blog.bioethics.net

UPDATE: And Baby H Makes 8...No, 14!

As the story over the California octuplets born this week has unraveled, the ethical issues surrounding their birth have expanded beyond those of just the health and welfare of the mother and 8 tiny little fetuses but to questions of social justice and the choice of the mother to have 8 more children, period.

Of course, as a MSNBC article clearly articulates, the "birth of octuplets is not a medical triumph." I think Art Caplan put it best when he said, ""I think when the press goes googoo and gaga over these multiples, they don't seem to understand that it's really risky for the mothers and for their fetuses."

But since the announcement of these octuplets' birth--the plot has thickened. As if eight babies wasn't enough for any woman to handle, it turns out that Babies A through H already have four older brothers and two older sisters at home, a mother who has already filed for bankruptcy (according to one CBS news report).

These facts raise serious questions about the mother's decision to pursue this most recent pregnancy at all, given that at least one of her previous pregnancies was a multiple birth (she had twins), and that in this case she pursued fertility treatment.

I point the finger at the fertility clinics--both of which allowed this mother to exponentially grow her family to a size that no woman (even with the support of her mother, which whom she lives while her husband is in Iraq) could support. Even with an entire village, which it would take to raise 8 newborns and 6 children between the ages of two and seven, it is unconscionable that a fertility clinic would implant eight embryos into this woman in the first place.

I wish all 14 of these children the very best start in their lives. My only fear is that they may not be able to get it in a household with enough members to have three strings of a basketball team.

Summer Johnson, PhD

Ghana Gets a Bioethics Commission

How do you know that bioethics has made it big time in a country, in my humble opinion? Their government creates a bioethics commission, of course! According to ModernGhana.com, UNESCO has bought bioethics, via commission, to Ghana and has empaneled a 16 member group to discuss important bioethical issues play an advisory role, and to facilitate the simplification and dissemination of complicated scientific information for the public and stakeholders.

However, what many of you followers of US or other kinds of commissions (all 3 of you) may not know is that most bioethics advisory commissions in other countries are not filled with prominent academics who sit in poorly ventilated, slightly too cool hotel ballrooms drinking bad coffee and nearly stale danish.

Most national bioethics commissions in Africa, in Eastern Europe, and South America are comprised of members from the various governmental agencies who have a stake in bioethics who come to the table with their political agenda on their sleeve and their bureaucratic hat on. In the case of the Ghanaian committee, UNESCO representatives have join the mix--which should make for a rocking good time.

In one sense, putting governmental officials directly on a bioethics commission increases the likelihood that its recommendations might be implemented by the government. On the other hand, there is a striking lack of public participation on the part of any members of the public at all--whether they be the ivory tower, academic kind or the lay public. In my view, bioethics commissions--if governments are to have them at all--ought to be constituted by the persons who understand the issues the best. I doubt seriously that bureaucrats from the Ministry of Food and Agriculture will be such people. Perhaps the sole philosopher appointed to the Ghanaian committee can keep the enterprise on track, but I'm not hopeful.

But I was when I read the headline and saw that bioethics had risen to the federal level in Ghana and UNESCO had helped get it there. Let's just hope the bureaucracy doesn't foul it up and that sound bioethics policy could come from a bioethics commission--for once.

Summer Johnson, PhD

With 47 Million Humans Uninsured, Can We Really Ask About Health Insurance for Dogs?

Well, the Houston Chronicle did today in the article, "Should You Get Health Insurance For Your Dog?" The justification: "Dog owners can expect to pay a few hundred dollars a year for routine veterinary care, but a serious illness could send the bills soaring into the thousands."

According to the article, fewer than 1% of pets are covered by health insurance in the US and of the 13 pet insurance plans available in the United States, not one of them will cover a pre-existing condition. I'm sure their owners can relate.

So while the legislators on Capitol Hill are trying to get universal health reform passed, why not tack on doggie health coverage? For just a few dollars more, man's best friend could have his health insured too and save his owner thousands of dollars in vet bills when Fido jumps up on the counter and eats an entire chocolate cake or has to have tubes put in his ears to prevent ear infections (yes, just like children do).

Then again, there is some irony here--it is infinitely easier and cheaper to get insurance for your cat or dog than it is for yourself. Go figure.

Summer Johnson, PhD

Blogher Asks "Why Do We Need Medical Ethics Anyway?"

I was drawn into a story of a patient undergoing a routine breast exam described on Blogher.com and the discomfort that occurred as the physician with less than bedside manner overzealously examined her breasts.

However, what went from a story about a borderline unethical doctor changed became much more dull fare: it became a bioethics book report. It would have been acceptable for "Medical Ethics, Bloggers, and The Ethics of Integrity" to have left blog.bioethics.net off the list of medical ethics blogs, but the real problem with the commentary was the lack of understanding that medical ethics is a discipline rather than simple rule following, the value of codes of ethics for medical practitioners, and the difference between research ethics and medical ethics itself. It would appear that the answer to the question "Why do we need medical ethics?" is to keep health care professionals in line, to be code followers. A pretty vacuous notion of medical ethics indeed.

Now, I would hardly expect just anyone to understand such nuances, but if one is going to outline bioethics for the masses--it would be important to get these details right.

Luckily for Gena Haskett, author of the post, we do agree on one thing about how we ought to think about medicine and interacting with the healthcare system. She said: "We need a common ground of acceptable and responsible behavior, particularly in a setting where humans may be required to expose themselves physically or emotionally. There has to be an understood foundation of trust, communication and respect."

On that, my fellow blogger, we certainly can agree.

Summer Johnson, PhD

Scrotumgate: Live from the UK

Elaine Murphy, a Baroness and doctor from the House of Lords in Britain, and her husband, John Murphy, have admitted to submitting a fake medical journal article to the British Medical Journal in 1974, says Fox News.

The two created a false medical condition, later to become known as "guitar nipple", when they "described three young classical-guitarists who had inflamed nipples because the edge of the guitar was consistently pressed against their chests", says Fox. The article was submitted to BMJ as correspondence about unusual cases.

The report was signed and submitted by John Murphy, who was not a doctor, on behalf of himself and his wife Elaine Murphy who was a physician, professor, and member of an oversight board of Britain's National Health Service. It was meant to be a prank, but when it was accepted the couple let it slide.

According to Fox, "Last month, "guitar nipple" was dubbed "cello scrotum" in a reference paper about music-related disorders, so the Murphy's decided it was time to come clean. The Journal has dubbed the scandal "Scrotumgate."

To think, for all time, classical guitarists could have lived in fear of getting the dreaded "guitar nipple". Thank goodness for Scrotumgate.

Summer Johnson, PhD

NYC Is At It Again. This Time Salt Is The Enemy.

Last month, we blogged about New York Governor David Paterson's announcement that he was supporting an 18% tax against sugary drinks that contribute to the obesity epidemic in his state (and across the country). I called him "New York Governor--Public Health Crusader."

Now, New York City's Department of Health and Mental Hygiene Commissioner Dr. Thomas Frieden is on a crusade of his own. This time he's waging a war against salt. That dangerous NaCl. As the New York Times remarks, he's already won resounding victories against formidable foes such as trans fats, smoking, and calories, but now he's taking on one of the most ubiquitous chemical compounds in the food industry.

But have no fear: he's not coming after your grandmother's salt shaker. Frieden wants to reduce the number of pre-packaged and pre-prepared restaurant meals eaten by Americans. How will the CAN (Crusader Against NaCL) do it?

By identifying the most salty foods and convincing companies to reduce the sodium content by 25% in the next 5 years and 25% more in the next 5. Methinks this does not sound like an easy task. But who would have thought trans fats could have been banned from the Big Apple?

Moreover, I see no ethical argument against what Frieden is proposing. He's not trying to rid the entire city of salt or round up all the boroughs' salt shakers and burn them in a giant bonfire. He's arguing for a step-wise approach for food manufacturers to phase out sodium to the 50% level of what they currently use in their product. Plus, there are salt alternatives on the market for consumers. Remember Mrs. Dash?

Frieden's support from the AMA and other national organizations means that this initiative has the potential to reach nationwide--as it should. We are a nation addicted to salt. The food lobbies will fight it for sure. But kudos to Dr. Frieden for making salt the enemy and for infringing upon our liberties where salt is concerned, just this once.

Summer Johnson, PhD

And Now For Something Completely Different: DNR Song

To give you a chuckle this Wednesday morning at your desk or on your iPhone, here is something that should probably have never been put to alternative rock: DNR.

Even with its low production sound and video quality, it's still a must watch for its creativity and simply hilarity. A great class project for undergraduates in my view.

Dear class: put your favorite bioethics policy to contemporary music. If anyone is able to make beside rationing, physician assisted suicide, or pet cloning into a catchy tune, please email it to me. I'll do my best to give it some airtime. In my view, there simply isn't enough bioethics policy put to song in this world.

Summer Johnson, PhD

Fertility Fix from Adult Stem Cells?

According to LA Times' Booster Shots, IPS cells have been coaxed into becoming germ cells that could allow infertile couples to conceive from healthy sperm and egg cells.

Of course, this experiment is a long way from being safely or effectively performed in humans and like with most stem cell reprogramming, the process involves viruses that prevent their implantation into humans without concerns about causing cancers and other serious health problems.

The advantage: egg and sperm bearing genetic material from the parents, all from skin cells of Mommy and Daddy!

While this research is remarkable, the study's own author remarked that the same work could be done more safely and reliably if using embryonic stem cells with less chance for uncontrolled growth or mutations. For this reason, even she argues the funding of embryonic stem cell research is crucial.

Summer Johnson, PhD

High Fructose Corn Syrup Isn't JUST Sugar After All....

Well, it turns out that the anti-high fructose corn syrup crusaders had something to fear all along. Not just rotting teeth or hyperactivity, but evidently mercury in their children's Frosted Flakes and Fruit Gushers, too. As discussed in today's Huffington Post, this news isn't a recent discovery: FDA has known about this mercury, which is left as a residue from the production of caustic soda, since 2005.

The initial study of this, published in the journal Environmental Health, outed high fructose corn syrup as a mercury containing substance. Other studies have confirmed the findings. But the Huff Post put the real ethical and policy questions best:

"So the question is, what will the FDA do with this new found information? Dufault urges the creation of a mercury surveillance program, that monitors foods besides fish, along with additional public health evaluation of the exposure to mercury through HFCS. But can we really keep avoiding the deeper problem, that HFCS, as a product of the human imagination, could possibly be a failed experiment? For the sake of our health, it might be time for the government to finally intervene."

In the meantime, stay away from the HFCS laden foods. Eat an apple. Give your kids a banana instead.

Summer Johnson, PhD

And Baby H Makes Eight!

One California mother received the surprise of her life on Monday.

As if seven bouncing bundles of joy weren't going to be enough for a new mom to handle at feeding and diaper changing time, but lo and behold, it was announced yesterday morning at the Kaiser Permanente hospital that an eighth newborn had arrived, according to CNN. The eighth arrival, Baby H, (a name we hope the parents don't stick with!) was completely unexpected, clearly hidden by all the arms and legs and torsos of his or her other brothers and sisters jam-packed into the uterus. Upon arrival, everyone, including the doctor, was surprised. "It is quite easy to miss a baby when you're expecting seven," the doctor was quoted.

The parents requests for anonymity have resulted in no information having been released about them, including whether they had under gone any in vitro fertlization treatment. Anyone want to take a guess as to whether they did?

Summer Johnson, PhD

The Promise of SCHIP

Ronald Bayer and Amy Fairchild published a commentary on the impending expansion of the SCHIP program on the Huffington Post.

While the column is the standard public health ethics and history fare, it is an interesting read for those of you interested in children's health policy, politics, and the ethics of public health.

Summer Johnson, PhD

I Want My Kidney First. I Signed My Donor Card.

According to USA Today, a proposal has put forth by the president of the nonprofit organization, LifeSharers, to reward those who had agreed to be organ donors (by signing the organ donor cards) prior to being put on the transplant list by moving them to the top of the transplant list.

Why? According to Lifesharers' president Undis, only half of Americans eligible to be organ donors sign up. So is this a proposal to incentivize signing the back of one's driver's license or to reward those who chose to donate organs when they were healthy or both?

While it certainly is a provocative proposal and may even have the incidental benefit of increasing the number of persons who sign donor cards, there is merit in the system that currently exists which is based on giving organs to those with the greatest medical need.

What I would propose is some combination of the Lifesharer's criterion--having signed a donor card--considered in combination with the sickness of the potential recipient. It seems hardly fair that all persons who signed donor cards who need organs should jump the queue ahead of even the sickest of patients, yet there is at the very least some intuitive appeal in rewarding those individuals who had been willing to donate kidneys, livers, eyes, hearts and more prior to their own illness.

Lifesharer's just may be on to something, but I don't think they've solved the entire organ shortage and queuing problem. A hybrid solution between the UNOS prioritization system used now and Lifesharers is most likely to be the optimal solution for all. Plus it may have additional benefit of incentivizing choosing to be an organ donor.

Summer Johnson, PhD

Will President Obama Listen to Conservative Bioethicists?

Robert P. George, former member of the President's Council on Bioethics appointed by former President George Bush, has raised precisely this question in an online essay entitled, "A Diverse Bioethics Council?". The article published at Public Discourse, recounts his experience serving on the Kass Council.

However, his account, as reported on CatholicNewsAgency.com, is not only reminiscent but also forward-looking to the upcoming administration under President Obama. George, fairly certain that another presidential bioethics commission is soon to follow the President's Council on Bioethics, says:

"When he does, will he favor the country with a council as diverse as his predecessor's? ... Will nearly half hold strong pro-life views that contradict the President's own beliefs about the moral status of the human embryo and related questions? Will Obama be as open to differing perspectives and ideas as Bush was?"

The idea that President Bush's bioethics council was open to "differing perspectives" is an incredibly tough sell. Yet, George fails to elaborate on what that phrase really means. Would Elizabeth Blackburn agree? Or does openness really mean that a wide range of scholars were invited to speak at the "bioethics seminars" held by the Council and that in those sessions no voices were excluded. But when a report was actually written only a few voices were included in the discussion?

(read the rest)

CDC Name Change: Semantic, Symbolic, or Silly?

U.S. Preventive Medicine is lobbying for a name change for the government's public health agency. The proposed change would be to convert the Centers for Disease Control and Prevent to the shockingly dissimilar Centers for Disease Prevention and Control. No potential for confusion there.

According to a press release today, the motivation for the change is clear: "we need to consciously break with 'health care' norms of the last century and establish a new preventive health care paradigm." Clearly by putting "prevention" ahead of "control" in the NAME of the federal organization, it will demonstrate to bureacrats, politicians, and citizens far and wide that the health care system must change to a preventive model of thinking about disease.

Such a move is much too subtle and will do little, in my view, to change the way we think about healthcare, disease, and our responsibilities toward our own health and the public's health. Thumbs up on the symbolic value, but as for any real political impact--let's not waste money changing the signs to CDPC and spend those resources and mental energy instead on making real policy changes that may actually make a difference in the prevention of morbidity and mortality in the United States.

Summer Johnson, PhD

Training Doctors to Teach Doctors to Care

A recent study published in Academic Medicine has found that a new method of training physicians how to teach the dimensions of care--effective communication, compassion and relationship building--results in physicians who love their profession and their patients, says Booster Shots, the LA Times Health Blog.

The longitudinal study conducted at 5 medical centers around the country attempt to determine whether doctors could be taught how to teach humanism and care--which they did and significantly more so than their control group counterparts.

The good news: appropriately trained medical school doctors can pass on what they learn about compassion, communication, and patient care to the next generation of physicians.

Summer Johnson, PhD

Spine Transparency

The North American Spine Society has announced that researchers must disclose not only that they receive money from medical device makers but also the sum of those consulting fees, reports the Wall Street Journal.

The policy is not simply a recommendation, but a requirement for all society members, and would appear to be the first mandatory reporting policy of its kind. Time will tell whether the NASS becomes a trendsetter for medical associations in other medical specialities or whether spinal surgeons and spine researchers will remain alone as the lone rangers in full disclosures to their professional society about their relationships to industry.

Summer Johnson, PhD

Contaminated Chinese Milk Turns Deadly...For Company Execs

Two men responsible for the melamine contamination scandal in China, Zhang Yujun and Geng Jinping, were given the death penalty by the Chinese government today and the company's chairwoman, Tian Wenhua, was given life in prison for being responsible for the melamine-contaminated milk responsible for killing six children and hundreds of thousands of illnesses, says the International Herald Tribune.

(read the rest)

A Well-Timed Step Forward

Today, the FDA announced its approval of the first stem cell clinical trial in human beings. Geron will perform the trial on 10 spinal cord injured patients. To call this trial, "medical treatment" is the biggest overstatement one could make--and fully illustrates one of the biggest ethical problems with stem cell clinical trials at this very early stage in the game: therapeutic misconception.

With all the hype and hope surrounding embryonic stem cell research, it will be nearly impossible to prevent using the language of "treatment" and "cure" and "therapy" when talking about the Geron study and others that are certainly soon to follow with FDA approval. However, somehow researchers, the FDA and the media MUST find a way to resist the temptation of over-promising what these studies are designed to do and what they can hope to achieve. To expect that we will learn anything more than about safety from these first 10 patients is unreasonable and almost cruel. To raise these patients' and their families' hopes would be wrong.

(read the rest)

Who Is Subject Number 2143? Oh, He's Just My Son.

What do researchers do in an era of scarce research funding and difficult to find research subjects? Enlist their own children, of course! At least according to a New York Times piece reprinted in the Dallas Morning News, researchers are capitalizing on the fact that their kids are a captive audience to perform studies on them.

As the article explains,

""You need subjects, and they're hard to get," said Deborah Linebarger, a developmental psychologist at the Children's Media Lab at the University of Pennsylvania. She has involved her four children in her studies of the effect of media on children."

Summer Johnson, PhD

The Eight-Way Kidney Swap

Washington Post video journalist Pierre Kattar became a living kidney donor so that his father could receive a kidney and have another chance at life.

What became of Pierre's donation ultimately was an 8-way kidney exchange. To hear the story, watch the video below or read the article.

Summer Johnson, PhD

Tony the Tiger, Count Chocula, and the Cereal Gender Gap

And for the academic research one ought never have had funded: "You are what your mother eats: evidence for maternal preconception diet influencing foetal sex in humans". I can't possibly thank Brandon Keim of Wired Science Blog enough for bringing this research to my attention.

(read the rest)

Quick, Easy Criticism of Conjoined Twins' Parents is Just That

Last week on Bioedge, Michael Cook brought to our attention a story from the UK involving Lisa and Mike Chamberlain, soon-to-be parents of conjoined twins, who have refused to consider terminating their pregnancy. The exact extent to which the twins are conjoined is still not known to their doctors, but to date their physicians have seen two heads, a single body cavity and set of limbs, and have only heard a single heart beating. Doctors have estimated that the twins' chances of survival are around 20%.

Even with these basic known facts, the Chamberlains have refused to consider termination. Why? For one, the couple tried to conceive for seven years--and upon conception, these two babies are their only children. To give them up would surely be a devastating tragedy. The Bioedge blog sharply criticized the Chamberlain's critics, who have been many according to Bioedge, but in particular a columnist from The Telegraph who said that the couple is "selfish", "irredeemably selfish" and condemning their children to a life as a "freak show".

However, I wouldn't be so quick to judge. For one, after seven years of trying to conceive, the recent news that your children are conjoined and have a 20% chance of survival would be enough to give any parent poor judgment. Moreover, after twenty weeks, when more conclusive data regarding whether the twins share all their vital organs, particularly the heart, come in--then it will be time to ask the parents to weigh all the information and to make and informed choice. Perhaps they will have to make a choice as many parents of conjoined twins do in favor of one twin over the over. Or perhaps termination of the pregnancy entirely will be the only option.

At this point, however, I think criticism of these parents is premature. Only they really understand how difficult this situation is. Once a full set of facts is available, they will have to make a decision. If the data suggest that the twins share all their vital organs and a single body, termination will likely be the only option. However, due to their personal religious beliefs (they are Roman Catholic), the Chamberlains still may not choose it. And even if the majority of persons disagree with their decision, ultimately it is Lisa and Mike Chamberlain who have to live with their moral choice. Even if we will never understand it.

Summer Johnson, PhD

Sick--and Tired--of the Same TV, Americans Want WebMD Equivalent on Daytime Television

>According to the New York Times, Americans are turning to daytime television, in addition to the Internet, to get health information they can use--from none other than the former ABC drama star of Bachelor fame, Travis Stark. At least he actually IS a doctor, and doesn't just play one on TV.

But it would appear to be what's in high demand. WebMD, according to Alexa.com, the authoritative source for web traffic on the Internet, says that the health information website is ranked 728 of ALL websites on the Internet and accounts for 1% of all web traffic in the world. That's a lot of health information seeking. A lot.

By comparison, The Doctors' two million visitors per day doesn't really seem to compare, even to Oprah's three times as many daily viewers (according to at least one source).

Even so, a show dedicated completely to health information on daytime TV does demonstrate that the demand for health information is growing--and shows no signs of going away. The show's audience has only grown since September. I've yet to see the show myself (or the Bachelor, from which the show's star hales)...but perhaps it's worth a watch.

Summer Johnson, PhD

Put the Best Face on Bioethics, Please?

We're playing this "Facebook" game, because it links millions and millions of young people, patients, those seeking clinical trials, and those who want to find a hot date [or others at Yale, where Facebook was invented and thrives] to bioethics. These are people who would not find bioethics blogs or even bioethics news and resources and frankly would hear about discussion and debate concerning medical humanities only when it came up on the national news or over a beer. So help us out by joining the bioethics blog FACEBOOK PAGE by clicking that link, which should instantly make you a "fan" and thus increase the presence of the bioethics information on the blog in the broader news stream that is the "face" of facebook. Don't ask me what that means. I just know it's true. I learned all this stuff when I was writing Beyond Genetics, my last book, about how portable computers and the Internet are the future of consumer genetics. It's weird, yes. But it's true.

Health Privacy Exists No Matter Who You Are

According to a recent New York Times article, "health privacy isn't an issue when you are a legend." The article, discussing the recent health disclosures, rumormongering, and volatile stock prices at Apple, due to Steve Jobs' health claims that privacy isn't a luxury that Mr. Jobs can have when he is such a public figure and one on which stockholders and the public rely and admire.

As Mr. Nocera, author of the article writes, "There are certain people who simply don't have the same privacy rights as others, whether they like it or not. Presidents. Celebrities. Sports figures." However, I disagree. Presidents do not have the same privacy rights as ordinary citizens--that is true. Sports figures. Right again, Mr. Nocera. But celebrities and particularly celebrity CEOs? I'm not so sure your argument extends as far as Steve Jobs. Unless his health is so poor that his mental function is actually impaired to the point that he imperils the company and then he actually refuses to do what he actually did do (step-down as CEO temporarily taking medical leave), then and only then would a public outing of someone's medical status for the public good be morally justified.

Otherwise, such medical information should be kept private unless the individual wishes to make it public. Which Mr. Jobs did not. He has reluctantly, only when hard pressed and the stock of the company has fallen precipitously, spoken or written publicly to discuss his health status.

I have yet to hear anyone argue that Steve Jobs' health status has endangered Apple's status as a company or the public's safety because of his health itself. Has he botched the next generation of iPhone because of his illness or delayed the creation of the tri-fold Mac Book because of his "hormone imbalance"? If so, then there could be a reason for forcing the disclosure to shareholders. Some have argued that Mr. Jobs and Apple have played with Apple's stock prices through multiple health disclosures over the last 6 to 8 months. This, if it were true, would be unethical as well and an unjustifiable use of health information.

I say: let's leave the beloved Steve Jobs alone to recover in peace and quiet and stop demanding of him what we would not ask of our friends and neighbors--to disclose the intimate details of one's illness in one of the most trying times in a person's life.

Summer Johnson, PhD

Free Market Madness Hits Stores On Inauguration Day

A few of us here at bioethics.net were recently informed that something very important is happening on January 20th. Anyone know what? Does that date mean anything to anyone?

Well, for starters, an exciting new book called "Free Market Madness: Why Economics is at Odds with Human Nature, and Why That Matters" by Peter Ubel will be available for your post-inaugural reading pleasure. As described on Ubel's own website,

What's wrong with free market theory? It doesn't take into account our human nature. We humans aren't entirely rational creatures. We decide to roll over and hit the snooze button instead of going to the gym, and then we fret over our health insurance payments. We take out home loans we can't possibly afford. We live hours away from our jobs when free time is clearly our most valued asset. All too often our subconscious causes us to act against our own self-interest.

Ubel's website contains much more than an all-too-short teaser for his book. At the risk of being a typical academic's website with a vita and articles posted, Professor Ubel has pictures of a Simpsons character (whom he presumably has been told he resembles?) and him running with his kids.

Moreover, the very best part is the "Decision of the Month" section of the website (Ubel is a professor of Medicine and Psychology and studies decision sciences). The link takes you to Professor Ubel's center at the University of Michigan and runs you through a series of vignettes which illustrate how people make health-care decisions. It's great fun...just give it a try!

Congrats to Peter Ubel and President Obama who both have a reason to celebrate this January 20th!

Summer Johnson, PhD

Who Cares about Nanotechnology Anyway?

Today on Nanotech-Now, I discuss what it would take to make the abstract discussions about "nanoethics" as a discipline, sub-discipline, or whatever it is into a meaningful discussion about a future where nanotechnologies impact our world and do so in a way that we have anticipated ethical issues that actually will come to pass, and when they do, we are prepared for them because ethicists, policy-makers, scientists and other interested stakeholders have engaged, not in theoretical debate about whether nanoethics is a field or discipline, but about what kind of nanotechological future we want.

To read more, go to my column at Nanotech-Now.com. This column is sponsored by The American Journal of Bioethics.

Summer Johnson, PhD

Direct-to-Consumer Ads Fail to Direct Many Consumers

According to MSNBC, direct-to-consumer advertising for pharmaceuticals are cluttering the airwaves with offers to cure Americans of their bipolar disorder, irritable bowel disease, sleeplessness, acid reflux, high cholesterol and more. However, when these Americans who are bombarded by magazine and television ads go into see their doctor, only a tiny fraction, about 3.5%, ask for the drugs they see in advertisements.

The study, reported in the Annals of Family Medicine, was based on a survey in Colorado and reflects similar findings from 2003. This data, MSNBC reports, is concerning for a $5 billion pharmaceutical advertising industry.

Moreover, the study noted that when patients do ask for an advertised drug, it's often not a doctors first choice for a patient--another barrier between a successful advertising campaign and a sale for a pharmaceutical company. Raising questions, again, about the utility of direct-to-consumer advertising versus other kinds of advertising.

Although some say the study was flawed, it does raise some important questions about whether the pharmaceutical industry will choose to continue to advertise to patients or advertise only to the decision-makers--doctors.

Summer Johnson, PhD

Didn't You Just Know This Was True? Vicks May Be Bad For You

How many of you have the urge upon reading this headline "Vicks Might Make Kids Sicker" to immediately forward the article to your mother and say, "See I told you so all those years ago! I knew that nasty stuff was making me feel worse!!"

Actually, those noxious fumes radiating up from our chests as children when we had colds may have been harming us after all--not just annoying us--if we were young enough, says MSNBC.

Use of Vicks VapoRub in toddlers may actually make them sicker, new research suggests. The menthol salve can actually irritate the airways and make them smaller in children under the age of two, a dangerous thing when you already have lungs filled with phlegm.

However, there is something to note about this new study--it was not performed in humans--it was performed on ferrets. So, of course, Procter and Gamble jumped on the chance to say the study was less than conclusive due to the rodent research.

In reality, when you read the results--they AREN'T that conclusive--in fact, the live animal results aren't even statistically significant. So, why the crusade against Vicks? Perhaps part conventional wisdom that it does no good, perhaps part recent events which include a young girl who presented to an emergency room in respiratory distress after using Vicks.

In any case, it seems clear the verdict is still out on the mentholated rub. So perhaps you should save that accusatory email to your mother--just for a little while.

Summer Johnson, PhD

Google Goggles Prevent "Sleep Mailing"

Sleep researchers have discovered that in addition to other activities known to be part of sleepwalkers' acts emailing is now part of that, says the New York Times. In order to prevent email mishaps attributed to late night mailing, Google has developed so-called "Mail Goggles" to prevent inappropriate mails from flying across the Internet due to drunkenness, anger, or insomnia.

How does it work? NYT says:

"Once a user has turned Mail Goggles on, Gmail pays attention to the time. If a user tries to send a message within designated hours -- say, 10 p.m. to 3 a.m. on Friday and Saturday nights -- a window pops up, requiring the solution of five simple math problems within 60 seconds before the message is dispatched. If a user can't solve one set of problems, a new set is presented, accompanied by messages that gently scold, like "Water and bed for you. Or try again.""

Google is protecting its Gmail users from sending bad mail, and now the sleepwalking can benefit from that protection, too.

Summer Johnson, PhD

January 2009 Issue of AJOB Now Available at Bioethics.net

The first AJOB Neuroscience issue of 2009 is now available at bioethics.net. This issue contains a Target Article by researchers from Dalhousie University who are exploring the ethical issues associated with non-clinical uses of pediatric fMRI, particularly in as it related to the educational system and legal settings. Fenton, Meynell and Baylis discuss the potential benefits and harms that may come from the use of this technology used on children and multiple authors respond via Open Peer Commentary--some arguing that this is just fear of new technology writ large, others arguing that because we are talking about children this is particularly dangerous, and others arguing that the settings themselves are what make the use of the technology inappropriate.

The second target article by Muller discusses whether the elective amputation of limbs by those suffering from BIID (body integrity identity disorder) is ever ethically justified and furthermore, whether it is ethically justified in the ways that ethicists have previously argued. Muller doubts that autonomy arguments used by bioethicists (and others) to justify physicians amputating limbs can be justified and argues that BIID is a neuropyschological disturbance.

This issue also includes abstracts from the first annual meeting of the Neuroethics Society. Full-text of the abstracts is available for download at bioethics.net.

Summer Johnson, PhD

Mexico's Healthcare System Wins Red Tape Award

And you think your health insurance company is bad? Just be happy you don't live in Mexico. There it takes two physicians, four bureaucrats, and quadruplicate forms to get life-saving medications in that country, and as Cecilia Velazquez, winner of this year's red tape "prize" in Mexico has brought to our attention, Mexico's healthcare system is a bureaucratic nightmare that is just unacceptable--to the point of winning said contest in her home country for the long waiting times, multiple hoops, and redundancies built into the system.

What is interesting is that Mexico both knows that its government is so bureaucratic that it can have a "red tape" contest, have 20,000 entrants, and always find a compelling and interesting winner who has struggled against the inadequacies of the government for years. What is MORE interesting than that is that the government is willing to publicly acknowledge and admit what that failing is and then try to change it. Could you imagine either of these things happening in the United States? I, for one, cannot.

Let's hope that this acknowledgement is the beginning of health reform for Mexico. No person--parent or patient--should have to go through this much red tape to secure access to life-saving medications.

Summer Johnson, PhD

The Wonders of Polyheme...By Press Release

In the time since my research group published numerous articles concerning community consultation in the trial of the oxygen-carrying blood substitute Polyheme, particularly the most recent trial, conducted in a number of institutions (all Level I trauma centers), Polyheme has been subjected to more criticism than any other substance ever tried under the FDA's special exception allowing some research to be conducted without informed consent. Johns Hopkins published a press release decrying the company's failure to release data and announcing its opinions about the Northfield Laboratory's Phase II study, which preceded the Trauma Centers trial, in which stroke patients received polyheme. Yet for all the scrutiny, Northfield soldiers on. Soldiers - really - because that is the market for which Polyheme and its ken were designed from the start, the military at war, where a blood carrying substitute that doesn't provoke an immune response and keeps a patient's tissues oxygenated would be miraculous.

But a funny thing keeps happening, and nobody seems to care, or at least not enough to kill the continuing trials or even slow them down. My own group's study at Albany Med - a phone study of more than ten thousand residents of that metro area - found that essentially no one knew anything about the trial or the substance, and another study found that those who were presented with the possibility that they might get the substance were quite adamant that they would not want to be involuntarily enrolled - if at all. Criticism of Polyheme in the special issue of The American Journal of Bioethics was covered, well, pretty much everywhere [click on that link to find copies of the AJOB articles as well], and Senator Grassley literally convened a meeting with FDA officials to discuss the special issue of AJOB, which was just a wee bit discomfiting for those of us who had worked on the issue while in an institution conducting the trial...

Nonetheless, the trials continue...after countless efforts by everyone - bioethicists, IRBs, patient activists, journal editors (other than myself), and plenty of ED docs, including those in several trauma centers who cancelled the trials long before some of us were able to get our own institutions to stop. And that brings me to the point...a quick check of Wikipedia's entry today on Polyheme revealed what a quick check of the literature confirms...to this date, despite all the obvious issues with a clinical trial that has had at best disappointing results, given the trade-off of informed consent and the vulnerability of the subject population, continues to do its publishing of clinical findings by...press release. It's a bloody shame. The FDA must amend the subsection of its rules that allows an exception from informed consent requirements, at a minimum, so that those who conduct such trials not only have to tell the communities who end up participating in the survey about the outcomes, but also have to publish their findings in real journals.

- Glenn McGee, PhD

Video, Video, Video...

The bioethics.net video library is opening, and soon, through iTunes and already some of the free video we plan to make available is sitting around on a half-baked You Tube page that you can access at youtube.com/bioethix as well as via bioethics.net. At the moment we're just dumping the disks - 4 terabytes worth - into other disks, which dump into other disks...but the Greenwall Foundation-funded program, that built the Bioethics Education Network in the first place, has provided licenses for free viewing of hundreds of videos that will shortly be up in at least three places.

If you have video you'd like to share, please do so at the You Tube site, or join the Facebook page for The American Journal of Bioethics to share and view there. Sorry for the ridiculous sample above. It was what was on the disk this hour...

- Glenn McGee PhD

Will a Recession Mean that Botox Users Have to Use the 'Wisdom of Repugnance'? Maybe Not.

There's great news for those of you who would prefer to hide any expression whatsoever on your face, particularly those of you who think that a smooth brow and forehead is the calling card of youth and virility. The news? A cosmetic solution that still uses your favorite neurotoxin, botulism, to smooth things out - I know, I know, who doesn't love the idea of botulism in their face - and that costs less, lasts longer, and has a funnier name: Reloxin.

Botox has been so expensive in its history that it was not uncommon to see "Botox Parties" in dermatologists' offices; once the bottle is open, it doesn't last long, and if you can get an invite to a Botox party you're in like...um...flat?

Botox grossed on the order of $1.2 billion for its maker, Allergan, in 2007. Lots of the people who funded that run on smoothness are going to be wrinkly this year, one might reasonably assume. The wisdom of repugnance takes on a whole new meaning with that possibility, at least in the eyes of the beholders. Or, perhaps, Reloxin will save those whose notion of health includes that super smooth look that says "I'm not really thinking very much, or at least no expressing it."

- Glenn McGee PhD

Husband Wants Kidney Back

Many divorces turn acrimonious, but a New York divorce has turned potentially life-threatening. But a new litmus test has emerged for real acrimony: has your soon-to-be ex asked for a donated organ back? Only then do you know you are in a truly deadly divorce!

According to Newsday, a New York surgeon, Richard Batista, is asking his wife, Dawnell Batista, for the kidney he gave her in 2001 back, or if she can't live without it (ha ha)--for $1.5 million in exchange for his regret over the gift.

It occurs to me that husbands and wives who are divorcing often don't get to ask for other large, costly, or otherwise meaningful or significant gifts that they give to their spouse while they are married back just because they aren't in love or don't wish to be married anymore. From engagement or wedding rings to Christmas presents, gifts stay with the recipient in most cases.

Moreover, it's hard to imagine ex-ish spouses asking for other medical "gifts" back. I can just hear it now: "Hey hon, I really loved you when I bought you that rhinoplasty, but now you don't deserve to have a perfect nose anymore, so I want it back. And if I can't I have it, I want $50 grand." Divorce lawyers will gather over martinis and begin drawing medical gift price lists that their clients, who can't really take back breast augmentations and liposuctions, will say that they deserve their "investments in their spouse" back and conjure up ridiculous figures for them above and beyond what the actual procedures cost.

Never mind that asking for a kidney back would put Dawnell Batista on a dialysis machine and endanger her health while she cares for three children, never mind that Richard Batista voluntarily gave her the kidney seven years ago, never mind that we don't sell kidneys in the United States.

Here's my diagnosis of the case: divorce-induced insanity on the part of client and attorney. No reasonable client or attorney would propose asking for a bodily organ or $1.5 million if desperation weren't involved.

Surely no judge or jury is going to force Dawnell Batista to give up her kidney--but will she be forced to pay her husband for some pain and suffering for "losing" a kidney he voluntarily gave? It's hard to imagine. Oddly, if she does pay, she'll probably get paid her own money right back in child support or alimony--getting her kidney money right back.

Summer Johnson, PhD

Dr. Gupta Goes to Washington?

Reported by Howard Kurtz at the Washington Post yesterday, Obama administration officials have announced that Dr. Sanjay Gupta of CNN and CBS news fame has been offered the job of Surgeon General of the United States.

Is Dr. Gupta going to leave behind the teleprompters and exotic locations for medical reporting for gritty Washington politics? Kurtz says that he has already told officials that he wants the job, so it's more or less a done deal, one that is likely to make him one of the highest profile Surgeons General in history. Not only that, but he's also likely to weigh in on policy. Where will he stand on bioethics questions? Hard to tell, so far as a journalist, he's reported on the facts. Now, with healthcare certain to be at the forefront of the weeks away Obama administration, Dr. Gupta gets to have an opinion and make an impact.

Summer Johnson, PhD

Kidney on the Rocks or Perfused? I'll Take Mine Perfused.

As reported in TIME, researchers from the University of Groningen have found a new method to keep organs from cadaveric donors better preserved for transplant. Better than simply tossing them on ice in coolers, organs that were perfused, or had a cold blood-like substance pumped through them while they were waiting to be transplanted, had a longer survival rate at one year and and just a few weeks post-transplant.

The difference in terms of survival was only 4% between perfused and iced kidneys, so we aren't talking about a big difference in terms of outcome, but in terms of the money saved from these 4% of patients who do not have to be on dialysis--that is a significant cost savings. Moreover, the authors argued that as the technology is perfected and more widely used the need for living donation could be decreased--thus not having to harm living donors.

Summer Johnson, PhD

Could Spider Silk Save Your Life?

Posted today at Nanotech-Now.com, Summer Johnson has written a column on the ethical issues with the new polymer nanocomposites that material scientists have created and their appropriate and inappropriate uses inside (and outside) the human body for the Lifeboat Foundation's column called "Scenarios and Solutions for a Nano-World".

To read the column, click here.

These columns are the result of a collaboration between the Lifeboat Foundation, Nanotechnology-Now, and The American Journal of Bioethics. Podcasts for these columns will soon be available at podcast.bioethics.net. So stay tuned!

Summer Johnson, PhD

Wolpe on "60 Minutes": Reading Minds for Cookies and Car Accidents

If you missed it this Sunday, as our own Dr. Paul Wolpe himself did for being in an airplane, you can catch it again here--the 13-minute segment from this past Sunday's "60 Minutes" where neuroethics is the focus. Leslie Stahl discusses the present and future potential of "mind reading" technologies, neuromarketing, and the ethics of a future where thoughts, intentions, and our minds are no longer private with AJOB's own, Paul Wolpe.

The title of this post only makes sense if you watch the video all the way to the end--but trust me--it's worth it. Then ask yourself, will Dr. Wolpe be one of the early adopters of the first "mind reading" machines to really find out which of his daughters dinged his car? (Just kidding...)

Watch CBS Videos Online

Summer Johnson, PhD

Thrill Seeking Brains and the People Who Have Them

Researchers from Vanderbilt University have found that some brains process dopamine differently resulting in greater "thrill seeking" behavior, says BBC News. Essentially, these individuals have fewer dopamine "autoreceptors" in their brains, which would normally result in a feedback loop that would stop the release of dopamine when stimulating events occur.

However, in thrill-seekers, free-spenders, and those who are impulsive, the regulatory cycle is inhibited due to the lack of autoreceptors meaning that the thrill is all the more thrilling, the reward all the more rewarding--thus making the person wanting to do it again.

Does this mean that the impulse buyer is not responsible for the $60,000 sports car he bought because he can blame it on his lack of dopamine autoreceptors? I'm not so sure. But it helps his wife, if it is the case that his brain is built that way, be more forgiving when he comes home with the keys in his hand.

Summer Johnson, PhD

The Nose Knows (Or Why Smoking Should Be Banned Everywhere)

According to a recent Harvard study, published in this month's journal of Pediatrics, there isn't just first-hand and second-hand smoke, now there is another kind of smoke to fear: third-hand smoke. As the New York Times described it, it's "the invisible yet toxic brew of gases and particles clinging to smokers' hair and clothing, not to mention cushions and carpeting, that lingers long after smoke has cleared from a room." It's that smell that non-smokers can distinctly pick out when the go to a hotel room that has been declared a "non-smoking room" but they know it recently has been occupied by a smoker.

So what's the big deal anyway? So there are these lingering odors that remain? As long as children and other non-smokers aren't present for the actual puffing away--are they actually at risk for unhealthy exposures? The simple and unequivocal answer is: YES.

As the New York Times explained:

Among the substances in third-hand smoke are hydrogen cyanide, used in chemical weapons; butane, which is used in lighter fluid; toluene, found in paint thinners; arsenic; lead; carbon monoxide; and even polonium-210, the highly radioactive carcinogen that was used to murder former Russian spy Alexander V. Litvinenko in 2006. Eleven of the compounds are highly carcinogenic.

That's enough for me to say: third-hand smoke can kill. And to also argue that smoking isn't safe for anyone, anywhere. It's effects are long-lasting and deadly.

Summer Johnson, PhD

Son, Just Tack Your Ritalin onto Your Tuition Bill

John Harris has publicly proclaimed that university students should be allowed to take cognitively enhancing drugs, such as Ritalin, to boost academic performance, says the Times Online. This view is precisely the one that he and his colleagues espoused last month in an article in Nature that was discussed right here on blog.bioethics.net.

Yet, Harris goes on to say that only should students at university be allowed to take these drugs, but they should be available without prescription, simply over the counter, or at least for them to be prescribed for non-therapeutic purposes. The interesting angle here is the over-the-counter bit. I worry that 18 to 21-year-old would be running to the pharmacy downing Provigil to turn their 48-hour stint into a 96 hour one without regard for their bodily needs or any side-effects or that they would ignore even the most conscientious pharmacist's instructions.

Prescribing cognitive enhancing drugs for non-therapeutic purposes is fine--we use all sorts of drugs for non-therapeutic purposes, particularly enhancement all the time.
The reality is that this era has come and that college students will--whether by prescription or some other means--use enhancing substances to improve their academic performance. The key is how to do it.

It would seem preferable and safer to promote a scenario by which these drugs could be easily procured from a physician, given in doses that require monthly follow-up visits (i.e. with 1 or no refills), and that physicians, parents, and society all accept that cognitive enhancement is going to be part of the 21st century.

Summer Johnson, PhD

The American Journal of Bioethics Editors' Blog Top 20 Essays of 2008

Below are the 20 most viewed essays on blog.bioethics.net for 2008.

#1: Monkey Cloning Follow-Up

#2: Jon Stewart as Socrates

#3: Is Being Infected With Malaria Worth $2000?

#4: The World Waits Breathless as Nebraska Considers Banning Cloning

#5: Bioethics Abandons Creationism Debate

#6: Forum on Nanotechnology in Consumer Products

#7: Jim Fossett Election Roundup on States, Bioethics & Stem Cells

#8: Where the Presidential Candidates Stand on Cloning

#9: Weekend reading: organ donation, designer babies

#10: The Pregnant Transgender Man Talks to Oprah

#11: Do Nerds Have a Different Sense of Empathy?

#12: Suzanne Somers Stem Cell Master

#13: A Comment from Paul Gelsinger on Gene Therapy and Informed Consent

#14: Money! Turns Out It's Bad for You...

#15: Should I Sell My Eggs?

#16: How Many in The US Un/Underinsured?

#17: A Pregnant Father

#18: Symposium to Examine Flu Pandemic Prep and Pharmaceuticals

#19: Men and HPV

#20: Art Caplan on Oscar Pistorious, the Double Amputee Sprinter