Tuesday, October 29, 2013

Great CBC feature film on assisted Dying in Canada on The National

The National broadcast last night the first of a three part investigation on the assisted dying issue. Check it out here.

Friday, October 25, 2013

Scientific research is in a serious crisis

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

A short while ago I wrote a column attacking homeopathy and other pseudo-scientific solutions to serious health problems. Not unexpectedly my Twitter feed gathered followers among friends of homeopathy, slamming me variously for not reporting the amazing scientific research supporting the use of homeopathy as well as for reporting uncritically mainstream science’s take on the issue.
Well, as to the former, there is zero evidence that I am aware of, to date, that homeopathic concoctions work. There is no homeopathic ‘remedy’ that will protect you against the flu, for instance.
As to the second point though, while there is no alternative to scientific research, not all is well in the scientific research enterprise either. And it’s not, as the friends of homeopathy would have us believe, one big conspiracy instigated by nasty pharmaceutical multinationals. It turns out, there is a lot of scientific evidence — how ironic — accumulating that things are going pretty badly wrong due to the way scientific excellence is measured today by folks in the business of ranking university excellence, as well as research funders, governments and sadly many administrators in the academy.
Scientific knowledge relies fundamentally on evidence that can be replicated. Say, I undertake a clinical study with a particular experimental agent and it turns out that this agent works — by some standard — better than an alternative drug given to trial participants, my trial could eventually provide sufficient evidence for the experimental agents to become an approved drug.
Of course, much relies on my trial having been methodologically sound, my statistical analysis of the results having been correct and so on and so forth. Typically I will publish my results in a scientific journal where my data and analysis are scrutinized by specialist peer reviewers. These reviewers are tasked by the journal’s editors with checking that my trial was ethical, that it was methodologically sound, and that my conclusions are actually supported by my data. Of course, even the best reviewers make mistakes, they might not have the competencies to evaluate the relevant stuff and so bad science slips through and gets published.
Sadly we have plenty of evidence for the failure of large numbers of peer reviewers to pick even the most basic errors in scientific manuscripts. This might have to do with the fact that they are typically expected to volunteer their time and that their university employers usually don’t give them credit for this sort of work. In fact, as a journal editor, I can tell you that frequently the most seasoned academics refuse to undertake these vital reviews because that work doesn’t add to their CV, peer recognition, name it.
Well, the error control mechanism that science is based on is that someone will try to replicate scientific studies and then the erroneous research studies will come to light. It really is trial and error. That’s the theory. The practice is that very many, if not most, scientific studies are not replicated. The reason for this is that there is little incentive by research funders to do so. The buzz word is ‘innovation.’ Oh yes, the academy has not remained above the vacuous babble of modern management talk. We all want to be ‘excellent,’ ‘innovative’ and ‘path-breaking’ at pretty much everything that we do.
In fact, our research funders expect no less of us. You are not innovative if you simply check whether someone else has done a proper job. You don’t have to be a scientist to realize how foolhardy such funding policies are. Some efforts at replicating so-called landmark studies have been made. The British magazine The Economist reports that only six of 53 landmark studies in cancer research could be replicated. Another group reported that it managed to replicate only about 25% of 67 similarly important studies.
The good news is that this has been done at all. The bad news is that this isn’t standard fare in the sciences, biomedical or other. Verification of other scientists’ research just isn’t a good career move in a research enterprise that doesn’t value such vital work.
Another problem is that scientists are demonstrably reluctant to tell us if their experiment failed. The reason could be that a commercial sponsor doesn’t want the world to find out too quickly that one of the ‘promising’ drugs in its pipeline is actually a fluke. Commercial confidentiality agreements stand in the way of serving the public interest. Shareholder interests typically trump the public good, and scientific researchers more often than not collude. The likely outcome of this situation is that at some point someone else will test the same component again. Time and resources are therefore wasted. So-called negative results currently are featured in only about 14% of published scientific publications. Of course, in reality the odds are that very many more research studies fail. Scientific progress, to a large extent, depends on failure.
Alas our current systems don’t reward the reporting of failure. Academic journals have their quality measured by a foolish tool, devised in Canada, called Impact Factor. Basically this tool measures how frequently articles published in a journal are cited over a two-year period. Obviously, you won’t be able to become a high-impact journal with papers that report failed studies. People rarely cite such results. Accordingly many researchers don’t even submit such important study outcomes. Don’t we all just love success? Have you ever seen a university marketing department celebrating a researcher’s failure? Me neither. It’s not how we roll in the academy. To be fair to the marketing folks, not many media outlets would report Professor C. Ancer’s failure to replicate a landmark, breakthrough cancer study, despite the fact that the much-reported landmark study has so been shown to be of questionable quality, if not outright flawed.
Some efforts are currently under way to register all trials and to ensure that outcomes are reported, if not in scientific journal then in some other forum that’s easily accessible. The same holds true for the raw data gathered in a trial. Still, progress on this front is far from satisfactory.
New commercial publishing models in the academy further aggravate some of the problems just described. A new business model called Open Access relies overwhelmingly on authors (as opposed to subscribing university libraries) paying for the publication of their work. The journals’ commercial success depends on uploading as many academic outputs to their webservers as possible. The more they publish, the higher their profit. Recently a science journalist submitted an error-ridden manuscript to 304 such Open Access journals. A total of 157 accepted it happily for publication, subject to the article upload fee I mentioned earlier. From there said paper would have gone straight into relevant biomedical databases as a peer reviewed paper. On the face of it, a sound scientific publication.
Sadly, due to the publish-or-perish mentality that isn’t a myth in the academy, quite a significant number of academic researchers engage in academic misconduct in some form or shape. One recent survey reports that about 28% of scientists know of researchers who engage in scientific misconduct in the research they undertake. It is not clear whether all of that misconduct necessarily translates into fraud or useless research outputs, but a significant amount of it almost certainly does.
I could go on in this vein for quite a while because there is plenty of dirt to be found where there is scientific research. It is high time universities and researcher funders have a serious look at the kinds of systems they have created to measure and incentivize research activities. It does appear to be the case that what is in place currently incentivizes unethical conduct to a significant extent. That must change.
And yet, keeping Winston Churchill’s dictum in mind that ‘democracy is the worst form of government except for all those other forms that have been tried from time to time,’ much the same can be said for scientific research. It is the best we’ve got, but that shouldn’t stop us from fixing the problems we are aware of.
Udo Schuklenk holds the Ontario Research Chair in Bioethics at Queen’s University, he is a Joint Editor-in-Chief of Bioethics the official publication of the International Association of Bioethics, he tweets @schuklenk

Saturday, October 19, 2013

There's medicine and then there's other stuff


Today's piece from the Kingston Whig-Standard on 'alternative medicine'.

It’s one of those things: you better not criticize homeopathy or else there will be a deluge of complaints from homeopathy ‘practitioners’ as well as satisfied ‘patients’ questioning your motives, your connections to that oh-so-evil pharmaceutical industry, and whatnot else.
Well, let me start this off then by saying that I am not an industry shill, that — to the best of my knowledge — I own no shares in pharmaceutical companies and that I am not paid by any pharmaceutical company to say what I am about to say.
How do we establish whether a particular chemical substance works as medicine? We test it elaborately in clinical trials. Typically we test the substance first in animal experiments. That has its own set of ethical issue that I won’t go into today. Then we move from animal experiments to toxicity tests in a small number of people. All we want to find out here is whether a particular candidate drug is safe. Once we have established that it’s sufficiently safe to test it on a much larger number of people we begin in all earnest clinical trials. Here we compare our candidate drug either against an already existing drug — to see whether it fares better or worse — or against a placebo if we have no gold standard of care. These trials, while not perfect, give us pretty good indications of whether something ‘works’ for particular conditions. Based on the evidence accumulated in these clinical trials drugs get eventually approved (or rejected, as the case may be) by Health Canada, the FDA in the United States and their equivalents elsewhere. It is a system that isn’t perfect, but as far as the scientific method goes, it’s the best that we can do.
Then there is other stuff out there in the business of health care. Plenty of ‘complementary’, ‘alternative’, ‘natural’, you name it concoctions. We know of many of them that they either definitely do not work at all or that they can in fact be bad for your health. There is ever more evidence accumulating that those much praised anti-oxidants in many ‘natural’ products, for instance, might actually be detrimental to our health. What all these concoctions have in common is that they have not been rigorously tested. Had they been tested they would already have lost their cloaking device of ‘natural’, ‘complementary’ and ‘alternative’. Simply put: any such concoction can in principle be tested for safety and efficacy. Once they have been tested we can know whether they work or not. Once we know they become standard medicines or they are discarded. After all, most of them have chemical substances at their heart that do something, but until we test what they do, they’re just that, untested concoctions that may or may not do what their buyers hope they will do.
Strangely these concoctions can be bought as ‘remedies’ of some sort or another in many alternative health food stores, and sadly even pharmacies. They are actually really expensive, too. I went to such a store a few months ago, and I couldn’t believe how much these little plastic bottles with their miracle powders and natural pills of sorts cost. It all seemed like a rich people’s hobby to me. In any case, this begs the question of why Health Canada approves the sale of such concoctions.
According to an editorial published in the British Columbia Medical Journal, Health Canada has approved the sale of various homeopathic concoctions as flu remedies. They are supposed to prevent flu and its related symptoms. Well, to cut a long story short, these homeopathic concoctions are nothing other than super-highly diluted infectious agents that are orally administered. They are so highly diluted that often you can’t find anything other than water in these homeopathic remedies. The danger here is that people choose to ‘protect’ themselves against the flu by using such untested concoctions. None of them have been shown to actually protect against the flu. Health Canada is seemingly OK with this status quo. It notes on its websites that these concoctions can be used safely as long as the directions from the manufacturer are followed. Funny enough, they can be used safely, because they don’t actually do anything. You could also drink water from the tap safely that’s properly treated. Do you recall the mass ‘suicide’ attempt by homeopathy critics a year or so ago? They publicly, all over the world, ‘overdosed’ on homeopathic sleeping remedies. Ignoring the warning labels they downed full bottles of homeopathic sleeping pills, and, surprise, surprise, they didn’t even get tired.
Health Canada now requires such remedies to show warning labels stipulating that they are not meant to replace properly tested vaccines. That’s all nice and well, but it begs the question why health remedies that have not been shown to have any demonstrable health effects should be on the shelves of health food stores, pharmacies and other outlets at all? The British Columbia Medical Association got it right when it insisted that Health Canada should only permit the sale of such concoctions after they have been shown to be both safe and effective. That is not the case today. There is a reason why the English National Health Service closed down its last homeopathic non-treatment facility, aka hospital. It just doesn’t work.
There is another danger in our regulatory agency’s approach to these kinds of remedies. By virtue of its stamp of approval people skeptical of mainstream vaccines might think of them as possible alternatives, despite the agency’s disclaimer. After all, Health Canada has approved these concoctions for sale. The fewer people get vaccinated, the weaker we are as a group. Herd immunity prevents outbreaks of infectious illnesses, but it requires that most of us participate. We know that in communities with high levels of resistance to mainstream vaccines infectious disease outbreaks occur. Alternative untested flu concoctions will likely contribute to such occurrences if Health Canada does not stop their sale as health products.
Udo Schuklenk teaches bioethics at Queen’s University, he tweets @schuklenk.

Sunday, October 13, 2013

The reasonableness of atheism

The Jamaican national broadsheet The Gleaner published during the last two weeks columns by one of its columnists, Ian Boyne, attacking atheists. You can find them here and here. Today the paper published my response to Boyne. I replicate that response below.


Over the last two weeks, Ian Boyne decided to call a spade a spade as far as us annoying atheists are concerned. They were two overly long columns, saturated with names of people he likes and scorns. Their authority typically is celebrated by means of affiliation or Oxford University generally.
Boyne even manages to ascribe competencies to Christian writers he agrees with that they demonstrably do not have. Alistair McGrath, a Christian theologian trained in history whose qualifications even include a doctorate in molecular biology, is declared without further ado a philosopher by Mr Boyne.
While he says he is braced for ad hominem attacks by 'trite atheists', it strikes me that such generalised statements about a very diverse group of people are, well, ad hominem themselves, aren't they? Reading his columns, I tried to understand what his message to the reading public is other than walking away with the bragging rights of having read more books than those 'trite atheists'.
Well, I have only one column in which to respond to Mr Boyne. I am actually a trained philosopher, in fact a professor of philosophy, and I happen to be an atheist. I can truthfully say that I've read the works of most people he mentions in his columns. Some of these authors I happen to know well personally. Alas, that has not persuaded me of the reasonableness of theism, and that, surely, is what Mr Boyne is after.
I will not spend the next few paragraphs dropping names on you, or at least there will be very few. I will focus on arguments, not prestige, affiliation and whatnot. What I will do is to address - hidden under all those names and Oxford University Press volumes - what I take to be Mr Boyne's main bones of contention with philosophical atheists.
They seem to be these: As human beings, our capacity to understand things in the world is limited by our biological limitations. There could be realities that are beyond our scientific abilities to discover.
Among others, one of Mr Boyne's favourite Christian apologists, Alvin Plantinga, has developed this kind of argument. He claims that we would have no reason to assume that our cognitive faculties are reliable if they were just the product of evolutionary processes. So, he ends up proposing a form of evolution - many of Mr Boyne's fellow Christians will shudder in disbelief - that includes an element of divine guidance, as only that would give us reason to trust our faculties. After all, God wouldn't fool around with us, or would He/She/It? Well, most philosophical atheists happen to be philosophical naturalists. Guilty as charged, Mr Boyne.
We acknowledge our scientific limitations. To us, the fact that our intellectual capacities are limited by the state of our evolution is not evidence that there is something else to be discovered that is outside our senses and that we just cannot grasp.
BOYNE DESPERATE
Incidentally, talking in this context vaguely about 'non-scientific ways of knowing', as Mr Boyne does, sounds a tad bit desperate to me. Unless he, or his fellow Christian apologists, give us a bit more meat to play with, let me just say that I do think this theological emperor is pretty naked. It appears to me that naturalistic processes provide us with the necessary reliability in selecting true beliefs about the world around us.
How can we test that claim? One way would be to point to our never-ending and ever-accelerating scientific progress. We know more about the world and the universe than we ever did. Insisting that there could be something else around us that we just cannot grasp by means of scientific inquiry is, for all practical intent and purposes, just hand-waving by the religious.
Is it possible that there is something else in the universe that we cannot grasp because of how we have evolved? Sure, it's possible. Just as it is possible that our planet rests on a metaphysical teapot that our scientific methods have so far been unable to discover and that requires Boynian 'non-scientific ways of knowing' to understand it.
What I am trying to get at is that raising this exceedingly unlikely possibility is clutching at straws. It's a desperate attempt by theists to avoid drowning in an ever-increasing sea of scientific knowledge.
So, even if Professor Schellenberg has a philosophical point, nothing follows with regard to the reasonableness of theism. Perhaps that is the reason why he is an atheist. At the end of the day, you have to assign probabilities to these sorts of theoretical possibilities. And the probabilities are vanishingly low for the God proposition.
To support his views, Mr Boyne cites an atheistic philosopher, Thomas Nagel, at great length. The thing about Nagel is that his book on the subject matter (as well as an earlier article in a leading philosophy journal) was ripped to pieces by evolutionary biologists and philosophers specialising in the study of biology. Nagel does not appear to have a sound grasp of
evolutionary theory. Hence his tacit support for 'intelligent design' is not based on a sound understanding of the scientific matters at stake.
MISPLACED EXCITEMENT
Mr Boyne also gets excited about another poster boy of current-day Christian apologetics, William Lane Craig. Boyne claims that he has seen many an atheist debate Lane Craig, but he has not seen a single one floor him. Funnily enough, I have seen many of these debates, too, and it seems to me that Lane-Craig looks bad in pretty all of them, but so it goes, I guess. You'll always give more credence to those batting on your team.
Lane Craig's claim to fame has been his attempt to recycle medieval Christian and Islamic theologians' attempts at proving the existence of God by means of a cosmological argument.
Basically what's done in this argument is to use remarkable features of our natural world, particularly its origin in the Big Bang about 14 billion years ago, and posit God as the best explanation. Of course, 'God' is really a place-holder indicating what we do not know today. If history is anything to go by, we are likely able to find out tomorrow.
However, even if we never found out, 'God' would still not constitute an explanation for things we do not understand in the world around us. And if we do find out, there would probably be some further mystery for which 'God' will be offered as an 'explanation'.
At the heart of this all, seemingly, is the need of religious believers to attain something approaching certainty about their various godly saviours. If they had simply decided to stick to believing that their God exists, everything would be hunky-dory. But no, they started fantasising about ways of 'knowing' about their invisible friend in the sky. They tried hard to develop logical proofs for the existence of their gods, and what not else. All that failed.
Even if one granted them everything they're saying about the limitations of scientific inquiry, nothing follows at all with regard to the existence of 'God'. Scientists would have no problems at all adapting their methods if they turned out to deliver new insights. Meanwhile, vague reference to 'non-scientific ways of knowing' won't do.
To give credit where credit is due, Mr Boyne seems to search seriously for answers to obvious doubts that he must have about his beliefs. Why else would he spend this much time engaging in debates with 'trite' atheists in the pages of this paper? After all, he could squander words beating up on homosexuals, as his fellow columnist Mr Espeut is wont to do.
It's a good thing that Mr Boyne, even if he cannot let go of his beliefs, is looking sincerely at the arguments. There is some empirical evidence to suggest many people might never be able to let go of their deeply held religious beliefs. It could well be biological and irreversible. No, I am not kidding here. In case you care about religiosity as a biological phenomenon, you might want to check out Andrew Newberg and Eugene D Aquili's book Why God Won't Go Away: Brain Science and the Biology of Belief.
Udo Schuklenk is a professor of philosophy at Queen's University in Kingston, Canada, and with Russell Blackford co-author of '50 Great Myths About Atheism'. Email feedback to columns@gleanerjm.com. Schuklenk tweets @Schuklenk

Friday, October 11, 2013

Assisted Dying - Why the Debate Won't Go Away

Here's this weekend's column in the Kingston Whig-Standard on the Assisted Dying debate in Canada.


KINGSTON - The British Columbia Court of Appeals set aside this week a lower court decision that would have decriminalised assisted dying in the country. The lower court decided about a year or so ago that provisions in the Criminal Code that prohibit assisted dying were overly broad. That is, it realised that there are situations toward the end of our lives where it would be reasonable for some of us to consider assistance in dying and where our considered choices ought to be respected and facilitated by trained health care professionals. Unlike the lower court the Court of Appeals did not actually look at the substantive issues, rather the majority of judges on the court — it was a 2:1 decision — decided that if any court should look at this matter surely it is the Supreme Court’s job to do that.
I actually agree on this issue, and I do not recall any legal expert in the country who doesn’t think that this issue will eventually end up on the plate of the Supreme Court of Canada. Stay tuned for a decision on this matter some time in 2015. It is far from over.
Independent of the so-called Carter case that’s furthest advanced in the legal system, another legal challenge to the prohibition of assisted dying is currently winding its way through the court system in Quebec. Also in Quebec the government has introduced legislation that would essentially permit assisted dying for legally competent people.
It has given voice to what the overwhelming majority of Quebecers think ought to happen in that province. A whopping 80% of Quebecers believe assisted dying should be made available to competent patients provided certain stringent conditions of voluntariness, unacceptability of the patient’s quality of life, etc., are met. This distinguishes Quebec’s government — it is supported by a cross-party consensus on the issue — pleasantly from the fundamentalist Christian politicians currently in charge in Ottawa.
Stephen Harper and his government colleagues know very well that support for the decriminalisation of assisted dying has strong majority support in all Canadian provinces — even among conservatives.
Why should we decriminalise assisted dying in the first place? Well, consistent majority support of the Canadian people for the last two decades or so is a pretty good start if you ask me. Fundamentally though it boils down to the question of what kind of society we want Canada to be.
Is it a society whose citizens have the right to make fundamentally important self-regarding decisions with regard to how we live our lives or a society where, when it really matters, the state steps in and tells us what we can and what we cannot do?
It is self-evident that these kinds of rights are particularly important toward the end of our lives. Throughout our lives, in important matters affecting our own destiny, we are in control, yet when we reach the end of our lives the state apparatus steps in and inflicts its moral views on us.
Just to be clear, we have already certain rights that even Mr. Harper hasn’t taken away from us. There is no law in the land that criminalises us killing ourselves. Yes, we are legally entitled to commit suicide if we wish to do so. We are also legally entitled to refuse medical care even if that leads foreseeably to a shortening of our lives. So, as far as our federal government is concerned, if we really find our lives not worth living any longer, it is cool to jump off a building, shoot ourselves, or end our lives in any other number of deeply unpleasant and stressful ways.
The one thing we must not do, as far as our Ottawa overlords are concerned, is to receive assistance from medical professionals that would permit us to end our lives peacefully when we wish to do so, surrounded by our loved ones. That’s just not on.
We know that even the best palliative care, available reliably when it’s needed to whoever needs it, won’t do away with some people asking for assistance in dying, simply because palliative care isn’t actually the answer to their suffering toward the end of their lives. Anti-choice activist in the palliative care community are either disingenuous or dishonest when they pretend otherwise.
A lot of hay has been made of the risk of abuse, the so-called slippery-slope risk. Disability activist organisations such as Not-Dead-Yet paint a scenario where the lives and well-being of disabled people would be in grave danger if we decriminalised assisted dying. They express concerns, worries, and even graver concerns. The one thing they do not have are hard data to back up their wild claims. A significant number of jurisdictions have decriminalised assisted dying in some form or shape. We have a lot of data with regard to what is and what is not happening in those jurisdictions. The one thing you cannot find, is that a disproportionate number of disabled people seeing their lives ended in these jurisdictions.
So, much as one appreciates these concerns and worries, they just aren’t a good reason not to decriminalise. They are red flags indicating that we should put the necessary safety mechanisms in place that would stop any attempts at such abuse right in their tracks, but that’s where this matter should rightfully end. Baseless concerns and worries are not a good foundation for government policy.
Talking about abuse. I have recently spent two years of my life investigating end-of-life issues as part of a research project on behalf of the Royal Society of Canada. Our international team of experts combed through all the available empirical evidence from the jurisdictions that have decriminalised. Given that people who are supportive of the decriminalisation of assisted dying are strongly motivated by empathy for the suffering of their fellow citizens toward the end of their lives the abuse question quite naturally weighs heavily on one’s mind.
The fact of the matter is this: We have seen zero evidence that the decriminalisation of assisted dying has led anywhere to an increase in the number of cases that arguably constitute cases of abuse. In jurisdictions where data about the before and the after decriminalisation exist we actually found that cases of abuse halved.
Does that mean that we should be complacent about these issues if we decriminalised? Certainly not. But, we live in a functioning democracy. It is certainly not beyond our capacity to legislate and regulate an assisted dying regime in Canada that reflects the will of the Canadian people on this issue and that at the same time protects our most vulnerable against abuse.
Udo Schuklenk holds the Ontario Research Chair in Bioethics and Public Policy at Queen’s University,between 2009 and 2011 he chaired an international expert panel drafting an end-of-life report commissioned by the Royal Society of Canada. He tweets @schuklenk

Friday, October 04, 2013

Why you should get your flu shots


The flu season is just about upon us. Soon flu shots will be available to virtually everyone free of charge. And yet, if past years are anything to go by, some 20,000 Canadians will be suffering so severely from the flu virus that they will end up in hospital. The rest of us will foot the bill for their by and large avoidable health care costs. Public Health Canada reports on its website that between 2,000 and 8,000 Canadians die every year of the flu or its complications.

Strangely only those of us in possession of a valid health card will be able to access the flu vaccine free of charge through our health care system. That obviously makes no sense at all. Because of this policy those amongst us without a health card will be more likely to contract the flu, and, quite a few of them will pass it on to others. Any sensible public health strategy would offer these shots to anyone to increase the level of protection for everybody.

There are, of course, as with every pretty obvious issue, a large number of people out there who won’t get the flu shots even though they are entitled to receive them free of charge. They encompass conscientious objectors as well as people simply too lazy to bother. People who do not get immunized themselves pose a higher risk to others, both those who are also not immunized as well as those who are immunized. The latter are also subjected to a higher than necessary risk, because while the flu vaccine offers a higher degree of protection, it is not 100% efficacious (few things in modern medicine are).

What is the morality of our behavior in the age of influenza? Are we ethically obliged to get vaccinated? Should it be compulsory for people who have contacts with large numbers of customers, clients or even patients to get vaccinated? Should employers be permitted to fire or remove temporarily from work those employees who refuse to get vaccinated? And what about those of us who catch influenza, should we stay at home, or should we drag ourselves to work or school regardless? Seeing that we would be carriers of a highly infectious illness that has the habit of killing thousands of us every year, should we be yanked off trains, buses and planes to protect members of the public that otherwise would be stuck with us?

Let’s start with the easy one: Yes, we should get vaccinated. It does not take a degree in public health or in bioethics to figure out why this is so. In important matters that affect only ourselves or predominantly ourselves it needs a very good reason for the state to override our decisions. When it comes to influenza vaccination the issue is not only about ourselves but also about potential harm to others. Now, you could say that there wouldn’t be any risk to those who got vaccinated, and whoever does not get vaccinated and decides to venture out during flu season kind of consents to the risk of catching it. That isn’t quite correct. The risk of catching the flu is only reduced by about 60% for those who got vaccinated, and even this figure varies depending on one’s age group and other factors. So, those of us who choose not to get vaccinated not only pose risks to others who also have not been vaccinated but also to those of us who did what they could to protect ourselves and others by getting vaccinated. Basically the negative impact of a single person who decides not to get vaccinated quickly cascades through society. The more people there are who don’t get vaccinated the more people we will see ending up in hospitals and, unfortunately, in the morgues. That does seem an unreasonably high price to pay for individual laziness or unfounded ideas about vaccines and autism.

Autism and vaccines? Oh, in case you have not heard, like with all good things, there are always some people (like ex Playboy model and actress Jenny McCarthy) who make wild public claims about matters they know little about. In the case of vaccines, a quite efficient grassroots campaign has got off the ground irresponsibly misinforming us that we should not get vaccinated lest we wish to increase the risk of developing autism.  Health authorities around the planet, including Health Canada and the Centers for Disease Control in the USA have declared categorically that vaccines do not cause autism. There is zero evidence for the claim that autism is linked to vaccines. Will that stop the fans of conspiracy theories from claiming the opposite? Likely not. Is that a good reason to refuse getting vaccinated? Not really.

Well, back to our questions. What if you failed to get vaccinated or you got vaccinated and you realise the vaccine doesn’t quite do the trick for you. Should you drag yourself to work or school and show that you’re not a wimp? Well, the long and short of it is that you should stay at home to protect others as good as you can. The best you can do is to limit the number of people you interact with while you are highly infectious. The primary aim of your actions should be societal harm minimization. It follows that if you can avoid going on the journey you booked, do not board buses, train and planes as it is very likely that while you and the other passengers are stuck in these confined spaces for a couple of hours, you will infect a whole bunch of others who in turn will infect a whole bunch of others, etc.

Should we require health care professionals who see patients as part of their daily work routine to get vaccinated? Of course we should. Health care professionals typically see people in an already weakened health state. The last thing these patients need is to be treated by professionals who think nothing of passing a dangerous virus on to them. First do no harm remains one of the foundational principles of medical practice. It would behoove health care professionals refusing to get vaccinated against influenza to keep this one in mind. Even though influenza vaccines do not grant 100% protection, at least they dramatically decrease the likelihood of a vaccinated health care professional catching and passing the virus on to their patients. Working in the healing professions both comes with special rights as well as special obligations.

Udo Schuklenk is a bioethics professor at Queen’s University, he tweets @schuklenk

ethics of charitable giving anyone?


My OpEd from last weekend's Kingston Whig-Standard
Many of us donate our time, and more often our money, to charitable organizations working toward helping people in need. Realistically, there are two or three prominent reasons for this.
Some persons simply donate because their religion demands it, and their religious community monitors closely who does and who does not donate. Peer pressure works. Then there are people who donate because there are tax benefits to be gained, so that a largish donation – at the end of the day – doesn’t cost us personally that much. And finally, there are others who donate because they truly want to help others. I am mostly interested in this latter group.
(It goes without saying that, for a lot of people, their motives might be an amalgam of reasons as opposed to a clear, single factor. Not everyone will just be motivated by tax benefits; most religiously motivated donors will care about the benefits others derive from their donations, etc.)
I donate mostly because I hope to help others in dire need – tax credits are a nice additional benefit, but often I end up donating to charitable organizations that are not registered in Canada, so no tax benefits accrue on those occasions.
Why should we donate to assist others in dire need? I guess it’s mostly due to the fact that these others are like me with regard to their interest in living a life worth living. The more of us that are able to live a life worth living, the better off we are as a global community of individuals with similar needs.
How much should I donate, then, as a percentage of my income? I guess it’s not unreasonable to propose as a rule of thumb that whatever amount I donate should not dramatically impact negatively on my own quality of life. Wealthier people arguably could and should donate more toward the improvement of others’ living conditions than poorer people.
As it turns out, Canadians are doing pretty well as donors to good causes. In 2011 we donated about $8.5 billion, and those are just donations captured by Revenue Canada. Surprisingly, the number of Canadians donating is shrinking, but those who do donate seem to become ever more generous.
Who should benefit from our generosity? Is it more important to contribute, for instance, toward local child or animal welfare, or to causes affecting people in much more dire – possibly life-threatening – straits in far-flung places?
If you believe that all human lives at least are equally valuable, you would probably have to go for struggling-for-survival people in far-flung places, but only if you could be reasonably confident that your money can be effectively deployed; otherwise, you might as well donate only to your local charity.
Judging that question can be a bit of a challenge. How effective could your donations to a cause in Somalia or Afghanistan really be, given the ongoing strife? You might be better off considering a target for your donations in a society that is at least reasonably functional. Somalia might be out of the running then for the time being.
You would also want to ensure that the charity that you are donating to is not gobbling up most of your donation for administrative costs and high-salary senior management types.
Keep in mind, though, that managing a well-run charity requires highly skilled people. They need to be paid properly, too. A good way to check how charities you consider donating to are doing is to use websites such as Charity Intelligence Canada (www.charityintelligence.ca/) or the U.S.-based website Charity Navigator (www.charitynavigator.org/). You would be surprised, even as far as prominent charities are concerned, how wide the efficiency differential is between organizations that work in the same field. So, if the target of your donations is the maximization of human well-being, that information becomes crucial.
We are also surprisingly emotional when it comes to charitable giving. There should be no surprise in that. In addition to being morally obligatory, we typically also feel strongly about where our money goes.
Dire need opens our heart and pursestrings. There is a reason why international aid organizations don’t hesitate to show pictures of starving children, typically, as opposed to starving adults. The latter they show, too, but not nearly as often as images of children.
This is problematic, obviously. Large charities really are multimillion (some possibly multibillion) dollar businesses. They need to rake in large sums of money not only for their programs but also to pay their staffs. It is perfectly possibly that our irrational responses to requests for donations leads to charities setting their sights on to wrong targets. They are not helping where the need is greatest or where they could help most cost-effectively, because a particular cause or country might be a difficult sell.
Research reported this week indicates that we are very good at throwing good money at questionable, if not outright bad, causes. It turns out that the more people who have died in a natural disaster, the more money we donate. Ask yourself: Is it possible to improve the quality of life of dead people? Surely not! So why do we donate toward disasters causing many casualties, as opposed to disasters where many people are still alive and in need of our help?
Similarly, if we were really primarily concerned about actual need as opposed to proximity, how is it that Americans donated only half of what they donated to Hurricane Katrina victims to the much-larger number of much-needier Haitian earthquake survivors?
As a species we seemingly have not evolved sufficiently to accept that all humans have equal moral standing and that our obligations toward others in need should be measured by how efficient our response would be with regard to the objective of improving others’ quality of life.
For the reasons mentioned, I take as a given that we are morally obliged to donate some of our resources to assist others. Those of us who agree might want to take another look at who we give money or other resources to, and ask ourselves whether our chosen charity really is most effective at improving human well-being.
Udo Schuklenk teaches bioethics at Queen’s University. Follow him on Twitter @schuklenk

Interesting question on SCIENCE spoof

I received the below question from someone who then managed to leave a mistyped email sender address...

I didn't think this would fit as a comment on your blog, so I tried to find an email address for you but found this. I hope you don't mind.

Have you seen the recent news article in Science? Here's a link: http://www.sciencemag.org/content/342/6154/60.full


Basically, a journalist sent a spoof paper to a large number of open-access journals to gauge the quality of peer-review. The paper was scientifically flawed in ways that would be obvious to any half-competent reviewer, and realistically it should not have passed beyond an editor's desk without rapid rejection. In fact, that's exactly what happened when he submitted the paper to some journals. Many, though, not only did not require significant revision, but simply accepted the paper for publication, clearly indicating total incompetence at that journal.

I thought of you and asking for your take on this because over on "In the Pipeline",  Dr. Derek Lowe's blog mostly about pharmaceuticals and chemistry, his discussion includes a comment thread that features some accusations about the need for, among other things, institutional oversight as what this journalist did constitutes research on human subjects.

That's a long run-on sentence, sorry. Short version: is it unethical to seek out incompetence and/or fraudulent patterns of behaviour by this kind of spoofing?

My reply:

guess you're asking two different questions: One is whether this kind
of activity required ethics approval. I suspect this might yield
different answers in different countries. On an ethical level though:
In this particular instance, strictly speaking, the people tested were
not tested in their personal capacity (eg as patients) but as
professionals doing their jobs. It's a bit like me writing to a
colleague who is a clinician at UoT asking a question about how he
thinks professionally about a particular article. Say I ask another 20
other professionals in other universities. Should my intention to
publish the results of my survey mean I need to ask for ethics
approval? My honest view on this matter is that anyone who is
approached in a professional capacity as opposed to a personal
capacity doesn't need the kinds of special protections afforded by
ethics review.

That's not to say that formal rules and regulations may have been
breached in this particular case. I just don't know (and truth be
told, I don't care either).