February 2009
Ethics: The Phased In Plan
On Tuesday, medical device maker Medtronic Inc. announced that they will begin disclosing their consulting fees to doctors in 2011, says the Minneapolis Star. Slow down there, Speed Racer! Don't go disclosing those dollar figures too quickly now! You wouldn't want to allow your company a whole two years to change your consulting amounts as to allow your company time to appear as though you didn't previously give massive amounts of cash to physicians who used and implanted your medical devices over those who did not, would you?
Call me cynical, but any company really committed to making these disclosures would do so immediately and open their books now and put them out into the sunshine for all to see. Others might say, "Better late than never." But I'm not so sure. It seems like a tactic to buy time and to create the appearance of not buying off doctors to me.
It's as though they said, "We planned to be come ethical....later." Way to go, Medtronic, you really are a leader in ethics.
Summer Johnson, PhD
DBS for OCD? OMG!
As I read on the Triage health blog at the Chicago Tribune, deep brain stimulation (DBS) has been approved by the FDA as a treatment for obsessive-compulsive disorder (OCD).
Medtronic was given "humanitarian device exemption" for its DBS device based on the data: 26 patients were shown to have a 40% reduction in their symptoms after using the device for a year.
It seems like a rather extreme therapy for such a disorder, and based on rather a small data set.
Plus this is certain to be precedent setting. It is the first time, according to Triage, that DBS has been approved for a psychological disorder. One can only guess that others will be sure to follow.
Summer Johnson, PhD
The Wakefield Scandal Thickens...
When I wrote a week ago about Andrew Wakefield, I approached it from a research ethics perspective: about data falsification, the retraction of an article, the colleagues who didn't stand by him on his Lancet paper, etc etc....but as the world continues to talk about this researcher who, amazingly, continues to stand his ground regarding his more than debunked theory about how the MMR vaccine causes autism--I have grown increasingly upset.
Because as long as Andrew Wakefield, the father of the antivaccine movement in the last decade, clings to his theory, so will the parents and families of children with autism. As well as the other middle to upper-middle class parents who don't want to get their children vaccinated which has significant public health consequences. Wakefield has done his damage.
Want to Get Away From It All?
If you have a book, article, or PhD to finish and you'd like to do it in Europe for a month or up to six months, the Brocher Foundation, a non-profit organization dedicated to giving scientists a community in which to do research, is accepting applications for visiting researchers now through March 2nd. The Brocher Foundation funds research on the ethical, legal and social issues of genetics, biotechnology, nanomedicine, bioart, and much, much more.
The call for stays can be found here.
To see more about stays at the Brocher Center, click here to view.
Summer Johnson, PhD
The Data Fake That Set the World Afire
If it is actually the case that Andrew Wakefield faked, fudged, or whatever you want to call "making up" one's data, in his original studies regarding the effects of vaccines on children who later came to have autism, as reported in the UK's Times Online, then his research misconduct didn't just set back scientific research 10 years--it set back an entire generation of children, their families, and a society grappling with autism, and that will do so for decades to come.
As Bad Astronomy's post predicts, Wakefield's outing--if it happens--may result in some losses from the antivaccination community, but it is unlikely that parents of children with autism are going to cease to cling to that explanation in the absence of an alternative one.
The bottom line is that it appears that Wakefield faked his data, and even though most of the other researchers had already backed away from the idea that MMR vaccination caused autism and in fact retracted the conclusion section of their paper in the Lancet in 2004, Wakefield has not. Even if he did, the damage has been done. A decade's worth of children with antivaccination parents have avoided shots that may have been perfectly safe for them while measles cases have been on the rise. Plus, with all the focus on vaccines as the problem, other causes for autism have likely gone overlooked.
The damage done by the Wakefield fake is inestimable to the research community, to families, and most importantly to the children suffering from autism. Yet, parents, clinicians and caregivers will still likely cling to a theory that will be shown to have had NO scientific merit from the beginning--because without some explanation and something to blame, it is very hard to move on.
Summer Johnson, PhD
Shout Out to Our Sponsors of 2008, 2009 and Beyond....
The year of 2009 has already started out to be a fascinating year for bioethics: divorcing spouses want internal organs back as part of settlement offers, Angelina Jolie look-alike gives birth to octuplets, and an inmate who is suing prison officials for force feeding him on his hunger strike.
Bioethics.net wouldn't survive without unethical doctors who decide it might be a good idea to implant eight embryos into a woman's uterus, crazy divorces, or any of the dozen other medical, scientific, and social oddities that crop up each day that we have the privilege of writing about. At the risk of appearing and sounding like "bought" bioethicists doing what we do (as some bioethicists themselves have claimed about the entire academic enterprise, ironically enough), a long overdue "THANK YOU" is here to our sponsors.
We are able to do what we do in large part because of the support of key institutions like
Albany Medical College,
the American Medical Association,
Case Western Reserve University,
Cleveland Clinic,
Harvard University,
Neiswanger Institute for Bioethics and Health Policy at Loyola University,
the Journal of Hospital Ethics and Washington Hospital Center,
the Bioethics Program of Union University and Mount Sinai,
the Brocher Foundation, and
Wake Forest University.
Many thanks to all of our supporters, financial and otherwise, advertisers, and advisors. Bioethics.net is a rapidly growing, shiny, happy place to be--and read--because of you.
Summer Johnson, PhD
I Think Glenn McGee Predicted This Would Happen....
Today, the Wall Street Journal reported that a Los Angeles fertility clinic is offering parents the capacity to choose the traits of their child to allow them to make, um, "The Perfect Baby." 
The WSJ article, titled "A Baby, Please. Blond, Freckles -- Hold the Colic", describes precisely what McGee predicted in 1997, yes more than 10 years ago, parents would want to be able to do, what he calls the "under the hood" phenomenon. The idea that while parents are screening embryos for genetic diseases, they will also have the ability to select for gender or other traits, like eye and hair color. And having that ability, they will go ahead and tinker with the traits of their baby while they are "under the hood" as it were.
Smokers Will Quit for Money and Pet Health
Two recent stories about smokers have caught my eye. One, published from the University of Pennsylvania, has found that smokers paid $750 to quit smoking are 3 times more likely to quit smoking and be smoke free a year later as their unpaid counterparts. As MSNBC reports, the study implemented at the General Electric corporation had such dramatic results that it will be implemented nationwide next year. Now, the $750 only worked on 15% of the study participants, but that is still expected to result in a significant amount of health savings for GE in overall worker health, time lost, and other externalities that result from smoking cessation.
Anything wrong with paying folks to quit smoking? Hardly seems wrong to incentivize quitting something that is harmful to human health---essentially giving people that little extra push they need to kick the habit. But the question remains: will the motivation to stay nicotine free remain once the joy of having received the $750 has passed? Well, the data suggest that these paid quitters were still smoke free after one year, so it would seem so. Plus, if payment comes with support and education, one could hardly object to the initial monetary nudge. It certainly will pay off in health benefits in the long run--not just for the company but for the individuals themselves.
So....not only will people quit smoking for money; they will also do it for their cats and dogs. New research suggests that secondhand smoke isn't just bad for your human cohabitants but also your animal ones as well. A new survey, according to CNN.com, reports that one in three smokers would kick the habit to protect their pet. Oddly, they wouldn't do it to protect their own health. Cats, dogs, and even birds can be hurt by the secondhand smoke from their owners, and that clearly bothers smokers---so much so that they might consider quitting.
My recommendation for a new anti-smoking campaign: You a smoker? Get a pet!
Summer Johnson, PhD
Cotton Candy IS Good for You!
New research suggests that cotton candy may help re-grow human tissue such as bone, skin, or muscle, says MSNBC.
The technique is actually a bit to complicated for me to explain, but it sounds a bit like if one poured candy apple solution over cotton candy to create a complicated network out of the thin interwoven strands and what would be left inside would be an intricate network of blood vessels or skin.
A great concept...but does it work? So far it does in rats, so stay tuned, you may find cotton candy-based blood vessels or skin substitutes coming soon, right out of those crazy whirling machines from county fairs around the country. Now if they could only find a medicinal use for a funnel cake. Just kidding.
Summer Johnson, PhD
Can You Hear Van Halen Playing In The Background?
A new report issued by the Center for Genetics and Society has been released titled, "Responsible Federal Oversight of New Human Biotechnologies: Opportunities for the New Administration". The document, found here is a policy brief that clearly outlines the ways in which the new Obama administration can RIGHT NOW lift restrictions on funding for embryonic stem cell research, ensure comprehensive oversight of that research, and outlaw reproductive human cloning.
Going further, the report outlines the ways in which the Obama administration can promote a discourse that allows for a discussion that promotes a biotechnology friendly nation that is pro-science and technology and eventually leads to a nation that has oversight over assisted reproductive technologies (a little too late for that), better oversight of human subjects research, more consumer projections, and better international cooperation.
While any of this would seem hard to object to, it's loftiness and over-promising is precisely where President Obama is likely too to fail--if they expect it all to happen RIGHT NOW. If the report had stopped at the first there points, it would have had me at hello and singing AMEN. The first three are objectives that are achievable--in the first four years. The rest of the report is a generational shift of a magnitude that to put on President Obama's shoulders is simply setting this administration up for failure. It isn't a practical road map--it's idealism for sure. They are great aspirations--and one's that I agree with for sure. Most liberals would. But to ask this administration to go that far, isn't reasonable--not when there isn't even an HHS secretary confirmed yet.
So, I commend CGS for their recommendations. They are a strong set of recommendations for how policy should be reshaped over the next 8-10 years. Maybe they will prove me wrong and show that I am too cautious and expect too little out of the administration. What can happen right now with stem cell funding and regulations will likely come to pass. But as for the rest of the report, beyond embryonic stem cell research funding and regulation, those agenda items will happen are likely to happen after the first four years of the Obama administration.
Summer Johnson, PhD
ASBH and the March of March of Dimes Want You, Young Scholars of Bioethics!
The American Society of Bioethics and Humanities and the March of Dimes are pleased to announce the creation of an annual Young Scholars Award in Perinatal Bioethics. To be eligible for this award, applicants must be early in their career development, including those who are actively enrolled in graduate school, post-doctoral programs or no higher in their career achievement than the assistant professorship level.
Applicants are invited to submit proposals on the topic of perinatal ethics in any of the submission categories offered in the ASBH Call for Proposals. Proposals about pregnancy, birth, lactation, prenatal causes of disability, neonatal decision-making, and other perinatal issues will be considered. Submit an abstract to the ASBH Call for Proposals on the ASBH Web site no later than March 2, 2009. From those submitted abstracts, a select group of applicants will then be invited to submit a full paper for review by the March of Dimes/ASBH review committee.
The award will be presented at the ASBH Annual Meeting in October to the applicant whose paper was selected to be of the highest quality and intellectual rigor among the submitted papers. The award winner will be receive an honorarium of $1,000 and will be invited to present his/her paper at a plenary session at the ASBH Annual Meeting, which will feature an invited lecture by a distinguished scholar from the field of perinatal ethics.
For further information concerning this award, please contact Alison Saylor of ASBH or Ann Umemoto of the March of Dimes.
Don't delay, young scholars of bioethics! A plenary session at ASBH and $1000 is well worth putting down one's fingers to the keyboard and writing a stellar proposal. Do not procrastinate. Uncle Sam is pointing his finger at you. But please, don't write about octuplets. Please. Haven't we all heard enough about that for TWO lifetimes?
Summer Johnson, PhD
Build It and They Will Come....Not To Use It
According to the L.A. Times Booster Shots blog, doctors who use electronic drug-prescribing systems and receive warnings about potentially fatal drug interactions they are prescribing for patients simply ignore them.
"Darn beeping machine. How annoying. Worse than pagers these things!"
According to a study published in the Archives of Internal Medicine, doctors ignored 90% of the drug interaction alerts and more than 75% of the allergy alerts sent out by the prescribing systems. Only slightly more reassuring is the fact that doctors were more likely to respond to high-severity interactions than moderate or low-severity ones, but given the low proportion of overall response--it really isn't all that assuring.
The upshot here: a system is only as good as the physicians who use it, and if the physicians will not use it, then the system is worthless. This data suggests that serious education is needed before electronic prescribing systems will ever do any good to increase patient safety and prevent deadly and harmful drug interactions.
The real question here is why? Which this study does not answer. One can only hope future studies will.
Summer Johnson, PhD
Don't Look Now....But Do.
Today, I am ashamed to say that I was born a Hoosier. The state of Indiana, as well as Texas, Nebraska, and 8 other states are attempting to pass laws that would require ultrasounds prior to performing abortions, says USA Today. Not for the good or health of the mother mind you--remember this is pre-abortion--but on the off chance that she might catch a glimpse of her unborn fetus and change her mind.
Read more after the jump....
Goats: Not Just for Making Feta Cheese and For Petting Zoos Anymore
Researchers have finally done it. Engineered a goat to save lives. On Friday, the FDA approved a genetically engineered goat that is able to produce in its milk (not for feta cheese making, mind you) a drug that will save the lives of patients born with a rare hereditary deficiency of antithrombin in their blood. A reported in the New York Times, these transgenic animals were approved to be bred with a human gene that allows them to create the human anticlotting protein, antithrombin.
The advantage: according to the company, GTC Biotherapeutics, a single doe can produce as much antithrombin in a single year as 90,000 blood donations. That's a lot of goats milk.
I wonder though: is that true because these goats are milked continuously all day long? Will these goats get to walk around in grassy fields or be treated like so many other commercial livestock and be locked down only to see sunlight an hour a day? What kinds of conditions are these animals kept in?
One might assume they would be treated like royalty, but also given that they are drug pumps for a pharma company, it's just as likely that once old "Betsy" stops being a steady of milk producer, she's just as likely to be treated similar to how female dogs are treated in puppy mills. Sorry "Betsy", time to go to the big green pasture in the sky.
I say this only because the NYT quote from GTC's spokesman speaks for itself: "If you need more, you breed more."
Concerns about whether goats in particular will enter the food supply are pretty far-fetched at this early stage, but there are legitimate concerns about the abuse of these animals. But with the success of using goats for antithrombin, the use of other animals for "pharming" other pharmaceuticals, other companies are certain to follow suit with other milk and meat-producing animals.
Eventually, though, as the practice becomes more widespread, "pharms" should be kept completely distinct from conventional farms to ensure that milk and meat meant for standard consumption are not mixed with those meant for medical consumption. Labeling and signage will have to be devised by the USDA and FDA in conjunction to indicate that this is a "pharm" meaning that transgenic goats or cows or sheep are being raised here.
That time has come and we need to be ready.
Summer Johnson, PhD
Nanotech Development: You Can't Please All of the People, All of the Time
This month's column from the Lifeboat Foundation, Nanotech Now, and AJOB Collaboration posted on Friday last week discusses the "rational" development of new technologies and the balance between a technology with great promise and unknown risk.
Tom Powers, Director of the Science, Ethics and Public Policy Program at the University of Delaware concludes that every discipline has a unique point of view and that "you can't please all of the people all of the time." Especially not with players as diverse as engineers, material scientists, philosophers, policy makers, and more.
As if we didn't know that already, Tom!
Click here to read the entire column.
Summer Johnson, PhD
Don't Blame Momma.
Today from the Philadelphia Inquirer, Arthur Caplan has published an opinion piece on the issue that has all of bioethics (and the entire country) talking: the famous (or infamous) California octuplets.
So unless you've been flying in an airplane continuously for the last 96 hours or don't own a television, you know the story, but below is Caplan's take--given only the way Arthur Caplan can give it: by giving us insight, but also telling us as a country how to get our act together so that other women can't ever get in the same predicament by falling into the wholly unregulated Wild West of the American fertility treatment system.
Diversity in the Next Generation of Bioethicists
One university is putting diversity front and center and helping to ensure that the next generation of bioethicists is more culturally and ethnically diverse than ones gone by. The students at the University of Maryland Baltimore County recently started a Bioethics Student Association.
This year, the UMBC Bioethics Student Association (BSA) will be sending seven students to the 12th Annual National Undergraduate Bioethics Conference at Harvard University. BSA now boasts 70+ members and had only 2 members attend attended NUBC last year, but this year has a proud troop of 7 marching their way to Boston.
Why is THIS undergraduate bioethics group, in particular, an important harbinger for the future of diversity of bioethics writ large?
The Princeton Review ranked UMBC one of the 20 most diverse universities in the nation, and the membership of the BSA reflects this diversity. BSA Vice President Batsheva Melissa Chapman comments, "Although we all come from different races and religions, we have one goal in mind: to bring about the awareness of the different ethical issues that society faces in the world of science."
Students with majors as diverse as philosophy, bioinformatics and computational biology, biochemistry, molecular biology, public health, and statistics will attend NUBC from UMBC this year. One student, Richard Blissett said, "Once I got to college, I suddenly started wondering about many of the ethical issues in my field." He will present on the ethics of marketing preimplantion genetic screening to infertile couples.
Pictured: 2009 NUBC attendees (left to right) Richard Blissett, Mary Rhee, Sid Agarwal, Batsheva Melissa Chapman, and Michael Young (not pictured: Justin Donlan, Jacqui Wanjohi)
Finding the resources to get seven students to Cambridge has not been easy. Harvard generously waived the registration fee for students who are presenting. Additionally, the UMBC Deans of the College of Arts, Humanities, and Social Sciences and College of Natural Sciences and Mathematics both made generous contributions for the students whose abstracts were accepted.
UMBC also has a new travel fund through the Office of Undergraduate Education to which the students will apply. For the remainder of the travel expenses, the BSA has scheduled a bake sale fundraiser.
If we want a diverse field and, thus, diverse dialogue, we need to start recruiting at the undergraduate level. ASBH should also up the ante and make it possible for more students like these who want to begin their academic careers earlier, to enhance the diversity of the dialogue in bioethics and make it possible for them to attend this conference and so many others. Diversity grants for undergraduate students just like these should be made available NOW.
We applaud these students for their tremendous contribution to this conference and to their field and for the contributions they are certain to make in the years and decades to come.
To learn more, go to UMBC.edu
Andrea Kalfoglou, PhD and Summer Johnson, PhD
Turn Off That TV or You are Going to Be Depressed.
It turns out that the amount of television that your teenager watches during his or her youth may be a determinant of whether they develop depression later in life, a recent study has found. According a report in the Los Angeles Times, researchers from Pitt and Harvard found that for each additional hour of TV watched per day there was an increased risk of depression in adulthood of 8%.
Other forms of media, such as the bedeviled video games, did not have such a correlation.
Of course, such a study doesn't prove that TV makes teens turn into depressed adults a wide range of other factors could also contribute to mental illness later in life. However, given the fact that excessive TV viewing also contributes to a sedentary lifestyle associated with childhood obesity and other behaviors known to contribute to obesity and other morbidities--limiting the amount of teen television watching is probably a good idea all the way around.
So what does this mean for the moral responsibility of parents these days? Make your kids turn off the television and give them a good book or get them on a skateboard a little more often, you just might be doing their mental health later in life a favor.
Summer Johnson, PhD
Stop Bailing Out Wall Street and Help Global Health
As reported in the LA Times health blog, Booster Shots, a grim economy is making global health organizations nervous that nations and individual donors are going to back out on their financial promises.
Jeffrey Sachs, Director of Columbia University's Earth Institute, has gone a step further: arguing for the US government to take back the huge bailouts to Wall Street that went to pay CEO bonuses and to put it directly into the Global Fund to Fight Aids, Tuberculosis, and Malaria.
As Booster Shots reported:
"Calling the bonuses "unbelievably egregious," Jeffrey Sachs, director of Columbia University's Earth Institute said: "Those bonuses are being paid out of our bailout funds... I suggest the U.S. government reclaim that funding and put the money into the Global Fund immediately.""
There is no doubt who needs the "bailout" more and that the abuse of funds given to Wall Street to pay corporate bonuses, rather than help the economy, was an ethical breach beyond reproach. Sachs is right: let's some of that money to good use and save lives.
Summer Johnson, PhD
Once a Fast Food Junkie, Always a Fast Food Junkie
New child and adolescent heath research suggests that once the fast food industry has you hooked you on commercials for you to "run for the border", you are all the more likely to continue those behaviors into adulthood, says the Washington Post.
Interestingly enough, however, it's not the actual consumption of these foods in the teenage years that results in adult fast food consumption--but the watching of five or more hours of television per day. The connection? Exposure to fast food television ads that drill into our brains the deliciousness of The Whopper.
The conclusion of the study reported in the post is to reduce television viewing to the AAP recommended 2 hours per day. But absent the television police coming into homes across America and turning off the plasma, can there be a more realistic solution, more consistent with parents' and children's autonomous choices about how and where and when they watch TV?
Perhaps a better solution would be to change the number, frequency and the content of fast food ads during the prime teen television viewing hours to prevent our adolescents from becoming abundant adult fast food consumers. This type of policy changes puts the onus on television networks and the fast food industry, rather than families and children, to advertise in different ways to the individuals who can make autonomous choices about what to eat--adults--rather than bombarding children with messages throughout their childhood and teen years so that before they even reach the age of maturity are completely programmed. Under the current model, by the time they can drive, they are like zombies on autopilot set to drive to the nearest McDonalds to fuel up on superfood.
In one sense, it's easier to recommend to parents to turn off the TV than to get the fast food industry not to advertise or to convince the networks not to run the lucrative ads. On the other hand, the downstream implications of an entire generation who is obese and unhealthy because they were seduced by fast food commercials will pay a pretty great price as well. So the question remains: will we change our advertising policy now or ask our children to pay the price over the long term?
Summer Johnson, PhD
