Saturday, November 16, 2013

A tale of two bioethics journals

I did something probably not conducive to mental health: I looked at the American Journal of Bioethics and the Indian Journal of Medical Ethics during the same evening. The current issue of the American Journal of Bioethics, whose blog has a motto that wears its ambition on its sleeve ('Where the World Finds Bioethics') is all about advances in neuroscience and psychopharmacology that could lead to the control of 'bad' forms of love. Of course, we do not have the scientific capacity to actually do this, but why not speculate about the ethical implications of emotional enhancements anyway? True enough, even if anti-love pills are a far way off, the thought experiment might help us understand a bit better what that phenomenon called 'love' is all about. Love is important. Still, the debate gives something of a rarified, parlor game feel, especially in a world where millions do not have access to immunological enhancements (like antibiotics) or nephrological enhancements (like dialysis).  

The Indian Journal of Medical Ethics is tackling quite another kettle of fish, very much non-speculative in character. Researchers conducted a randomized placebo controlled trial of cervical cancer diagnostics in India, despite (a) the intervention being tested already widely being regarded as efficacious, and certainly more effective than no screening at all and (b) despite the possibility of testing their hypothesis by using an existing diagnostic (Pap smear) as comparator.  For a decade, some 76,000 Indian women were monitored (apparently including monitoring of the growth of their cervical cancer) but allegedly did not receive sufficient information regarding alternatives to screening and did not adequately consent to the study. It is said that over the years, 6.5 more women died in the control group from cervical cancer than the intervention group. The ethics of this study is what the current issue of the IJME is debating, with scientists defending it, and journalists and ethicists criticizing it.

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