Inaugural Café Scientifique at King’s College: November 21, 17.00- 19.30

Professor Anne Marie Rafferty, Director of Academic Outreach and Professor of Nursing Policy Florence Nightingale School of Nursing &Anne-Marie-Rafferty-2013-490x250 Midwifery and Centre for the Humanities and Health Kings College London, is delighted to announce the inaugural Café Scientifique event on Thursday 21st November at 5.00pm in Chapters at the Strand Campus. The event is running under the patronage of of Professor Evelyn Welch Vice-Principal, Arts and Sciences and Karen O’Brien, Vice-Principal, Education, and aims to bring together the different and increasingly overlapping, communities of the Centre for the Humanities and Health (CHH), Centre for the History of Science, Technology and Medicine (CHOSTMS) and the Department of Social Science Health and Medicine to begin a conversation to scope out the synergies and common ground between these scholarly domains.

The idea behind the Café Scientifique is to create an atmosphere in which all participants feel able to contribute in a more informal setting than the seminar room. In order to stimulate discussion three eminent speakers; Brian Hurwitz, David Edgerton and Nik Rose will outline where their field is heading in terms of the exciting ideas that are animating the field. After each has spoken for not more that 15 mins we shall open it up to you, the audience for a café conversation expertly facilitated by Daniel Glaser, Director of the Science Gallery at King’s.

In the spirit of a café conversation we hope to continue the evening with a reception after the event.

The running order for the evening will be:

1. Welcome and introductions 17.15-17.30
2. Pitches from panellists 17.30-18.15
3. Café conversation 18.15-19.00
4. Reception 19.00-19.30

This event is open to all KCL students and academics with an interest in this field.
To reserve you seat please RSVP to Sabrina Beck, Centre Manager for CHH: chhATkcl.ac.uk

Understanding the Health Bill

Catching some of Sir Paul Nurse’s programme on climate change scepticism, and the wider issue of communicating scientific knowledge and research to the public, I started thinking about the issues raised by this week’s publication of the Government’s Health and Social Care Bill. Sir Paul, speaking to individuals opposing the “consensus” view on climate change, HIV / AIDS, and GM foods, began to think about the responsibility falling upon the scientific community to better communicate its ideas, research papers, and the complexity of scientific knowledge and discovery. By considering scientific coverage in blogs, newspapers, and public opinion, Sir Paul seemed to suggest that the need for a simple narrative ran counter to the considered, hypothetical and provisional conclusions drawn in scientific papers.

Of course mentioned, but never really examined by the programme, was the Andrew Wakefield case, which has received so much coverage in the BMJ this week. The Times journalist Brian Deer has been exposing the ethical and scientific concerns at the heart of Wakefield’s research paper, published in The Lancet in 1998. Wakefield’s case is perhaps analogous to Sir Paul’s argument; that a robust piece of scientific research is no match for a strong narrative (or scare story) in the public opinion.

So how does this bring us onto the Health Bill? In its proposals to abolish Primary Care Trusts (PCTs) and Strategic Health Authorities, the legislation would introduce consortia of GPs as the commissioning bodies for the £80bn NHS budget. This means that family doctors will be tasked with making the decisions on which treatments are financially viable for their patients, rather than this being based on a judgement by the advisors at NICE (who recommend maximum-price treatments, based on the number of quality adjusted life years they would provide) and the accountants at the PCTs. Resource allocation will become much more personal; if a GP has to decide whether or not to provide expensive medication to a long-standing and well-liked patient, the dilemma will be that much more complex than for a PCT bureaucrat (this is not to condone or condemn either approach). Similarly, if a patient is denied treatment due to cost issues, they will know that the decision has been made by their GP, with all sorts of potential issues for doctor-patient relationships (as pointed out by the Royal College of GPs).

These are real, complex issues; could it be that it is about better communication between doctors, or politicians, and patients, or the public, to see the necessity of certain treatments being denied? Can a seriously ill patient relinquish the hope of treatment due to resource issues? And will this be any easier to stomach when decision-making is being conducted in your local surgery? Sir Paul seemed confident about the potential of science to overcome these pitfalls. It will be interesting to see how the changes to healthcare are communicated to – and understood by – the public.

Alcohol vs. Heroin: What’s the Harm?

If the headlines are to be believed, a recent paper in the Lancet claims that alcohol is more harmful than heroin. The reaction to this claim by most commentators has been sceptical to say the least: in what possible world could this claim be true?

First, some context. The paper’s lead author, Professor David Nutt, set up the Independent Scientific Committee on Drugs after being sacked from his advisory role by the previous Labour government. He has been a longstanding critic of the government’s approach to drugs and drug policy, arguing that it is based not on scientific advice or evidence but rather political ideology. It is therefore perhaps unsurprising that his latest research aims to undermine the basis of the government’s stance on ‘hard drugs’, in this case by pointing out that in fact the legal drug, alcohol, does far more damage to both users and society at large.

The interesting question (for a philosopher at least) is: what does Prof. Nutt mean by ‘harm’ here? Two distinctions need to be made in order to get a handle on this. Firstly, harm to whom? This is addressed in the paper by distinguishing between harm to the user and harm to others. Heroin, crack and methamphetamine cause the greatest harm to the individual user, but alcohol tops the list for cumulative harm to the user and to others.

This seems counterintuitive: many of us enjoy the odd tipple, occasionally even drinking to excess, without causing harm to ourselves or to others. This is where the second distinction comes into play, and it is not made particularly clear by the Lancet paper itself. This is the distinction between public health and individual health. The paper is concerned with the public health implications of the consumption of these drugs, i.e., its interest lies in the point at which their use becomes an issue for health (and social) services at an epidemiological level: the analysis of harms conducted “rang[es] from the intrinsic harms of the drugs to social and health-care costs.”

Clearly for most of us our drug habits do not concern health services at all. But at the point at which they do, the harm implications of alcohol consumption become much more evident: risks of liver cirrhosis, cardiomyopathy, losing one’s job, family breakdown, criminality etc.

There is no doubt that heroin use causes huge harms to the individual user and to society, but at an epidemiological level, these harms are dwarfed by the scale of the problems of alcoholism in this country. Estimates from the Institute of Alcohol Studies suggest that based on statistics from 2000, around  3 million adults in the UK are alcohol-dependent.

2 factors therefore combine to justify the intentionally provocative conclusion that alcohol is more harmful that heroin. Firstly, the ‘harms’ recorded are those which fall within the domain of health and social services. This excludes the ordinary drinking habits of the vast majority of ‘social’ drinkers. Secondly, as a public health issue, the scale of alcoholism or alcohol dependence as compared to heroin addiction does entail that alcohol causes greater health and social problems than heroin in this country. But I guess with those caveats the headline doesn’t sound as snappy.