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Taking a Page from Pres. Clinton's Book, Obama Asks PCSBI to Study Synthetic Life

Me thinks this bodes well for PCSBI indeed.

Without missing a beat, President Obama has asked the newly empaneled Presidential Commission for the Study of Bioethical Issues (ever more on this blog to be referred to as PCSBI, because that's just a mouthful) to do a comprehensive review of the issue of synthetic life on the heel's of the announcement made by the J. Craig Venter Institute that it had created the first synthetic self-replicating life form.

Why do I say this bodes well for PCSBI? The President had the presence of mind, for one, to remember that he has a bioethics commission and to use it for precisely what it was created to do, to in the words of its charter "identify and examine specific bioethical, legal and social issues related to the potential impacts of advances...in science and technology." And ta-da! Here is what some have called one of the most important advances in biology in decades.

And President Obama doing precisely what President Clinton did when Dolly the Sheep was cloned, called upon his bioethics commission to inquire as to what one should do or think about these matters. One major difference however: unlike Clinton who gave NBAC 90 days to write a report, President Obama is giving the commission sufficient time with 6 months to inquire and analyze this emerging issue.

Time will only tell what the commission will have to say in its report, but it is certain that if the commission proves its utility on this issue that it is likely to be tasked with similar timely and important topics for the President during its lifetime.

Summer Johnson, PhD

Public Health Ethics, the Podcast.

Live from the Center for Practical Bioethics, Dr. Summer Johnson (that's me) provides a basic introduction to public health and public health ethics.

In addition, I explain how public health ethics differs from traditional ways of analyzing health care ethics problems, and in particular how this applies in the case of public health emergencies.

This podcast is delivered courtesy of The Bioethics Channel.

Summer Johnson, PhD

Caplan Asks, "What Does It Mean to Be Alive?"

Venter has done it again. But this time, he's really done it--according to an article in Science, Venter's team has made a truly living, self-replicating organism made from non-living parts, a bacterium. It's ALIVE!

To read Art Caplan's take on what this feat means scientifically and ethically, click here or read the full text below.

Summer Johnson, PhD

First synthetic lifeform holds promise, peril
Scientists alter genes to create living bacteria from non-living parts
by Arthur Caplan, PhD

What does it mean to be alive?

That's a weighty question that scientists, theologians and philosophers have been wrangling over for eons. Most have concluded that the wondrous nature of what permits life is a mystery that science never could penetrate.

Until now.

What seemed to be an intractable riddle -- and one with significant religious overtones -- has been solved. A research team led by J. Craig Venter, Hamilton Smith, Clyde Hutchison, and Daniel Gibson at the J. Craig Venter Institute in Rockville, Md., has just announced in the journal Science that they have created new living bacteria from non-living parts.

The scientists have crafted what they're calling a "synthetic cell" from a set of genes they decoded, artificially combined and then stuck into the cored-out remains of another bacterial cell.

The Venter team has been working for many years to create a synthetic bacterium. Having built a synthetic virus some years ago, they have now shown that they can take the next step.

A truly living thing
Some argued that making a virus was not a demonstration that life is reducible to its subsidiary parts. Viruses have to use bacteria to reproduce. No one can say that making a bacterium, a much more independent, complex, self-replicating critter, is not synthesizing a truly living thing.

Why did the Venter team do it? Well, it was in part to resolve that age-old debate about reducing life to the sum of its parts. They wanted to show it could be done. More important, however, is that the techniques of gene synthesis involved in this remarkable achievement hold out much promise for humankind.

Synthetic biology should permit scientists to make microbes that can solve many of our most pressing problems. Building bacteria that secrete food edible by other tiny ocean creatures will provide us with more to eat as the now-endangered ocean food chain is rebuilt. There could be bacteria that digest oil from leaks and spills, or bacteria that consume cholesterol and other dangerous substances in our bodies. There could even be bacteria that attack other microbes that cause so much death and illness. All those are in the offing, and that is all to the good.

Oversight will be vital
That said, there is great need for more oversight of this hugely powerful technology. Bad guys making nasty bugs or scientists who are not very careful about where they make new microbes or where they release them could pose serious risks to our health and environment.

Venter and his group were careful to use tiny molecular changes to "watermark" or stamp their creation. Any scientist or company who uses the techniques of synthetic biology in the future ought to be required to use similar identifying markers. If an artificial life form escapes, it must be easy to identify in order to hold those who made it accountable.

The regulatory, social and legal challenges can be solved. It will take both national and international commitments to do so, but the risk of inaction is greater than the risks of moving forward given the tremendous benefits this technology promises.

The real fallout from the Venter group's achievement is subtle but more powerful. The scientists are chipping away at the view that there is something unique and unknowable about life itself. From this day forward, we know that the right chemical messages, presented in the right order and put in the right chemical context, can produce life.

Some may find this discovery a bit deflating. Others may worry that a line has been crossed in creating a new living thing. I think that none of this is true.

The dignity of life has never rested in its mystery but in its remarkable diversity, complexity and ability to manifest itself in all manner of conditions and circumstances. Coming to understand how life works, even taking small steps toward creating it, crosses no line. It is up to us to put this knowledge to good use. If there is any mystery, it is whether we will succeed.

Ethics of Reproductive Tourism Questioned

I was simply astonished to read the "ethical analysis" (if one could call it that) from DNAIndia.com in an article titled "New Age Moms Want Pregnancy Outsourced!"

Written from the Indian perspective, where everything from the UK and the US is outsourced to Indian laborers, I can understand the title, but the analysis is simply flawed every way.

The discussion describes two different prospective parent sets--both healthy enough to conceive and moms healthy enough (they believe) to carry their own children to term. However, both for career reasons (one is even a model), they would prefer to conceive using IVF and have surrogates carry their children to term.

So, on the face of this scenario, I can hardly see how this would be objectionable that these women (along with their husbands) for their own reasons (careerist or not) would want to use surrogacy as an option. Yet, according to the medical ethicists on DNAIndia.com, they argue ""If a woman does not have medical condition that reduces the chances of conceiving a baby we discourage them to opt for surrogacy."

Now never mind that there are differences between conception (the use of IVF) and gestation (the use of surrogacy), but the simple claim that doctors would be so paternalistic as to deny women the option of using a surrogate if the surrogate were willing to do so is simply outrageous.

Then comes my favorite claim of all made by an IVF expert in India, Dr. Nayna Patel: "If a woman cannot carry her own child in her womb can she be responsible enough to raise the child?" This claim, would appear to apply not only to these women described above, but to all women who use surrogacy--if the moral standard for being able to be a responsible parent is carrying a child in one's womb. This would also rule out all adoptive and step-parents as well. Who knew that gestating a child was the absolute standard for parental responsibility?

In short, the analysis of these two cases is absurd and I hope that this is not the general thinking about surrogacy in India or the UK. Of course, the decision to "outsource" as the article put it surrogacy to India as opposed to finding a surrogate in the UK is an interesting decision, but one that is devoid of context on the website. Are these women of Southeast Asian decent? Or is this simply a decision about reducing the cost of surrogacy? Is finding a surrogate so difficult in the UK that it would be nearly impossible but that is not so in India?

I do not know the answers to these questions--but DNAIndia.com does not provide the answers to them either.

So before they or anyone else is so quick to condemn women who seek surrogates beyond their backyards, one should not question their motives, but explore the social, cultural, religious, and economic contexts in which they do and remember that reproductive choice is what trumps, for both couple and surrogate.

Summer Johnson, PhD

Becoming a Doctor--By Video Game?

Apothecary Healers vs. Lords of Pestilence in the land of Soma? No, it's not something you missed from Brave New World or a bad knock off of Lord of the Rings. In fact, it's a new video game called "Healing Blade" created by Nerdcore Learning (how'd they come up with that name?) designed to teach medical students how to treat bacterial infections one pathogen at a time.

According to The Scientist, the game introduces basic concepts of bacteriology in a way that med students find both memorable and fun. So does it work? Well the students seem to think so and the game is selling like hotcakes.

And while this new way of teaching doctors concepts isn't likely to be applicable to most kinds of medical knowledge, acknowledging that a new generation of physicians who may be "game" (pun intended) for other pedagogies is important. This is has certainly been the trend in medical ethics where everything from television to movies to plays to literature to comics have been cited as ways to teach morals in medicine. Maybe it's time the rest of medicine caught on....

I wonder if Nerdcore will be up for making "Healing Blade 2" featuring Wizened Bioethicists vs. Dukes of Injustice. Just an idea guys.

Summer Johnson, PhD

May Issue of AJOB: SPECIAL ISSUE ON STEM CELL TOURISM

Featuring paired issues by Stanford's Charles E. Murdoch and Christopher Thomas Scott and University of Alberta's Amy Zarzeczny and Timothy Caulfield, the May issue of AJOB addresses the hot topic of the ethics of stem cell tourism.

Target Article authors and Open Peer Commentators alike address such essential questions as what are the moral obligations owed to patients who travel abroad to China or Russia seeking treatments unavailable in the United States, how to regulate these trials internationally, and how to handle the special cases of pediatric trials or orphan diseases.

In addition, associate editor David Magnus in his editorial writes about stem cell research and commissions under the "bioethics president."

A must-read, groundbreaking issue that definitely deserves a look. Click here to read more at bioethics.net.

Summer Johnson, PhD

24 Hour Genetic Testing at Your Local Walgreens Pharmacy

Courtesy of Pathway Genomics and Walgreens Pharmacy, on Friday in 7500 pharmacies around the nation, you too can send your spit off for genetic analysis and find out your genetic predisposition for a wide range of conditions including breast cancer, diabetes, and Alzheimer's disease, says ABC News.

And how's this for over-promising? Pathway says that the test can be used "to forecast what genetic disorders future children might have, and weigh the likelihood that they'll become obese or go blind", says ABC. Gee, I think I missed the headline where they found the "fat gene".

Of course, over-the-counter genetic tests have been debated to death and the ethical issues are obvious, but what I'd love to see at my Walgreens pharmacy on Friday is someone going up to the pharmacy counter and speaking to the pharmacist about whether to take such a test. Or better yet, when the giant report comes back from Pathway Genomics, which includes test results for "drug responses and adverse reactions", I'd love to see a pharmacist react to the endless questions that any average person would have to having a gene that gives you a increased rate of caffeine metabolism or might predispose you to statin induced myopathy.

Why am I picking on pharmacists? Well, I surmise that people who purchase these products at the pharmacy will go back to the pharmacy (heck, many are open 24-7) to ask questions about their results. The logic being--if they sell the product, they ought to be able to help me with these results when I get them, right?

But even when the pharmacist does a woefully inadequate job interpreting the risk factors and what they mean for any given test-taker, a physician, as we all know, is unlikely to do much better interpreting these over-the-counter test results.

But maybe this is all much ado about nothing. Maybe few will purchase these over-the-counter tests. But who will? Those who are curious and then will likely spend hours on Google trying to decipher the result themselves and then those who believe, based on family history or other factors that they are at risk of some genetic condition. But then who will help them decipher what their results mean? Who will help them from being either the worried well or deal with a meaningful result?

Therein lies the problem and it's one that neither Walgreens nor Pathway Genomics have even begun to resolve.

Summer Johnson, PhD

AJOB Neuroscience Issues 1 and 2 Available Online NOW!

Now under the editorship of Paul Root Wolpe, Director of the Emory Center for Ethics, AJOB Neuroscience has rapidly and excitingly launched the first two issues of its first volume, now available online via Informaworld.

Eager to read more about the cutting edge ethical thought and research being done in neuroethics? Look no further than clicking on the image at the right to find the first two Tables of Contents.

Congratulations to AJOB's sister journal on this great accomplishment and we all look forward to reading more issues of AJOB Neuroscience (published quarterly) later this summer and again in the end of 2010.

Summer Johnson, PhD

What's the Harm in a Pinprick?

It all depends on the context when asking the question--what's the harm in a pinprick?

According to the American Academy of Pediatrics, when talking about female circumcision, their committee on bioethics has decided that the procedure should be permitted for American doctors. It would be far better for American doctors to be permitted to perform a ceremonial pinprick or "nick" on girls whose families want them to have the procedure rather than these being forced to travel to Asia or Africa to have a full procedure done, says the NYT.

Medically speaking, the harm in a pinprick or "the nick" shouldn't be much--and that is the goal--to prevent these girls from undergoing a much more severe procedure in places where the surgery (if you could even call it that) resembles the practice's more common name--female genital mutilation. So in one sense, this position is attempting to reduce harm for these young girls.

Moreover, the notion of a "prick" is a standard we use for minimal risk in research all the time for needle sticks for blood draws, for example. Thus, the AAP is not recommending some risky procedure at the expense of American girls to appease parents who want the procedure for religious or cultural reasons.

However, opponents of FGM are right to worry about the message that endorsing the practice at all sends--at least from our Western perspective. For those who just flat out think that female circumcision is wrong and that it suggests a certain view that these cultures hold about the role of women, their power and sexuality in those cultures--they take the black and white view--anything that even resembles female circumcision or FGM must be bad and must not be allowed.

But taking such a view imposes our Western cultural values upon families who take a different point of view. These families ought to be allowed to express one of their important cultural rituals in a manner that presents minimal harm to these young girls. The AAP statement has found that middle ground--it would seem. If it does, in fact and upon empirical review, prevent these families from going oversees to get a more complete procedure. That is the key. The "nick" as it were would have to satisfy these families need for female circumcision in order for this policy to meet its intended goals.

If it in fact can do that, I think that the half-way position is a reasonable one. It will never please the fervent opponents of the procedures or feminists who believe that any genital cutting is morally wrong, but if the data bear out, it may be the solution we have all been looking for for a truly problematic moral problem that has plagued us for decades.

Summer Johnson, PhD