August 2010
Want to Feel Morally Superior? Use Purell.
We have all heard the adage "cleanliness is godliness", but according to a new study reported in Wired, cleanliness also translates into moral superiority.
Behavioral scientists have found that students who were asked to rate moral situations who use antiseptic gel or who were described as being clean and fresh were much more harsh regarding immorality than those who were left unclean.
Perhaps there is something magic in the cleansing process? The study leaves that question unanswered. But for those who just were told they were clean, they were more condemning too and also felt better about their own moral actions.
What does this all mean? Can't make it to a confessional? Just try some antiseptic gel. It will make you feel all better about yourself (and condemning of very one else).
Summer Johnson, PhD
Going to the Movies To Become a Little Less Fun....
When you snuggle down in your movie seat to watch your next action flick or romantic comedy with a barrel sized popcorn bucket and gallon of Coke at your side, your movie theater euphoria might be a bit diminished--if the FDA has anything to say about it.
That's right. First came restaurants being required to post the calorie content of all of their foodstuffs on their menus. Now FDA in an effort to curb the obesity epidemic has announced plans to require movie theaters, airplanes, and any eatery defined as a "chain" (with more than 20 locations) to post their nutritional information for consumers as well, says WSJ.
Yep, that includes grocery store food courts and salad bars (yes, salad bars), trains and convenience stories. Oh thank heaven 7 Eleven will finally be required to tell us how many calories and grams of fat are in a cheeseburger dog!
Ultimately, the proof will be in the bottomless popcorn bucket. That is to say, whether posting nutritional information at these locations will curb excessive caloric intake and thus reduce obesity will require outcomes research that will have to control for hundreds of confounders. But if it works, it could be a low-cost, high impact policy intervention with ripple effects that will resonate nationwide.
Cross your fingers it will work and until the policy goes into effect I will go in blissful ignorance to the movies and enjoy my movie snacks.
Summer Johnson, PhD
Caplan: America's Sick Deserve Better
Many have called it legislating from the bench. Others have called it sending us back to the stone age. But as Arthur Caplan puts it in this week's MSNBC column Judge Royce Lamberth's ruling preventing the use of federal funding for embryonic stem cell research hasn't just hobbled stem cell research--it has killed the hopes for recovery of tens of thousands if not millions of Americans.
To read more about Caplan's view of this landmark court decision, click here.
Summer Johnson, PhD
TSA Has A Good Body Image...and Is Keeping It On File.
No, I'm not talking about how one feels about oneself when they look in the mirror. I'm talking about the Transportation Security Administration (TSA) who is taking tens of thousands of full body images of travelers going through scanners at major airports. What do they do with all these choice images? That's right. They keep them.
According to CNET.com, TSA has hoarded over 35,000 of these checkpoint body scans. And let's be clear, they don't need that many for "testing, training, and evaluation purposes."
What else TSA might do with these images is entirely unclear. Privacy advocates are outraged, but clearly the real problem is the lack of transparency from TSA while American travelers are being examined down to the millimeter without ever knowing their images are being recorded, stored, or potentially used for any reason, innocuous or not. Even the despite the fact that these images are in all likelihood used anonymously, until that fact is known, TSA should not be allowed to use any image without consent.
Just like tissues collected from a medical procedure or any other similar circumstance where consumers of a large institution create by-product that can be used for teaching, research, or quality improvement, travelers have a right to have their images used or not for the benefit of improving airline safety. We give patients the right to make that similar decision to contribute to medical research, so too should travelers have such a choice.
Then and only then, with the appropriate consent and anonymity protections in place, could the storage and use of these scans be acceptable. Travelers, just like patients, have a right to know where their images are going, to whom and for what purpose.
Summer Johnson, PhD
Do We Harm Our Children By Naming Them "Pop"?
Sometimes parents can over-think things. Then sometimes parents are just crazy. Then sometimes parents name their child "Pop".
According to the University of Oxford Practical Ethics Blog, a Swedish couple has decided to keep the sex of their toddler a secret as to avoid the pressures placed upon children from having to grow up as one gender or another.
As reported in the Guardian, "We want Pop to grow up more freely and avoid being forced into a specific gender mould from the outset. It's cruel to bring a child into the world with a blue or pink stamp on their forehead." Oddly, I didn't know that we were doing that to babies these days. Maybe only in Sweden.
Personally, I think it is cruel to bring a child into the world and to force a parent's wild-eyed expectations that the world could somehow be gender-neutral upon him/her. What happens when little "Pop" (who quite frankly is going to get popped in the nose regularly in grade school for having such a ridiculous name) has a penchant for playing with dolls or Transformers over more gender-neutral blocks or sock puppets?
What happens when "Pop" wants to wear pink for 7 days in a row (as children often do)--won't "Pop's" ambiguous sex cover be blown? Or will his/her parents force "Pop" to wear only khaki for the next 18 years?
Frankly, this sounds like more of a publicity stunt to me than anything else. But it raises important questions about how we think about raising our children as well. Could we ever be truly neutral in what we expose our children to--and would we really want to be? Would we really want our children to be without gender? The position of "Pop's" parents deny something wonderful about being a little girl or a little boy.
I say let "Pop" be whoever he/she is going to be--if that is a blue clothes wearing, Hannah Montana singing boy, then so be it. Shrouding a boy or girl in gender-neutrality will only result in a child who grows up wondering--"Why were my parents hiding my gender and my male/female-ness all this time? What were they ashamed of?" Quite frankly, I'd like to ask them that myself.
Free "Pop" from her bondage and let him/her be a toddler who can be anything he/she wants to be.
Summer Johnson, PhD
Slicin' and Dicin' Doesn't Work for BDD Sufferers
As shocking as this might sound, those who suffer from body dismorphic disorder (BDD) don't feel better or improve on any indicators after having plastic surgery according to a recent study in the Annals of Plastic Surgery.
As reported in Booster Shots, 7-8% of cosmetic surgery patients have these disorders, but among these patients, only 2% found that the procedure they received actually made them feel better about how they looked. After surgery they feel just as critical about their appearance as before.
So what is the cure? Not going under the knife, say the authors of the study. But what about giving patients the right to choose whatever procedures they want? Frankly, that goes right out the window when you are talking about costly, potentially risky or disfiguring cosmetic procedures that result in no psychological and no health benefits at all.
And what if there were even some psychological benefits? I'm still not so sure. There must be better ways to improve the self-image of those who feel bad about their bodies than cutting into them.
What is clearly the case is plastic surgeons need to be better at detecting those who have BDD and steering them away from procedures that will only leave them feeling unsatisfied about themselves and to steer them toward psychological help. This is one clear case where autonomy is trumped by beneficence if there ever was one.
Summer Johnson, PhD
Jumping on the DTC Genetic Testing Bandwagon
It is as though the entire world in one week woke up and realized that direct-to-consumer genetic testing is a big deal and perhaps someone should be paying attention to it.
Just this week alone the GAO released a report saying that most results from at-home genetic tests are mostly bunk and are pretty much impossible to interpret. This was followed on by the Human Genetics Commission in the UK issuing guidelines for how these tests should be provided and to whom.
Then there was the 5-part Newsweek column written by Mary Carmichael called "DNA Dilemma" chronicling her personal decision whether or not to swab her cheek and send her own genetic material off to a DTC genetic testing company.
So what gives with all of this sudden attention to these tests? It could be coincidence, of course. Another explanation is that these tests have been around just long enough to catch the eye of both federal regulators and government agencies and the popular media at the same time.
Combine that with our own self-absorbed tendencies and desire for self-knowledge and you have the perfect combination for a wave of societal discourse about DTC genetic tests that may continue for some time to come. If society is primed to use these technologies, to read about others using them, and regulators who are just beginning to realize that there may be societal issues to deal with, then we are about to embark upon an interesting time indeed in the era of consumer genetics. And I argue that in fact we are.
Summer Johnson, PhD
A Patient Is Rescued, From Melodrama
Theresa Brown, R.N. is right to point out on Tara Parker Pope's Well Blog that most depictions of health care on television are sensationalized, over-dramatized, not particularly realistic characterizations of health care today. But in her story, A Patient is Rescued, Quietly, she goes to far in the other direction.
Brown's lament about the understaffing of the nursing profession and the lack of praise for the nurse today is also true, but her melodramatic story about how thanks to the lack of patients on her floor that day she was able to spend enough time on her critically ill patient to be able to save his life. Had her unit been full that day, she might have failed to rescue him when his blood pressure critically dropped and never even noticed.
But alas, the next day after saving his life, she returned to see him--even when she was not his nurse any longer, seeing him sitting happily in his bed, being bathed in sunlight.
Now, if some television dramas make healthcare seem overly critical and dire, Ms. Brown makes this healthcare situation seem overly simplistic, sweet and light. As anyone knows, it is just as likely that even if the unit had been over or understaffed that her patient could have taken a turn for the worse overnight and when she returned to the unit the next morning she would have found an empty bed.
That is also the reality of healthcare. What Ms. Brown fails to see is that there is a middle ground without melodrama or hype, but with simple reality. Some patients crash, some patients improve. Sometimes it's due to healthcare staffing issues and medical mistakes, sometimes it has to do with bad luck or fate.
Ms. Brown does a disservice to her profession by saying anything other than that.
Summer Johnson, PhD
Could (or Should) Bioethicists Prevent These 14 Inevitable Scientific Breakthroughs from Changing The World?
For just a little levity on a Wednesday, click on this link at Cracked.com to see their reader's picks for the 14 Inevitable Scientific Breakthroughs The World Will Regret!
Nearly all of them touch on some aspect of bioethics: nanotechnology, obesity and public health, genetics, transhumanism and more.
SPOILER ALERT: #1 is pictured below. And yes, the are all as funny as this one.
Summer Johnson, PhD
Putting Adderall in the Water--Irrestistible!
I have, from time to time, jokingly accused my neuro-enhancement colleagues about wanting to put cognition improving drugs in the water. All of them have resoundingly denied (publicly anyway) wanting to do it. Until now.
Oxford professor Julian Savulescu has advanced a claim, rooted deep public health origins, that much like fluorination of the water, society might be much improved by mass dissemination of neuro-enchancers. Well, sort of.
The argument, articulated in a 2008 paper discussed here, starts out with a simple argument about the virtues of fluorination. Then in a modified slippery slope fashion, he takes it a step further:
Irresistible maybe. But is it ethical? We may all want to have our tap water make us alert longer or test a few points higher on a standardized test, but is that what we really ought to do as a society? Obvious justice questions raise red flags--will these drugs be put into the water supply in every city in the nation (or the world) or only those who can afford them? Will this simply exacerbate the gap between those who are cognitively enhanced and those who are not in terms of social or financial achievement?
Sure fluoridation may have been one of the top 10 public health achievements of the last century, but it was solving a public health PROBLEM. Applying a public health approach to an issue of enhancement is a separate thing altogether--and one that doesn't work. The goal of public health is to improve the overall public's health, not to enhance it beyond what is typical. Moreover, creating disparities (or exacerbating existing ones) would be contrary to the moral goals of public health.
So, would it be consistent with public health to put neuro-enhancers into the water supply? It could be, if it were done in the right way with transparency and public consultation and found to improve the health of entire populations rather than only a select few within a society. In principle, enhancement technologies are not inconsistent with public health, but these technologies should be pursued only after the basic public health needs of a society are met.
Summer Johnson, PhD
A Monty Python Approach to Organ Procurement Butts Heads with CSI.
Bring out your dead! Bring out your dead! We'd like to harvest their organs now!
Most Monty Python fans associate organ harvesting with The Meaning of Life's Live Organ Transplantation, but New York City's "rapid organ recovery plan" has much more in common with this other famous Holy Grail skit than it does with anything else.
The claim made by Bellevue Hospital Center is simple enough: most people do not die in hospitals, and therefore, a way to procure cadaveric organs for transplant in settings outside the hospital is needed. Enter the (drum roll please) "organ preservation vehicle"! Yes, that's right folks, an organ harvesting team on wheels that can come directly to your recently deceased loved one and pluck those precious commodities right out.
But this isn't really the problem. Not anymore.
After painstakingly working to ensure appropriate consent and other procedures are in place, seriously, who could object? It turns out--just to name one stakeholder--law enforcement. I mean, it's great that we can increase the number of organs available for transplant and all, but some of these dead bodies are needed for crime solving.
What is an organ harvesting team to do when Gary Sinise comes knocking and says "Don't touch that body! It's evidence!" all CSI-style?
The bottom line is that the dispute needs to be worked out. If bodies feared to be part of foul play have to be looked over by the medical examiner, the small window in which organs can be harvested will likely pass and precious life-saving organs will be lost.
Of course, I question whether or not this kind of at-home, real-time harvesting is the appropriate method at all. In the case where the newly deceased is clearly an organ donor and has expressed wishes to donate, I think that the case is clear and donation is unobjectionable.
However, having the "OPV" roll up on every house with a 911 call for a massive MI or a gunshot or stabbing where a patient's wishes about donation may not be known puts the family (or whoever is present) in the awkward position of having to deal with decision-making that is likely to be sub-optimal.
Frankly though, these law enforcement issues are silly and are likely to impact very few cases except those in the precise area where the program is being piloted (which is interesting in and of itself).
Otherwise, I think the program has potential, but only for harvesting organs for those who already planned to donate organs but who happened to die at home.
Summer Johnson, PhD
Geron Gets Green Light...Are the Floodgates Opening?
With the FDA approval of the first human stem cell trial from the Geron Corporation, there can be no doubt that dozens of other human clinical trials will quickly follow on its heels for approval for hESCs to be used in human beings to treat everything from spinal cord injuries to Alzheimer's Disease to cancer.
What I doubt is the hype I read on the Huffington Post blog that "If these hESCs are safe, and perform as hoped, that injection will be the 21st century's "shot-heard-round-the-world"."
It would be a mistake and a disservice to this research, just as it has been to adult stem cell research, research with iPSCs, or any other area of research to advocate now, on the precipice of human trials, that this single study is the game changer.
If we have learned anything from the progress of previous human clinical trials in gene therapy and other areas, it is that the progress is likely to be anything but swift and anything but definitive. The results will be debated and disputed in the scientific literature.
But I too am hopeful that this first step down the path of actual stem cell therapies (not the false, misconceived use of the word perpetuated by those who want to prey on the hopes of patients without treatment options) will soon result in the gathering of data that will some day lead to cures for those conditions and diseases that are currently incurable.
But that day is likely to be a long way in the future (a few years anyway) and until then, it is best to keep hopes lofty, but interpretations of the science realistic.
Summer Johnson, PhD
