The 5 most popular Bioethics News stories from the week of May 5
Here are the most popular Bioethics News items from last week based on average clicks per day:
1. Rapid organ recovery
(USA Today) New York City has a plan to equip ambulance crews to prep bodies for organ harvest -- before receiving consent from families. No organs would actually be removed without consent.
(This story ran away with the number one ranking last week. The #2 story wasn't even close in popularity.)
2. Major city hospitals lack surge capacity
(USA Today) A House committee investigation reports that trauma centers in seven studied cities don't have the capacity to handle the influx of patients from a terrorist attack. The chair of the committee called the report "truly alarming."
3. Health care costs starting to squeeze the insured
(NYT) With incomes stagnating and costs rising, more people are having trouble paying premiums and co-pays.
4. California awards $271 million for stem cell research
(NYT) It's the biggest disbursement to date of money from the state's $3 billion stem cell research fund. The money will go toward building 12 research centers around the state.
5. When does adulthood start?
(Washington Post) Neuroscience, including brain imaging, is becoming part of the legal discussion about whether young adults who commit crimes should be subject to laws for full adults.
The top five stories from two weeks ago.
Blood Matters
In NYT this weekend, Jennifer Senior reviewed Masha Gessen's Blood Matters: From Inherited Illness to Designer Babies, How the World and I Found Ourselves in the Future of the Gene this weekend:
... While it was Gessen’s misfortune to have inherited her mother’s cruel mutation [BRCA1], it was her good luck — and ours — that she also inherited her mother’s storytelling grace and critical dexterity (Yolka Gessen was a writer and a translator). “Blood Matters” is valuable reading to almost anyone facing a huge health decision, not only for the literary commiseration it offers, but also for the inspired example of medical sleuthing on one’s own behalf that it provides. Gessen keeps an inflammatory topic at room temperature, writing elegantly and without self-pity. The book is very funny in places. (My favorite sentence, for reasons I can’t quite describe: “DNA-testing equipment tends to fall into two categories: things that look like printers and things that look like toasters.”) It’s also very lucid, even when the science gets complex. It’s a liberating book. Strange as it sounds, it would make a great Mother’s Day present.
Given the relative odds, one would think Gessen’s genetic counselors would have advised a pre-emptive mastectomy rather than an oophorectomy, or removal of the ovaries. To her surprise, they recommended an oophorectomy. One can understand their logic: breast cancer is easier to detect and survive; removing the ovaries reduces the risk of breast cancer; and most women can’t even countenance the idea of parting with their breasts. But Gessen balked, well aware of the studies associating surgical menopause with cognitive troubles and depression, to say nothing of osteoporosis, high blood pressure and heart disease. “I politely suggested I could just shoot myself tomorrow: That would prevent my death from cancer with a 100 percent probability,” she writes. “The joke remained suspended in the thin air between us and the counselors, and with it, our disengagement from one another was complete.”
And that question I had last week about what you call the state of potential disease? According to Gessen's book, the word used in the community of women with BRCA1 is "previvor." Gessen herself calls it being in the "cancer caste."
-Greg Dahlmann
UPDATE: Be sure to check out Larry McCullough's comment about terms such as "previvor."
Art Caplan on med schools and industry freebies
Over at MSNBC, Art writes that a recent recommendation for medical schools to ban free stuff from industry is on target:
The American Association of Medical Colleges recently released a long-awaited report recommending that pharmaceutical companies and medical device manufacturers knock off their efforts to bribe medical students and faculty. The Association said in no uncertain terms: No more freebies. That means no more doling out free lunches, tickets, trips, pens, binders, flashdrives, bookbags, free samples and other trinkets in classrooms, offices, exam rooms and reception areas of medical schools.
What led the leaders of the schools that train American doctors to pull the plug on the free flow of chachkes, baubles and doughnuts to medical students and their teachers? The report says that the steady marketing of drugs using freebies raises questions about the “objectivity and integrity of academic teaching, learning and practice.” In other words, if you let young, well-coifed drug company representatives run around your school in short skirts or snazzy suits doling out gifts, it conveys a very bad image — that a school is an appropriate place to do marketing.
Worse still, making your medical school a drug company free-fire zone conveys the impression that the faculty believe there is a lot to learn from slanted drug company sales pitches. And worst of all, when the welcome mat is out for drug reps bearing small gifts, this says that the faculty believe the best way to educate the next generation of doctors about drug safety and efficacy is to make sure students remember a drug’s name by having it thrown in their faces 10 times a day on every pen, notepad, vase, clock, key ring, calculator and coffee mug that a pharmaceutical company’s marketing department can have their legions of salespeople lug into the hospital.
I think a ban makes good ethical sense. I am proud to say that my medical school and its teaching hospitals were the first in the country to boot the drug reps and freebie peddlers off campus.
But the policy of banning marketing in medical schools has drawn some predictable criticism.
10 Reasons to Sequence the Platypus Genome
By Ricki Lewis
Move over Craig Venter and James Watson, the latest celebrity to have her genome sequenced is Glennie, a member of Ornithorhynchus anatinus. She hails from New South Wales, Australia.
When the planners of the human genome project set aside funds for sequencing the genomes of others, I was glad that the enigmatic platypus made the list. Occupying a key branchpoint on the evolutionary tree, the platypus is a hodgepodge of parts borrowed from birds and reptiles, and echoed in the vastly more numerous placental mammals. The curious web-footed and furry, egg-laying and lactating beasts diverged from the most recent shared ancestor of all mammals about 166 million years ago, heading in a different direction from its pouched and placental brethren. The reports on the platypus genome are published in Nature and Genome Research.
Why sequence the platypus genome? Let me count the ways.
Are you diseased? Pre-diseased? Potentially diseased?
Today's Science Times included an interesting story about work toward classifying diseases by their genetic underpinnings. There are bunch of interesting angles to this idea, but one in particular stood out for me: as we gain greater insight into the nature of disease, our concept of what it means to be "sick" changes. From Andrew Pollack's piece:
The shift from symptoms to anatomical measurements had big implications for patients, said Dr. Duffin, who is also a hematologist.
“Up until the 18th century, you had to feel sick to be sick,” she said. But now people can be considered sick based on measurements like high blood pressure without feeling ill at all.
Indeed, Dr. Duffin said, people who feel sick nowadays “don’t get to have a disease unless the doctor can find something” and instead might be told that it’s all in their head. Doctors argue, for instance, about whether fibromyalgia or chronic fatigue syndrome, which have no obvious anatomical causes, are really diseases.
Genes might allow the study of diseases at a finer level than even physiological tests. Genes are the instructions for the production of proteins, which interact in complex ways to carry out functions in the body. Disruptions in these molecular pathways can cause disease.
“It gives you a direct connection to what the root causes are,” said Dr. David Altshuler, a professor of medicine and genetics at Harvard and Massachusetts General Hospital, and a researcher at the Broad Institute. “That is different from listening to a stethoscope.”
The 5 (OK, 6) most popular Bioethics News stories from the week of April 28
Here are the most popular Bioethics News items from last week based on average clicks per day:
1. House passes GINA
(NYT) The Genetic Information Nondiscrimination Act passed on a 414-1 vote. President Bush has said he would sign the bill.
2. Praying parents charged
(AP) The parents of a Wisconsin child who prayed while the child died from diabetic complications have been charged with reckless homicide. The parents regarded their daughter's condition as "a test of faith" and a "spiritual attack."
3. Med college group: no more industry gifts
(NYT) The Association of American Medical Colleges has proposed banning free food, gifts, travel and ghost-writing from drug and device makers.
4. More details on McCain's health plan
(NYT) The presidential candidate's plan would try to shift the basis of coverage from employers to individuals. McCain has also called for the federal government to assure that coverage will be available for people who have been turned down.
5. Marrying for health care (tie)
(LA Times) A survey sponsored by the Kaiser Family Foundation reports that seven percent of Americans said they or someone in their household got married for healthcare benefits last year.
5. iPS cells used to create heart cells in mice (tie)
(Reuters) Researchers from UCLA report in the journal Stem Cell Express that they got mouse iPS cells to differentiate into two types of heart cells as well as hematopoietic cells.
The top five stories from two weeks ago.
Surrogacy without drama
When surrogacy comes up in the media, it's usually within the context of a story about celebrities, outsourced wombs, court cases or comedy. But this past weekend, the Washington Post had the story of a surrogacy gone absolutely, positively... normal. From Brigid Schulte's piece:
Fourteen years ago, Kovacic, a married, middle-class mother of three, signed a $15,000 contract with Carol Van Cleef and Doug Thompson, now of McLean, to carry the embryo that their sperm and egg had created in a petri dish. On her 35th birthday, Kovacic gave birth to Jamie. The two families, without a second thought or a hint of awkwardness, have celebrated together every year since.
In technical terms, Kovacic was a "gestational carrier" for Carol and Doug, the "intended parents." Kovacic, 49, short and easygoing with an impish sense of humor, and Van Cleef, 52, a tall, willowy, self-described type-A partner in a major law firm, couldn't be more different. But theirs is an intimate bond of flesh and bone, forged in science and the ancient yearning for a child that society has yet to find the words to describe, much less understand.
Kovacic, who lives in Herndon, brought two of her own daughters to the birthday dinner. The girls gushed about movies and bands and teased Jamie's 17-year-old brother, Peter. Jamie, sitting between Kovacic and Van Cleef, mentioned that she would be singing soprano in her upcoming chorus concert.
Kovacic looked at Van Cleef and raised an eyebrow. "I know she didn't get that from either one of us, did she?"
Kovacic has been Jamie's "special friend" at preschool. She has attended her graduations, school performances and confirmation. She babysat for her as a child. But the one thing she clearly isn't is Jamie's mother.
One interesting fact from this piece: surrogate births account for less than one percent of all births from reproductive technologies.
-Greg Dahlmann
Toward test tube meat
PETA recently announced it would award $1 million to the first person who develops commercially viable in vitro chicken meat during the next four years. They've set the bar pretty high -- the meat has to have "a taste and texture indistinguishable from real chicken flesh to non-meat-eaters and meat-eaters alike."
So, what's the likelihood of that happening? In the near future, not too good, according to Time:
In theory, this seems like an excellent idea, with the potential to ease the burden on the environment from meat production, reduce greenhouse gas emissions and improve human health. In practice, however, the chances of anyone actually winning the prize seem slim. "No one has yet produced [in vitro meat]. No one has succeeded in coming close," says Dr. Stig Omholt, director of Norway's Centre for Integrative Genetics and chair of the In Vitro Meat Consortium, which held its first symposium this month. Still, Omholt says, "it seems possible to develop this technology."
If such a product is created, it would raise some interesting questions.
Bioethics and pop culture watch
Two recent items that probably don't mean a whole lot, but might be interesting in a bioethics-in-pop-culture kind of way:
+ Oprah's interview with the pregnant transsexual man scored big ratings.
+ And Tina Fey's surrogacy comedy Baby Mama easily topped the box office last weekend, delivering (!) more than $18 million.
-Greg Dahlmann
Can you buy changes in health behaviors?
By Stuart Rennie
And the girl behind the counter has a tattooed tear
One for every year he's away she said
Such a crumbling beauty,
Ach there's nothing wrong with her
That a hundred dollars won't fix
Those are lyrics from Tom Waits' song '9th and Hennepin.' They slipped involuntarily into my consciousness when I read about a World Bank study that is being planned in Tanzania. According to the report in the Financial Times, the study involves 'incentivizing' sexual behavior change by means of cold hard cash. Participants, if they do not pick up sexually transmitted infections during the study period, are told that they will receive $45 for their efforts. The study also will have a comparative control arm in which participants will also be tested for STIs, but will not receive any money. One of the researchers from the University of California-San Francisco is reported as saying: “We hope this ‘reverse prostitution’ will make people think hard about the long-term consequences of their short-term behaviour.” An intriguing statement, since it implies that the problem with Tanzanians, in regard to sexually transmitted infections, is that they are just not thinking hard enough. Nothing like 45 dollars to get you to think straight. If the question is -- as the accompanying Editorial puts it -- "Are the funders saying young Tanzanians cannot be trusted to do what is good for them without a bribe?", it looks like the answer is a resounding yes.