Editor's pick: Lawyers and the definition of risk
Avril Danczak is unhappy with the idea that pregnant women's doctors could advise them of the risks of vaginal delivery “as though it were a medical procedure” (Letters, 13 August). She mentions the UK Supreme Court's award of damages to a woman whose physician didn't warn her, on the basis that the mother had a chronic disease that increased the risks of vaginal delivery.
The implication is that cautions in cases where no increased risk is apparent would constitute an unwarranted intrusion.
Danczak reckons without the long reach of the law on personal injury (“tort”). Now a precedent has been established, she may be quite certain that the threshold for what constitutes “increased risk” will fall progressively until the test is merely whether a woman is pregnant or not.
Obstetricians will start to be sued for not recommending a planned caesarean delivery, on the basis of statistics showing that this results in fewer complications than vaginal delivery. I agree that unassisted vaginal birth, spontaneous and inevitable, is not a medical procedure; but personal injury lawyers may beg to differ, and will be doing their best to make it so.
Living wills and assisted dying
Clare Wilson describes resistance to legalised assisted suicide (23 July, p 16). Is this by those to whom selfish love of an ideal is worth more than unselfish love for someone who is suffering? Soon, I hope my human rights will include having the legal choice to end my own suffering, if needed.
Living wills and assisted dying
How does one define “terminally ill”? My wife had vascular dementia, was in hospital for four years and comatose for three of those. There is no recovery from such dementia. I suggest Rhona was terminally ill for that period. Medically assisted dying is illegal here in New Zealand, though a parliamentary committee is looking at this.
Rhona wrote a living will years ago, while in good health, stating that if a major accident rendered her unable to communicate she did not wish to be resuscitated. To require a person to lie in bed for years, against her expressed wish, incontinent and unable to communicate or recognise loved ones, seems to me inhumane. It was a non-existence and her death was a blessing.
The debate here focuses on people who are able to take part in the discussion about their death. Those with dementia are largely ignored, and I noted that in the Dutch data there were only a few such cases where assistance to die was approved. I wonder why?
First class post
To avoid the sudden onset of raging fevers and lack of sleep
Alison Rixon women keep taking HRT despite breast cancer risks (27 August, p 7)
Yes, mothers must know birth risks
Women should absolutely be informed about the likely risks during childbirth, and of the various interventions and their consequences (9 July, p 5 and p 8). Vaginal delivery is now rarely a wholly “natural” event, any more than caesarean section could be considered an ideal outcome in all circumstances.
Yes, there are greater risks with emergency caesareans than with planned ones; and greater risks for older first-time mothers. It is generally true, however, that small interventions during labour can cascade to more intrusive interventions. It is also difficult to compare different interventions. For example, how much of the risk of anal tear occurring during vaginal delivery stems from having an episiotomy?
Ideally, women and their partners should be able to make informed decisions. This should apply to considering a vaginal delivery or a planned caesarean section. It should also apply to the outcomes recorded for the hospital they attend, and the specialist they engage.
True informed consent would ensure a woman knew how likely particular interventions were at the hospital she plans to use, and from the doctor she will have – including how likely it is she will receive an episiotomy, an epidural or be encouraged to give birth in a position other than supine.
The prosecutor's fallacy at work
Linda Geddes recalls that the paediatrician Roy Meadow failed to mention the possibility of genetic factors that might boost a family's risk of sudden infant death syndrome (18 June, p 39). But the figure he gave of “1 in 73 million” odds of two cases occurring in one family represents a still worse error.
Given the present birth rate, the SIDS rate and the distribution of family sizes, I calculate that we would expect two SIDS deaths to occur by chance in the same family, somewhere in the UK, once a decade on average. If we assume that the police always prosecute a parent on the basis that this is very unlikely, Meadow would have had us convict an innocent parent once every 10 years. I wonder how the jury would have voted if told that.
The National Forest is meeting targets
The stalling of tree planting rates has been a problem across England for the last decade, and is not specific to the (13 August, p 5). We have continued to deliver between 100 and 200 hectares of new forest for the last nine years, and expect to meet the national target for woodlands in management well before the 2020 deadline.
Drawbacks of dairy diet diaries
The that Ian Johnson cites in his comment piece on dietary fats reported an association between the intake of saturated fat and heart disease and cancer (16 July, p 18). But such findings rely on participants accurately reporting their food intake. This has repeatedly been shown not to be the case, which is why randomised controlled trials are preferable.
Several such trials have looked at replacing saturated fats with omega-6 polyunsaturated fats (PUFA). Earlier this year, of the US National Institutes of Health and colleagues , using the whole data set. They found that replacing saturated fats with omega-6 PUFA had increased the total mortality.
Mediterranean diets are, as Johnson says, indeed rich in monounsaturated fats and have much omega-3 PUFA, but negligible omega-6. Kerstin Vormund of the Canton of Berne and colleagues that people in Switzerland who consumed a Mediterranean-type diet had lower mortality overall than the general Swiss population and specifically for cardiovascular disease and cancer. They found that eating dairy products with the Mediterranean diet did not alter the outcome.
Safety of GM foods at the checkout
Michael Abraham suggests an experiment to establish the health outcomes of eating genetically modified foods by selecting 20,000 volunteers to take part in a double-blind experiment (Letters, 30 July). Why not use data that's already gathered? The UK National Health Service has data on our health status. Supermarkets have exhaustive data on what foods we buy. Matching these two data sets could be a start to resolving the safety concerns around GM foods.
Put an ultimate accelerator in space
Andrzej Krauze illustrated Gavin Hesketh's thoughts on a possible “nightmare scenario” for particle physics with a researcher as a girdle round the Earth (20 August, p 18). This took me back to seeing an early particle accelerator in the 1960s – and then thinking of possible advantages of building particle accelerators in space.
A ring of magnets in stationary orbit could be maintained comparatively easily, enabling much higher collision energies than at present. The vacuum required for collision-free beam acceleration is naturally present.
Such magnets might have to orbit a planet further out from our sun than Earth. If a future humanity ever reached the level of technology by physicist Freeman Dyson, at which it captured most of the energy of its star, might a collider in an orbit well beyond the Kuiper belt allow even string theory to come within range of testability?
Nuclear waste is worse than that
I wholly support Gregory Sams's sentiments on the difficulty of containing nuclear waste (Letters, 30 July). I would suggest, however, that his phrase “thousands of years” suggests something rather more cosy than reality. It calls up images of ancient Rome, whose Pantheon and other buildings survive. The nuclear repositories to which he refers will need to be secure from all forms of incursion, accidental and deliberate, for at least as long as our species has hitherto existed. Not such a comfortable image.
What comes out of echo chambers
Chris Baraniuk mentions “echo chambers” of opinion in social networks (16 July, p 20). As the US presidential campaign is demonstrating, these “chambers” can be finely tuned resonant cavities in which only a single coherent opinion is maintained.
So, as those who study such resonant cavities would put it, we find a population inversion into a degenerate metastable group state. This then emits propaganda via the LASER (Lie Amplification by the Stimulated Emission of Rhetoric) process. The exclusion principle requires that such excited degenerate states are occupied only by identical right-spin bozos.
For the record
• It was Sang-Hoon Kim at the Mokpo National Maritime University in South Korea who noted that the country is almost earthquake-free (23 July, p 34).
• The number of permutations of n particles each of which may be in m states is mn (Letters, 13 August).
• Francis Crick is reputed to have announced the discovery of the structure of DNA in Cambridge's Eagle pub (UK edition, 20 August, p 23).