October 2007
An update on the lethal injection question
Just 15 minutes before a man in Mississippi was set to be executed last night, the Supreme Court issued a stay. Court watchers say that this latest action is a "nearly indisputable indication" that the court will block all executions involving lethal injection until it hears Baze v. Rees in January. Baze will take up the question of whether the lethal injection protocol currently in use is cruel and unusual punishment. There's more analysis over at SCOTUS Blog.
Earlier on blog.bioethics.net:
+ Another angle on the lethal injection question
+ Is lethal injection cruel and unusual punishment?
+ Is 2 Hours and 10 Tries Humane?
Speed reading the October 30 Democratic debate
The Democrats running for the presidential nomination got together in Philadelphia Tuesday for another debate. We've pulled highlights from the transcript that might be of interest here at our little intersection of the web. Topics included universal health care, drawing talented people to the health care field, cancer research and marijuana decriminalization. The breakdown is after the jump.
The pharmacist as conscientous objector
Pope Benedict XVI recently told the International Congress of Catholic Pharmacists that pharmacists have a right to be conscientious objectors if they are asked to dispense drugs that will be used in a way they regard as immoral. From an AP report:
Benedict told a gathering of Catholic pharmacists that conscientious objection was a right that must be recognized by the pharmaceutical profession.
"Pharmacists must seek to raise people's awareness so that all human beings are protected from conception to natural death, and so that medicines truly play a therapeutic role," Benedict said.
Benedict said conscientious objector status would "enable them not to collaborate directly or indirectly in supplying products that have clearly immoral purposes such as, for example, abortion or euthanasia.
The AP reports that the Pope also told the gathering that pharmacists have a responsibility to educate patients so that drugs are used ethically and morally.
The US hasn't been the only country dealing with this issue. It's also come up in Chile, where whole pharmacy chains have refused to sell morning after contraceptives, and in Italy, where pharmacists are required by law to dispense prescriptions regardless of their ethical objections. In response to the Pope's comments this week, the Italian health minister said, "I don't think his warning to pharmacists to be conscientious objectors to the morning after pill should be taken into consideration."
-Greg Dahlmann
Earlier on blog.bioethics.net:
+ The Illinois plan for Plan B and reluctant pharmacists
Developing a system around newborn screening
Via Jim Fossett comes this story from today's Wall Street Journal about some of the problems surrounding the screening of newborns for genetic disorders. The Journal cites a March of Dimes figure indicating that the number of children being screened for these conditions has more than doubled in the past two years. That rapid expansion has brought many of the usual problems: false positives, lack of information among doctors and parents, limited availability of treatment. From Shirley Wang's article:
To improve the screening process, health providers and government officials are starting to expand beyond the push for more screening to also address shortcomings in the entire system. Efforts include creating a national standard for assessing screening, in order to cut down on false positives. Genetics experts are developing an online map of specialists across the country to help families find treatment. And researchers and health officials are working to educate doctors about screening and create state registries to track the long-term impact of early diagnosis.
"We're trying to see the newborn screening as a system and not a lab test," says Rani Singh, associate professor and director of the Genetics Metabolic Nutrition Program at Emory University in Atlanta, which has been working in a collaborative of southern states to improve access to genetic services.
Editors and bloggers elsewhere
Here are a few recent mentions of AJOB editors and blogger elsewhere in the media:
"These companies are essentially taking advantage of people's ignorance and fears to make a buck."
Paul Root Wolpe on Morning Edition: "Foolproof Test for Catching Liars Still Elusive"
"There is just no question in my mind that if we had an effective lie detector that the pressure to use it for security purposes, in courtrooms — even in sensitive employment settings — will be so strong that it will make its way into those settings," said Paul Root Wolpe from the Center for Bioethics at University of Pennsylvania. "The reason polygraphy hasn't done that yet is because it is just not good enough."
Art Caplan in Tech Journal South: "Should we really try to live forever?"
“Is it really unnatural to seek a longer better life, as critics argue?” [Art Caplan] asked. He pointed out that there is really nothing natural about a 70 or 75-year average lifespan. In ancient times, lifespans were closer to 35. To those who say advance the Biblical idea of three-score and ten, he asks, “What about all those earlier in the Bible who lived 800 years?”
There's more on the "AJOB Bloggers Elsewhere" page.
Watson retires; search for "foot in mouth" gene continues
After decades of letting absurdities fall out of his mouth that have embarrassed the genetics community, James D. Watson, Nobel Laureate and the legendary co-discoverer of DNA's double-helix shape, has finally called it quits. His resignation falls on the heels of his most recent racist remarks that there is scientific proof that Africans are genetically less intelligent. African's haven't been Watson's only target. Women scientists are more "difficult" then men (he still refuses to acknowledge the role of Rosalind Franklin in the discovery of the structure of DNA). In 2003, he said that molecular biologists have a duty to devise gene therapies or screening tests to cure stupidity, and it would also be great if we could genetically engineer girls to be pretty. Perhaps his "risk-taking" personality is part of what made him an exceptional scientist and leader of the Cold Spring Harbor Laboratory, but I can hear a collective sigh of relief from the damage control PR folks.
-Andrea Kalfoglou
David Brooks is ready for his outboard brain
The culture's apparent fixation with memory (and its related technology) crossed over some line this past weekend with a column by David Brooks in the New York Times:
Since the dawn of humanity, people have had to worry about how to get from here to there. Precious brainpower has been used storing directions, and memorizing turns. I myself have been trapped at dinner parties at which conversation was devoted exclusively to the topic of commuter routes.
My G.P.S. goddess liberated me from this drudgery. She enabled me to externalize geographic information from my own brain to a satellite brain, and you know how it felt? It felt like nirvana.
Through that experience I discovered the Sacred Order of the External Mind. I realized I could outsource those mental tasks I didn’t want to perform. Life is a math problem, and I had a calculator.
David Brooks? What? Exactly. When Brooks is writing about how he's given over some portion of his brain to the technological cloud, something has shifted. I mean, he doesn't exactly seem like a modern guy -- only two years ago he was writing about the horrors of married people who keep separate checking accounts. So to see him writing about "The Sacred Order of External Mind", well, let's just say what was once the stuff of cyberpunk is now cocktail party currency for Patio Man.
-Greg Dahlmann
photo: NYT
Bringing ethics to the Grand Challenges in Global Health
By Stuart Rennie
Social scientists and people working in ethics have been gradually infiltrating international health research over the last decade. The first step -- in the wake of well-known controversies -- was to make challenges raised by international health research into objects of ethical analysis. The literature on the subject has grown, a couple of new journals have sprung up to meet the demand, and the traditional journals are increasingly making space for ethical reflection on the globalization of research. The second step is to deeply integrate social science and ethics workers within international research projects themselves, turning them from outsiders to insiders. The forerunner in this respect is the ELSI (Ethical, Legal and Social Implications) program within Human Genome Project, established in 1988 by James Watson (who is getting press for different reasons these days). The International HapMap project and the National Nanotechnology Initiative have continued the trend of bringing social science and ethics workers into large-scale, heavily funded and potentially controversial research initiatives.
The newest example of this movement is the Ethical, Social and Cultural (ESC) program of the Grand Challenges in Global Health initiative, a $450 million project funded by the Bill and Melinda Gates Foundation. Grand Challenges funds 44 projects that will (hopefully) lead to scientific breakthroughs against neglected diseases in developing countries, and its accompanying ESC program has the mission of addressing the ethical, social and cultural issues that may arise in development of the scientific research or in the use of resultant knowledge or technologies by communities in need. Last month, PLoS Medicine published four fascinating articles on different aspects of the ESC program. It is striking how prominent community and civil society engagement feature in their methodology, a response to recent international research projects that collapsed under the weight of community distrust.
There are many appealing aspects of this new trend in general and the ESC program in particular. Not the least of which: it gives ethics workers a job. But more than that, the job in the case of the Grand Challenges seems worthwhile (and somewhat glamorous), since it contributes in a creative way to the development of research that aims to make a difference to health and well-being in the developing world. And (for a change) the jobs are not being distributed exclusively to those residing in the industrialized north of our planet. The program's leaders include those from South Africa, Ghana, and India, and the program has interviewed key informants from numerous developing countries to ask where they think the key ethical, social and cultural challenges lie. People have often complained that the ethical dimension of global research has been neglected, and when there has been attention to it, the voices of developing world have been underrepresented. So what's not to like?
A quick course on clinical trials
From public television's Second Opinions, a "webisode" about clinical trials and therapeutic misconception featuring, among others, our own Glenn McGee:
If you can't see the video, try watching over on the Second Opinions site.
Psychiatric hospital posts the no smoking sign
NPR's Morning Edition carried a story this week about a psychiatric hospital that's banned patients from smoking. From the story by Alix Spiegel:
[Hospital CEO] Canavan says some of his staff argued that it just wasn't fair to the patients to take their cigarettes away.
"The attitude was people who are mentally ill have so few things in life that are enjoyable to them. They don't have significant relationships, they may not have a home, they don't have meaningful work. If this is something that is pleasurable, why would you even consider taking it away?" Canavan says.
Nevertheless, the hospital reports that the transition has gone smoothly. And the hospital's CEO seems certain they've done a good thing.
Others aren't so sure. Again, from the story:
"At this point in time, we have no confidence that smoking bans are going to serve the best interests of patients, and we can't support them," says Ron Honberg, a spokesman for the National Alliance on Mental Illness. The organization has more than 1,000 affiliates in the United States.
Honberg says his organization supports the idea that mentally ill people, like everyone else, should stop smoking. But, he says, mentally ill people go to psychiatric institutions at their most vulnerable point, and it's just wrong to force them to quit when they're in such crisis.
"We are worried it's going to make people sicker, it's going to make recovery that much more difficult. And there are many people with mental illnesses around the country who similarly articulate those concerns," Honberg says.
Honberg explains that part of the fear is that if institutions go smoke-free, mentally ill people will no longer be open to getting institutional help.
Many, if not most, health facilities have gone smoke-free over the last decade, but in this case it sounds like the hospital is not just telling patients to smoke elsewhere -- it's actually keeping them from smoking. Is the hospital on the right path here? Or has it overstepped? Would we think about this situation differently if the people involved did not have mental illness?
-Greg Dahlmann
Neuroethics in this week's Science
In an editorial out this week in the journal, Hank Greely calls for greater support of work looking into the social implications of neuroscience. From the piece:
For me, the most exciting questions involve how neuroscience might change society. If we could reliably predict that certain adolescents will eventually be diagnosed with schizophrenia, what use should we make of that information? If learning how brains make decisions could reliably indicate malign intent, should we use that information in criminal decision-making? What if we produce a pill that enables people in early stages of dementia to make, retain, and retrieve declarative memories? Should it be used by healthy people, such as premedical students?
Alas, some of this is not speculation. Already, at least one company is selling functional magnetic resonance imaging services for lie detection. Some foreign hospitals are performing psychosurgery for drug addiction. And judges and juries are being asked to make decisions based on beautiful “pictures” of people’s brains. People working in neuroethics need to point out when unproven new technologies are being used recklessly and to explore the social consequences of effective new technologies. In both cases, we need to maximize the benefits of the applications of neuroscience and minimize their harms.
Mad about memory
As others have pointed out, our culture has a thing for memory right now. Articles about it seem to be everywhere. Here are a few of the most recent:
The advantages of amnesia (Boston Globe)
As digital-storage capacities reach seemingly boundless proportions, however, some thinkers are becoming nervous about the unintended consequences of memory technology. Certainly Google's enormous reserves of user information, stored in dozens of secretive data centers across the world, and the literally photographic memory of the Internet Archive, which preserves billions of defunct Web pages for posterity, are enough to leave anyone rattled. New forms of memory are permanent and accessible from anywhere. As their reach grows, scholars are asking if now - perhaps for the first time in human history - we need to find ways to forget.
The Ethics of Erasing a Bad Memory (Time)
The burning pain in Ellen's arm was due to the rapid application of propofol, a paper-white liquid medication, which the perceptive Dr. Frank had plugged into Ellen's IV the second he heard the c-word. When he saw her reaction, he pushed. The drug, sometimes called "milk of amnesia," stings some patients sharply in the veins, but what it also does is erase your last few minutes. (Think of the "neuralyzer" from the Men in Black movies.) Oh, and it puts you to sleep. An amazing molecule, a great anesthesiologist and a great save.
Not everyone agreed. I looked up at three sets of eyes, the nurses' eyes, that bored into Frank and me accusingly. How can you do that? they demanded to know. Don't you need consent or at least fill out some kind of form before you steal a patient's last 10 minutes? But all I could say was, "Awesome job, Frank." Somehow with that, and with the calm sleep on their patient's face, we were given not forgiveness, but a reprieve.
Remember This (National Geographic)
"Why do we study history?"
"Well, we study history to know what happened in the past."
"But why do we want to know what happened in the past?"
"Because, it's just interesting, frankly."
EP wears a metal medical alert bracelet around his left wrist. Even though it's obvious what it's for, I ask him anyway. He turns his wrist over and casually reads it.
"Hmm. It says memory loss."
EP doesn't even remember that he has a memory problem. That is something he discovers anew every moment. And since he forgets that he always forgets, every lost thought seems like just a casual slip—an annoyance and nothing more—the same way it would to you or me.
An Active, Purposeful Machine That Comes Out at Night to Play (New York Times)
Scientists have been trying to determine why people need sleep for more than 100 years. They have not learned much more than what every new parent quickly finds out: sleep loss makes you more reckless, more emotionally fragile, less able to concentrate and almost certainly more vulnerable to infection. They know, too, that some people get by on as few as three hours a night, even less, and that there are hearty souls who have stayed up for more than week without significant health problems.
Now, a small group of neuroscientists is arguing that at least one vital function of sleep is bound up with learning and memory. A cascade of new findings, in animals and humans, suggest that sleep plays a critical role in flagging and storing important memories, both intellectual and physical, and perhaps in seeing subtle connections that were invisible during waking — a new way to solve a math or Easter egg problem, even an unseen pattern causing stress in a marriage.
-Greg Dahlmann
Earlier in AJOB:
+ Propranolol and the Prevention of Post-Traumatic Stress Disorder: Is it Wrong to Erase the "Sting" of Bad Memories?
+ Not Forgetting Forgetting
Earlier on blog.bioethics.net:
+ Should we all have a spotless mind?
Who should be first in line for vaccine in the event of a flu pandemic?
The federal government released yesterday a draft of its guidance for how health authorities should allocate scarce doses of influenza vaccine during a pandemic. The working group behind the plan sorted the population into categories and then ranked groups in order of priority inside each category. Details after the jump.
Following up: meat eating and the environment, brain-computer interfaces
Here are a few updates and extensions to earlier posts on blog.bioethics.net:
Attention, Planet Destroying Carnivores
Back in August, Kelly wrote about a report examining the effect of livestock production on greenhouse gas emissions. This week in Slate Brendan I. Koerner takes up the question of whether veganism is the most earth-friendly of diets. The answer's a little more complicated than it might at first seem.
Should you have the tools to hack your brain?
In September we passed along a link to an article about the wariness of some scientists to the marketing of games that use brain-computer interfaces. Recently on the Neurophilosophy blog there was an item about how a lab at Keio University in Japan has developed a brain-computer interface that allows people to control the movements of an avatar in Second Life. There's video of the interface in action, too.
Jon Stewart as Socrates
Philosophy has a way of coming up during discussions around here (we are talking about ethics, after all) and from the traffic to a recent post about Stephen Colbert we know that more than a few of us are Daily Show fans. So with those two facts in mind, we pass along this article from the Sacramento Bee about Jason Holt's work on philosophy and the Daily Show. Here's a clip:
Just as Socrates' and Diogenes' reason-over-emotion doctrines served as an antidote to the sophists and rhetoricians of their day, Stewart's nightly reports combat the dissembling of politicians and the blathering of mainstream media's so-called "chattering class." At least, that's Holt's thesis.
And then, there's this: Socrates and Diogenes were as snarky then as Stewart is now.
Diogenes once lived in a bathtub to show citizens the folly of the pursuit of wealth and comfort. And Socrates was known for comically feigning ignorance – "I know that I am intelligent, because I know that I know nothing" – to dissect an opponent's argument.
Holt is an assistant professor at Acadia University in Canada and his work on this topic led him to compile the aptly titled book "The Daily Show and Philosophy," a collection of essays by Holt and a number of contributors.
While there's definitely a joke here, Holt does seem to think there's something meaningful, too. Again, from that Bee article:
For his part, Holt says that Stewart can show current philosophers and "public intellectuals," such as himself, a thing or two.
"Intellectuals in the past used to do a lot more public engagement, reaching out behind the walls of the ivory tower," Holt says. "Now, many have not taken this challenge up, and they've left a gap in the culture. A lot of pundits have taken over.
"What Stewart and 'The Daily Show' do is fill that gap, not because it's intellectual discourse first and foremost, but because they're doing a better job than academics like me have traditionally done."
And, of course, if Jon Stewart is Socrates you know what that makes Stephen Colbert? Plato.
(via)
-Greg Dahlmann
screen capture: The Daily Show
Frozen embryos get some colorful representation in court
Via Art Caplan and BioEdge comes this item by Wired's Kristen Philipkoski about a lawyer who has filed suit on behalf of a frozen embryo. Martin Palmer is suing California Institute of Regenerative Medicine chairman Robert Klein on the argument that the use of embryos for embryonic stem cell research violates the 13th and 14th amendments of the US Constitution (that would be the prohibition against slavery and equal protection under the law, respectively).
There was a hearing to decide the appropriate venue for the case last week and it seems to have been quite the scene. From a KNBC-TV report:
In Tuesday's hearing, Palmer started his argument by paraphrasing the Bible.
"In the beginning there was a message and that message is life," he said, then later quoted the New Testament's Gospel according to John.
"Your argument is quite eloquent but it's not addressing why we're here today," said Judge Kim Wardlaw.
Undeterred, Palmer sought to liken Doe's situation to the plight of slaves before the Civil War. The choice of the name "Scott" is a deliberate reference to Dred Scott, the slave who in 1857 lost a lawsuit aimed to win his freedom, Palmer said.
"Have embryos been enslaved?" [Judge] Fernandez asked.
Palmer replied they had, and added that California was "abandoning its heritage" because it was admitted into the Union as a free state in 1850.
When Fernandez pressed Palmer on exactly what injury Doe suffered, he finally said: "We're seeking to invalidate Proposition 71 on its face."
Palmer then accused the defendants of ignoring the issue of the morality of stem-cell research by focusing on the legal issue of venue.
Apparently this exchange was later followed by Palmer scattering rose petals and the judge rolling her eyes.
Speed reading the October 21 Republican debate
The Republicans running for the presidential nomination got together in Orlando, Florida Sunday for another debate. We've pulled highlights from the transcript that might be of interest here at our little intersection of the web. There were no mentions of stem cells, cloning, chimeras or biomedical research. The breakdown -- including a bonus item -- is after the jump.
The state of our robotic overlords
On some days, it seems like robots are bound to put us all in boxes. On others, they just seem to be struggling to catch up. And today? Well, today is a little bit of both.
Wired's Danger Room blog has been following an incident in South Africa where a robotic gun malfunctioned and killed nine people. There's some doubt as to whether the "robot" part of the gun had anything to do with the accident. But as Wired's Noah Schachtman reports, it wouldn't be the first time something strange has happened with these kinds of weapons.
But before you go welcoming our new robotic overlords, the path to robot world domination has hit a snag: they're just not getting smart enough, fast enough. So says MIT's Marvin Minsky in a recent lecture. From the notes accompanying video of the lecture:
Marvin Minsky is worried that after making great strides in its infancy, AI has lost its way, getting bogged down in different theories of machine learning. Researchers “have tried to invent single techniques that could deal with all problems, but each method works only in certain domains.” Minsky believes we’re facing an AI emergency, since soon there won’t be enough human workers to perform the necessary tasks for our rapidly aging population.
So while we have a computer program that can beat a world chess champion, we don’t have one that can reach for an umbrella on a rainy day, or put a pillow in a pillow case. For “a machine to have common sense, it must know 50 million such things,” and like a human, activate different kinds of expertise in different realms of thought, says Minsky.
So, to recap: We're having trouble developing robots with common sense, yet we're giving them guns. Um, somebody's still working on that robot code of ethics, right?
-Greg Dahlmann
(Minsky link via)
Earlier on blog.bioethics.net:
+ And you thought gay marriage was controversial
+ Living, dying and playing with robots
+ Asimov would be pleased
Forum on nanotechnology in consumer products
We got word from the Project on Emerging Nanotechnologies (a joint project of the Wilson Center and Pew) that it's teaming up with Consumer's Union for an online forum this Tuesday and Wednesday about the potential risks and benefits of nanotechnology in consumer products. The forum is free and open to the public -- in fact, the online dialogue is aimed at opening up this issue to the general public. From the site for the forum, here's the agenda:
Tuesday, October 23 : Nanotechnology and Consumer Products: Introduction
Nanotechnology is no longer simply a science of the future, but it is a way of producing and using materials at a tiny scale that is rapidly entering our everyday lives in cosmetics, medicine, food, sports equipment, computers, automobiles, and many other consumer products. On the first day of this dialogue, we invite you to learn about nanotechnology and its current applications, to ask questions, and to share your thoughts on the benefits and risks of these technologies.
Wednesday, October 24 : Nanotechnology and the Consumer: Moving Forward
Day two of our dialogue will provide a forum for discussing existing and potential nanotechnology regulation, oversight and outreach activities associated with nanotechnology consumer products. Participants are invited to discuss their thoughts on the type of nanotechnology oversight and involvement they would like to see as the technological development moves forward.
Another angle on the lethal injection question
Last week we posted about the current legal proceedings over the constitutionality of lethal injection. On Sunday the LA Times reported on a related situation in North Carolina, where the state medical board in a legal fight over whether it has the authority to bar doctors from taking part in executions (state law requires a doctor be present). From the article:
There has been considerable debate about whether doctors should be present during lethal injections, a conflict sometimes described by doctors as "The Hippocratic Paradox." On one hand, doctors may be needed to carry out a lethal injection execution so that it is consistent with 8th Amendment prohibitions against cruel and unusual punishment. But others say the Hippocratic oath to preserve life rules out their involvement.
A state court judge ruled in March that the medical board didn't have the authority to keep doctors from participating and the board appealed the decision last week. That March ruling included an assertion by the judge that executions are not a "medical procedure or event." The LA Times asked Art Caplan and Ross McKinney about that statement:
The judge's decision "is patently wrong on its face," said Arthur Caplan, chairman of the medical ethics department at the University of Pennsylvania Medical School.
The reason that prison officials want doctors present at executions is "for their medical expertise," Caplan said.
Dr. Ross McKinney Jr., director of the Trent Center for Bioethics, Humanities and History of Medicine at Duke University, said that the intravenous administration of drugs clearly has the trappings of a medical procedure. "It is hard for me to imagine someone saying that a doctor being there and contributing to someone's death is not a medical procedure that violates the Hippocratic oath," he said.
"On the other hand," he said, "I can understand a physician saying the death penalty was justified for some people, thinking lethal injection is more humane than other forms of execution and therefore be willing to participate. . . . To some degree it becomes a political decision, and it gets wrapped up in the entire debate over the death penalty."
Middle School Based Health Clinic to Offer Prescriptive Contraception - Without Parental Consent or Notification
Like many of you, I’m here at the annual conference of the American Society for Bioethics and Humanities. (And if you’re here, and reading this, please do stop by and say hello – I’ll be at the AJOB table most of the weekend, and would love to put faces to names!) Hopefully unlike most of you, my brain is spinning and flying at twice its normal speed, stimulated beyond belief by all the amazing conversation going on here. Thus I found myself awake at 3:30am, deciding I might as well catch up on the internet, since sleep was apparently going to be elusive. (The 7:30am “meet the professor” breakfast ought to be even more fun on two hours of sleep!) It seems that, despite his fulltime job, as well as being exec editor, and co-manning the AJOB table with me at the meeting on top of it all, Sean’s been able to keep up on updating the bioethics newsfeed, and one story literally had me sitting up in bed going “whoa – that’s unexpected!”
Seems that the Portland, Maine school board approved, on Weds night, a measure that will allow students at King Middle School to gain access to prescription birth control methods without parental notification. It was a near-unanimous vote, justified by two very simple things:
- there are students being seen in the health center who are engaging in risky behaviour (unprotected sex)
- it has been shown, time and again, that providing access to birth control does not increase who is sexually active, only who is safely sexually active
Reaction, as you might expect, has been mixed, from utter outrage and threats of lawsuits and claims of violations of parental rights, to people saying that the reality is, not every student is receiving the sort of guidance at home necessary to make good sexual choices. (And to that, I would add, or receives good guidance and tosses it right out the window in a fit of pique and/or hormones.)
What might be most interesting about this decision is that the independently operated health care center (which offers things like immunizations, physicals, and other clinic-based medical care) says only about 5 of the 500 students at the school have identified themselves as sexually active. While I do realize that those who’re actually good at maths have ways of extrapolating from admitted rates of sexual activity actual (and typically higher) rates of sexual activity, I can’t imagine any sort of mathematical wizardry is going to make the number substantially higher. So it really is an offering of services to a limited number of students.
Several of us were sitting around a table earlier tonight, and the conversation drifted (thanks to a stress-relieving spermatozoa fellow blogger Andrea Kalfoglou was showing us) to sex education, and the average age boys and girls hit puberty. None of us knew off the tops of our heads when boys first start producing fertile ejaculate, but we did know that the average age of menarche has dropped to middle school ages – thus meaning that these middle school bodies are being hit by hormones at an age they perhaps might not have the wisdom necessary to handle the urges and inclinations. But at the same time, even though I have long been an advocate for free access to contraception in high schools, I find the idea of middle schools providing not only access to contraception but hormonal/prescription contraceptives slightly alarming.
While the clinic is independent of the school, and thus providing a service the students could receive if they went to a local Planned Parenthood, simply at easier access, I wonder at the prescription emphasis, and why other methods of birth control are not mentioned. Do they offer free condoms? What are they telling the students about safe sex? Is there some very specific and targeted situation going on they are trying to address, with only a few students – abuse, questionable relationships, accusations of rape, or some other need to provide this ease of access to prescription - motivating the measure? After all, as we all know from the endless education done in pharma adverts for hormonal birth control, it protects against pregnancy, not sexually transmitted infections.
-Kelly Hills
An Aspirin a Day May Not Keep the Doctor Away
A new study out of the University of British Columbia’s cardiovascular center is causing a bit of controversy. Seems they analyzed aspirin-as-heart-protection trials
“>hints that those trials with a higher number of female participants were less likely to show that there was benefit to taking aspirin daily as a part of a preventative regime. In fact, those studies involving mainly women show a lesser benefit than studies involving mainly men – or no benefit whatsoever. The immediate question, of course, is why?
The researchers from the James Hogg iCapture Center for Cardiovascular and Pulmonary Research – and what a fabulous name is that for a center? – have suggested that perhaps women’s hearts and surrounding blood vessels are simply physiologically different, making the functional properties of aspirin (which prevent clots from forming) moot.
Of course, the critique has been coming fast and furious, with experts disagreeing on the report and findings, and cautioning against women who are taking an aspirin a day to keep the heart attack away from stopping.
But as anyone who’s taken aspirin continually knows, there are risks to it damaging the stomach lining and causing its own issues – and for that reason, if it’s not necessary or medically of benefit for women to take a daily aspirin, it’s certainly worth knowing! The research will undoubtedly continue, and be worth keeping an eye on.
-Kelly Hills
A religious objection? Um, sure.
Via the ever vigilant Jim Fossett comes an AP story reporting that the number of children being exempted from vaccination requirements for religious reasons has doubled -- or even tripled -- during the last four years in many of the states that allow such exemptions. From the article:
Sabrina Rahim doesn't practice any particular faith, but she had no problem signing a letter declaring that because of her deeply held religious beliefs, her 4-year-old son should be exempt from the vaccinations required to enter preschool.
She is among a small but growing number of parents around the country who are claiming religious exemptions to avoid vaccinating their children when the real reason may be skepticism of the shots or concern they can cause other illnesses. Some of these parents say they are being forced to lie because of the way the vaccination laws are written in their states.
"It's misleading," Rahim admitted, but she said she fears that earlier vaccinations may be to blame for her son's autism. "I find it very troubling, but for my son's safety, I feel this is the only option we have."
An Associated Press examination of states' vaccination records and data from the Centers for Disease Control and Prevention found that many states are seeing increases in the rate of religious exemptions claimed for kindergartners.
"Do I think that religious exemptions have become the default? Absolutely," said Dr. Paul Offit, head of infectious diseases at Children's Hospital in Philadelphia and one of the harshest critics of the anti-vaccine movement. He said the resistance to vaccines is "an irrational, fear-based decision."
Earlier on blog.bioethics.net:
+ Art Caplan at MSNBC: Students' meningitis shots should be required
+ Caplan on Vaccines and Autism
Is lethal injection cruel and unusual punishment?
The Supreme Court issued a stay of execution yesterday for a man on death row in Virginia. Analysts are calling the court's action a de-facto moratorium on lethal injection, which is the method of execution used in all but one of the states with the death penalty.
The stay of execution comes after the Supreme Court announced in September that it would hear a case about lethal injection during its current session. That case, Baze v. Rees, will take up the question of whether the three-drug process used to execute death row inmates is cruel and unusual punishment. (One of the drugs can cause extreme pain.)
As the SCOTUS blog points out, the court's actions with regard to the lethal injection question are extraordinary -- the court hasn't taken up the constitutionality of a method of execution since at least 1890.
One court watcher is already speculating that Baze will lead to the court ruling that at least one form of lethal injection is unconstitutional.
Odd fact pulled from that WaPo story linked up top: of the 38 states that have the death penalty, Nebraska is the only one that doesn't use lethal injection. It uses electrocution.
-Greg Dahlmann
Beyond Abortion: Evolving Stem Cell Politics
By James Fossett
We’ve written before that political cleavages around embryonic stem cell issues and other public bioethical issues are increasingly different from conventional party alignments and even “red state/blue state” divisions around abortion and other “values” issues. Republicans are increasingly divided into pro- and anti-stem cell groups, and traditional “liberal” groups such as public employee unions and minority groups have been lukewarm supporters of stem cell research at best. Some women’s health advocacy organizations, who are unreservedly pro-choice, are strong detractors of egg acquisition practices and have called for restrictions on stem cell research until safety issues connected with these practices are resolved. Among the strongest supporters of stem cell research in many states are its potential beneficiaries -- disease advocacy groups, universities and medical schools who do the research and want financial support, and governors and other politicians wishing to claim credit for improving their states images and economic futures—most of whom don’t qualify as traditional “liberals”. As in much else, politics continues to make strange bedfellows.
OK, who hasn't taken money from drug companies?
Via Jim Fossett comes word of a paper in the October 17 JAMA reporting that 60 percent of respondents to a survey of medical school department chairs indicated they had some form of personal relationship with industry -- either as a consultant, a member of a scientific advisory board, a paid speaker, an officer, a founder, or a member of the board of directors.
Here's what Eric Campbell, the paper's lead author, told HealthDay:
"There is not a single aspect of medicine in which the drug companies do not have substantial and deep relationships, affecting not only doctors-in-training, resident physicians, researchers, physicians-in-practice, the people who review drugs for the federal government and the people who review studies."
...
"Drug companies have relationships with everyone. They're involved in every aspect of medicine. Someone has to decide which of these is OK."
And from an AP story about the paper:
Alan Goldhammer of the industry group, Pharmaceutical Research and Manufacturers of America, said the study results don't mean these relationships are a problem. He said it makes sense to reach out to academic heads because they have the most expertise.
But Dr. Jerome Kassirer, a former New England Journal of Medicine editor and frequent critic of industry influence over doctors, called the study eye-opening.
"I was appalled by the results," Kassirer said. "No one knew that so many chairs of medicine and psychiatry were paid speakers. We've never had that data before."
Earlier on blog.bioethics.net:
+ Stanford: No More Small Gifts
+ No More Free Lunch
From AJOB:
+ All Gifts Large and Small
NIH director publicly opposes Bush position on embryonic stem cell research
Via Art Caplan comes this item from Mary Ann Akers' WaPo blog "The Sleuth" in which she highlights Elias Zerhouni's statements of support for embryonic stem cell research in a recent NIH magazine. Here's a clip from the issue of NIH Medline Plus (pdf):
(emphasis added)
Klose: How difficult is the challenge?
Dr. Zerhouni: It is extraordinarily complex. Picture the embryonic cell (and its DNA) as a very complex keyboard, with thousands of keys. With the human genome, we’ve identified the size of the keyboard, the number of keys, and the notes each plays. What we haven’t figured out is how they end up playing Bach and Beethoven, so to speak—how becoming a neuron is one symphony, a skin cell another.
There are billions of cells, all with their own music. As the brain develops, it turns out they’re pretty harmonious—an orchestra of keyboards. So signaling among them becomes important. But who is the conductor? How is an adult cell that only plays neuron music conducted, why does it stop, and how can you make it play heart or skin music? And for the embryonic stem cell—a keyboard that has never played—how is it directed to play neuron music and not muscle or liver music, even though all of our cells contain the same instruction books?
This is what stem cell science is all about.
Klose: All in search of a conductor?
Dr. Zerhouni: Yes. We’ve made great progress, but people still suffer. With stroke, as with all conditions, we must be able to predict them earlier so we can act at the personal level—through changes in lifestyle, diet, exercise, etc.—to preempt it from striking, if possible. Fundamentally, however, we need to understand how things are organized.
Therefore, all avenues of research need to be pursued.
Klose: Despite the controversy over stem cells?
Dr. Zerhouni: Yes. Unfortunately, the scientific foundation of stem cell research is sometimes lost in the societal, moral, and ethical battle between hype and hope. But our job at NIH is to push the science forward to serve our patients.
Klose: When can we expect results?
Dr. Zerhouni: The research is advancing at an incredible pace, but as we move forward we’re finding more complexity. When I became director of the NIH we only knew of one gene that had anything to do with diabetes. Then, last June, we discovered 10 more that are clearly associated; we must accelerate our research into how these notes play.
Klose: And that’s the issue of supporting basic research, isn’t it?
Dr. Zerhouni: That’s right. We must continue the research at all levels, or there will be no progress. We need to understand these fundamental facts of life: how and why the young brain adapts, why the old does not. If we can know how a disease occurs, we can prevent it. So I think it’s a multi-pronged attack, both from the point of basic understanding and continually improving what we do. Finally, it’s important to emphasize that science evolves with strong ethics.
Good science is good ethics.
Akers talked with spokesmen from both Zerhouni's office and the White House and she reports that both seemed to think the director's comments were no big deal.
October 2007 AJOB
The latest issue of AJOB features two target articles:
Biotechnology and the New Right: Neoconservatism's Red Menace
by Jonathan D. Moreno, Sam Berger
"Show Me" Bioethics and Politics
by Myra J. Christopher
As always, each target article is accompanied by a group of peer commentaries. This month's issue also features two editorials: "Access for the Terminally Ill to Experimental Medical Innovations: A Three-Pronged Threat" by Shira Bender, Lauren Flicker and Rosamond Rhodes; and "A Clean Well Lighted Place: In Search of Food Ethics in the 21st Century Grocery Store" by Glenn McGee. The full text of the latter is available for free. Here's a selection:
Suffice it to say that people love food. Only slightly less interesting than sex, eating is the most natural thing humans do. Before any questions of aesthetics, ethics or politics take the stage, it seems fitting to suggest that people feel their finest when they are fully fed. Most of the behaviors we observe in animals before they eat, after they eat and when they are deprived of the pleasure of eating are mirrored in human behaviors. These same behaviors have taken on vast mythical significances throughout time in rituals celebrating the entanglements we have with food (Lévi-Strauss 1969).
Shopping for food is then a seductive experience. Every possible avenue for advertising is exploited to teach us not to think about food, but instead to develop "gut feelings" about various food products and brands. Pictures of "serving suggestions" on glossy packaging sell a brand name, a taste and feelings of safety and fullness and virility and success. The grocery story is a sensory odyssey for the hungry of body and spirit alike, who enjoy being sold food as much, if not more, than eating that food.
Changing our perceptions of aging
Two pieces -- from very different perspectives -- about efforts to change the way we think about the elderly.
In the first, Portfolio's "Odd Numbers" blogger Zubin Jeleveh looks at a recent working paper that attempts to define "elderly" not by number of years lived, but rather by mortality risk and remaining life expectancy. By the standard definition, the number of elderly people in the US will roughly double by 2030, representing one out of every five people in the population. But if you define elderly as having a 1.5 percent and above risk of mortality, the number of people in the category would grow by only 20 percent. The bottom line here is that if the average life span continues to stretch, maybe 65 really does become the new 55. And that would have all sorts of implications about the way we might view older workers and programs such as Social Security.
The second piece follows the Smart Set's Jason Wilson as he goes through a program intended to increase empathy with the elderly:
I’m told that my tribulations are common, and I’ll likely be labeled a complainer around the senior center. Aging is not for sissies, I’m told. But here’s the big difference. Twenty-five minutes ago I was a relatively fit 37-year-old. Not a triathlete, but certainly someone who didn’t need help opening a pill bottle. Now I am suddenly old and feeble. Allow me to be perfectly candid: It really sucks.
There's an interesting bit at the end from a professor at Rutgers who requires her students to go through the aging simulation:
Earlier, when I finished my Rutgers simulation with Wood, I asked how healthy, young undergraduates generally react to their sudden aging. Wood makes her students write a two- to three-page paper in which they reflect on their experiences, and she tells me that the reactions have clearly changed over the years.
“In the past,” Wood says, “I’d get responses such as, ‘Now I understand why Grandpa is so grumpy.’ But over the past two or three years, the responses I’ve been getting in class have been very different. Now they say, ‘I don’t want to be like this when I grow old. I’m going to start taking better care of myself. I’m going to quit smoking. I’m going to go to the gym. I’m going to eat better.’”
Wood sees this as a definitive generational difference in young people raised by Baby Boomer parents. “I don’t know if it’s a belief that they have control over their destiny, or the attitude that if they really want something bad enough it will happen,” she says. “There’s a downside to that. It leads to thinking that if people are handicapped, or overweight, or old…well, then it’s just their own fault.”
-Greg Dahlmann
"You can't punish an ailment"
The Lexington (KY) Herald-Leader is running a package of stories this week about one woman's experience working her way through drug court, a program aimed at keeping addicts out of jail by providing counseling, frequent testing and structure. From one of the articles:
It's a recognition that to address drug crimes, the system must address the disease of addiction.
"You can't punish away an ailment. It's that simple. Why should we punish people for what is clearly a brain disease?" said Doug Marlowe, director of law and ethics research at the Treatment Research Institute at the University of Pennsylvania.
The first drug court started 20 years ago in Miami. According to the Herald-Leader piece, there are now about 2000 of these programs nationwide. A 2005 GAO review of drug courts (pdf) reported that the programs seemed to lower rates of recidivism, though their record at actually reducing relapses in drug use were mixed.
(via)
-Greg Dahlmann
The Illinois plan for Plan B and reluctant pharmacists
If a proposed settlement in Illinois is approved, pharmacists in the state who oppose filing Plan B or other emergency contraceptive prescriptions on religious grounds would not be forced to do so. The settlement comes as a response to a series of lawsuits filed by disgruntled pharmacists against Wal-Mart and Walgreens pharmacies as well as the state of Illinois, complaining of religious discrimination.
Under a law passed in the state two years ago, pharmacists have a duty to stock and fill any lawful prescription for contraceptive. The rule was passed in order to ensure women would have immediate access to the “morning-after” pill, therefore avoiding the need for abortions. Several pharmacists opposed this prescription for religious reasons, claiming that by preventing implantation of a fertilized egg to the uterus, the pill itself acts as an abortion. After refusing to fill patients’ prescriptions for the emergency contraceptives, the pharmacists were subject to disciplinary actions by their respective employers. The resulting lawsuits claim the pharmacists are protected by the First Amendment (free exercise of religion) as well as Title VII (employment discrimination based on religion).
If approved, the settlement would allow an objecting pharmacist to relay the prescription to an off-site pharmacist, who would then process the emergency contraceptive prescription instead. As with all settlements, however, parties on both sides remain unsatisfied. Those who religiously oppose Plan B are still unsatisfied that pharmacies would be required to stock the prescription, even though the pharmacists would no longer be required to dispense it. And proponents of the current law have a right to be concerned with the potential ramifications the settlement may have on patient care. What if, for example, the off-site pharmacist also refused to fill the prescription based on moral grounds?
The implication of this settlement also raises interesting questions about other prescriptions linked with strong religious beliefs. Aside from emergency contraceptives, could the argument similar to ones filed currently against Walgreens and Wal-Mart be stretched to include more traditional forms of birth control? Or taking the slippery-slope, would a pharmacist religiously opposed to premarital sex be justified in denying an unmarried individual a prescription, of, say, Valtrex? Those who worship at the temple of Big Pharma shudder at the thought, but perhaps consumers should also be concerned. Moral judgment, perhaps, is better suited for church than it is the local Walgreens.
-Roopali Malhotra
Earlier on blog.bioethics.net:
+ Federalism and Bioethics -- the Case of Emergency Contraception
Networking with Pfizer
Online social networking sites are all the rage these days, so it was only a matter of time before there was one for doctors -- and that's what Sermo is aiming to be. The site decribes itself thusly:
Here, physicians aggregate observations from their daily practice and then - rapidly and in large numbers - challenge or corroborate each others opinions, accelerating the emergence of trends and new insights on medications, devices and treatments. You can then apply the collective knowledge to achieve better outcomes for your patients.
Sounds pretty good, right? Like Facebook meets evidence-based medicine. OK, so how does a site like this make money? Well, they could sell advertising like others are doing in this space. But Sermo has a different idea. Here's how they describe it:
Sermo's business model is one of information arbitrage, the opportunity that arises when breaking medical insights intersect with the demand for actionable, market-changing events in healthcare.
Translation: Companies such as Pfizer can pay their way into the conversation. The site is touting the partnership as an opportunity to improve care, but the deal has also generated criticism. Here's what Merrill Goozner told Marketplace, "We need, as patients and consumers, to see physicians talking among themselves about what's best for patients -- not having another space where every time they turn around, it's the equivalent of a drug rep with a pizza showing up to tell them 'Hey, here's the possible solution.'"
-Greg Dahlmann
Weekend reading
The Scientist: The Future of Public Engagement (free access)
The dominant assumption is that ignorance is at the root of conflict over science. According to this traditional "popular science" model, the media should be used to educate the public about the technical details of the issue in dispute. Once citizens are brought up to speed on the science, they will be more likely to judge scientific issues as scientists do and controversy will go away. The facts are assumed to speak for themselves and to be interpreted by all citizens in similar ways. If the public does not accept or recognize these facts, then the failure in transmission is blamed on journalists, "irrational" beliefs, or both. Yet many scientists ignore the possibility that their communication efforts might be part of the problem.
Wired: Your Outboard Brain Knows All
In fact, the line between where my memory leaves off and Google picks up is getting blurrier by the second. Often when I'm talking on the phone, I hit Wikipedia and search engines to explore the subject at hand, harnessing the results to buttress my arguments.
My point is that the cyborg future is here. Almost without noticing it, we've outsourced important peripheral brain functions to the silicon around us.
And frankly, I kind of like it.
WP: Stricken With Cancer, and Then Terminated
She had worked as an emergency communications specialist, directing calls for the fire and police departments for 12 years. But July 26 this year, after going on long-term disability while she underwent seven surgeries and chemotherapy, Tremul received a letter in the mail terminating her employment. With her job went her health and life insurance benefits, she said.
"You don't cut someone off at the knees when they're sick. And that's what they did," Tremul said. "I was fired for having cancer."
And you thought gay marriage was controversial
Via Art Caplan comes this article in which a researcher at the University of Maastricht predicts that human/robot marriage could be no more than a few decades away:
"My forecast is that around 2050, the state of Massachusetts will be the first jurisdiction to legalize marriages with robots," artificial intelligence researcher David Levy at the University of Maastricht in the Netherlands told LiveScience. Levy recently completed his Ph.D. work on the subject of human-robot relationships, covering many of the privileges and practices that generally come with marriage as well as outside of it.
At first, sex with robots might be considered geeky, "but once you have a story like 'I had sex with a robot, and it was great!' appear someplace like Cosmo magazine, I'd expect many people to jump on the bandwagon," Levy said.
Unless they watch this important public service announcement.
Absolut Inventiveness
In this week's news of the weird and inventive, doctors in Australia are reporting treating a case of ethylene glycol poisoning by giving the patient three standard drinks of alcohol an hour, for three days, via a nasogastric tube.
This inventiveness came about when doc's quickly ran out of pharmaceutical grade alcohol. Due to the late hour, they first raided their home supplies of alcohol, and once the stores opened in the morning, bought a case to continue treatment.
Thankfully, hospital administrators appeared to be understanding about the rather large alcohol bill!
-Kelly Hills
Abortion Declines Wordwide, Corresponds with Contraceptive Use
A new study released in The Lancet's current issue, which focuses on the health of women and mothers worldwide, shows that abortion rates have declined worldwide. According to the Guttmacher Institute, one of the authors of the report, abortion rates fell most significantly in Eastern Europe, "a trend that corresponds with substantially increased contraceptive use in the region." Also of note is that the abortion rate fell the most in the regions where abortions are safe and broadly legal.
When thinking of maternal health, especially in developing countries, abortions must be taken into account. Dr. Paul F.A. Van Look, the director of WHO’s Department of Reproductive Health and Research, says that "nearly half of all induced abortions are unsafe, putting the lives and health of women at major risk. Each year, about 70,000 women die due to unsafe abortion and an additional five million suffer permanent or temporary disability."
Echoing Dr. Sharon Camp, we know that the best way to reduce abortion is to reduce unwanted pregnancies, which is easiest done by the simple method of increasing access to contraception. And the only way to improve the health of women who do have abortions is to make them safe, and provided by a skilled professional.
-Kelly Hills
Days of styrofoam cups and M&Ms
Via Jim Fossett (and Bioethics News) comes this NYT story about how a Minnesota law limiting gifts to doctors has affected drug reps there. It seems some of the glamour is gone:
Two years after Minnesota officials forbade drug makers to give doctors more than $50 worth of food or other gifts per year, drug company sales representatives there are having a far harder time marketing to doctors. The rule change was small and almost accidental — a state official decided to interpret a 1993 law differently from his predecessor. But the effect on drug makers has been profound.
The year after the change, the number of visits that Minnesota primary care doctors accepted from drug sales representatives decreased at about twice the rate of the decline reported by primary care doctors nationwide, according to a survey by ImpactRx, a New Jersey firm that tracks pharmaceutical marketing. A growing number of Minnesota hospitals and clinics have banned routine visits from them.
“We have an extended hallway, and the sales reps sit there now without anything except maybe Styrofoam cups filled with M&Ms. The 30 pizzas are gone,” said Dr. Michael Severson, a pediatrician in Brainerd, Minn. “It’s made the doctors think about whether to ban them.”
Forget the carrot, here's the stick
Back in August Art wrote about company health plans that offer discounts for healthy behavior. He criticized the idea for being an invasion of privacy and added:
The emerging movement toward corporate health fascism is no friend to the chubby and wheezy among us. But, if allowed, corporate health policing won't stop there.
How long will it be before slackers will be told that discounts are over, and instead, surcharges on them will begin? Who will be next? The guy who skis on the weekends? The woman who wears high heels? What about the family that decides to have a baby, knowing the child may have sickle-cell disease or cystic fibrosis? Will companies be willing to put up with that sort of personal “irresponsibility”?
At least one employer is already headed down the punishment path. Clarian Health, an Indianapolis-based hospital system, recently announced that starting in 2009 it will fine employees $10 per paycheck if their body mass index, blood pressure or glucose levels are too high.
Add another employer to the list. Michael Mayo, a columnist for the South Florida Sun Sentinel, recently wrote on his blog about how his paper's parent company, Tribune, will be charging smokers -- or anyone with a smoking family member on their health plan -- an extra $100 per month for health insurance. And he's a little upset that the company bypassed the carrot and went straight for the stick:
Will there be fees for alcohol use? Eating fast food? Having high cholesterol? Not adhering to proper weight/body mass guidelines?
The other thing that gets me is that there’s no reward for not being a smoker. If the company imposed a surcharge on smokers and then gave a proportionate break to all the non-smokers I could maybe be a little more positive about the whole thing.
Instead, everyone’s premiums, deductibles, co-pays and out-of-pocket maximums are going up next year. In my case, my annual out-of-pocket maximum for each family member is going from $1,250 per person to $2,000 per person. And that’s not even including prescription drugs. And that’s in addition to my $4,000 share of the annual premium that I’m paying.
Yikes. I’ve seen the future, and it’s damn expensive.
It seems Mayo isn't the only one upset by the plan. Editor and Publisher reported this week that two union locals have filed grievances partly in response to the smoker surcharge.
-Greg Dahlmann
Digging up the Gipper
The AP reports that the family of Notre Dame football great George Gipp (of Knute Rockne's famous "Win one for the Gipper!") recently exhumed their ancestor for DNA testing. The exhumation didn't sit well with some members of the Gipp family. One called it "a desecration" and another said "It’s absolutely ridiculous and uncalled for."
So, why dig up the Gipper? Apparently to resolve a "sensitive family matter." So sensitive, in fact, that ESPN was there to record the exhumation. It seems there's also a book involved.
The Encyclopedia of Death and Dying has info on exhumation law.
-Greg Dahlmann
Are dentists doing enough for the poor?
That's essentially the question behind a story in the New York Times today about the state of the dental profession:
For middle-class and wealthy Americans, straight white teeth are still a virtual birthright. And dentists say that a majority of people in this country receive high-quality care.
But many poor and lower-middle-class families do not receive adequate care, in part because most dentists want customers who can pay cash or have private insurance, and they do not accept Medicaid patients. As a result, publicly supported dental clinics have months-long waiting lists even for people who need major surgery for decayed teeth. At the pediatric clinic managed by the state-supported University of Florida dental school, for example, low-income children must wait six months for surgery.
In some cases, the results of poor dental care have been deadly. A child in Mississippi and another in Maryland died this year from infections caused by decayed teeth.
The dental profession’s critics — who include public health experts, some physicians and even some dental school professors — say that too many dentists are focused more on money than medicine.
“Most dentists consider themselves to be in the business of dentistry rather than the practice of dentistry,” said Dr. David A. Nash, a professor of pediatric dentistry at the University of Kentucky. “I’m a cynic about my profession, but the data are there. It’s embarrassing.”
A defender of the profession is Dr. Terry D. Dickinson, a practicing dentist who is also the executive director of the Virginia Dental Association. He says he believes that dentists are charitable and want to provide care to poor patients. But dentists are also in business; they must pay rent and employee salaries, and they deserve fair fees, he said.
“Charity is not a health care system,” Dr. Dickinson said.
Dentists, of course, are no more obligated to serve the poor than are lawyers or accountants. But the issue from a public health standpoint, the critics say, is that even as so many patients go untreated, business is booming for most dentists. They are making more money while working shorter hours, on average, even as the nation’s number of dentists, per person, has declined.
The article seems to have struck a nerve -- it's currently the most emailed story on the NYT site.
-Greg Dahlmann
Peeking at George Clooney
So apparently George Clooney was in a motorcycle accident recently (it was news to us, too) and he and his companion were taken to a northern New Jersey hospital for treatment. Well, it seems that the state of Clooney's rib (world's sexiest rib?) is quite a juicy piece of info -- and someone leaked it to the press. The hospital investigated the leak and says it found 27 people -- doctors and nurses included -- who had accessed Clooney's file without authorization. And now those 27 people have been suspended for a month without pay.
Does the punishment fit the infraction? And would the penalty have been this severe if the file in question hadn't been someone famous? For his part, Clooney says he'd prefer that the hosptial would resolve the issue without the suspensions.
A related question: do electronic health records make this kind of unauthorized access more or less likely? Presumably any system handling this kind of info would be encrypted and have strict access controls. But as people have come to find in the digital age, electronic information seems to live forever -- and even secure systems fail (every other month there seems to be a breach in some sort of database containing sensitive info). Or, to put it a different way, should you trust Microsoft to keep your health information safe?
Earlier on blog.bioethics.net:
+ Bush: "[Electronic Health Records Must Be] Secure & Private (Except When They Aren't)
+ HIPAA Gutted Again - the Sound and Fury of Patient Privacy Laws in the U.S.
-Greg Dahlmann
Speed reading the October 9 Republican debate
The Republicans running for the presidential nomination got together in Dearborn, Michigan yesterday to debate topics related to the economy. We've pulled highlights from the transcript that might be of interest here on the blog. (We'll try to do this for future debates.) For yesterday's debate, that meant comments from the candidates about health care. There were no mentions of stem cells, cloning, chimeras or biomedical research. The breakdown is after the jump.
The metaphysics of baboons
Today's Science Times includes an article about Dorothy Cheney and Robert Seyfarth, biologists who study the mental and social lives of baboons. Why baboons?
Reading a baboon’s mind affords an excellent grasp of the dynamics of baboon society. But more than that, it bears on the evolution of the human mind and the nature of human existence. As Darwin jotted down in a notebook of 1838, “He who understands baboon would do more towards metaphysics than Locke.”
Earlier on bioethics.net:
+ Evolution and morality
+ Evolution and morality, continued
-Greg Dahlmann
Science and the next president
This month in Seed Chris Mooney calls for the next president of the United States to be a sort of scientific researcher-in-chief:
As a prerequisite, the next president must grasp how science flows into a democracy at all levels. Whoever wins the election—man or woman, Democrat or Republican—will face profound science-based challenges and questions. Will space become militarized, or remain a neutral zone of unfettered international access? Will we successfully protect our populations and cities from the threats of nuclear and biological terrorism, as well as from emerging pandemics? Can we bring the AIDS crisis in Africa under control? How can we foster continuing biomedical advancement without crossing moral lines?
Will there be enough jobs available to employ the nation's scientists? If foreign researchers are better qualified for those jobs, will they receive visas so that US companies can benefit from their skills? And what of research in areas of pure science? As Europe's Large Hadron Collider at CERN in Geneva—the world's most powerful particle accelerator—heads toward a slated May 2008 startup, will the US revisit the idea of building its own collider, and willingly take on that next phase of research into the very nature of matter? More important, will the next president understand the significance of such scientific questing? And if so, will he or she also know how to tell that story to the public?
Watching as the issues of the future careen toward us, a true national leader will recognize the moral imperative to take what we know from (and about) science and use that knowledge to build a better and smarter America. That's not to say the next president must be a scientist. Being able to talk shop with the NIH lab workers isn't a job requirement. It's far less important that the next president know any field of science in depth than that he or she knows how to learn—how to become informed about scientific or technical subjects where there's often much uncertainty and yet also a pressing need for a policy decision.
It's hard to argue with Mooney's desire for a president who will make a good-faith effort to draw on the expertise of the nation's scientific community. (Policy decisions based on fact and careful consideration of the evidence? Where do we sign up?) But the scientific issues Mooney highlights -- climate change, stem cells and forensic neuroscience among them -- are also intensely political. The challenge for the science-based administration will be to keep science from turning into just another interest group (or, more than it already is).
-Greg Dahlmann
Answers we'll probably never have
The British Psychological Society's Research Digest Blog recently asked 13 psychologists the question "What's the most important psychology experiment that's never been done?" And while some of the research ideas prompted by the question just simply haven't been attempted yet, some of the most fascinating -- looking into the relative influence of nature and nurture, studying the brain as a person dies -- probably never will be for ethical reasons. The psychologists proposing the research acknowledge this... usually. One of the experiments that seems just blatantly unethical -- a sort of Truman Show study -- is dismissed not because of ethical concerns, but because of complexity.
(via)
-Greg Dahlmann
Casting doubt on mandated health care
Over at Businessweek, Glen Whitman criticizes the "health insurance like auto insurance" plans that many candidates (Hillary Clinton among them) are touting:
As anyone who has ever driven above 55 mph knows, mandating something is not the same as making it happen. Some people will not comply: 47 states require drivers to buy liability auto insurance, yet the median percentage of uninsured drivers in those states is 12%. Granted, that number might be even higher without the mandates. The point, however, is that any amount of noncompliance reduces the efficacy of the mandate.
None of this means the uninsured are not a problem. Yet the true issue isn't that they cost the rest of us too much. It's that they simply get less care than most people (one reason uncompensated care is such a small fraction of health-care spending). And if the real concern is making health insurance and health care available to those in need, we should focus on reducing health-care prices and insurance premiums. The individual mandate is, at best, a distraction from that goal.
Whitman concludes that the best way to bring health insurance to the uninsured is to have governments remove many of the current mandates for benefits, a move which he says will open the way for low-priced catastrophic coverage plans.
(Via Marginal Revolution, which today includes a post on the "nanny state" and some quality comments.)
-Greg Dahlmann
Venter team claims to have created a synthetic chromosome
Via Art Caplan comes word that Craig Venter's effort to create a synthetic microbe has taken a step forward. The Guardian reports that Venter's team has created a synthetic chromosome and could announce very soon that it has created the world's first synthetic life form. The Guardian piece touches briefly on some of the ethical and regulatory challenges such an organism would pose:
Mr Venter said he had carried out an ethical review before completing the experiment. "We feel that this is good science," he said. He has further heightened the controversy surrounding his potential breakthrough by applying for a patent for the synthetic bacterium.
Pat Mooney, director of a Canadian bioethics organisation, ETC group, said the move was an enormous challenge to society to debate the risks involved. "Governments, and society in general, is way behind the ball. This is a wake-up call - what does it mean to create new life forms in a test-tube?"
He said Mr Venter was creating a "chassis on which you could build almost anything. It could be a contribution to humanity such as new drugs or a huge threat to humanity such as bio-weapons".
Mr Venter believes designer genomes have enormous positive potential if properly regulated. In the long-term, he hopes they could lead to alternative energy sources previously unthinkable. Bacteria could be created, he speculates, that could help mop up excessive carbon dioxide, thus contributing to the solution to global warming, or produce fuels such as butane or propane made entirely from sugar.
"We are not afraid to take on things that are important just because they stimulate thinking," he said. "We are dealing in big ideas. We are trying to create a new value system for life. When dealing at this scale, you can't expect everybody to be happy."
Related on bioethics.net:
+ Wired:Three smart things about genomics
+ Science anxiety
+ Design, More Intelligent Every Day
+ Synthetic biology
Social science at war
The New York Times has an interesting story today about the military's use of anthropoligists and other social scientists in its counter-insurgency efforts in Iraq and Afghanistan. Army officers tell the Times that the scientists have been a great aid in their efforts to understand local populations and dynamics. But the program has drawn criticism from other academics:
Ms. McFate, the program’s senior social science adviser and an author of the new counterinsurgency manual, dismissed criticism of scholars working with the military. “I’m frequently accused of militarizing anthropology,” she said. “But we’re really anthropologizing the military.”
Roberto J. González, an anthropology professor at San Jose State University, called participants in the program naïve and unethical. He said that the military and the Central Intelligence Agency had consistently misused anthropology in counterinsurgency and propaganda campaigns and that military contractors were now hiring anthropologists for their local expertise as well.
“Those serving the short-term interests of military and intelligence agencies and contractors,” he wrote in the June issue of Anthropology Today, an academic journal, “will end up harming the entire discipline in the long run