Tortured ethics

In the wake of new revelations about Bush-era torture of terrorism suspects, the American Medical Association has written a letter to US President Barack Obama telling him that the use of doctors in torture violates basic medical ethics.

Any involvement by physicians in torture is fundamentally incompatible with the physician’s role as a healer. Such involvement would violate core ethical obligations of the medical profession to “first, do no harm” and to respect human dignity and rights.

These core principles are enshrined in the Code of Medical Ethics of the American Medical Association (AMA) and the codes of other professional medical organizations throughout the world. Our AMA Code forcefully states medicine’s opposition to torture or coercive interrogation and prohibits physician participation in such activities. Our Code calls on physicians to support victims of torture, to report the use of torture, and to strive to change situations in which torture is practiced. At stake are the rights and well-being of individuals, the integrity of medicine, and society’s trust in the profession.

The group says it is ready and willing to work with the new president "to ensure that these core principles guide our nation’s physicians."

Last Saturday, the Washington Post outlined the role of medical professionals in the torture.

The CIA dispatched personnel from its office of medical services to each secret prison and evaluated medical professionals involved in interrogations "to make sure they could stand up, psychologically handle it," according to a former CIA official.

The alleged actions of medical professionals in the secret prisons are viewed as particularly troubling by an array of groups, including the American Medical Association and the International Committee of the Red Cross.

AMA policies state that physicians "must not be present when torture is used or threatened." The guidelines allow doctors to treat detainees only "if doing so is in their [detainees'] best interest" and not merely to monitor their health "so that torture can begin or continue."

The various justifications used by the CIA for using medical professionals are outlined on the Mic Check blog, along with other justifications, as contained in a declassified CIA memo.

Being a middle aged guinea pig

For anyone who has ever been tempted to participate in a health study -- or wondered about those who do take part -- it might be worth reading the Booster Shots medical blog at the LA Times.

The blogger, Rosie Mestel, takes readers through her experience being interviewed as a control subject for a cancer study.

A few weeks back, I came home to find a letter stuffed in my mailbox explaining that a group of researchers was seeking an adult woman to match against another individual in the neighborhood who'd had a cancer diagnosis. As far as I could figure, it was an epidemiology study in which they make lots and lots of similar matches and try to tease out lifestyle and other factors that may have a bearing on cancer risk.

I ummed and awwed for about a week, and then finally sent a form back with an agreement to be interviewed.

It turns out, she kind of liked it, and was sad to see it end.

From the other side of the gurney, researcher and blogger Summer Johnson, said the blog made her reflect on the impact her work has on her subjects.

Perhaps atypical, idiosyncratic, or just one person's point of view, it made me pause to think about the human subjects I've interviewed and how this process effects them during and after the research study is over.

Now on Twitter

I'm just back from almost three weeks off, and have just set up a Twitter account, which you can follow to get regular updates on the things I am blogging about.

I also plan to use Twitter as a way to get debates going on various medical ethics topics -- such as one I will be blogging about in a few minutes: organ sales. It seems that Singapore has gone ahead with plans to legalize payments to people who "donate" organs, such as a kidney.

What do you think?

GlaxoSmithKlein plan for developing countries backfires

A recent announcement by drug giant GlaxoSmithKlein to spend 20 per cent of its profits from developing country sales on building the health care infrastructure of those same countries, and to sell patented drugs there at a quarter of their market price, sounded quite generous.

At least on the surface.

The plan, however, has not held up to the scrutiny of some of those analyzing it, including The Global Bioethics Blog, which focuses on biotech research in developing countries.

These promises may make GSK look saintly, but the impression largely fades on reflection. 20% of GSK's profits in developing countries does not amount to much. ...

Gestures of philanthropy towards the world's poorer nations, on the part of aggressively profit- seeking pharmaceutical companies, is to be taken with a grain of salt at the best of times. In a down economy, when pharmaceutical companies are merging for their own survival, full-blown skepticism is in order.

The blog cites an editorial in the respected medical journal, The Lancet, and an analysis of the Glaxo plan by the Policy Innovations think tank -- which both point out that because the company makes so little money in poor developing countries (where few can afford its products), 20 per cent of its developing country profits is very little indeed.

... an editorial in the Lancet calculates it as less than 0.1% of GSK's total profits, and the folks at Policy Innovations see this as boiling down to about $50,000 per country, hardly a generous investment in local health infrastructure. Selling patented medicines at a quarter of the usual (bloated) price may not be of much help either to those who live on a few dollars per day. And while giving access to patents sounds nice, the road from possession of patent information to research to marketing is a long and winding road paved by a great deal of money. Who has that kind of money? The big pharmaceutical companies, like GSK. But they won't really invest to create drugs for conditions affecting developing countries because the profit margin would be meagre. We come full circle.

Not everyone, of course, questioning the company's move. New Scientist welcomed it, noting that it at least will spark a debate about how much Big Pharma should do to help people in developing countries.

Oxfam spokesman Rohit Malpani urged other companies to emulate GSK, but would like to see the company free up its anti-HIV medication patents as well. Richard Barker of the Association of the British Pharmaceutical Industry says GSK's stance will spark a debate about "how much further industry can and should go" in promoting global health.

 

Tooting my own horn -- one of 50 top blogs!

Allow me a moment of self-indulgence.

This blog has been rated in the Top 50 Medical Ethics Blogs in the world by the web site Uspharmd.com -- 23rd overall and Number One internationally. Or, at least, first on the international list.

Congratulations to me.

Uspharmd.com targets pharmacists, pharmacology students and consumers, rating schools, giving industry news and offering consumer information -- and has its own blog.

Here's what they say about this blog:

International Medical Ethics Blogs.

As the world grows more connected, medicine cannot be isolated to ethics in just one country. The following bioethics blogs offer an international perspective.

Medical Ethics blog. This blog at the Toronto Star, written by a long-time ethics journalist, gives a Canadian perspective on North American medical ethics.

The top blog in the world is blog.bioethics.net. "Written by the editors of American Bioethics Journal, this blog includes information the editors receive and share with readers," according to Uspharmd.com.

That's a tough act to beat, and it's certainly on honour to be on the same list.