal world for psychiatric disorders: implications for psychiatric nosology

Paying GPs for Dementia Diagnoses

A GP in Guildford has recently revealed that the NHS is to pay GPs £55 each time they diagnose dementia in a patient. Writing on the medical website Pulse, Dr Martin Brunet, called the incentive scheme a “bribe,” put in place so that the government can “hit its target to raise diagnosis rates.”

The ‘Dementia Identification Scheme’ requires GPs to count how many patients with a dementia diagnosis there were on their register at the end of September, and to compare this with the number at the end of March 2015. They will then receive £55 for every extra patient. The full service specifications can be found here.

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Cooperating with the future

This is a guest post by Oliver P. Hauser & David G. Rand.

“It often strikes me that the complex problems we face in the world – problems of corruption, environment, politics, and so on – almost always indicate a failure of moral ethics and inner values. … The failure of the 2009 Copenhagen Summit on the global environment was, sadly, an example of how, when parties fail to look beyond their own narrow self-interest, cooperation becomes impossible.”

— The Dalai Lama, Beyond Religion

Do we have a moral responsibility to sustain the planet for future generations? The Dalai Lama, in the quotation above, gives an almost unequivocal ‘yes’. But a cursory understanding of economics shows us that it’s not just about morality – or at least, that morality doesn’t always have the final word. We, today’s decision-makers, are simply better off economically if we harvest all resources today without thinking about the future. To state the economic, ‘rational’ argument in bald terms: why leave something for the future if we won’t benefit from it?

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The Genetic Epidemiology of Psychiatric and Substance Abuse Disorders: Multiple Levels, Interactions and Causal Loops

What causes psychiatric disorders, such as depression or alcohol abuse disorders? It’s obvious that  background and upbringing often play a significant role, as do life events, such as losing one’s spouse or one’s job. And we also know now that genetic propensities are  important. But how do these different factors inter-relate with one another? For over three decades, these issues have been at the centre of the research of Oxford’s first Loebel Lecturer, Professor Kenneth Kendler.

Professor Kendler is one of the world’s leading, and most highly cited, psychiatric researchers. He uses a range of methods, including family studies, twin and adoption studies, and molecular genetics. He also has a serious interest in the philosophy of psychiatry. His first Loebel Lecture — The Genetic Epidemiology of Psychiatric and Substance Abuse Disorders: Multiple Levels, Interactions and Causal Loops – was presented at the Oxford Martin School on Wednesday 15 October 2014, and is now available on Youtube and as an MP3 audio file.Read More »The Genetic Epidemiology of Psychiatric and Substance Abuse Disorders: Multiple Levels, Interactions and Causal Loops

Assisted Suicide: A Better Alternative

The new DPP Alison Saunders has clarified the Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide issued by the previous DPP, Keir Starmer, in 2010. This has led to claims by right to life groups that assisted suicide will be available in the UK. This is, I argue, false. Assisted suicide remains a crime. I argue a better alternative under current law is Voluntary Palliated Starvation. This could render unconscious patients who embark on suicide by starvation and dehydration, such as the recent tragic case of Mrs Jean Davies. This could be lawful under current law and acceptable to doctors who do not wish to kill, but wish to relieve suffering.

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The Humane and the Ethical in Animal Research

A recent article by Marc Bekoff, written for the website The Dodo, asks whether it might be true that researchers who currently test on animals are less humane than their predecessors. Bekoff thinks it is. His reasons for that belief seem to be something like the following: We know considerably more about the cognitive and emotional faculties of animals now than we did in the past. That is, we know that even smaller mammals and birds can be quite cognitively sophisticated and emotionally developed. In the face of this knowledge, our continued use of those animals for the purpose of conducting research is less humane than it was at a time when we believed animals to not possess any such faculties. Bekoff uses this belief to cast doubt on the ethical status of continued research on animals. If we are being less humane in our research now than we used to be, then we are also being less ethical. It’s not clear to me that this inference is correct.Read More »The Humane and the Ethical in Animal Research