Pascal's Wager, infective endocarditis and the "no-lose" philosophy in medicine

Doctors and dentists have traditionally used antibiotic prophylaxis in certain patient groups in order to prevent infective endocarditis (IE). New guidelines, however, suggest that the risk to patients from using antibiotics is higher than the risk from IE. This paper analyses the relative risks of prescribing and not prescribing antibiotic prophylaxis against the background of Pascal's Wager, the infamous assertion that it is better to believe in God regardless of evidence, because of the prospective benefits should He exist. Many doctors seem to believe the parallel proposition that it is better to prescribe antibiotics, regardless of evidence, because of the prospective benefit conferred upon the patient. This has been called the "no lose philosophy" in medicine: better safe than sorry, even if the evidence inconveniently suggests that following this mantra is potentially more likely to result in sorry than safe. It transpires that, just as Pascal's Wager fails to convince because of a lack of evidence to support it and the costs incurred by trying to believe, so the "belts and braces" approach of prescribing antibiotic prophylaxis is unjustifiable given the actual evidence of potential risk and benefit to the patient. Ultimately, there is no no-lose if your clinical decisions, like Pascal's Wager, are based on faith rather than evidence

Tackling socially determined dental inequalities: ethical aspects of Childsmile, the national child oral health demonstration programme in Scotland

Many ethical issues are posed by public health interventions, including whether they ought to be aimed at improving health across society or reducing specific health inequalities, whether they should be targeted or universal and the issue of which targeting criteria ought to be used. Although abstract theorising about these issues can be useful, it is the application of ethical theory to real cases which will ultimately be of benefit in decision-making. To this end, this paper will analyse the ethical issues involved in Childsmile, a national oral health demonstration programme in Scotland that aims to improve the oral health of the nation’s children and reduce dental inequalities through a combination of targeted and universal interventions. With Scotland’s level of dental caries among the worst in the Western world, Childsmile represents perhaps the largest programme of work aimed at combating oral health inequalities in the UK. The areas of ethical interest include several contrasting themes: reducing health inequalities and improving health; universal and targeted interventions; political values and evidence base; prevention and treatment; and underlying all of these, justice and utility

Struggles for Citizenship in South Africa

South Africa’s first democratic constitution of 1996, which defines the content and scope of citizenship, emerged out of what the country’s Constitutional Court accurately described as ‘a deeply divided society characterized by strife, conflict, untold suffering and injustice which generated gross violations of human rights, the transgression of humanitarian principles in violent conflicts and a legacy of hatred, fear, guilt and revenge’ (cited in Jagwanth, 2003: 7). The constitution was internationally noteworthy for its expressed protection of women’s and sexual minority rights and its extension of rights of citizenship to socio-economic rights, such as rights of adequate healthcare, housing and education (SAGI, 1996). During South Africa’s first two decades of democracy, the Constitutional Court has proven its independence by advancing citizenship rights on a number of occasions (O’Regan, 2012). The struggle for citizenship was at the heart of the liberation struggle against the apartheid regime and within the complex dynamics of the anti-apartheid movement, increasingly sophisticated and intersectional demands for citizenship were made. South Africa’s constitutional rights for citizenship are not always matched in practice. The country’s high rates of sexual violence, ongoing poverty and inequality and public attitudes towards the rights of sexual minorities and immigrants lag well behind the spirit and letter of the constitution. Nevertheless, the achievement of formal citizenship rights in South Africa was the result of a prolonged and complex liberation struggle and analysis of South Africa demonstrates Werbner’s claim that ‘struggles over citizenship are thus struggles over the very meaning of politics and membership in a community’ (1999: 221). This chapter will begin with a contextual and historical overview before moving onto analyzing the development of non-racialism as a basis for citizenship, non-sexism and gendered citizenship, contestations of white, militarized citizenship and the achievement of sexual citizenship by the Lesbian, Gay, Bisexual and Transgender (LGBT) rights movement. As shall be made clear, all these citizenship demands emerged during the decades of the country’s liberation struggle

Margaret Thatcher, Dress and the Politics of Fashion

Through Margaret Thatcher’s private and public performances, the micro-politics of dress translated into the macro-politics of power. Thatcher’s changing career can be traced through her dress (see Young 1991: 416-417); analysis of her dress leading up to and during her Premiership reveals both her aspirations and increasing power. Understanding of Thatcher’s agency in her embodied, dressed performances can be informed and developed through Butler’s (1999) conceptualization of performativity. Through adaptation, repetition and divergent dress, Thatcher constructed different identities, some of which became iconic symbols of her self and her politics. Examination of Thatcher’s dress refines the understanding of the relationship between constraints and agency experienced by actors in the public realm. Upon becoming party leader, Margaret Thatcher’s gender, class and ideological viewpoints were incongruent with her unprecedented political status and she faced many challenges in attempting to overcome this. Dress became a potentially destabilising focus for her critics and symbolic of her “outsider” status. Yet in the face of these challenges she recognized and learned from the expectations of others, adapting and changing her dress. However, this was not an instantaneous, complete or permanent transformation. What Thatcher achieved, as she crafted her dressed performances, was agency over a further aspect of her life and her politics. There was also an evolving alignment of her dress with her political ideology and domestic and international roles over time

Whose Lifestyle Matters at Johannesburg Pride? The Lifestylisation of LGBTQ+ Identities and the Gentrification of Activism

In response to criticisms of whiteness and the privileging of middle-class South African experiences over the black majority and those in poverty, Johannesburg Pride expanded from a one-day event to include a ‘Lifestyle Conference’ in 2018. This article argues that rather than including broader South African LGBTQ+ experiences, rights and needs, the conference centred privileged and normative ‘lifestyles’ and emphasised individual agency, rather than making intersectional inequalities visible and a basis for collective action. Drawing from ethnographic research at Pride events, and interviews with Pride organisers and LGBTQ+ activists, this article builds on critiques and insights from social theory to analyse Johannesburg Pride’s Lifestyle Conference; its aims, politics, marketing and messages. By exploring the raced and classed exclusions of Johannesburg Pride, this article addresses key gaps in the academic literature on Pride, and traces how the lifestylisation of LGBTQ+ identities obscures inequality and contributes to the neoliberal co-option of Pride