Reviews: Editorial commentary

Abstract

Home Truths about Child Sexual Abuse: Influencing Policy and Practice: A reader Catherine Itzin (4) Routledge, London, 2000. ISBN0415 15261 5 (hbk) f55.0O/f18.990415 152623 (pbk) £18.99

Child Sexual Assault: Feminist perspectives Pat Cox, Sheila Kenhaw andJoy Trotter (eds) Palgrave, London. 2000. 248pp. ISBN 0 333 77153 2. (hbk) £45.00

Athletes and Acquaintance Rape Jeffrey R Benedict Sage (Violence Against Women Series). London, 1998. 120pp ISBN 0 7619 0966 4 (hbk) f47.00 / 0 7619 0967 2 (pbk) £19.00

Whistleblowing in the Social Services: Public accountability and professional practice Geoffrey Hunt (ed.), Foreword by Allan Levy, QC Edward Arnold, London, 1998. 278pp. ISBN 0 340 65245 4 (pbk) £18.99     

Regulation of cognitive enhancement devices: commentary

Maslen et al. (2013) have provided us with a comprehensive overview of the current legislation regulating non-clinical cognitive enhancement devices (CEDs) in the European Union and have proposed a specific model whereby CEDs would be regulated in the same way as medical devices. An alternative model would be to require manufacturers to quantify risks only. Irrespective of the purported ‘benefits’ of a product, this would allow the consumer freedom of choice to use the product at their will and allow the periodic review of worthwhile indications and unexpected adverse events. Although this departs from the standard Cochrane-type assessment, it takes into account the facts that (i) the evaluation of clinically used cognitive enhancement techniques may not be as rigorous as one might expect, (ii) variations and case-by-case use might be widespread, and (iii) independent variables of significance and useful endpoints may not be obvious ab initio. We consider cerebrospinal fluid diversion techniques which are widely used clinically to enhance cognition in patients with normal pressure hydrocephalus despite any large-scale clinical studies demonstrating substantial benefit, and the real risks of paralysis and death from these invasive procedures. The risks of CEDs which have been available for some time need to be kept in perspective: are the risks really more than using conventional cognitive enhancement techniques such as imbibing too caffeinated drinks? Furthermore, the loss of Europe as a market for CEDs which do not comply with the proposed regulatory model implies a potential gain in the market for other parts of the world. This could impact on the ability of companies in Europe being able to compete in an evolving market demand for CEDs. Legislation to regulate CEDs should be guided by the principle of ‘do no harm’ and allow for innovation and competition.     

Case commentary: anonymisation is not exoneration

This case commentary analyses a ruling that any use of information given in confidence for unconsented purposes is a breach of confidence capable of supporting a legal action (even if the information has previously been anonymised and aggregated). The ruling is being appealed. It is argued that, while it is reasonable to delineate a narrower duty of confidentiality (not to disclose personal information, against breach of which anonymisation protects), this must be within a broad duty of confidence (not to use private information, which using anonymous information can still breach). Thus, the ruling is fundamentally correct in holding that anonymisation does not permit information obtained in confidence to be used for unconsented purposes. This, however, implies that information obtained for a patient's treatment may not be used lawfully for medical research or NHS management purposes without consent, even if it is anonymised. Such a consequence is unacceptable as a matter of public policy. However, it is equally unacceptable to seek an exemption through the idea that patients give "implied consent" for medical research and NHS management purposes. It is also unacceptable to maintain that the public interest in medical research (regardless of its aims) justifies unconsented use of information obtained in confidence, even if the information is anonymised. The way in which Section 33 of the Data Protection Act 1998 creates an exemption to its Second Data Protection Principle provides a ready-made model for a public interest based exemption for medical research and statistical NHS purposes.