Showing posts from 2007

Donepezil: Nicely done NICE. What about the gap in affordability though?

The National Institute of Clinical Excellence (NICE) has been bolstered by a recent Court decision and is beginning to flex its powers of rationing. Dobbs J sitting in the English High Court heard an appeal by way of judicial review from a decision of the appeal committee of NICE. [1] In a 139 paragraph judgement given on 10 th August 2007 he decided that NICE: had the power to issue guidance declaring the use of Donepezil (an anticholinesterase inhibitor that has proven benefits for patients suffering from Altzheimer’s disease) to lack cost-effectiveness in patients with mild to moderate disease and; had not been irrational in its approach nor procedurally unfair in the way it had reached it’s decision. The appellant ( Eisai Limited) was merely a consultee in the process and had been treated appropriately by NICE during the evaluation process. NICE’s victory was not complete. It had a duty in relation to ensuring that its guidance complied with anti-discrimination laws. In i

Asymmetric morality is one key to victory in asymmetric warfare

On the 10 th of May 2007 General Petraeus made 3 things clear in a letter about values : 1. The war in Iraq is about securing the population of Iraq. This means more than providing them with personal safety and a secure environment in which to live. It also means winning the battle for their hearts and minds. 2. The way to secure that population, in both senses, is to uphold important human values particularly respect for human dignity. 3. Personal integrity must require that the captured enemy prisoners are treated in accordance with the rules applicable to any detainee. For the American Army this is Field Manual 2-22.3: Human Intelligence Collector Operations . The key to this is to understand that if you sacrifice your values you become no different from your enemy. If the population cannot distinguish you from the enemy you are doomed to defeat in the battle for their hearts and minds. But victory in this sphere is critical because the physical war is being fought with as

Organ donation: Presumed consent is a two-headed horse

Introduction There is a debate in progress surrounding the need to increase the organ supply, in particular for renal transplants. [1] , [2] There are currently 2 major fronts. One is the argument to increase the supply by allowing payment to donors for organs. Another is the argument for presumed consent recently raised by the Chief Medical Officer . Focusing on the latter argument it is possible to see that, in essence, it boils down to the choice between those who believe that the loss of something intangible but valuable in society is justified in light of the potential lives saved. The intangible social goods that are exchanged are: (1) the gift relation that currently exists between donor and recipient of a human organ and; (2) a power give to the state permitting it to harvest organs from those who have not declared their intentions in relation to personal donation. 2 positions within presumed consent The crux of presumed consent is that we are asked to accept the r

Animal loving means something else in Wales

Shambo's finally been taken. Sadly I note that the formal diagnosis of bovine TB is made at the post mortem . At the removal I noted a lack of animal rights activists. Perhaps they knew that the legal case turned not on animal rights but on the balance between the need to kill Shambo to protect public health and the right the monks had to respect for their religious views. At first instance Judge Gary Hickinbottom was unimpressed by the argument of the Welsh Ministers. But in the rematch the Court of Appeal [1] decided that even a large invasion of the monks right to respect for their religious views was justified on the facts. A contentious decision that deserved to go to further appeal. Yet the case did not make it to House of Lords let alone the European Court of Human Rights. A tragedy in itself. All this came about by the exercise of a discretionary power vested in the the Welsh legislature and exercised by or on behalf of Jane Davidson as the Minister for Sustainability