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Archive for March, 2014|Monthly archive page

Ben Goldacre & patterns of public policy

In 2014, Research ethics on March 31, 2014 at 8:49 am

“The patterns of public policy … are determined not only by such final decisions as votes in legislatures, … but also by the fact that some subjects and proposals emerge in the first place and others are never seriously considered.” John Kingdon

Hazel Biggs and I enjoyed Ben Goldacre’s recent discussion of ‘Medicine and Money’, part of the Nuffield Theatre’s inaugural Fulcrum Southampton: A point of balance between science and art, held over three days on 21-23 March 2014. His fast-paced impassioned talk focused, unsurprisingly, on the problems regarding the non-reporting of clinical trial data and what this means for medicine, money/government spending, patients, i.e., ‘us’ public in general. When considering exactly what this might mean, and the apathy that sometimes results – it’s not about ‘me’, has little or nothing to do with ‘me’, why is this really a problem etc – he flagged up the ‘dead babies’ problem. That is, the (potential) natal fatalities that have resulted as a result of the precautionary non-use of medicine, due to a lack of knowledge regarding side-effects of use on pregnant women (as clinical trial data was not published), when using the substances in question may have saved many lives. (This write up is inevitably ‘couched’ as – in law – causation would need to be proved: once a Tort lawyer …).

Interestingly, Ben Goldacre tweeted this message last Friday afternoon:

ben goldacre (@bengoldacre) 28/03/2014 15:43
Fab briefing by Parliamentary Office Sci Tech @POST_UK on withheld clinical trials bit.ly/1h0kJIP #alltrials Unimaginable 2 yrs ago

The POSTNOTE referred to is a briefing paper on issues around increasing transparency of clinical trial data. It’s the last part of the tweet that grabbed my attention: ‘unimaginable 2 yrs ago’. It reminded me of John Kingdon’s seminal text on pre-decision public policy processes, in which he provides a compelling and authoritative account of the messy world of public policy formation. His starting point is the question: ‘what makes an idea’s time come?’ He identified two categories of potential factors that may influence agenda setting and consideration of alternatives, namely i) participants, and ii) processes. These categories are further refined into i) participants inside and those outside of Government, and ii) problem recognition, policies/the generation of policy proposals and politics/political events. At crucial points problems, policies and politics meet, are coupled together, and according to Kingdon, it is at these junctures that the ‘greatest policy changes’ emerge.

It may be too early to determine whether or not the activities of those participants outside (see especially All Trials) and inside Government – during this month’s Southampton talk Ben Goldacre credited Dr Sarah Wollaston MP for her pivotal role in bringing this issue to the (agenda) table – together with ‘events’ such as the MHRA reportedly ‘shredding’ documents pertaining to the efficacy of Prozac, after 15 years on file, will inevitably lead to a sustained policy change. But, if anything, this seems more likely now than ever.

Caroline Jones

(More) HEAL teaching outside the Law School

In 2014, Genetics, Gratuitous self-promotion, Reproduction, Teaching on March 24, 2014 at 8:31 am

Following on from John’s post last week, about teaching on the MSc in Public Health Nutrition, I recently led a session on ‘identity’ for the CIP module Ethics in a Complex World. The module is led by Dr Julie Wintrup and therefore ‘housed’ in Health Sciences. But, it draws in (a lot of) contributions from the Law School, not least from our current Head of School, Professor Hazel Biggs, who co-led a number of the initial large-group sessions this semester, alongside Professor Roger Ingham (Psychology), and Dr Angela Fenwick (Medicine). Both John Coggon and A.M. Viens will also be making cameo appearances later this semester.

As the list of names and disciplines in the preceding paragraph suggests, this is a truly inter-disciplinary module. For the teaching team this demands some reflection on ‘our’ respective disciplinary boundaries and assumptions – not only in setting up the overarching aims and objectives, but down to the detail of selecting the ‘what and how’ of discrete sessions/topics, and indeed the assessment(s). In turn, the diverse student body bring their own disciplinary, and other, assumptions, life experience and questions to the table, both in the large and small group sessions – raising some excellent questions for further engagement, analysis and reflection. The other colleagues can be quite challenging with their questions too, which can only be a good thing! Further, the team actively engages with social media throughout the course, and as I was speaking Fiona was ‘Scoop’ing, and Julie tweeting.

I was part of the core group that set up this module, but had to step aside this year due to other commitments, so it was a real pleasure to return for a ‘guest’ spot, and to (re-)consider donor conception, mitochondrial donation and identity matters (after thinking about hidden law-making for a fair while – more news on that project to follow in a future post). As John made clear last week, these types of sessions are not about ‘instructing’ people as to the ‘correct’ answers to ethical issues, but rather to provoke reflection.

Certainly, in terms of academic study, legal developments and policy-making, interest in donor conception has waxed and waned over the decades. We seem to be in a ‘waxing’ phase, inasmuch as this area was the subject of a dedicated NCOB Working Party and Report in 2013, and is linked to the debates around mitochondrial donation, including a 2012 NCOB Report and the current DH consultation on the Draft Regulations on mitochondrial donation (i.e., how should we treat egg/mitochondria donors in this context?). I was privileged to be asked to give evidence on the regulatory aspects of donation to the former Working Party, and to have my research referenced within its Report (fn 112, 397); further, being involved in an evidence session for the latter Working Party, and being invited to comment on the draft Report.

But, no matter what can be said about the academic treadmill – whether for the good, the bad, or with indifference – it is still the greatest privilege to introduce people to new areas and/or ideas, and ask them to have a re-think about their assumptions, and in doing so to continue to challenge your own thought processes and rationale(s).

Caroline Jones

Seminar of interest: ‘Using the owned home to fund social care’, 19 March 2014, Southampton

In 2014 on March 18, 2014 at 2:23 pm

Tomorrow, Dr Emma Laurie and Professor Nick Hopkins (formerly Soton, now at Reading), will be giving a Law School staff seminar on ‘Using the owned home to fund social care: assessing the legitimacy of the Care Bill through the social contract’ at 1pm in rm 2055, building 4, Highfield campus.

AbstractThe funding of adult social care is undergoing reform through the Care Bill with the overriding objective of achieving “fairness”; in particular by ensuring that the home does not have to be sold during the lifetime of the owner to fund the cost of care and to limit the extent to which wealth accumulated in the home is used for that purpose. Increasingly, the responsibility to fund certain aspects of welfare has shifted to the individual and is linked to releasing the financial value in the owner-occupied home. There is a growing body of literature concerned with this phenomenon of asset-based welfare. We assess the extent to which it is legitimate for the government to require owner-occupiers to draw on the equity in their home to fund social care. We locate this enquiry within the framework of social citizenship and, specifically, the new social contract. We identify that the Care Bill raises issues of concern for intergenerational justice and has the potential to imbalance the social contract. Nevertheless, the consistent way in which the ideology of home ownership has been promoted justifies treating the home more favourably than other assets – at least for the current generation. We argue, however, that incremental change would protect current legitimate expectations of home owners but would enable the intergenerational imbalance to be corrected over time.

HEAL teaching outside the Law School

In 2014, Public Ethics, Teaching on March 17, 2014 at 8:34 am

There’s been lots going on in HEAL over the last couple of weeks, with various research papers being presented on campus, development of a HEAL consultation response regarding organ donation after brain death, and A.M. Viens jetting off to Copenhagen where he was co-organsing a conference on Public Health Ethics. Further to all this, and of course the regular path of the academic treadmill, I recently taught at the medical school to students on the MSc in Public Health Nutrition. It’s always interesting to deliver teaching outside of the familiar disciplinary frame. For this class, I was charged with introducing ideas about public health ethics, law, and governance. This means bringing a philosophical focus that places many of the students on the course outside of their academic comfort zones.

Such a foray into ‘alien’ literatures and methods means that the teaching raises distinctive challenges both for the tutor and the students. A complexity for the students in this context comes in the open nature of many of the questions asked when bringing philosophical approaches to the curriculum. In particular, this strikingly relates to questions concerning the very meanings of public health practice, and public health ethics. For example, I got very interesting and mixed answers on whether or not I, or Penny Nestel who runs the course, can be said to work in public health.

The productivity in exploring such questions doesn’t arise in reaching the ‘right’ answer. Rather, it’s about the critical self-reflection and questioning that they trigger in the students. People who study on courses such as our MSc are motivated to work in health promotion; they are committed to what Larry Gostin characterises as an article of faith in the great importance of health. My purpose in bringing a philosophical analysis to the education is not to lessen that faith, but to invite the students to scrutinise the strength and substance of its foundations.

I find the reward of this sort of teaching really comes out in the small- and whole-group discussions. A vast range of interesting ideas and questions were raised at the recent session. I’m looking forward to starting teaching the full, ten-week course on Public Health, Law, and Ethics with A.M. Viens later this year on the MSc in public health. We’ll be able there to explore philosophy and public health in a much more sustained, and deeply engaged, way.

John Coggon

This week’s joint ICJR/HEAL event – Dr John Coggon on ‘Legal Moralism and Long-Game Healthism? – the regulation of smoking’

In 2014, Meetings, Public Ethics on March 11, 2014 at 3:10 pm

This week we have a joint ICJR/HEAL event on Wednesday 12 March 2014, from 4pm in Building 54, Room 10037 (10th Floor), with John Coggon speaking on ‘Legal Moralism and Long-Game Healthism? – the regulation of smoking’.

Abstract This paper is concerned with coercive policies and regulatory strategies that aim at a prohibitionist end whilst avoiding individual legal measures that would individually provide an outright ban on an activity. It compares jurisprudential debates regarding legal moralism, which concerns the use of law as a mechanism for enforcing moral norms, with debates in public health ethics about healthism, which refers to an ideological political agenda aimed at making people behave in ways that (apparently) promote their health. It then takes as its focus the ‘end game’ agenda in tobacco policy; a strategy designed ultimately to mean that smoking will be eradicated. Against the background of ideas designed to legitimise such health policy—such as those entailed in ‘libertarian paternalism’—the paper examines whether long-game strategies avoid or are subject to concerns that apply to immediate prohibitions. In short, it explores the question: if on principled grounds we could not ban smoking overnight, (why) is it acceptable to do so over a decades-long period?