March 2009
Hot Off The Presses! AJOB's April Issue is Here!
The American Journal of Bioethics' April 2009 issue is now online with some timely and thought-provoking Target Articles that certain to catch your attention.
From should we scan our entire bodies, to whose perspective matters, to are parents rushed into end-of-life decisions for dying children, this issue promises not to disappoint. Click here to read the Table of Contents.
To read a more detailed description of the Target Articles, read more after the jump.
MercatorNet Calls It Evidence-Based Ethics. I Call It Bogus Intuitionism.
Sometimes you just have to call it like you see it. I was intrigued to see that the third most popular post on the "bioethics" blog MercatorNet was entitled, "Who's the real expert?" and I was astonished to learn a multitude of answers ranging from, unsurprisingly the Pope, an epidemiologist hailing from Spain with a MPH and "doctorates in Medicine and Biostatistics and Epidemiology", and of course, the interlocutor from MercatorNet.
An expert in what you might ask? Ethics? Sure. Public health? You bet. The spread of HIV/AIDS and other STDs in Africa? Bingo! The interview with Dr. Jokin de Irala focused on prevention strategies for the spread of AIDS in Africa and to my astonishment the claim was so simple:
"any public health specialist who is aware of the epidemiological data knows that no major HIV epidemic in the world has been curtailed with programs centered on the the promotion and distribution of condoms."
I must have missed that day while I was earning my PhD in public health at Johns Hopkins.
How do we know that? The Pope told us so: "the scourge cannot be resolved by distributing condoms; quite the contrary, we risk worsening the problem."
It turns out that the ABCs of AIDS prevention--Abstinence, Be Faithful, and Use Condoms--actually doesn't need the "C" at all. Not at least, if you ask the Catholic Church. You just need AB's. Yet for all of Dr. Jokin de Irala's talk about "evidence-based ethics"--he cites no data whatsoever about the impact of doing away with condoms on the spread of HIV in nation's where condoms aren't part of the message.
Dr. Jokin de Irala relies upon a simple intuitionism about how abstinence means no risk of transmission and how being faithful embodies Christian values rather than citing any data at al. However, what we know about actual human behavior--real evidence about what people actually do--is that people will engage in sexual intercourse and absent condoms they will contract HIV in high prevalence countries. Absent education about how to use those condoms, they are likely to contract HIV and the epidemic will continue to spread. To believe anything else is only to contribute to the problem.
Such naivete about human behavior is a disservice to the African people and people around the world. Despite Dr. Jokin de Irala's claim that "many scientific experts have in fact said exactly the same as what the Pope is conveying...the Pope is being in fact more scientific than many of his critics," there is no evidence that the Church is directly responsible or that A and B alone without C makes people better off. And to see that MercatorNet is spreading this message to millions as though it is scientific fact is truly disheartening.
So before MercatorNet makes any further claims to "evidence-based ethics", I suggest that it actually puts some kind of data behind its claims.
Summer Johnson, PhD
Some Women ARE Born to Be Skinny....
It turns out that for some women it is just in their genes. At least according to the research done by one group of British researchers who are claiming that anorexia nervosa is actually genetic. In today's Daily Mail, it has been reported that neurological development in the womb is the reason why most sufferers of the disease develop the condition.
The study found that in women suffering from anorexia in treatment centers in the US, UK and Norway more than 70% had suffered damage to key neurotransmitters that caused them to become anorexic. These neurological changes can be detected as early as age eight, say the researchers.
These findings could revolutionize the way we both conceptualize the disease and how it is treated around the world. Such a finding doesn't just effect our understanding of etiology, but how these women understand themselves in the world and how they can interact with others--from their families, their friends.
Yet, it raises another key question: screening eight-year-olds to determine whether or not they are at risk for becoming anorexic seems like a pretty dangerous proposition to me. In fact, I would argue that it should not be done. Parents testing their children for the "anorexic brain" could go one of two very dangerous ways:
1) Katie's potentially anorexic brain and lithe frame makes her an ideal candidate to become a supermodel if she's coached in just the right way and pushed just a little, but not too hard or
2) Hannah's possibly anorexic brain makes her parents terrified of her future anorexia such that they are constantly asking her "Honey, want another cookie?", resulting in her becoming an overweight teenager who then resorts to bulimia nervosa to keep the weight off, or
3) you simply have constantly nervous parents who are wondering what will happen to their daughter now that they have the knowledge about their daughter's potentially "anorexic brain".
The research is interesting for sure. But testing children to find out if they will have anorexia seems like a horribly bad idea to me. Let's try instead to control the images they see in the media and teach our children through the examples they see at home and the lessons they hear that they are beautiful no matter what weight or shape or size they are.
Summer Johnson, PhD
Don't Put Your Baby on a Diet
One of the most frustrating aspects of reviewing research studies that at the end of them, when the data is reported--either in journals or the media--one has to wonder, "What is a person supposed to do with this data?"
Here is one more study where this is obviously true: as reported in the Chicago Tribune, rapid infant weight gain is linked to childhood obesity. This study published in the recent issue of the journal Pediatrics says that packing on the ounces (and the pounds) in the first six months of life increases the chances the child will be overweight at age 3, much more than other factors such as birth weight, parents weight, or how much the mother gained during the pregnancy.
While this is incredibly interesting information to learn, the real question I have to ask is: so what? Are new parents supposed to sit around and wonder about every ounce their newborn gains in the first six months? And what is the acceptable range of weight gain for infants, anyway?
Studies like these drive me crazy because they really only serve to create a group of worried parents who will do ridiculous things like put their babies on "string bean baby food" or "vegetarian only" baby food diets to prevent them from being obese later in life. While the author says in the Trib article, "parents should not put their chunky babies on diets", some parents will not be able to resist worrying about and changing the diet of their son or daughter if they happen to look like the Michelin baby.
Don't get me wrong, learning about the roots of childhood and adulthood obesity is important. But scaring parents that their rapidly growing babies are going to shortly become obese is not the goal of research. Nor was it the goal of this research. However, the unintended consequences of the way research can be reported in the media and how it can be relayed by researchers can be just as important as how the research is conducted in the field or in the laboratory.
Summer Johnson, PhD
Move Over Victoria's Secret! Stem Cell Trials for Breast Enlargement
Thanks to Wesley Smith's Secondhand Smoke blog for point out this story from the Times Online, Stem Cells to Grow Bigger Breasts.
While the title is more than jumping the gun as trials are only underway in the UK using fat cells from women's stomachs then trying to coax them to grow again as mammary cells to help turn A cups into Cs, one can understand the excitement. Having already worked in women with breast cancer who had their breasts removed, the method is now being used in healthy women, says Times Online.
Here's the hitch: "The use of stem cells in healthy women undergoing cosmetic surgery is controversial. Medical bodies have warned that the breast enlargements should not be offered to healthy women until large-scale trials in cancer patients have shown that the new technology is safe and effective. The treatment is not yet routinely available to women solely for cosmetic purposes."
One can already hear the therapeutic misconception running wild even in this article in the Times Online. The very first line of the article calls these initial studies "a stem cell therapy". Women tired of padded bras and who have a poor self-image will be ready to leap into these trials. The key will be how to explain to them that this is research and not therapy, and once we get to the point of having therapies AND trials available at the same time for stem cell breast enhancement, how to know the difference.
Summer Johnson, PhD
Bioethics: The Next Generation
What will the next generation of bioethicists look like? Well, if the 2009 NUBC is any indication it is likely to be more diverse and larger than the previous ones.
Over 300 undergraduate students from more than 60 institutions were in attendance. That's a lot of budding bioethicists, if you ask me. Twenty-seven undergraduates presented, while the Harvard faculty gave plenary sessions on areas of their expertise. That's enough presentations to fill an entire AJOB issue!
What does this say about the next generation of bioethicists? Even if a quarter of these students stay tangentially related to bioethics, there's going to be a "baby boom" of bioethics. How will we train them? Where will they work? The answer is: I don't have the answer--but someone better start thinking about it because as we simultaneously train dozens upon dozens of mid-career professionals in bioethics at the same time, while these students soon will become post-bacs looking to train in bioethics before going on to medical school and law school and want to be bioethicists too the explosion of bioethicists is going to be real, in my humble opinion.
Back to NUBC: UNC-Chapel Hill won the "Bioethics Bowl" competition besting 11 other teams. Princeton philosopher and bioethicist Peter Singer talked about his new book, The Life You Can Save: Acting Now to End World Poverty. To see more about the conference, you can visit its website.
To keep up the discourse among the next generation of bioethicists, there is a new burgeoning bioethicists blog called emonk.org. With such provocative titles as "Is Peter Singer a Hypocrite?" (clearly written before attending NUBC!) and "What's Wrong with Incest", it's certainly a blog that catches the readers attention.
Since we recently wrote about supporting undergraduate minorities interest in bioethics as a way of diversifying the field, I am happy to report (secondhand) that there was great diversity among the student attendees. Let's hope to see these students attend ASBH in Washington DC in October.
If even half of these students come, ASBH might want to be sure that there's a really large room reserved for the student reception during ASBH and the student affinity group as well.
Summer Johnson, PhD
**Thanks to Andrea Kalfoglou, PhD for providing many of the facts and the picture from NUBC for this story.
The Hospital That Pays Together Stays Together
What do you do when your hospital is in budget trouble and layoffs are expected? Well, at Beth Israel Deaconess Medical Center, the department heads open their wallets and decide to pony up some of their own hard earned money to keep their departments afloat.
According to the Wall Street Journal Health Blog, "heads of 13 medical departments say they'll donate a combined $350,000 to the hospital -- about $27,000 from each one's annual pay -- to further cut down on expected staff layoffs."
How's that for taking responsibility for one's institution? In an era where we see nothing but a lack of accountability from leaders on Wall Street and corporate corruption, it's refreshing to see leaders in medicine, at at least one institution, saying with their pocketbooks that they want their institution to survive in these tough economic times. Let's hope that other institutions can follow their example and that everyone can give a little bit where they can to ensure that healthcare institutions in dire financial straights do not falter and the workers who need jobs in a tough economy keep their jobs.
Summer Johnson, PhD
What Are Doctors Asking Teen Patients About?
Should parents be listening in when doctors ask their teenage sons and daughters medical questions? At what age are "tweens" and older teens entitled to some medical privacy? A recent Associated Press story, republished in the Chicago Tribune, asked precisely these questions.
The article goes on to suggest that many parents are asked to step out of the room so that teens feel comfortable sharing sensitive information about sexual activity or other health behaviors so that doctors have the full picture and can provide appropriate care without fear of repercussions for teens. The ethical line is where a teen could be hurt or unsafe, says the American Academy of Pediatrics physician in the story. ""If we are concerned that someone is in danger, we are compelled to share that information."
So what are the big topics? Sex and sexuality, alcohol and drugs, mental health problems, using proper traffic safety measures, including wearing seat belts, and vaccinations are the ones listed in the article. That seems to cover a fairly wide range of public health topics--and seems consistent with the major problems plaguing teens and 20-somethings today.
As for the ethics, I think the practice of asking parents to leave the room in the "tween" years is just about right. Creating a sense of promoting patient autonomy and privacy at the age of 12-14 will help to foster a sense of empowerment as a patient and to create a trusting physician-patient relationship at an early age. Parents should teach their children how to ask questions of physicians and model such behavior for them so that they learn how to interact with the healthcare system and navigate it well, and to encourage independent interaction with healthcare practitioners. So long as parents are not offended when asked to leave the room, tweens and teens will see this as an opportunity to become a patient in their own right. This time alone with the physician will promote not only autonomy but self-confidence in the physician-patient interaction and over the long-term will promote, in my view, a more empowered, self-reliant patient in the adult years as well.
Letting "tweens" have their own independent relationship with their physician, therefore, is not only good for allowing physicians to have correct information about the patient's health behaviors and allow tweens and teens to ask their own questions without parental interference, but over the long-term is much more likely to result in a patient who knows how to communicate with physicians over their lifetime.
Summer Johnson, PhD
Detecting Disease by Tattoo
If you ever swore to your self (or to another) that you'd never get a tattoo, you may just want to reconsider. You may within just a couple of years have a very good reason to get one made out of "nanoink".
As recently reported on Discovery News, "nanoink" allows for monitoring blood glucose in real-time right under the skin. It does so by using a hydrophobic nanoparticle that changes colors as glucose levels rise and fall. The ink consists of a glucose-detecting molecule, a color changing dye and a molecule that mimics glucose. These three particles continuously swish around in side a 120-nm orb. When glucose is present, the glucose-detecting molecule attaches and glows yellow; if absent, the ink turns orange.
The use of this technology has the advantage over traditional glucose monitoring, of course, in that there is a one-time needle stick for placing the tattoo over the tens of thousands of sticks that a diabetic will have to have over a lifetime.
Another advantage of nanoink tattooing: they can be removed. At least one researcher from Brown University has developed tattoo ink with microencapsulated beads coated with a polymer that when broken with a single laser treatment can simply be expelled from the body, as opposed to multiple laser removal treatments for conventional tattoos.
Diabetes isn't the only disease candidate for using this technology. The original research involving nanoink tattoos was for monitoring sodium levels in the body, but then it occurred to researchers that glucose could be infinitely more useful as a disease target. The potential uses for "nanoink" as a monitoring technology are almost limitless; for chronic disease monitoring, once the concept can be proven to work for more complex molecules such as glucose, almost any disease could be monitored from heart disease to hyperthyroid to various blood disorders.
According to the researchers at Draper Laboratories studying this technology, the tattoo doesn't have to be a huge Tweety bird on your ankle or heart on your shoulder; in fact, according to one of the Draper researchers, the tattoo could be just a "few millimeters in size and wouldn't have to go as deep as a normal tattoo" . Disease monitoring nano-tattoos, therefore, can be both tiny and painless. Of course, they could be stylish, too, but the nanoink is likely to cost a pretty penny---so before you are imagine a giant tribal arm stamp to monitor your heart disease, you may have to think again.
It may be at least two years before tattoos for monitoring your diabetes are available on the market--so unfortunately, those strips and sticking of fingers and thumbs aren't going away for diabetics any time soon. But hopefully, someday in the not so distant future, nanotechnology will make the quality of life just a little bit better for diabetics and perhaps improve the disease management for other chronic diseases like heart disease and others as well. In the meantime, you can dream up what you want your "nanoink" tattoo to look like.
Summer Johnson, PhD
State Wants 23andMe to Incinerate Spit
No, I'm really not kidding. In their own version of "No DNA Left Behind", the New York State Department of Health is requiring that samples collected within the state must be destroyed because it does not have a license to operate as a laboratory and "labs can only order tests at the request of a state-licensed physician", says GenomeWeb.
But this is not just about 23andMe. New York is now treating the more than 23 DTC genetic testing companies as laboratories, requiring them all to have permits--or if they do not to destroy all samples.
Will the companies do it? 23andMe says they already have destroyed the samples they have collected from their famous "spit party", but does this apply to all samples collected from people from NY. New York State says yes, of course, but will all DTC genetics companies agree and abide by the rule? Only time will tell.
Summer Johnson, PhD
Harvard Prof to Lead Effort to Get Doctors to Use Computers
With no small task on his hands, the Obama admininistration has tapped Harvard professor David Blumenthal to be the national coordinator for health IT, says the Boston Globe.
Blumenthal will be responsible for watching over the $20 billion dollars in the economic stimulus package allocated for health information technology and modernizing the healthcare system. One of the keys, of course, is not just building the systems, but getting doctors to use them. As both a physician and a scholar on health policy, and Director of the Institute of Health Policy at Massachusetts General Hospital, the Obama administration has picked someone whom they hope as both the knowledge and practical wisdom to get this enormous job done.
Summer Johnson, PhD
Robertson Wants Stem Cells with Longhorns and Lonestars
On Wednesday in the Houston Chronicle, John Robertson argues for changes to the law in the Republic of Texas that would allow for embryonic stem cell research. He makes two major claims--first, that the Obama policy represents an emerging national consensus in favor of embryonic stem cell research and that as such Texan stem cell researchers, regardless of what Governor Rick Perry may believe (who opposes embryonic stem cell research), ought to move forward in doing this research in state laboratories.
Moreover, Robertson goes on to argue that Texas law must to be changed so that scientists can actually derive stem cell lines there; current Texas state penal code makes all embryo research illegal because it defines a human being as alive from "fertilization to birth". That puts a pretty big wrinkle in embryo research.
Robertson certainly has it right--without such changes, Texas is likely feel the similar brain drain that the US did on the national scale when embryo research could not be done the last 8 years under the Bush administration. While Robertson does not explicitly mention this fear in his commentary, one cannot help but consider the implication for Texas universities if stem cell lines cannot be created there. Grants will not be able to be written for those institutions and the money will not follow. The implications could be devastating for UT, Baylor College of Medicine, and others. Implicitly, Robertson is making that argument as well. The implications of that could be felt for a very long time.
Perhaps Governor Perry and the legislature will consider that and think twice about stem cells with longhorns and lonestars on them before they continue with the status quo.
Summer Johnson, PhD
Kids Having Kids...and Adults, Too
For the second year in a row the teenage birth rate has increased, reports the Washington Post.
No one is certain as to the reason why, but many are pointing the finger at the abstinence-only sex education programs of the last eight years promoted by the previous Bush administration, stating that they simply do not work. Putting it simply: teenagers will have sex. The key, of course, is teaching them is how to prevent pregnancy, not to prevent sex. The moral responsibility is not to put one's own values on teens and to convince them that premarital sex is bad, but to make sure that if they are going to have sex that they prevent unintended pregnancies.
Interestingly enough is this other statistic from WaPo: "The new statistics also showed that the total number of U.S. births in 2007 -- 4,317,419 -- was the highest on record, surpassing the peak "baby boom" year of 1957." It turns out that not just teens are having babies, but everyone is. Why is this important? Well, in a bad economy and even worse healthcare crisis, we are in the midst of an even bigger baby boom. So if we don't solve the former two problems, who will care for these infants as they grow into children and then adults? And with 1 in 80 white males being diagnosed with autism (to pick just one health condition), and half of the above number (approximately) identifying as such, you do the math....
With headlines every day of patients cutting back on prescription drugs and necessary medical appointments because they cannot afford them, and now a baby makes three? Sounds like a recipe for disaster to me. Babies are supposed to be a blessing, but absent radical healthcare reform and adequate coverage for mommy and baby (and daddy, too), whether the parents are teens, in their 20s, or 40s, it's guaranteed to create huge problems for the family, but also for whatever healthcare system is created.
Anyway you slice it, these new statistics are troubling.
Summer Johnson, PhD
One Bioethics Council Dies, As Another Carries On
What will become of government bioethics? At this point, it's anyone's guess. Last Thursday, in Washington, the President's Council on Bioethics convened the some of the world's experts in government bioethics councils to discuss the past, present and future of bioethics councils including the head of the UK's Nuffield Council, former executive directors of national bioethics councils and former chair's of US executive bioethics bodies.
Meanwhile in New Zealand, their national bioethics council, Toi te Taiao, has been disbanded by their government saying its work is redundant and unnecessary.
The upshot? President Obama has kept President Bush's previous bioethics council, at least for the time being, while it asks the question about where are we headed in terms of public bioethics.
Meanwhile around the world, governments create bioethics commissions continue to serve in multiple capacities in places as diverse as the United States, the UK, and Ghana giving public policy advice, research ethics review, or some other combination of science and health policy creation.
Will the tradition of presidential bioethics commissions continue? Possibly. I have argued that it is likely to, but only time will tell. Let's hope that bioethics commissions in the US don't go the way of the dodo bird.
Summer Johnson, PhD
Interview with the Bioethicist
Okay, it's not quite as provocative as an Anne Rice novel...no vampires or anything, and not anywhere as long, but if you want to read about what our colleague Lisa Eckenwiler is doing at George Mason University, the Washington Examiner will tell you.
Summer Johnson, PhD
President Obama Takes Food Ethics Seriously
In his Saturday morning radio address, President Obama took on the issue of food safety as a moral responsibility for our nation. The lack of food safety and a "demoralized" Food and Drug Administration was characterized as a "threat to public health" by the President, according to the Wall Street Journal.
The President offered up numerous substantive and procedural solutions to the problems of lax food safety regulations and oversight, including increasing accountability at the highest levels of his administration.
From closing the loophole that made it possible for us to eat "downer cattle" (sick cattle who are then slaughtered for human consumption) to the system that allowed for contaminated peanuts to circulate the country for months, President Obama concluded that ""no parent should have to worry that their child is going to get sick from their lunch".
I couldn't agree more. It's time our government lived up to that responsibility.
Summer Johnson, PhD
Krauthammer: President Obama's "Science Fiction"
Charles Krauthammer, writing an op-ed in today's Washington Post, talks about his opinion about the Obama' stem cell policy and his perspective having served on the President's Council on Bioethics.
My favorite rant against Obama's decision is here:
"Obama's address was morally unserious in the extreme. It was populated, as his didactic discourses always are, with a forest of straw men. Such as his admonition that we must resist the "false choice between sound science and moral values." Yet, exactly 2 minutes and 12 seconds later he went on to declare that he would never open the door to the "use of cloning for human reproduction.""
Clearly this is horrible compared to the vapid language used by President Bush 8 years earlier that research on stem cells "offers both great promise and great peril, so I have decided we must proceed with great care." Great, great, great.
In any case, one would not expect conservatives to do anything but to attack President Obama's stem cell policy. Krauthammer is another voice in the crowd attempting to attack the logical consistency of the policy and the definition of "ethics" and "values" used by the new kids on the political block.
Summer Johnson, PhD
Want a "Perfect Baby"? You're Gonna Have To Make It The Old-Fashioned Way.
That's right, Fertility Institutes in Los Angeles, who announced last month that they would be offering PGD for eye and hair color and other cosmetic traits, has now announced via their website that they are backing off of their plans, says Fox News. Some say due to ethical criticism, other believe it may be because they never had the capability to offer trait selection in the first place.
Whatever the reason, one cannot doubt that Steinberg and colleagues certainly benefited from the attention their international clinics received--and that alone may have been the reason that they promoted their new service. Also, one can be assured that parents have asked for trait selection on Glenn McGee's "under the hood" model, but the question is whether Steinberg's clinic promised it to them and whether he and his colleagues could have delivered prior to the media and ethical storm that ensued.
Have no worries though--Fertility Institutes are also running a spring sale on a single cycle of IVF as a deal to their patients in these lean economic times! (I'm not kidding.... and no, I'm not linking to it.)
If you can't have a perfect baby, at least you can try to have one that costs less--apparently.
Summer Johnson, PhD
BMA Says No To Chocolate Tax. Thank Goodness!
The Easter Bunny and chocolate fans around the UK must be breathing a bit easier after learning that the British Medical Association has voted against a chocolate tax.
In an attempt to curb the obesity epidemic, some physicians in the UK were supporting a plan to add a levy to the sweet treat, says the Press Association.
Luckily, the group came to their senses and voted the plan down by just two votes. Someone must have told them that demonizing any single food will not help to solve the obesity epidemic and that the roots of increasing British waistlines are not the result of any single food or even food group or behavior and are certainly not the fault of Cadbury.
Phfew. I'd hate to have to pay more for my British chocolate bars.
Summer Johnson, PhD
Cheaper, More Quiet, and Just: The Female Condom 2.0
Female Health Co has finally achieved a long sought after goal: a female condom that is affordable, user-friendly, and will allow for the double X chromosome crowd to take greater control over their sexual health.
According to MSNBC, the condom is anticipated to cost as little as 60 cents when purchased in bulk by governments or other agencies, but the actual shelf cost to female consumers is still unknown. Even so, it is certain to be a vast improvement over the Model T version of this product which cost in the range of $2-4.
Not only is it manufactured more cheaply, it's made out of a new material that solves the other problem with the FC--the noise factor. Now the quieter 2.0 version will make the method less intrusive in the bedroom.
What does all this mean for women? A quieter, cheaper condom able to be purchased by and used by women means control over their sexual health and protection from STDs and unplanned pregnancy that was heretofore impossible. This product is now within reach of women in developing countries as well--assuming the price is right. If women no longer have to rely upon men for a cheap, effective method of birth control and STD prevention, the hope is that this will translate into fewer unplanned pregnancies and infections.
Only time (and research) will tell if that is actually correct, but with the approval of this product at least women's reproductive freedom and health is moving along the right track.
Summer Johnson, PhD
Anything Not to Destroy Embryos--Even Octo-Mom?
That would appear to be the argument advanced by Charmaine Yoest, president of Americans United for Life, discussing alternatives to using embryos for stem cell research in a debate with Art Caplan.
Not only does such a claim about the use of excess embryos--look, you can implant them into anybody!--misunderstand why the majority of excess embryos remain in storage and are never implanted into anyone (either to do genetic abnormality or generally being otherwise unsuitable for implantation) or how the "Octo-Mom" case is actually the strongest argument against implanting multiple embryos into a mother, rather than arguing for it.
Click on the link above to watch the interview, though, provided by US News and World Report to see how conservatives are now spinning embryonic stem cell research as "irrelevant" and "research of the past" and using "Octo-Mom" as a moral exemplar for appropriate IVF practice.
Summer Johnson, PhD
Harvard Undergrads Getting into the Stem Cell Business
In the hopes of riding the wave of this week's Executive Order allowing federal research involving embryonic stem cells, Harvard University has announced a new stem cell biology undergraduate major. CBS News reports that the major in Human Developmental and Regenerative Biology will have classes on human genetics, aging, human disease, and more.
As the article reports, "the major will allow students "to study biological processes through the lens of developing humans." Does this mean that students will have access to actual stem cell lines and embryos? It would appear so, based on the press release provided by the College.
Is this morally problematic? It all depends on what students will do with them. Details of the major are scarce, but bioethics courses are not explicitly mentioned as a required part of the major. One can only hope there will be more than a smattering of bioethics in the major--given the nature of the ethical and political debate surrounding this research.
Summer Johnson, PhD
Ethics by Checklist
Published last Friday in British Medical Journal, Daniel Sokol asked this question, "If you were a patient, would you prefer your medical team to use an ethics checklist?"
Washington Hospital Center already uses one apparently as a sort of "crib sheet" for the standard set of ethical issues that arise in the hospital, reports Sokol.
While it doesn't reassure me personally to think that my hospital could be doing ethics by checklist, it could perhaps be a way to ensure that glaring omissions aren't made by physicians doing rounds in a hurry or serve as a way for doctors themselves (rather than ethicists) to keep an eye out for ethical issues and to know when to call in the calvary.
Summer Johnson, PhD
Caplan Weighs In On Obama Stem Cell Policy
Arthur Caplan writes today in his MSNBC column that the US government finally has a "coherent stem cell policy." To watch a video of President Obama's announcement about lifting the stem cell research ban, click here.
Visit msnbc.com for Breaking News, World News, and News about the Economy
Read the full-text of the column below.
Summer Johnson, PhD
Finally, a Coherent Stem Cell Policy
President Obama is carrying out his campaign promise to permit federal funds to be used for embryonic stem cell research.
This reversal of former President George W. Bush's ban on such funding is good news for the science needed to find treatments for currently incurable conditions and for the ethics at stake in the issue.
Research involving embryonic stem cells is still in its infancy. It has had a very hard time moving forward because the Bush administration would not allow the National Institutes of Health and other federal agencies to pay for such research.
But now that Obama is overturning that scientifically unsound policy, there are those, from the Vatican to right-to-life groups in the United States, who are complaining that, on scientific grounds, he need not do so.
The critics contend that there are other routes to get the benefits of stem cell research that do not involve the use of human embryos. Some opponents of stem cell research even have the chutzpah to argue that treatments using adult stem cells -- which occur naturally in some parts of the human body such as bone marrow and the lining of our intestinal tracts -- have been more effective in curing diseases then embryonic stem cells.
It is true that more than 40 years of federal funding of adult stem cell research has produced certain effective treatments such as bone marrow transplants. But after eight year of zero-budget funding of embryonic stem cell research, it is hardly fair and completely disingenuous for critics to point to the practice and wonder why it lags four decades behind government-funded adult stem cell research.
Scientists, doctors support aggressive research
The people who know best -- scientists and doctors -- are nearly unanimous in the belief that embryonic stem cell research ought to be generously funded and aggressively pursued.
No one, not even some of the outspoken religious leaders who suddenly seem to find themselves possessed by the spirit of biological expertise, knows what the best source of stem cells will be for treating diabetes, spinal cord injuries or cardiac damage from heart attacks. No actual scientist can say with any degree of certainty whether it will be embryonic, fetal, adult, cloned or induced stem cells -- those made by modifying adult stem cells so that they act like embryos -- that will prove most effective.
It will take a lot of money and at least five to 10 years to find out. Uncertainty simply is the state of stem cell science. Keep in mind that nearly all of those who prattle on about alternatives to or the lack of cures from embryonic stem cell research spend precious little time with scientists or reading the scientific literature. Their claims about stem cell research are based firmly upon their religious beliefs.
So if I'm right and embryonic stem cell research is worth supporting with your tax dollars on scientific grounds then is it also worth supporting on ethical grounds? Absolutely.
President Bush's opposition to embryonic stem cell research was built on a single claim -- that destroying human embryos is always wrong. But, even the president did not believe in his own moral principle.
Bush permitted taxpayer money to be spent on research using a few cell lines that had been made from human embryos before he became President. But, if it is wrong to destroy embryos to get stem cells then why would it be ethical to spend federal money to support such research simply because it began before an arbitrary date?
Even screwier was Bush's tolerance of private funding for embryonic stem cell research. If embryo destruction is blatantly wrong, then isn't it just as wrong if it is done by a private company?
IVF clinics warehouse, destroy embryos
The utter ethical incoherence of the policy that Obama is now happily putting to rest was reflected by Bush never doing anything to close American infertility clinics. Studies I conducted and that others have done show that human embryos are routinely destroyed at many IVF clinics for a variety of reasons as an unavoidable part of the effort to help the infertile to have children.
Not only do some clinics destroy embryos, others accumulate them -- in huge numbers. When a doctor is not an immoral lunatic like the one who treated the recent mother of octuplets, Nadya Sulemin, he or she puts aside some embryos so as to avoid the tragedy of mega-multiple births.
Over the past 30 years since Louise Brown -- the first "test-tube" baby created through in-vitro fertilization -- was born in England, more than 500,000 embryos have been frozen in American infertility clinics. There are hundreds of thousands more worldwide.
No one will ever use these embryos. They will never be put into a woman's womb. They will all ultimately be destroyed. Why would we not permit these embryos, which already exist and whose fate is sealed, to be used in research? The critics of human embryonic research have never given a persuasive ethical answer.
Obama's decision to permit federal funding of embryonic stem cell research is -- finally -- the correct policy for the United States to follow. We have the scientific expertise and infrastructure to establish whether embryonic stem cell research can deliver cures. And we have sufficient moral consensus that it is the right thing to do. Obama's decision puts the sick and severely disabled at the center of federal research efforts -- right where they should be.
Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.
Nanofood: Without Transparency and Accountability, A Guaranteed Public Health Crisis
Also published on NanotechNow.com, this month's Nanoethics column focuses on the ethical issues of nanofood. You can read the article by clicking the link above, or you can read it in full-text below.
If you've heard it once, you've heard it a thousand times: "You are what you eat." Well, if recent research in nanotechnology has anything to do with it, in the 21st century you be "nanofood".
But is this what we want to be? Or is there anything wrong with having our food enhanced by nanosized powders that enhance the absorption of minerals, particles that replace cholesterols in our foods that are plant rather than animal based or entirely new was of agriculture that make farming more environmentally friendly? At first blush, this all sounds wonderful. But before we dive into our first "nanofood" buffet, we have to consider the ethical backdrop against which we find ourselves in the midst of this food revolution and why we even need it in the first place.
NYU MA in Bioethics Takes a Novel Approach
Bioethics.net is proud to welcome the NYU Master of Arts program: Bioethics: Life, Health, and Environment to its group of sponsors.
The NYU Master of Arts in Bioethics: Life, Health, and Environment promotes a broad conception of bioethics encompassing both medical and environmental ethics through conferences, workshops, public lectures, and graduate courses.
Although still taught separately in most universities, medical ethics and environmental ethics have in recent years grown closer in concerns and concepts. Initially focused on doctors, patients, and research subjects, medical ethicists have increasingly taken up social issues of access to healthcare, drug testing and distribution, and spread of disease on both local and transnational scales. Once focused on preservation of wilderness, natural resources, and biodiversity, environmental ethicists are more and more concerned with the "built environment" and its impacts on human health and wellbeing.
Likewise, the two fields have advanced moral principles and concepts similar enough to invite close comparison--for example, "Above all do no harm" with
the Precautionary Principle; the "sanctity" of human life with the "intrinsic value" of non-human life; just distribution of healthcare with just distribution of environmental burdens; personal responsibility for individual health with collective responsibility for "environmental health."
Thus the NYU MA in Bioethics program merges these two areas of inquiry together to explore the human relationship to both persons and the earth and our moral responsibilities to both.
Who's Scared of A Little Online Feedback? Doctors.
Professors have a website for it, so do plumbers. So why are physicians all up in arms over websites that would allow online ratings and feedback of patient experiences?
According to USA Today,
"Consumers and patients are hungry for good information" about doctors, but Internet reviews provide just the opposite, contends Dr. Jeffrey Segal, a North Carolina neurosurgeon who has made a business of helping doctors monitor and prevent online criticism. Some sites "are little more than tabloid journalism without much interest in constructively improving practices," and their sniping comments can unfairly ruin a doctor's reputation, Segal said."
Yet, expecting patients to evaluate a doctor's medical skill is like asking a layperson to evaluate a plumber's skill. The point of these websites is not to evaluate one's technical expertise but to help other consumers be aware of problems in customer service or overall performance and to choose a professional based on that information.
Maybe the only factor some patients care about is the professional pedigree of their physician or his/her technical skill--but for a lot of patients bedside manner, the quality of the office staff, and the overall experience are just as important. This kind of feedback is precisely what these websites can and do provide.
Doctors who oppose these websites appear to fear this "democratization" of medicine where anyone can say anything about you, even if they just have an axe to grind--but what it really seems that they are upset over is public accountability. The website featured in the USA Today article, RateMDs.com, has a feature where users can disagree with any "libelous or erroneous" reviews. Moreover, if this provides physicians with even the tiniest incentive to make their practice or their own care any better, kinder or more efficient, then all the better for the patients in their care.
Summer Johnson, PhD
Hey! Who Wants to Share Google Health Records?
As reported on CNET, Google is now allowing its users of its online health record service, Google Health, to share their health records with each other.
Google has said, according to CNET, this sharing function was created in response to the need of friends and family members to have access to medical records in emergencies and to keep concerned caregivers up-to-date on their loved one's health.
That seems benign enough, but the privacy concerns that abound from this technology boggle the mind. Google appears to have thought of some of them:
"Recognizing the sensitive nature of sharing health records, Google said it has built in several security measures to preserve privacy. Users choose who can view their histories, and the link to the patient's profile will work only in connection with those people's e-mail addresses--meaning the link won't work if it is forwarded to a third party. Users can also decide what information they want to share, and those allowed to view the profile will not have the ability to edit the data. Users will also be able to see exactly who has reviewed the profile."
This last feature isn't all that helpful--to learn after the fact that someone has viewed your profile and had access to your health information hardly protects one's privacy. Plus, giving one person access to your health record is only as safe as that person is trustworthy and will not print it, screen capture it, and show it to others. Having health information sitting on friends' and family's computer screens would only seem to be a good idea if there were a 2-minute timeout feature, no way the screen could be captured or printed, and a number of other security features that don't know are possible to build into Google Health.
While the idea of sharing is in principle an interesting one, it presents more potential harms and breaches than it solves social or medical problems. My advice: use Google Health if you want, but if you want to share information with caregivers and loved ones, do it by word of mouth.
Summer Johnson, PhD
Art Caplan Video: "Designer Babies" Ethical?
Well, Art Caplan clearly disagrees with me on two very important things. Last week when I wrote about the Los Angeles fertility clinic that is offering PGD to prospective parents for eye color, hair color, as well as sex selection, I suggested that for traits such as these there is relatively little harm that can come to the future offspring. Caplan, as you will see in the video below, appears to disagree: when you get into trait picking for your child, you put expectations on your child no matter what the trait.
I think it matters how much the trait matters to the parents. On the one hand, you could argue the traits must matter enough if the parents are willing to pay thousands of dollars to select for it. On the other hand, if you are already selecting for gender, let's say, which is the trait you really care about, and are offered the option of selecting for eye color or hair color or freckles, you may do so while you are "under the hood" (again to borrow from Glenn McGee's Perfect Baby theory). In the latter case, I don't see how expectations will play into the trait-selected brown-haired, brown eyed boy that the couple selected to look just like Dad after all. Sure, the parents really wanted a boy--but beyond that having a boy that looks a bit more like Papa is just a bonus.
Where Caplan and I really diverge is in this quote, however: "who's to say what's the better trait? Is it better to be red-headed than it is to be brown-haired? Is it better to have freckles or not? Those sorts of things are subjective."
Please. Everyone knows it's better to have red hair and freckles, Art. (Okay, maybe I'm just biased....)
Summer Johnson, PhD
Baby Einstein? Well, Maybe Not So Much.
We already knew that too much television watching was not good for the health of adults and teens and even young children, leading to a more sedentary lifestyle. Plus, it turns many of our brains into gelatin--how else could millions of Americans watch American Idol and The Bachelor?
But how about for your infant? You know, the pre-gelatin brain phase--before years of exposure to modern media, could TV really harm the littlest among us?
Well, recent research reported in the journal Pediatrics suggests that while it may not do immediate harm to infants and toddlers to watch the tube, it also doesn't do anything to help them. So wait, you might say, what about those amazing Baby Einstein DVDs everyone raves about? Sorry, staring at the television in infancy is not associated with better verbal or motor skills at age 3, says these researchers from the Pediatrics study.
But does TV harm infants? This study doesn't offer that conclusion. However, at least one research study, according to TIME Magazine, suggests that DVD watching by infants results in a reduced vocabulary--a whole 6-8 fewer words in their repertoire. Then again, when you are an infant--that could be anywhere from a 5% to a 50% reduction in vocabulary!
The upshot here is that no one is going to haul your baby away to foster care if you set him or her in front of the television while you read a book for 30 minutes or bake a cake, but if your goal is to make your child a genius, clever little DVDs are not the way to do it. Actually reading to and talking to your child is the only proven way to guarantee they will have a strong vocabulary and visual skills as they grow into a child.
Some things just have to be done the old fashioned way.
Summer Johnson, PhD
March Issue of AJOB is Now Online
Ever wonder what are the obligations by industrialized nations to the countries from which health care workers come? Are these workers free to move or are countries like the US and UK "poaching"?
Or considered what the long-term impact of implementing the Oregon Death with Dignity Act has had upon palliative care, assisted dying, and attitudes toward the end of life in that state and the US generally?
Can we come to a consensus on the standards for the standard of care for clinical trials around the world?
These are just some of the questions raised in this month's issue of The American Journal of Bioethics. Click here to read the Table of Contents and find out more.
Summer Johnson, PhD
Chinese Doctors: Do As I Say, Not As I Do
The Chinese government is cracking down on smoking--among one of its most heavily using populations: physicians. Yes, according to Reuters, more than 50% of China's male MDs smoke cigarettes. Now the government is asking them to set an example for their patients by kicking the habit.
While this is only a recommendation--it is certainly a reasonable and informed one. Physicians are role models and, especially if they were to do so publicly and to discuss it with their patients, their quitting tobacco would certainly impact at least some of their patient population. Physicians who smoke, while they certainly have the right to engage in whatever healthy (or unhealthy) behaviors they wish, are something like a personal trainer who is 100 pounds overweight. Sure they can dispense the advice, but if they can't walk the walk--do they really know what they are talking about?
It's time for Chinese physicians to get on the public health bandwagon and kick the habit with their patients. It will improve that nation's health overall and send the right message across the board.
Summer Johnson, PhD
Stem Cell Treatment Tourism Reported on the Local News!
Southern Illinois Man Seeks Stem Cell Cure in China. That's the headline. From KFVS12, Live from the Heartland. Meanwhile, Midwesterners are raffling off big ticket items to make it possible for Chuck Melton, sufferer of a spinal cord injury, to make multiple trips to China, to receive umbilical cord stem cell treatments not available in the United States.
The story reports that he feels better after his first trip to China, and while he dreams of one day walking his daughters down the aisle, he knows that he should be realistic, and that after maybe six or seven trips to China perhaps he will feel good enough to someday pursue the same treatments here in the US.
Okay--have I rattled off enough problems enough in this narrative for you, yet? This story is straight from the news article, which in and of itself, reads like a giant ad for the Chinese stem cell company doing the research, in my humble opinion. Go to China and get the therapy that the Americans who have been slacking for 8 years can't give you.
Can a Medical School Afford NOT to Have Medical Ethics?
Evidently, at least one major medical school things so. And to boot, their Chancellor, President and Board of Trustees appears to think that they can not only afford to live without a medical ethics department but to actively do away with their current one.
The Health Science Center at the University of Tennessee is considering a series of cutbacks that includes the excising of the Department of Human Values and Ethics at that university. When searching for places that the budget could be trimmed, clearly ethics was something that was expendable. Yet, clearly these administrators did not think about how much money ethicists actually save a university in terms of real costs--ethics consultations prevent real and horrible conflicts from happening at university hospitals around the country every day that cost hospitals millions of dollars. Having ethicists on staff mean that problems with research and in the clinical setting get solved, new policies get made, and most ethicists do this work without additional pay--while they are teaching classes and performing other essential services to the university.
It is odd that this institution would choose this cut at this time while most other medical schools are racing to add medical ethics to their curriculum, to their rosters of centers and departments. Clearly it's not just window dressing either--these departments and faculty members do real work for universities and medical schools---if I toot the horn of my colleagues!
So, let's ask the critical question again: can UT or any other medical school afford not to have medical ethics? I think the answer is a clear: I think not.
Summer Johnson, PhD
