blog.bioethics.net

The Two X Chromosome Penalty

Women have broken through glass ceilings, they have narrowed the pay inequity gap, taken control of their reproductive health and become empowered in countless ways.

Yet, in the area of healthcare, women still face significant inequities. The one about which is most important to raise to day was reported on by the New York Times, which informed us that where women are concerned they are expected to pay significantly higher health insurance premiums than men. As the WSJ Health Blog stated it:

In a Humana plan with a $2,500 deductible, a 30-year-old woman pays 31 percent more than a man of the same age in some cities; Anthem Blue Cross (part of WellPoint) charges 30-year-old women 49% more than men of the same age for its Blue Access Economy plan in at least one city.

All this for having two X chromosomes? Not exactly. It is also the case that women utilize healthcare services more, not just during the childbearing years, but overall. Ever notice how men put off going to the doctor until their leg is actually falling off? A slight overstatement, but not much. In doing so, they utilize fewer health care resources and thus justify having lower premiums.

Plus as the image below shows, women will always be a part of the red and yellow parts of the healthcare dollar breakdown, but its the utilization of the most expensive services--hospital care, physicians, and drugs that make women a much costlier and riskier patient to insure.

So, oddly, because many women are proactive, get regular checkups, and in many cases catch deadly diseases like breast cancer or ovarian cancer early and get treated for it, they are penalized by hiking up their premiums. Good plan, insurers.

No matter what the reason, we all know that it comes down to actuarial tables and pooling of risk and a bottom line. A line under which many women fall. It may be good insurance business, but it's not good ethical practice.

Summer Johnson, PhD

The Hairy Truth about Alcohol Consumption

Many people think that hair conveys a lot about a person's personality; others see it as just this nuisance growing out of the top of one's head requiring maintenance. But now, hair holds the secret to what can be anything from a social habit to a serious addiction.

That's right: there is now a test that can provide an extended history of alcohol consumption, says WSJ's Market Watch. The AbuseCheck(TM) by Consumer Genetics uses a hair sample to detect the level of fatty ethyl esters in one's hair. The more you have, the longer you have been drinking.

A few hiccups: the longer the hair, the better the test as the hair has time to build up these esters while it grows. Sinead O'Connor would not be a good candidate for AbuseCheck. Like looking at the rings of a tree trunk, scientists can use long strands of hair to measure the amount of these esters present as the hair grew--thus determining how long and how much one has been consuming alcohol.

The problem with this kind of testing, besides the "Barber Defense", as a means of determining whether employees or recovering alcoholics are alcohol free is that hair grows somewhat slowly. Even a long hair sample could appear ester-free, but that person could be downing scotch hand over fist in the last week or the morning before the test for that matter. If all the testing requires is a period of abstaining from alcohol until one's hair is "clean" (Consumer Genetics' website says it can detect alcohol consumption for 6 months to 1 year), then it would seem to me that this method is no better at preventing fraud in drug testing than any other.

Only if a company instituted yearly AbuseCheck testing would this work--and at $495 per test, this is an expensive endeavor for any company.

In any case, it's a creative idea. Maybe it will work. Or maybe the companies who are known to do this kind of testing will suddenly have a 100% increase in the number of bald applicants coming into their HR departments.

Summer Johnson, PhD

Docs Tired of Paper Work? I Have a Solution

Today in one of my favorite blogs, the Wall Street Journal Health Blog, Jacob Goldstein comments on the fact that doctors, drowning in paperwork, have less and less time to heal.

The solution, of course, which health economists, health policy analysts, and bioethicists have been clamoring for for years, is to have a centralized healthcare billing system. As NEJM reminds us the administrative costs for ALL of the Canadian healthcare system is 16.7% of the total healthcare budget while in the good-old US of A we spend something on the order of double that. And JUST overhead spending the US spends 10 times as much as Canada.

So, you don't like Canada or think they are anomaly in comparative health examples. Fine. The point still stands. Would you rather have your doctor spend more time filling out forms for your insurance company and every other person under the sun or spending that time with you in the exam room? Would you rather spend less time filling out forms and more time reading People Magazine in the waiting room?

We know administrative costs must be cut. But no one, neither presidential candidate even, knows how. But perhaps if medical schools taught doctors how to run a business and manage well the idea of "pushing paper" wouldn't seem so onerous. Or be done so poorly. Then they could get back to the important stuff. Doctoring.

Summer Johnson, PhD

Is There Anyone Who We Won't Let Be A Physician?

No one is perfect--but a physician charged for the tenth time for sex related allegations is still seeing patients in Canada.

How this is possible completely eludes me. Were the previous nine allegations all found to be completely unsubstantiated? Is this poor fellow being singled out? I don't think so.

According to a report from EnergeticCity.ca, the physician was arrested in June for the first nine allegations occurring between both male and female patients, even minors.

Even so, in their infinite wisdom, the Alberta College of Physicians and Surgeons did not suspend his license. Perhaps he received fifty lashes with a wet noodle and a "hall monitor" to attend is visits with patients.

One doesn't even have to consider the ways in which medical ethics has been violated here and that those violations have been ignored by the local medical association. It's just plain wrong. This physician should lose his license and be looking for a new job selling boats. Then there would be no code of ethics or Hippocratic oath to get in the way of his impulses and inappropriate behavior.

Summer Johnson, PhD

One-Eyed, One-Horned Flying Purple Tomato Eater

News reports say that researchers from the John Innes Center in the UK have grown a potentially cancer-preventing tomato. These tomatoes genetically altered to grow with the dark purple pigment anthocyanin are hoped to either prevent or reduce the effects of a number of chronic diseases including cancer.

When the purple tomatoes were fed to mice in the laboratory, their lives were significantly extended--and one can assume not simply over the excitement of eating a purple tomato!

Researchers conducting this study say its still too soon to tell how much an effect these GMOs will have on human health--and of course the key is still getting these veggies into people diets. But the successful introduction of this compound into the vegetable makes this GMO a huge success for metabolic engineering.

Oh--and one other thing: anthocyanin is found in snapdragon flowers naturally--but I wouldn't go out and start chewing on the petals. These researchers say that the best way to prevent cancer is still to eat a balanced, healthy diet--not to bulk up on this single compound.

Summer Johnson, PhD

Forget Red, Blue and Pink States! Go Green!

Courtesy of Strange Maps, I have a chance just one week before we elect a new president of the United States to look at a very different kind of map so that my eyes don't bug out over staring at electoral maps and electronic "whiteboards" with every shade of state from red to pink to mauve to navy blue.

Instead, Strange Maps brings us what I will affectionately call "the Fat Map". This map ranks by percentage of population that is obese. Unlike these 2008 election maps, this one is filled with brown states (which must represent the color of their people's almost cardiac arresting hearts), orange states (where clearly these citizens should be eating more actual oranges and less Cheetos), the peach states (slightly better off, but they should lighten up on the red meat), the light green states (where they go light on the greens), and the bright green state (that would be Colorado, where despite the abundance of breweries, they still turn out to be the leanest in the nation).

(read the rest)

And You Thought Electric Chairs Were Cruel and Inhuman

Oxford University's Practical Bioethics Blog informs us that the tools of eugenics are alive and well in Europe--but for an entirely new reason all together. Polish Prime Minister, Donald Tusk, is lobbying for the use of involuntary chemical castration for sex offenders in Poland. Arguing that the rights of victims should be placed above offenders, the Prime Minister has argued that the only suitable punishment in a case of incest is to perform non-voluntary chemical castration. The justification for this argument is simple in the Prime Minister's view: sex offenders are not humans with moral standing but "creatures" who clearly do not have much if any at all.

While the practice of chemical castration is not new--it has been used by eugenists during the Third Reich--it would seem to have taken on new popularity in Poland and other European countries and (gasp) the United States, too. At least six of our own states use this as a method of punishment and/or deterrent for sex offenders using drugs like Depo-Provera and a law-enforcing needle.

Yet, it would seem that there are other ways of protecting innocent persons from sex offenders. While rates of recidivism are high, perhaps greater resources should be put into effective therapy programs, community based groups and resource centers for sex offenders released into their community.

Moreover, one cannot hold the view, ignoring basic human rights, that these human beings do not deserve certain protections such as the obligation of a physician to do no harm. Many of these drugs used in chemical castrations have serious side effects for men. For that reason alone, these drugs should not be forced on sex offenders. Instead, they should be given the choice if they are truly committed to remediating their behaviors and felt that such a treatment would be effective.

Only the voluntary use of such chemicals for sex offenders would acceptable--but only if they were fully informed of the risks of the drugs used and that such actions were not done in exchange for early release or shorter parole. The only way to ensure that sex offenders will not continue to commit the same crimes is to have their genuine commitment to remediating their behavior--not chemically inducing their bodies to have lesser desires to perform illegal and immoral acts.

Summer Johnson, PhD

A Concierge Isn't Just at A Hotel Anymore...

The Sunday Baltimore Sun featured a story about "concierge" medicine and a Maryland trend of primary care docs charging premium membership fees on the order of $4000 or more for patients to be part of their practice. The reason? One doc was quoted in the article:

"Primary-care doctors are seeing 30 to 40 patients a day - that's too many," said Dr. Harry A. Oken, who has been with Charter Internal Medicine for more than 20 years. "It's not about the money. It's about having the time to spend with your patients to keep them healthy."

With a shortage of primary care docs already existing in this country, the fact that some of them will now be isolating themselves inside these so-called "boutiques" of medicine is troubling to some. For example, Art Caplan has said it's a clear sign of a broken primary care system. Yet, the AMA has said that the practice is not inherently bad, unless the practice means that differential care is provided by concierge medicine.

In any case, these positions would both seem to raise relevant questions about the development of this trend. The fact that primary care physicians feel the need to change their practices to restricted-access, members-only places more like country clubs than doctors offices suggest that these doctors are feeling too overwhelmed with the demands of their profession and that perhaps more primary care physicians must be trained. If that is difficult to do, primary care as a career path must be incentivized for doctors-in-training and the practice of primary care must be made different not the horrible 30 to 40 patient a day experience described in the Baltimore Sun.

Moreover, doctors must understand the ethics of providing primary care--and whether they treat 2 or 22 patients a day they all must receive the same quality of care. Regardless of whether one paid a $20 co-pay or a $20,000 concierge membership fee to see them.

Summer Johnson, PhD

Nurse, Give This Patient a Placebo.

A new study published in British Medical Journal has shown that almost half of internists have prescribed drugs that were expected to have nothing more than placebo effect. As reported by Bloomberg, these useless prescriptions were handed out as often as 2 or 3 times per month.

Why would docs do this? To increase "positive patient expectations" says Jon Tilbert, author of the study. Among the physicians who participated in the study, 67 percent reported that they believe that this practice is ethical or even morally obligatory.

This is perhaps the best data yet to prove that there is rampant consumerism in healthcare and that physicians are complicit. Prescribing drugs and other unnecessary treatments merely to satisfy the whims of demanding patients who have "expectations" physicians believe must be met, even if this were in the service of maintaining the physician-patient relationship, is not acceptable. This practice, instead of promoting rapport and trust and good communication between doctor and patient, actually erodes it.

That is, if the patient ever knew. But then again, why would a patient ever complain or feel unhappy when they are getting everything they want? Even so, this is unethical, plain and simple. Promoting positive patient experience by prescribing drugs that are no more than placebos is simply unacceptable and unsustainable for the ethical practice of medicine.

Summer Johnson, PhD

Ethic-Mart

Chris MacDonald at The Business Ethics Blog has pointed out that Wal-Mart may be the "next Nike", jumping on the business ethics bandwagon in China.

The retailing giant, often criticized for its business practices, is now trying to influence more than 1,000 of its suppliers by raising its human rights and environmental standards. By raising expectations for its suppliers, Wal-Mart hopes to enhance its own ethical profile--abroad and eventually at home.

Whether this move by Wal-Mart is a symbolic one for PR value or a sincere turnaround (or some of both), there can be no doubt that one of the world's largest retailers making ethical changes in the nation's most populous country is likely to have an effect and other corporations are going to play "follow-the-leader".

Summer Johnson, PhD

Stem Cells? I Don't Know, but I Want To.

According to the National Poll on Children's Health--only 11 percent of voters feel as though they know a lot about stem cell research, says University of Michigan Health Service.

The silver lining? Data suggests that voters WANT to know about stem cell research, but they just don't know much yet. Plus, the more voters know about stem cells, the more they want it: 85% of respondents who knew a lot about stem cells support the research, compared to 25% of those who do not know much.

Of course, this data could be biased in the sense that those who learn about stem cell research are already those who support it--thus why they learn more about it in the first place. Nothing in this data suggests that knowledge alone influences voting patterns.

In this poll, there's bad news for federalists though--72% of those surveyed say they would prefer national legislation to state law.

These facts are relevant for the upcoming stem cell research vote in Michigan (Prop. 2) where that state will decide whether they will allow embryonic stem cell research. Half of the battle it would appear is general education on stem cell research, not over the specifics of the issue itself.

Summer Johnson, PhD

Bioethicists Discuss "Future Tense" in Cleveland

Starting today in Cleveland, Ohio, more than 700 bioethicists from around the world gather to debate topics ranging from enhancement in sport to vaccine ethics to the bioethics of food at the 2008 Annual Meeting of the American Society for Bioethics and Humanities.

This year's meeting is held at the Renaissance Cleveland Hotel and will host 4 days of lively sparring over the hottest and most controversial topics in the field and collegial receptions sponsored by the American Journal of Bioethics, Taylor and Francis, Oxford Journals, Cleveland Clinic, Penn Bioethics, and more.

The meeting's theme "Future Tense" highlights the ways in which bioethicists are forward looking, anticipating new ethical questions and problems as well as, as the conference co-chairs, Elisa Gordon and Jason Robert state, expressing "disquiet over imminent ethical issues prompted by new technologies (e.g. nanotechnology) and new funding mechanisms (e.g., CTSAs)".

First, the conference kicks off with pre-conference sessions ranging in topics from medical residency education, led by Howard Brody from UTMB; preventive ethics, led by Ellen Fox and colleagues from the VA healthcare system; an informed consent workshop from a group from the University of Michigan; a panel on ethics consultation led by Mark Aulisio from Case Western; and a law and bioethics teaching workshop by Katie Watson from Northwestern University.

Following these optional sessions, the ASBH juices really get flowing with some "God" talk from the author of House of God (read about it here), Stephen Bergman who will explore the concept of "inhumanity" and the use of fiction to convey healing in the medical context.

The first day of the ASBH Annual Meeting promises not to disappoint. Two sets of panel sessions in the afternoon are packed full of interesting and diverse topics. These are buttressed by plenary sessions and receptions that promise to stimulate and connect old colleagues and new friends.

Live from Cleveland,
Summer Johnson, PhD

**ATTENTION Conference attendees: AJOB and bioethics.net will be hosting its reception at Shucker's on the 1st floor of the Renaissance from 7:00 PM to 8:00 PM tonight.**

Love Pharma, Get a Free TV Spot

The pharmaceutical industry is saying a big "THANK YOU" to its favorite politicians by promoting them in television ads, says the Wall Street Journal Health Blog .

Thanks to the watchdogs at the Center for Public Integrity, we now know that more than $13 million has been spent to praise the politicos who voted for the expansion of the SCHIP program.

The problem here, of course, is that it is neither obvious or transparent that these ads are funded by pharma rather than the impossible-to-object-with name of "America's Kids: Health Care for Kids". According to PhRMA, "these aren't campaign ads." Hmmm....just happened to produce an ad praising politicians up for reelection just 2 weeks before the vote takes place? Perfect timing, America's Kids, what a lucky accident.

The second problem is, of course, that particularly House members who often run cash strapped campaigns benefit from these ads--and my suspicion is that Congressmen and women will remember that little boost when it comes time to vote on the next health related bill that impacts the industry.

I don't fault the politicians--campaigns are tough and fundraising even tougher. It's large corporations or their trade organization trying to guarantee pro-pharma votes in Congress that pushes the ethical envelope. If you are going to buy votes, at least do so transparently, then at least we know what you are made of.

Summer Johnson, PhD

Loving to Hate Bioethics

Wesley Smith's Second Hand Smoke is promoting Bioedge, a blog that slams bioethics and its professionals hard. Michael Cook's screed takes to task bioethics as a discpline and its members saying that "That sexy little prefix "bio" has become a Kevlar vest for so-called experts who couldn't score a job in the philosophy department of Monty Python's University of Wooloomooloo."

Ouch. Moreover, he calls out specific bioethicists, namely Julian Savulescu of Oxford University's Uehiro Centre for Practical Ethics. But rather than making logical arguments against Savulescu's positions with which he takes issue, Cook instead engages in snide, ad hominem attacks against the Oxford bioethicist and the field generally, going so far as to suggest that we "abolish bioethics and bioethicists" in favor of something, indecipherable called "vanilla ethics".

Yet, it would appear that Cook, ranting and raving about bioethics in Online Opinion, doesn't really know much about the field or its members. First, the fact that he believes that an argument for mandatory organ donation is new and sinister, just shows that Cook doesn't know the literature. Second, it appears he just likes to make the Uheiro Center for Practical Ethics the whipping boy for his disdain for bioethics, slamming them again in his blog yesterday. Third and finally, calling for an abolition of the field on the basis of disagreement with one person's arguments in favor of organ markets or enhancement in sport seems a bit overreaching to me.

In any case, Cook is making really weak arguments, if they are arguments at all, against bioethics all based around a disdain for one Oxford ethicist. When you have some real arguments about the lack of theory available to make bioethics a discipline, any evidence at all that bioethicists are not as well-trained, rigorous, or qualified as other ethicists, or know the literature, Mr. Cook, then we can talk.

Summer Johnson, PhD

Got A STD? Send an E-Card.

As unbelievable as this sounds, partner notification for STDs are coming to an e-card near you. When you can't tell your partner face to face, inSPOT (sponsored by Internet Sexuality Information Services and the San Francisco Department of Health) will help you spread the word via a cute email, says US News and World Report

Let's just hope Hallmark doesn't get in on the action and start sending messages via those annoyingly funny Hoops and YoYo characters. That could be enough to throw the email away right there.

Summer Johnson, PhD

I Can't. My Baby Is Allergic.

It would appear that autism isn't the only early onset disorder that is plaguing a greater percentage of children. Next posing a risk to child health: food allergies, says USA Today.

Not only are the allergies to eggs, nuts, and other foods culprits, but researchers have found that accompanying the allergies are other conditions such as asthma, hay fever and more. So allergies to food aren't just serious for the reactions caused themselves, but they actually are a co-morbid condition for a number of life-long conditions. Thus, food allergies aren't just a condition that children can grow out of, but instead can be a harbinger for a life filled with other health problems.

The solution? It's hard to tell. The real question: why are food allergies on the rise and what can be changed--environmentally or otherwise--to prevent these serious reactions and their co-morbid effects from occurring? Hopefully this will be the next question for researchers and this dramatic increase in food allergies can be better understood and stopped.

Summer Johnson, PhD

Letting the Genome Loose? No Biggie.

Announced today in the NYT, Harvard Medical School unveiled the first 10 participants in their Personal Genome Project.

Ranging from entrepreneurs to academics to healthcare execs, the goal of the project is to raise awareness about the possibility of personal genomes for everyone. However, the project's lead researcher and participant in the first 10, George M. Church, is the first to say that they don't have a clue what the social or psychological effects of such information will have: "We don't yet know the consequences of having one's genome out in the open."

Well, perhaps a little more thought should have gone into that before these individuals--not randomly chosen--but chosen for their particular status or position--participated in the project. These persons may have the knowledge and resources about genetic information to make good decisions in the light of genomic revelations--but what about the average person? Will they?

The participants themselves, quoted in the NYT article, raised their own ethical concerns--yet they participated. Why? Curiosity? Support of the project? Or the belief that their genetic information will not be used against them? Someone should be asking these questions as the project expands to 100,000 people. These perennial questions and problems are not going to go away. The personal genome may be here, but no one seems to know for sure if it's really a good thing.

Summer Johnson, PhD

Simulations aren't Just for Training Pilots Anymore

Recent research done at the Feinberg School of Medicine at Northwestern University has revealed that first year anesthesiology residents who first practice using simulations perform better than their real-world counterparts, says Newswise.

Really, this just makes good sense--rather than having patients in teaching hospitals exposed to residents who may be encountering complications from anesthesia or other issues for the first time, exposing residents first to these scenarios in simulation increase the likelihood that they will know what to do when the real thing happens.

Sounds like for anesthesiologists, at least, the motto ought to change to "simulate one, see one, do one, teach one".

Summer Johnson, PhD

Autism Becomes an Electoral Issue

I agree with the comment of Orac on Respectful Insolence that it was remarkable in the last Presidential debate how discussions of autism treatment and research became mainline issues in the campaign.

Oddly, Sarah Palin was credited (by McCain) with this sudden realization that autism (a disease that now effects 1 in 150 children) is a major child healthcare issue, despite the fact that her child has Down's Syndrome, not autism.

Don't get me wrong--the need for more and better services for children with a wide range of developmental disabilities is clear. Autism is the disorder that is most likely to have downstream effects, not just for healthcare, but for social services, employment benefits, and many more sectors of the economy, for decades to come.

(Not if you listen to Denis Leary, though, who says that autism is merely an excuse for lazy kids and parents...no I'm really not kidding. )

It's a good sign that the candidates have taken notice. What they actually plan to do about it....well, that's a whole other story all together.

Summer Johnson, PhD

Music You Can Save a Life To...

Ever have a Bee Gees song stuck in your head and you just can't get it out? Well, if you are an EMT, that just might be a good thing.

According to researchers, the 103 beats per minute in the ever classic "Stayin' Alive" provides the perfect rhythm for performing CPR. "Stayin' Alive" isn't just a song anymore--it's a means to keepin' alive--hum along to that 1977 disco hit and you can be the perfect lifesaver.

As described on MSNBC.com, a small study done at University of Illinois Chicago found that 10 docs and 5 med students who listened to the tune while doing CPR did it perfectly. How this occurred to these researchers, one may never know.

And how many more songs out there that are catchy and in the minds of every American are 103 beats per minute? Well, our fearless editor-in-chief of AJOB, Glenn McGee, who would more often rather than not hide the fact that he was once a DJ, has told me that one could "beat" patients back into existence with the following songs: "The Macarena" by Los Del Rio, "Crash" by Dave Matthews, "Luekenbach, Texas" by Willie Nelson and Waylon Jennings, and "Iris" by the Goo Goo Dolls.

One has to wonder: can the Time Life music series "Songs to Save a Life By" be far behind?

Summer Johnson, PhD

Going to the Chapel of...Annoyance?

County clerks in California are flabbergasted at the rush to change marriage forms in that state from "Party A" and "Party B" to "Bride" and "Groom" and then back again.

In accordance with a recent Supreme Court decision that ruled that gender-neutral is the way to go--all forms in CA after January 1--will be gender-neutral regardless. But it turns out that some soon-to-be wed couples in a few counties in California are raising a fuss about having to be identified as a "party" rather than good-old bride or groom. As a result, forms are being switched around.

What is inexplicable to me is how, at the happiest time of these couples lives, they should care one iota whether one a county marriage form they are identified as Mr and Mrs. Claus or Bride and Groom or Party A and Party B. In the days, weeks or months before your marriage would hardly seem to be the time to be arguing about a political statement or to be fussing over denying other couples their right either to be Parties A and B or Bride and Groom.

The whole fight seems ridiculous to me, a huge waste of resources, and a continued debate of a unjustifiable civil rights violation that California has sought to discontinue. So let us have all couples--gay or straight or any other persuasion sign the forms as they are--as parties and end this silly fight.

Summer Johnson, PhD

I Love Joe the Plumber

If any one watched the third and final Presidential Debate last night, they learned absolutely nothing new about the future of the American healthcare system. Except of course that there's a guy named Joe the Plumber whom both of the candidates were making love to or pandering to....it's hard to tell these days.

In any case, McCain told us that under Obama's healthcare plan Joe's small plumbing business would force him to buy into scary almost-socialized-medicine or be fined. (Plus he's rich in Obama-land, says McCain!) Obama said that McCain's $5000 voucher for healthcare would hardly be a drop in the bucket toward Joe's hefty premiums leaving him to fork over the rest for himself and leaving his employees out in the cold.

Neither Obama nor McCain told us anything that we hadn't heard, positive or negative, actually true or disinformation, in countless stump speeches before.

Disappointing for sure--and not a word about social justice, public health, or any other important bioethics topics. Not to mention stem cells or any other topics one would have thought might have surfaced in the 2008 election.

Just about Joe--first it was Sixpack, then it was the Plumber. What American icons are left? Joe Burger? Joe Comic Book? Joe Pickup Truck? There's only so many demographics left to pander to, candidates.....

Alas, at least we know what McCain and Obama's priorities' are for the next 18 days--talking to Joe the Plumber.

Summer Johnson, PhD

Earbuds Killed the Radio Star

How many times have you told someone or been told that the tunes blaring in your MP3 player of choice are just too darn loud and that "you're going to hurt your hearing"?

Well, it turns out the scolders were right. EU scientists have learned, according to multiple international news agencies including the Australian BC, that as many as 10% of portable music fans may suffer permanent hearing loss from rocking too hard to tracks that are just too loud. According to the Scientific Committee on Emerging and Newly Identified Health Risks, those most at risk for this long-term damage from "leisure noise" (as opposed to occupational noise) are--you guessed it--young people.

So we aren't talking 20 years of pumping Metallica or Green Day out of your precious little listening devices......as little as an hour a day for five years can result in the kind of damage reported in this study. How long does the average teenager or college student you know spend with earbuds in his or her ear? Walked across a college campus lately? There isn't an unplugged ear to be seen!

And how long as the iPod been all the rage with...well EVERYBODY? Seven years. First generation iPod users beware: that's plenty of time to fry one's auditory sense for good. And forget about the Walkman. If you've been rocking out to that device since it came out, cross your fingers you've been on the lower half of the volume dial.

That's really the point here. No MP3 or other audio device is bad. Just jamming your eardrums full of high decible sound waves is.

The solution? Young people around the world need some sound education about sound. Without it, we'll have a generation of hearing-damaged persons in just a few years. We must tell the youth of the world to turn down the volume or even (gasp) try activities without a soundtrack blazing into their heads. It may just save their ears.

Summer Johnson, PhD

Lonely "Virgin Mary" Shark Proves Her Species Doesn't Need Males Either

Scientists have reported in the Journal of Fish Biology (a real page turner) that for the second time, a lonely lady shark in captivity has given birth to a shark pup. Yes, folks that's right a girl shark who has not come in contact with any boy sharks has become a mom! Astonishing!

Actually, it turns out that this blacktip shark is just harkening back to her primordial roots and parthenogenesis to reproduce asexually. According to one shark expert quoted in the LA Times, sharks were the first vertebrate species to have "penetrative sex" so it's likely that evolutionarily speaking that they also had the capacity at some point in their evolutionary history the ability to asexually reproduce--which is what, I'm calling, virgin Mar has done in her male-less existence.

Just another species to prove that males aren't essential to their survival. Wondering which one will be next?

Summer Johnson, PhD

Bioethicist, Nancy Kass, Joins the IOM Ranks

EurekaAlert says that Johns Hopkins School of Public Health bioethicist Nancy Kass has been elected to the National Academy of Sciences' Institute of Medicine. She is one of three JHU researchers elected this year.

Kass is the deputy director for public health at the Johns Hopkins Berman Institute of Bioethics and the Phoebe R. Berman Professor of Bioethics and Public Health in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health.

Congratulations, Professor Kass, you have joined the ranks of bioethicists at the IOM. It's an honor well-deserved.

Summer Johnson, PhD

Web Searching Better For Brain Than Books

Neuroscience researchers have found that Googling is more stimulating to the brain than reading a book, crosswording, or any other kind of activity for baby-boomers, says the Daily Mail.

Even better, the most internet savvy among us get the most out of internet searching.

So toss that library card, unless you use it to access the Web, and get surfing--to boost the mind and better the memory. At least that's what the UCLA neuroscience crowd says.

Summer Johnson, PhD

Web Searching Better For Brain Than Books

Neuroscience researchers have found that Googling is more stimulating to the brain than reading a book, crosswording, or any other kind of activity for baby-boomers, says the Daily Mail.

Even better, the most internet savvy among us get the most out of internet searching.

So toss that library card, unless you use it to access the Web, and get surfing--to boost the mind and better the memory. At least that's what the UCLA neuroscience crowd says.

Summer Johnson, PhD

Run Away from the Border?

I too want to praise Yum! Brand Foods, right along with the Association of State and Territorial Public Health Officials for its commitment to put nutritional information on its menu boards of Taco Bell, Pizza Hut, KFC, and Long John Silvers restaurants.

Yet, should it really take until January 1, 2011 to make this change? When Taco Bell comes out with its new Volcano Taco all of the Taco Bell menu signs in America change instantly---so what's the hold up with the nutritional numbers?

I really don't need to ask the question though--we all know why the Hut, the Bell, the Colonel, and Long John are going to take so long to put the digits up on the board--we would all be terrified to know at this very moment precisely how many calories are in those Chalupas we down, the stuffed crust pizza we crave, and those fish and chicken planks that call our name from the "drive-thru".

My guess is that Yum! is going to undergo a little "slim-down" before calories get slapped up on the menu boards nationwide. Maybe I'm wrong. But I bet if I knew what I was eating during my late night run for the border I'd think twice and so would you--and that's what Yum! is thinking about, too.

Regardless of how many calories are in your Chalupa, other fast-food chains should follow suit and make nutritional information more accessible than some impossible to find paper menu that you have to hunt down inside the restaurant and no one but the daytime manager knows how to find. All restaurants should plaster their menus with their caloric, fat, and other nutritional info--it's the least they can do to allow their consumers to have the chance to be healthy.

Summer Johnson, PhD

Something to Declare...But No One Cares

Disclosing financial conflicts of interest to potential research subjects does not effect their willingness to participate in research, found a recent Johns Hopkins, Duke, and Wake Forest University study. In fact, the effects of such disclosures upon potential research participants were minimal, except in one group--the participants told that the researchers owned stock in the company doing the research.

These possible research participants, asked about a hypothetical trial in this study, really only cared about one thing--trust. Trust in the institution and the researchers mattered much more to all three groups of study participants than whether any kind of potential conflict was disclosed.

Amazingly, the group who was told that the researchers were paid on a per capital recruitment basis believed that made the investigators motivated to do good research, not motivated merely to enroll more people in the study.

What this goes to show clearly is that trust trumps all in decisions to participate in research--and this fact means that the responsibility of researchers is even greater to ensure that disclosures are made and that trust is not violated. Non-disclosure of potential financial or other conflicts of interest, even if research participants would still choose to participate otherwise, undermines the entire research enterprise and ultimately will erode all trust in the institution and the investigator.

I agree with Dr. Sugarman's claim that patients have a "right to know" prior to giving consent to participate in research and such disclosures, even if they make no difference in the ultimate outcome of whether persons participate in research are the duty of all investigators.

But be prepared, investigators, if you own stock--you may get a few more prospective participants declining than you might otherwise.

Summer Johnson, PhD

Lowering the Exercise Bar, Raising the Numbers on the Scale?

Last week, the DHHS changed the guidelines for physical activity from 30 minutes of moderate activity 5 days a week to just a total of 2 1/2 hours total per week. A reported in the Washington Post, in order to fit into American's busy lifestyles, changing the recommendations means that people can now fit their physical activity into longer sessions and get the same benefits as shorter ones--and still feel as though they are meeting their goals.

But what about all the data that suggests that "weekend warriors"--those folks who don't work out all week but then attempt to run 10 miles on the weekend--are prone to more injuries? Or what about the fact that when exercise is not part of a daily routine it is all the easier just to "forget" about it and for it to fall completely out of one's lifestyle?

Moreover, not integrating healthy, routine physical fitness into people's lifestyles suggests that it is just an "every once in a while" thing--and that behavior can ultimately have an effect on the waistline. Not to mention that physical fitness is just one part of a multifaceted puzzle when we are talking about battling the obesity epidemic.

DHHS should think carefully about how they promote this new message about physical fitness for Americans. The impact could be long lasting and permanently seen right around our midsections.

Summer Johnson, PhD

Caplan Asks Whether Genetic Tests Are Worth The Price

Last week in his MSNBC column, Art Caplan asks whether breast cancer genetic tests are worth the price or whether biotech companies are cashing in on women's cancer fears.

Below is the full text of the column:

Breast cancer gene tests -- not worth the price?
Biotechnology firms hope to cash in on women's fear of the disease

Fear of breast cancer has created a tempting market for companies to sell genetic testing directly to consumers. The disease kills 40,000 people a year in the U.S., with an estimated 212,920 new cases diagnosed in 2007, according to the Mayo Clinic.

It's no wonder women would want a reliable gauge of their risk. However, American women should be aware that genetic tests for breast cancer are more hype than real hope.
On Wednesday the biotech research company Decode Genetics of Reykjavik, Iceland, announced it will sell a new test for $1,625 that it claims will allow women "to assess their personal risk for the common forms of breast cancer."

Genetic testing for all sorts of conditions is all the rage these days. Everywhere you turn, some company is urging you to spit in a cup, take some blood or swab your cheek so your DNA can reveal your health risks, know who your long-dead ancestors are, pick the right mate or help you design a diet that is perfect for your genetic makeup. But, "spitomics" has gotten way ahead of genomics.

Sadly, the tests Decode and other companies are offering are more likely to empty family pocketbooks and leave women with a false sense of security than they are to prevent breast cancer. There is simply not enough federal and international regulation in place to determine which tests are accurate or how heredity interacts with lifestyle to create individual risks.

If the Food and Drug Administration and Congress do not rein in the corporate greed that is currently driving the sale of genetic tests for breast cancer and other diseases and conditions, we could soon have an industry that bears an uncanny resemblance to the home mortgage business.

Marketing for genetic tests is already ubiquitous. The television commercials and magazine ads, which ran in Denver, Atlanta and various cities in the Northeast, promise women that cancer does not have to be "inevitable." They also claim that the average woman can reduce her risk of developing cancer through genetic testing.

Myriad Genetics, the Salt Lake City biotechnology company behind the heavy ad push, charges about $3,000 for a complete risk-disposition test. Myriad, which holds a patent on the first breast cancer test, has been taking full advantage of the genetic testing monopoly it enjoyed until Wednesday when Decode entered the market with its new, more generalized test. To date, Myriad has been very tough about enforcing the patent, even though medical centers in the United States and other countries say they could do the same testing for a much lower cost.

Only small fraction would benefit
In reality, the numbers about detectable risk don't really back up Myriad's ad claims. Of the more than 200,000 new breast cancer cases, only about 20,000 seem to be connected to the BRCA1 and BRCA2 genes -- the genes most closely linked to the inherited form of the disease that Myriad's test can detect. For women without a family history of the disease, perhaps 1 percent would benefit from the test.

On one hand, it would seem to make sense to seek out genetic testing to avoid becoming a breast cancer statistic. Or does it?

Contrary to the marketing messages, only women who have a strong family history of breast cancer -- two or more parents, grandparents or siblings who have developed the disease -- need to talk to their doctor or a genetic counselor about the value of any form of genetic testing.

Decode's newer test is not really accurate enough or based on a large enough sample of women to accurately predict much about an individual woman's chance of getting breast cancer.

If you are worried about your risk of getting the disease, or are thinking about getting a genetic test done for any other reason, talk with your doctor or a genetic counselor who can determine whether your family history justifies the expense. You may be surprised to find that you can make changes in lifestyle and monitoring your own health that can reduce your risk without testing.

The genetic revolution holds much promise for improving our health. Currently, profit and market advantage are playing the key roles in shaping how genetic testing is evolving. These are not the right navigation tools to help women at risk of breast cancer -- or the rest of us -- capture that promise.

Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.

Truckers Save Us in a Pandemic

Who should get priority in a pandemic? Some say healthcare workers; some say the garbage collector. But according to one Johns Hopkins study, says the Toronto Star, it's truckers driving across the country and who are committed to serving those areas affected by an outbreak who should get the medical care.

Why? Essential supplies must get to hospitals and other key destinations and this is a key part of maintaining the nation's infrastructure. Supplies must be replenished--and the best way to do that will likely be by truck.

So--remember in a time of crisis--it may just be a trucker who saves your life--as she or he will be the one ensuring that critical health supplies, food, or other goods are making their way to your neighborhood.

Summer Johnson, PhD

The Perils of a Wrinkle-Free Face

Across the border, Canadians are dying for a wrinkle-free face. Literally. Health Canada has reported that 5 people have died and 8 more have had serious reactions from Botox injections.

The worst part is that these uses of Botox were off-label uses in all but one case--not the typical face relaxing treatments, but also to reduce muscle and neck spasms in children with cerebral palsy.

Take home message? Beware of the Bo. Especially if you have underlying conditions like neurological conditions like cerebral palsy or Alzheimer's. Avoiding the toxin could just save your life.

Summer Johnson, PhD

PA Pooches Get Health Care, But Their Human Counterparts? No Way!

While lawmakers in Pennsylvania are cracking down on "puppy mills" and other unhealthy conditions for the care and raising of dogs in the Quaker State, it seems that these same legislators just couldn't find it in them to forge a consensus about how to provide care for 20,000 or more uninsured Pennsylvanian people.

According to the Pittsburgh Post-Gazette, Pennsylvania dogs are now guaranteed better conditions in kennels and veterinary care on a regular basis--which is more than you can expect if you don't have employer-based health insurance in PA.

While Governor Rendell has been said to have been trying to rid Pennsylvania of its reputation as the "puppy mill capital of the East", it seems too bad that it would now have, thanks to Senate Republicans, the reputation of putting dogs ahead people.

Summer Johnson, PhD

The Pharmacists Love Us!

According to the NursingGuide.com, our blog ranks 29th out of all pharmacy blogs--placing us squarely in the top 50.

Right back at ya pharmacists, we love you too!

Summer Johnson, PhD

Forget Condoms? Use Diet Coke!

I can hardly believe it myself--but yes, there are funded researchers who study whether Coca-Cola actually is an effective spermicide. But even more astonishing reports the LA Times is that America's favorite carbonated beverage actually is an effective sperm immobilizer.

Better yet, Diet Coke is more deadly to men's seed then regular Coke.

What would ever have inspired such research frightens one to think about, but then again, Coca-Cola has been considered a wonder cure for everything from hiccups to colic, to relieving jelly fish stings. So why not killing sperm? Furthermore, it is clearly noted by the researchers that they DO NOT recommend this as a form of birth control.

Sorry folks--simply drinking it certainly won't work. You can explode Mentos with it or kill a snail, but to prevent unwanted pregnancy--you are going to have to stick to the tried and true methods.

Summer Johnson, PhD

What's Lurking in Your Freezer?

It seems as though almost weekly we have another food quality scare--and this time it comes from the friendliest of foods. The thing that everyone says, "Oh yeah, this tastes just like it..." You guessed it: it's chicken.

The Department of Agriculture reported this week that there have been 32 cases in 12 states of food-borne illness resulting from microwaving frozen chicken. These poor folks then came down with salmonella. Their crime? Using the microwave instead of the oven.

But these chicken kievs and cordon bleus are not unique among frozen poultry to have gone bad, says the NYT (the source of this story). Evidently, chicken pot pies and other chicken treats have caused illness in the last few years.

But seriously, the problem is not the preparation--it's the poultry. These birds are raised in unsanitary conditions, slaughtered in less than ideal settings, and then are not properly handled from butcher to the dinning room table. Rather than blame it on the "microwave defense", it's time to reevaluate food safety in this country--and it sounds like we should start with the chicken.

Summer Johnson, PhD

deCODE demoted

I have something to tell you about deCODE--there's good news and there's bad news.

First, for the good news: today deCODE announced that it has filed an IND with the FDA for a new drug on cognition designed to combat memory loss and the other effects of Alzheimer's disease. The compound DG071 has shown promise in animal models and while it doesn't rebuild or restore neurons, it aims to "llow the remaining neurons to store and retrieve memories more efficiently".

Now, for the bad news: Nasdaq announced that deCODE was given a slap on the wrist for falling below the minimum value of common stock being traded (that minimum being a mere $50 million) nor is the company worth enough overall to continue being listed on Nasdaq's Global Market. deCODE has 30 days to rake in the big bucks or it's out of the Nasdaq Global Market and will fall to the Capital Market.

Looks like this drug had better be a blockbuster.

Summer Johnson, PhD

Female Med Students On Edge? Leave Them Alone

It turns out that female doctors-to-be don't just feel more nervous than their male counterparts but they actually appear more nervous to their patients, says an Indiana University School of Medicine Study.

Published in this month's issue of Patient Education and Counseling, researchers found that this decreased confidence among women is not connected to academic performance, but only clinical performance in undergraduate medical education. Their suggestion? Changes to the medical curriculum to boost fem-docs confidence.

What the study does not reveal is whether the gender gap that exists at the time of training persists beyond med school into residency or actual practice. Moreover, why highlight these differences?

Particularly if this gap represents only a phase during the earliest periods of becoming a physician, singling women out and making them feel as though their increased anxiety, their lesser confidence is a problem to be medicalized and cured like the diseases they study? This approach is completely backward.

These findings are interesting sure--and something for undergraduate medical educators to be aware of and to take account of--but this is not something to "treat" or to change medical education over. Let women be aware of and experience their feelings--they will go on to be doctors who are just as confident, calm, and patient-centered as their male counterparts. That is, unless they are made to feel at the earliest stages of their training, that they are in some way lesser.

Summer Johnson, PhD

You Break It, You Buy It

It turns out that the feds have finally decided to stop shelling out dollars to pay for the surgeries that fix the botched one from the first time around. What a novel idea!

According to the Arizona Republic, hospitals can no longer bill Medicare for these "second time's a charm" surgeries where someone leaves an instrument inside or operates on the wrong appendage.

Instead, Medicare is trying to reward good outcomes, rather than covering the bad ones. While the verdict is still out on pay-for-performance, and certainly its ethics, it certainly seems to be good policy not to pay for hospitals to are careless and hurt patients. For that they should have to pick up their own bill, and hopefully learn from their mistakes.

Summer Johnson, PhD

Bargain Basement Genome

Next Big Future says that Applied Biosystems has announced that the $10,000 complete human genome is now in reach, taking less than 2 weeks to sequence the whole shebang.

And have no fear--ABI is still on track for the not-so-illusive anymore $100 genome by 2012. Down from a starting price of $300 million, the human genome is getting right cheap--but what I want to know is what are we all going to do with it once we can carry around our genome on flash drive for a few hundred dollars?

Our entire genome isn't all that interesting--it's the differences between species and between individuals that are. I doubt that will be part of what we get for that bargain sequencing for the $100 genome in the future will be an understanding of all the SNPs and mutations that make me different from you and give me risk for diseases that you don't have. Instead we'll just get a pile of information, no analysis, and have no clue what any of it means--and the answer will truly be--not much.

Summer Johnson, PhD

Clean a Tooth--Save a Baby

Who would have thought there would be a correlation between healthy teeth and healthy babies? Well, it turns out that researchers at Aetna and Columbia University College of Dental University have found that women who receive dental care prior to or during their pregnancy are likely to have heftier tots than those who don't, says MarketWatch.

Now, let me see--could that be that those who are likely to have better oral health are also more likely to also be more attentive to prenatal health and therefore are more likely to have babies within normal birth weights?

But if it is more than a correlation, if there is something about access to dental care that makes for better prenatal health, so be it. And if we can get pregnant women dental care and it can make babies be born within normal weights, healthy birth weight also correlates to all sorts of better health outcomes of infants. All just for getting soon-to-be moms to open up their mouths and to polish those pearly whites. Go figure.

Summer Johnson, PhD

Wait a Minute Mister Postman....

First, actual anthrax showed up in letters in a mailroom. Now, DHHS says that the treatment for anthrax is doing to be delivered out of mailrooms directly to your mailbox.

As described by the Washington Post, it was announced by Michael Leavitt that three cities will try a pilot program where mail carriers, escorted by police, will deliver pill bottles with a note. In Philadelphia, where it was already tried, 50 mail carriers reached 53,000 households in one day.

Now, let me see...Philadelphia has almost 2 million households. And why the need to be escorted by police? I doubt the police in any city are necessary to deliver mail in any other time.

During a suspected bioterrorism attack, just guessing here, the police might be needed in other areas other than to escort mail carriers delivering the drug stockpile. This is going to be a real problem if mail carrier's safety is going to be at risk, which in all likelihood it will be.

It's a creative idea--but ultimately, we need a faster, easier dissemination method than walking or driving Cipro around via USPS carriers. And in any case, what is the plan to compensate them? To pay them hazard pay? Offering them enough drug to protect their family is a start, but unlikely to be enough to induce them to continue risking their own exposure day in and day out. Their meritorious acts must be compensated in such a difficult time--even if such a plan is fool-hardy.

The plan is not good enough, sending police out is not a good idea, and giving their families drug is not a good enough form of compensation. Leavitt and his gang better come up with another plan in the even that anthrax hits one of our major cities or heaven forbid, more than one. Otherwise, we'll all be in big trouble.

Summer Johnson, PhD

23andHerBreasts

On Thursday, 23andMe announced their latest initiative aimed at bringing together the largest cohort of women with breast cancer "to build an infrastructure, based on genetics, that will accelerate consumer-based research of the disease."

The women who opt for 23andMe's genetic testing services can opt-in for other kinds of surveys and other kinds of information gathering studies as well as the opportunity to be part of a growing community of women touched by breast cancer.

The ultimate goal, says the company, is to some day have personalized treatments. What the company doesn't say to these women, though, is that this reality is certainly years if not decades away. The real benefits of this "research arm" of 23andMe is most certainly the "community" that this group provides--and these benefits can be quite real. The sense that there is a whole world of women out there going through what these women are, that can share information and experience, is a real benefit of this research--but telling these women that participation in this RESEARCH, not treatment, is nothing more than that.

Providing information to 23andMe will certainly help women in the future be cured and maybe even someday prevent breast cancer. Participants in this research are just as likely to be misled about this as any other kind of population genetics research of this kind. But 23andMe with all its press and with its purported goal to be the largest cohort study in the world should also strive to get the ethics right.

Summer Johnson, PhD

Genetic Karma

I don't really know what John Kass is talking about in his Chicago Tribune column: some scary combination of personal experience with featherless chickens that he put into strange positions, genetically engineered animals (that he has nothing to with) and non-existent chimeras such as "superchickens" that he's scared of, and biotechnology companies that he's chastising for cloning a goat that produces "silk milk" containing a protein that has the properties of spider silk, namely that it is 25% more tensile than any other polymer in the world.

Not that this is anything new, Nexia Biotech has been doing this, as in cloning the goats that produce this biopolymer since 1998. But all I know is that it has Kass' feathers ruffled and it makes for interesting, even if it isn't novel, reading.

Summer Johnson, PhD

Let's Get Physical

I agree with The Wall Street Journal Health Blog and NEJM's Brian Rank, that executive physicals are, as they are currently practiced little more than a sham.

To be more specific, as Rank argues, executive physicals are three things: inefficacious, too costly, and inequitable. More akin to going to a spa than going to the doctor's office, executive physicals pamper the elite but also provide them with more to worry about, more cost, and also fewer answers.

And this is just plainly unethical.

(read the rest)

Michigan Stem Cell Battle

Now here's something you don't see every day: in Michigan, the opponents to Proposition 2, a bill about embryonic stem cell research, argue in a television spot that such a bill is "too costly to Michigan taxpayers", says the AP.

Well, it turns out that Michigan Citizens Against Unrestricted Science and Experimentation don't tell viewers that the bill doesn't cost a single cent. The bill is to promote, and only to promote, scientific freedom, and not to fund stem cell research (To see the actual language, read here.)

(read the rest)

Food Ethics--21st Century Style

Food ethics is becoming more complex than it used to be. With the recent crisis in China over baby formula, the slow food movement, the debates over locally grown food, organic food, cloned cattle, trans fats, the obesity crisis and more--food ethics is no longer limited to Leon Kass' The Hungry Soul.

Of course, there's Peter Singer talking about the ethics of eating and the moral responsibility to eat locally, and those in rural sociology who became concerned with responsible agriculture and modern food production, and then GM.

Still there are a number of issues that those food ethicists and those in related fields have left unaddressed.

In this day and age, whether you decide to labor over a hot stove or drive thru is a political decision about not only food itself but about society and culture. And soon going to the grocery store won't only provide you with choices of buying lean or ultra-lean beef, but instead grass-fed, regular, or cloned beef. Not only can you get your vegetables organic or in a can, but also you can get them GMO-style grown with nutriceuticals to give you extra calcium in your potatoes or omega-3s in your green beans.

But even when this is possible, what will it mean for us ethically? Does the choice not to buy these engineered meats and vegetables mean that we are abdicating our responsibility to be healthy? If these foods are reasonably priced and are available, everyone should eat them. There is no difference between eating these foods and taking a daily multivitamin and arguably one can forget to take a vitamin whereas you aren't likely to forget to eat.

Another part of these new food ethics culture is the responsibility to know what you are eating. If cloned beef or new foods can have the staying power to be shipped half way around the world, you have a responsibility to know so. In a new global food market, it will be the moral responsibility of the consumer to be aware of agricultural practices in China or Brazil and if you don't want to eat those foods, then don't.

The last, and perhaps most important part of food ethics for the 21st century, will be taming the obesity beast. This epidemic is the moral responsibility of everyone to help get waistlines, portion sizes and caloric intakes under control. Perhaps newly engineered foods will be the ticket, like the fat-burning waffles I wrote about a few weeks ago, but that can only be a part. Food ethics will have to change restaurant chains, groceries, and most importantly, the minds of consumers, if we are ever to change the trend of ever increasing weight.

This is a practical, real food ethics for the 21st century.The kind of food ethics I am proposing is not the ethics of the sustainable agriculture crowd or those who oppose GM. Nor can food ethics be just the morality of eating anymore. It's about places, ways, and things we eat and why, but more than that. Food ethics is about where our food comes from, who makes it, why it's made and to what end. The answers to these questions are what food ethics demands of us for a better, healthier, more fruitful nation.

Summer Johnson, PhD