Prime time ethics

Medical ethics debates move into prime time TV with the second season of Grey's Anatomy spin-off, Private Practice, premiering Wednesday night.

Creators of the show say they hope to distinguish it from Grey's by tackling ethical issues throughout the season. Researcher and writer Elizabeth Klaviter, who also writes for Grey's, says the show will draw on real-life medical dilemmas.

"We look at the things that have ourselves and our family members and friends buzzing — the issues that people are talking about in terms of right or wrong and the laws, ethics and social morays that are put on us in terms of how we conduct ourselves."

There is plenty to draw on.

This season, the doctors will have to decide what rights prostitutes have to medical care and whether to treat a sex offender at their child-friendly practice. They will debate abortion and grapple with whether to deliver a premature baby they believe was conceived solely because the umbilical-cord blood could save the family's older, dying child. Another doctor wonders what to do when a teenager — who has HIV but doesn't know it — says he plans to have sex for the first time.

"We're telling stories ... that will provide a lot of moral debate among our doctors and maybe debate at home when you watch," said series creator Shonda Rhimes.

Patents hurt innovation: study

Canadian researcher Richard Gold says strict patenting regimes intended to spur innovation are, in fact, having the opposite effect.

He presented the study yesterday in London, England.

"The old [intellectual property] approach of the biotechnology community has failed to deliver on its potential to address disease and hunger in both developing and industrialized nations. We need to do better, and the [information technology] world has shown us part of the solution," said Gold. "Look at the way that change has swept through the IT world and brought benefits to millions."

Gold said he expects the pharmaceutical companies to lead the charge for change.

"I have talked to biotech executives who say the message we are giving is the right one, but [they] cannot afford to say so openly."

He called for more public-private partnerships to share risks during early stages of research, and more patent pooling during the later stages of development and commercialization.

Groups such as the Canadian Health Coalition have long argued that Canada's patent system needs an overhaul.

Selective trials make companies look good

To get a drug approved in the US, companies must submit at least two studies to the Food and Drug Administration showing the medication is safe and effective.

So far, so good.

But what's to stop a company from commissioning four, five, six, or more studies and then only submitting the two that make their product look good -- ignoring anything that would hurt their chances of approval.

Well, according to a new study, not much. In fact, that appears to be exactly what drug companies are doing.

Over half of all supporting trials for FDA-approved drugs remained unpublished (more than) 5 years after approval. Pivotal trials and trials with statistically significant results and larger sample sizes are more likely to be published. Selective reporting of trial results exists for commonly marketed drugs.

The study in the Public Library of Science journal this week raises serious questions about how new drugs are approved. "We found that there was indeed a pattern that favorable studies were more likely to be published than unfavorable trials,'' Ida Sim, associate professor of internal medicine at UCSF and the lead author of the study told Bloomberg.

The study says bluntly, "a pivotal trial in which the new drug does no better than an old drug is less likely to be published than one where the new drug is more effective, a publication bias that could establish an inappropriately favourable record for the new drug in the medical literature."

In other words, the researchers are saying, the companies publish what makes them look good.

`A duty to die'

In a startling interview, Baroness Helen Mary Warnock, one of Britain's top bioethicists, says elderly people with dementia may have `a duty to die.'

"If you're demented, you're wasting people's lives – your family's lives – and you're wasting the resources of the National Health Service. I'm absolutely, fully in agreement with the argument that if pain is insufferable, then someone should be given help to die, but I feel there's a wider argument that if somebody absolutely, desperately wants to die because they're a burden to their family, or the state, then I think they too should be allowed to die."

The comments by the 84-year-old, who has never shied away from controversy, were quickly condemned by the British Alzheimer's Society

"The people Alzheimer's Society works with are valued, treated with respect, accorded dignity as unique individuals with past, present and future needs and desires. They may wish to discuss end of life issues with loved ones but the language Lady Warnock uses about `wasting the resources of the National Health Service' does not help those discussions."

The Baroness's comments have, of course, been fodder for online commentators. Some making much of her peerage, even suggesting that they "start with the Baroness," while others have been more reasonable in their response:

"Sufferers and relatives should be helped through the provision of better treatments and improvements in care. To say that the demented should instead end their lives shows a quite chilling absence of elementary human sympathy."

Like it or not, however, deciding who gets access to the health care system is one of the looming issues in medical world.

Doctor college passes religion policy

The Ontario College of Physicians and Surgeons has amended its policy statement on the right of doctors to refuse to provide health services on the basis of their personal religious beliefs, and yesterday passed the policy unanimously.

The changes, however, are unlikely to satisfy many of the critics of the policy, who felt the college should have come to the defense of doctors rather than advise them on how to avoid a human rights complaint from a patient who is refused care.

"No right is absolute," college president Preston Zuliani said after the vote. "There are two people in a doctor-patient relationship, and both of those people have rights."

Doctors, the policy says, are expected to inform patients about treatments they won't provide, make sure patients know about all their options and to tell patients about other doctors who might help them.

"Saying that you are morally against something is not sufficient. We are not going to accept that as a defense," Zuliani said.

Doctors and religion debate today

The Ontario College of Physicians and Surgeons debates a policy today on the rights of doctors to refuse to provide medical care that goes against their personal religious beliefs.

The Ontario Medical Association and Toronto Catholic Archbishop Thomas Collins have opposed any restrictions on doctors.

The college could approve its new policy today, amend it, send it back for a complete rewrite or reject it.

The policy warns doctors that refusing treatment could see them ending up before the Human Rights Commission or a college disciplinary panel.

It should be an interesting debate.

McCain opposes stem cell research

US Republican presidential candidate John McCain, who has previously called for ending the Bush administration's ban on financing embryonic stem cell research, now seems to be calling for it to be extended.

"He cannot be trusted to be a supporter of embryonic stem cell research," University of Pennsylvania bioethicist Art Caplan told Wired magazine. "He is moving toward a straight pro-life stance and this sort of answer can only be read as such."

Responding to questions posted by Sciencedebate2008, McCain said, "I believe clear lines should be drawn that reflect a refusal to sacrifice moral values and ethical principles for the sake of scientific progress."

Wisconsin bioethicist R. Alta Charo called it "a close echo of Bush's language used to support the ban on funding for work with newer lines."

Democratic candidate Barack Obama called for an end to the US federal funding ban.

Religion and treatment discussed

It seems the 34th meeting of the US President's Committee on Bioethics was dominated last week by discussions over a debate raging on both sides of the border: the right of doctors to refuse to provide treatments that go against their personal religious beliefs.

Debate ranged from those saying doctors must exercise judgment all the time on what treatment is best, using all factors in their decision -- including their personal beliefs -- to those arguing that doctors who can't perform certain procedures should perhaps stay out of medicine.

Clearly, there is a wide variety of opinion on this, the Ontario College of Physicians and Surgeons will be grappling with all of them at its meeting this Thursday as it debates a draft policy on religion and doctors. The Ontario Medical Association and the Catholic Archbishop of Toronto Thomas Collins oppose any such limits on doctors.

In the US, a California court has ruled that doctors cannot refuse treatment, based on their personal religious beliefs. US President George Bush has vowed to ensure they can.

Refusing care for religious reasons

The intersection of faith and medical care can be a touchy subject, and one being debated on several fronts this week.

National Public Radio, the American radio equivalent to PBS television, asked two ethicists to debate the rights of doctors to refuse to provide treatment to patients that violate their personal religious beliefs. The debate there was sparked by a California court decision that said doctors cannot deny service. US President George Bush says he will protect such doctors.

In Canada, the Ontario College of Physicians and Surgeons will debate the issue on Thursday. The Ontario Medical Association is fighting any restrictions.

On the other side of the coin, a Toronto mother and father are charged after refusing medical care for their malnourished baby, saying their religion favours homeopathic treatments.

Stem cells in US election

Joe Biden, the Democratic vice presidential candidate in the upcoming U.S. election, has questioned how the Republicans can claim to care about the needs of families with disabled children and still oppose embryonic stem cell research.

The Wall Street Journal says his comments are apparently directed at Sarah Palin, his rival on the Republican ticket.

"I hear all this talk about how the Republicans are going to work in dealing with parents who have both...the joy and the difficulty of raising a child who has a developmental disability, who were born with a birth defect," Biden told a rally in Columbia, Mo. this week.

"Well, guess what folks? If you care about it, why don't you support stem-cell research?"

Palin has an infant son with Down syndrome and opposes embryonic stem cell research.

Republican spokesman Ben Porritt accused Biden of "playing politics with this issue."

Stem cell researchers are hoping the November election will see an end to a federal ban on funding for embryonic stem cell research, which they fear has put the U.S. at a disadvantage internationally.