That eBay auction of a human kidney

The recent moral outrage surrounding the sale of Live8 tickets on eBay reminded me of the 1999 eBay organ trafficking scandal. The details of this are quite well-known now, though I am not sure the key questions have really been addressed. To recap, in 1999 a human kidney appeared on the internet auction website eBay. Perhaps it is needless to say that the auction was terminated by eBay, though not before the highest bid reached extraordinary figures.

The problems of organ trafficking seem to be exacerbated through the Internet, if only because it is much harder to control. However, control is not the only problem. Perhaps the bigger question relates to the degree of control that online companies have over the moral culture surrounding medicine and health. In this case - and in relation to the Live8 tickets - we see an immense institution being able to dictate what people are permitted to do. While the auctioning of human organs certainly has a considerably more complicated legal and moral context than Live8 tickets, each of them raises questions about how morality is constructed in society. In the case of the Live8 tickets, the pressure came from celebrities, particularly Bob Geldof and there was no legal reason to forbid people from selling these tickets. Yet, eBay took the moral high-ground, so to speak.

For many, the auctioning of human organs is unequivocally immoral. At the very least, it creates a messy debate about whether organs should be sold at all, though this is a more difficult issue. Offering a financial compensation for a body part is, for many, a reasonable exchange and, given the lack of organs, a necessary one. The difficulty, however, is that anybody who would want to auction an organ would clearly be someone in a vulnerable position and it is unreasonable to take advantage of that vulnerability, even if they might gain financially through it.

Healthism online?

Is Cyberspace the latest context to be targeted as a means to achieve health promotion, has it become the latest space within which we continue monitor and modify our bodies in relation to cultural ideals around health and morality? Are these spaces encouraging vigilant approaches towards the ways in which we might regulate our bodies, diets, exercise etc?

Analysts are now pointing towards a continued trend in the use of the Internet for health promotion, predicting that the ‘virtual health care system’ will consist of the ‘preventive Web’ not only on 'chronic illness' but on health living. These include programmes for certain preventative forms of behaviour related to ‘risk’, such as alcohol, diet, exercise and smoking. Health promotion agencies have made efforts to utilise cyberspace as a way to encourage people to engage with ‘healthy behaviours’ and is indicative of the type of ‘multi-sectoral’ collaborative approach to health promotion, which as Castel suggests has shifted from the ‘clinic’ to the ‘epidemiological clinic’. For example, the American Heart Association and the Mayo Clinic, are investing considerable resources in developing and marketing Internet-based programs for health promotion and disease management. There has also been a proliferation of more commerically based Internet sites offering the means through which to self-diagnose, regulate and shape the body. These include online training sites, health screening, and weight loss programmes. Might these online developments be emblematic of wider socio-cultural shifts associated with late modernity and the notions of a ‘risk society’ (Beck, 1992) with the growing preoccupation with body, lifestyle and consumer culture in relation to health?

UN warns of dangers of drugs sold on internet

In March 2004, The British Medical Journal reported on the International Narcotics Control Board statement on the sale of drugs over the Internet. They highlight popular drugs such as sildenafil (viagra) and fluoxetine (Prozac) - who hasn't received email about these substances!?

It is interesting that some of these drugs are associated with so-called 'lifestyle' enhancements. While the lack of regulation over online drugs is significant, I wonder how much of their concern is about how these drugs reflect a shift in the way people use and perceive medicine. One of the difficulties facing the medical profession is how to curb the tide on lifestyle medicine. There seem to be a number of legal and moral questions arising from the development of online pharmacies and, even if the current regulations offer a structure through which action could be taken against a dodgy company, we need to take into account how online pharmacies are different social spaces, compared with high-street retail outlets. For example, how does a physician take a history of their patient through the Internet? What relationship between the physician and patient is possible?

There also seem to be difficult boundary issues facing regulation. Even if the legal issues are similar to the importation of substances from one place to another, the manner in which people transcend these boundaries is radically different - it is much easier to click on a website of a company in a country far away, than it is to go there or connnect with a supplier in that country.

World's first robot doctor

A few months ago, the University of California Davis Medical Center began testing its robot, Rudy, as a way of dveloping greater flexibility for physicians and more personal care for patients. At first sight, this looks like such a bad idea - there is no escaping the technological face of this charcater, it is surely better than a 'Hal' like camera, which might surely have been an alternative. It just reminds me of one of the Daleks from Doctor Who. (Let's hope there's no 'exterminate' facility, unless, of course, assisted suicide becomes more acceptable!)

E-Scaped Medicine?

An interesting article I read recently - Nettledon, S. (2004). The Emergence of E-Scaped Medicine? Sociology, 38(4), 661-679.

The concept of 'e-scaped' medicine as outlined in this paper is one which resonates with discourses about the changing role of technology and information. Nettledon describes the emergence of 'e-scaped medicine' whereby a new medical cosmology is being formed - the spaces, sites and locations of the production of medical knowledge are changing. The internet is not seen here as altering the social epidemology of health via the empowerment of 'expert' patrients through increasing access to information (as it has been in many accounts of empowering technology). Rather, nettledon suggests that the Internet will impact more significantly upon the locus of knowledge production, ie social epistemology. She argues that the the proliferation of information and communication technologies will influence the means by which knowledge and information are generated and sustained. The emergence of more varied and complex medical discourse may be both generated and mediated by digital technologies. This invites questions about how the health information seeker, the 'expert' patient, and health and illness narratives may be located in this medical cosmology.

Ethics of cybermedicine

Gregory Pence is keen on digital technology applied to medical encounters. He describes cases where patients use the Internet to develop shared communities, where they can talk about the illnesses thy suffer in open spaces. He is also concerned that technology often gets a rough deal in the media, where genetics is characterised as Frakenstein science and IT separates people from each other. In Chapter 2 of his book 'Re-Creating Medicine' , he discusses the Doctor-Patient role specifically, suggesting that doctors can use WebMD to find out about conditions they know little about and encourages a dialogue between patients and doctors about these discoveries. As he states:

"Moral informational exchanges, ones that help and empower patients, rather than keep them in the position of passive children, do occure in cybermedicine. Such exchanges humanize both parties involved"

Welcome

Welcome to the blog associated with our book 'The Medicalisation of Cyberspace', due for publication by Routledge in 2006. This blog has been created as part of our own research process and to develop an awareness of the issues we will discuss in the book.