July 2005
Senator Frist, Stem Cell Advocate
Perhaps sensing thatAs you may have seen on this morning’s news, Senate Majority Leader Bill Frist has announced his support for H.R. 810, a bill that would expand the current federal policy on embryonic stem cell research. Senator Frist now joins the nation’s top scientists and researchers, 80 Nobel Laureates, a majority of the American public, more than 200 top patient advocacy and medical research organizations, and a majority of the United States House of Representatives in supporting legislation to further this research that holds great promise for curing or treating a variety of diseases that currently afflict more than 100 Americans.In a speech on the Senate floor today, Senator Frist declared his support for embryonic stem cell research by stating:
“While human embryonic stem cell research is still at a very early stage, the limitations put in place in 2001 will, over time, slow our ability to bring potential new treatments for certain diseases. Therefore, I believe the president’s policy should be modified… Cure today may be just a theory, a hope, a dream, but the promise is powerful enough that I believe this research deserves our increased energy and focus. Embryonic stem cell research must be supported. Its time for a modified policy – the right policy for this moment in time.”
H.R. 810, the Stem Cell Research Enhancement Act of 2005, was passed by the House in May, and now has more than 40 cosponsors in the Senate. Its champions in the Senate, led by Arlen Specter (R-PA) and Tom Harkin (D-IA), had been pushing to bring H.R. 810 to the floor, but were not able to reach an agreement on the vote before the August recess that begins this weekend.
The Senate will be out of session through Labor Day, which means that your Senators will be back in their home state attending public events and holding town hall meetings. Please use this opportunity to explain why embryonic stem cell research is important to you, and personally ask your Senators to support H.R. 810 when the Senate returns in September.
Short People Have No Reason to Live
A study of Swedish men found thatShorter men may be more likely than their taller peers to commit suicide -- suggesting, researchers say, that various factors related to growth and development also affect suicide risk later in life. In a study of records for nearly 1.3 million Swedish men, the investigators found that for every 2 inches a man gained in height, his suicide risk dipped by 9 percent. Overall, the shortest men in the study were about twice as likely as the tallest men to commit suicide.A few previous studies have uncovered a similar height-suicide relationship among men, with some suggestion that income and social class explain the link; children who grow up disadvantaged may have both poorer growth and a higher suicide rates as adults.
The Complicity of the Media in Drug Marketing
The thesis of this piece in Columbia Journalism Review is that the media is complicit in drug marketing. I would somewhat disagree. I think the media often does not know how to evaluate marketing claims and that is hardly unique to the pharmaceutical industry--think of the coverage of the food industry or of the space program or of claims about medicine's war on cancer and its successes. The media is in the news business a bit of the time and the entertainment business much of the time and the grab your attention in any way we can mode all of the time. No one should think of the media as really capable of getting past its fundamental business values to become a 'fair' broker of health news.Not gonna happen. - Art Caplan
The Future Looks Grim. Again.
Time's Richard Schickel reviews The Island, the new cloning movie just out.If we're to believe The Island, the private sector, in the very near future, is about to make Halliburton and[thanks Andrew Rosenthal]the rest of those scary big guys look like a kids' corner lemonade stand. Director Michael Bay's new movie posits a secretive biotech operation offering rich people the opportunity to have their very own, disease-free clones. In other words, for $5 million you can have a more or less living insurance policy. Need a kidney transplant? You got it, helicoptered right to the operating room.
It's a sweet, even vaguely plausible, scheme. The clones are kept in a nice white bunker, their health is closely monitored, all their needs--up to the mental age of 15--are provided for, and sex is not an issue since the system's mastermind, Merrick (Sean Bean), has simply eliminated that messy urge. He feeds them on two myths. One is that they are the only survivors of a vast "contamination" that has wiped out the rest of human life. The other is that there's a paradisical, uncontaminated island on which you can win residence by giving birth or through a lottery that is the clones' major source of entertainment.
What Merrick doesn't count on is the clones developing minds of their own. Well, not exactly minds--more like trace memories borrowed from the people they are doubling for. But you know how it is: you get to remembering, and then you get to thinking. It's sort of the same way with romance. Cute guy (Ewan McGregor) and pretty girl (Scarlett Johansson) start making eyes at each other, escape to the fully populated, slightly dystopian real world and, sure enough, find time amid the car chases and explosions to start fooling around. There are other trace elements in the film: a clone Adam and Eve, a bit of Faust, a touch of George Orwell (McGregor is like 1984's Winston Smith, whose curiosity about unanswered questions got him into such terrible trouble).
But mostly the roots of The Island are to be found in every (presumptive) summer blockbuster you ever saw, especially the futuristic ones--or decided, upon mature reflection, not to see. To give Bay (Armageddon, Pearl Harbor) his due, there's a certain wit and splash (or should we make that splat?) in his action sequences--nice stuff with a flying motorcycle and a surprise-filled sequence in which the leads are hanging onto a skyscraper sign that's losing its moorings. But for all the menace of its techno-prattle, its implicit boosts for humanism and its swell production design, the picture is finally a bore. Sci-fi was more powerful when its special effects were cheap and crude, its ideas simple but potently stated.
Unduly Induce Us, Please
The Austrian philosopher Ludwig Wittgenstein famously claimed that many traditional philosophical problems are ultimately rooted in conceptual confusions. Once these confusions are carefully exposed and analyzed, he believed, the problems are not just answered: they forfeit their original status as genuine problems, and simply vanish into thin air.
In this week’s Lancet, Ezekiel Emanuel et. al. make a noble attempt to make the problem of undue inducements disappear. Undue inducement is commonly regarded a standard research ethics problem and is viewed as particularly acute in international biomedical research. On the one hand, researchers are instructed not to provide excessively attractive incentives to prospective research participants, because this ‘offer you can hardly refuse’ could undermine the voluntary element of consent. On the other hand, much of international research takes place in impoverished countries where simply having blood pressure taken for free by a medical practitioner could be wildly seductive. Many an international researcher has agonized over how to recruit participants in low-income countries without violating their autonomy in the process.
According to Emanuel et. al., worries over undue inducements in international research are misplaced. Properly understood, undue inducements involve (1) the offer of a highly attractive good where (2) the offer undermines the persons judgment and (3) has them agreeing to take serious risks that threaten his/her fundamental interests. But in fact (3) is doing all the ethical work here. Inducements in research are only unethical according to Emanuel et. al. if they entice the participant to enter a study with a highly unfavorable risk-benefit ratio. Inducement itself, in other words, is not the problem: inducement into unduly risky research is the problem. As long as a research study fulfills basic ethical requirements – including the minimization of risk – then the problem of ‘undue inducement’ vanishes.
The argument seems to have an interesting implication. There appears to be nothing in principle stopping researchers from pulling out all the stops in terms of benefits, for as long as the research study is in ethically good shape, even awesome inducement is not undue inducement. In moderate and low-risk studies, why not just offer research subjects whopping big sums of cash to join?
Given the current state of health research budgets, and the general reluctance to substantially reduce global inequalities, the lavishing of benefits on developing world research participants is unlikely to happen. But it is nice to hear that there is nothing ethically against it.
- Stuart Rennie
Mexico to Map the DNA of its Population
The Mexican Government, IBM, and Applied Biosystems Group will map the genes of all Mexicans. The project's commercial arm is pharmacogenomics: "Besides mapping genes, the Genomic Medicine institute and Applied Biosystems will launch a pilot project looking for genetically based drugs specific to Latin Americans and those of Latin American descent."This Guy is from Massachusetts?
Massachusetts Governor Mitt Romney, eagerly seeking to give life to a possible run for the White House, has
vetoed the morning after pill legislation in Massachusetts. The bill, which makes it much easier to obtain the morning after pill, even in Catholic hospitals and without a prescription at pharmacies around the state, is veto-proof. So it is a symbolic gesture. But what is the symbol? That he is clueless?The governor said he believed that the pill sometimes functioned as "an abortion pill," not just contraception.That he lied to get elected?
In 1994, during his failed effort to unseat Senator Edward M. Kennedy, he told The Boston Herald in response to a question: "I think it would be a positive thing to have women have the choice of taking the morning-after pill. I would favor having it available." And during his successful run for governor in 2002, he replied yes when asked on a Planned Parenthood questionnaire, "Do you support efforts to increase access to emergency contraception?"That he has Rove-esque sensibilities?
He said supporting the legislation would mean breaking a promise he made during the governor's race that while he personally opposed abortion, he would not change the state's abortion laws. At the time, that promise was widely interpreted as an effort to satisfy the majority of Massachusetts' constituents by pledging not to make abortion laws more restrictive. But Mr. Romney said Monday that he would also not change the laws to make them more permissive.You choose.
Why is Media Coverage of Medicine So Awful?
The complaints are familiar (but accurate) in this article in PLoS Medicine. The real question is what will it take to bring about substantive change in media coverage of health and health care. Nothing on the immediate horizon points toward any reason for optimism given the lesser emphasis on news on the networks and local TV, attacks on public radio, and the continued infotainment push on cable news outlets.- Art Caplan
Attention Deficit Disorder, Drugs, and Enhancement
The new issue of The American Journal of Bioethics is just out, and
the Target Articles include a major exploration of dosing of medication for children with ADHD by Illina Singh, which features open peer commentary essays by, among others, Peter Kramer and Paul Appelbaum. As well there is an exploration of the ethics of enhancement by Francis M. Kamm, Guggenheim fellow and now Littauer Professor of Philosophy at the Kennedy School of Government. Kamm takes on Sandel, and furthers a debate started in AJOB's very first issue by Norman Daniels - where should we go with enhancement technologies? Also in this issue: a review of George Annas' new book American Bioethics by Al Jonsen, a review of Zeke Emanuel, Robert Crouch and John Arras' new book on research ethics, an In Focus article on U.S. military sponsored vaccine trials in Nepal, and a pointed exchange of letters between Jeffrey Kahn, Carl Elliot and James Coyne concerning the latter's article about Carl Elliot and the David Healy affair. Bon appetit.
Us, Only Somewhere Else
Classical Values, a great blog that covers much of politics and is written by someone with tons of investigative instinct, took one of our posts as a jumping off point on stem cell research. His post is a great place to begin in looking into the Senate debate on stem cells this coming week.Pray for Placebo Control
Prayer's power to heal is examined in a recent study entitled "Mantra II" conducted at Duke by a cardiologist. The experiment involved 748 patients who were treated for heart problems at nine hospitals around the nation. Contrary to several recent and oft-cited studies, in this the largest study of the phenomenon, there was no empirical evidence that prayer by strangers made any difference in outcomes:The researchers enlisted 12 congregations of various Christian denominations, Jews, Muslims and Buddhists around the world to pray for some of the patients, giving them names, ages and descriptions of the illness. The researchers then divided the patients into four groups. The first quarter had people praying for them. The second quarter received a nontraditional treatment known as music, imagery and touch (MIT) therapy, which involved breathing techniques, soothing music, touch and other ways to relieve stress, such as calming mental images. The third group received both prayer and MIT, while the fourth received nothing.In the final year of the study, the researchers took the additional step of asking more religious congregations to pray for the prayers of the initial group to work. Neither the patients nor their doctors knew whether someone was praying for them. The prayers varied depending on the religion, lasting between six and 30 days.
The researchers then followed all the patients for six months to see which patients suffered serious complications, were re-hospitalized or died from heart problems. Overall, there was no difference among the four groups, the researchers report in Saturday's issue of the Lancet medical journal.
Drugged Up Celebrities
Endorsements are everything in pharmaceutical marketing, or at least that is the current conventional wisdom. The big endorsements of course would be from famous bioethicists, I know, because I read it in the Lancet. But I guess all of the bioethicists were too expensive, so pharma had to settle for buying celebrities. Tim Murphy found this account of who represents what. The B-list folks are really hawking some pretty sad stuff, too:Ian Anderson, band member of Jethro Tull, has discussed deep vein thrombosisAll I know is that I'm not selling out for less than Dan Quayle. It would be unethical.
for the maker of the blood-thinner Lovenox, from Aventis.
Julie Andrews, singer, has discussed osteoporosis on behalf of the drug Evista, from Eli Lilly. Her mother has condition.
Lauren Bacall, actress and Blackgama icon, has promoted the anti-macular degeneration drug Visudyne, for Novartis. Her friend has the condition.
Angela Bassett, actress, has promoted the anti-cholesterol drug, Pravachol, for Bristol-Myers-Squibb.
Lorraine Bracco, actress, discusses depression for Pfizer, which makes the anti-depressant Zoloft. She has been treated for depression.
Linda Carter, "Wonder Woman," has discussed irritable bowel syndrome for maker of Zellnarm, Novartis. She has the condition.
Mike Ditka, coach, restaurateur, and sometime purveyor of pork chops, has pitched Viagra for Pfizer.
Robert Dole, former Senator and Presidential candidate, has encouraged treatment for impotence in ads paid for Viagra, from Pfizer.
Kirk Douglas, founder of acting dynasty, has promoted the anti-cholesterol drug, Pravachol, for Bristol-Myers-Squibb.
Olympia Dukakis, actress and cousin to presidential candidate, has discussed shingles while promoting Lidocaine for Endo Pharmaceuticals. Her mother had the condition.
Peggy Fleming, Olympic skater, has promoted Lipitor for high cholesterol, for Pfizer. She has the condition.
Kelsey Grammar, actor, has discussed irritable bowel syndrome for maker of Lotronex, GlaxoSmithKline. His wife has the condition.
Dorothy Hamill, Olympic skater, has pitched Merck's Vioxx for use against arthritis.
Bruce Jenner, Olympic athlete, has pitched Merck's Vioxx for use against arthritis.
Magic Johnson, basketball star and entrepreneur, has spoken about AIDS awareness for anti-HIV-drug maker GlaxoKlineSmith. He has had HIV infection since 1990.
Guy Lafleur, hockey player, has pitched Viagra for Pfizer.
Tara Lipinski, Olympic skater, has discussed deep vein thrombosis for Aventis, the maker of the blood-thinner Lovenox.
Rob Lowe, actor and Dukakis supporter, has spoken about infection that occurs during chemotherapy, for Amgen, the maker of Neulasta. His father had this problem.
Alonzo Mourning, has done an ad for the anemia drug Procrit, for Johnson & Johnson. He has used the drug himself.
Jack Nicklaus, golf master, has promoted the blood pressure drug Altace, which he has used.
Rafael Palmiero, baseball star, has pitched Viagra for Pfizer.
Pélé, soccer legend, has pitched Viagra.
Mike Piazza, baseball star, has promoted Claritin. He has used the product. Dan Reeves, football coach, has promoted the anti-cholesterol drug, Zocor, for Merck. He has heart disease.
Debbie Reynolds, irrepressible Broadway actress, has promoted Detrol for Pfizer. She has an overactive bladder (among other things).Dan Quayle, former Vice President and money-in-the-bank for late-night comics, has discussed deep vein thrombosis for make of Blood-thinner Lovenox, Aventis.
Sylvester Stallone, wealthy actor in spite of everything, has promoted the anti-cholesterol drug, Pravachol, for Bristol-Myers-Squibb.
Kathleen Turner, husky-voiced actress, has discussed rheumatoid arthritis, for maker of Enbrel, Wyeth. She has condition.
Ricky Williams, football player, has promoted Paxil for GlaxoSmithKline. He has used the drug.
Anna Wilson, rock singer, has promoted the Lap-band, for Inamed. She has used the device - which fastens around the abdomen -- following her obesity surgery.
Children, Witches and Bioethics
Writes Stuart Rennie:In June this year, three Angolans in London were convicted of abusing an eight-year old orphan Angolan girl by (among other cruelties) beating her with a belt, cutting her with knives, and rubbing chili peppers in her eyes. But it was not just the gruesome details that caught the British public’s attention. It was the motives for the torture: the girl was regarded by her tormentors as a witch. What might seem an obvious case of child abuse was, in the eyes of the perpetrators, a matter of ‘do-it-yourself exorcism’.Stuart Rennie is a Research Assistant Professor in bioethics at UNC-Chapel Hill. We missed you; welcome back.
The case has drawn attention to the fact that in central
African countries plagued by war poverty and state collapse, a significant number of children are regarded as witches. While general beliefs in witchcraft and spiritual possession is not at all uncommon in countries like Angola or the Democratic Republic of Congo , the idea of the child-witch is relatively new and deeply disturbing. Children as young as three years old can be accused of bringing misfortune on households – everything from unemployment to the death of family members – and cast out into the street to fend for themselves. According to Save the Children, 60% of the 30,000 street children in Kinshasa, capital of the Democratic Republic of Congo, are accused of being possessed by evil spirits, capable of casting spells, flying at night, transforming into non-human animals or consuming human flesh. Children infected by AIDS are particularly susceptible to accusations of witchcraft.
The child-witch phenomenon in Central Africa has spawned a veritable industry of self-appointed ‘healers’. Family members who want to rid their child of demonic possession often turn -- with what little money they have -- to traditional African practitioners or evangelical ministers. In either case, the child may be forced to undergo painful exorcisms, in abominable conditions, sometimes lasting days. Some don’t survive the ordeal.
What has all this got to do with bioethics? Plenty. Bioethics is not just about the ways North Americans and Europeans come to terms with the ethical implications of their expensive technologies. Those who practice bioethics in central Africa have little choice but to reflect critically on how traditional healing practices and influential local forms of religion impact on health and human rights. The influence of beliefs in witchcraft and satanic possession in these regions is unlikely to diminish soon, but local bioethicists could do a great service by redirecting these energies away from the most vulnerable members of society.
Specter Threatens an End Run To Get Vote on Stem Cell Bill
Writes Rick Weiss in today's Washington Post:With prospects dimming for a simple Senate vote on a bill to loosen President Bush's restrictions on human embryonic stem cell research, Sen. Arlen Specter (R-Pa.) threatened yesterday to circumvent the political logjam by attaching the wording to the appropriations bill for the Department of Health and Human Services.
"I don't like to put it on an appropriations bill, but we waited long enough," a frustrated Specter told reporters in the Capitol. The strategy, he said, is a "fall-back position which I have avoided up 'til now."
Specter is a lead sponsor of a bill, passed by the House in May, that would allow taxpayer dollars to be used to conduct research on medically promising stem cells derived from embryos that are destined to be discarded by fertility clinics. Such cells are off-limits to federally funded scientists under the policy Bush set in 2001. The bill, which polls indicate has broad support and has been considered sure to pass in the Senate, could trigger a showdown with Bush, who has promised a veto.
Although Senate Majority Leader Bill Frist (R-Tenn.) promised months ago to bring the Senate version to the floor, the field has become muddied by the filing of at least six competing bills that would restrict embryo research in various ways. Senators on both sides of the aisle have been unable to agree on which should be brought to the floor and under what terms.
As chairman of the subcommittee overseeing HHS appropriations, Specter said he was in a position -- in consultation with other senators -- to add the stalled bill as an amendment.
Frist spokeswoman Amy Call suggested the prospects for a vote are not dead. "We keep working for a discrete and clear debate and vote on the House bill and other ideas in this sphere," she wrote in an e-mail.
Misusing the Nazi Analogy
Sixty years ago, Allied forces brought an end to Adolf Hitler’s dream that Germany would rule Europe and dominate the world. The death of Nazi Germany gave birth to a charge that still haunts the scientific community— what might be called ”the Nazi analogy.” In ethical or policy disputes about science and medicine, no argument can bring debate to a more screeching halt then the invocation of the Nazi comparison.
Whether the subject is stem cell research, end-of-life care, the conduct of clinical trials in poor nations,
abortion, embryo research, animal experimentation, genetic testing, or human experimentation involving
vulnerable populations, references to Nazi policies or practices tumble forth from critics. “If X is done, then we are on
the road to Nazi Germany” has become a commonplace claim in contemporary bioethical debates.
Sadly, too often those who draw an analogy between current behavior and what the Nazis did do not know what they are talking about. The Nazi analogy is equivalent to dropping a nuclear bomb in ethical battles about science and medicine. Because its misuse diminishes the horror done by Nazi scientists and doctors to their victims, it is ethically incumbent upon those who invoke the Nazi analogy to understand what they are claiming.
A key component of Nazi thought was to rid Germany and the lands under German control of those deemed economic drains on the state—the mentally ill, alcoholics, the “feeble-minded,” and the demented elderly. They were seen as direct threats to the economic viability of the state, a fear rooted in the bitter economic experience after the First World War. The public health of the nation also had to be protected against threats to its genetic health. These were created when people of “inferior” races intermarried with those of Aryan stock. Threats to genetic health also included, by their very existence, genetic degenerates— Jews and Roma. Theories of race hygiene had gained prominence in mainstream German scientific and medical circles as early as the 1920s.
What is important to keep in mind about these underlying themes that provided the underpinning for Nazi euthanasia and eugenic practices is that they have little to do with contemporary ethical debates about science, medicine, or technology. Take, for instance, the case of Terri Schiavo, a massively brain-damaged patient who was kept alive by means of artificial feeding for more than a decade. When congressmen and religious leaders in the United States commented on her situation during the weeks leading up to her death on 31 March 2005, soon after her feeding tube was removed, they described it as analogous to what the Nazis had done to Jews in concentration camps—a complete misuse of the Nazi analogy. Whatever one thought about the ethical issues raised by the decision to allow the removal of a feeding tube from this woman, the decision had nothing to do with the belief that her continued existence posed a threat to the economic integrity of the United States or that her racial background posed a threat to America’s genetic health. The fight over her fate was about who best could represent her wishes so that her self-determination could be respected—a moral principle not afforded those killed by deliberate starvation in the Nazi euthanasia programs.
Similarly, when critics charge that allowing embryonic stem cell research permits the taking of innocent life to serve the common good, and then compare it to Nazi research in concentration camps, the claims of resemblance are deeply flawed; moreover, they demean the immorality of Nazi practices. Concentration camp prisoners were used in lethal experiments because they were seen as doomed to die anyway, were seen as racial inferiors, and, given the conditions of total war that prevailed, they were considered completely expendable in the service of the national security of the Third Reich.
There are many reasons why a practice or policy in contemporary science or medicine might be judged unethical.
But the cavalier use of the Nazi analogy in an attempt to bolster an argument is unethical. Sixty years after the fall
of the Third Reich, we owe it to those who suffered and died at the hands of the Nazis to insist that those who
invoke the Nazi analogy do so with care.
- Arthur Caplan [an Editorial in the July 22 issue of Science]
High Noon. Frist. Specter. Stem Cells.
On stem cells, Specter's playing for keeps , writes Margaret Carlson in the LA Times. Specter is not going to lose this battle. Writes Carlson:... Specter, who has been battling Hodgkin's disease sinceAnd Senator Bill is hurting:February, is his own draw now. Never weaker physically, never stronger mentally, Specter says he is propelled out of bed each day by his work and by the hundreds of letters he has received from patients determined to see stem cell research expanded. His former chief of staff, David Urban, calls him the Lance Armstrong of the Senate: "If you close your eyes and don't look at his bald head and gaunt cheeks, but just listen to him, you'd think he was a well man at the height of his powers."
Frist enters this fight weakened by his own mistakes. Stung by a string of miscalculations and transparent panderings that haven't paid off, he's made some senators wax nostalgic for the good old days under Trent Lott, who at least wasn't distracted by dreams of being president.Earlier this year, Frist was unilaterally disarmed by Sen. John McCain (R-Ariz.), who stole seven Republicans to form the Gang of 14, taking Frist's "nuclear option" on filibusters off the table for the time being. Then Frist couldn't get a vote on the floor on John Bolton's nomination as ambassador to the United Nations. In another gaffe, Frist went on "Good Morning America" to claim he hadn't diagnosed Terri Schiavo by videotape. Problem with that was there was a videotape showing him doing just that.
Wanted, Donor Eggs, Cheap; Young Women Preferred
It's right to pay women who give their eggs for research, writes Ronald Green, chair of the ethics advisory board for the stem cell company that is recruiting the largest pool of potential egg donors for stem cell research. He's on the right track, frankly, in that egg donation for research isn't fundamentally different from egg donation for reproduction, and that if it is ok to pay women to donate eggs for reproduction, then it is ok to pay them to donate for research.But it isn't right to pay them for reproductive donation. In reproductive donation of eggs, the kiddos from colleges are offered preposterous amounts of money for their egg donation, and it has long been suggested that exploitative payments encourage donors who have high credit card debt, etc. Big problem. In egg donation for stem cell research, by contrast, the fee will be smaller. But it will still be priced high enough to attract the very young women whose eggs are best suited (it turns out, as we blogged) to produce stem cells. The payment is not for out of pocket expenses - at which point one would really know that these women are risking their fertility and even their lives for the cause. No, this is just buying eggs cheap. The women are every bit as coerced - in fact perhaps more so.
The big issue in egg donation is that it has to be truly consensual, not bribed.
[disclosure: Dr. McGee was Chair of the Advanced Cell Technology ethics advisory board until 2000]
Fewer Abortions
The Guttmacher Institute reports today that "for every 1,000 pregnancies that did not result in miscarriage in 2002, there were 242 abortions. This figure was 245 in 2000 and 280 in 1990." In other words, "in the year 2002, about 1.29 million women in the U.S. had abortions. In 1990, that number was 1.61 million." Washington Post summarizes other parts of the report:Women with unintended pregnancies are those most likely to get abortions. According to the Guttmacher report, 47 percent of unintended pregnancies are aborted.Teenagers, unmarried women, black and Hispanic women, and those with low incomes are more likely than the population as a whole to have unintended pregnancies.
The report shows that non-Hispanic white women get about 40 percent of all U.S. abortions, black women 32 percent and Hispanic women, who can be of any race, 20 percent. Women of other races account for the other 8 percent. Black and Hispanic women have higher rates of abortion than non-Hispanic whites, the report states.
Other facts about U.S. abortions from the Guttmacher report:
· Six in 10 women who had abortions in 2002 were mothers. "Despite the common belief, women who have abortions and those who have children are not two separate groups," said Finer.
· The incidence of abortion spans the economic spectrum, but low-income women are overrepresented among those having the procedure. Sixty percent of women who had abortions in 2000 had incomes of less than twice the poverty level --below $28,000 per year for a family of three, for example. This is in part because "low-income women have lower access to family planning services" such as contraception and counseling provided by health departments, independent clinics or Planned Parenthood, Finer said.
· The majority -- 56 percent -- of women who terminate their pregnancies are in their twenties. Teenagers between 15 and 19 make up 19 percent of abortions, although this percentage has dropped substantially in recent years.
This drop may be due to use of longer-acting hormonal contraceptives and lower rates of sexual activity, said Joyce Abma, a social scientist at the National Center for Health Statistics at the Centers for Disease Control and Prevention (CDC).
She added that there has been a decline in sexual activity reported by teenage males, which could be a contributing factor to lower pregnancy and abortion rates among teens.
One More Time, this Time with More Berg and Goldstein: The Stem Cell Alternatives are Baloney
From today's Post:by Paul Berg, George Q. Daley and Lawrence S.B. Goldstein
Given the general agreement that such research has the potential to relieve the misery and suffering of millions, we find it troubling that opponents of this legislation (H.R. 810 or S. 471) are trying to divert the debate about the merits of expanding this research by promoting dubious approaches to obtaining stem cells that even their supporters concede are scientifically and ethically problematic. What is so bizarre about this effort is that there is no need for the administration and its congr essional followers to seek authorization to pursue these proposed "new" approaches for obtaining stem cells. Research on these proposed alternatives is already legal and can be funded by existing mechanisms.
We want to be very clear: The most successful demonstrated method for creating the most versatile type of stem cells capable of becoming many types of mature human cells is to derive them from human embryos -- at present, excess embryos created at in vitro fertilization clinics and freely donated for research by couples who choose not to have them destroyed as medical waste.
While some of the proposed alternatives being suggested may have some promise, they are unproven. Some, in fact, are ethically questionable when performed with human tissues. One idea is to derive stem cells from embryos that have stopped developing and are thought to be "biologically dead." Beyond the fact that scientists haven't developed a reliable method for determining an embryo's "death," there is no scientific evidence that stem cells derived from these embryos would have the required properties or be safe for human therapies.
Another set of proposals focuses on attempts to reprogram adult cells to revert to an early, undifferentiated, stem cell-like stage of development. This is an important, though highly speculative and ambitious, goal. Indeed, it is a goal that developmental scientists are already seriously investigating today, but with many uncertainties about whether and how it can be made practical. Still another proposal is to separate a single cell from a live embryo while attempting to preserve the embryo's potential to initiate a pregnancy and normal birth. This proposal is not only speculative but poses ethical concerns as to possible damage that might be inflicted on the embryo.
In a July 12 op-ed in The Post, Leon R. Kass, chairman of the President's Council on Bioethics, wrote: "It may be that some opponents of embryo research are using the se worthy proposals for . . . a political purpose." We agree: It is likely that some opponents are pursuing a political purpose in their public embrace of these proposals. We also agree that federal funding for these and many other proposed options, including adult stem cell research, should continue to be provided.
... We urge Congress to deal with this matter on its scientific merits without raising a laundry list of other speculative scientific approaches that serve only to confuse the issue. The treatment of otherwise intractable diseases can become a reality if we expand the number and quality of the stem cells that American scientists have to work with.
Why Can't Scientists be Cooler
This week's The Scientist reminds the reader just how few people love scientists. Not many are viewed like rock stars, writes Richard Gallagher, scientist and editor of The Scientist. In fact, more than he knows, scientists (like intellectuals more generally in the past 20 years) have been almost uniformly demonized by in popular culture in the West. Gallagher imagines a day in which scientists will be much more beloved by the public, even viewed as heroic.A recent poll of the Top 100 Americans1 included just four scientists, Einstein, Sagan, Salk, and Tesla (although this could be increased to seven if we include Edison, Bell, and Franklin). A similar BBC project2 yielded a healthier 12 scientist in the list of "100 Great British Heroes." Before you get too excited, however, what was striking about that is that only one – Stephen Hawking – is alive. It seems that scientists can be memorable, but only one of us is. To hammer home that point, in another poll teenagers in the UK floundered when asked to name a single contemporary scientist, producing suggestions such as Madonna, Chemical Ali, and their science teacher.3 And in the same poll, only 7% considered scientists to be "cool or fun."
Eric Lander in wrap-around
shades and a black trench coat isn't going to carry the same punch as Bono, and I don't see Tony Blair cuddling up to Craig Venter on MTV like he did with Bob Geldof. But we don't want or need to have the impact of the rock fraternity on world opinion. We just need researchers to have a higher profile than the current, pitiful, low.
UPDATE: A READER WRITES: ... caught the latest blog and saw a picture of Tori Higgenson as Dr. Weir posted with the blog on The Scientist's commentary on why scientists can't be cooler ... Why not mention using Dr. Weir/Stargate, and the potential positive connotations scifi television can bring to scientists, since you did use the show/character, and thus roundaboutedly implying just that. (I'll be teaching a class next year using Stargate SG-1 to illustrate ethical principles from Greek time to present, so admit I'm rather biased and keyed to pick up on seeing the show mentioned outside the geek-blog forums.) [Thanks for mentioning it and why not beam up a copy of that syllabus to syllabi@bioethics.org?]
Ties to Industry Among NIH Scientists
A review by the NIH of its own researchers finds that more than 40 government scientists have violated the ethics rules in the institution. There isn't much news here but it made for good press for science foe Joe Barton of Texas.[thanks Darby Penney]
The Awful Truth about Drugs in Sports
Brian Alexander has done a superb job outlining the key issues and challenges facing doping or 'juicing' in sports. - Art CaplanCenter for Practical Bioethics gets $3M gift
Kansas City Business Journal notes the latest feather in the cap of Myra Christopher, leader of the productive and innovative Center for Practical Bioethics in Kansas City: The Francis Family Foundation has awarded the center $3 million, more than enough to hire an endowed chair, and to move ahead on one of the impressive initiatives that distinguishes that Center as the leader in literally working on policy issues in conjunction with community, clinicians and leaders.And Speaking of the Deep South
TheA 14 foot by 48 foot billboard, paid for by Tulane and LSU alumnae concerned about the direction of their alma maters, looms above the I-10 eastbound toward the Superdome and the LSU-Tulane medical parkway.The aim is to bring out the same folks who desperately fear gay marriage, book burning fruitcakes, and ask them to direct some of that passion against those dern eggheads.The billboard asks the question, "Are Tulane and LSU Planning on Cloning Human Embryos?," and directs viewers to learn more about the Universities' legislative committee testimony and activities at http://www.CuresNotClones.org.
All I know is that Dr. John and Professor Longhair would have supported stem cell research. There won't be many protesters who come from the Quarter.
Delivering While Intoxicated
Alta Charo pointed us to an AP story in Oklahoma, where stuff like this actually happens:BARTLESVILLE, Okla. (AP) -- A woman has been arrested on child neglect charges after giving birth while drunk, police said. Melissa Irene Tanner, 37, is accused of having a blood alcohol content close to three times the legal limit when she gave birth to a baby girl on June 30.
She is being held in jail with bail set at $30,000 and the baby has been placed in foster care.
The baby was not breathing upon birth and had to be administered a medication to counteract any narcotics that may have been present in the child's system. After an emergency procedure by hospital staff, the child started breathing.
Tanner reportedly has six other children. According to a July 11 probable cause affidavit filed in the case, Tanner told police she and another person had consumed a case of beer.
Want to Work in Bioethics' Grand Central?
The executive managing editor of The American Journal of Bioethics is leaving us to do lawyer stuff (no, she's not suing us, she actually is a lawyer, and is going to be working in a hospital general counsel office, actually doing something rather than playing academic like the rest of us).
So if you love bioethics and want to be engaged in the craziness that comes along with working on a print journal that also controls a website, a blog and umpteen other funded and unfunded projects - alongside 150 writers a year, a 50 member editorial board and zillions of readers - and if you always dreamed of living Upstate, maybe this is your moment. But it really is only a moment - we must hire within the next 30 days:Alden March Bioethics Institute
Title: Executive Managing Editor, The American Journal of Bioethics
Responsibility: Responsible for Operations of AJOB
Description: the Alden March Bioethics Institute at the Albany Medical College of Union University announces an immediate opening for Executive Managing Editor of The American Journal of Bioethics (AJOB). Start Date: no later than August 22, 2005. The American Journal of Bioethics is the most cited and most widely circulating peer-reviewed journal of bioethics, published in paper and online format by the world's largest science publisher, Taylor & Francis Group. The Executive Managing Editor is involved in all aspects of the editorial and publishing process, but does not have responsibility for sales or customer service. Bachelors degree required. The ideal candidate will be an aspiring scholar or librarian of bioethics. Alden March Bioethics Institute offers the M.S.Bioethics as well as a doctoral program in bioethics and numerous combined degree possibilities (JD/MSB, MPH/MSB, MSW/MSB, MD/MSB), and the position could include tuition remission for graduate study as well as the opportunity for teaching, participation in the AMBI clinical and benchside ethics consultation services, and/or participation in one of the Institute's research programs. Salary to be determined based on qualifications but based on a 25-hour work week. CV and one letter of reference (by email acceptable), or nominations, to Prof. Glenn McGee, Director, Alden March Bioethics Institute, the Albany Medical College of Union University, 47 New Scotland Avenue MC153, Albany NY 12208. Direct questions to Jamie Salm, search coordinator at 518.262.6082.
William Saletan on the Forced Marriage of Stem Cell Opponents
Saletan pens "You're Having My Baby - The forced marriage of stem-cell opponents" in today's Slate, in which he does some clever juxtaposition of the folks who testified to the Senate on the madness of "alternate sources" for embryonic stem cells. The whole debate seems like something out of 1984 - full of double talk and acting and a ballet of appearance and reality. It is mild compared to the Schiavo case, but nutty nonetheless, as we've opined again and again and again here.
Saletan does a nice job painting the hearings: Tuesday morning, I drive past the White House on my way to a stem-cell hearing on Capitol Hill. It feels like one of those basketball playoff series that go back and forth from one city to the other. A month and a half ago, proponents of embryonic stem cell research—for simplicity's sake, I'll call them the pros—pushed a research funding bill through the House, establishing their supremacy in Congress. Then the series moved to the White House, where the antis scored a victory as President Bush pledged to veto the bill.
Now the series moves back to Congress. The pros have orchestrated this hearing. All the senators present are on their side, as are three of the four advocates scheduled to testify. The lone anti witness, Stanford biologist Bill Hurlbut, serves on Bush's bioethics council but opens his remarks by quoting President Clinton's. That's what you have to do in the other team's building.
But it turns out that the pros aren't in control of this game. In fact, it isn't a game, and this is no longer a series. It has become a dialogue, born of each team's failure to eliminate the other. The pros, by winning a referendum in California last fall and passing the House bill, have forced the antis to propose alternative, non-lethal ways of getting embryonic stem cells. The antis, by offering four such ideas in a report from Bush's bioethics council, have forced the pros to apply their scientific ingenuity to those ideas. The ethics and the science are all mixed up. It's beautiful.
Quebec Man Faces Jail Possibility After His Ailing Wife Dies
The Globe and Mail reports that he had left his job as a homecare orderly to look after his ailing wife. Now she is dead and he could go to jail. In the latest case to fuel the ethical debate over mercy killing and assisted suicide, a the man is expected to be charged with the slaying of his wife, who suffered from Friedreich ataxia, a degenerative disorder of the nervous system. Andre Bergeron, 46, had originally been charged with attempted murder after his wife, Marielle Houle, had been rushed to hospital in a coma Thursday. - Art CaplanThe Yammer Begins: Senate Appropriations Subcommittee on Labor Health etc. Takes Up the "Alternative Sources of Stem Cells" Nonsense
George Daley testified this morning and hit the ball out of the part. This is longish, but deserves presentation since you wouldn't see it anywhere else without searching the web like an MIT brat. Daley, who wrote the "Missed opportunities in stem cell research" piece in New England Journal last year, testifies:Senator Specter, members of the Committee, thank you for inviting me to testify before you. My name is George Daley. I am here today representing the American Society for Cell Biology, a professional society of nearly 12,000 basic biomedical researchers in the United States and 50 nations around the world. I am Associate Professor of Pediatrics and Biological Chemistry at Boston Children’s Hospital and Harvard Medical School, the Associate Director of the Stem Cell Program at Children’s Hospital, a member of the Executive Committee of the Harvard Stem Cell Institute, and Board Member and President-elect of the International Society for Stem Cell Research (term to begin June 2007). My research is focused on using embryonic stem cells and adult stem cells to study blood development, and to develop new treatments for leukemia, and genetic diseases like immune deficiency, sickle cell anemia, thalassemia, and Fanconi’s anemia. I am also clinically active as a hematologist at Children’s Hospital, where I see first-hand the pain and suffering inflicted by these diseases on children and their families. My career is dedicated to making a difference in their lives through research and patient care.I am here today to state my strong support for Senate passage of HR 810, which has already passed the House of Representatives by an impressive and bipartisan margin. HR 810 would ensure that scientists can use Federal grant funds to study the wide range of valuable human embryonic stem cell lines that have been created since August 9, 2001, the date that President Bush announced his restrictive stem cell research policy. HR 810 would expand research opportunities and accelerate progress towards newer and better therapies for the many children I currently cannot treat successfully.
I am also here to give scientific perspective on the several additional strategies proposed for deriving human pluripotent stem cells that have been considered recently by the President’s Council on Bioethics, and which are the subject of this hearing today. I want to state at the outset that I support efforts to derive pluripotent stem cells by methods that would be ethically acceptable to all, but I do not support delaying the pursuit of medical research on existing human embryonic stem cell lines while these more speculative methods are tested. I believe that Senate passage of HR 810 is the surest means of supporting stem cell research at this juncture.
First let me emphasize why research on human embryonic stem cells is so vitally important, and why alternative forms of adult stem cell research cannot substitute for the study of embryonic stem cells.
Critics of embryonic stem cell research are fond of saying that adult stem cells have been used to cure dozens of diseases while embryonic stem cells have helped no one. I would like to examine that claim. In essentially all cases adult stem cell therapy really means transplantation of blood stem cells to treat leukemia, lymphoma, and various genetic diseases of the blood. Although bone marrow transplants have saved many lives, bone marrow transplant is never a certain cure. Even after many decades of clinical experience, bone marrow transplant remains an aggressive and toxic therapy that carries the highest mortality rate of any medical procedure that is routinely performed. For patients whose only bone marrow match is from unrelated donors outside the family, the treatment itself claims the lives of ~30% of patients in the first year. Indeed, I have cared for many patients who have died during treatment. All of us working in hematology today agree that additional research is needed.
My laboratory is studying embryonic stem cells in hopes of making blood stem cell transplants safer and more widely applicable. A critical part of the strategy is using somatic cell nuclear transfer to generate stem cells that are customized to the specific patients I mentioned earlier, kids with leukemia, immune deficiency, and sickle cell anemia. We hope to correct the genetic defects in these patient-specific cells, direct their differentiation into blood, and transplant kids with these genetically matched autologous cells. This strategy is already working in mice, and we are eager to translate this work into humans. The current Federal funding policies have held us back.
Although it is true that no one has to date been treated with cellular therapies based on human embryonic stem cells, I can assure you that mouse embryonic stem cells have had a major impact on medical research. Over the past 25 years, mouse embryonic stem cells have been used to create models for scores of human diseases, including cancer, heart disease, obesity, and Alzheimer’s. Research discoveries based on these models has led to new drug development and therefore touched countless lives. As for the criticism that no one has been cured with embryonic stem cells, the field of human embryonic stem cell research is a mere 7 years old, so it is premature to expect successful cell therapies to have already been delivered to patients. I believe it is only a matter of time before human embryonic stem cells are used in drug development research and become the basis for important new cell therapies.
As further evidence of how human embryonic stem cells enable unique opportunities to study disease, consider research on Fanconi’s anemia. Kids with Fanconi’s anemia suffer bone marrow failure, and often develop leukemia. Scientists have tried to model this disease in mice, but the mice do not develop bone marrow failure, and the adult blood stem cells from Fanconi’s patients cannot be maintained in culture. Recently, a team from the Reproductive Genetics Institute of Chicago isolated a human embryonic stem cell line that carries a Fanconi’s gene mutation. This cell line could enable us to study the uniquely human aspects of Fanconi’s anemia. However, because of the current Presidential policy, we cannot study these cells with our Federal grant dollars. Thus my lab has been left to attempt to generate a Fanconi’s model in one of our Presidential stem cell lines, which has proven to be far more cumbersome than simply obtaining the cells from Chicago. To date, we have not succeeded. By this direct example, the President’s policy is hindering our research on this terrible childhood disease. Senate passage of HR 810 would make available Federal funds to perform this important medical research. [I have written about the “missed opportunities” for human embryonic stem cell research under the current Presidential policies, and wish to introduce this article into the record.
Let me now turn to the several proposed new methods for making pluripotent human stem cells that are designed to avoid the destruction of a human embryo. These so-called “alternatives” are not TRUE alternatives, as they currently represent only speculative proposals for research that might yield new stem cell lines, and are fraught with their own ethical problems. In most of these cases, the experiments needed to establish feasibility of these proposals would require research on human embryos, and thus would be prohibited under current Federal law by the Dickey amendment. Far preferable to spending limited research dollars on these speculative proposals, in my opinion, is support for research on additional embryonic stem cell lines that are available today—lines that are similar to those already approved under the Bush policy. Senate passage of HR 810 would advance research that we know works, research where the ethical dilemmas have been understood and accepted by most.
Among the speculative methods under discussion, the first involves extracting stem cells from embryos that could be considered “dead”, because they have stopped dividing and will not develop further. If individual cells remain alive (and hopefully normal), they might be used to initiate lines of stem cells. The President’s Council found this strategy ethically sound and scientifically feasible and so endorsed it. However, I anticipate that attempts to generate pluripotent cells from these defective embryos will be far less efficient than from excess IVF embryos. Even if cell lines can be generated, I imagine scientists will remain suspicious that they are abnormal and might lead to erroneous conclusions in research.
The second speculative method derives from pre-implantation genetic diagnosis, or PGD, in which one or two cells are removed from an early embryo and analyzed to diagnose serious inherited diseases like Sickle Cell Anemia. PGD insures that only embryos found free of gene defects are transferred to the woman so that she may have a healthy child. The suggestion has been made that biopsied cells might be used to produce pluripotent stem cell lines, and this would be ethically acceptable if the embryo remained unharmed. Dr. Lanza is here to represent his as yet unpublished success in using this strategy to produce pluripotent stem cell lines from mouse embryos. However, the biopsy procedure raises all sorts of ethical concerns and indeed has been dismissed as unacceptable during the initial inquiries of the President’s Council. [Those who equate the zygote to a human being would reject the use of embryo biopsy because it removes cells at a stage when they might be considered developmentally equivalent to the zygote—that is, totipotent. Removing a totipotent blastomere is then the moral equivalent of producing a twin, which, in the view of opponents of embryonic stem cell research could not then be sacrificed for research. Embryo biopsy for stem cell research entails risks to embryos that are wanted for making a baby, rather than destined to be discarded as medical waste. If my wife and I carried a genetic disease we would accept the risk of the embryo biopsy procedure to insure we could have the healthiest child possible, but if we were simply infertile and using IVF to assist us in reproduction, we would not consent to having our healthy embryos biopsied; we would chose instead to donate our excess embryos to stem cell research. Dr. Lanza may suggest that lines be derived only from embryos already being biopsied for PGD, but the more cells one biopsies to accommodate both PGD and stem cell derivations, the greater the risk for embryo loss. As a practical and scientific matter, embryo biopsy for derivation of pluripotent cell lines is an unacceptable option.]
The third speculative method involves deriving pluripotent stem cells from something the President’s Council has termed “biological artifacts”. The best described of this procedure is called “Altered Nuclear Transfer”, which entails introducing a genetic defect into a somatic donor cell prior to nuclear transfer, so that a disordered embryo results that can be a source of pluripotent stem cells but cannot develop into a human. According to Dr. Hurlbut, the method’s chief proponent, what is produced would “lack the essential attributes and capacities of a human embryo”, a biological artifact whose destruction to produce pluripotent stem cells would be ethically justified. Such a strategy is technically feasible but in a piece written for the New England Journal of Medicine, my colleagues and I have rejected this concept as flawed2. In reasoning echoed by the President’s Council, we questioned whether the planned creation of what amounts to a defective embryo would silence ethical objections.
A more recent proposal put forth by Markus Grompe is a variation on Altered Nuclear Transfer called Oocyte Assisted Reprogramming, (OAR). Grompe also suggests altering the input somatic cell so as to preclude formation of a viable human embryo. He proposes using a gene like nanog, which might promote reprogramming of the donor somatic cell directly to something that resembles an embryonic stem cell, which is pluripotent, and avoids generating a cell like a zygote, which is totipotent—that is, able to divide on its own and form a viable human blastocyst. Scientifically, this idea is a reasonable hypothesis that must be tested and might or might not work. But even if this strategy works in mice, there is no guarantee it will work in humans, and verification would then require the creation and destruction of many manipulated human embryos, which might or might not have the altered characteristics that would make this method ethically “acceptable”. If it works, I am concerned that in order to use Federal dollars for research US Scientists will be relegated to less-efficient processes like Altered Nuclear Transfer, while Korean scientists employ superior techniques.
The fourth speculative approach is to derive pluripotent cells via direct de-differentiation of somatic cells to an embryonic stem cell-like state using chemical treatments or cell culture manipulation alone. The President’s Council found merit in this fourth proposal, but also raised the technically thorny issue of how to rule out whether a totipotent and therefore morally significant cell might be created by this procedure. In my view, these last two proposals raise a curious and challenging question: can we distinguish the moral value of a human cell based on its particular gene expression pattern? Can humanity really be diagnosed at the level of a single cell?
From my view, this last approach has scientific merit. We know cellular de-differentiation is possible; indeed, that is precisely what we do when we perform somatic cell nuclear transfer and reprogram a somatic cell back to a zygote. The Federal Government is already funding research into such cellular reprogramming. Indeed, last year I was one of nine recipients of the inaugural Pioneer Award from the Director of the National Institutes of Health to support highly innovative (that is, speculative) research of exactly this type. Although this strategy is worth pursuing, it is extremely high-risk, and may take years to perfect, and may never work as well as nuclear transfer, which we know we can practice today.
Research on each of these proposed strategies is at present untested in human cells, but if judged to be meritorious by the peer review process, should be funded. However, the already proven routes to obtaining embryonic stem cells from excess IVF embryos or through the use of somatic cell nuclear transfer should not be put on hold pending the outcomes of the more speculative methods.
Finally, let me emphasize that research on embryonic stem cells and embryo research in general is not solely about making tissues for transplantation to treat disease. Although the promise of new therapies is perhaps the most compelling reason to support expanded access to embryonic stem cells for research, I stress that it is equally important to pursue research that addresses fundamental questions about the earliest stages of human development. We know that a variety of birth defects can be traced to abnormal cell divisions during the first few days of life, and that infertility and miscarriage can also be traced to defects in the early embryo. We cannot learn everything there is to learn about these human disease conditions from studying animals. We must study the unique aspects of human embryo biology directly, and the Federal government should support this vitally important basic research.
Science certainly cannot define when in the gradual course of human development we deserve individual and autonomous rights. I do not agree with the premise that the single celled zygote should be given the same considerations as living persons and I do not view the embryo as a human being, particularly when it is frozen in a freezer. As a physician and as a scientist and as a father I live in a practical world of choices, and a world in which disease is a grim reality. Unless we want to turn back the clock, and outlaw in vitro fertilization, then we as a society have already accepted that many more embryos are created than will ever become children. I feel it is morally justified to derive benefit from these embryos through medical research instead of relegating them to medical waste. And unless we are willing to argue the biological absurdity that our humanity can be defined by a particular signature of gene expression that exists in the totipotent cells of the early human embryo, then we must support the vitally important applications of embryonic stem cells to medical research.
Chemical Trust: An Oxytocin Oxymoron
In the new issue of AJOB, Darby Penny and I take on the notion that trust can and should be chemically controlled. Here is our rant:Writing in the journal Nature, Michael Kosfeld and colleagues reported that intranasal administration of oxytocin, a human neuropeptide involved in maternal bonding, “causes a substantial increase in trusting behavior, thereby greatly increasing the benefits from social interactions.”1 The double-blind study involved a trust game with real monetary stakes, in which the subjects played the role of either an investor or a trustee. Investors could choose whether and how much money to invest with an anonymous trustee, and the trustees could choose whether to honor or violate the investors’ trust. The investors who had inhaled the oxytocin invested 17% more money than those who received the placebo.
In what is becoming an increasingly tantalizing form of neuroscience, researchers in this study obtained consent not to study the phenomenon about which they were interested, trust, but rather the effect of a hormone more generally. The seemingly subtle shift in language, with its attendant deception, was obviously necessary for the researchers to conduct their study. But did they, and do researchers who would study phenomena of character more generally, have a special responsibility to inform subjects about the risks of “shifts in subject consciousness?” It is more than a question of informed consent that is at hand. For just as there is an obvious irony in manipulating subjects’ inclination to trust in order to study the biochemical basis of that trust, there is a broader safety—and indeed human—concern about whether trust should be scientifically manipulated in clinical studies in this way at all.
In reporting the findings, the Kosfeld et al. wax enthusiastic about the importance of trust in human relations and social institutions and about the potential clinical benefits of chemically enhanced trust, particularly for people with neurological or psychiatric disorders that are “associated with social dysfunctions.”2 While acknowledging a hypothetical risk that their “findings could be misused to induce trusting behaviors that selfish actors subsequently exploit,”3 at least one of the authors seemed sanguine about the possibility in recent media interviews. “I don’t think we currently have such abuses,” Ernst Fehr said. “However, in the future it could happen.”4
The ethical issues raised by this study are legion. First, there is the matter of the consent process involved in the study. The researchers recruited 194 healthy male university students in Zurich and informed them that the experiment would test “the effects of a hormone on decision-making.”5 At best, this is incomplete. Their finding was that the level of trust could be manipulated using oxytocin, a much more broad claim, and one clearly preconceived in the study’s design, than was described to the prospective subjects. At worst, the information could be considered deceptive, and participants might feel that their trust, ironically, was violated.
Trust is a complex human phenomenon, involving social behavior, emotions, and values—the potential medicalization of trust is cause for concern. While the researchers focused primarily on what they viewed as the positive aspects of trust as the glue that holds families, economies and societies together, a high level of trust is not necessarily an unmitigated good. The researchers reported that the drug inhibited defensive behaviors and betrayal aversion; this necessarily leaves affected individuals more vulnerable. Essentially, a person or institution with the capability of artificially manipulating trust levels would be in a position to increase people’s level of gullibility. Artificially manipulated trust levels could compromise people’s ability to make sound judgments and put them in risky situations.
It doesn’t take a cynic to envision some of the predatory or nefarious purposes to which the findings of this study might be put in social and interpersonal interactions. The possibility that this substance could become a new date rape drug is chilling. Governments might use chemical means to enhance citizens’ trust in its policies and actions; one can only imagine how this might be used to sway public opinion or stifle dissent. Political candidates could use it to reap the benefits of unearned trust at the polls. Schools, employers and the military might use the drug to increase control over and enhance the compliance of students, workers, and soldiers. Powerful commercial interests could have a field day with oxytocin: retailers could better manipulate customers, corporations could overcome skepticism about their environmental practices or the value of their stock, and used car salesman would have an advantage that went beyond the “new car smell” aerosols they currently spray in vehicles. The number of ways in which the unscrupulous could use such a substance for harm is probably endless.
But even more troubling risks are inherent in the potential clinical interventions of oxytocin that are foreseen by the research team. The authors speculate that further study may result in “positive clinical implications for patients with mental disorders that are associated with social dysfunction (for example, social phobia or autism).”6 The history of psychiatry is fraught with cautionary tales of major violations of patients’ trust, particularly that of institutionalized patients. During the 20th century, mental patients were subjected, most often without informed consent, to brain-damaging procedures such as insulin coma therapy, electroshock, and lobotomy; to life-long loss of liberty, physical brutality and mechanical restraint; and to powerful psychiatric drugs with dangerous, debilitating, and sometimes lethal side-effects. With the exception of insulin coma and lobotomy, these practices continue in the 21st century, and informed consent procedures involving people with psychiatric disabilities continue to be less than optimal.7 Psychiatric inpatients, as well as other institutionalized people, such as those with developmental and neurological disabilities, are inherently at the mercy of the people who run and staff the wards. Inside an institution, skepticism and guardedness are self-preservation techniques, and trust needs to be earned by clear and convincing evidence. The possibility of chemically manipulating the trust levels of vulnerable institutionalized people, particularly by doctors who believe they are doing so for the patients’ own good, is a disturbing and chilling prospect.
Given the wide range of possibilities for abuse inherent in the use of a hormone that is already available in the United States by prescription in both nasal spray and injectable forms, healthy skepticism and enthusiastic debate would be a wise response to the findings of this study. But one scientist apparently thinks it is too late for that. Writing in the same issue of Nature in which the oxytocin study appeared, Antonio Damasio, a neurologist at the University of Iowa College of Medicine, said that “civic alarm at the prospect of such abuses should have started long before this study, and the authors cannot be blamed for raising it.”8 Perhaps the responsibility for introducing the question of trust in this research, though, really did lie with the researchers.
Clinical Trial for Stem Cells [Update]
A small study that received far less press than was merited last week concerned patients with advanced heart failure, in Ecuador, who were treated with stem cells derived from fetuses.The study showed, 30 days after receiving the stem cells by injection into their hearts, patients improved an average of 41% in their hearts' pumping efficiency and the distance they could walk nonstop increased by 72% in a standard test widely used to assess heart patients. After 90 days, the heart-pumping improvements were sustained and patients further improved the distance they could walk in the standard test by an additional 16% compared to 30 days and doubled compared to baseline.UPDATE: One of our more astute readers (smart enough to stay anonymous) writes:The study is the first to use human fetal-derived stem cell therapy in patients with heart failure.
Unhappy as I am to suggest this to the folks at my favorite blog, I think the piece on the stem cell trial for heart failure might not be quite what it seems. The text below comes from a different Institute for Regenerative Medicine press release. The tip off is that they provide their "stem cell treatment" for the "effects of aging":About the Institute for Regenerative Medicine
Based in Barbados, the Institute for Regenerative Medicine (IRM) offers stem
cell treatment to patients with conditions ranging from diabetes and heart
disease to digestive diseases and nervous system disorders. Opened in September
2004, IRM is one of the first facilities in the world to offer human
fetal-derived stem cell therapy. IRM medical professionals provide individually
tailored treatments based on a patient's medical history and status, and will
coordinate with a patient's physician to integrate treatment.IRM is dedicated to providing stem cell therapy for disease states resulting
from tissue damage and/or the effects of aging. IRM's stem cell therapy is
based on its novel research combined with findings from more than 30 years of
clinical research and experience of the Institute for Problems of Cryobiology
and Cryomedicine, as well as other research documented in the medical
literature. Under the guidance of its scientific consulting board and chief
scientists, IRM is committed to developing new stem cell technologies for the
delivery of stem cell therapy for disease management.Source: http://www.pressreleases.be/script_UK/newsdetail.asp?nDays=m&ID=27064
The press release below, dating to several weeks ago, has the institute awaiting ethical approval in Barbados and adds that the alleged stem cells come from the Ukraine:
Speaking during a breakfast press conference at the recently reopened Barbados Hilton, Suskind noted that the stem cells being used in the local study would come from foetuses sourced in the Ukraine, and that these had undergone rigorous testing before they were approved for use. He added that at least two other countries were being looked at as possible sources of cells.
The procedure involves the injection of stem cells from foetuses between five and 12 weeks old into diseased heart cells, and research has found that the stem cells have the ability to rebuild the damaged tissue. The technology was first explored in the former Soviet Union in the 1970s, but a recent study done in Ecuador, which showed some positive and encouraging results, was the first one done where the cells were injected into a heart that was still beating. It is hoped that this type of surgery will become an alternative to organ transplant surgery.
Source: http://www.barbadosadvocate.com/NewViewNewsleft.cfm?Record=21739
I have no basis to doubt the data from Ecuador, but I'm afraid I do doubt the gents at the institute in Barbados. Thirty year-old technology from the Ukraine makes me nervous, as does the notion of "rigorous testing" of biologics in Russia :) A Twelve week-old foetus is also relatively elderly if you're interested in stem cells, no?
While Professor Kass and his colleagues have been drinking tea and killing trees, various and sundry have set themselves up in business peddling "stem cells" for everything under the sun, but nearly always beginning with "anti-aging". Some of these businesses are plain old health fraud scams that offer cures for incurable diseases side by side with dietary supplements and laetrile. Others specialize in "treating" kids with autism by dosing them with umbilical stem cells.
MEDRA's web site is typical:
http://www.medra.com/index.htmDr Rader is a California psychiatrist, if memory serves. Another Californian is David Steenblock, DO. I leave you to draw your own conclusions from this media piece:
http://abclocal.go.com/wabc/news/wabc_052005_stemcellfamily.htmlIn 2003 FDA Office of Criminal Investigations shut down an osteopath in Atlanta who was conducting a bogus "study" on people with ALS - at $24,000 per injection. He caught FDA's attention when he didn't obtain his unlicensed biologic from a company with a clue about handling such products. Nasty stuff.
Dr Steve Barrett has a good article about these businesses on Quackwatch:
http://www.quackwatch.org/06ResearchProjects/stemcell.htmlPerhaps I'm wrong, and jumped to conclusions ... The proliferation of these cranks is one of the consequences of substituting ideology for science and regulation. Looking at the education, training, and facilities of many practitioners and their so-called clinics and institutes, these folks might be peddling adventitious organisms with their cures.
Any way, just my two cents to take or toss.
Fake Research is On the Rise
Forget a few painted mice. According to a new study, more researchers are lying, more often. An AP story today reveals thatAllegations of misconduct by U.S.- Art Caplanresearchers reached record highs last year as the Department of Health and Human Services received 274 complaints -- 50 percent higher than 2003 and the most since 1989 when the federal government established a program to deal with scientific misconduct.
Chris Pascal, director of the federal Office of Research Integrity, said its 28 staffers and $7 million annual budget haven't kept pace with the allegations. The result: Only 23 cases were closed last year. Of those, eight individuals were found guilty of research misconduct. In the past 15 years, the office has confirmed about 185 cases of scientific misconduct.
The Rich Die Differently From You And Me, Study Shows
The Rich Die Differently, or so says this press release from Michigan, noted by Jay Hughes. Nothing surprising here, but the numbers are significant:Specifically, men and women age 70 or older whose net worth was $70,000 or higher were 30 percent less likely than poorer people to have felt pain often during the year before they died. This difference persisted after the researchers controlled for age, gender, ethnicity, education and diagnosis.Wealthier elders also experienced a lower number of symptoms overall, the study found. Those in the wealthiest half of the elderly population not only had less pain, but were less likely to suffer from shortness of breath and depression.
Really, Really Smart Monkeys
Sunday Mail writes:EXPERIMENTS where human brain cells are injected into monkey foetuses could lead to a moral nightmare, scientists will be warned this week.Have seen nothing of either this group and its deliberations or of Evan's coming Science publication. But buckle up for this one.A high-powered American committee is to call for restrictions on the research, amid fears that it could produce monkeys with brains that are more human than animal.
The group of neuro-scientists, bio-ethicists, animal behaviouralists, lawyers and philosophers was set up four years ago to investigate the growing science of human-primate 'chimeras' - named after Greek literature's myt hical monsters, a combination of lion, goat and snake.
Now the team, based at John Hopkins University in Maryland, is publishing its conclusions in leading journal Science.
Brazil Threatens to Break Patent on Drug
blackenterprise.com reports thatAIDS activists and humanitarian groups are praising Brazil for taking the first step by any country to break an AIDS drug patent and produce copycat versions, a decision they hope leads to massive exports to other poor countries devastated by the disease.But property-rights advocates and the pharmaceutical industry are equating the nation's high-stakes move against U.S.-based Abbott Laboratories Inc. as government-sanctioned piracy of intellectual property driven by greed.
Brazil has repeatedly forced AIDS drugs manufacturers to reduce prices by issuing threats to break patents during the past several years, but it made an unprecedented legal decision last week after it didn't get as much of a price cut as it wanted from Abbott on its Kaletra pill.
Latin America's largest country declared the outcome a public health crisis for its world-renowned free treatment program, and it will use a World Trade Organization process to break the patent and clone Kaletra - unless Abbott gives a steep discount by July 6 or lets Brazil make generic versions of the drug.
Woman, Dead, Continues in Pregnancy
Washington Post notes in this piece from last week the continuing pregnancy we previously described of Susan Torres, who had indicated that her body should be maintained after her death - which occurred 55 days ago - so that her fetus might be born as the child of her and her husband, Jason, a 26 year old in Arlington Virginia.Pharma Owns Bioethics [and Other Fables]
Writes Carl Elliot in this coming week's Lancet:North American bioethics has a growing credibility problem. As the influence of bioethics has grown, so has the willingness of bioethicists to seek out funding from the pharmaceutical and biotechnology industries. These industries have begun to fund bioethics centres, lectureships, consultants, advisory panels, conferences, and private regulatory boards.1, 2 and 3 The results of this industry-funded work are now making their way into peer-reviewed academic journals. Readers of the medical and bioethics literature have recently seen articles on the ethics of recruiting homeless individuals for research, funded by Eli Lilly;4 on the ethics of biotechnology and the developing world, funded by Glaxo, Merck, and Pfizer;5 on the ethics of stem-cell research, funded by Geron;6 and the ethics of placebo-controlled trials for mood-altering drugs, funded by antidepressant manufacturers.7 They have also seen pharma-funded university bioethicists collaborating on ethics articles with biotech entrepreneurs8 and a medical ethics and humanities journal issue funded by a pharmaceutical lobbying organisation.9 The authors of these articles have disclosed their industry ties, but readers are left to wonder: is an industry-funded bioethicist a bioethicist that we can trust?
Even discussions of conflict of interest have become tainted by questions of conflict of interest—or at least the perception of a potential conflict. The American Journal of Bioethics recently published an article on the ethics of taking gifts from the pharmaceutical industry which was itself funded by Pfizer, while the American Medical Association's Council on Ethics and Judicial Affairs launched an educational project on industry gifts that was funded by a US$675 000 gift from the pharmaceutical industry.10 and 11 When the US National Institute of Health (NIH) commissioned a so-called blue-ribbon panel to investigate their conflict-of-interest scandal, in which researchers were found to have undisclosed financial ties to private industry, the blue-ribbon panel included an insurance executive, the vice-president of a for-profit health-care company, the chief executive officer of a leading weapons manufacturer, and the director of the Ethics Resource Center, Washington DC, an ethics institute funded by Merck.12 One can see the reasoning behind appointing these panellists, but they are hardly likely to inspire trust in observers worried that the NIH has become too close to private industry.
I'm sure Pfizer is just thrilled with the "ethics of taking gifts" publication in AJOB that Elliot lambasts (here and elsewhere). What pharmaceutical company doesn't want to be identified as funding a study that finds that pharma's most frequent marketing practice, one in which it itself engages, is pervasive and unethical, and then to see that publication in a major journal and splashed all over most U.S. newspapers?
It is becoming clear that Dr. Elliot is trying to cause rather than report on a scandal about industry funding of bioethics. There is a scandal to report on - bioethics is being compromised - but the powerful who are taking over bioethics are not in the world of industry but in politics. There is a well developed neoconservative bioethics "movement" now, a virtually unadulterated tool of the Bush administration that has most recently busied itself with apologetics for the Bush administration position on stem cell research.
Meanwhile, there is no evidence whatsoever that bioethics is becoming a "thought leader" tool for industry. Elliot's lists of who is taking what money are just horrendous - they lack any context and show a genuine disregard for the truth of the matter. I for one have tired of reading one accusation after another about the way in which my colleagues are bought by industry, while Elliot utterly ignores the way in which pharma funds virtually every institution in which bioethics is practiced - and more important ignores the bigger threat to "buying bioethics" that comes almost exclusively from the right wing. I for one am very proud of the work I and others in bioethics have done in the context of funding by industry, and I am convinced that much of it was possible - and that it was possible for my colleagues and I to challenge industry so pointedly - exactly because we had that funding. It is insulting to me that Elliot simply reviews sources of funding without reviewing the papers attached to that funding. And the notion that in taking funding from industry I or my colleagues became tools of industry is mean spirited inuendo and nothing more, no matter how it is spun in the clever rhetoric of this editorial or other nearly identical versions of it in other publications.
Elliot makes innumerable claims that strain credibility about the erosion of bioethics' integrity among the general public, and the biggest problem with them is the assertion that there is a growing wariness about industry bioethics. However, to the extent that it is true that there is wariness about bioethics and industry, that wariness is almost certainly a product of Elliot's own well-placed articles in which he alleges it to be true. For example, in speeches Elliot has taken to describing a speech at Minnesota by Alan Milstein, the attorney who has built a major practice in litigating against institutions (including Penn) that have been alleged to be involved in research misconduct. Milstein, Elliot says, mentioned in his talk that he was proud of having sued bioethicists (by which he meant that he named one bioethicist, Arthur Caplan, in the lawsuit against Penn involving the gene therapy case of Jessie Gelsinger). The big punchline in Carl's talk about how bioethics is actually beginning to show signs of losing credibility is that, amazingly, the crowd broke out into applause at that suggestion. With embarrassment, Elliot says it: people are beginning to clap when they hear that we bioethicists are being sued, because we're all bought out, tools of industry.
The only problem with this story is that, like the general argument that bioethics is being bought out by industry, it is not exactly as reported. Take a listen. Shortly after 1:13, you'll find the punchline by Milstein, then laughter and one person heartily clapping as he laughs. Maybe the rousing ovation is in the Spanish version of the soundtrack?
The point is that while the cautionary tale Elliot spins in the Lancet, enough to inspire an early online publication of this article, and tons of media interest, is interesting and grounded in an important concern about academic integrity, it isn't as simple as Elliot makes it out to be. Elliot, whose hard money position at Minnesota is funded in large part (as are most bioethics positions in major medical centers) by dollars from pharmaceutical companies directly to those medical schools, is searching for a monastic cleanliness of funding that simply doesn't exist. Many of the most revered institutions of bioethics, such as the Hastings Center, receive significant contributions from industry as a matter of simple live-or-die economics.
There are big issues here that deserve to be treated with much more subtlety and far less conspiracy theory. The notion that bioethics is losing its credibility has become a self-fulfilling crusade for Elliot, who seems to be waging an almost single handed campaign to convince a broad audience that bioethics is less than credible, rather than (as he claims) reporting on the evolving demise of the field.
The reporters are calling. They keep asking the same question: is industry funding changing the claims or orientation or bearing or credibility of bioethics. I try again and again to think of a single point at which that might even seem to have happened. But, nope, none appear. Except for that one, glaring set of examples: huge funding from the religious right to keep a PVS patient in Florida alive at all costs - bioethics paid for by the right wing of the Republican Party. But hey, that Schiavo thing had no real impact - let's focus on a dozen small grants to two or three bioethics centers from which it is difficult to identify any papers that would fit the category "bought."
I'm sympathetic to the quest - my own resignation as chair of the ethics advisory board of Advanced Cell Technology started this mess in the media in the first place. But those of us who are worried about the dangers of corporate influence on ethics need to direct our attention at best practices rather than identifying villains. And the scandal/scare tactics in this and other iterations of the Elliot mantra are shameful. It is time for those who claim to want a better bioethics to abandon their McCarthyism.
New Supreme Court Judge Gets to Really Go At Bioethics
Washington Post reports on the new justice's power on assisted suicide:In October, physician-assisted suicide will be before the court in Gonzales v. Oregon, No. 04-623. The administration has appealed a lower court's order barring the Justice Department from taking away the prescribing rights of Oregon doctors who prescribe lethal doses of drugs to terminally ill patients who have chosen to die under that state's 11-year-old Death With Dignity Act.
Assisted suicide is an intensely emotiona l issue, both for advocates of a "right to die," who see it as many people's only means of a dignified death, and for conservative Christians, who see it as a form of murder.
Opposition to laws such as Oregon's was a favorite cause of former attorney general John D. Ashcroft, who issued a November 2001 directive determining that assisting suicide is not a "legitimate medical purpose" under federal drug-control law -- and that the Drug Enforcement Administration could act against any physician who authorized drugs to help someone die.
The directive overturned a 1998 decision by President Bill Clinton's attorney general, Janet Reno, that permitted Oregon doctors to assist in suicides.
Strictly speaking, the case does not involve any assertion of a constitutionally protected right to die. The court unanimously refused to recognize such a right in 1997, ruling that it should be left to the states to determine wh ether legalized assisted suicide is wise policy.
Rather, the case is framed by the parties as a clash between federal power to regulate drugs and states' power to regulate the practice of medicine.
But the practical effect of the Ashcroft directive is to make Oregon's law a dead letter -- and O'Connor might have been sympathetic to Oregon. She vigorously dissented from the court's 6 to 3 ruling last month in which it upheld a federal override of California's medical marijuana law. In the 1997 case, Washington v. Glucksberg, the court was ruling on state bans on assisted suicide. O'Connor was one of five justices who wrote or signed concurring opinions implying that they might not strike down a state law such as the Oregon one that permits assisted suicide.
"Death will be different for each of us," she wrote. "For many the last days will be spent in physic al pain . . . some will seek medication to alleviate that pain and other symptoms."
Alta Charo on Using Pre-Implantation Diagnosis to Derive Stem Cells without "Harming" Embryos
Roll Call today describes yet another wrinkle in the "alternative methods to derive stem cells" discussion, a method that is certainly creative. It employs the Leon Kass "make the problem 'go away'" logic, that is, if no embryo can easily be said to have been killed, the method is fine. In this case those arguing for the moral logic of the method is confused, though, because the embryos that are made for this purpose would have to be made in the lab - which is against Catholic doctrine by definition - and would be exposed to the special hazards of PGD. But I get ahead of myself. This is the plan:The basis of the still-to-be drafted Senate bill would allow for federal funds to be used for embryonic stem-cell research, but would require that the embryo not be harmed during the process.Several Republicans said Congress should be promoting a technique currently used during genetic testing and in vitro fertilization that allows for a stem cell to be taken from the embryo without destroying it.
“We are trying to see if we can find some ground that allows for research to continue,” said Senate Republican Conference Chairman Rick Santorum (Pa.). “Even though I question the potential of that research, nevertheless it is an area that the scientific community wants to do research and we want to make sure it is done in an ethical way.”
Santorum said the discussions include Senate Majority Leader Bill Frist (R-Tenn.) and Health, Education, Labor and Pensions Chairman Mike Enzi (R-Wyo.) as well as rank-and-file Members.
Enzi’s panel approved a different stem-cell measure last week that promotes the use of stem cells extracted from cord blood and bone marrow. A similar bill has already passed the House, but many people do not believe these cells hold as much healing potential as embryonic stem cells.
Sen. Johnny Isakson (R-Ga.), who is involved in the talks about the safe extraction of stem cells from embryos, said he thinks that this compromise bill would appease people on both sides of the debate.
“My position is, if there is a way to develop a stem cell without destroying an embryo, then that is where [the National Institutes of Health] should be making their investment, because the ethical and moral questions to me go away,” Isakson said.
Of this method, Professor Alta Charo of Wisconsin (easily the smartest stem cell bioethics scholar to emerge so far in the debate) writes:
first, note that the piece erroneously talks about removing an hES cell without harming the embryo; it should be talking about removing a single cell, leaving the primary embryo for its fate (presumably reproduction) and using the dissected cell to begin new growth to the blastocyst stage for subsequent removal of the inner cell mass and derivation of hES cells. In other words, it's about making an identical twin embryo and killing the twin! Anyone want to start taking bets on the following options?(a) this splits the anti-research crowd, with some arguing that it is fine because the primary embryo goes on unaffected and others arguing that the twin is now an independent life with all the moral (and, in a post-sandra-day-o'connor-world, perhaps legal) rights attendant thereto
(b) the tolerance of some for this option points up the degree to which opposition to embryo research and even to abortion is not necessarily based on an argument like the one made by robert george, i.e. that all diploid human cells with an intrinsic potential for development to term are human beings deserving of equal moral and legal protection. instead, those who tolerate this option reveal that it is the way research and abortion divert embryos and fetuses from their pre-ordained fate, i.e. a fate to become children. understanding this difference in reasoning allows one to re-examine the abortion debate.
(c) PGD, which has been somewhat under the radar screen for the right-to-lifers (who have not really focused on the fact that the cells removed for biopsy are now independent human beings) may come in for some unwanted attention
(d) if this option really builds up steam in congress, the bush bioethics council will begin backpedaling from its concerns, expressed in its white paper, that the technique poses too much risk to the primary embryo
(e) if this option really builds up steam in the senate, hES funding is dead in this congress because the house won't want to back down from funding the more efficient and sensible and less convoluted approach of using doomed, surplus embryos.
(f) all of the above?
Miles on Medical Culpability in Afghan and Iraqi Prison Homicides
Steve Miles has just published Medical Investigations of Homicides of Prisoners of War in the Medscape General Medicine online journal. It is quite a read - an inventory of cases in which it now appears clear that physicians and other health professionals used their clinical tools as weapons - or at a minimum neglected to intervene to save those who were at risk from their interrogation.Fourth of July Weekend Reader Quiz
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