Ethics

Babies below 25 weeks: Do so-called ethical limits trim the wings of science? In the meeting of the International Society of Neonatologists in Heidelberg, German and Swiss neonatologists recently locked horns over whether babies below 25 weeks should routinely be resuscitated or not. The guide-lines of the Swiss Society of Perinatology do not recommend caesarian sections for the sake of the baby below 25 weeks nor is automatic resuscitation done for them. Their recommendations are based on the EPIcure study carried out in England and Ireland in which 70% of babies below 25 weeks died and half of the survivors had severe deficits. The German argument was that disabilities are no excuse to refuse treatment. Besides the issue of ethics, keeping artificial cut offs may hinder medical advance in the care of these babies. In 1984, 1200 grams was the weight cut off used to decide aggressive treatment. Rules and limits are made to be broken but need tempering with wisdom and common sense (eBMJ 27 Sept 2003).

MRI scans are now so ubiquitous in the practice of modern medicine, it was inevitable that scientists who helped to bring it from the lab to the patient would get medicines highest prize. Before the 1970's MR was used to investigate the chemical structure of molecules. Then Lauterbur of the University of Illinois at Urbana-Champaign, USA discovered the possibility of creating a two-dimensional image by introducing gradients in the magnetic field. Sir Peter Mansfield, Professor of physics at the University of Nottingham, UK who improved the speed and efficiency with which the detected signals could be analyzed and transformed into an image, then improved this technique. In addition, he developed so-called echo-planar scanning, in which changing the gradients in the magnetic field more quickly enables extremely rapid imaging. So Lauterbug and Mansfield now get to share the 10 million Swedish kroner, Nobel prize for medicine on December 10 this year (Scientific American 7 October 2003).

Out of Africa: A new concept in knowledge sharing took birth when a Canadian surgeon just back from Africa called up his librarian. The Ptolemy Project is based on the premise that access to reliable health information is "the single most cost-effective and achievable strategy for sustainable improvement in health care". The participants are the electronic resources co-ordinator of the University of Toronto Library, Bioline International, which publishes many African journals online, and the Association of Surgeons of East Africa. Surgeons in east Africa become research affiliates of the University of Toronto and have access to the full-text resources of the university library via a secure Internet system that monitors and verifies use. Large university libraries have the technical capability to establish remote access at minimal extra cost and scientific and medical publishers are unlikely to lose revenue by doing so, as poor countries are unlikely to be able to afford their own subscriptions in the foreseeable future. For the present it looks like a win- win situation for all concerned ( eBMJ 4 October 2003).

Gouri Rao Passi,
Consultant, Department of Pediatrics,
Choithram Hospital & Research Center,
Indore 452 001, India.
Email: [email protected]