August 2007
New, No Interest Loans - From Your Doctor
Soon, mixed in with those continual mail offers for new credit cards, you might find a new kind of no interest loan being offered: one to cover that expensive piece of plastic surgery, cosmetic surgery, Lasik, or dental work you cannot afford out of pocket, and your insurance doesn't cover.
Eager to tap into a willing market of consumers who are already accustomed to credit card debt, more than 100,000 dentists and doctors are offering financing for patients customers who want services but cannot afford the upfront, out of pocket fees. And like most other credit card situations, the terms are attractive, as long as you don't miss a payment.
But directly involving a doctor with the financing of a patient's medical care, while perhaps a practical necessity in an era of low insurance coverage and high deductibles, seems to continue changing the doctor/patient relationship away from its traditional dynamic and towards one of consumerism, where a client finds a provider to perform services for a fee. The doctor moves from being a (hopefully trusted) adviser and partner in your healthcare to being the person willing to perform what it is you want done, a for-hire specialist.
And the for-hire is important to note; these no interest loans are only available to those with good to excellent credit. This means that the loans offer no help to those who most need it, the 47 million uninsured Americans whose difficult financial situations make them ineligible for the loans.
-Kelly Hills
What do Bacteria have to do with Albert Einstein's Theory of Relativity?
Tattoos are only skin-deep, and, besides, we are as yet unable to pass these inky imprints on to our offspring. So why not imprint a message directly onto our DNA -- DNA which is not utilized in composing our genes, that is -- and have these messages translated to hundreds and thousands of our descendants? This idea is not so far from reality. A team of Japanese geneticists, led by Masaru Tomita of Keio University, successfully wrote -- in code -- Albert Einstein's theory of relativity into the genome of a bacterium. The purpose? To demonstrate that DNA is the ultimate information storage material.
"While ink may fade and computers may crash, bacterial information lasts as long as a species stays alive -- possibly a mind-boggling million years," MSNBC paraphrases Tomita.
Approximately 97% of the information contained within the human genome has nothing to do with the miniscule remaining 3% that actually creates the genes that make us what we are. All this leftover DNA -- referred to as "junk DNA" -- could potentially be a receptacle for whatever information we wish to store and preserve for, well, a long time. Will people want to have something written in the idle DNA of their cells? Perhaps mom would like to chart the Smith family tree. Maybe Uncle Alabaster would like to preserve the greatest symphonies of the eighteenth century. Maybe we want to project our contemporary knowledge into the future -- far into the future -- so that we can believe that what we do now matters, and will continue to matter, to those descendants of us who still bear our written code.
Or perhaps we will be wary of meddling with our own DNA. Maybe we will not be convinced that our junk DNA is really junk after all.
Since it has been shown that various mammals share many identical stretches of "junk DNA", some scientists tend to believe that whatever the function of junk DNA, for it to have been preserved for 400 million years, it is clearly of some kind of importance. In order to protect our own human genomes, perhaps instead we will record our manifestos in the genomes of insects. Maybe a new posh trend of the future would be ant colonies with ants who actually contain the knowledge of our human ancestors. Perhaps bacterium will contain religious scripts, famous literature, and scientific writings, as part of their own junk DNA. Should we "go there"? Should we manipulate the genomes of other lifeforms to serve our purpose? Should we be allowed to turn curious grasshoppers into filing cabinets and cuddly caterpillars into the newest form of the compact disc?
Still another question Masaru's experiment raises: Are there messages already written in the vastness of our junk DNA? Perhaps in the not-so-distant future, people will be paying large sums of money to figure out what their noncoding-DNA "says". And will they be able to find messages -- written by God, aliens, or what-have-you? Probably -- those who seek will often find exactly what it is they are looking for (just like Jim Carrey's character in the movie The Number
23. Will religious figures find hidden messages from God? Will others find messages from the cosmos? Will still others place blame for their actions on the messages mysteriously encrypted in their DNA? Perhaps, perhaps.
And perhaps extraterrestrials will discover our planet at some point in the distant future and discover Stephen Hawking's A Brief History of Time in our DNA. Or maybe they'll merely read I Am The Walrus. Only time will tell.
-Kristy Kolb, AMBI Bioethics Intern
Genetic Testing for Disease Predisposition
Along the lines of Greg's post about genetic predisposition testing, I thought folks might be interested in knowing that the Social and Behavioral Research Branch of the National Human Genome Research Institute at NIH is conducting a study to better understand how the public is going to react to offers for high-quality genetic testing for predisposition to late-onset genetic disease (like cancer, heart disease, and diabetes). Research questions include how best to communicate the test results to participants, what to say about the meaning of the test results, and what kind of health care or life style advice to offer. With GINA (the genetic non-discrimination act) still pending in the Senate, we were also interested in knowing whether fear of insurance discrimination was a reason for declining to participate in the study. I spent the last two years working with the research team to develop this protocol, and it is now in the field and public. You can learn more about the Multiplex Initiative through an ABC report on the study. And, you can ask the PI, Colleen McBride, question about the study at here.
-Andrea Kalfoglou
More on Forced Abortions in China
The AP had published a follow-up report on forced abortions in China.
While Chinese sociologist, Zhai Zhenwu, reports that draconian measures to limit China's population have declined since 1993, one couple is suing the government for essentially kidnapping Jin Zhongchen in her 7th month of pregnancy, forceably injecting her with a poison, and then delivering her dead baby with forceps. The event left Jin sterile. Chinese courts have thus far thrown out Jin's case because she and her husband were not married at the time the baby was conceived. Human rights advocate, Chen Guangcheng, who spoke out against the forced abortions is now serving a 3 1/2 yr prison sentence for "inciting a mob."
-Andrea Kalfoglou
Attention, Planet Destroying Carnivores
Car or chicken? Which one contributes more to global warming?
The answer might surprise you, but it's the chicken. More specifically, it's the raising of meat for human consumption, which apparently contributes more to global warning than all sports utility vehicles combined. And in fact, according to a United Nations Food and Agriculture Organization report, raising livestock for food generates more greenhouse emissions than all forms of transportation.
Now, animal rights organizations are pooling their efforts to get this information out, with media surges and PETA-typical tactics, such as dressing someone up in a chicken suit to drive a Hummer, with a banner proclaiming meat the number one cause of global warming, with the attached message that in order to go green, you must also go vegetarian. PETA has gone so far as to say that you simply cannot be a meat-eating environmentalist.
Other organizations take other tactics. The Humane Society highlights the benefits of vegetarianism, including multiple studies saying that "switching to a plant-based diet does more to curb global warming than switching from an S.U.V. to a Camry," while the Sierra Club goes for a more moderate, non-alienating message encouraging efficiency and green behaviour without castigating. Hank Stewart, senior copywriter at Green Team Advertising, explains the rationale behind this as "using global warming as a tactic for advancing the cause of vegetarianism feels a bit opportunistic," and questions the logistics of having "a supermarket [announcing] 'Attention, Planet-Destroying Carnivores' on the in-store radio?"
Regardless of how or what you eat, the fact of the matter is, you do eat. And how you eat is now becoming not only a political statement, it's becoming an ethical one that has moved beyond animals rights and is now about much, much, more. Do you eat local? Organic? Vegetarian? Forage? Raw food? Are you an obligate omnivore? These questions are moving away from announcing your thoughts on how animals should be treated, and are becoming an interconnected, global issue.
The omnivore's dilemma is not only about following food from farm to table, but is about how that very farming itself is done, and what extended effect the growing, shipping, and packaging of food - be it omnivorous or otherwise - has on the global environment.
-Kelly Hills
Two Years Past, Has Anything Changed?
While conservative and liberal thinkers might continue to disagree about familiar ethical issues like suitable limits on enhancement technologies, they should find common cause in the need to care for a fragile and increasingly ailing planet. ...[H]uman happiness and well-being is dependent upon a complex ecological system in which we are all inextricably linked, a system in which we are all actors and patients, doers and sufferers. We ignore these brute facts at our peril. -Jonathan Moreno, AJOB 5(5)
August 29 marked the two year anniversary of Hurricane Katrina. Trials are on-going, other cases never made it to a grand jury. Only 10% of the 70,000 destroyed homes have been rebuild; half of the temporary FEMA trailers provided are still in use.
When I was at ASBH last year, I met and ended up talking to a physician from New Orleans who had stayed through Katrina, trying to practice medicine from the hospital roof, parking lot, anywhere he could. He had attended sessions on disaster ethics, preparedness, what we learned from the wake of Katrina, and I remember most clearly his anger. Anger at being reduced to numbers, sure, but mostly anger at being forgotten.
For a short time after Katrina, disaster prep was the hot trend. It was sexy, it was timely, it had glamour attached to it, and disaster ethics followed with it. But the winds changed, we became preoccupied with other things, and focus shifted.
So now where are we, where is the Gulf Coast, and has anything really changed? Are we, as bioethicists, as public health workers, doctors, nurses, politicians, communities, individuals, any more ready to handle a disaster on Katrina's scale? How can we be, when it doesn't even seem like we've figured out how to pick up the pieces.
-Kelly Hills (with thanks to G. Williams for the reminder)
Should I sell my eggs?
Via Art Caplan comes this pointer to a first-person piece by Jill Colvin in the New York Press about egg "donation." Here's a snip:
While Julia's repeated donations were beyond anything that I could imagine, as a self-declared feminist, the idea of taking charge of my body was appealing. I would be desexualizing conception and motherhood and taking charge of my own fertility, which seemed like an empowering idea. To be honest, the thought of altruistically fulfilling the dreams of a desperate, infertile couple didn't seriously enter my mind until a social worker at the fertility clinic I visited asked me why I was interested in donating my eggs “other than the money,” and I was forced to muddle together a heartfelt story about knowing a woman who had had difficulty conceiving and about how I wanted to bring joy to the world. Nonetheless, that all sounded good, too.
But my initial excitement and visions of empowerment soon began to fade as I learned that the process was far from the simple one promised on agency homepages. The risks were frightening, with potentially devastating consequences (see sidebar page 15). Most telling, however, were the pages and pages of photographs of young, attractive women who were featured on numerous online donor catalogues for potential recipients to choose from. The women's names, heights, bodyweights, hobbies and IQ scores were listed, with price tags all but stamped onto their foreheads. Some even included asking prices and donor status. It was like flipping through a human Sears catalogue, and I felt uncomfortable with the idea of gracing its pages.
Does she end up donating? You'll have to read the rest to find out. Interesting fact reported by Colvin: in New York City the going price for eggs is currently about $8,000.
Paying -- or not -- to keep fat off in the future
While we're all talking about how -- and how much -- to pay for medical care, here's one more item to chew on. If obesity can be caused by a virus, then it might also be prevented with a vaccine. And if a company ever develops one, imagine that marketing campaign. And the fight over how much the vaccine should cost, and who should pay for it.
Of course, the cost-savings in the long-term could be enormous.
-Greg Dahlmann
Calling "Not it!" on paying for the genomics revolution
The Economist recently reviewed the rapidly growing field of individualized genetic testing and personalized medicine. It covered a lot of the usual questions about privacy, but the article is primarily about health insurance. The short story: the promise of genetic medicine has insurance companies a little worried. Why? They figure that future legislation will prevent them from offering coverage on the basis of a person's genes (or maybe even family history), but it won't prevent people from opting in or out of insurance based on their gene-forecasted future -- and that will upset the risk pools. This projected situation even leads one insurance executive to speculate that personalized medicine will necessarily result in some kind of universal or compulsory healthcare system.
Think about that for a second: universal healthcare could come to be in this country not for moral or social reasons, but rather to save... insurance companies.
-Greg Dahlmann
CNN: DA never called medical experts to testify in Katrina hospital deaths
In July, a grand jury decided not to indict one doctor and two nurses on second degree murder charges that they had taken actions to kill patients in their care at New Orleans' Memorial Medical Center during Hurricane Katrina. CNN reported on Sunday that the five medical experts lined up by the state to testify in front of the grand jury were never called to testify, even though all five experts had concluded that as many as nine patients had been deliberately killed. Here's what Art Caplan, one of the experts, told the network:
Arthur Caplan, the chair of the Department of Medical Ethics and director of the Center for Bioethics at the University of Pennsylvania, said it's inconceivable that the case is not going to go to trial.
"I was never called to the grand jury," said Caplan. "As far as I know, the grand jury never saw my reports. As far as I know, none of the reports prepared by these experts, who looked at all the cases, who were independent, and came to the conclusion that massive amounts of drugs were used as the cause of death and that they couldn't have been requested [by the patients], they had to be given involuntarily. That's evidence that I think a grand jury would want to be familiar with before it made its decision as to whether or not to proceed with an indictment.
"Now you can still get into a dispute about the evidence," Caplan added. "You can get into a dispute about the circumstances and all the rest of it, but at face value there is no other conclusion I think that's possible, other than these people -- or someone -- killed them."
CNN also quoted from the reports, which it obtained after filing a public records request:
Caplan wrote that there was no evidence any patient asked to be given assistance in dying, and no evidence that any consented to be given an overdose of medication to end their lives.
"In reviewing the facts and opinions, my conclusion is that the deaths of the nine persons at Memorial Medical Center in New Orleans are all cases of active euthanasia," Caplan wrote. "Each person died with massive doses of narcotic drugs in their bodies."
Dr. Ann Pou, the doctor charged in the case, recently told Newsweek that painkillers and sedatives were administered to patients for comfort reasons only.
The bullseye on Bush
It came out earlier this month that President Bush was treated a year ago for what looked like a case of Lyme disease*. This information only came to light recently as part of the president's annual physical -- and it was a bit of a footnote. The low-key manner of the disclosure prompted a few accusations that the White House was "hiding" Bush's condition. Of course, these accusations were probably inflected by partisanship. But even the AP accorded the story a bit of a raised eyebrow. From the story (emphasis added):
President Bush was treated for Lyme disease last August, the White House announced Wednesday after failing to disclose the problem for nearly a year.
According to reports, Bush got the standard course of antibiotics and he didn't seem to encounter any symptoms beyond the infamous bullseye rash. And the team of physicians checking under the president's hood declared him, according to the White House, "in superior fitness for a man his age."
Did it matter that the American public wasn't aware of Mr. Bush's rash? Um, probably not. But then, again, why do we even bother with the multi-doctor, multi-day presidential check-up? Is it for propaganda purposes? (Yeah, we're bogged down in Iraq, but for an old guy, our commander-in-chief can totally rock a mountain bike!) Sure, there's probably some of that, especially after all the presidential ailments that have gone hidden throughout history. But there is a practical part to it all, as well: Mr. Bush is the head of state and if his health was seriously compromised, we'd all probably want to know.
So, where do we draw the line? What constitutes a "reportable" presidential ailment? And in what detail? Should the president's colonoscopy be put on YouTube? Does the President of the United States have a right to medical privacy?
That image at the top of this post is from Design Observer, which had a little fun with the presidential rash idea.
*Apparently Texas has its own Lyme-like disease called STARI. Unlike other things, though, it appears to be smaller in Texas.
-Greg Dahlmann
Following up
Here are a few updates and extensions to recent posts on blog.bioethics.net:
APA: Members shouldn't be involved with abusive interrogation
The first time through on this topic we should have mentioned Steven Miles' editorial from the April 2007 AJOB. Here's a clip:
The diverse clinical societies' ethics codes should be harmonized and unequivocally grounded on the standards in international laws like the Geneva Convention. In this way, the United States medical community would express its accountability to international law and be able to call upon foreign governments and medical communities to do likewise.
Mitt's moment on stem cells
Our little look at Mitt Romney's "I talked with Doug Melton and everything changed" story was prompted in part by the former governor's recent successes in Iowa. The Economist recently wrote that we shouldn't read too much into that success.
Birthing, competitive and constrained
While China is reformulating the marketing of its one-child policy, India continues its path toward becoming the worlds' most populous country. And it's making a lot of headway thanks to Nanu Ram Jogi. According to The Times (UK), Mr. Jogi is the world's oldest new father. He's 90 and child number 21 was recently born. As he's quoted in the report: "I want to have more children. I can survive another few decades and want to have children till I am 100. Then maybe it will be time to stop."
You're wonderful. Now change.
Yet more tales of digital enhancement. Apparently Nicholas Sarkozy's poignees d'amour weren't suitable for publication. And after seeing a recent ad featuring her image, Keira Knightley was prompted to say: "Those things certainly weren't mine."
-Greg Dahlmann
Glenn McGee in The Scientist: How Much Should Gardasil Cost?
Glenn's August column for The Scientist looks at the HPV vaccine:
A sneaky virus has infected 20 million Americans. For most, it's just an inconvenience, causing unattractive lesions. But for some, the infection leads to cancer, killing 250,000 people worldwide and costing billions in medical expenses every year. The vast majority of people who develop the cancer live in low-income countries, where it has become the most common type of cancer in women. After years of research, a company has released a vaccine that prevents nearly 100% of infections by the four forms of the virus that cause most of its problems. The question is: How much should such a life-saving vaccine cost?
Most of you probably realize that I'm talking about Gardasil, which Merck developed and the US Food and Drug Administration approved last year. The vaccine targets human papillomavirus (HPV), which can cause genital warts and, eventually, cervical cancer. Given the impact HPV has on sexually active people worldwide, it would appear that no price is too high ? unless it's priced out of reach of millions of women, which it does.
At $360 for a three-dose regimen, not including administration costs, the vaccine is incredibly expensive, especially for women in developing countries. Insurance companies, moreover, have balked at covering the full cost of the vaccine, some reimbursing as little as $2 per dose. Merck suffered mightily from the safety issues associated with Vioxx and other similar drugs, and Gardasil won't become a blockbuster drug if it is an elective intervention. But can't Gardasil make money for Merck without a prohibitively high price?
the fog of academic war
In academic feuds, as in war, there is no telling how far people will go once the shooting starts. - Benedict Carey, NYTimesWhat constitutes research? It's a question that's been idly lurking in the back of my mind since I first picked up and read Malcolm Gladwell's book The Tipping Point. Most of my academic colleagues at the time knew that I was fascinated by the science of (social) networks, and it was not uncommon for me to quote Barabasi or Watts in long and passionate chunks. Obviously, then, I should read this book on networks by an author shooting up the NYTimes bestseller list!
So I read it, and walked away with disappointment. Not because the book was bad, but because the book was common. Simple. Which is not to say that there was anything wrong with the book, I simply wasn't the appropriate audience. I had gone looking for scientific rigor, and had found instead a book directed towards lay audiences.
What's the point of this musing about the academic or the popular? An article in today's New York Times details out a longrunning battle in academia over the book The Man Who Would Be Queen by Northwestern's J. Michael Bailey. Bailey's book is intended to explain the biological basis of gender and sexual orientation to a lay audience, but took a controversial approach in doing so, saying
that some people born male who want to cross genders are driven primarily by an erotic fascination with themselves as women. This idea runs counter to the belief, held by many men who decide to live as women, that they are the victims of a biological mistake — in essence, women trapped in men’s bodies. Bailey described the alternate theory, which is based on Canadian studies done in the 1980s and 1990s, in part by telling the stories of several transgender women he met through a mutual acquaintance. In the book, he gave them pseudonyms.
Bailey received praise for the book from a variety of sources, from fellow academics to the Lambda Literary Foundation, which nominated the book for an award. And then the critics started to speak up, and out, and then act out, going so far as to resort to personal (and sexualized) attacks on his children, justifying it as echoing the disrespect in his book.
Into all of this waded Northwestern bioethicist Dr. Alice Dreger, who made the decision to investigate the claims against Bailey herself. Her research, available online and to be published next year, came to one simple conclusion: the accusations against Bailey were groundless, and the book was not scientific research.
By saying that The Man Who Would Be Queen does not meet the federal definition of scientific research, and is anecdotes rather than a systematic investigation, Dreger is able to dismiss the majority of charges of ethical abuses by Bailey - variations on a theme of no informed consent - are brushed away as not relevant. After all, informed consent is a part of academic and scientific research, not anecdotal stories.
Critics say that theories that affect the lives of so many people should be based in good science, and presented responsibly. But what does it mean to practice good science? It might sound like an empty question, but seems like it is more applicable than any of us might want to admit. Is it practicing good science to publish a blog? To write for an audience that doesn't read peer reviewed journals? To aim for a best-seller list?
And maybe more to the point - can it be good science if it's not a popular opinion? If it's controversial, if it challenges the norm? When I last had a "proper" science class, we were taught that the best of good science is that which challenges us to think outside the box, to re-examine our biases and beliefs, and, if necessary, to grow to accept new ideas.
Is it good science to harass the family of a researcher who publishes an opinion you disagree with?
Dr. Dreger answers for us why this is important:
What happened to Bailey is important, because the harassment was so extraordinarily bad and because it could happen to any researcher in the field...If we’re going to have research at all, then we’re going to have people saying unpopular things, and if this is what happens to them, then we’ve got problems not only for science but free expression itself.
And if we're going to have research at all, we're going to have people turning that research into books that explain it to "the average joe", books that commit the sin of being popularized science, provoking thought and dialogue, of expanding who shares in the knowledge, and who becomes inspired to do the next round of research.
-Kelly Hills
Of biology and society
A few recent items that examine the intersection of the two:
3 Quarks Daily: Is Depression a Medical Condition?
Despite the title, philosopher Justin Smith (himself a sufferer of depression) doesn't deny the biological basis of depression, but he wonders if there's more to it:
Whether we are going to speak about a tortured soul or about a defective brain seems to depend mostly on the rhetorical purpose at hand. Students hoping to be excused from some responsibility or other have learned to talk the medical talk very skillfully: how can a mere Ph.D. in philosophy, they seem to be saying to me, possibly argue with a medical note from a real doctor? We're talking about an illness here, not some fleeting mood. Doctors take on the social role of magicians, able to transfigure any procrastinating or hard-partying adolescent into a special kind of creature --a depressive, a manic-depressive, an obsessive compulsive, a sufferer from attention deficit disorder-- usually with nothing more than the most perfunctory speech act. I am not saying these categories do not exist (at least as far as the first three are concerned). Indeed, I have claimed some of them for myself. But I doubt that their reduction to medical conditions like any other is what best helps us to understand them, or to live with them.
In the past several decades we have witnessed the encroachment of medical talk into nearly all domains of social life. The refusal of some drivers to wear seatbelts is spoken of as a 'public health problem'. Of course, a smashed skull is truly a medical condition, but must that mean that every course of action that could lead to its smashing is also medical? Similarly, is the undeniable existence of a chemical substratum to our conscious experience sufficient reason to conceptualize unpleasant or burdensome mental states as medical?
Salon: Cupid's science
Rebecca Traister interviews Helen Fisher, an anthropologist whose ideas are behind the match-making site Chemistry.com. Evolution, hormones, scent and finger length all come up in the conversation.
A Farewell to Alms
Gregory Clark, an economic historian at UC-Davis, argues in this recently published book that many of the attributes that lead to success in the modern world -- non-violence, literacy, work ethic -- were spread through Europe and East Asia through natural selection. As NYT reported, people are calling the book "a real challenge." Marginal Revolution is running a book forum about Clark's work.
-Greg Dahlmann
APA: Members shouldn't be involved with abusive interrogation
Via the Washington Post comes word that the American Psychological Association ruled Sunday that its members can no longer be associated with many of the "alternative" interrogation techniques in use at US facilities around the world. The ruling also calls on psychologists who witness the use of these techniques to intervene. The penalty for not doing so is ejection from the APA.
The ruling stopped short of banning APA members from working at all interrogation sites, for which a vocal faction inside the organization had been advocating. The issue was the subject of protests at this past week's APA Conference in San Francisco.
It's come out over the last year that psychologists were instrumental in the development of the torture-in-everything-but-name tactics that have been described by the Bush Administration as "an alternative set of procedures."
According to the Post, here's what the APA now says psychologists can't be involved with: mock executions, simulated drowning, sexual and religious humiliation, stress positions, sleep deprivation, exploitation of prisoners' phobias, the use of mind-altering drugs, hooding, forced nakedness, the use of dogs to frighten detainees, exposing prisoners to extreme heat and cold, physical assault and threatening the use of such techniques against a prisoner or a prisoner's family.
Now someone has to tell Jack Bauer.
-Greg Dahlmann
August 2007 AJOB
The latest issue of AJOB features three target articles:
The Imperatives of Narrative: Health Interest Groups and Morality in Network News
by Joshua A. Braun
Acceptability in France of Induced Abortion for Adolescents
by Maria T. Munoz Sastre, Elizabeth Legrain, Etienne Mullet, Celine Peccarisi, Paul Sorum
Towards a Global Human Embryonic Stem Cell Bank
by Jason P. Lott, Julian Savulescu
As always, each target article is accompanied by a group of peer commentaries. This month's issue also features an editorial by Matthew K. Wynia: "Breaching Confidentiality to Protect the Public: Evolving Standards of Medical Confidentiality for Military Detainees" -- its full text is available for free. Here's a snip:
One might surmise that it would be easier to ethically defend a breach of confidentiality to prevent possible harms to a large population compared to a breach to protect just one person, but in fact it's been the opposite. There seems to be something in human nature that allows for extreme responses to prevent harms to identifiable individuals (this is the so-called "rule of rescue;" see, for example, McKie and Richardson 2003). Despite ethical questions about this (for example, is being 'identifiable' a morally legitimate basis for getting extra attention?), breaching confidentiality to protect populations has been harder for doctors to accept than has breaching it to prevent harms to identifiable individuals.
And there's more, including book reviews and correspondence. Check it out.
Caught in the database
The AP recently reported on how E-ZPass, the electronic toll collection system on the East Coast, is being used to catch cheating spouses. One divorce lawyer quoted by AP couldn't resist a play on the name:
"E-ZPass is an E-ZPass to go directly to divorce court, because it's an easy way to show you took the off-ramp to adultery," said Jacalyn Barnett, a New York divorce lawyer who has used E-ZPass records a few times.
The AP found that seven of the 12 E-ZPass participating states will release toll information in both criminal and civil cases.
It's hard to have much sympathy for these fast-lane philanderers (the wordplay is too easy), but their situation may be a preview of what's to come for the rest of us. Geographic tracking systems are popping up all over. Just recently, there was a story about people "tagging" spouses who have Alzheimer's. And how long is it until people start chipping or tagging their kids? They already do it to their dogs.
As Art pointed out recently on MSNBC.com, there are number a reasons why keeping our various lives (private, professional, etc) separate is a good idea. When geographic information is added to the mountain of details about us already filed away in databases, it's not too hard to see a day when your application for health insurance (or almost anything else) goes something like this: "After merging your data profile, we've noticed some hot spots around casual dining chains such as Applebees. Do you have a riblet problem that we need to address?"
-Greg Dahlmann
Art Caplan on MSNBC: Privacy is true price of healthy worker discounts
Art's been thinking about those company health plans that give discounts to healthy workers:
The latest fad in American health care is to give discounts to workers who are healthy. Many corporate CEOs and their benefits department managers are showing enthusiasm for the idea that workers who don't take care of themselves ought to pay more for health insurance.
Like a lot of temptations, this one is attractive. Why should you pay the same rate for insurance as that bloated, pasty oaf of a co-worker down the hall?
But cupcakes, beer and cheeseburgers are not the only temptations you should try to resist. Paying less for being healthy is an enticement you ought to oppose as well.
Gary Kasparov and other protein machines
Writing in the MIT Technology Review, Daniel C. Dennett looks back at Kasparov's historic chess defeat at the hands (processors?) of Deep Blue ten years ago:
The verdict that computers are the equal of human beings in chess could hardly be more official, which makes the caviling all the more pathetic. The excuses sometimes take this form: "Yes, but machines don't play chess the way human beings play chess!" Or sometimes this: "What the machines do isn't really playing chess at all." Well, then, what would be really playing chess?
This is not a trivial question. The best computer chess is well nigh indistinguishable from the best human chess, except for one thing: computers don't know when to accept a draw. Computers--at least currently existing computers--can't be bored or embarrassed, or anxious about losing the respect of the other players, and these are aspects of life that human competitors always have to contend with, and sometimes even exploit, in their games. Offering or accepting a draw, or resigning, is the one decision that opens the hermetically sealed world of chess to the real world, in which life is short and there are things more important than chess to think about. This boundary crossing can be simulated with an arbitrary rule, or by allowing the computer's handlers to step in. Human players often try to intimidate or embarrass their human opponents, but this is like the covert pushing and shoving that goes on in soccer matches. The imperviousness of computers to this sort of gamesmanship means that if you beat them at all, you have to beat them fair and square--and isn't that just what Kasparov and Kramnik were unable to do?
Dennett asks us to examine our feelings about being the equal (or the inferior) of a machine. And if we are, does it matter that the machine arrives at its solutions through different means? And how different are those means? Dennett compares Deep Blue's "thought" process with that of Kasparov and finds the apparent differences small (which could be a credit to the human brain).
Maybe that isn't surprising since Deep Blue is a creation of the human mind -- our machines will probably always include an element of their creators. But it prompts the question: can a machine be a better version of us?
-Greg Dahlmann
photo courtesy of IBM
Enhancement today
Two stories, one for her and the other for him. First up, an Israeli company is marketing the first "internal" bra, which it's calling minimally invasive mastopexy (MIM). Here's how one of company's doctors described the procedure to Israel21c, an Israeli technology site:
"What we've done is build a silicon bra, insert it into the body and attach it to the ribs and to the fascia. It's like a normal external bra," he continues, "where a strip lies on the shoulder and attaches around the body. We attach it to the ribs instead of to the shoulder, and to the fascia in the lower part of the body."
...
"It may sound scary but take a look at cosmetic and plastic surgery - that's much more invasive," said Gur. "The most prevalent procedure in the world is breast implantation. Who is the crazy woman who agreed to be the first woman to put silicon into her body? Very strange things happen within the cosmetic world and the MIM is not as crazy as it sounds; that's the end point of what I'm saying."
And now for the "his" story. The Houston Press reports on circumcised men who are trying to restore their foreskin. It seems that many of the men pursuing this goal feel like they were violated when the circumcision choice was made for them. Their drive for restoration often leads them to using odd contraptions and methods, including tape, clips and batteries. Here's how the inventor of one device described the moment he told his wife about his plan:
"It was April 1, 2001, at about nine o'clock in the evening," he says, speaking on the phone from the Chicago suburb of Northbrook. He and his wife "were sitting in front of the TV set and I said, 'Hon, I've got to tell you about something. I'm going to start applying tape to my penis every day because I want to stretch my skin and make a new foreskin grow.' And she said, 'Well, that's crazy. That's ridiculous.' And I had to look her straight in the eye and tell her I was deadly serious. 'It's not crazy, and I'm going to need your support, dear.'" And she's been supportive ever since.
According to the article, there's been little research in the medical community about foreskin restoration. And it does mention recent research indicating that circumcision may lead to lower rates of STI transmission.
(Both stories via Buzzfeed)
-Greg Dahlmann
2016
Over at The Stem Cell Blog, Christopher Thomas Scott files a report from the future. The headline: "Ailing George W. Bush to undergo stem cell therapy in London." It's well worth a read.
About zonking the kids with Benadryl...
It's frowned upon. The issue's been floating around the web after a mom and toddler were booted from a flight last month when the kid wouldn't stop chanting, "Bye bye, plane!" According to the mother (and ABC), her conversation with the flight attendant went like this:
"She leaned over the gentleman who was sitting next to me, and she said, 'OK, it's not funny anymore. You need to shut your baby up," Penland said.Penland said she told the flight attendant that she expected her child to fall asleep momentarily.
"'It doesn't matter. Regardless, I don't want to hear it,'" Penland said the flight attendant told her.
"'It's called Baby Benadryl,'" Penland said the attendant told her, suggesting she give her child allergy medication to help him fall asleep fast.
"I said, 'Well, I'm not going to drug my child so you have a pleasant flight,'" Penland said.
And that's when the skies became not-so-friendly.
Well, an article in today's New York Times rolls out some of the reasons kids shouldn't be "sedated" with diphenhydramine. They include possible side effects such as breathing problems, constipation, increased hyperactivity and -- though it's not spelled out exactly -- a belief that zonking your kid is just kind of tacky. Yourself? Now that's a different question. From the article:
Dr. Kenneth R. Cohen, a psychiatrist in New York who specializes in psychopharmacology, suggested another way of looking at the problem: not the restless children, but the adults who have a hard time dealing with them.
For those adults, he said, there are anti-anxiety medications, which should be taken under a doctor's direction and should be tried out at home first.
Hmm. So, let's review:
Drugging the kids because they're being annoying? Bad.
Drugging yourself because the kids are being annoying? OK.
Noted.
-Greg Dahlmann
William Gibson on emergent technology
At the end of an otherwise ordinary "so, you have a new book" interview in Salon, sci-fi author William Gibson drops this remarkable take on emergent technologies:
I think what scares people most about new technologies -- it's actually what scares me most -- is that they're never legislated into being. Congress doesn't vote on the cellular telephony initiative and create a cellphone system across the United States and the world. It just happens and capital flows around and it changes things at the most intimate levels of our lives, but we never decided to do it. Somewhere now there's a team of people working on something that's going to profoundly impact your life in the next 10 years and change everything. You don't know what it is and they don't know how it's going to change your life because usually these things don't go as predicted.
... I find that both dreadful and exhilarating.
-Greg Dahlmann
Mitt's moment on stem cells
The 2008 US presidential election is still more than a year away and it's still way, way too early to predict what's going to happen (ask Howard Dean), but the general outlines of the situation are starting to come together. Mitt Romney won the Iowa Republican straw poll this past weekend. He's leading the polls in New Hampshire. And nationally, he's slowly moving up (though Giuliani is leading the pack).
So, there's a little bit of a Mitt moment going on. Let's take a look at where Romney stands on stem cell research and, by extension, abortion. Much has been made of Romney's "conversion" already, but there's an interesting story that goes along with his positions. And it's worth the attention if he ends up as one of the main players on the Republican side.
Who's funding stem cell research
by Jim Fossett
We've been arguing for a long time here that states have been spending more on human embryonic stem cell(hESC) research than the feds, and now we have some numbers to back it up. In a piece just posted on the Rockefeller Institute of Government website, we try to tote up who's spending how much on stem cell research in general and hESC in particular. While we can't be nearly as precise as we'd like, several things are clear..
Regulating nanotechnology
The FDA's Nanotechnology Task Force recently released a report laying out its take on regulation of products containing nanoscale materials. Here's a clip:
A general finding of the report is that nanoscale materials present regulatory challenges similar to those posed by products using other emerging technologies. However, these challenges may be magnified both because nanotechnology can be used in, or to make, any FDA-regulated product, and because, at this scale, properties of a material relevant to the safety and (as applicable) effectiveness of FDA-regulated products might change repeatedly as size enters into or varies within the nanoscale range. In addition, the emerging and uncertain nature of the science and potential for rapid development of applications for FDA-regulated products highlights the need for timely development of a transparent, consistent, and predictable regulatory pathway.
The report includes a number of recommendations:
+ Consideration of guidance that would clarify what information manufacturers should give FDA about products, and also when the use of nanoscale materials may change the regulatory status of particular products.+ That manufacturers contact the FDA early in the product development process. In addition, the report recommends that the agency should assess data needs for regulated nanotechnology products, including biological effects and interactions of nano-particles.
+ That FDA develop in-house expertise and ensure the consideration of new information on nanotechnology as it becomes available. FDA also should evaluate current testing approaches to assess the safety, effectiveness, and quality of nanoscale materials.
Richard Canady, a member of the task force, talked about the report in a podcast with Genetic Engineering and Biotechnology News.
Living, dying and playing with robots
This year's DARPATech conference (a sort of show-and-not-really-tell affair) features a portable surgical robot called the Trauma Pod. The device allows surgeons to operate from afar, but it also can operate independently to provide accompanying procedures such as intubation. As Popular Mechanics reports, much of the surgeon's remote role will be to tell the robot what it should not do. DARPA seems to think this robot might actually be ready for field use in a few years.
If/when the Trauma Pod does it make into service, it looks like it will have plenty of robotic company. The military has already been using robots for bomb disposal in Iraq, and as Wired reports, it will soon be using them to shoot people.
And just in case you're a little anxious about the eventual robot revolution, be confident that they're still a long way from beating us at Go.
-Greg Dahlmann
Birthing, competitive and constrained
Following up on the babies-as-luxury-items thread... NPR's Weekend Edition Sunday recently ran a piece about "competitive birthing." The short story: the last decade has seen large families become status symbols for wealthy couples. In other words, babies have become another form of conspicuous consumption. Says one demographer who appears in the piece, "It's an unprecedented trend and completely counter to a hundred years of history."
As it so often is, the story is very different in China. It came out this week that the Chinese government is reformulating the marketing campaign behind its one-child message. Slogans such as "One more baby means one more tomb" and "Raise fewer babies but more piggies" are apparently now out. In are messages such as "The mother earth is too tired to sustain more children." The change of tune comes two weeks after the government of Hunan province announced it would be cracking down on wealthy families that have flouted the one-child policy. (via)
-Greg Dahlmann
From "yuck!" to "awesome!"
You all remember that famous photo of the mouse with the human-like ear growing out of its back. It's not exactly an image you forget, in part because it's, you know, kind of gross. In fact, that image is often cited as one that prompts people to say "Yuck!" Well, it's been 10 years since that image first became public and maybe the culture had changed over the last decade:
Yep. That's a t-shirt design drawing on the infamous image. And there are at least two other designs . People even wear them.
-Greg Dahlmann
Linkage
BBC: Call for children donor awareness
A group of MPs in the British Parliament is calling for a provision that would require birth certificates to include a mention if the child was conceived using donated sperm or eggs. Supporters of the provision say current rules make the state a party to a potential lie. One opponent called the provision a "bizarre and intrusive solution to a problem that has never been demonstrated to exist."
NYT: Baby's First Diet Pill
NYT Mag's Idea Lab section looks at research aimed at programming (or reprogramming) the metabolism of babies shortly after birth. The idea raises a bunch of interesting questions.
The Economist: Lest we forget or lest we remember?
Researchers have identified a gene variant that seems to make people more susceptible to remembering emotional events.
It's not just the developed world
Last week we referenced an article in The Economist about Japan's struggle in adapting to an aging, shrinking population. There's speculation that Japan's situation is a preview of what many other developed countries will face in the not-to-distant future. That last sentenced should be edited, though, to remove "developed." As this engaging stats presentation from last year's TED conference shows, most of the countries in the world are headed in the direction of longer lifespans and lower fertility rates (the part in question starts at 2:30, but the whole thing is worth a look):
Maybe babies are on their way to becoming an luxury item for everyone.
-Greg Dahlmann
Reviving injured brains
There's a paper in Nature this week detailing how doctors used an implant to increase the level of brain function in a man in a minimally conscious state. (Coverage from News@Nature, NYT, others). This is exciting news, but it does raise a few questions:
-As some of the coverage has asked: Are we stepping into an ethical gray area by doing experimental procedures on people who are not able to consent?
-Every few months there's some kind of report about doctors finding a new way to prompt, revive or observe activity in the brain's of people who otherwise would be in the little-or-no-hope category. Should these research developments push us to view the status of people in unconscious states differently?
-This most recent development was observed in only one patient, but it will get a lot of spread in the press (as a lot of these stories do). How should doctors and ethicists approach the conversations that will inevitably come up now with the families of patients in these states? How do you help families balance hope and reality?
-Greg Dahlmann
How not to explain African distrust of Western medicine
By Stuart Rennie
The New York Times has an article this week with the ambitious title 'Why Africa fears Western Medicine' by Harriet A. Washington, author of the generally well-received book Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. The title is ambitious, because it is a short opinion piece about a rather large question. And some might say: the question itself is questionable, considering that most Africans have little access to Western medicine, and hence have little to fear. And in my experience, those who finally do gain access, if anything, are often a bit too trusting. But let's take the bait, and examine Washington's mini-theory anyway.
