All entries for April 2006

April 27, 2006

Operation survival rates: should we have the information?

Writing about web page http://news.bbc.co.uk/1/hi/health/4947046.stm

A breaking story today announces that hospital heart surgery survival rates are being published for the first time. However, they have stopped short of making the publishing of success rates compulsory for individual surgeons: only those who have volunteered have had their results published. Perhaps unsurprisingly the ones who have come forward have success rates above the expected average. However, there is much pressure to make the publishing of these results mandatory and for other medical specialisms to follow suit.

  • If I was a patient going in for major surgery I would want to know that my surgeon was competent and was not likely to make mistakes. Do we have a right to know this information and possibly make changes to our treatment on the basis of it?

  • It may encourage some with lower standards to make more effort to improve their techniques. On the other hand, it may cause extra counterproductive stress.

  • Surgeons may refuse to operate on high-risk patients in case they bring down their averages.

  • Will the results be truly reflective of a surgeon's ability? A doctor could just have a string of bad luck and as a result be blacklisted because the sample size isn't large enough to reflect a true average.

Is this an irreconcilable situation?


April 24, 2006

Death row injections and whether we have our priorities right

A New Scientist article from early last month discussed the ethics behind the US method of execution: lethal injection. At the end of February Californian officials delayed the execution of Michael Morales, sentenced to death for a murder he committed in 1981:

His lawyers argued that a lethal injection would constitute cruel and unusual punishment, prohibited under the US constitution. Their case was based on a study published last year in The Lancet (vol 365, p 1412) that suggested some inmates were given too little anaesthetic before receiving fatal doses of other drugs, and might therefore experience unnecessary pain. At a hearing set for May, the state of California must show that it has a lethal injection that does not kill in a cruel and unusual way. Several other states, including Florida, Maryland, Missouri and Texas, have similar cases pending. Medical opinion is not on their side.

I have blogged before about the possible objections to the treatment of inmates in prisons in this country. Many have expressed the view that prisoners should be punished for their crimes and that the current prison system is far too comfortable to be a proper deterrent or to reform anyone. Often inmates gain access to far more readily available medical treatment, health and exercise facilities than they would when free. Far more is spent on a meal for a prisoner than on one for a child in a state school.

A recent survey, I forget where I read it, considered the sensitive subject of the care of people dying naturally in the UK. I think the respondants indicated that approximately a third of deaths were not satisfactory: they didn't think that homes, hospitals or other organisations provided sufficient care to make the death of their loved ones as peaceful as possible. A recent survey of health workers (from a BBC news article) indicated that '69% admitted that many conditions suffered by the elderly, such as dementia, arthritis and sensory impairment, were overlooked… some 57% said they lacked training and support, and a quarter said they struggled to cope with dying patients.'

I know that these examples come from different countries controlled by different systems of law, but are we getting the balance right by worrying too much about some, who have indeed subverted our laws, when we're neglecting other law-abiding citizens?


April 21, 2006

The job of the monarch

Of course today is the Queen's 80th birthday, and I wish her a very happy one. On the Today programme this morning a debate was had about the accession of Prince Charles to the throne. It was pointed out that whilst we knew very little about the Queen's personal opinions when she was crowned, in contrast we know much about Charles's, sometimes controversial, views. Indeed, we still know very little about the Queen's affiliations and opinions: she has successfully maintained a very neutral stance.

Should a monarch, bearing in mind that they have very little political sway, actively air political or other important views? Is it in their interest not to? Has our current Queen's neutrality contributed significantly to her popularity? And the much-reiterated question… what role does the monarchy really serve bearing in mind their limited power to do anything?


April 17, 2006

A question

This one got me thinking yesterday…

Which is the most influential and defining event in the history of mankind?


April 13, 2006

Potential alcohol substitute: would you choose to drink it?

I read an article in New Scientist this morning detailing the development of a new cocktail of drugs that mimics the neurological actions that cause the pleasurable effects of alcohol without causing any of the downsides. Whilst limiting the immediate adverse effects, such as violence and illness, it would also reduce the occurrence of longer-term problems like liver cirrhosis.

This all sounds like a fantastic idea, but I'm not sure I'm convinced that it will catch on. It started me thinking about my habits: I know I sometimes feel like I just need to go out and get a little pissed at the end of a long week, but most of the time I drink alcoholic beverages because I like the taste of them. What reason do people really have for drinking alcohol: is it for the love of the drinks themselves or the way that they affect you? What is it particularly about the state of drunkenness that is so attractive that we want to repeat it: many people still go out and binge drink despite often being ill and wasting days as a result of painful hangovers? Would there be a stigma associated with an alcohol substitute because it is an admission that you only like drinking because it gets you drunk?


April 12, 2006

Shirking

It occurs to me that I, and sometimes others, have been talking a great deal on these 'ere blogs about responsibilities. It is a common observation, I believe, that many of the younger generation have the constant urge to shirk their responsibilities, even going so far as to deny things they have been seen doing (I have lots of first-hand experience of this). I personally think this attitude is becoming a real problem.

But why is it happening?

Another modern phenomenon, which seems to be linked, is the increase in numbers of individuals suing companies for apparent negligence, or for the emotional results of bullying or prejudice. Now of course I would never advocate maltreatment in any form, but some of the recent cases do seem a little ridiculous: the deputy headteacher who tried to claim £1,000,000 for the emotional scarring left after having, in her office, a chair which made farting noises; the guy who bought a bike from Taiwan and was badly injured because the Taiwanese wire their brakes the opposite way around and he put on the front brake instead of the back when going quickly down a hill (apparently the manufacturers didn't make this quite clear enough in the instructions, despite detailing the wiring of the brakes).

Is this attitude a logical result of the regulations that are being put in place to try to make things more rigid? Essentially, when a company writes a list of instructions, they are declaring that they take responsibility for the safe working of a product when following them. When they begin to consider common sense as part of the required instructions can it not then be inferred that the user is not expected to use any common sense in their approach, other than that detailed? It also occurred to me that there may be a link between the regulation of teachers and the attitude of pupils. Teachers are now having to follow incredibly strict instructions regarding everything they do. They are being observed and checked up on constantly (some schools have even installed CCTV cameras with sound feedback and two-way mirrors), and they have to document every tiny incident to cover their backs and all punishments have to be standardised and approved. If you take away the responsibilities and independence of teachers how can they instil in their pupils the need for accepting responsibility? If teachers lose more and more authority (for example, parents can refuse to let their children stay for detentions) how can we expect them to be respected?

Is this change good for us? Health and safety regulations are dictating that we now need to put instructions on the back of bags of nuts to say 'may contain nuts' and on clothing labels to say 'please remove before washing'. I'm sure, a few years ago, these things would have been dismissed as being far too painfully obvious to bother with. These helpful hints are, I assume, supposed to assist users in being safe. However, we now have a situation where companies have to cover all ridiculous eventualities and yet still get sued because they missed just one loophole.


April 02, 2006

Why, oh why…?

Yesterday Justin and I were having a very civilised afternoon stretching our legs by browsing the shops of Leamington. We decided to break this up by going for tea (and cakes) in the Pump Rooms Cafe, and one of the eternal mysteries of this country of ours raised its ugly head. Why, in a nation of enthusiastic tea drinkers, are the manufacturers of teapots still permitted to produce pots and milk jugs that are totally useless at fulfilling their primary function: pouring?

April 2006

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