blog.bioethics.net

Progressive Bioethics: The Conference

The Center for American Progress bioethics initiative, created and pushed quickly along by Jonathan Moreno at a very important time in American political life, held a conference on the political challenges to bioethics from conservatism. Streaming video to come; you can still watch the streaming video from their first conference in October.

Susan Sherwin Wins Killam Prize

There is more money devoted to bioethics research in Canada than in the United States by a factor of ten. Seriously. Nobody seems to know how it happened, but unless you count the money allocated for study of ethics in nanotechnology in the U.S., Canada has lapped the U.S. nine times and continues to increase its devotion to the importance of bioethics research.

A recent example is the award to Dalhousie University philosopher Dr. Susan Sherwin of the Killam Prize for her work in feminist bioethics.

Sherwin says being awarded the $100,000 Killam Prize is simply overwhelming.
I'm deeply honoured,' she said in an interview. 'The only way I can make sense of it is that it is a recognition of the importance of the whole field of work that I engage in.'

But that field, feminist bioethics, is one she largely pioneered. Combining her interests in feminist philosophy and health-care ethics, Ms. Sherwin's 1992 book, No Longer Patient: Feminist Ethics and Health Care, was the first to consider the subject.

Dalhousie's Department of Bioethics has exploded along with others in Canada, home to Canada Research Chair in bioethics holder Francoise Baylis , Nuala Kenny, and lots of other smart people, as well as a number of interesting and well funded projects in areas as diverse as neuroethics - for which there is basically no funding in the U.S. - and developing world bioethics.

The Starbucks of Suicide

"We never say no," writes Wesley Smith, arguing that the Swiss organization Dignitas - which is planning to create a network of organizations to provide assisted suicide - is the template for the right to die movement. The problem is that Dignitas is a nutcase outfit; Smith quotes its founder from an interview in the Times London:

Minelli believes that all suicidal people should be given information about the best way to kill themselves, and, according to the Times story, "if they choose to die, they should be helped to do it properly." Dignitas admits to having assisted the suicides of many people who were not terminally ill. As Minelli succinctly put it, "We never say no."

Does that sound like Timothy Quill to you? No? Me either. But this is the nature of the argument against the right of the terminally ill to end their lives: the fallacy of the domino theory.

Drug Trials in India: Finally Somebody is Paying Attention

I've made it clear that in my view pharma trials in India should be the focus of a huge amount of attention in the world of research ethics. Why no one in the U.S. other than the occasional journalist (see, e.g., the Wired piece in March) seems to care is beyond me.

In fact I'll go further. That we should focus so much attention on the tiny trial of Parexel in Britain, which injured six people, while two million Indian patients, almost all of whom are poor, almost none of whom have any real health care at all, and none of whom will be empowered to sue anybody, are enrolled (by 2010, according to estimates quoted in the BBC story) in clinical trials.

The Parexel subjects knew they were in a clinical trial. There are problems with the trial. But the trials in India that have surfaced as problematic are so much more problematic. Has it dawned on those who discuss the evils of the Parexel trial that the next step for trials of this variety is that to avoid controversy they will be moved to India?

Here's the ultimate "progressive bioethics" issue.

Anyway there is a very interesting BBC exposé that will be aired very soon on the matter and if you care about ethics in research and can watch BBC you'd better watch. Here's a little clip.

The Big Problem will be a Masculine Container

Male birth control is coming, and a big leap toward its acceptability is the discovery that the male pill won't affect long term male fertility.

And then Suddenly, Drugs Were Cheap

Sort of. Anyway they are going to be generic, about 75% of them, as they fall off of patent and get dopey new names - what in the world will they call the generic form of Zoloft, one wonders. The list is long: Ambien, Pravachol ...

Anti Euthanasia Crowd Descends on Penn

The Penn bioethics center's 10th anniversary conference was sure to attract some attention from the Save Terri crowd (and not just the folks who believe that she could have returned from PVS with just a few more years of tube feeding), given that Michael Schiavo, Judge Greer, etc. are scheduled to speak. But the rhetoric that pro-life groups have employed is truly extraordinary:

The probate judge who ordered the dehydration death of brain-injured Terri Schiavo will join Michael Schiavo and other key proponents of her death as a guest speaker at a bioethics conference.

Who knows if there will be a book signing by the Schindler family, but at least one is planning a great big protest.

Bobby Schindler, Terri Schiavo's brother, calls Greer's speaking engagement "offensive," and on behalf of the Terri Schindler Schiavo Foundation Center for Health Care Ethics [ed: this has to be the most eggregious use of the language of "ethics center" ever - zero academic work, 100% lobbying and fundraising] intends to protest Geer’s presence at 10:30 a.m. Monday outside of the university's Biomedical Research Building.

And the Schindler family has actually commented on its anger that Judge Greer will be appearing. Their comments are incredible:

"Judge Geer’s presence at the University of Pennsylvania's bioethics conference is not only outright offensive and inappropriate but it is indicative of his own biases against the disabled," Schindler said.

He also wonders if Greer's appearance is a "violation of Florida's judicial canons as prescribed by the Supreme Court of the State of Florida."

"We are entitled to a fair and unbiased judiciary," Schindler added. "Judge Greer is confirming exactly what my family has maintained from the beginning of Terri's case – that he has a disposition against the vulnerable people whose cases he controls."

I just do not get it. At what point does the family and the movement acknowledge that Terri was in fact beyond therapy? Does that even matter? Somebody ask the protesters tomorrow, please, and comment. Or if you're scared, send in some hapless Penn student with a script.

What we are reading today...

• Pill Pushers Go Into Overdrive
  
• For Women, Food is Food for Thought
  
• Genzyme's Drug for Rare Enzyme Deficiency Is Approved
  
• Glaxo Denies Pushing 'Lifestyle' Treatments
  
• Stolen Body Parts Linked to Patients' Illnesses
  
• Chinese Scientist Cleared of Faking Results
  
• Pfizer Boldly Advertising Celebrex Again
  
• Herceptin Gets European Approval in Record Time
  
• Circumcision Studied in Africa as AIDS Preventive
  
• In U.K., Optimism Over New Regulator
  

Physicians Just Do Not Trust the Government Anymore

Brian Alexander is an extraordinary writer and in his latest piece for Glamour he tells the story of the profound mistrust physicians now have in the U.S. government:

For the past 15 years, Ruth Shaber, M.D., has been an ob-gyn in San Francisco for Kaiser Permanente, one of the nation's largest health maintenance organizations. She sees all types of women—union members, executives, waitresses. Most of them, Dr. Shaber says, have questions for her, including how to protect themselves from sexually transmitted diseases, how to preserve their fertility, how to prevent breast and cervical cancer and whether the latest Internet health scare they've heard is really true.

Dr. Shaber tries hard to separate fact from fiction because, she says, "rumor and hearsay can start to seem real." In the past, she'd sometimes refer patients to government websites and printed fact sheets, or rely on those outlets to help create her own materials. Not anymore. "As a physician, I can no longer trust government sources," says Dr. Shaber. She is not a political activist or a conspiracy theorist; in addition to her own practice, she's Kaiser Permanente's director of women's health services for northern California and head of the HMO's Women's Health Research Institute. Yet this decidedly mainstream doctor and administrator says, "I no longer trust FDA decisions or materials generated [by the government]. Ten years ago, I would not have had to scrutinize government information. Now I don't feel comfortable giving it to my patients."

Such doctor mistrust represents a major change. For the past 100 years, the Food and Drug Administration (FDA) has been the world's premier government agency ensuring drug safety. The National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) have similarly stellar track records. But recently, Dr. Shaber charges, the government has lost its most precious asset: credibility.

How did it happen? Many prominent figures in science and public health think they know the answer. "People believe that religiously based social conservatives have direct lines to the powers that be within the U.S. government, the administration, Congress, and are influencing public-health policy, practice and research in ways that are unprecedented and very dangerous," says Judith Auerbach, Ph.D., a former NIH official who is now a vice president at the nonprofit American Foundation for AIDS Research. In fact, Glamour, has found that on issues ranging from STDs to birth control, some radical conservative activists have used fudged and sometimes flatly false data to persuade the government to promote their agenda of abstinence until marriage. The fallout: Young women now read false data on government websites, learn bogus information in federally funded sex-education programs and struggle to get safe, legal contraceptives—all of which, critics argue, may put them at greater risk for unplanned pregnancies and STDs.

The Cow That Will Not Lose Its Mind (or Kill You)

Karama Neil found this lovely tidbit. I always get scared when the Chinese government announces a tiny breach in public health or a small change in animal policy. So here's great news. The Chinese have cloned a mad cow resistent calf. The calf, which smiles all the time, was produced though transgenic cloning by the two professors in China who pioneered cloning of cows.

Chernobyl Legacy

The Chernobyl legacy is the subject of a webmontage that is very powerful and raises some unique bioethical issues. There is little written about the devastating legacy of malformed and mentally challenged child victims of the disaster, and this photojournalist has created a searing, narrated set of images that I encourage my colleagues to view.
- Paul Root Wolpe

What we are reading today...

• Black Men Have Less Heart Blockage
  
• States Skewer AIDS/HIV Law Funding Changes
  
• Mother Matters When It Comes to the Heart
  
• Government Sued Over Medicare Drug Benefit
  
• Medicare Rule Guarantees Continuity of Drugs
  
• Only Drugs and Vaccines Will Deflect Bird Flu Pandemic
  
• Edit at Your Own Risk
  
• Doctors Urge Safety Panels for Devices
  
• New Jersey Law is a First for Moms
  
• Are Movies, TV Scaring Off Organ Donors?
  

Don't Sneeze When You Take Your Shoes Off

The year is still young, but the Centers for Disease Control and Prevention (CDC) might pull in the wacky public health policy award of 2006. This week, the CDC proposed quarantine rules to prevent bird flu from entering and spreading through the United States. In case of a major outbreak, all airline and ship passengers would be required to give detailed contact information, and those among them suspected (but not necessarily proved) of being infected by bird flu would be sent to a special island detained at an airport terminal for three days. In short, after the security screening comes the health screening. As Ram Koppaka, chief of the (terrifyingly named) Quarantine and Border Health Services branch of the CDC puts it: “The federal government feels it has a responsibility to notify people who have been exposed to a communicable disease while traveling.”

The innovative part of the proposed policy is that those responsible for avian flu screening would be flight attendants, pilots and cruise ship crew, when they are not busy pushing food carts around, mopping the deck, or flying the plane. They are to check passengers for mild symptoms like fever, cough, sore throat, and muscle aches (not due to sitting in economy class), and also for more serious symptoms such as eye infections, pneumonia and respiratory diseases (not due to breathing recirculated air). Of course, any old pilot or flight attendant can see if someone is coughing; the real art is to detect bird flu among passengers who have bird flu but are asymptomatic, and dispatch them to Terminal D. If the proposed guidelines go through, and avian flu takes off, it might be wise to be very, very nice to the flight and cruise staff. And cancel international trips if you have a head cold.

- Stuart Rennie

What we are reading today...

• Asian Nations Team Up for Bird Flu Research
  
• It's Okay to Drink Lots of Coffee
  
• Illinois Governor Slips Funds to Stem Cell Researchers
  
• How a Spoonful of Sugar Helps the Medicine Go Down
  
• Vatican Studying Condoms and AIDS
  
• After the Adoption, a New Child and the Blues
  
• Fatal Disease From Flavoring Raises Flags
  
• World Bank Criticised Over Anti-Malaria Efforts
  
• Studies Find Elusive Key to Cell Fate in Embryo
  
• 'Bloodless' Surgery Avoids Risks of Transfusion
  

Happy Birthday Snuppy

"Let it not be said that you forgot the birthday of Snuppy," says Stuart Rennie, and so it is. Happy birthday Snuppy the cloned dog. Your dad's other experiments have all turned to vapor, so you may truly be a Hwang's best friend.

Gerald Schatten and Pitt - an Analysis

Pittsburgh Tribune Review dissects the events at the University of Pittsburgh that led to and fed the development of Gerald Schatten's and the school's involvement in the Hwang controversy. It is a complex story with many levels of commentary.
[Update] However it describes me as the director of the largest program on ethics and stem cell research, a dopey and preposterous attribution;is there a large program on ethics and stem cell research?? Well if so it isn't in Albany.

Prayer Studies Do Not Have a Prayer

The big problem with prayer studies is theological. God is more likely to heal people if enough strangers gather to ask? God can be fooled into participating in - or will be willing to participate in - a study in which some patients are deprived of that power deliberately?

The power to heal the sick and answer prayer is profound in most religious traditions. But sometimes the answer to a prayer could very well be - as it most profoundly in the Christian tradition is for Christ when he asks God to allow him to forego suffering at the cross - that suffering (even the suffering of Job) is the will of God. Life on earth remember is for the Judeo-Christian tradition and indeed in most major religious traditions a mortal coil, a matter of ashes to ashes.

So prayer studies are a preposterous, misguided and ultimately perhaps blasphemous activity, and from a scientific point of view they have more than been shown to be a waste of money and effort. And this is the subject of our Caplan & McGee column this week in the Times-Union for Hearst News Service and NYT News Service:

Despite the fervent hopes of a few faithful, the idea of prescribing prayer to cure diseases and disabilities just doesn't have a, um, prayer. Study after study shows that prayer flunks the test of hard scientific evidence when it comes to measurable effects. But should this really be the test to which prayer is put?

Harvard researchers and the John Templeton Foundation, a philanthropy devoted to bridging the gap between science and religion, recently poured nine years and $2.4 million into the most comprehensive study to date of the power of prayer for the sick. They wanted to see whether prayer by strangers, sometimes called "intercessory prayer," would increase the chances that people got better or had fewer problems as they healed.

A few weeks ago they announced their findings. Prayer by strangers had no effect on minimizing side effects for 1,802 heart bypass patients. This study confirms what five others have shown -- there is no empirical evidence that praying for the sick works.

Some are still unconverted. They contend that this study, just like the earlier ones, was not done correctly. Perhaps the people praying didn't get the prayer right. Or they did not pray with sufficient zeal, or pray long enough. Or maybe patients were scared at the thought of strangers praying for them, which may very well explain why many heart patients who were told they were the subjects of prayer did more poorly than those who were unaware.

The problem isn't prayer itself.

Prayer can be the most generous, open, solemn and thoughtful form of human expression. Faith that a prayer may enlist God's help to heal someone is about as universal a religious experience as there is. When medicine fails and science reaches its end, a physician would have to be pretty callous to scorn the faith of patients and their families.

But that is the point. Faith is a matter of -- faith. Religions recognize the frailty, mortality and finitude of human life and, when a person is dying, the need to accept our finitude.

Perhaps the most troubling aspect of prayer treatment is the eerie clarity that its advocates have about the idea that death is a failure. What if the Harvard study had shown that more patients who had been the subject of intercessory prayer were slower to heal or had more health problems? Would that show that God does not exist? That all prayer is pointless? On the other hand, what would intercessory prayer do for medicine if it actually worked? Would we have to warn those with no family and few friends that they aren't going to do as well because sadly they are prayer deficient? Would HMOs and insurance companies have to cover the costs for professional prayers?

[READ THE REST OF THE ARTICLE]

What we are reading today...

• States Spar Over Federal HIV/AIDS Funds
  
• Cash Payments for Organs?
  
• Wash. Pharmacy Board Drafts Rule on Refusing Service
  
• In the Money, And in Court
  
• Judge Upholds California Stem Cell Agency
  
• Cardinal: Condoms Are 'Lesser Evil' Vs. AIDS
  
• NIA Stem Cell Chief Resigns
  
• Making Tamiflu Cheap Enough For the Poor
  
• Half in U.S. Don't Trust Feds to Handle Bird Flu
  
• North Carolina Execution Raises Ethical Concerns
  

I Really, Really, Really, Really think People Should be Treated for (... Honey, Who's that Check From?)

Experts Defining Mental Disorders Are Linked to Drug Firms

"I'm Going to Eat the Placenta" Says Father, Insane Movie Star

What more need be said than:

in an interview with GQ magazine a few weeks ago, Cruise announced that he planned to eat the placenta after the child was born.

Cruise said in the article: “I’m gonna eat the placenta. I thought that would be good. Very nutritious. I’m gonna eat the cord and the placenta right there.”

Mission improbable?

This led to more speculation about Cruise’s taste for women, and speculation about whether or not he was joking. We here at The Blogaroni don’t believe what he said for a second. We don’t think he would eat it “right there.” We envision him doing it on a Very Special Oprah show during the publicity tour for his next movie — perhaps in the company of his next girlfriend.

Eating the placenta, it turns out, is not a very normal thing to do by American standards. But it is not unheard of. In fact, there’s even a name for it: placentophagia.

The piece goes on and one about who's going to eat placenta, Donald Trump, Angelina Jolie, Karl Rove. Mmmm.
[thanks Art]

What we are reading today...

• Experts Defining Mental Disorders Are Linked to Drug Firms
  
• Learning to Savor a Full Life, Love Life Included
  
• Ruling Limits Merck's Liability
  
• Brazil and Kenya Press for Neglected-Disease Research
  
• A Dangerous Import?
  
• Drinking Problem? Try Drugs
  
• Seeing Pill-Swallowing No TB Cure
  
• Wal-Mart Offers To Help Fix U.S. Health Care
  
• Benefits Threatened, Auto Workers Line Up for Elective Procedures
  
• Judge: Doctors Not Required To Report Teen Sex
  

Sour Business

Rants Stuart Rennie:

The number of new HIV infections continue to rise, particularly in sub-Saharan Africa, but also in south-east Asia and elsewhere in developing countries. Condom promotion has not stemmed the tide, nor abstinence, nor faithfulness. There is no HIV vaccine in the immediate future. So there is understandably a great deal of interest in novel approaches to HIV prevention.

One interesting line of research leads to ... lemons. For some time, lemon juice -- applied to the female genitalia -- has been used as a relatively cheap, natural contraceptive. Sex workers in Nigeria and elsewhere in Africa use lemon juice as a way of killing potential HIV virus in the semen of their male clients, particularly those who pay more for the privilege of not using a condom. The safety and efficacy of lemon juice for this particular purpose is unknown: for the moment it seems that the concentration of lemon juice that might be effective may be unsafe for women. Findings presented at this month's Microbicides 2006 Conference in Cape Town may provide more answers. Those trading in lemons should take note.

Begging Versus Advertising

Is there any difference between living organ donations being recruited from strangers by "campaigns" to beg for a donor and those where people hear (during sweeps week...sorry...wrong post...see below) about someone needing a transplant an come forward? Metrowest considers the question.

Who Owns What is in the Dish? Wash U, that's Who

St. Louis Dispatch reports that:

A federal judge in St. Louis has ruled in favor of Washington University that donors of tissue samples for medical research surrender control over who uses them...

The decision "runs roughshod on patients' rights," said Dr. William J. Catalona, the prostate cancer researcher who collected the disputed samples. Catalona was a faculty member at the university for 27 years. He established a tissue bank, known as the GU Biorepository, that now includes samples from more than 30,000 men.

When he left to become director of the prostate cancer program at Northwestern University's Feinberg School of Medicine in Chicago, Catalona sent letters to 10,000 patients who had donated blood, tumor samples and DNA for his research. The letters asked patients to write to Washington University and ask that their samples be transferred to Catalona.

More than 6,000 men told Washington University that they wanted Catalona, not the university, to possess their samples.

When Catalona tried to block the National Cancer Institute from using samples from the repository, Washington University filed suit for control of the material and accused the doctor of making misleading statements to patients in his effort to take it back.

On Friday, U.S. District Judge Stephen Limbaugh ruled in favor of the university, declaring it the sole owner of the disputed tissue samples and granting it permission to use the samples for appropriate research, and the authority to transfer the tissues to other institutions.

"I do think it is a big setback for patients' rights," said Lori Andrews, an ethicist at the Illinois Institute of Technology and a law professor at the Chicago-Kent College of Law.

Sweeping Up the Bird Poop

Jason Schwartz, who spends all day long thinking about vaccines now that basketball season is over, emailed to tell us about what has to be the most important movie of the year: 'Fatal Contact', a May sweeps broadcast (that means, for those of you who only listen to NPR and brag about it to your neighbors, a program aired during the month in which some kind of device is activated that measures for networks and advertisers how many morons would actually tune in to watch a made-for-TV bird flu movie) that is ready to go.

And at ABC they stay on top of the news when they make their "scare the hell out of everyone" TV movies:

"We had wonderful consultants who were actually ahead of the [bird-flu] curve," Kerew said. "The way the disease popped up in China, then moved to Turkey and Africa, were things we already knew about."

"Our movie has a character who was in Iraq and got the bird flu there and survived - and, as we were shooting, the bird flu hit Iraq," Verno said.

And ultimately, isn't television supposed to serve the public?

"We feel we're providing a level of awareness and we've gone to great effort to make sure the film is accurate," co-producer Judith Verno said. "We've included a lot of information we believe people need to know."

What I want to know is which ads will run. Maybe we should run a public service announcement for the politics and bioethics conference?

What we are reading today...

• Storm Evacuees Found to Suffer Health Setbacks
  
• Mad-Cow Firewall Has Gaps, U.S. Consumer Groups Say
  
• Inadequate Breast Cancer Screening for Black Women
  
• Screening Boom
  
• In Heart Disease, the Focus Shifts to Women
  
• No Big Changes for Nanotech Regs
  
• Ill-Equipped South Asia Looks Resigned to Bird Flu
  
• Genome-in-a-Day Promised as DNA Is Put Through Hoops
  
• Pregnant Robot Gives Birth All Over the World
  
• At Some Medical Schools, Humanities Join the Curriculum
  
• Patients Seeking Transplants Turn to China
  

Are the Chinese Harvesting Organs from Living Falun Gong?

The Epoch Times, apparently a website of the Falun Gong, reports not only that the Chinese government is harvesting organs from live Falun Gong, but also on the controversy about its reports. There is an eerie lack of specificity in the Epoch Times' report, and a terrifying certitude in the official responses from China Daily. That there are tens or hundreds of thousands of Falun Gong prisoners, however, at any given time in China is not in question.
[San Francisco Chronicle updates the story]

Happy Holidays: How to Turn on a Dime

The CDC is literally doing a 180 on bird flu:

“There is no evidence it will be the next pandemic,” Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention in Atlanta, said of avian flu. There is “no evidence it is evolving in a direction that is becoming more transmissible to people" ...

Gerberding noted that, though the disease has killed “gazillions of birds,” it has killed about 100 people out of about 200 sickened worldwide. The victims were in intense, daily contact with sick flocks, often sharing the same living space. Two people have become infected from person-to-person contact.

She did not say what had changed the thinking of health care officials about bird flu, but said that, at this point, there is “no reason to think it ever will” pass easily between people.

Given those facts, bird flu, like SARS, swine flu and other once widely publicized health threats, might never become a significant human illness.

The visit by Gerberding and the other federal officials was part of a 50-state tour to encourage state and local planning for pandemics, terrorism and other health emergencies.

- Art Caplan

What we are reading today...

• Runners' Bar Codes May Help Health Officials
  
• Chinese Bear Attack Victim Gets Face Transplant
  
• Reaction Time of Bausch Is Questioned
  
• Volunteers to Start Getting HIV Vaccine
  
• Five GM Products Approved as Brussels Overhauls Food Safety Body
  
• Pope Condemns Geneticists 'Who Play at Being God'
  
• New Form Approved for Alcoholism Drug
  
• Medical Data at NYC Jails Enter the Era of Computers
  
• More Britons Have DNA Held by Police Than Rest of World
  
• Print Me a Heart and a Set of Arteries
  
• Smugglers Undercut Fight Against Bird Flu
  
• Do We Still Need the Cartagena Protocol?
  
• Nanotechnology Raises Health Questions
  
  

Not Much Question Where NY Dems Stand on Funding Stem Cells

srcElliot Spitzer unveiled his $1 billion stem cell proposal to the acclaim of a crowd of folks who gathered in an unlikely location (Long Island Jewish Health System) for the announcement. The Times' coverage is thin but essentially he is promising a bond initiative, and the effect of his proposal would be two or three times that of the pending (and not-so-pending) programs in New York State at the moment. On the other hand, if you think the opposition who have tied up the money in California are creative, just wait until you meet the people in New York who tied up law governing decisionmaking by significant others - tied it up entirely, allowing no action at all, so that only Mississippi has a worse family decisionmaking situation - over the question of whether or not fetuses would be protected. It has become clear that even with a balloted initiative the money doesn't flow easily from the states into stem cells, tiny advances against Prop 71 to fund stem cell training grants in California notwithstanding.

Intimate Surgery in Guatamala

This week’s Lancet reports on a troubling development in Guatemala. Approximately 2% of Guatemalan women undergo reconstructive surgery of the hymen to be able to claim themselves as virgins before marriage. This raises ethical issues at a number of different levels. Given that the surgery involves risks without compensating medical benefits, ‘intimate surgery’ conflicts with the Hippocratic injunction of ‘doing no harm.’ What doctor, in good conscience, ought to participate in this cultural practice? And in the Guatemalan context, the surgical risks are elevated: most of the surgeons performing the interventions are not fully qualified, many clinics operate under the regulatory radar, and the women are typically not informed of the potential side-effects of the surgery, including infections, hemorrhaging, fistulas and extreme pain during sexual intercourse. And this is among the women ‘lucky enough’ to afford the $1000 procedure; one can only imagine the social repercussions for those that cannot. (As usual, there is no corresponding community pressure concerning male virginity.)

As Hannah Roberts, the author of the article points out, intimate surgery and the cult of virginity is only a symptom of a larger biopolitical struggle in Guatemala for women’s reproductive rights. A new law backed by a parliamentary majority on family planning and reproductive health could improve the dismal levels of maternal and infant mortality, and women’s knowledge of and access to contraceptive choice. But the new law is opposed by the Guatemalan president, Oscar Berger, and by his influential supporters within the Catholic Church. The Church is unhappy about the prospect of programs giving women the power to control their own pregnancies -- only roughly 40% of women current have ever used any conceptive technique at all. Promoting contraception, the Church claims, is like promoting bullets: it creates a ‘culture of death.’

- Stuart Rennie

Why Do Bioethicists Talk to Industry? Sometimes, Industry Listens

Bloomberg.com reports:

Bausch & Lomb Inc., the maker of a contact lens cleaner linked to a dangerous eye infection, withdrew the product from the U.S. market and offered refunds to consumers.

The action may blunt criticism from securities analysts, marketing specialists and a medical ethicist who said this week that the 153-year-old optical products maker wasn't doing enough to inform the nation's 30 million wearers of contact lenses. Bausch & Lomb shares leadership in the U.S. market for the eye care products with Alcon Inc...

"Bausch & Lomb's first priority is the health and safety of consumers,'' said Chief Executive Officer Ron Zarrella in an open letter that the company said will be in newspapers starting tomorrow. ``If there is a problem with our product, we'll find it and we'll fix it. If there's not, when we come back you'll be able to know with absolute certainty that we've taken every possible step to ensure your safety.''

Zarrella, 56, wasn't available for an interview today, said Meg Graham, a company spokeswoman. The U.S. Food and Drug Administration didn't ask Bausch & Lomb to remove the lens cleaner from the market, she said.

Tom Cruise Does Not Live in New Jersey

From ABC:

NJ Gov. Jon Corzine today signed a bill aimed at helping women with postpartum depression.

Advocates said the measure, which requires health professionals to screen new mothers for pospartum depression and funds an education campaign about the disorder, is the first of its kind in the nation.

"The birth of a child is a time for celebration, but also a time for concern as 80 percent of women in New Jersey experience some form of depression after giving birth,” Corzine said at a bill signing ceremony at Hackensack University Medical Center. “This new law will make postpartum depression screening a requirement rather than an option, and that’s a significant and positive step for New Jersey’s mothers, newborns and families.”

Corzine was joined at the ceremony by former Gov. Richard Codey and his wife, Mary Jo, who raised awareness of the dangers of postpartum depression as first lady.

"I know, first-hand, the grief caused by postpartum depression and it is not something that any woman should have to suffer alone in silence." said Richard Codey, who is state Senate President.

No word on whether the state will be paying for therapy.

What we are reading today...

• The Myth of 'Mood Stabilising' Drugs
  
  
• A Crystal Ball Submerged in a Test Tube
  
  
• Pioneering Surgery on Girl Reverses Heart Transplant
  
  
• Court Backs Briton's Right to a Costly Drug
  
  
• Massachusetts Legislation on Insurance Becomes Law
  
  
• Can a Whites-Only Drug Trial Be Prudent and Scientifically Valid?
  
  
• Doubts Over Safety of Using Lime Juice Against HIV
  
  
• UK's Bird Tests May Be Missing Flu Virus
  
  
• Studies Challenge Traditional Breast Cancer Treatments
  
  
• Mom-and-Pop Drug Testing
  
  
• Judges Set Hurdles for Lethal Injection
  
  
• Schizophrenia Drug Comparison Shows Bias
  
  
• Health Officials Turning to Internet to Fight STDs
  

Huge News Flash - Brace Yourself - Pharma Funded Studies Often Show the Funder's Drug to be Superior!

Stunning news to anyone without a brain: industry funding affects research.

Pharmaceutical giant Eli Lilly and Co. recently funded five studies that compared its antipsychotic drug Zyprexa with Risperdal, a competing drug made by Janssen. All five showed Zyprexa was superior in treating schizophrenia.

But when Janssen sponsored its own studies comparing the two drugs,
Risperdal came out ahead in three out of four.

In fact, when psychiatrist John Davis analyzed every publicly available
trial funded by the pharmaceutical industry pitting five new
antipsychotic drugs against one another, nine in 10 showed that the best
drug was the one made by the company funding the study.

"On the basis of these contrasting findings in head-to-head trials, it
appears that whichever company sponsors the trial produces the better
antipsychotic drug," Davis and others wrote in the American Journal of
Psychiatry.

Calling Dr. Kevorkian. Or Rather, Not Calling Dr. Kevorkian.

What better way to eliminate the problem of using physicians in execution (or rather, having to call off executions because physicians have found an issue on which they will not bend - period): use a machine to do their part in the procedure. Somebody sold North Carolina a bispectral index monitor, designed for entirely different purposes:

"It's not a stand-alone device," said Dr. Scott D. Kelley, the medical director of Aspect Medical Systems, which makes the device and said it inadvertently sold one to a prison hospital in Raleigh, N.C., on Tuesday. "It's another information source. It turns brainwaves into clinically useful information to help anesthesia professionals guide their monitoring of the patient."

Using only the device to discern the potential suffering of condemned inmates, Dr. Kelley said, "is taking a leap of faith I simply cannot endorse."

Dr. Kelley said his company, based in Newton, Mass., took no position on the death penalty or on executions by lethal injection. But the sale of the device on Tuesday was, he said, "a regrettable system failure."

"Any use of this technology that is not in a health care facility is outside the intended use of the technology," he said.

The state is nonplussed; "In its filing yesterday, state officials said that the otherwise unspecified "execution team" would not administer the second or third chemicals until the monitor showed that Mr. Brown was unconscious. Should he awaken, the filing said, more barbiturate would be administered until the monitor again showed unconsciousness."

It's hard to believe anyone would want to pay close attention to executions, because lethal injection is performed so carefully and is so painless, as Adam Liptak reported in today's New York Times:

The three chemicals used in lethal injections in about 35 states have
long attracted attention for what critics say is their needless and
dangerous complexity.

The first chemical in the series is sodium thiopental, a short-acting
barbiturate. Properly administered, all sides agree, it is sufficient to
render an inmate unconscious for many hours, if not to kill him. The
second chemical is pancuronium bromide, a relative of curare. If
administered by itself, it paralyzes the body but leaves the subject
conscious, suffocating but unable to cry out. The third, potassium
chloride, stops the heart and causes excruciating pain as it travels
through the veins.

Problems arise, lawyers and experts for the inmates say, when poorly
trained personnel make mistakes in preparing the chemicals, inserting
the catheters and injecting the chemicals into intravenous lines. If the
first chemical is ineffective, the other two are torturous.

At Last, Congressmen Dumb Enough to Believe William Hurlbut

I really believed that the 15 minutes were over. How wrong I was. Roscoe, Rick and Phil held an actual briefing for Congressional staff to discuss how to do embryonic stem cell research without harming embryos. Altered nuclear transfer, which we prefer to call Semantic Nuclear Transfer to signify that it is stupid nonsense, is going to be all the rage. And Bill, who seems to have acquired something approximating an academic title in Stanford's Neurosciences Institute, helped brief the crowd on the technique we have discussed on this blog ad nauseum:

Dr. William Hurlbut is a physician and a Consulting Professor in the Neuroscience Institute at Stanford. He is a member of the President's Council on Bioethics and the author of Altered Nuclear Transfer, one of the four proposals for a solution to our stem cell impasse discussed in the Council's White Paper. Altered Nuclear Transfer would employ the basic technology of nuclear transfer (SCNT) but with an alteration such that no embryo is created, yet pluripotent stem cells (the functional equivalent of embryonic stem cells) are produced. The scientific feasibility of this technique has been established in mouse models by stem cell biologist Rudolf Jaenisch at MIT. Recent advances in developmental biology suggest promising prospects for this approach and it has received wide support among leading moral philosophers and religious authorities.

Dr. Hurlbut is a strong proponent of legislation to fund these proposals and in a Senate hearing last July described them as providing "one small island of unity in a sea of controversy." At the briefing Dr. Hurlbut said, "Approaches, such as these, that open scientific progress while preserving the most fundamental moral principles, are in the best spirit of positive pluralism and would be a triumph for our nation as a whole."

I swear, this guy should run for office; with so many red states to choose from, surely someone needs a neoconservative willing to lie this blatantly about stem cell research.

Cutting Kidneys From the Poor: It Isn't an Urban Myth

Yes, health care reform is a huge issue in the United States. But it is hard to focus on the 25% of Americans who are under- or uninsured when Yahoo! News reports on something like this, a phenomenon that used to be passed as urban myth, the "Missing Kidney" phenomenon:

The large scars slicing the sides of many Egyptians in impoverished Cairo neighborhoods most probably testify to an illegal kidney sale to a rich fellow countryman or a Gulf Arab who could not find a donor.

"A Saudi patient can pay up to 80,000 dollars split between the doctor, the donor and the go-between," says Hamdi al-Sayyed, the head of Egypt's doctors' union.

"For example, a Jordanian or a Saudi who needs a transplant comes to Egypt accompanied by a relative as an official cover and then looks for an Egyptian or a Sudanese who is ready to sell his organ," he explains.

While most donors are poor and hoping for a better life, not all are volunteers, with grisly accounts of forced organ 'donations' earning Egypt the sinister reputation of 'Brazil of the Middle East.'

Like millions of Egyptians, Abdelhamid AbdelHamid, Ahmed Ibrahim and Ashraf Zakaria were seeking better paid jobs in the Gulf but their quest cost them a kidney.

In a recent interview to the independent Al-Masri Al-Yom daily, they explained how they had been promised jobs but were requested to undergo a medical examination beforehand.

The doctor "discovered" they were all suffering from a kidney infection requiring immediate surgery. They woke up later in hospital with a missing kidney. The go-between had vanished but they feared to speak out.

A few days later, the health ministry caught a trafficker red-handed as he was selling a kidney to a Saudi citizen for 3,500 dollars. The Cairo hospital was supposed to be paid the same amount.

According to the main anti-narcotics body, a kilogram of bango, the popular local form of marijuana, fetches around 100 dollars on the drugs market. But dealers expose themselves to major risks to run their trade while organ trafficking can offer a safer and often more lucrative alternative.

Things Are Just Great in the Bush Stem Cell Program

Wired News reports that:

The leader of the stem-cell unit at the National Institute on Aging, part of the National Institutes of Health, announced today he will leave the NIH to join the private sector at a biotech company called Invitrogen in Carlsbad, California.

Dr. Mahendra Rao says the president's executive order that embryonic
stem-cell lines created after Aug. 9, 2001 are not eligible for federal
funding, is the reason behind his decision to leave the government
agency. He spoke to Wired News...

Wired News: What made you leave the National Institute on Aging to join
Invitrogen?

Rao: In a nutshell, it was because of opportunity. The stem-cell
program at Invitrogen is quite international in scope, and the
regulations on stem-cell work in the United States, particularly for
government employees, are more constrictive than I would have liked.

WN: Can you talk about the restrictions that you faced while working at
the National Institutes of Health?

Rao: The biggest issue was the policy decision -- I work primarily on
embryonic research and the big issue was that we could work only on a
limited number of lines that had been derived before Aug. 9, 2001. The
number of available lines is quite small and I felt we needed to be
working on a larger number of lines -- at least on lines that carried
certain characteristics that were derived subsequent to that deadline.

And this is the guy the Bush people wanted.
-thanks Art Caplan

Bioethics & the Scientific World Conference in U.N. Plaza

The program is out for the IHEU/Appignani Center for Bioethics/Genetics Policy Institute/Alden March Bioethics Institute "Is There a Global Bioethics? Moral, Legal, and International Norms in Bioscience" conference April 21-23rd in New York City at the U.N. plaza offices of the Center. From the press release:

The conference will involve more than two dozen major speakers who will discuss the entity of bioethics and its place in the scientific world through paper presentations and panel discussions.

Topics in the panel discussion include: stem cell research, genetic engineering and human rights, reproductive and sexual rights of women, the United Nations as a forum for bioethics, intellectual property in global bioscience, ethical issues in infectious disease control, and the challenge of evolutionary theory.

The conference will open with a cocktail reception for which you must RSVP (by calling Ana Lita at (212) 687-3324 or by email at AnaLita@iheu.org), from 6:00 p.m. - 9:00 p.m., taking place at the Turkish Consulate General, Culture & Tourism Office located on 821 United Nations Plaza in New York City with the following speakers:

Arthur Caplan is currently the Emmanuel and Robert Hart Professor of Bioethics,
is also the chair of the Department of Medical Ethics and director of the
Center for Bioethics at the University of Pennsylvania at Philadelphia.

Johan Scholvinck, Ph.D. is currently Director of the Division for Social Policy
and Development of the Department of Economic and Social Affairs (DESA). He has
held positions in the UN Secretariat for population and development policy, and
Chief of the Policy Coordination Branch in the Division for ECOSOC Support and
Coordination. He is responsible for cooperation on issues of aging, persons
with disabilities, youth and the family and support for the UN Commission on
Social Development, ECOSOC, as well as the General Assembly Second and Third
Committees. Dr. Scholvinck holds M.S. and Ph.D. degrees in Economics from
Cornell University, USA and is a national of The Netherlands.

Paul Kurtz, professor emeritus of Philosophy at the State University of New York
at Buffalo, is a former co-president of the
International Humanist and Ethical Union (IHEU). He is the editor in chief of
Free Inquiry magazine.

The main discussions will
take place on Saturday, April 22 and Sunday, April 23, 8:30 am - 3:30 pm at
777 UN Plaza, 2nd Floor, NYC, NY 100.

We're All Manic: The Selling of Bipolar Disorder

PLoS medicine has a great, great, great series of articles out today on, well, as you can see, "disease mongering." Among the more controversial articles is a piece by David Healy on the increasing diagnosis of mood disorder. He attacks his favorite company, and there's been lots of discussion of a piece published on the role of David Healy in similar debates about antidepressants. But the piece in PLoS is the most pointed critique of mood disorder marketing yet to appear in the literature.

Science or Sizzle?

Washington Post dignifies snake oil this morning, in the form of "black vitamins." There is some fact here - there are well known differences between populations of humans (or worms for that matter) that we can see (their phenotype) and we know that they come in part from genes (their genotype). But it takes more to treat people based on how they appear than just bad guesses about how to identify and respond nutritionally to their genes. And seriously, even good mass-market "maintenance" vitamin products aren't that good.

BiDil didn't go very well, and it was based on good guesses. A good guess is that this will not only be unsuccessful as a product, because it is like selling stigma, but also that it may well confuse the public at large about vitamins and what they can and can't do:

The GenSpec brand of dietary supplements, proclaimed to be the "first genetically specific product line," aims distinct products at blacks, whites and Hispanics, and at men and women within each group.

GenSpec's multivitamins for African American and Hispanic males and females, for instance, contain higher amounts of vitamin D because, the Florida-based maker of the products says, the skin of darker-toned people doesn't make as much vitamin D from the sun as that of lighter-skinned people.

Unique "physiological and metabolic differences" can make certain groups more likely to develop some diseases, said Joseph Lander, president and founder of GenSpec. The small company, which also sells race-targeted weight-loss pills, bases its products on research into key racial health distinctions, Lander said. The company plans to start selling an Asian multivitamin in the next month.

What we are reading today...

• In End Run Around Legal Challenge, California Gives Out Stem Cell Research Grants
  California's program to study embryonic stem cells awarded its first round of grants Monday, drawing on money put up by state business leaders trying to move the program forward despite legal challenges.
  
  
• Saying No Is a Patient's Choice, However Risky
  Over the last several years, researchers have begun to study how patients balance the risks and benefits of proposed interventions.
  
  
• Drug Firms Accused of Turning Healthy People into Patients
  Eleven new studies, published in the journal Public Library of Science Medicine, accuse the pharmaceutical industry of "disease mongering" - a practice in which the market for a drug is inflated by convincing people they are sick and in need of medical treatment.
  
  
• Rule Demands Proof of Citizenship for Healthcare
  Almost all of Massachusetts' poorest residents will have to show proof of US citizenship to continue getting medical care by July 1, under a little-noticed federal law that could endanger coverage for many, as the state is trying to expand access to healthcare.
  
  
• Science or Sizzle?
  A dietary supplement-maker is aiming distinct product lines at blacks, whites and Hispanics, saying their products target race-based biological differences. Some experts say it's only a marketing gimmick.
  
  
• Regrow Your Own
  Stem cell therapy has long captured the limelight as a way to the goal of regenerative medicine, that of repairing the body with its own natural systems. But a few scientists, working in a relatively obscure field, believe another path to regenerative medicine may be as likely to succeed.
  
  
• Top Government Stem-Cell Scientist Quits
  Thanks to restrictive stem-cell regulations, one of the United State's top medical researchers is leaving for a job with a private biotech company.
  
  
• 'Uppers' Affect Men More Powerfully
  Amphetamines have a stronger effect on men, a finding that may help explain patterns of addiction and why Parkinson's and Tourette's strike them more often
  
  
• Abortion Pill Ruled Out in One Woman's Death
  ealth officials said Monday they have ruled out the abortion pill RU-486 in one of two deaths in women who had taken the drug. The second remains under investigation.
  

Disclose Diabetes Information in New York City? Caplan Says No.

New York Daily News asks the question as to whether the incredibly imaginative new idea the City has employed will work, is smart and is ethical. Caplan weighs in on the latter:

I love it when government agencies take action to prevent a real problem. Thus, I should love the fact that the city Department of Health as of last January requires medical labs to report your name to them if a test shows you are at risk of diabetes. But this is a public health program I don't like at all.

I recognize the plague that diabetes has become. Only 15 years ago, 1 in 10 New Yorkers was obese. Now it is 1 in 5 and climbing. The health-care costs of a diabetic are three times those of someone who is not. The toll the disease takes in premature death, blindness, immobility, pain, amputations and absence from work is beyond belief.

The numbers tell a story that demands a response. But the response should not be a letter from the health department.

The program is pretty mild. If you turn up positive for diabetes, the health department does not come and padlock your refrigerator. Someone simply calls or writes to let you know you're at risk. And you can send a form if you want them to leave you alone. You are still free to gobble up another pint of Haagen-Dazs.

But the precedent of having the health officials get your confidential medical information to contact you is simply too frightening to contemplate. Imagine the letters clogging your mail box as they write you to sleep more, stop drinking, lay off the marijuana or to get a condom on those private parts before heading out into the wilds of the city.

Even worse, they are generally writing to people whom no doctor will treat because they are covered by Medicare or Medicaid, who have lousy health insurance or who have no health insurance at all.

Writing warning notes to diabetics has the problem backwards. Our government needs to get us a health-care system that works and get our butts into it. Then they can start writing us hate mail if they think our backsides have grown too big. Anything less is just, well, sugarcoating.

How Drug Study Volunteers Became Elephant Men: The Informed Consent Form Now Revealed

Bloomberg news is the first to have gotten a look at the informed consent form in the Parexel sponsored trial in the UK in which 6 subjects had adverse reactions. The consent form had major deficiencies--certaintly worthy of further inquiry by British regulatory authorities.
- Art Caplan

Salt in the Wound

If Mohandas Gandhi were alive today, Glenn McGee argues in The Scientist, he would lead a march on Indian pharmaceutical research organizations, where the oppression of Indians is every bit as terrible as was the imperialism of the British:

In March 1930, Mohandas Gandhi set out from his ashram in western India on a 387-km trek to the sea. Twenty-five days later the tens of thousands who joined that march watched as he stooped, raised a handful of salty mud, and declared the end of British imperialism in India. The march culminated as Gandhi led nonviolent protesters to the doors of the salt factory in Dharasana, where they attempted to push their way into the facility without weapons or raised fists. On that hot day hundreds were beaten, a spectacle that would make its way into newspapers worldwide and change the face of India forever.

If Gandhi were alive today, he would lead protesters to the doors of a clinical research trials facility, where the oppression of the Indian poor dwarfs that of the 1930s. Why? Not because Gandhi was a Luddite, a man who held meetings while spinning thread. And not because many of the excellent research institutions that have led India into its embrace of multinational bioengineering and medical research bear his family name.

No, the problem for Gandhi would be the outsourced clinical trials that have enrolled tens of thousands of Indians in a $1 billion business aimed not at the improvement of Indians’ health or technology, but at providing deep discounts to pharmaceutical companies in other nations.

It is a perfect storm: The number of open slots in clinical trials around the world increases, the number of Americans willing to enroll in such trials lags (as few as 1.7% of patients with cancer), and the cost of clinical trials in India is half that in the United States. It is no surprise that American and European pharmaceutical companies are fanning out across the second most populous nation in the world...

Read the rest of this essay here [subscription required].

What we are reading today...

• Schools Will Shut in 100,000 Flu Death Fear
  Bristish government officials are drawing up plans for widespread closure of schools to halve a potential 100,000 deaths among children in the event of an avian-flu pandemic.
  
  
• Exercises in Fertility Can Be Very Unpleasant
  Every year, millions of American couples try to get pregnant, and every year thousands fail. For a vast majority of these couples the first step in their treatment is clomiphene, a drug that is effective and inexpensive. For as many as 30 percent of patients, it will solve the problem. But also for many, the side effects leave a lasting impression.
  
  
• Science and Religion, Still Worlds Apart
  Should believers be encouraged when a miracle is corroborated by science, or disappointed that it might have been the outcome of natural forces?
  
  
• Healing Rooms Embrace Prayer
  Trained volunteers pray over the sick in a modern-day faith-healing ministry practiced in storefronts and conference rooms. Does it really help?
  
  
• New Online Resource Guide To Help Bulimia Sufferers
  Funded by a $300,000 grant from the Hilda and Preston Davis Foundation, the nonprofit ECRI has recently launched an online bulimia guide to provide everything a person needs to know — from how to recognize the problem in a loved one to how to evaluate insurance plans and treatment options.
  
  
• Factory farms in Asia Blamed for Avian Flu Pandemic
  The insatiable demand for cheap food, the global poultry industry and the giant factory farms of south-east Asia have been blamed for spreading avian flu around the world.
  
  
• Sides React To F.D.A. Study Rule
  The pharmaceutical industry applauds the Food and Drug Administration's decision to evaluate its process for phase 4 commitments, but analysts and consumer advocates don't think any significant changes will come out of the review.
  
  
• Drug Plan's Side Effect Is Severe
  With the new Medicare drug program, thousands who take pills to fight cancer have found themselves with new bills to pay for their essential medicines.
  
  
• British Rethinking Rules After Ill-Fated Drug Trial
  Although tests of TGN1412 in monkeys showed no significant trouble, all six human subjects nearly died. In response, the British government has announced it was convening an international panel of experts to "consider what necessary changes to clinical trials may be required" for such novel compounds.
  
  
• Nanotech Raises Worker-Safety Questions
  No U.S. worker-protection rules yet address the specific risks of exposure to nanomaterials.
  
  
• Beyond Swollen Limbs, a Disease's Hidden Agony
  Lymphatic filariasis, a disease that causes lymph nodes to swell is not curable, but health experts hope to eliminate the disease within a generation.
  
  
• Secret Plan by the British NHS To Ration Patient Care?
  Patients are being denied appointments with consultants in a systematic attempt to ration care and save the NHS money. Leaked documents show that while government officials promise patients choice, a series of barriers are being erected limiting general practitioners' rights to refer people to consultants.
  
  
• Study: 9/11 Escapees Have Health Problems
  A majority of survivors of the 2001 attacks that destroyed the World Trade Center suffered from respiratory ailments and depression, anxiety and other psychological problems up to three years later, federal health officials said Friday.
  
  
• Nanopatterns Guide Stem Cell Development
  Stem cells can be prompted to grow into bone, instead of muscle or cartilage, purely by placing them on a nano-etched surface – with no added chemicals
  
  
• Over-The-Counter Fat Blocker Gets Tentative OK
  GlaxoSmithKline has received conditional approval for over-the-counter sales of the weight-loss drug Xenical, a Food and Drug Administration spokeswoman said Friday.
  
  

Convicted Felon Charles Colson Weighs in on Fraud in Science!

The answer to the stem cell scandal is simple - and you can find it in the Florida Baptist Witness - at the end of the day it is "Christians and other pro-life citizens with the task of bringing some honesty to a field where following the money leads from the lab to the corporate boardroom. The next time politicians try to push for more funding of embryonic stem-cell research, ask them to follow the money."

This was not the line Colson used when he was Chief Counsel for President Nixon.
- Art Caplan

What we are reading today...

• Mass. Health Care Plan Riles Some Liberals
  he most radical portion of Massachusetts' move toward universal health care - a requirement that all residents carry insurance - is giving indigestion to some who view it as a breathtaking expansion of government power.
  
  
• Vaccine Hailed as 80% Guard Against Cervical Cancer
  The cervical cancer vaccine could be even more effective than previously thought, giving protection against the sexually transmitted infections that cause 80% of all cervical cancers, scientists say today.
  
  
• F.D.A. Plans to Intensify Oversight of Heart Devices
  The Food and Drug Administration plans to strengthen how it monitors critical heart devices like defribrillators by appointing outside medical experts to help it review the safety of units already on the market, a top agency official says.
  
  
• F.D.A. OKs first attention deficit patch
  The Food and Drug Administration on Thursday approved the first skin patch to treat attention deficit hyperactivity disorder in children.
  
  
• Safety Checks on GMOs Flawed: E.U. Environment Chief
  Europe's environment chief attacked the EU's top food safety agency on Wednesday for flawed risk assessments of genetically modified (GMO) crops and foods, saying it relied too much on data given by the biotech industry.
  
  
• Scientists Cleared of Blame For Drug Trial That Went Wrong
  Tough rules are to be introduced for drug tests on people after an interim report on the disastrous trial at Northwick Park Hospital found no evidence of human error, contamination or failure to follow protocols.
  
  
• How AIDS in Africa Was Overstated
  Years of HIV overestimates, researchers say, flowed from the long-held assumption that the extent of infection among pregnant women who attended prenatal clinics provided a rough proxy for the rate among all working-age adults in a country.
  
  
• Deadly Bird Flu Invades Britain
  Tests have shown that a wild swan found dead in Scotland had the lethal H5N1 strain of bird flu, the British government said on Thursday.
  
  
• Vioxx Jury Splits in Suits by 2 Heart Patients
  A New Jersey jury ordered Merck & Co. yesterday to pay $4.5 million in the case of a man who blamed the firm's Vioxx painkiller for his heart attack, but rejected a similar claim from a second plaintiff who had taken the drug for less time and suffered less severe damage to his health.
  
  
• Access To Drugs: A Suitable Case for Treatment
  Increasing access to affordable drugs in developing countries requires better government intervention, not less of it.
  
  
• Drug Trial Horror - The Official Interim Report
  The "unprecedented" reaction which left six men fighting for their lives was not due to dosing errors or contamination, but the effects of the drug itself
  
  
• Nanotech Product Recalled in Germany
  Government officials in Germany have reported what appears to be the first health-related recall of a nanotechnology product, raising a potential public perception problem for the rapidly growing but still poorly understood field of science.
  
  
• Article on Bird Flu Criticizes Effort to Monitor Cats and Dogs
  Five leading European scientists think officials should better monitor cats, dogs and other carnivores for their possible role in transmitting avian influenza.
  
  

What we are reading today...

• Childhood TV and Gaming Is 'Major Public Health Issue'
  These media should carry a health warning, argue researchers, who claim research shows exposure can increase obesity, tobacco and alcohol use, risky sex and violence.
  
  
• Thorny Legal Issues in Case of HIV in Marriage
  The California Supreme Court will sift through the ruins of the marriage of an AIDS-infected couple today to decide what information partners must tell one another about past high-risk sexual activity.
  
  
• 'African Law' Needed To Protect Traditional Medicine
  The African Union and World Health Organization should draft a law that African nations could use to protect traditional knowledge, say local experts.
  
  
• GAO Criticizes Bush's AIDS Plan
  The requirement that a large fraction of President Bush's global AIDS plan go to promote abstinence and fidelity is causing confusion in many countries and in a few is eroding other prevention efforts, including ones to reduce mother-to-child transmission of the virus.
  
  
• Health Insurance May Be Mandatory in Mass.
  Lawmakers overwhelmingly approved a bill Tuesday that would make Massachusetts the first state to require that all its citizens have some form of health insurance.
  
  
• Tonsil-Adenoid Surgery May Help Behavior, Too
  Researchers have found strong evidence that adenotonsillectomy — the surgery to remove the tonsils and adenoids — can help relieve childhood behavioral or attention problems, including attention-deficit hyperactivity disorder, or A.D.H.D.
  
  
• Vaccine Best Tool To Combat Bird Flu Outbreak
  A recent study suggests that the most effective way to combat an outbreak of bird flu in people would require a rapid and aggressive vaccination campaign as soon as the outbreak began, even if the vaccine wasn't a perfect match.
  
  
• Siblings of Disabled Have Their Own Troubles
  Many support outlets are intended for disabled children themselves or for their parents, often leaving their siblings overlooked. Those children face many of the same challenges — and joys — as their parents, but they also face other problems.
  

The Zuma Trial: Insight into HIV

The American media has understandably been closely following the court proceedings of Zacarias Moussaoui, the only person indicted in the September 11th attacks. Southern Africa, however, has been riveted by another legal case lately: the trial of Jacob Zuma, former South African Deputy President. The 62 year old politician, once regarded as a future Presidential candidate for the African National Congress, is accused of raping a 31 year old AIDS activist.

As with anything to do with AIDS and politics in South Africa, there is no shortage of weirdness. Before the trial started, Zuma’s followers already deemed the rape accusation a political conspiracy, a vile attempt to discredit a leader described as a ‘man of the people’ and ‘Mr. Nice Guy.’ Supporters of Zuma have jeered and heckled his female accuser every time she has arrived at Johannesburg High Court. During the time leading up to the trial, the otherwise happily married Mr. Zuma has vigorously denied the rape charge, taking the moral high road by claiming that he and the woman in question merely had consensual sex. Or rather: knowingly had consensual sex with an HIV positive woman. Or rather: knowingly had consensual sex with an HIV positive woman without a condom.

Yesterday saw Zuma take the stand to be questioned by the state prosecutor. The prosecutor asked a simple question independent of the rape charge. Why, the prosecutor asked, would the previous head of the South African AIDS Council and the Moral Regeneration Movement have unprotected sex with a woman he knew to have HIV? His answer was noteworthy: the risk of acquiring HIV through unprotected sex with a woman, he stated, is small for a healthy man. “I had the knowledge that …chances were very slim that you could get the disease.” As for his own HIV status, Zuma stated that he knew he was HIV negative, and besides, he ‘had a way of having sex that protected him from infection.’ Not wanting to give the wrong impression at this point, Mr. Zuma told the court that he regularly uses condoms, a piece of information that may be reassuring both to the nation and to his four wives.

Mr. Zuma’s statement offers a peek into the understanding of HIV/AIDS among the highest political circles in the country with the most HIV positive persons in the world. As is well-known, South Africa has a President with a soft spot for rogue scientists who deny that HIV causes AIDS, and a Health Minister who is convinced that garlic and local herbs are just as good at controlling clinical AIDS as antiretroviral drugs. Now South Africa has a political leader with a bold new vision of HIV prevention: just be a healthy guy, and do it in a special way, and you’ll be fine. The trial is ongoing, so stay tuned for lurid revelations and creative approaches to HIV/AIDS.
- Stuart Rennie

Everyone In Massachusetts Will Have Health Insurance

This afternoon Boston lawmakers approved a bill overwhelmingly that will require health insurance of all citizens. Note the language: citizens are required to have it:

The plan — approved just 24 hours after the final details were released — would use a combination of financial incentives and penalties to dramatically expand access to health care over the next three years and extend coverage to the state's estimated 500,000 uninsured.

If all goes as planned, poor people will be offered free or heavily subsidized coverage; those who can afford insurance but refuse to get it will face increasing tax penalties until they obtain coverage; and those already insured will see a modest drop in their premiums.

Art Caplan who sent this one along writes "hooray, hallelujah and huzzah! Sometimes my home state makes me very proud!"

The Boy in the Bubble

PBS American Experience will air what promises to be an extraordinary documentary by WGBH about David Vetter, the boy in the bubble, to be followed by a panel discussion.

Culture Dish on Vindication of Baby Experiment

Culture Dish is a blog I hadn't seen before, but she wrote us to say she likes our blog and there's this great post there, but I found her so fascinating that it was 20 minutes before I finished reading her CV and sample work. Wow. Anyway the post begins:

Eight years ago, two UK doctors were suspended from their posts for using an experimental treatment on babies in respiratory distress. Instead of intubating the infants (which is standard practice but can cause damage), they used something called Continuous Negative Extrathoracic Pressure (CNEP), which involved putting a box over the baby's chest to create a vacuum that helps the child expand it's lungs and draw in air. In 1998, two years after they published their research, the doctors became the focus of a governmental inquiry because parents complained that they hadn't consented to the use of experimental treatments on their children. The doctors were suspended, the investigation took years -- it uncovered problems with the trial, but the hospital challenged the parents' complaints, saying they couldn't prove they hadn't been told. Then the whole thing seemed to fade away ...

Virtual Virus

AMA's Virtual Mentor, an online journal that is very very well put together - perhaps because they seem to have twice the staff of any other bioethics journal - has a fabulous new issue that features a number of essays on epidemics and the ethics of working thereon, one particularly good by Marty Strosberg.

Karama Neil Talks to Schering-Plough About the Study that Bans Blacks

In her Open Letters blog, which I hadn't seen before but which is a very cool idea, Karama talks to representatives of Schering-Plough about their trial and concludes:

My current research focuses on ethical and scientifically-responsible uses of race in biomedical research. The information I have suggests that this is not an ethical or scientifically-responsible use of race. As I noted in the original letter, defining 'race' is a complex issue that cannot be accomplished using only biological or scientific means. That makes the concept of 'race' particularly difficult to use in biomedical research, especially since it is a very real social concept that correlates strongly with certain health indicators. It is my position that this study, like many others, misuses the concept of 'race'.

Don't Lose Your Mind Over Avian Flu

Avian flu as a low risk but high impact public health problem has commanded quite a bit of policy attention in recent months. Oddly, the fact that our health care system in the USA is in tatters and that we really don't have much in the way of a public health infrastructure to combat good old standard flu or any other infectious problem has not gotten much attention. This article helps put avian flu in its proper perspective.
- Art Caplan

How the Biotech Tail is Wagging the Pig

The last guest post from Dr. Autumn Fiester of Penn stirred up a fuss (as she wrote, "The last blog I did for you on pet cloning was clearly the most widely read piece I have written and it is being reprinted into two different volumes (it's a hell of a blog you've got going!!"). So when she sent us a guest post on piggie biotech based on her interview on NPR, we jumped into the slop. Here's Autumn:

The new omega-3 pig is the perfect example of what is terribly wrong with American animal biotech research: scientists pursue whatever interests them, and then they try to find a problem for which their results can be hailed as the solution. Instead of having the animal biotech agenda driven by the public’s true needs and values, we have an agenda-less agenda, with individual research teams expending vast resources on frivolous projects the public doesn’t want or need. The backdrop here is that Americans are, at this point, overwhelmingly opposed to this science, and much of this research is federally funded, so the American people actually pay for the research through their tax dollars. We need a biotech strategy that serves the public’s collective interests and conforms to their values.

For the majority of Americans, we could stop right here. Given the level of opposition to this research, this is all the argument they need to demand more federal planning and regulation. But you might say of the super-pig, “So no one will buy them or eat them. Scientists learned a little something. What’s the harm?” Let’s lay it out.

First: the omega-3 pig represents the worst type of “research waste:” precious scientific resources of