blog.bioethics.net

Doc Goes "Up in Smoke" for Selling and Partaking in Medical Marijuana with "Patients"

Imagine, if you can, walking into your doctor's office, jumping up onto the paper lined table and the following dialogue occuring:

DOCTOR: "[Coughing] Whew. That's Kush stuff. That's OG Kush. Whew, that's some great potent herb. It's just good to be in California. Yeah. We could be in Oklahoma."

The doctor then performs no medical examination or takes a medical history of you at all and deeming you worthy of your pot prescription says,

DOCTOR: "The herb is going to be in here. It's going to be mixing around. Hot air, we're going to catch it. It's just vaporizing. You don't burn it, so you're heating all the good stuff, but you're not creating all the poison that you do when you burn something."

No, really, this isn't from the Onion. Or from the latest Cohen brothers movie. And I couldn't make up a story this good, even if I tried.

Southern California physician Dr. Tollette has been arrested for lighting up his medicinal herbs with his "patients" in complete contravention with California and federal law. Caught during a sting operation after being suspected for running more of a marijuana dispensary than a legitimate medical practice, as a news report stated it Dr. Tollette "recommended marijuana to just about anyone, as long as the price was right."

This very same news report described Dr. Tollette as having a man with a "very unique specialty [who] displays some questionable medical ethics." Really? I know of, well, no physicians who practice the specialty of marijuanatology.

No worries, Mr. Tollette is no longer a physician. He is serving time in federal prison having pled guilty to marijuana related offenses and Medicare fraud.

Unfortunately, cases like this give legitimate uses of medical marijuana a bad rap and make it an easy target. But if any one can't see that the former Dr. Tollette was a pure opportunist/drug dealer looking to make huge amounts of money from his medical licensure and the ability to dispense marijuana in California, then they simply aren't paying attention.

Summer Johnson, PhD

October Comes Early for AJOB!

Already live and available on bioethics.net is the October issue of The American Journal of Bioethics.

Featured this month on the cover is the topic of nanomedicine including an editorial by Dr. Summer Johnson on whether the era of nanomedicine is upon us, still galloping toward us, or likely simply never to arrive.

This editorial is in response in large part to a Target Article by Fritz Allhoff reviewing the broad spectrum of ethical issues in nanomedicine's "coming era".

Also in this month's issue of AJOB is an Target Article by Rentmeester and George discussing the morally complex clinical ethics cases when a psychiatric consult is requested by physicians.

Lastly, Gesundheit et al raise the question of "who is a terrorist?" and even when the definition is clear, they ask the question of scope and nature of the responsibilities of physicians to treat such persons, even against their own personal moral convictions.

To read more about the October issue of AJOB, click hear to read the entire Table of Contents. (Free copies of this issue will be available at the upcoming American Society for Bioethics and Humanities Annual Meeting in Washington, DC.)

Summer Johnson, PhD

Former Governor Embraces the "R-Word"--And It's About Time!

Former Governor Dick Lamm has come out to do something that most of us realists in the healthcare debate have done long ago: acknowledged that the "r-word"--rationing--is not a dirty word, and in fact, is something we already do in our health care system. Moreover, rationing is not something to fear as a result of any public healthcare option we would embrace as part of "Obamacare", but in fact rationing is a real part of the healthcare system we exist in each and every day. We simply accept it as part of a system that we fear changing and it is that stubbornness that will be our downfall.

In his commentary on the Huffington Post blog, Lamm makes the point clear and simple:

"The United States now has the worst form of rationing. We ration people by leaving them out of the system. We tell each other that this is indirect rationing, and apparently we find this morally easier to accept than direct rationing. A sin of omission is easier to live with than a sin of commission. But it is rationing in its cruelest form: the Institute of Medicine estimates that 20,000 Americans die each and every year simply because they lack health coverage."

So rather than steering clear of the r-word, Lamm calls a spade a spade and says that it's time to stop the very worst kinds of rationing--the morally unacceptable, indirect kinds that leaves people uninsured and out in the cold, and to explicitly ration where we can and must using whatever resources we have available.

I couldn't agree more. We are long past due to stop thinking of rationing as a dirty word. We already do it--indirectly and with disastrous results. If we did it explicitly, the outcomes are certain to be better.

Summer Johnson, PhD

Warning: This Magazine Cover is Hazardous to Your Teenage Daughter's Self-Esteem

Now, I'm not sure what the symbol will be for that warning label or what government agency will regulate the waif-ish model photography that makes your child have a complex department, but the French government believes that all-too-skinny models are creating a problem for the self-images of that country's youth. But it's not the models who should be regulated, says the French government, but those retouching the photos to make them look even MORE skinny that should be regulated, says the WSJ Health Blog.

Warning! This woman doesn't look like this in real life! In fact, she actually has thighs and real cellulite!

There can be no doubt that American children suffer from a similar problem--being bombarded with images of size 0 and dangerously thin, bordering on (or actually unhealthy) models who represent in this day and age the pinnacle of beauty. They establish an unreachable standard for all but a miniscule portion of woman and men who then feel they are failures for not looking like Kate Moss or even Megan Fox.

Would adding a disclaimer on the front cover of fashion magazines make any difference? I doubt it. Adding an icon on the cover that connoted that the image was digitally enhanced would hardly dislodge the notion that women could, should, or can look like the image they are bombarded with in beautiful dresses, bikinis and the like. I applaud the French for trying to think of some kind of policy option to prevent young women, in particular, from feeling as though they must live up to a totally unrealistic standard in terms of their body image; I simply fear that this solution may not do the job.

Summer Johnson, PhD

Creepy or Cure-All: The Pill That Nags You for Missed Meds

Have our medicines entered the Big Brother era? At least one medicine developed by Novartis is being tested to be able to have the ability to remind us when we have forgotten to take our next dose of our chronic disease medicine so that we keep up our blood levels of our blood pressure medication, says the Wall Street Health Blog.

How can this be a bad thing? The tiny little microchip inside the medication would monitor one's blood level and when it slips too low it sends a message to the patient saying, "Hey dude, time to take your medication!" It's efficient, simple, and could potentially save your life. No complaints here, right?

Wrong! This invades patient's privacy and a patient's right to be delinquent taking medication and screwing up their dosing. It makes it much more difficult for patients to ignore doses or to say, "If I don't want to take medication, I don't have to" with a microchip inside their body beaming out text messages to a device annoying them all the time. Particularly if that device can send its data to their physician or worse yet to their insurance company reporting them as a non-compliant patient.

But isn't that the point? To motivate patients to be compliant? Personally, I think the more we can do to encourage chronic disease management that actually works and compliance with long-term dosing regimens that work, the better.

If this drug can actually do what it promises, I hope they make more of them.

Summer Johnson, PhD

Creepy or Cure-All: The Pill That Nags You for Missed Meds

Have our medicines entered the Big Brother era? At least one medicine developed by Novartis is being tested to be able to have the ability to remind us when we have forgotten to take our next dose of our chronic disease medicine so that we keep up our blood levels of our blood pressure medication, says the Wall Street Health Blog.

How can this be a bad thing? The tiny little microchip inside the medication would monitor one's blood level and when it slips too low it sends a message to the patient saying, "Hey dude, time to take your medication!" It's efficient, simple, and could potentially save your life. No complaints here, right?

Wrong! This invades patient's privacy and a patient's right to be delinquent taking medication and screwing up their dosing. It makes it much more difficult for patients to ignore doses or to say, "If I don't want to take medication, I don't have to" with a microchip inside their body beaming out text messages to a device annoying them all the time. Particularly if that device can send its data to their physician or worse yet to their insurance company reporting them as a non-compliant patient.

But isn't that the point? To motivate patients to be compliant? Personally, I think the more we can do to encourage chronic disease management that actually works and compliance with long-term dosing regimens that work, the better.

If this drug can actually do what it promises, I hope they make more of them.

Summer Johnson, PhD

NIH Stem Cell Working Group Chaired By Card-Carrying Bioethicist?

With Jeffrey Botkin appointed as the Chair of the Working Group for Human Embryonic Stem Cell Eligibility Review, can anyone be surprised that the committee is also comprised of two other card-carrying bioethicists: Dena S. Davis and Bernard Lo?

This, in my view, is something to herald for the committee--and ethics committee for certain, but it was by no means a lock that so many obviously "bioethics" folk would be part of the committee.

While some may quibble as to which bioethicists are on the panel or some may say there are even too few, I think that what is most notable is that it is chaired by someone who is so obviously among the bioethics flock. What will this mean for the quality of the review, time will only tell, but it certainly means that ethics will be at the forefront and values questions will certainly be at the center of the debate.

Comments, anyone?

Summer Johnson, PhD

Caplan Canvasses the Globe for Lessons on Health Care

Why does the rest of the world get it when it comes to health care and we don't? Perhaps we should take out our globes and world atlases and examine other countries to see how they do it and find some answers, suggests Arthur Caplan in his most recent MSNBC commentary.

A great idea, no matter how humble and un-American, and certain to be enlightening. Borrowing the lessons learned from other nations might take us just a few steps closer to resolving our own health care nightmare here in the US, notwithstanding the own unique circumstances of each of the countries Caplan lists below.

To read more about what Caplan's analysis found, click here or read the full-text below.

Summer Johnson, PhD

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Spinning the Globe Offers Lessons in Health Care

We are 37th! We are 37th! No, this is not the cheer to be heard this week at a Notre Dame football pep rally. Rather, it is, according to the last rankings done by the World Health Organization, the chant appropriate for the U.S. health care system.

The pressure is building to do something about our broken system.

President Obama says he will not back down -- we have to reform our system before more Americans die prematurely or go broke.

Senate Finance Committee Chairman Max Baucus has put forward his Obama-lite plan, which abandons the option of a government-run basic insurance option competing against the private market to get coverage for everyone. Instead, Baucus calls for tax credits for small business, the end of underwriting and a mishmash of government-subsidized insurance plans -- co-ops to make health care affordable for all.

The Republicans continue to wring their hands at the prospect of a trillion dollars being poured into a reform plan at a time when government debt has reached the nearly incalculable stage.

Meanwhile, the rest of the world is watching to see if we will really finally do what nearly all of them did decades ago -- provide health insurance for everyone. The French, Swedes, British, Canadians, Taiwanese, Singaporese, Dutch, Germans, Spaniards and Italians cannot believe that we plod on year after year with exploding costs and hordes of uninsured.

So what do they know that we don't?

First, we spend more money to insure fewer people than our peer-group nations. According to the Kaiser Family Foundation, we are spending twice as much or more than other comparable countries around the globe. Those spending less per person include Australia, Austria, Belgium, Canada, Denmark, France, Germany, Iceland, Italy, Japan, Singapore -- well you get the idea -- while covering everyone in their country.

And, the cost gap is getting worse. Our rate of inflation for health care costs is the fastest growing among rich nations on the planet. If you earn more money in the years to come at least half of it will go to cover your out-of-pocket health care costs if the inflation rate is not slowed. Things are so out of control that we have a form of bankruptcy unheard of anywhere else in the world -- the inability to cover medical costs is tied to more than 60 percent of all personal bankruptcies in America.

Not only do we lag far behind many nations in terms of how much we pay, we get less for our money. We rank 52nd in the number of doctors per thousand people. Sure, we rank behind the usual suspects: Italy, France, Sweden and Norway. But did you know America also trails Cuba, Uzbekistan, Moldova and Mongolia?

We also limp along behind many nations in the number of babies who die at childbirth, including Singapore, Bermuda, Britain, Sweden and Japan. And they live longer than we do in Singapore, Japan, Israel and Italy, while spending a heck of a lot less for their care.

All that said, I do not hesitate to use American health care. After all, I have good insurance with access to a world-class academic medical center as a University of Pennsylvania employee. People from all over the world come here to train as doctors because when American medicine is good, we are very, very good.

But when you look at how we do as a nation overall, our health care system is just shy of awful. Being 37th in the world in key health measures, spending a ton more money while leaving a good chunk of our friends and neighbors to fend for themselves or go bankrupt, dying sooner than they do elsewhere and having a less than stellar infant mortality rate only shows that as a national system, American health care is a mess.

As we move toward the end-game for health reform, a quick spin around the globe reveals that No. 37 has a lot to learn from the rest of the world.

Canada
The denizens of the Great White North know they do at least two things better than Americans -- hockey and health care. There is a lot of talk about waiting lists in Canada but the reality is that there is no delay in getting urgent medical needs attended to and the rich and the poor both get high quality care. Primary care works well. And if you don't want to wait for elective procedures you can simply buy more insurance or pay out of pocket and get out of the line. Canada has everyone covered and the quality of care is very good.

Switzerland
There is no place more in love with markets and capitalism then this nation. So how do the Swiss handle health care? Surprise -- the Swiss have Obamacare!

Health insurance is mandatory -- mandatory -- so everyone has basic health insurance. No one in Switzerland can be denied basic insurance coverage no matter how sick or disabled they or their children may be. The government subsidizes care for the poor but they still have to pay something. This is the Swiss version of a co-op plan. There are private insurers who compete for business above the basic minimal insurance and do quite well.

The Swiss do pay something out of pocket for each health care visit but usually no more than 10 percent of the cost. Those in the subsidized basic insurance system have somewhat restricted choice in where they can go to the doctor. Everyone else can go to any doctor or hospital anywhere they want in the entire nation.

Israel
Israel has superb primary care. It is not just that everyone is insured but there is primary care available in nearly every city and town all over the country. This makes a big difference, as shows up in the care of chronic diseases like diabetes.

In the U.S., lots of visits to emergency rooms are related to diabetic ketoacidosis -- people becoming faint, feverish and dehydrated because their insulin is out of whack. The condition is very serious and costs a bundle to treat in hospital ERs.

In Israel, very few cases make it to the hospital. There is readily available primary care and diabetics are closely monitored by their doctors. As the Israeli system becomes increasingly computerized, something Obama has been calling for here, it becomes easier to see which diabetics are having problems and to proactively intervene to make sure their disease is being properly managed at home so they don't wind up costing a fortune in the hospital. The big lesson out of Israel is that ready access to good primary care will save money.

Britain
The Brits have something very important to teach us about health care. And it is not just the all-in national health system that they so staunchly defend. It is about the value of prevention. They have developed a system of caring for newborn babies that the U.S. should have instituted long ago. In America, mom has a baby and goes home. You are on your own even if you don't have a clue about how to breast-feed or what to watch for in terms of your or your baby's health problems. Not so in the National Health Service in the U.K.

When you have a baby in Britain, a midwife will come to your house to check on you and the child at least a few times for 10 days after the birth. Then a community nurse will visit at least once over the next month or two. You can then go to see a midwife or a doctor for as long as you wish if you are having problems breast-feeding or for any other concerns for five more years. The Brits not only have a smart preventive focus on newborns, they are making smart use of non-physician health care personnel. Taking full advantage of nurses, midwives, pharmacists, physician-assistants, and social workers has to be a key part of our health reform.

Japan
Everyone must be insured in Japan but there are many private insurance plans. One especially interesting feature of health care in Japan is that insurers are prohibited from advertising. So all the money wasted here on ads, TV campaigns, marketing and sales gimmicks goes to the actual delivery of care.

Any citizen of Japan can visit any primary care physician with or without an appointment and will be seen, albeit briefly, within an hour or two. They will pay a fixed fee of about $50 for which their insurance pays 70 percent. Why is this possible? Because doctors are not drowning in paperwork or on the phone arguing with insurance companies or managed care bureaucrats. One fee everywhere with a small co-pay means the doctor will see you now.

One other interesting feature of universal health care that has not gotten much attention is its connection to tort reform. Japan, like all other nations with universal coverage, has nothing like the malpractice crisis that we do. Most doctors pay about $1,000 per year for malpractice insurance. There are only a tiny number of lawsuits every year. One major reason is that if a mistake happens you don't have to sue to get your medical costs covered -- they already are. Plenty to be learned from the land of the rising sun.

Australia
Two interesting features about health care in Oz. First, they pay much less than we do for their prescriptions. Why? Because the government won't pay without some demonstration of cost/benefit analysis involving efficacy, safety and a fair price from the drug company.

Emergency room visits are free, but they make sure to push primary care. Visits to a primary care doctor are heavily subsidized, costing on average about $20. While the U.S. has great specialty care for many of its citizens, what gets the best return on the health care dollar is, as the Aussies, as well as everyone else outside the USA seems to know, primary care.

France
The French are recognized around the world as having a fabulous health care system. Not only do outsiders admire what they have, the French report the highest satisfaction rates of any country in the world with their health care. The government provides easy access to primary care and insures that every person can utilize a full array of specialty services by keeping a close eye on where new technology and services get placed. In fact, the French have better access to most forms of high technology care than do Americans.

Two features in particular stand out about the French health care system. In 2002, France instituted a national no-fault insurance scheme for medical errors and mishaps. As a result, people who are injured in a hospital or nursing home receive prompt payment and there are nearly zero lawsuits.

The other remarkable feature is that medical school in France is free. This means more doctors are willing to practice primary care unlike American doctors who, saddled with huge debt from their time in medical school, head toward specialties in droves. And since medical education is free, salaries and fees paid to French doctors are far more reasonable then they are in the USA.

The bottom line
A lot of what the President is calling for is reflected in the health care of these nations. An emphasis on having widely available primary and preventive care is the key to controlling cost and getting better outcomes. Covering everyone will help reduce malpractice costs. Getting rid of paperwork will give doctors time to actually see you. And giving non-physician providers a bigger role in basic health care management is the key to handling chronic illnesses and pre and postnatal care. There are many places doing better than we are. We can and should change that.

Michael Jackson's "Unintended, but Foreseen" Death

On OUP's Medical Monday blog, Robert Veatch talks about the decision made by Michael Jackson's physician to offer him what was arguably a potentially lethal dose of the anesthetic, propofol, and the trade-off that he believes that Mr. Jackson and Dr. Murray made to give him some much needed rest.

This decision, says Veatch, was one doctors must often make where unintended but foreseen consequences exist that may even include death but that the potential benefits often outweigh those consequences.

In such cases, the outcomes are not considered "homicides", particularly when the decisions are made between a trusted doctor and a consenting patient.

Of course, these claims made by Dr. Veatch are all assumptions in the Jackson case, but were they to be true, then his analysis would be sound. Moreover, from a simple medical ethics perspective it would seem that the key question here--that no one will ever really know the answer to is the nature of the relationship between Dr. Murray and Michael Jackson. Was he trusted implicitly to make those decisions? And on that fatal day did Jackson agree to take those medications or was the consent at least implicit because of the nature of the relationship?

If the answers to those questions are in the affirmative, then Veatch may have something here. If not, then I think that he may be looking for a solution to this criminal case via bioethics that simply does not hold up.

Summer Johnson, PhD

Will The Down syndrome Children Disappear?

This is the incredibly provocative question asked by a Children's Hospital Boston researcher in a recent article published in Archives of Disease in Childhood.

Given the new prenatal tests available to mothers, the author, Brian Skotko, asks, are we entering an era where slowly Down Syndrome babies will begin to be born in dwindling numbers? And is this, he asks something that we as a society would even want to happen?

As covered in the Washington Post, Skotko provides some interesting data: "in the USA, there would have been a 34% increase in the number of babies born with DS between 1989 and 2005, in the absence of prenatal testing. Instead, there were 15% fewer babies born [with DS], representing a 49% decrease between the expected and observed rates."

This difference between what is expected and observed is not likely to change, but only increase when some 92% of women who know their fetus has Down syndrome choose abortion. And as testing becomes more sophisticated and more reliable, this number may increase as more women know even sooner and may choose this option given more time to choose it.

But what will our society lose if all the Down syndrome children disappear? There will certainly be a thread of our humanity that would be lost. Moreover, I doubt that there will ever be a time when Down syndrome is ever completely gone from our population. 100% of women will never terminate their Down syndrome pregnancies--nor should they. Their is a richness and fullness that raising a handicapped child brings to parents' lives and for some parents that is what they wish to have.

So will the Down syndrome children disappear? No. But will they dwindle in number? Yes, due to advances in prenatal screening and genetics and parental choice. And yes, we will lose something for having fewer Down syndrome children and adults among us.

Summer Johnson, PhD

Caplan Says It's Time to Have a Joint in PA

Well, thirteen other states are already doing it, so why not Pennsylvania? It's time for the Quaker State to loosen up and allow for the use of medical marijuana there, says bioethicist Arthur Caplan.

"Some have glaucoma, some have cancer, and medical marijuana would really go a long way toward helping some of these people. My attitude is if a doctor prescribes it, then marijuana ought to be available to all Pennsylvanians. We should be on board the shift and make sure that Pennsylvanians have everything they need to control their suffering," he says.

So what about the "glamour factor"? Making pot legal in a few instances may make it more enticing to teens and others who will seek it out, say opponents. Caplan is skeptical. Patients in pain or who are nauseous all the time are hardly good spokespeople for the "Hey, let's spoke pot!" campaign.

I, for one, absolutely agree. It's time for PA to jump on the marijuana bandwagon and let sick patients who need it have access to it at long last.

Summer Johnson, PhD

Doctors Not Making the Big Bucks Say Bye-Bye to Medicine

The practice of medicine has just become too tough for many physicians. Too many long days, too many lawsuits, too much paperwork, all for too few zeros after the dollar sign. So with increasing frequency doctors are hanging up the white coat and stethoscope and saying "Adios!" to the clinic and entering into new, more lucrative, careers.

What could be more lucrative than being a doctor? Well, in this current healthcare system, and certainly the one we may be embarking upon, a good number of careers. Healthcare consulting for pharmaceutical companies and device manufacturers, or working physician search firms (aka headhunters) just to name two. Never mind the physicians who simply move into management rather than practicing.

What is so regrettable about this trend is recent surveys suggest that 10% of physicians polled planned to move outside of healthcare altogether. So completely fed up with the entire system, maybe they will just move to Colorado and run a ski lodge or run a vineyard or something.

But regardless of what any of these ex-docs do--they are contributing to an ever-growing crisis in this country--the skyrocketing shortage of primary care physicians. Moreover, they are taking away a valuable resource for which we, the citizens of this country have paid in large part for them to become educated. This is not a debt that has to be repaid forever, but in this time when we need primary care physicians, and physicians generally, more than ever, it is a shame that so many doctors are choosing now as the time to seek greener pastures.

With healthcare reform on the horizon, it is not surprising that many docs are heading for the hills and streets that they hope will be paved with gold. It is simply a shame that they are choosing to do so when we need them most.

Summer Johnson, PhD

Something to Say about Personal Genomics? Here's Your Chance.

Hat tip to the Business Ethics blog for letting us know about a new research study on personal genomics, privacy and consent currently underway being conducted online from researchers at at University of British Columbia, Saint Mary's University, & Ryerson University.

Called a "deliberative" survey, the study differs from the traditional online survey in that participants will be able to read what previous respondents have said and react to those responses in their answers, sort of like one giant online, asynchronous town hall meeting.

To learn more, check out the survey here.

Summer Johnson, PhD

Let Semenya Run

Some people are simply just born to run, to compete, and to excel in athletics. We never quite understand why--and until recent years when Olympic-level athletics has become in large part overrun by science and technology and highly sophisticated physical training and dietetics, we did not understand why the Michael Phelps of the world could perform almost super-human feats.

But now, when women in particular are able to achieve astonishing, record shattering goals in athletics, we take a much closer look--even into their genetics--to determine, "How did she do that?" Sometimes, as in the case of Caster Semenya we find that in fact there is something unique about her physiological and genetic make-up. But should this exclude her from doing what she was clearly made and born to do. Her body is uniquely suited for these pursuits. Simply because she is different should she be excluded from pursuing it?

I think not. While it may be the case that she has a hard time fitting into the rigid categories laid out by the IAAF, if it is in fact the case according to recent reports that she in fact has no female reproductive organs, then the question remains is this biological fact enough to exclude her from running track? It in fact raises a much deeper philosophical question about what makes someone female in regards to gender, which seems not to be the IAAF's concern at all.

IAAF only seems to be concerned with biological fact and whether or not this young woman is in fact verifiably "woman-enough" to be categorized as such to race against other women who have all the "right" female body parts. But this is a view so antiquated as to allow articles to be written using the horrible word "hermaphrodite".

What matters here is that Semaneya's privacy has not been protected at all and that her basic sense of self--her gender, her sexuality, and both her sense and her actual reality of who she can be professionally as a track star have been thrown into question by antiquated notions of what it means to be a woman. This is shameful, regrettable, and simply wrong.

With all the other supplementation and enhancements that Olympic and other professional athletes are allowed to use in this day and age, I can hardly see how it is fair that this young woman has been singled out to say that her unique biological make-up can be construed as an advantage for which she should be disqualified. So many other woman work very hard to make their bodies look, feel, and have similar biochemical and hormonal levels not unlike Semenya's.

So perhaps we should just let Semenya run and stop probing her biology, using her as an example, and let her become the person that she was meant to be.

Summer Johnson, PhD

**Note: I have used the pronoun she here to refer to Semenya only as a convention, given that the gender with which she has affiliated herself up to this point has been female.

I Forgot (Sort Of)

As it turns out, many of the things we think we forget are memories actually stored somewhere in our brains as memories we simply cannot access, say neuroscientists who have recently published a paper in Nature.

According to Wired, the brain still holds these lost feelings or thoughts, you just won't have access to them. So what good are these lingering, but inaccessible old memories? Perhaps nothing--for the moment. However, one day we may possess the mind-bending drugs or mind-reading machines to unlock those memories that we've long since forgotten from when we were infants or from a traumatic experience that may help us remember what it was like before we could walk ("Gee, this baby food really was disgusting! Mom, why do you feed me this stuff?!") or key insights to solving crimes locked away in brains with PTSD.

Whether this would be a good thing, I'm not entirely sure. Some lost memories may be protective or in fact a good thing for humans--a part of growing up or growing older. But perhaps some day unlocking these memories deep in the human brain could be of benefit to society---the key, of course, is knowing the difference between those that would offer such benefit and those that could potentially harm individuals and/or society. The key between now and then is figuring out who will be able to decide how to make that determination as well.

Summer Johnson, PhD

MercatorNet Asks (Ridiculously), "How Much Are We Entitled to Use Each Other?"

Jennifer Roback Morse on the MercatorNet blog reflects on the moral issues raised by the movie adaptation of Jodi Picoult's novel "My Sister's Keeper", oft discussed among the assisted reproduction crowd as the paradigmatic case of "savior sibling" gone bad.

Yet Morse reduces what most regard as a fine novel (if not a sub-par film) to a very simplistic question: to what extent are we entitled to use others? To me this seems to be an absurd way to shape such a debate about the use of ART to create children who may be able to save the lives of their relatives, particularly their siblings, given the fact that we, whether it is spoken or unspoken, "use" others with whom we are in relation all the time.

In fact, I would argue that it is the nature of relationships that we "use" each other each and every day. We don't think of it as "use" in the typical sense of taking an using one's organs or bone marrow or stem cells to cure oneself, but we do in fact get (and hopefully give back in return) a tremendous amount from those with whom we are in relation all the time.

This is why I think Morse's analysis of the relationship between the "savior sibling" and her sister, and in fact, the entire family dynamic is completely off--and does quite a disservice to the use of ART for creating children who may be able to help their unwell older siblings. It entirely ignores the ways in which parents "use" children often to fulfill their own unfulfilled hopes, dreams and desires (rightly or wrongly). The background condition that parents clearly do use children to fulfill these desires sheds light on the fact that children may also be used in other ways to fulfill others' expectations as well. This use, can hardly be construed as morally wrong, but simply the way in which we relate to each other in society.

Of course, when those expectations result in abuse or harm to a child, that when it does become morally reprehensible--but in the case of a savior sibling whose cord blood or some other bodily part is given to save the life of a sibling whom they love--this can hardly be construed as harm.

Just because we do use each other in countless ways in relationships does not of course make it right, but absent harm coming to savior siblings, it would seem to me that the good far outweighs the fear that there is no "reliable barrier against moral excesses and medical abuses" of these children.

Personally, I think that the great lengths that parents who want to have savior siblings go through suggest a tremendous love for BOTH their children and that this is a fear completely unwarranted and that they will not "use" their children or each other any more than any other parents, beyond the obvious instance for which that child was created.

Summer Johnson, PhD

There's Something Different About You. And You. And Everyone Else You've Ever Met. They Are All Mutants.

It turns out it wasn't all a bunch of rubbish when our parents told us as children that each one of us was very special, in fact unique, from everyone else. Scientists have now proven it.

According to a study in Current Biology, scientists say they have learned that every single human being is comprised of between 100 to 200 new genetic mutations, which means--yes, that's right--we are all mutants. (Our parents put it much more nicely, don't you think?)

Now our mutations aren't going to give us powers like Wolverine (sorry guys) or Mystique, but they do perpetuate the genetic variation of our species, leading both to minor improvements in some cases and the introduction of negative traits including diseases in others, say scientists.

So at least we all know it now, we are all genetic oddities, so as the City Brights blogger said, "Embrace your inner mutant." And cross your fingers that someday our mutations will make us look and have powers like X-Men characters.

Summer Johnson, PhD

On Nanofoods, Someone is Finally Listening

Move over "Frankenfoods", here come "nanofoods, says thebigmoney.com. Quoting blog.bioethics.net, they note that nanofoods' potential and their pitfalls--and what may be coming down the pipeline.

One of the first articles in a long while to take notice of the social and ethical implications of these new developments, hopefully it will be part of a new trend noting that nanofoods are on the way and something to take note of.

Summer Johnson, PhD