Saturday, 29 June 2013

Hilary and Steven Rose lift the lid on modern biomedical science.

Science is neither politically nor ethically neutral. Science as a social activity runs on priorities and interpretation, each of which has political and ethical significance; priorities set by governments and funding agencies. Modern science is big business. Science is a competitive enterprise. Big groups compete for funding and they compete for a platform to push their pitch. It is the story of science that is rarely told.

Science I hear you say is surely 'objective'. It sets about measuring things and testing ideas. But scientists do not work in a vacuum. Scientists are positioned, culturally at least to view the world in the way we do. What we measure and how we interpret the findings has as much significance as the measure itself. What we measure has as much to do with funding as it does with 'pure scientific endeavour'. Promotion within modern academic institutions has more to do with the size of the pot of funding a scientist can bring than on intellectual merit. We are encouraged to think within the  box rather than challenge it. It is surely best to be honest about this.

Honesty is what we find in Hilary and Steven Rose's book, Genes, Cells and Brains: The Promethean Promises of the New Biology. It is a book I would recommend all students of science to read. It is a book I would recommend we all read because it lifts the lid on the enterprise of science. It is honest because the authors do not hide their left wing political credentials. Theirs is a  distinctly Marxist view of the world. As a result I have seen this book dismissed crudely by those who find the story uncomfortable.

What these distinguished authors do is "trace the unfolding narratives of the biotechnosciences of genomics, regenerative medicine and the neurosciences" in the context of global neoliberalism and the culture of the 21st century. It is a story much of which I recognise from my own four decades working in academic institutions first as a neuroscientist and then as a biomedical ethicist. But it is a narrative they develop with precision and insight. It is a challenging story.

As an ethicist I was certainly challenged by the chapter on bioethics as part of the enterprise. Indeed an enterprise in itself. Much of what we do in bioethics is locked in to the science itself. Modern ethics, like science, claims a neutrality; it is as if it comes from nowhere. Yet much of what we do is self-justificatory. It asks not whether we should do something but rather what the justification for doing it can be. And in its utilitarian view 'science' often provides the justification in terms of numbers who may benefit. In weighing the benefits and harms, who is to say how much benefit outweighs any given amount of harm? The currency of exchange is often provided by the science itself. It is as if there can be a dessicated answer free from position, free from the narrative we share, free from emotion; a calculated balance; a formulaic ethic. And as Hilary and Steven point out any major biomedical project will today have an embedded ethicist on the payroll. Indeed so, I have been one such.

They also point out the link between the major science funding agencies such as the Wellcome Trust and the Medical Research Council and the major UK ethics bodies such as the Nuffield Foundation for Bioethics. These organisations are conjoined like twins sharing the same blood supply.

And what then of the Promethean promise? The last few decades, Hilary and Steven note, have been exciting times for bioscientists. It has been full of promise as it persuaded governments and funding agencies that big funding would lead to success, particularly in genomics and the birth of new biotech industries. For major diseases there would be a genetic cause for which a gene therapy would provide the cure; a brave new world of individually tailored medicine.

But with this new biology came a new language with a culture of metaphors that have influenced more than the science. The language of 'codes' and 'blueprint' that has influenced politics and the search for the holy grail, or as the authors say the Gene Grail. It is informatics gone mad with hope; the hope that somehow this 'code' can be unravelled; and where 'genes' don't provide the answer, they use proteomics, trying to correlate gene expression with given diseases. A decade passes without much success, so the answer must lie in getting more funding to get bigger databases, more information, more correlation power for the risk of this or that condition. New breeds of scientific entrepreneurs have "emerged from the universities and stormed into the corporate world."

Far from this information creating certainty, it creates uncertainty. The genetic complexity leads to predictive weakness with at best an associated risk.  Yet it is big business. Big Pharma's profits continue to rise, but this rise conceals a problem. The cost of bringing a new drug to market has risen to over a billion dollars. And where are these new drugs? The truth is that more and more drugs are failing in the advance stages of trials. The magic bullet is elusive.

If you want a challenging read then I can recommend this book. Indeed I would say it is compulsory reading for those who want to see a true public understanding of science, and who want to see science understood in its social and political context.

Hilary and Steven Rose's book, Genes, Cells and Brains: The Promethean Promises of the New Biology is published by Verso Books.


You may also be interested in my article: Rocking the Foundations of Biology and Politics

Friday, 28 June 2013

The disgraceful falsehood of Mr Osborne's spending review

Mr Osborne's spending cuts are based on a falsehood. He says the cuts in welfare spending are necessary to "end the something-for-nothing culture."  As the government has repeatedly done, they seek to portray those in receipt of benefits as 'scroungers'. It is of course an electoral ploy. Mr Osborne knows that he is on a winner with that kind of stereotype. It feeds the public mythology. But it is dishonest and unethical.

Mr Osborne knows that the majority of those receiving benefits are in work. He knows also that, far from receiving something-for-nothing, most of them are receiving below subsistence wages. It is not those on benefits who have become 'welfare dependent'; it is the companies who pay such derisory wages who have become dependent on a low pay workforce subsidised by welfare.

The Office for National Statistics data on employment reveals the problem. More and more people are having to work part time for low wages, and where many of them would like to work more hours they are not able to because the work isn't available.

Since the financial crash the numbers of working people classified as 'underemployed' has increased by almost a million, 980,000 since 2008.  There are now over 3 million workers classified as underemployed. That is 1 in 10 of the UK workforce.  These workers are not 'something-for-nothing scroungers'. Theirs is a culture of work, yet they are being targeted and stigmatised by this unethical and disgraceful government approach.

It affects particularly low-skilled workers, where 23% are 'underemployed'. We should note again that what that means is that they are not able to increase their hours of work to earn a living wage. They are cleaners and bar staff and dinner ladies. They are also the people who help our children cross the road. They are doing worthwhile jobs for which they receive on average just £7.49 an hour. But that is an average because many receive less.

These are good folk who are not only working hard, but who would like the opportunity to work more to make ends meet, to put food on the the table and pay the rent. These are decent people who don't deserve to be stigmatised as if they were cheating the system because they receive benefits. They are the people being hurt by Osborne's cuts.

Mr Osborne, Mr Cameron, Mr Clegg and Mr Duncan Smith should be ashamed of themselves, because they know these truths. Yet they still peddle the myth that the welfare bill is high because people don't want to work. On the contrary, there are more people employed part time now and they want to work more hours.


Thursday, 27 June 2013

The Nuffield Trust warn of increased pressure on NHS following spending review.

The independent health care think tank has warned that notwithstanding the Chancellor’s announcement that NHS spending remains relatively protected into the financial year 2015/16, the financial outlook for the health service is set to worsen in the longer term if its leaders and staff fail to deliver much needed change.

Commenting, Nuffield Trust Chief Economist Anita Charlesworth said:

“Next month’s projections from the Office of Budget Responsibility are likely to conclude that the pressure on services such as health, pensions and long-term care will continue to rise faster than tax receipts, even after the economy has recovered.

“Against this background the Government faces choices at the next spending review in 2015 that are even tougher than those at present. By that point departmental spending on non-ring fenced areas such as policing and local government would have fallen by a third.

“In the absence of major tax rises or a relaxation of the Government’s borrowing targets it is difficult to see how the NHS could continue to be protected in such circumstances.

“To date the NHS has delivered its efficiency targets largely through strong central measures such as cutting administrative costs and holding down pay. These are short term fixes. The pace of change needs to increase in the NHS, with a greater focus on longer term transformation.

“Without such a shift we are storing up financial risk and NHS managers will find it harder and harder to match rising demand to a stagnant budget.

“Within the overall allocation for health, the administration budget is set for further cuts of 10 per cent in real terms. It is absolutely right that the front line should take priority when resources are scarce. However, with Clinical Commissioning Groups (CCGs) and the Care Quality Commission playing a vital role in ensuring quality and security of services, ministers must ensure that they have enough funding to do their jobs well.

“Many CCGs are already expressing concern about the financial pressure they are under given their current allocations. We need further clarification on where these cuts will fall, and assurance that the Government has fully considered any potential impact on the commissioning and oversight of care.

“The decision to allocate £3.8 billion to fund joint work across health and social care has the potential to help enable new ways of working which could meet the needs of patients better while improving efficiency. If it is to achieve this, new funding and pooled budgets must be supported by cultural and leadership commitment to integrated working at a local level, and by governance structures which help create common goals across social care and the NHS.

“It is critical that these funds are carefully targeted towards innovative service models, with decisions backed by careful evaluations of what works and what doesn’t. As demonstrated in our latest report, released today, past studies of integrated and community care initiatives have often failed to provide evidence for cost savings in the short term.

The Government must ensure that they take into account broader benefits and the long-term impact of new programmes of joint work.”

Wednesday, 26 June 2013

BMA concern that cuts will seriously affect social care

Responding to the Government’s Comprehensive Spending Review, Dr Mark Porter, Chair of the BMA Council, said:

“Although the NHS budget in England has been protected this does not allow for keeping pace with new treatments, an ageing population and rising demand. All too often short term cuts are being made to meet soaring financial pressures often without the involvement of clinicians. Only by putting resources in the right place and working with doctors can the Government strive to meet the challenges the NHS faces.

“We support the Government’s commitment to the care of older people and we hope that the allocated funding is indeed used to genuinely meet the needs of patients and help alleviate the current pressures on emergency departments. However, we are concerned that the Chancellor’s decision to cut the local government budget by 10 per cent will seriously undermine the Government’s commitment to vulnerable people because of the impact on social care, and wider public health needs.

“We welcome the Government’s decision not to transfer funds for medical training and research from the Department for Business, Innovation and Skills, taking on board the concerns we raised that such a move would disturb the highly successful integrated arrangements which currently ensure a world class medical profession.”

“We will need to see further detail regarding the Government’s intentions but for many doctors pay progression is already based on satisfactory completion of their duties and other criteria. There are currently exploratory talks taking place on junior doctor and consultants contracts and they will need to consider any potential changes.”

Tuesday, 25 June 2013

Breastfeeding boosts ability to climb social ladder

A growing body of evidence now suggests that early life events influence cognitive ability and later life trajectories. Now a new study published today demonstrates that breastfeeding boosts social mobility.

Breastfeeding not only boosts  chances of climbing the social ladder, but it also reduces the chances of downwards mobility, suggests the large study published online in the Archives of Disease in Childhood.

The findings are based on changes in the social class of two groups of individuals born in 1958 (17,419 people) and in 1970 (16,771 people).

The researchers asked each of the children’s mums, when their child was five or seven years old, whether they had breastfed him/her as a baby.

They then compared people’s social class as children - based on the social class of their father when they were 10 or 11 - with their social class as adults, measured later when they were 33 or 34.

Social class was categorised on a four-point scale ranging from unskilled/semi-skilled manual to professional/managerial.

The research also took account of a wide range of other potentially influential factors, derived from regular follow-ups every few years. These included children’s brain (cognitive) development and stress scores, which were assessed using validated tests at the ages of 10-11.

Significantly fewer children were breastfed in 1970 than in 1958. More than two-thirds (68%) of mothers breastfed their children in 1958, compared with just over one in three (36%) in 1970.

Social mobility also changed over time, with those born in 1970 more likely to be upwardly mobile, and less likely to be downwardly mobile, than those born in 1958.

None the less, when background factors were accounted for, children who had been breastfed were consistently more likely to have climbed the social ladder than those who had not been breastfed. This was true of those born in both 1958 and 1970.

What’s more, the size of the “breastfeeding effect” was the same in both time periods. Breastfeeding increased the odds of upwards mobility by 24% and reduced the odds of downward mobility by around 20% for both groups.

Intellect and stress accounted for around a third (36%) of the total impact of breastfeeding: breastfeeding enhances brain development, which boosts intellect, which in turn increases upwards social mobility. Breastfed children also showed fewer signs of stress.

The evidence suggests that breastfeeding confers a range of long-term health, developmental, and behavioural advantages to children, which persist into adulthood, say the authors. So what then is the reason? Is it nutrition or greater social contact.

The authors of the paper note that it is difficult to pinpoint which affords the greatest benefit to the child - the nutrients found in breast milk or the skin to skin contact and associated bonding during breastfeeding.

“Perhaps the combination of physical contact and the most appropriate nutrients required for growth and brain development is implicated in the better neurocognitive and adult outcomes of breastfed infants,” they suggest.

The study is yet another in a growing body of information suggesting that early life events determine future life trajectories.

Monday, 24 June 2013

"NHS on the edge of failure"

The NHS will fail unless doctors, other health care staff, patients and their families are listened to, the BMA’s Chair of Council warns today (24/6/13), as he addresses an audience of over 500 doctors on the opening day of the BMA’s annual conference in Edinburgh.

In his first speech as Chair of the BMA’s UK Council, Dr Mark Porter warns government that medicine is becoming a profession “on the edge” as doctors try desperately to deal with the “sheer, unparalleled scale of demand”.

He says: “As doctors we have one of the most privileged jobs in the world - helping patients and improving the health of the nation. It’s what we do and it is often wonderful, inspiring and life affirming. But it’s easy to forget that as the NHS struggles to cope with the double whammy of cuts and structural change. I feel as if we’re becoming a profession on the edge. And a medical profession on the edge, means a National Health Service on the edge.

“Doctors are desperately trying to just deal with the sheer, unparalleled scale of demand on existing services. And we experience overwhelming frustration that we cannot achieve the changes and improvements that we can see are so necessary to deal with this pressure.

“We need to make sure the voice of the profession is heard, if it isn’t the NHS will fail.”

Nowhere in that message more important than in improving the safety and quality of care in the aftermath of the report of the Francis Inquiry, Dr Porter says. In a tribute to Julie Bailey, who fought to get her voice, and those of others, heard when she tried to expose failings at Stafford Hospital, he says:

“I salute Julie Bailey, a woman of singular courage, who brought a measure of belated justice for those who had suffered at Stafford Hospital. She got herself heard, she stood up to obstruction and abuse.

“We (doctors) have a responsibility to bring in a culture of quality and safety across the whole of the health service and nothing should get in the way of that.

“We will work with government, with medical managers, with nurses and physiotherapists and with anyone else we can, to guarantee the protection of the patients in our care. But doctors must feel comfortable and safe when raising concerns - at present we do not. Many doctors express fear about the consequences, and this inhibits us from doing what we know to be right.”

In the 12 weeks since the Health and Social Care Act in England came fully into force, Dr Porter says that although we are yet to see its full impact, the government’s response so far to the problems facing the NHS has been “inadequate and divisive”, and cost improvement programmes are “cutting resources to and beyond the bone”.

He says: “While building a Byzantine system that no-one wanted, the government’s response to the real problems in the health service has been inadequate and divisive.

“We are all painfully aware of the funding restraints on the NHS. It may have escaped the kind of swingeing real-terms cuts that other departments will suffer when the comprehensive spending review is published on Wednesday. But the claim that health spending is protected rings hollow when we face rising demand, new treatments to pay for, and virtually every NHS organisation is suffering year-on-year cuts.

“The financial pressures are leading to far too many botched, quick fixes, including some drastic cuts in staffing which leave remaining staff spread far too thinly. How can we expect this to be safe for our patients?”

Postscript:
The British Medical Association have today passed an unprecedented vote of no confidence in the Health Secretary Jeremy Hunt.

Red tape and lack of capacity prevent NHS improvements, reveals new BMA survey

Readers of this blog will know that I have written recently from my own experience of  a deep malaise at the heart of the NHS The problems are not the result of a lack of compassion. They don't stem from inefficiency of staff per se. The problem is systemic. There is indeed a deep malaise at the heart of the NHS. It results from underfunding and a reorganisation that has produce chaos and a lack of joined up care. It results in large part from savage cuts that have impacted dramatically on front line care and the capacity of doctors to make a difference.

Now a new BMA survey, published today at the BMA's annual representative meeting (ARM) in Edinburgh, has revealed that red tape and a lack of capacity are preventing NHS improvements. Furthermore, the BMA warns, the NHS is at breaking point.

Two thirds of doctors (67%) say they wanted to make changes or improvements in the past year but were hindered by excessive red tape and lack of capacity or support.

Almost 1,000 doctors responded to the BMA’s UK-wide Omnibus survey which assessed their current attitudes to working in the NHS. Almost nine in ten (89%) doctors said they had faced barriers or obstacles when attempting to make changes or improvements.

The main barriers respondents describe include:
  • lack of time and capacity (51.3%) 
  • financial constraints (39.2%) 
  • insufficient managerial support (39%) 
  • too much bureaucracy (34%) 

Despite the Government’s pledge to rid the NHS of wasteful bureaucracy and give doctors more control, almost two thirds (65%) of doctors feel less empowered than they did a year ago and seven out of ten (70%) describe their experience at work as ‘worse’ or ‘much worse’ to this time last year. The vast majority (81%) describe work pressures as either ‘high’ or ‘very high’, with the top pressure being meeting patient activity levels. GPs are most likely (89%) to report very high or high levels of pressure.

Overall respondents were most likely to indicate being frustrated rather than encouraged and to have a more pessimistic than optimistic view towards working in the NHS. However doctors were more likely to give a more positive response towards enthusiasm or motivation.

As the NHS nears its 65th anniversary, doctors said the things needed to keep the NHS going for another 65 years were greater integration between health and social care (48%), better management of activity (44%) and less emphasis on competition (33%).

Commenting on the findings, Dr Mark Porter, Chair of BMA Council, said:

“Despite the huge and relentless pressures they face, many doctors remain enthusiastic and motivated about working in the NHS, and this is very heartening, but it is a grave cause for concern that those who wanted to make improvements to patient services feel there are barriers prohibiting that. It is particularly worrying that the pressures so many doctors are experiencing on a daily basis appear to be getting worse.

“The Government wants to give doctors more control so they can work effectively for their patients, yet they often find this impossible in the face of an unprecedented funding squeeze, inadequate staffing levels and rising patient demand. Instead of directing the blame towards individual parts of the health service when the NHS comes under pressure, we need the Government to work with staff, who see the pressures first hand, to help solve the problems. Doctors should be encouraged and supported, not burnt out and drowning in red tape.”

“If the NHS is to survive another 65 years there must be a clear recognition that we are reaching boiling point with patient demand. There must also be a greater focus on integrating health and social care, rather than the continuing obsession of having a competitive market in health.”

The NHS is sleepwalking to a disaster. It is disingenuous for the government to claim that a £20bn cut in the NHS budget could be made without affecting front line staff, doctors, nurses and vital technical support. The claim that 'streamlining' efficiency savings could be made without cuts in front line staff is wrong. The government knows this of course. But it doesn't stop them repeating the falsehood. Now the BMA survey reveals there is more red tape not less. Cuts and top down reorganisation has pushed the NHS to breaking point. It will take the government no time at all to destroy the NHS. It will takes decades to rebuild. 

Thursday, 20 June 2013

Stardust in Oxford

It is often said we are all made from stardust. Meteorites, such as those in the museum in Oxford, contain a remarkable ‘fingerprint’. The imprint of a time before our solar system was formed. Grains of stardust you can look at under a microscope; micron-sized grains of silicon carbide a billion years older than our solar system, spewed out from supernovae and giant stars, now trapped in the meteorites that were formed by the accretion of debris in the early development of our solar system.

But how can we be so certain of the origin and formation of these grains of dust? This is just one of the exciting questions discussed with Professor Alex Halliday when interviewed by Denis Noble for Voices from Oxford. Alex Halliday specializes in the chemistry of the planets, and is also the head of one the largest Divisions at the University of Oxford: Mathematical, Physical and Life Sciences. He studies the isotope nature of the composition of the earth and its evolution.

The unique properties of radio isotopes enable us to “trace the geological components and to determine where they came from and when they were formed.” They provide a unique view of the history of the universe and our solar system. A history locked in bits of rock.

We can use isotope properties in a variety of ways, Professor Halliday explains. The first of these is dating. Some radio isotopes with very long half lives are decaying over billions of years; others have very short half lives. A very sophisticated set of techniques have now been developed and modern mass spectrometry “has driven the science forward and opened up new opportunities”.

But it isn’t a fingerprint of time alone. Atomic masses of isotopes “will result in slightly different behaviour in natural processes” and by measuring the amount of one isotope over another “you can say something about temperature in the past.” It was the Nobel Prize winner, Harold Urey, who discovered the isotope deuterium, but who also was first to discover you could use the behaviour of isotopes to say something about the temperature of the oceans in the past.

Using this “forensic fingerprinting” with the properties of isotopes, Professor Halliday explains, we can also trace the source of components and where they came from, and this has produced some unexpected results. It was assumed that things were fairly well mixed up in the solar system because meteorites from the asteroid belt and from mars had roughly the same composition as samples from earth. But it was discovered about 20 years ago that there was something peculiar in the isotopic make­­ up of these meteorites. There were “some funny noble gas isotopic compositions.”

If you did selective leaching of them, gradually dissolving the entire meteorite, you are left with a few grains that were “unlike anything found on earth”. Thousands of these grains have been analysed with high precision for their isotopic composition and they are not normally found on the earth’s surface. They are fragments of dust, grains of silicon carbide, from other stars, that were brought into this solar system 4.5 billion years ago before it formed. These meteorites provide an amazing new archive for understanding how stars work. By using spectroscopy on stars we analyse their chemistry. But as Professor Halliday puts it “now we have samples of stars which is mind blowing.”


Ray Noble is News Editor for Voices from Oxford

Care Quality Commission whistleblower receives international whistleblowing award

Mid Staffs whistleblower Amanda Pollard will be recognised today (June 20) at an international whistleblowing conference, receiving an award for her part in exposing negligent inspection methods within the Care Quality Commission.

The former Care Quality Commission inspector will pick up the ‘Middlesex University Whistleblowing Award’, at the International Whistleblowing Research Network Conference today (20 June) at Middlesex University’s Hendon campus in north London. It is awarded in recognition of an outstanding achievement in making a disclosure of information in the public interest.

Pollard was one of the key figures in exposing the severe wrongdoings within the Care Quality Commission (CQC) – the national healthcare inspector – and the NHS, particularly in relation to the poor level of patient care at Mid Staffordshire Hospital. She later gave evidence to the Francis Inquiry into the serious problems at Mid Staffordshire between January 2005 and March 2009.

She tried to alert CQC management to her concerns and warned that the organisation would not be able to spot another scandal in patient care such as in Mid Staffordshire.

Pollard specialised in infection control and it had been the spread of infection that claimed many of the needless deaths in Mid Staffordshire. Pollard told the Francis Inquiry that changes to the way inspections were carried out meant that she and her colleagues found themselves inspecting sectors in which they had no expertise or knowledge. Inspectors with no healthcare backgrounds were told to inspect hospitals, and no adequate training was given.

Tomorrow Amanda Pollard will tell delegates at the conference: “It was important for me personally to let the Mid Staffs Public Inquiry know about how NHS regulation had changed for the worse. When I was working for the Healthcare Commission the infection control inspections were thorough and cleanliness of hospitals improved as a result. The methodology was sound and the assessment of inspection decisions was robust. When the CQC introduced their new methodology for inspections, inspectors were quite worried. Our concerns were founded, but no-one wanted to listen.

“It will be two years in November that I appeared at the Inquiry, and this time has been more difficult than I expected. It makes this recognition by the International Whistleblowing Research Network Conference particularly gratifying. I am very surprised and overwhelmed by this award, and hope that I can raise the profile about the difficulties of whistleblowing.”

Convener of the International Whistleblowing Research Network and Middlesex University Professor of Employment Law, David Lewis said: “Whistleblowers serve private and public interests when they raise concerns about wrongdoing. However, rather that encouraging them, many employers have victimised the purveyors of bad news. The Middlesex University award is an attempt to change attitudes so that whistleblowers are recognised as heroes rather than villains. Amanda was very brave in speaking out in difficult circumstances and that is why we are gathering to applaud rather than shoot the messenger.”


The International Whistleblowing Research Network Conference brings together top researchers in the area of whistleblowing from America, Australia and The Netherlands amongst others. 

Friday, 14 June 2013

Peter Singer and the ethics of food

In the 1970s Peter Singer challenged thinking about animals in his seminal book ‘Animal Liberation’. It changed the debate about the use of animals from an emotional issue to one of practical and reasoned ethics. Peter Singer is a utilitarian philosopher and the use of animals had usually been justified on utilitarian grounds. But Peter Singer threw out a challenge. He pointed out that for a utilitarian justification an equal consideration of interest had to be given to all parties involved in the utilitarian balance. It was clearly not in the interest of animals to be harmed. In the first chapter of his book he argued that ‘All animals are equal’. His second challenge was to ask the question on what grounds we could make a moral distinction between species in the ethical balance.

In a discussion with Sung Hee Kim for Voices from Oxford, Peter Singer reveals what he calls the ‘decisive formative experience of my life’ at a lunch with a fellow student at Balliol College, an experience that led him to completely alter his views on the use of animals for food.

Faced with the choice of a plate of spaghetti with some ‘brown sauce on top’ or a salad, his friend asked if the sauce contained meat. It did, so he chose the salad. Peter Singer chose the spaghetti with the meat sauce.

Intrigued, he asked why his friend had avoided the meat. He expected an answer about his health or some religious reason, but his friend told him he didn’t think it was right to treat animals in the way they were when turned into food. This experience set Peter Singer to begin thinking about the moral status of animals and it led to the writing of his book ‘Animal Liberation’.

“I don’t think we can justify participating in a practice that is exploiting animals in the way it does.” Peter Singer became a vegan. But for Peter Singer it is not simply an emotional issue about the love of animals. It is an issue of practical ethics and morality. It was, he says, the “first real issue in applied ethics that I took up, not merely as an academic question, but that I wanted to change the world about.”

“We are talking about literally billions of animals being treated in ways that are not really defensible from an ethical point of view.”

It was at that time, in the 1970s, he reminds us, “a neglected issue”. Other issues dominated ethical discourse such as the war in Vietnam, Civil Rights and Civil Disobedience. The use of animals for food wasn’t an issue that was widely discussed. Peter Singer’s book helped to change that.

In looking to the future Peter Singer considers the issues of climate change need urgent attention. But, he reminds us, it “requires cooperation” between nations. If future generations could vote for drastically reducing our greenhouse gas emissions, then Peter Singer has no doubt they would do so. But they can’t, so it is this generation that must do it, and we have to make some sacrifices to do it. 

watch the video of Peter Singer's interview

Ray Noble is News Editor for Voices from Oxford

Thursday, 13 June 2013

A philosopher’s role in biomedical ethics.

Can there be objective and correct answers to bioethical problems? This was the central question put to the philosopher Peter Singer when interviewed by Denis Noble for Voices from Oxford.

As a utilitarian philosopher Professor Singer is preeminent in his contribution to developing a practical and systematic approach to medical ethics. In the early days of medical ethics eminent doctors would make somewhat naive judgements but without much depth or clarity of thought. There was little philosophical rigour. Medicine was paternalistic in its approach with the assumption that doctors would ‘know best what was in the patient’s interest’.

When new developments in medicine such as assisted conception through in vitro fertilisation (IVF) presented new challenges, the media would most likely turn to theologians for a moral perspective. But, as Peter Singer puts it, ‘we are not a confessional society’ and it is important that there is a ‘non religious voice’ in ethical discourse. Medicine has now moved to a much more patient focussed approach with the notion that the best person to make judgements about their interests is the patient themselves, particularly about priorities and in relation to quality of life. A key issue then is how best they can be informed to make such decisions.

There is nothing in the expertise of a clinician or scientist that enables them to pronounce on ethical issues. As Peter Singer puts it “you can’t draw normative conclusions from the facts”. The facts don’t tell us what we ‘ought to do’. Yet modern medicine presents a unique ‘technological imperative’; machines can keep people alive, but a key issue is whether we should always keep people alive longer if their quality of life has fallen below a certain point. The key questions then are when and how, and by whom should such decisions be made. There is little in the science itself that can present an answer. But are there any ‘correct’ answers to such questions?

Peter Singer believes there are. “I do believe there is a correct answer, although to demonstrate that is a major effort in philosophy”. It also demonstrates the role of the philosopher in practical medical ethical discourse.

In ethics there is some degree of expertise in terms of what philosophers have which is familiarity with the concepts and how they work. But the role of the lay person is much more significant and has to be brought into the discussion. We have to work with the views that they have.

Science has a responsibility not to oversell itself. There is a funding imperative that often leads to scientists to make claims for significant potential breakthroughs. As Peter Singer puts it “scientists are often very narrow in presenting the significance of their findings.” In relation to the human genome project “the way things work in the body appears to be more complex.” There are many instances when a little more humility might have been better.

See the video of interview with Peter Singer

Ray Noble is News Editor for Voices from Oxford

Wednesday, 12 June 2013

Electronic cigarettes to be regulated as medicines

All nicotine-containing products (NCPs), such as electronic cigarettes, are to be regulated as medicines in a move to make these products safer and more effective to reduce the harms of smoking.

The UK Government has decided that the Medicines and Healthcare products Regulatory Agency (MHRA) will regulate all NCPs as medicines so that people using these products have the confidence that they are safe, are of the right quality and work.

Smoking is the biggest single cause of avoidable death - killing 80,000 people in England each year. Making safe and effective products available for people who smoke can help them cut down or quit.

Jeremy Mean, the MHRA’s Group Manager of Vigilance and Risk Management of Medicines, said:

"Reducing the harms of smoking to smokers and those around them is a key Government health priority. Our research has shown that existing electronic cigarettes and other nicotine containing products on the market are not good enough to meet this public health priority.

“Some NCPs are already licensed and the Government's decision to work towards medicines licensing for all these products is designed to deliver quality products that will support smokers to cut down and to quit.

“The decision announced today provides a framework that will enable good quality products to be widely available. It’s not about banning products that some people find useful, it’s about making sure that smokers have an effective alternative that they can rely on to meet their needs."

Today’s announcement follows a public consultation on how to regulate these products which demonstrated widespread support for medicines regulation from the public health community. Scientific and market research into their safety and quality, including how they are used, has underpinned this decision.

People should use licensed NCPs – gums, patches, mouth sprays etc – to reduce the harms of smoking.

Recent public health guidance published by the National Institute for Health and Care Excellence (NICE) supports the use of licensed nicotine products in helping people to cut down or stop smoking.

The quality of NCPs can vary considerably which is why licensing them as medicines will allow people to have the confidence that they are safe, are of the right quality and work.
The UK Government will press for EU law to create a Europe-wide legal position on NCPs as medicines through the revision of the Tobacco Products Directive. The European Commission has said it expects the new legislation to be adopted in 2014 and for it to come into effect in the UK from 2016. From that point, all NCPs will require a medicine licence. This will allow time for manufacturers to ensure that their products meet the safety, quality and efficacy requirements of a medicine. Until that law is in place, the MHRA would encourage those manufacturers with unlicensed products currently on the market to apply for a medicine licence. 

Today's announcement has received widespread approval from healthcare agencies and charities.

Commenting on today’s announcement from the Medicines and Healthcare products Regulatory Agency (MHRA), Director of BMA Professional Activities, Dr Vivienne Nathanson, said:

“It is very good news that the MHRA has decided to regulate all nicotine-containing products, including e-cigarettes.

“We can now build on this and press for good research which looks at the efficacy and health implications of e-cigarettes. It’s really important that we find out if the hand to mouth use of e-cigarettes either breaks or reinforces smoking behaviours. We need to know if e-cigarettes actually help smokers quit.

“Smoking remains the biggest cause of avoidable death in England so we need to do all we can to help smokers give up but it is also essential that aids to quit smoking are safe.”


Chief Medical Officer Professor Dame Sally Davies said:

“Smokers are harmed by the deadly tar and toxins in tobacco smoke, not the nicotine.

“While it’s best to quit completely, I realise that not every smoker can and it is much better to get nicotine from safer sources such as nicotine replacement therapy.

“More and more people are using e-cigarettes, so it’s only right these products are properly regulated to be safe and work effectively.”

the move has also received support from ASH. Deborah Arnott, Chief Executive of health charity ASH, said:

“ASH strongly supports the MHRA decision to regulate e-cigarettes and other novel nicotine products – we think this is both proportionate and necessary. Regulation will ensure that e-cigarettes meet the same standards for quality, safety and efficacy as medicines while remaining as readily available to smokers as they are today. Crucially it will also ensure marketing of e-cigarettes and other such products is controlled to prevent their promotion to children and non-smokers”

Dr Clare Gerada, Chair of the General Council at the Royal College of General Practitioners said:

“Rates of smoking in the poorest in our communities remain high, and as a GP in a deprived area of London I see firsthand the deaths and disease this causes. The RCGP supports MHRA regulation of novel nicotine products such as e-cigarettes as this will ensure that they are of good quality and reliability and are effective in helping smokers who want to use them to cut down and quit.”

Tuesday, 11 June 2013

Failure to act on corporate tax avoidance is a disgrace.

There is a direct political link between the tax avoidance of major companies operating in the UK and cuts in welfare spending. That link is the budget deficit, a major cause of which is falling tax revenue. Long gone are the days when Cameron and Clegg declared we were all in this together. The truth is that it is the poorest in our society who are being hurt the most. Whilst falling tax revenue is the major problem, Osborne sets his sights on indiscriminately cutting welfare spending. Unfortunately Labour have now adopted the same approach.

Yet whilst the poorest are being made to pay the biggest cost of 'cutting the deficit', major corporations with billions of turnover in the UK are avoiding tax. Apple, for example, avoided over £550m in tax on more than £2bn worth of underlying profits in Britain by channelling business through Ireland.

Of course there is the ethical issue involved here; big companies avoid paying tax, yet the government attacks 'welfare scroungers'. But the truth is the strategy of dealing with the deficit through cuts in welfare spending clearly isn't working. The budget deficit is set to rise not fall. The Osborne strategy isn't working. This is why it is alarming that Miliband and Balls appear to be falling into the same mindset, that you can cut the deficit through cuts in spending. You can't if the major cause of the rising deficit is falling tax revenue. And here we return to the problem of tax avoidance. 

It is estimated that £120bn a year is lost through corporate tax avoidance, evasion and downright skulduggery. The poor pay the price.

We really do have to ask why the government continues to allow this appalling state of affairs to continue. Major corporations are failing to pay taxes in the UK and the wealthiest have got richer whilst the poor have suffered the most. Asda, Google, Apple, eBay, Ikea, Starbucks, Vodafone: all pay minimal tax on massive UK revenues, yet benefits cuts drive families from their homes.

Cuts cripple the NHS, whist companies such as Thames Water and Vodafone pay no corporation tax in the UK. For Thames Water they have 'deferred' payment. Meanwhile the NHS is expected to find some £20 billion of cuts. Front line services are suffering. Waiting lists are again becoming a problem and top down reorganisation has created uncertainty and chaos, threatening joined up care.

For richest 1,000 in Britain their wealth has increased by £155bn since crisis began. Heads they win, tails we lose.

The major cause of the budget deficit is falling tax revenue and yet the government fails to address this issue. It is a disgrace and it is time the government was forced to act.

Trading and investment profits made in the UK should be taxed in the UK. Corporations should not be allowed to squirrel them away.

Monday, 10 June 2013

Questions raised about safety of new diabetes drugs: regulators failing to act on warning signs

New forms of diabetes drugs, known as GLP-1 based drugs, and promoted as “the new darlings of diabetes treatment” - make the pharmaceutical industry billions. But are they associated with an increased risk of cancer and do we know everything we should about these new treatments?

The BMJ and Channel 4 Dispatches have investigated and found that evidence suggesting potential harm from the drugs in industry studies has not been published.

Furthermore, other independent studies challenge the conclusions of the drugs manufacturers' own research. Now some medical experts and patient groups are calling on the pharmaceutical companies to be more transparent in reporting of study data and to enter into dialogue about safety concerns.

As a result, millions of patients around the world have not been fully informed about some of the possible risks.

Some critics say the drug regulators in Europe and the US have been slow to pursue concerns about the potential adverse effects of these new diabetes drugs, despite the emerging warning signs in the medical literature, regulatory documents, and adverse event databases.

Full details will be published today on bmj.com  and broadcast in Diets, Drugs and Diabetes – Channel 4 Dispatches at 8pm this evening on Channel 4.

GLP-1 based drugs are used to treat type 2 diabetes by regulating blood sugar. Some of these drugs also suppress appetite and are currently being tested as a possible treatment for obesity.

In the course of this investigation, The BMJ has reviewed thousands of pages of regulatory documents obtained under freedom of information and found unpublished data pointing to “unwanted proliferative or inflammatory pancreatic effects.”

The BMJ has also found that, despite published reports that indicated safety concerns, companies have not done certain critical safety studies; nor have regulators requested them yet. And access to raw data that might help resolve doubts about the safety of these drugs has been denied.

Dr Deborah Cohen, The BMJ's Investigation Editor, says: “On their own the individual pieces of unpublished evidence may seem inconclusive, but when considered alongside other emerging and long standing evidence, a worrying picture emerges, posing serious questions about the safety of this class of drug.”

Three publications this year have raised concerns long held by some experts about the potential side effects of GLP-1 based drugs, prompting both the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) to launch a review into whether the drugs may cause or contribute to the development of pancreatic cancer. And in America, hundreds of people are suing manufacturers alleging that the drugs caused pancreatitis and in some cases cancer.

Yet the evidence is fiercely contested amongst scientists and manufacturers stoutly defending the safety of their products.

Some argue that the published evidence against the drugs is weak, while others say we can’t yet be sure that these drugs are safe and are calling for all the study data to be made public for independent analysis.

Research by Professor Peter Butler at the University of California Los Angeles, for example, found worrying changes in the pancreases of animals that received a GLP-1 based drug. He has also found abnormal changes, including pre-cancerous lesions, in the pancreases of eight organ donors taking GLP-1 based drugs compared with patients taking other anti-diabetic drugs.

And studies of side effects reported to the regulators have also started turning up cases of pancreatic cancer among patients on GLP-1 based drugs. Both EMA and the FDA have confirmed to the BMJ that they have “signal” for pancreatic cancer - but this does not mean there is a causal link.

Together these findings raise important and troubling questions about a possible link between these diabetes drugs and pancreatic cancer, but no safety alert has yet been issued by the regulators.

More information is expected later this month, when the US National Institutes of Health hold a two-day meeting on possible links between diabetes, diabetes drugs and pancreatic cancer.

But some consumer groups are calling for the drugs to be withdrawn as a diabetes treatment to prevent potential harm to patients while we wait for this evidence – and they don’t want to see them licensed as an obesity treatment.

Writing in The BMJ, Dr Fiona Godlee, Editor in Chief said: "All drug licensing is about balancing benefits and risks. But instead of engaging in open debate about legitimate and important scientific questions, the manufacturers have been unwilling to share their data. Meanwhile patients and doctors have not been kept properly informed about the uncertainties surrounding these drugs."

She adds: “The debate would be much easier to resolve if all the information was placed in the public domain so scientists, doctors and ultimately patients could make up their own minds.”

In an editorial in The BMJ, Edwin Gale, Professor of diabetic medicine, says this shows once again that current regulatory procedures are inadequate to deal with the challenge of drug treatments that have more than one biological target, which he calls "shotgun therapies." He says: "Similar scenarios will be re-enacted while secrecy rules and the companies control access to the data."

In statements to Channel 4 Dispatches airing tonight, the drug companies all maintain their commitment to patient safety. On monitoring, the companies all say they have regular, close and vigorous safety processes in place, including large scale, long term trials, and the results are routinely submitted to the regulatory authorities.

The BMJ is campaigning for improved access to data from clinical trials - see bmj.com/opendata

If patients have any concerns about the diabetes drugs they are taking, they are asked to consult with a doctor before changing their medication.

Diets, Drugs and Diabetes – Channel 4 Dispatches on Monday 10 June at 8pm.

Sunday, 9 June 2013

Labour disappoint on welfare. It is time to speak up for the poor.

Recent pronouncements on welfare by Ed Miliband and Ed Balls are disconcerting and disappointing. It is time the truth was put to the public on benefits. The government has been allowed to 'win' the presentation just as they fail to win the argument. They have succeeded in selling the image of 'scroungers', of 'shirkers versus strivers'. Sadly now Labour appears with the same message. 

There was a moment when Labour spoke up and Miliband put the case that the majority of those receiving benefits work, and work hard for too little reward. Now they appear to have abandoned that case. For the truth is that it isn't hard working people who have become 'welfare dependent'. The truth of it is that it is businesses, many of which pay insufficient taxes in the UK, who have become dependent on subsidised low pay. 

A 'living wage' must be at the heart of the alternative to the government's attack on the poorest. Labour should be putting that case. It isn't complex economics that prevents fair pay; it is bad economics. It is the economics of subsidised labour. The Tories always champion 'free markets', yet allow an unfair and skewed market in labour. The British people will respond to a campaign for 'fair pay for a fair days work'. It is the flip side of the 'scroungers' coin. For the poor in Britain, for too long it has been a 'heads I win, tails you lose' economy. This is why the poor have become poorer. This is why they are bearing the greatest burden of the failed capitalist economy. 

Labour must speak up for the poor. It would be easy not to. There aren't that many votes in doing so. The government have been allowed to 'win' the war on benefits. The recent study by the Rowntree Foundation shows that more people are inclined to blame individuals for their  poverty than to consider societal problems as the cause.

Two-thirds (66%) of the public, for example, are willing to believe that child poverty relates to the characteristics and behaviour of parents, compared to the 28% who say it is the result of broader social issues.

Even among Labour supporters there is an increasing view that welfare recipients are undeserving (from 21% in 1987 to 31% in 2011) and that the welfare state encourages dependency – 46% say if benefits were not as generous, people would learn to stand on their own feet, up from 16% in 1987.

Harold Wilson once said that the Labour movement is a crusade or it is nothing. We need that sense of crusade. Poverty in Britain is increasing. This we cannot tolerate. No fair and just society should  allow it. The government talks of fairness in its benefits reform, but hitting the poorest hardest is not fair. The poor are losers in good times and bad. The rich are winners in good times and bad. We need a new social priority. Labour has done little to set the agenda. It is afraid of its own shadow. But the argument can be won, if only it is put.

Friday, 7 June 2013

BMA launches new initiative to give patients the real story behind NHS change and pressures

The BMA has today (Friday, 7 June 2013) launched an initiative to help GPs in England explain to their patients and the public what’s happening in the NHS and what it could mean for them.

The activities are the first phase of a longer term programme to engage with the public on the future of general practice and include:

A new changingnhs.com web portal setting out the key changes and pressures affecting patients. This includes information about NHS reforms in England, including competition and patient choice, NHS funding, the GP contract and out-of-hours services. It also offers doctors’ views and explains how patients can have their say. 
 
A poster for GPs to display in their practices directing patients to changingnhs.com. This is being sent out to GPs in England in the BMJ this week. The web portal will also be promoted through online search ads and web links. 

An MP-GP visit scheme which invites MPs to spend time in a practice in their constituency to see what’s happening on the ground and to talk directly to practice staff about their priorities and concerns.

Dr Laurence Buckman, Chair of the BMA’s GP committee, said:

“The NHS is experiencing a period of profound change as it tries to absorb the impact of the Health and Social Care Act and unprecedented pressure from rising patient demand and an increasingly tight financial climate. General practice in particular is facing a testing time as it comes to terms with the introduction of clinical commissioning groups, imposed changes to the GP contract and continued pressure on out-of-hours services.

“GPs feel that our patients aren’t getting the real story about what is happening in the NHS which is why the BMA is launching this initiative. In a turbulent world, it is vital that GPs play a key role in giving patients the information they need about how their NHS is changing. We will be building on this initiative over the coming months, as we respond to the impact of the changes and pressures and as we seek to develop a positive way forward for general practice for our patients.”

The BMA website says "many doctors are really worried about several aspects of the latest changes to how the NHS is run and to how the financial pressures are being managed."

There is also a poll on the website for patients to have their say on how they think the NHS changes will affect them.

Thursday, 6 June 2013

Mr Miliband makes a Balls up on benefits.

I am sorry Mr Miliband but you concede too much and too easily. You accept the false government logic about 'fairness'. You should have stood your ground about the value of universality in benefits. Why? Because, as you know, it is often the best way to ensure that those who DO deserve and need benefits get them, and the wealthiest pay back in taxes.

This is particularly true for the elderly. Why on earth are you getting so concerned about wealthier pensioners also receiving winter fuel allowance?You have chosen the soft option, the easy politically expedient option; but it is an unjust option. For the sake of saving the tax payers a measly, piddlingly ridiculous amount, you introduce a threshold around which their will be injustice. It is known that the elderly are reluctant to apply for means tested benefits.

Your position becomes corrosive. You should have been willing to argue the unfairness of the governments case on benefits. Now you have made that argument all the more difficult by conceding on universality. Oh and of course the more wealthy elderly pay more taxes.

You will also be aware, Mr Miliband, that many elderly people do not claim the benefits to which they are entitled. It is estimated that the cost to the treasury would be some £5 billion should they do so. It should be of greater concern to us that so many pensioners struggle unnecessarily. Saving £100 million on winter fuel payments to the wealthiest really does nothing to address the real issues of pensioner poverty.

Labour should be leading the challenge to the government, not blindly accepting the warped premises of Ian Duncan Smith. Running scared of opinion polls shows a lack of political courage. What voters need is a clearly thought out alternative to the slash and burn approach of the coalition.