Fighting Talk (Doctors) – a duty to disclose?

(Warning: contains plot spoilers!) This is an old episode of the BBC’s daytime drama Doctors, centred on the Mill Health Centre, a fictional midlands clinic. The relevance is probably limited to clinical ethics training for medical students, but it’s great for that purpose so worthy of a quick note here.

In Fighting Talk (TRILT ID: 0059FD65, first broadcast on BBC1, 15th June 2006), Dr Greg Robinson is faced with a dilemma when local bully Darren Waters has beaten up geeky pupil Kevin Dobson on his way to school. What Darren doesn’t realise is that Kevin is HIV positive. When Darren presents at the clinic with a bleeding hand and then Kevin later comes in with cuts to his face, Dr Robinson realises there is a risk that the virus has been transferred from victim to bully. Does he have a duty to disclose the details to Darren and his family?

In truth, the episode is entirely focussed on this story, punctuated with snippets of longer term issues for those who work at the Mill Health Centre. One short section, however, conveys all that needs to be told as a case study for tutorial group discussion. In the section starting at 16:23 Dr Robinson visits Kevin and his mother trying to persuade them to let him tell Darren. Kevin’s HIV status is mentioned openly, it had only been hinted at in early clips. The scene runs onto 19:17, but is best stopped at 17:50 when Kevin’s mum puts her hand on his shoulder – the rest of the clip is window dressing.

For completeness, the clips in which the story unfolds are: 02:00-02:58 (the fight), 03:40-05:03 (mum patches Kevin up), 07:52-10:00 (bully goes to GP), 10:26-12:40 (Kevin goes to GP), 12:40-13:37 (Dr Robinson discusses what to do with colleague), 14:10-15:55 (Doctor visits Dobson family), 16:23-19:17 (HIV status discussed), 20:11-20:50 (Doctors discuss ethical duty), 20:50-21:10 (Kevin visits clinic to give consent), 21:37-23:38 (Dr Robinson tries to get Kevin’s mum to agree), 24:22-26:12 (Kevin persuades his mum).

Bird flu and uncertainty – deciding what makes the news

For a number of years in the 1990s, but sadly not in the recent past, the BBC had an annual review of the year programme called Decisive Moments,  in which key events from the preceding twelve months were illustrated via reference to still photos. I was always fascinated by the stories behind those images, how they came to be taken from the vantage point that they were, why that frame rather than, say, the next one taken, and so on.

When I finally got around to listening to a recording of the Radio 4 programme Inside Stories, I was captivated with the same fascination. In the series, Guardian journalist Steve Hewlett discusses with colleagues how and why the media choose to cover particular news stories and the angle that they take on them.  In an episode on bird flu, first broadcast on February 5th 2008, Hewlett talks with Charles Clover (Environment editor at the Daily Telegraph), Sarah Mukherjee (BBC Environment correspondent), Simon Pearson (Times) and Michael Pollitt (Eastern Daily Press) and traces the unfolding history of UK coverage of bird flu from the 1997 outbreak of H5N1 in Hong Kong poultry, through to the infection at Bernard Matthews’ Norfolk turkey farm in 2007. They consider the conflagrations that occurred, with SARS, H5N1 and the overdue flu pandemic all rolling into one in the mind of the public, and how the over-the-top reporting of a dead swan in Cellardyke, Scotland and the mis-handling of the Bernard Matthews story may actually have brought us to a point where people are better able to distinguish truth from hyperbole. Throughout, the underlying issue is really one of how the media copes with uncertainty.

Sadly, no online recording of the programme is available, but a transcript of the programme can be read here. BUFVC member can obtain a copy via the back-up service, quoting TRILT ID 007CFCC7.

The jab that can stop cancer – Dispatches

The thought of any family member dying of cancer is always emotive, and all the more so if you think you might have been able to do something to prevent the disease from wreaking havoc. In the Channel 4 current affairs series Dispatches, journalist Jane Moore considered the forthcoming campaign to treat all 12 year old girls in the UK with a vaccine that can prevent cervical cancer.

This sounds on the face of it like an excellent idea and Moore is not an immunisation skeptic, indeed she paid privately for her older daughter to have the jab, and fully expects her younger daughter to have the injection in the fullness of time. She does, however, raise a number of interesting arguments that show that the decisions about whether or not the UK should be entering into such a full-scale vaccination programme is rather more complicated. The main issues are: (1) is the vaccine safe?; (2) is the vaccine effective?; (3) will the vaccine offer false security?; (4) will it lead to greater promiscuity?; and (5) does this represent good use of NHS resources? Let’s take each of these in turn.

Science and Ethics of Drug Trials – Class Clips

The BBC’s Class Clips series does exactly what it says on the tin – the programmes are collections of short clips for use in classroom teaching. New in 2007, Class Clips programmes on a variety of subjects have since been transmitted overnight in the Learning Zone on BBC2 on several occasions and it looks like the website is gearing up to offer them via iPlayer, which will be a bonus in terms of availability (although, at the time of writing, the links are not yet active). The intended audience is advertised as Key Stage 3, but they could certainly be used with older students too.

The Biology section of Class Clips Science 2 is the most directly relevant for bioethics education since it includes two short sections on drug trials; one looks more at the procedures, the second at the ethics. However, if you are teaching at other times about modern medicine then don’t be put off by the physics-only sounding section on the electromagnetic spectrum – each of the clips on waves of different lengths (from gamma rays through to radiowaves) is looked at with explicit reference to their medical applications.