Sociology, Stigma and Innovation – Sam Rowlands on editing a book about abortion

Abortion Care Cover

After last month’s article about the journey of a medical book from an author’s perspective, this month we hear from Sam Rowlands, editor of Abortion Care, about editing a book which boasts more than 40 contributors – and which is about a particularly emotive topic…

There aren’t many medical books dedicated to abortion care. I felt there was a gap in the market for a smaller book that could be easily carried around. I wanted to produce a book that had all the conventional ingredients such as the methods of abortion, complications and so on but also looked at abortion from a wider perspective.

I drew up a list of around 30 chapters and identified potential authors for each. Cambridge were keen for the book to have international appeal so I endeavoured to select recognised specialists from around the world. I am fortunate to have met many of these personally through my career in sexual and reproductive health but still I was delighted (and surprised) that most of the colleagues I chose readily agreed despite their very busy schedules. I was then intrigued by how many chapter authors (15) asked to collaborate with their selected colleagues. This has resulted in an even richer authorship.

I had originally thought I might ask a couple of collaborators to co-edit with me but on reflection decided to edit the book on my own. The advantage of this was that I could be in control and do things my way, especially as I had by now a clear view of how the book would look. The downside was that when more than 20 chapter manuscripts arrived in a rather short space of time, I felt a bit overwhelmed! The lead chapter authors are all authorities in their fields. Some are academics and some are skilled practical clinicians, some both. Some are neither of these, just incredibly knowledgeable and wise. All authors developed their chapters in their own way; I encouraged them but tried not to steer them in any particular direction.

Although the book is mainly for readers with a medical bent, I have tried to include chapters to stretch their minds on topics that they might not necessarily otherwise tackle. Sociological topics are included but the authors of these were banned from using inaccessible terminology! There are two chapters with an epidemiological flavour which are not too daunting even to the numerically-challenged. There are two chapters written by lawyers which really flow, despite references to statute and case law.

Although the book is about a controversial subject and is bound to be serious in most of its content it is written in language that I hope is accessible and uses a lighter touch at times, for example a quote from Monty Python in the ethics chapter. The historical chapter provides a wonderful backdrop, painting a vivid picture of days gone by with some poignant examples of tragic cases. Stigma is a theme that runs through the book. Half a chapter is dedicated to this but reference is also made elsewhere, particularly in the chapter on staff. Although we all know that abortion is stigmatised, it’s only quite recently that it’s been written about and even measured.

I tried to include some innovations in the book and two chapters come up trumps in this respect. One covers abortion care provided by personnel other than doctors, showing that all the evidence points to this being not only safe but actually preferred by many women. The other looks to the future and shows how telemedicine can be applied to facilitate communication and treatment when the clinician and the woman are not in the same place, which has potential to improve access in more rural areas or in those parts of the world with restrictive regimes.

I’ve found it very rewarding to head up this project but don’t claim it is perfect. I invite anyone to make suggestions for a second edition.

Sam Rowlands MBBS, MD, LLM, FRCGP, FFSRH, Clinical Lead in Community Sexual and Reproductive Health, Dorset HealthCare and Visiting Professor, School of Health & Social Care, Bournemouth University

Sam Rowlands is the editor of Abortion Care (out now).

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Patient ethnicity proves to have no impact on detention under the Mental Health Act

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A study led by researchers at Warwick Medical School has shown that a patient’s ethnicity does not impact the likelihood of detention under the Mental Health Act.

For about two decades, there has been significant concern about the overrepresentation of Black and Ethnic Minority groups amongst people detained under the Mental Health Act. It has been suggested that British psychiatry is institutionally racist – dealing with ethnic minorities in a discriminatory, coercive and culturally insensitive manner to the detriment of those patients.

The new research studied data collected over four years on all patients who were assessed for possible detention under the Mental Health Act across three diverse regions; Birmingham, Oxfordshire and West London.

In over 4,000 such assessments, about two thirds of patients were consequentially detained under the Act. Patient ethnicity by itself did not affect the chances of being detained; detention was associated with serious mental illness, the presence of risk and levels of social support.

Professor Swaran Singh of Warwick Medical School, who led the study explained what this means: “the Mental Health Act enables services to offer much needed help and support to those suffering from serious mental disorders who are at risk and do not have adequate community support. Hopefully these findings will allow us to move forward without the lingering suspicion of institutional racism in British psychiatry and reduce mistrust between minority communities and the mental health services.”

The full paper “Ethnicity as a predictor of detention under the Mental Health Act” can be viewed here free of charge for a limited time.

Transplanting Autoimmune Research

Blog Post by Jonathan Kimmelman, Assistant Professor, Biomedical Ethics Unit/Social Studies of Medicine, McGill University, Quebec, Canada

What’s the difference between testing a typical small molecule drug, and testing a novel cell therapy strategy? And where might the latter raise ethical challenges that the former doesn’t? These questions are extensively discussed in my book, and given human drama in a recent story by Jennifer Couzin-Frankel in the Feb 12, 2010 issue of Science (“Replacing an Immune System Gone Haywire“). Read more of this post

Remembrance of Things Past: Revisiting Ethics in New Fetal Tissue Transplant Studies

Blog post by Jonathan Kimmelman, Assistant Professor, Biomedical Ethics Unit/Social Studies of Medicine, McGill University, Quebec, Canada

In a recent article in Science magazine, Constance Holden reports that European researchers are contemplating a revival of fetal tissue transplantation for the treatment of Parkinson’s disease. As the article recounts, fetal transplants were subjected to sham controlled studies in the late 1990s; none performed better than sham, and several caused disabling dyskinesias. So should fetal tissue transplantation be revived, and if so, how?
The challenges seem all the more formidable today. We now understand that Parkinson’s disease is not restricted to the dopaminergic neurons in the basal ganglia, but instead involves diffuse pathology. And yet, studies will not involve implantation of tissues throughout the brain. As Holden’s article points out, previous fetal transplant studies revealed that brain pathology spreads to implanted tissues, suggesting that permanent responses may be difficult to achieve.

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GUT decision-making

Blog Post by Alan Schwartz, Associate Professor of Medical Education and Pediatrics, University of Illinois at Chicago College of Medicine (reposted from Prof. Schwartz’s Making Medical Decisions blog)

I was recently at a workshop for National Science Foundation Principal Investigators focused on how to communicate research to the public and the media. One of the suggestions was to develop a three-word summary of the principle message of your research work. This is hard. After thinking about it for a while, though, I realized that medical decision science (at least as I practice it) is primarily about helping physicians and patients to do three key things:

  • know your goals
  • understand uncertainty
  • pay attention to trade-offs

Read more of this post

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