October 2005
From theCan We Have Harriet Miers Back?
Village Voice reminds us that there is - potentially - an extraordinarily clear motivation - brilliant even - behind making the announcement today that Samuel Alito is the nominee for Associate Justice of the U.S. Supreme Court: It allows the President to
divert attention (as he does so masterfully) from the gathering storm concerning Libby's alleged leaks to the media. What do we know from Iraq though - not our area here on bioethics blog except when it comes to the abuses at Guantanamo Bay and Abu G. The critical issue that has us terrified is the hard right turn from Harriet to Samuel.Alito has written some interesting rulings that are, um, important in the evolution of the new conservative approach to abortion - to grant states the right to whittle away at abortion rights. Most notably he joined the majority in the Casey decision that imposed numerous restrictions on women in Pennsylvania including mandatory notifications of alternatives to abortion and a 24 hour mandatory waiting period prior to abortion. Parental notification was also made mandatory in Pennsylvania under their ruling.
Washington Post writes of a particularly frightening writing from Alito in the matter of Planned Parenthood v. Casey:
"In addition," he wrote, "the legislature could have reasonably concluded that Section 3209 [the spousal provision] would lead to such discussion and thereby properly further a husband's interests in the fetus in a sufficient percentage of the affected cases to justify enactment of this measure. . . . The Pennsylvania legislature presumably decided that the law on balance would be beneficial. We have no authority to overrule that legislative judgment even if we deem it "unwise" or worse. "O'Connor, writing for the court in the matter when it reached SCOTUS, was the Justice most involved in rejecting Alito's view on that matter. The notion that Alito would be replacing O'Connor is in that respect particularly instructive.
The great fear here is that Democrats will have a very hard time 1) pushing back against a concerted effort by the conservative Republicans on this matter, and 2) fighting a battle on this matter and their desire to see a Congressional investigation in re: Karl Rove et al. We've been Borked.
Negative Eugenics? More Genetic Tests for Cystic Fibrosis, Fewer CF Births
Toronto Globe and Mail reports that in Canada:one in 3,608 babies is born with CF, down from one in 2,714 before a genetic test existed [in 1989]. "Our hypothesis is that pregnancies are being terminated," Dr. Mary Corey, a senior scientist at the Hospital for Sick Children in Toronto, said in an interview.- Art Caplan
While the 25-per-cent drop is impressive, the incidence rate has stabilized in recent years. That is because the genetic test is only offered to families with an established history of CF. For the rate to fall further, a screening program would have to be implemented in the general population, Dr. Corey said.
Sugar 'Pops' Indeed!
From "gizmag":he Danish company Aresa Biodetection has been engaged for several years in development and testing of genetically modified (GM) Arabidopsis plants that detect explosives present in the soil from landmines and unexploded ordance (UXO). The GM plants turn from red to green in the presence of explosives, within three to five weeks of growth. Geir Bj'rsvik, senior advisor on landmines at Norwegian People Aid, a humanitarian aid group, says of the discovery: "This is a promising development in the efforts to find a safe and cost effective solution to detect mines, and is likely to be a very welcome addition to current methods if successfully passing further testing in areas of operation." The article reports that Aresa has developed the GM plan ts to the stage where they are becoming commercially viable. It notes that the plants' growth can be strictly controlled because they are self pollinating and "conditionally fertile such that they are male sterile." According to the article, more than a million people have been killed or maimed by landmines since 1975; more than 100 million landmines are buried and active in the world today. The article can be viewed online at the link below.[biotech.org] - Art Caplan
Canadians: When the Bird Flu Comes, Be Nice to Your Doctor (or Die)
The Globe and Mail in Toronto points out that with a death toll that could run as high as 150 million should the avian flu mutate, Canadians are at risk. But this article isn't about the risk from the disease, it is about the risk from the
Canadian healthcare system, stretched to the breaking point and peopled by those who are themselves barely able to practice now:Health ministers across the country seem to assume that most of the aging, demoralized, burned-out nurses and doctors will, for ethical reasons alone, place their lives in jeopardy by continuing to treat patients during such a pandemic. Politicians overlook the fact that most of these health professionals lack adequate disability or life insurance and may fear infecting family members...
In the early 1990s, medical school enrolment was curtailed, with the result that, by 2000, we had 30 per cent fewer MDs per capita than did many European countries. Canada now ranks 16 out of 23 major countries in terms of physicians per capita. Compounding the problem is the fact that, in 2004, 27 per cent of MDs were between 50 and 59, and 17 per cent were over 60. The average age of a GP in Ontario is now 51. According to Canadian Medical Association president Ruth Collins-Nakai, 3,800 doctors are expected to retire within the next two years ... Many of these doctors, like their patients, may have developed chronic disorders such as diabetes, heart disease or malignancies -- all of which make it difficult or impossible to purchase adequate disability or life insurance. Even if they are healthy, they must wait 30 to 90 days before qualifying for benefits, and many additional weeks before actually receiving payment.
... and Beware the Canadian Internet Drugs
New York Daily News reveals a hillarious tale: the key pharmaceutical industry association (PhRMA) paid $100,000 to ensure the production of a ghostwritten novel about "a Croatian terrorist cell that uses Canadian Web sites to murder millions of unwitting Americans looking for cut-rate pharmaceuticals."[thanks Josh Braun]
Guantanamo Inmate Allegedly Intubated as Torture
According to a story on the Knight Ridder wire today,In his on-again, off-again hunger strike at Guantanamo Bay, Cuba, Saudi captive Yousef al-Shehri says U.S. troops forced feeding tubes up his nose and into his stomach to keep him from starving himself.But, his lawyer asserts, indignities suffered by her 21-year-old client did not end there.
Shehri told attorney Julia Tarver this month that U.S. forces - not doctors or nurses - have brutally inserted and removed feeding tubes, and on one occasion yanked a bloody tube out of one prisoner and put it up the nose and into the stomach of another, in the U.S. military effort to keep captives from starving themselves.
The Bush administration flatly denies the assertions and says the 505 or so suspected terrorists housed at Guantanamo get top-notch medical care.
Treated for Illness, then Turned Into a Cockroach
Perhaps someone at some point used a better metaphor for the patient experience of medical billing than that of a Kafka novel, but I've never read it. That is the image in this piece in the Times. What strikes me most about this excellent exposition of how it feels to be billed for medical services is the way that the leading medical information people in the nation feel about the matter:''I'm the president's senior adviser on health information technology, and when I get an E.O.B. for my 4-year-old's care, I can't figure out what happened, or what I'm supposed to do,'' said Dr. David Brailer, National Coordinator for Health Information Technology, whose office is in the Department of Health and Human Services. ''I can't figure out what care it was related to or who did what.''
Dr. Blackford Middleton, a professor at Harvard Medical School with special training in health services research, said he did not fare much better than Dr. Brailer.
''I understand the words of diagnoses and procedures,'' he said. ''But codes? No. Or how things are paid or not paid? I don't understand that.''
Dr. Brailer said he often used an analogy to describe the current state of medical billing. ''Suppose you walk into a restaurant,'' he said, ''and you don't get a menu, you don't get any choice of what food you'll eat, they don't tell you what it is when they're serving it to you, they don't tell you what it's going to cost.''
''Then, weeks or months later, you get a bill that tells you all the food you ate and the drinks you had, some of which you remember and some you don't, and although you get the bill, you still can't figure out what you really owe,'' Dr. Brailer said.
Theater of the Dead Bodies
Chicago Tribune reviews a very strange-sounding new bit of theater, performed in a surgical classroom at the Neuropsychiatric Institute of the University of Illinois at Chicago:This is a grim part of town on a weekend evening. Unless a few cadavers are looking to escape a future in research, Local Infinities Visual Theater is not going to attract walk-up business.Has anybody seen this? It sounds amazing, worth a ticket to Chicago even.This site-specific show sounds like a ghoulish Halloween prank. In actuality, it's one of the most intellectually absorbing theater pieces of the year. For anyone with an interest in medical ethics, or the history of science, or the way art and science fused uneasily together during the Renaissance, this Gelatin-fueled affair is not to be missed.Granted, you might take some persuading.In essence, this multimedia show wants you to ponder what it means and what it has historically meant to dissect a human corpse. There is, of course, the obvious issue of medical necessity. But that does not occur in a vacuum. The act of dissection comes with many fascinating questions. Is the dissectionist a scientist? Or an artist? Or an exhibitionist? Or all three at once?
This show is set during the Renaissance, when dissections frequently were done in public. But before you argue that's no longer the case and those issues thus moot, ponder the recent phenomenal success of the "Body Worlds" exhibit at the Museum of Science and Industry. There's still big, big money to be made from the exhibition of dead human bodies. And it's always fraught with ethical questions.
There's the issue of who gets dissected — it has often been criminals, or the otherwise dispossessed. In the case of the young Renaissance body of Suster Luyt, the first woman to get publicly pulled to bits in Amsterdam, there's no question that voyeurism and sexual fascination also played a part. Some people signed up to see the Luyt dissection because there was no other public forum to stare at a naked woman's body.
A Kinder, Gentler Quarantine.
With epidemiologists and virologists counting the months until a pandemic of avian flu strikes, it has become all-too-obvious that one of the most effective measures will be isolating infected and likely-to-be-infected populations. But 'quarantine' scares people to death, unless (perhaps) it can be rebranded - as 'community shielding'.People could stay in their homes. It might not have to be compulsory and, in contrast with the cruel, centuries-old tradition, the individuals under quarantine would be well cared for.Formal quarantine was pioneered by the city-state of Venice in the mid-14th century, according to Cetron, when the Black Death stalked Europe. The city fathers decreed that international ships would have to wait offshore for 40 days ("quarantina" in Latin) before unloading passengers and cargo.
"People either died of the contagion or survived and it was felt that the threat was over," said [Martin] Cetron, who called the practice "the sacrifice of the few for the benefit of the many."
In a flu pandemic, the effectiveness of quarantine - used to separate and restrict the movement of people or groups thought to have been exposed to a disease-causing agent - and of isolation - used for people who are already sick - will depend on the timing, said Cetron, who is director of the division of Global Migration and Quarantine of the CDC's National Center for Infectious Disease.
If a pandemic advances slowly, quarantine and isolation could buy some time to employ other measures - vaccination and the use of antiviral drugs, for example. The key is to detect the pandemic flu strain as quickly as possible.
Though a quarantine might seem like a tough sell, the world's experience with SARS suggests that citizens will come on board if they see it as in the interest of their families and communities. In Singapore, where both quarantined individuals and health care workers were stigmatized, according to Cetron, government leaders transformed the public image of the shunned groups by declaring that they were like soldiers fighting for Singapore.
Cetron said state and local health officials across the country would be in charge of community quarantine, and that state laws incorporate due process to ensure a balance between personal freedom and societal needs. The federal government is empowered to act in cases of state-to-state movement and to monitor and intercept, if necessary, those who arrive from abroad.
Quarantine-at-home is a daunting and costly undertaking, according to Dr. Ross Upshur, associate professor in the departments of Family and Community Medicine and Public Health Sciences at the University of Toronto and a member of the university's Joint Centre for Bioethics. He said more than 45,000 people in and around Toronto during the SARS outbreak were asked to remain in home quarantine for 10 days.
"That's a lot of people to contact twice a day and make sure that they're taking their temperature," he said. "That's a lot of people whose banking needs need to be serviced; who need to get food." He said that if people are going to be asked to give up their personal liberties for the good of society, the community needs to step in and help.
Dan Rutz, a special assistant for communications at the CDC's National Center for Infectious Disease, said that 85 percent of those polled for the CDC said they were "willing" or "very willing" to care for themselves or sick family members at home in the event of a serious flu outbreak.
More than half - 62 percent - said they and their families would be ready to limit contact with others for a month or more. About half said they'd be willing to wait months for a vaccine so that doctors, nurses and other high-priority individuals could get vaccinated first.
First FDA-Approved Fetal Cell Transplantation into Brains
FDA has approved a Stem Cells Incorporated-sponsored trial at Stanford that would transplant fetal cells into the brains of children who suffer from Batten diseaase. Stanford's IRB has yet to approve the experiment.Three Women and a Baby
How three sisters made one baby will be the subject of a BBC program, in the nation that cannot get enough television about reproductive innovation. Three sisters have a baby in the face of cancer:Nothing can beat a mother's love, so baby Charlie Patrick is trebly lucky as he has not one but three mothers - and they are all sisters.When Alex Patrick found out she could not have children, her twin and her older sister stepped in to help her have the baby she always wanted.
The 32-year-old was devastated to learn she had been made infertile by cervical cancer treatment.
When she broke the news to her twin sister Charlotte, she jokingly replied: "No problem - you can have one of my eggs."
But the throwaway comment became a mission as the family hatched a plan which eventually led to older sister, 35-year-old Helen Ritchie, carrying the baby.
Avian Flu is Lethal and Spreading. Recipe on Page 24.
The first Caplan & McGee column for the Times Union and Hearst Newspapers, on publishing the genetic code for a lethal virus, is out today.Avian fluis much in the news these days. And it should be. This is one nasty little critter. Why then would a recipe for how to make a nasty version of it appear in a leading scientific journal where anyone, including some of our worst enemies, can find it?
How bad is the current version of avian flu now racing toward us from Asia and Europe? Compare the impact of the avian flu on your lungs to the regular old strain of flu that appears around this time of year -- it takes your breath away.
Literally.
Avian flu releases 50 times as many infectious particles in the human lung as does an ordinary flu virus. If you wait four days, there are 35,000 times as many virus bits in a mouse lung infected with avian flu than are present in good old normal but nasty flu. In mice, 100 percent are dead a week after infection compared with a few deaths from other flu viruses.
When influenza first struck globally in 1918, it killed as many as 50 million people worldwide. Pandemic avian flu will probably kill just as many people, if not more.
Even worse, the existing flu vaccine does not protect against avian flu. Prescription medicines like Tamiflu may not do much if you do get infected, and a naturally occurring strain of avian flu resistant to Tamiflu has already been discovered. About the best you can hope for is not to get infected, which may not be an easy thing to do at a time when modern air travel means someone can be infected in Romania, Thailand or Indonesia on a Monday and be standing next you on a street corner by Tuesday.
Given this grim picture, you might imagine that the last thing scientists would try to do is to create this, or a similarly lethal bug in the lab. You would be wrong. A team of scientists recently announced in Science magazine they had re-created an artificial version of the original pandemic flu virus.
[Read the rest...]
Your Erection Has Been Called Off on Account of Rain
AP reports that as of today Congress has sent to the President legislation that ends Medicare and Medicaid funding for users of Viagra and other drugs for erectile disfunction.20% of the Genome is Now Under Patent
In Science today, Kyle Jensen and Fiona Murray at Massachusetts Institute of Technology calculated the proportion of human genes that had been patented by comparing the genetic sequences claimed in US patents to genes listed in the National Centre for Biotechnology Information gene database. They found that nearly 20% of the human genome, or 4,382 of the known 23, 688 human genes, have been patented, with over half owned by private companies. Around 63% of the patents are assigned to private firms, with one firm, Incyte Pharmaceuticals/Incyte Genomics, having intellectual property rights covering 2,000 human genes.The Seoul of Clones
An intrepid piece in Slate this
Wednesday tries to nail down why the Koreans are suddenly the world leaders in the stem cell race, at least in some respects, given their somewhat meager resources. You can listen to it as a podcast, but here are the high points:The Chopstick Theory of Scientific Supremacy goes like this: Koreans eat with narrow, metal chopsticks. Nabbing grains of rice with slippery, steel sticks requires a surgeon's dexterity. That's why Koreans have mastered extraordinarily precise "micromanipulation" of eggs and embryos required for stem-cell and cloning research. Westerners with their clunky forks—and even other Asians with their thick, grippy wooden chopsticks—can't hope to compete with the dexterous Koreans.
The Chopstick Theory is how Hwang Woo-suk, the world's greatest cloner, accounts for his nation's stem-cell success. The theory has undeniable appeal: It's exotic, it's funny, and it's even partly true. But it only begins to explain a peculiar anomaly of global science: how South Korea, a nation of only 48 million people and no history of biotech accomplishment, has emerged as the world capital of stem-cell and cloning research...
For starters, the country is not preoccupied with moral questions about the beginning of life. Unlike its Asian neighbors, Korea has a huge and powerful Christian community, with strong ties to the evangelical American churches that have bollixed up stem-cell research in the United States. Evangelical Protestants make up a quarter of the South Korean population, and Catholics are another 6 percent. Yet this has not translated into a moral movement against stem-cell research. Korean Protestantism is relatively new, only a century old. Prof. James Grayson, an expert in Korean religion at Sheffield University, says that Korean Christians—who have spent that century under occupation, at war, and then rebuilding a destroyed and colonized nation—have been busy with more practical moral questions of human rights, justice, and economic development. Whether life begins at conception, at implantation, at quickening, at birth—these abstract theological questions are distant from the daily demands of Christianity in Korea. (Non-Christian Koreans are not interested in these issues either.) The result is an entirely different approach to life issues. For example, despite a nearly absolute ban on abortion, Korea has one of the highest abortion rates in the developed world because the government looks away and no one protests. Similarly, the moral wrestling that has crippled American stem-cell research is absent. This liberates Korean scientists from exhausting debate and frees their research from condemnation. As Jose Cibelli, a Michigan State professor who collaborates with Hwang, puts it: "It really helps that every time [Korean scientists] give a talk, they don't have to have an argument about whether an embryo is a person..."Similarly, Koreans are extremely open to medical self-improvement: Korean cosmetic-surgery rates are among the highest—by some accounts the highest—in the world.
Korean fascination with bloodlines nurtures local stem-cell research in another way. Korean couples face enormous pressure to have their own genetic children, which has fueled one of the most vigorous assisted-reproduction industries in the world. According to Shin Young Moon, obstetrics professor at Seoul National and director of the Stem Cell Research Center, Korea has 95 IVF centers, and 4,000 IVF births occur every year. Korea's success rates for traditional IVF are as good as ours, says Shin, and its success rates for more specialized forms of assisted reproduction are even better. The IVF clinics have trained a generation of technicians with incredible lab skills. This outstanding technical ability—perhaps enhanced by steel chopsticks—explains why Korean stem-cell researchers can perform micromanipulations (such as gently squeezing DNA out of a single egg) that scientists in other countries struggle to master.
Korean scientists aren't just more technically skilled, they are also more diligent. Korean scientists work much harder than Americans. At Hwang's lab, everyone works every day of the week and holidays. This is not hyperbole. Hwang never takes a vacation, and neither do his underlings. In some branches of science—such as pure math or theoretical physics—this mania for work wouldn't matter much, but in stem-cell research, it's incredibly valuable. This research is repetitive, tedious, and factorylike. It rewards the persistent. Hwang's lab cloned and transferred more than 1,000 embryos into 123 dogs to make a single cloned puppy. "That tells you how single-minded they are. If it was me, I would have given up at the 10th transfer," says Hwang collaborator Cibelli....
Korea reveres scientists more than we do. Science is trendy in Korea. It attracts the nation's best students. There's no nerd derision. Hwang Woo-suk is a celebrity in a way we can't imagine an American scientist could be. The national law-enforcement agency assigns officers to protect him. Korean Airlines flies him around the world for free. The minister of science and technology ranks at the top of the South Korean Cabinet—as high as the secretary of state or treasury in the United States. While most foreign scientists who study in the United States end up staying there, nearly 90 percent of Korean scientists end up returning home, despite much lower salaries.
The reverence for science helps cloning research, in particular, because cloning requires a huge supply of fresh human eggs. For one recent paper, Hwang and his colleagues used nearly 200 eggs collected from Korean women. To gather such a supply of eggs in the United States would be practically impossible, legally dubious, and financially ruinous. But Hwang has a waiting list of Korean women who have volunteered to donate eggs for free, to help his cause...
Still, the most important reason why Korea leads the cloning race has nothing to do with the nation. The majority of Korea's stem-cell and cloning advances have been made by a single man, the profoundly brilliant, enthusiastic, and energetic Hwang. Korea's government, religion, culture, reverence for science, nationalism, and skinny chopsticks may make it possible for the nation to be a world leader in this research. But it is an individual genius who is turning his nation's potential into actual stem cells.
MercuryNews.com | 10/19/2005 | Don't let critics stifle stem-cell studies
Art Caplan and David Magnus write in the Mercury News today on the stupid "alternatives to embryonic stem cell research" articles in Nature:It is often said that science is racing ahead of ethics. Whether that is true or not, it makes no sense to distort science to meet a perceived ethical problem. That is what has just happened with the publication of two articles appeared in the prestigious journal Nature, touting ``alternative'' approaches to embryonic stem-cell research.The articles suggest that it is important to find ``alternatives'' to the existing methods for creating embryonic stem-cell research. But neither paper explains why existing methods -- using leftover embryos from infertility clinics or cloning them -- are immoral. Instead, the scientists involved in the new papers suggest that there may be ways to disable an embryo or to remove a cell from an embryo at a very early stage of development and create embryonic stem cells that way.
The driving force behind these papers is not science. It is, rather, to use some rather unimpressive technical tricks to meet the objections of some critics of embryonic stem-cell research. In a word, it is scientific pandering. And it is wrong.
Of course it makes sense to experiment and figure out the best ways to make embryonic stem cells. But few in the scientific community think that either of the techniques proposed will do that.
Does it make sense to fiddle with embryos to satisfy critics? Hardly. People are kidding themselves if they think opponents of embryonic stem-cell research will not find major moral problems with any technique that involves embryo disabling or embryo manipulation using in-vitro fertilization where some embryos are inevitably destroyed.
Moreover, holding up important research to pursue possible alternatives because there are critics of the morality of existing techniques is a terrible idea. The attention showered upon these articles in the media and by some politicians who oppose embryonic stem-cell research is a very dangerous development for anyone who is interested in doing embryonic stem-cell research or benefiting from it.
Regardless of what stem-cell opponents claim, a reasonable person might think that making it extremely unlikely that an entity has the capacity to develop is sufficient for research to morally proceed. However, it should be pointed out that cloning using somatic cell nuclear transfer of the sort already done in South Korea already meets that standard. There is no evidence yet that primate cloning is possible and all available knowledge suggests that embryos produced by cloning cannot reliably develop into fully functioning human beings. In other words, we have had the technology and techniques we need already. These so-called breakthroughs add nothing of much use, from either a scientific or an ethical point of view.
Must science proceed only if everyone in the nation agrees that the research is worth doing? If so, no science will ever be conducted. We would never do research in evolutionary biology since there are creationists who oppose it. We could not do research on cancer, mental illnesses or animals, since each of these has its critics. The idea that scientists should abandon embryonic stem-cell research while looking for alternatives is bad public policy.
The vast majority of the public believes that embryonic stem-cell research should be conducted, that embryos outside the body that will not develop on their own and that are routinely destroyed at infertility clinics do not have the same moral status as fetuses or people. A minority vehemently disagrees. We should not be trying to appease a minority with scientific flimflammery while delaying promising research that one day may lead to treatments that improve millions of lives.
Bad Ethics + Boring Science = Nature Publication
Shame on Nature for publishing two papers that do not deserve to be in such a prestigious journal. The research that was announced yesterday showing the possibility of supposedly more ethical alternatives to stem cell research is a lot less substance than hype. Neither result is really very surprising (at least in mice). The knockout mouse experiment demonstrates that a gene does pretty much what we thought it does (in mice). And the other experiment shows that cells separated at an early stage of development can do pretty much what we already knew they could do.
So why is anyone paying attention to this research? It seems to get its cache not from its scientific merit, but from its political and ethical import. But the ethics behind this are actually far weaker than people realize. Thoughtful opponents of stem cell research are just as likely to oppose this research as they are to oppose somatic cell nuclear transfer. All produce embryos or embryo-like constructs that are extremely unlikely to develop even if we attempted to create a baby. However, for none is it impossible (at least for future technologies if not present ones) that a child might (however improbably) be produced. If ectogenesis became a possibility, the fact that a genetically engineered embryo does not produce placental tissue could in principle be overcome as an obstacle. We do not yet know for certain if a cell broken off from the blastocyst could sometimes become a “twin”. These are actually bad arguments and it is dangerous for science to go down this road—what is the principle? If the goal becomes pursuing science that is unopposed by a minority, then no embryonic stem cell research should be conducted. If we reject that principle (which we should) then this research really doesn’t do much for the research.
- David Magnus [Link to AP Story]
Abstinence-only Sex Ed Defies Common Sense
From MSNBC:There may be a sillier strategy for dealing with sex among teens than promoting the choice of "abstinence-only-until-marriage," but I am not quite sure what it is. Not only is such an approach contradicted by everything that medicine and science know about teens and sex, but it flies directly in the face of everything all ordinary Americans know about teens and sex.-Arthur CaplanRecent surveys show that 70 percent of U.S. teens have engaged in oral sex by the time they reach 18, and more than 45 percent have had intercourse at least once. More than 70 percent of young women and 80 percent of young men approve of premarital sex, according to a study published recently in the Review of General Psychology.
In addition, studies show sexually transmitted diseases are spreading at an alarming rate among young people. The Centers for
...there is no evidence at all that it works...Disease Control and Prevention reports that nearly half of the nation's new cases of STDs each year occur among adolescents and young adults. A recent study found that teens who took pledges of virginity as part of abstinence-only sex ed classes ultimately had STD rates similar to other young people and were less likely to use contraception or other forms of protection when they did become sexually active.
In short, the idea that teens will remain celibate until they marry - and that they don't need information about sex - says much more about the values and fantasies of the people who are promoting these policies than it does about teens.
Confusing messages
So what should we teach our kids about sex? Most Americans want young people to be taught about sexuality as part of their junior high school and high school education, but there is almost no agreement on what the content of sex education should be. Popular opinion ranges from telling kids to "just say no" to how to find a woman's "G-spot." And since sex brings out our sense of morality like almost no other subject, science and the facts about sexual behavior tend to get lost in a lot of finger-pointing and teeth-gnashing.
For instance, in North Dakota, sex education is encouraged but there are few guidelines about what should be taught. In South Carolina, state law severely restricts sex education. There can be no discussion of contraception except with reference to marriage, no discussion of abortion, and nothing said about homosexuality except with reference to preventing sexually transmitted diseases. And in Texas, at least since the days when George W. Bush was governor, sex ed classes almost exclusively espouse abstinence-only messages.
In contrast, Oregon, California and New Jersey mandate that if a school does teach about sex it must provide medically accurate information, and age-appropriate and respectful discussion of the diversity of relationships, including those involving people with disabilities.Your tax dollars at work
I am completely against abstinence-only sex ed programs for three reasons: there is no evidence at all that they work; common sense says they have no chance of working; and it is not clear that ethically they send the right message to young people.But under the Bush administration, the federal government has planted itself firmly in the abstinence-only camp. More than a billion dollars have been spent to support these programs.
To make matters worse, the administration and Congress have played favorites with your tax money, with abstinence-only money going disproportionately to Arizona, Florida, Georgia and Texas. In contrast, Vermont received the least amount of federal funding. Maybe the kids in Vermont cannot hear admonitions to remain chaste amidst the sound of falling snow?
Eleven states have tried to evaluate their abstinence-only programs and the results have been dismal. In Kansas, the evaluators stated that "no changes [were] noted in participants' actual or intended behavior." Evaluators of the Texas program found the same thing - no change in the number of students pledging to remain celibate until marriage. In fact, more students reported having had sex after taking an abstinence-only sex ed course then they did beforehand.
There is no evidence at all that telling kids not to fool around has any more impact when the message is promoted by schools than it does when parents say the same thing at home.Sex and common sense
Which leads us to the world of sex and common sense. There are kids who are not going to have sex in junior high or high school. There are, according to what social scientists know about teens, not a lot of such kids but there are some. There are also some teens who are going to engage in homosexual acts and other non-standard forms of sexual contact. There are not a lot of these kids out there, according to what social scientists know, but there are some. An even smaller number of kids will, tragically, be forced to have sex by parents, relatives or rapists.
The fact is that a teen has a pretty good chance of getting involved in sex before graduating from high school and a small chance of being involved in something other than consensual male-female sexual intercourse. In addition to there being no evidence that abstinence-only sex ed works, there is no reason to believe that this form of sex education is even on the same planet as those it is intended to reach.Hypocrisy in action
So what message is sent to teens when abstinence-only-until-marriage is portrayed as the only acceptable way to deal with sex?When I went to child-parent meetings at my son's high school, parents of girls were frantic that the school reinforce the message that sexual intercourse was a bad choice. Parents of boys always seemed to me to be supportive but not nearly as frantic that this message be taught.
However, parents' attitudes seemed to change when these same kids went away to college or went off to get a job. A lot of these very same parents stopped preaching that sex before marriage was wrong. A fair number of them would whisper that sex before marriage might be a good idea, especially if the sex was with someone their son or daughter was thinking about marrying. Many of these parents had lived with someone before marrying and all of them who had done so had sex before marrying.
The message that sex must wait until marriage is not the right message to send to a young person. The people sending the message almost never lived up to it in their own lives and nothing turns a kid off like hypocrisy.Furthermore, most kids themselves just don't believe it.
And lastly, regardless of what someone's age is, it makes more sense to talk about maturity, love and mutual respect than to send an absolute message that sex is unacceptable outside marriage - a message that gets nullified the day a person graduates from high school.
Science and common sense, not wishful thinking and hypocrisy, should guide what we teach kids about sex.
The Power of a Supreme Court Justice
From the AP:An attorney for a pregnant inmate who wants an abortion said time is running out for his client to have the procedure while the courts decide her case.
The U.S. Supreme Court late Friday temporarily blocked a federal judge's ruling that ordered Missouri prison officials to drive the woman to a clinic on Saturday for an abortion.
Justice Clarence Thomas, acting alone, granted the temporary stay pending a further decision by himself or the full court.
Hometown Hero
Georgetown Voice expresses hope that Dr. Pellegrino can turn the President's Commission on Bioethics around.Is There a Progressive Bioethicist in the House?
So our pal Jon Moreno, whom we've yammered about here over and over, did in fact pull off the progressive bioethics conference at the Center for American Progress in DC (Podesta's new and fascinating liberal think tank), and the video of the session, which features Moreno, Art Caplan, Alta Charo and Vanessa Gamble, is now up for you to watch. It is great.Erika Check wrote a nice piece about the meeting as well, for Nature [PDF file]. [streaming video of proceedings].
Please Don't Create a Natalie Holloway Out of the Katrina Disaster
Euthanasia Witchhunt in Progress
I don't mean for this to be "hammer on the media" week, and nobody played a bigger role in circulating that story about purported euthanasia in New Orleans than our blog (we had 115,000 hits to that story alone in one day), but the story really just needs to, um, die now.After investigating the story that patients were euthanized in the New Orleans nursing home, we discovered (as did several reporters) that the original source for the original story in a New Zealand newspaper was not a physician or healthcare worker at all but in fact a bystander whose story could not be corroborated and in fact who could not be found to give more detail. I'm guessing it was a hoax, in fact.
Now I am the first to say that the story is still interesting in that it raises some of the issues that we confront in the special Bioethics in the Eye of the Storm issue, particularly concerning whether or not in fact it might have been appropriate under certain circumstances to aid patients in dying peacefully (the literal meaning of euthanasia) who would otherwise have imminently died in great pain. The "battlefield triage" question, in other words.
But that is not the question that CNN is asking. They are chasing phantoms in New Orleans, and from the read of it there is still no real evidence to support going on what may well take on a new life as a conspiracy theory. Check out the story on the CNN site:
The Louisiana attorney general's office is investigating allegations that mercy killings occurred and has requested that autopsies be performed on all 45 bodies taken from the hospital after the storm.It would certainly be important to find the folks who might have done such a thing, but until that happens can we please avoid turning the massive disaster in end of life planning in New Orleans into a non-stop Nancy Grace marathon, ala "find the Aruba girl"?Orleans Parish coroner Frank Minyard said investigators have told him they think euthanasia may have been committed.
"They thought someone was going around injecting people with some sort of lethal medication," Minyard said.
Dr. Bryant King, who was working at Memorial when conditions were at their worst, told CNN that while he did not witness any acts of euthanasia, "most people know something happened that shouldn't have happened."
Not Even Short Nonfat Half Caf, ehm, Excuse Me, Get it Right? Half-caf Short Nonfat Bioethics?
The University of Washington's daily student newspaper editorializes that it is time for a bioethics class in the medical school. This struck us as odd, given that UW has one of the most amazing online guides to bioethics curriculum out there, and a powerhouse bioethics program run by nice people who all have teaching training. So where's the bioethics course at u-dub? Anyone? Anyone? Bueller?
Gina Kolata Discovers the Amazing Hurlbut
It lives. It lives again. Jeb Bush's solution to the stem cell problem, The Hurlbut Suggestion, or semantic nuclear transfer, as we've begun to refer to it, has prompted the Times' Gina Kolata to essentially break the embargo on a major science journal's publication of studies that show, well, something we can't write down yet about how some folks have achieved success in producing embryonic cells that promise to anger nobody, by using techniques that make embryonic cells without awakening the Torquemadas of the right.The research all stems, Kolata claims - stretching matters a bit - from Hurlbut and his brilliant idea that we could avoid the embryonic stem cell debate if we could just make little embryo-like-things that are somehow disabled enough (through the prior alteration of the adult somatic cell from which they derive) that their creation will not involve the potential for birth. It seems to us to be a cross between nuts and a smokescreen, and the idea has (we noted) not really persuaded folks from the world of right to life either.
If having read all of our discussion and incessant whining about the idiocy of these "almost an embryo, but not" ideas you are still thirsty for more, then don't wait another moment, surf on over right now to read Ms. Kolata's "Hunting for Ways Out of an Impasse" at the New York Times site.
Sleeping with the Devil in the Struggle Against AIDS
In his 2003 State of the Union address, President George W. Bush unexpectedly announced a vast increase in support for the struggle against HIV/AIDS in the developing world: “I ask the Congress to commit $15 billion over the next five years, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean.” By May, the United States Leadership Against HIV/AIDS, Ttuberculosis and Malaria Act of 2003 was signed into law. The President’s Emergency Plan for AIDS Relief, or PEPFAR, was born.
The next step was implementation: how can antiretroviral treatment for AIDS, drugs for opportunistic infections (such as tuberculosis), testing kits, gloves, injection supplies, sterilization equipment and other medical resources be delivered in a sustainable and reliable way in countries marked by varying levels of poverty, poor transport infrastructure, weak communication systems and corruption? What is needed is a supply chain management system, or SCMS as it is called in the business.
And it is a business. In October 2004, the US government started soliciting proposals for probably the largest contract for international health service delivery in the history of humanity. Two weeks ago, the contract was awarded to a consortium of fifteen institutions, referred to somewhat ominously as ‘the Partnership’. The consortium is a mix of private sector, non-profit and faith-based organizations. But the eye is naturally drawn to one particular member of ‘the Partnership’: Northrop Grumman.
Northrop Grumman is the third largest military contractor in the United States. This is the company that brought us the B-2 stealth bomber (at a cool $2 billion per unit), the unmanned Global Hawk ($10 million each), and a $10 billion contract with the Pentagon to build a missile defense system. The company is also exceedingly well connected, with at least seven former Northrop Grumman officials, consultants or shareholders now holding posts in the Bush administration, including Deputy Secretary of Defense Paul Wolfowitz, Vice Presidential Chief of Staff I. Lewis Libby, Pentagon Comptroller Dov Zakheim, and Sean O’Keefe, director of NASA. Even the President himself finds himself visiting Northop Grumman facilities from time to time.
Perhaps it is unusual that a multinational corporation that makes much of its money from instruments of death would now be involved in the struggle against HIV/AIDS in developing countries. On the other hand, Northrop Grumman has some prior experience with supply chain management issues, considering its support of the US State Department’s ‘war against drugs’ in Columbia, though this is another sort of drugs, and another sort of management.
Relatively speaking, the other 14 members of ‘the Partnership’ are small fry compared to Northrop Grumman. The company will probably be playing a central role. So what are the arguments in support of this defense contractor, with its ethical baggage, being crucially involved in PEPFAR? The main one is baldly pragmatic: the logistics of setting up, administering and monitoring a supply chain on this scale is simply beyond the means of any non-governmental or non-profit organization, and certainly beyond the present capacities of the governments of PEPFAR countries. In short, Northrop Grumman may be ugly, but they are big, and powerful, and they arguably could get the job done where the alternative agencies cannot.
On the other hand, the fiscal mismanagement of US defense contractors is legendary. In 2003, Northrop Grumman itself paid $112 million out of court to settle a suit that its subsidiary, TRW, overcharged the US government’s space program. The question of efficiency is also open: Grumman’s $48 million contract to train the Iraqi National Army produced such dismal results that the Jordanian army has taken over the job. And already ‘the Partnership’ has taken on one regrettable feature of defense contractors: secrecy and lack of transparency. The consortium members are not to divulge the amount of the contract (rumored to be $7 billion), and have been given strict instructions on what they can say to the media.
- Stuart Rennie
Trust Us, "Justice Miers" Would Make a Big Big Difference
Reuter's analyzes the standing of the Court (SCOTUS) in the Oregon case currently before the nation's highest court, a case that will forever impact how patients die: The Court is evenly divided.As conservatives continue to pretend to object to Miers' nomination on the grounds that she might not be conservative enough, this the most political appointment in the history of the Supreme Court is about to go to the Senate where, if confirmed, Miers would no doubt tilt such rulings toward the conservative. And that, friends, ends the question of where the nation's jurisprudence on bioethics issues like stem cells, abortion and euthanasia will go. Is there really any question that the confirmation of Miers would mean a quick and sharp shift in Court decisions that would bear on abortion, euthanasia and stem cells, among a dozen other bioethics issues that will come before the Court in the coming decade?
No.
Yet the "GOP is not satisfied" charade continues, suppressing what should be a deafening echo of protest against this nomination by commentators from the left. Yes there are real intellectuals who oppose the Miers nomination on principle. But that isn't what is at stake here.
IBM Will Not Use Genetic Testing in Employment, Insurance or Benefits
In what is being billed as a Thought Leader Done Good, the world's largest technology company "by revenue" has promised not to use genetic information in hiring or determining eligibility for health plans and benefits. This leaves a hole large enough for a truck to drive through, of course, where insurance and other benefits are concerned, since requiring patients to release the results of a DNA test is only the beginning the use of hereditary information in those settings. But even if genetic testing is in its infancy in terms of volume and employer use, this is a nice gesture on the part of IBM that suggests it wants to be part of the debate about how corporations partake of the availability of genetic testing.Momma!
"I could hear everything, says man after two years in coma," reports John Hooper for The Guardian.Salvatore Crisafulli, 38, has had great difficulty in speaking since recovering, but, asked if he could remember the past two years, he replied "yes" and wept. In true Italian style, his mother told reporters that his first word had been "Mamma". The recovery is being hailed as a miracle in his home city of Catania in Sicily, and came to light on the day Italy's bioethics committee was voting on whether to feed patients in a persistent vegetative state.
The Catholic Church Funds Adult Stem Cell Research
According to Korea Times,South Korea’s Catholic church plans to donate 10 billion won ($9.61 million) for adult stem cell research to counter the burgeoning studies on embryonic stem cells.- David MagnusToward that end, the Seoul Diocese yesterday set up a committee to allocate the funds and appointed Bishop Yeom Soo-jung to head it.
``We decided to establish this committee to boost adult stem cell research that will treat hard-to-cure diseases practically. We hope our efforts will mark a turning point to wash away a recent tendency of making light of life, as shown by embryonic stem cell experiments,’’ Yeom said.
He added the 10 billion won is the largest amount ever contributed by any Catholic church in any country for adult stem cell research [yes, and by a 10 billion won margin - ed]
The Catholic church has been opposed to stem cell experiments with embryos, pioneered here by Seoul National University professor Hwang Woo-suk, because of the church’s belief that embryos are human lives.
Should There Be a 'Big' Bioethics Meeting?
Every year at least three major bioethics academic groups meet to discuss bioethics. The book publishers and journals are there, there are lots of hallway conversations about what is 'going on' in the field, and at one of the societies there is a new meeting of those who direct bioethics programs. The big three bioethics meetings are open to anyone but typically the audience is made up mostly of the folks who are actively working in the field in academic institutions.Every so often someone suggests that there should be a mega-meeting, not (or not just) of the academic societies together but of the audiences that are interested in bioethics but who wouldn't necessarily want to wade through a conference program filled with peer-focused academic sessions in order to find a few that are aimed at their own practical interests.
What about a meeting for the majority of those who are interested in the field: ethics committee members, IRB members, bench and clinical scientists, staffers in political offices, health lawyers, nurses, physicians, etc.... Would you go to a mega-meeting in bioethics if it met your needs? AJOB is helping a group that wants to do exactly that, but only if there is enough interest. Is there?
Click here for a 5 minute survey.
No Legislating from the Bench
(Except About Assisted Suicide)
Art Caplan writes on MSNBC:When it comes to U.S. Supreme Court appointments, President Bush and the Republicans in Congress have made it crystal clear what their core requirement is — no "legislating from the bench."
Both with the nomination of new Chief Justice John Roberts and now, with Supreme Court nominee Harriet Miers, Bush has insisted that he has selected people to serve as judges who will not override the will of the American people. So one has to wonder what his administration is thinking in pressing the case against physician-assisted suicide in the state of Oregon? Or, more accurately, why is the administration not telling us the truth about how it really views the role of the Supreme Court?
The state of Oregon is the only state in the nation where it is legal for a physician to prescribe a lethal dose of medication to a terminally ill patient who requests assistance in dying. The citizens of Oregon approved “The Oregon Death With Dignity Act” by a ballot initiative in 1994. In 1997, a push was made to revoke the law. But again Oregonians voted to permit physician-assisted suicide, this time by a larger majority than they had three years earlier.
Various attempts have been made by the Department of Justice to challenge the constitutionality of the law in court. In 2002, U.S. District Judge Robert Jones, in ruling against the attempt by the Bush administration to block the law, said, “Oregon voters decided not once, but twice to support the law and have chosen to resolve the moral, legal and ethical debate on physician-assisted suicide for themselves."But Bush and his administration will not give up. Then Attorney General John Ashcroft pressed the case on appeal and it has now wound up in front of the Supreme Court. The president’s conservative base is so strongly opposed to any form of assisted suicide that it has sought all possible means to overturn the Oregon law.
The Justice Department argued before the Roberts court on Wednesday that the federal Controlled Substances Act gives the U.S. attorney general the power to prohibit the use of drugs in assisted suicide, regardless of state law. This is truly grasping at a straw to overturn the will of the people of Oregon.
This 6-year jihad against the Oregon law might make some sense if there had been a pattern of terrible abuse of the dying and disabled since its enactment. As it happens, I am very wary of legislation permitting physician-assisted suicide. I worry that it could lead to pressure being put on people to end their lives prematurely or people with psychiatric or physical disabilities being dispatched for the convenience of others or to save money. But there is no such record of abuse in the wake of the law.
While some Oregonians dying of cancer, AIDS or Parkinson's disease do request a lethal dose of medication, very few actually wind up using it. There have been fewer than 300 cases in the years since the law was implemented. And despite a concerted effort by opponents of physician-assisted suicide to find cases in which the law has led to abuse or misuse, I know of only one case in the past five years in which any serious challenge has been raised regarding the ethics of patients, families or doctors who have honored a request to die.So what is Bush thinking? Why is the Justice Department trying to use a broad interpretation of an obscure federal statute to restrict a law legislated twice by the citizens of Oregon that has not led to any problems or difficulties since its enactment?
There is only one answer: The president is not telling the truth. He is only willing to respect the decisions of Americans if he agrees with them. He is only willing to advocate for a conservative court if it upholds a social agenda that he agrees with. He is not willing to allow a state to follow a policy regarding the terminally ill if he does not agree with it. And he clearly expects the Supreme Court to "legislate from the bench" when it suits his moral agenda.The federal government should not have brought the case against Oregon’s law. And the Supreme Court should not listen to the cockamamie argument that a statute intended to prevent the illicit use of drugs somehow gives the federal government the right to tell the citizens of Oregon how they must die when they are terminally ill.
The administration constantly bemoans the fact that Roe v. Wade imposed a policy on the American people about abortion that was never legislated. Oregon has a policy on assisted suicide that was legislated — twice. Bush and his administration should be ashamed for trying to use the Supreme Court to do what they claim they do not want any federal judge or court to do. The ethical hypocrisy involved is beyond description.
Making Death
The reconstruction of the 1918 avian flu virus raises some ethical and policy questions that have not gotten the attention they deserve in the bioethics community.
Who is guaranteeing that this or other nasty little critters are being held in secure locations? What policies is the scientific community following with respect to publishing the genomes of dangerous microbes such as polio, ebola or Marburg viruses and how to use synthetic genomics to make them? And how should existing treaties governing biological warfare extend to the rapidly developing world of synthetic genomics and microbial engineering?- Art Caplan
Morgan State Presents Tony Hooker's Tuskegee Syphilis Experiment Photography
The Greater Good is the name of this very powerful exhibition at the James E. Lewis Museum of Art at Morgan State University in Baltimore. Hopkins' Berman Bioethics Institute cosponsored the exhibition, which opens this Friday with a reception. Saturday, Vanessa Gamble of Tuskegee University 's bioethics program will give a keynote in a day-long symposium on Tuskegee, for which I can't find a link.
Celebrating the Integrity of a Canadian Scientist
Eric Meslin, director of the IUPUI bioethics program and a thoughtful guy, writes this week in the Toronto Star about the integrity of James Till.
Till, along with Ernest McCulloch was awarded a Lasker Award for their groundbreaking work in hematology, which today seems even more extraordinary given its role in the evolving science of stem cells. Till and McCulloch are an unusual pair, a scientist and a physician respectively by training, who by all accounts have enjoyed a very fruitful collaboration - they actually like each other - while defining the cutting edge in experimental hematology. Both are well known in science but hardly household names.That's where Eric Meslin comes in. With the Lasker prize, many Canadians have pointed to the pair as yet more evidence that Canadians can't get a break when it comes to public recognition of achievement. Eric takes the opportunity to point out that, in the revelation that Till and McCulloch haven't been as "famous" as other scientists, there is something to learn about scientific character:
I have never met McCulloch, but I had the opportunity in the late 1980s and early 1990s as a new assistant professor at the University of Toronto, to work with Till. By this time, Till had long since left the lab to begin investigating, with Heather Sutherland, how to measure "quality of life" experiences with cancer patients. As someone working in bioethics I had no prior knowledge of Till's work on stem cells, the most important of which occurred the year I was born...But I quickly learned what many other students and colleagues of his had learned over the decades: This was a person who oozed ethical integrity from every pore of his body...In fact, as Meslin points out, it may well be this integrity - of greatness achieved rather than sought, as he puts it - that kept Till and McCulloch out of the spotlight that some other more prominent scientists of their time sought.If he were a subject of a moral philosopher's assessment, he might be described as a virtuous scientist, the type of researcher who can habitually be relied upon to do the right thing without being told what to do.
These qualities of scientific rigour and ethical integrity make for a potent combination. Liberally sprinkled with an infectious laugh and sense of humour, there are few who can match Till's mentoring ability. So while we celebrate the scientific accomplishments, let us not forget that truly good science also involves good scientists.
Sure, it would be nice to have more Canadians win Laskers and Nobels, but the true measure of Canadian greatness in science might also be measured by the number of students whose ethical integrity in science approaches that of people like Jim Till.
Abortion, Technology and Roe vs. Wade
Luke Shockman at the Toledo Blade is a great health and technology reporter and in this great piece he reviews the effect of changes in technology on the scope and meaning of Roe vs. Wade.No Shots, No Service
Many pediatricians say they would not continue care for families who refuse vaccines, according to a study by Erin Flanagan-Klygis of Rush Medical College.As Thee Regulate, So Shall Thee Be Regulated
The FDA hurts. Lester Crawford, the recently resigned commissioner, left after serving only a year, and now the Dr. Andrew von Eschenbach is coming under criticism because he will be serving simultaneously as head of the National Cancer Institute and as the acting FDA commissioner. Can he do both? Will be be able to run an organization that presides over umpteen gagillion NCI-sponsored trials by simply recusing himself? Will the President call in Haliburton to approve cancer trials? Tune in at 11.Update: Never mind, a reader tells us.
Calling Peter Singer, Calling Peter Singer
Women: Caretaker of famous gorilla pressured us to bare our breasts - Courttv.com.- Art Caplan
Pennsylvania Discusses Stem Cell Research Funding ... Yeah Right
Art Caplan had the great idea of hosting a hearing on stem cell research at Penn for the Pennsylvania state legislators who are interested. He got lots of great people to come, and the agenda was right on the money; the typical sort of argument about how "our state will be left behind," an argument I was making when I led the Penn "stem cell initiative" in 2000. But will it make any difference for this key state - one in which stem cell research might actually have a shot? No chance, in my view. It is still a felony to destroy an embryo in Pennsylvania. Here's MSNBC's review of what happened in the hearing.Give or Take a Million Deaths
Last week has seen renewed fears about the possibility of a global avian flu epidemic. The United Nation’s new coordinator for avian and human influenza, David Nabarro, said on Friday that if a mutated form of avian flu develops which is transmissible between humans, it would cause between 5 and 150 million deaths. “It's like a combination of global warming and HIV/Aids ten times faster than it's running at the moment,” he told the BBC. Perhaps we should all be glad Dr. Nabarro did not add the Holocaust, Rwanda and the Black Plague to drive his point home.
No sooner than Nabarro’s words hit the press, the WHO issued a counterstatement. No, they assured, it would really not be that bad. Dick Thompson, the WHO spokesman on influenza, cheerfully claimed that only between 2 and 7.4 million persons would perish in the event of an avian flu epidemic. But when further pressed, Thompson admitted that all mortality projections concerning the avian flu were speculative. "You could pick almost any number. There is this vast range of numbers, absolutely. One of those numbers will turn out to be right. All of this is guesswork, nobody knows."
If the numbers are based on guesswork, it is worth asking why these ‘mortality estimates’ are publicized by global health authorities, rather than having them say that an avian flu epidemic would be really, really, really bad. Why the big numbers at all? It is not good enough to say that the high figures are publicized to ‘raise public awareness’, since the public itself can do little to protect itself against a deadly flu epidemic anyway. Public awareness is compatible with mass death. We largely depend on governments and public health authorities to take measures to protect populations against the spread of deadly disease. It is not supposed to be a do-it-yourself project.
Who knows? Maybe in the wake of Hurricane Katrina, Dr. Nabarro’s high mortality range is based on an expectation that the governments and public health authorities won’t be up to the task. This raises an interesting question: besides the usual factors, shouldn’t political incompetence, neglect and corruption be factored into epidemiological models and their mortality estimates? Or is it in bad taste to suggest that the actions and inactions of governments may be causes of citizen death?
- Stuart Rennie
Ah, Our Old Friends at the Florida Supreme Court
Miami Herald reports on something:called the Women's Right to Know Act, an abortion law that conservatives bragged about -- and liberals sued over -- after it was passed in 1997 by the first Republican-controlled Legislature since Reconstruction.
Now, eight years and a couple of court defeats later, the law seeking to inform women about abortion risks landed Thursday before the Florida Supreme Court, where justices appointed by Democrats and Republicans alike struggled with the same question:
What's the big deal?
The law requires abortion doctors to tell ''reasonable patients'' three seemingly simple things: 1) risks from the procedure, 2) the gestational age of the fetus 3) the medical risks of actually bearing the child.
First Evidence Of Brain Abnormalities Found In Pathological Liars
From the University of Southern California press release:While previous research has shown that there is heightened activity in the prefrontal cortex – the area of the brain that enables most people to feel remorse or learn moral behavior – when normal people lie, this is the first study to provide evidence of structural differences in that area among pathological liars.The research – led by Yaling Yang and Adrian Raine, both of the USC College of Letters, Arts and Sciences – is published in the October issue of the British Journal of Psychiatry.