Common Ground on Abortion? Not Likely.
President Obama isn't really asking for much. Really it's quite simple: both sides of the issue, conservatives and liberals, must give up a little bit to reach a "common ground" on a perennial issue to lay this "culture war" on abortion aside. Then both sides will have achieved a little good (in their eyes) and not have given up completely on their issues.
As Dan Giloff's God and Country blog explains this week, the White House is attempting to package an all-in-one abortion bill that would satisfy both parties--and provide access to reproductive services for pregnant women and provide contraceptives and sex education. Both stated goals ideally would reduce the need for abortions, or so the argument goes.
Seems smart, seems reasonable--but it will never happen. It's a little too smart and too reasonable for the one issue that seems to elude our rationality--at least in this country. The culture wars cannot be "repackaged", tied up with a tidy bow, and then sold as a problem so easily resolved. I think anybody can see the plausibility of such a proposal in an ideal world and see the utility of a moderate abortion policy for the United States. However, ours is not such a political world--ours is one filled with advocacy groups (on both sides) hanging on to this issue, in particular, as the barometer of their social policy and the future of women's health. More than that, It is simply just one of those issues that is supercharged, laced with all the emotion a policy issue can have, and therefore, is not amenable to the kind of reasonable approach President Obama's White House is attempting to exercise on it.
While this is probably the most imaginative policy approach to abortion policy in years, I am a bit skeptical as to its success. Asking both sides to give a little to get a little is more likely to result in each side asking the other side to give a little more for them to get a little more until the bills do not resemble anything like what was started with. Ultimately, the issues may have to be uncoupled and pushed through the Democratic Congress if progress is to be made on this issue. Common ground will be lost, but progress (at least in one direction and according to one set of folks) will be made.
Summer Johnson, PhD
Caplan: Think Big on Health Care
Arthur Caplan reminded us last week not to get bogged down in the details and to "think big" on health care. To read more about what he said, click here or read the full text of his MSNBC column below.
Summer Johnson, PhD
Details, Schmetails: Think Big on Health Care
As the debate over health care reform heats up this summer, the new battle cry of those who oppose change is that overhauling the nation's health care can't work because reform is "all in the details." And the details, the critics say, don't add up.
Republican critics in the House and Senate along with the American Medical Association, the United States Chamber of Commerce and the pundits of right-wing talk radio, TV and blogs are warning daily that without the "details," health reform cannot possibly proceed.
They demand mind-numbing minutiae about such things as comparative effectiveness research and information technology programming.
A larger load of baloney masquerading as an argument could not be imagined. The success of health care reform is not in the details.
Think I'm wrong? Details killed the early '90s Clinton effort at health reform. Hillary's team had stacks and stacks of details. In fact, they produced a magnificently detailed 1,800 page plan that became the unreadable, unsellable playbook of a movement that collapsed under the weight of its own detailed dilatory prose. None of this was of any help whatsoever to the nearly 50 million Americans without health coverage.
No one except for the critics looking for some way to derail health reform gives a hoot about the details. OK, a few others care.
Details fascinate the wonks, nerds and pointy heads that our very bright president has, thankfully, surrounded himself with to help figure out how to implement reform. And when challenged by critics every impulse of the wonk posse is to get the president to pile on more details.
Details are what the media long to report and you lust not to read. Details are the droppings of inside-the-Beltway gossip intended to impress your host or your date. Details, however, are not the key to health reform.
No nation on earth has ever reformed its health care system by asking the public to wallow around in the details. Canada, Britain, France, Germany, Switzerland, Australia, New Zealand and all of the other nations boasting universal health care coverage did not assemble their finest numbers crunchers and pencil pushers and send them into the front lines of the battle to sell reform.
Do the right thing
What matters in health reform? How about doing what's right?
Specifically, what is going to determine whether health reform can be pushed through by the well-intended Obama administration is the answer to one single, fairly simple ethics question: Is health care a right that every American should have? That is what Obama needs to continue to stress. If he can sell the American people on the idea that they have a right to health care, then the details will all be worked out in time. If health care is not viewed as a right then the details are the boggy swamp where reform goes to die.
Not so long ago I gave a speech to a group of about 75 influential hospital executives. Before starting my talk I asked how many of them thought health care was a right. About seven or eight did. I knew there and then that the fight to reform our broken, costly health care mess of a system would be all uphill.
In some societies, health care is seen as a right because it has been earned. The British National Health Service was created in response to the British public having endured the Nazi blitz for many awful years.
Some societies see health care as a right because a healthy work force means a stronger economy. That was the basis for health care reform in Germany and Singapore. And, in some nations, health care is seen as a right because of the ethical belief that a community should look after its own. Switzerland, Canada, Australia, France and New Zealand have grounded their right to health care in this idea of social solidarity.
Equal opportunity
The American public isn't likely to bite on any of these propositions. But there is another argument that speaks directly to a notion we Americans embrace -- equal opportunity.
We believe all Americans have a right to a basic education for this very reason. And isn't your health as essential to thriving in the free market this country so loves as your schooling?
Imagine if our nation had set out to establish public education with this same detail-bogged mindset instead of a commitment to attempting to level the playing field for all children.
Well, that playing field turns into a steep cliff when a child's medical needs aren't guaranteed.
Forget the details, Mr. President. Do not get bogged down talking about them. Leave them to Congressional staffers, the Office of Management and Budget, academics and lobbyists. In other words, the wonks, nerds and pointy heads.
You need to keep your eye on the prize -- creating a health care system that fulfills every American's right to decent care. If you constantly remind the public that health care is a right and the most basic underpinning of equal opportunity, Americans will demand that the details simply get worked out.
Follow-up on The Wild West of Nanotechnology
Today, The Scientist has revealed more about the scandal involving nanoscientist Chiming Wei which was first written about here on bioethics.net.
This scandal has brought into question what counts as "expertise" in nanomedicine, The Scientist claims, and one source was quoted as saying that it may have even damaged the reputation of the field.
My take: generally scientists trust that their credentials are accurate--the letters after their name, their CVs, their stated goals and activities. But some take advantage of that trust and in a field absent sufficient regulation and oversight, that may be even easier to do. The rules should not, however, be based on the Dr. Wei's of the world, but we should remember that absent sufficient regulation and oversight research and academic ethics violations can and will occur.
Summer Johnson, PhD
My Mommy Is My Daddy Is My Mommy
Stem cell research has the potential to change the standard gendered parental relationships by making it possible for women to produce sperm and eggs from stem cells say British researchers in the Globe and Mail.
Better yet, a new Canadian "mockumentary" called The Baby Formula brings to the public's attention the fact that some day in the future human reproduction may be markedly different than it is today.
So what's the big deal? So we will be able to produce sperm from women's bone marrow or other stem cell sources and reproduction will no longer require men. Lesbian couples will no longer rely upon sperm donors to have children who at best could only be 50 percent biologically theirs.
Really, the social hurdles shouldn't be the ones that are hardest to overcome, but rather the research ethics challenges. To know whether or not these new "sperm" are viable, embryos made with female only DNA will have to be created and implanted into women and brought to term. There are serious risks with performing this research, and inherently, the women signing up to do this research will be those most desperate to have a child. Thus, the most critical concerns will be: will these women care about informed consent or just having a child?
The ethics concerns here are numerous, but the social ones should not be. Giving same-sex couples a chance to have biologically related children is an important opportunity that ought not be missed--overcoming the ethics concerns is really the only issue that SHOULD have been addressed in such a movie, even a "mockumentary."
Summer Johnson, PhD
Be Careful What You Wish For
In collaboration with Nanotech-Now.com and Lifeboat Foundation, Ti
hamer Toth-Fejel comments as this month's guest columnist about the prospect of a much less ominous future for nanotechnology that most. Yet, as the title suggests, it still presents some issues for society that heretofore we may not have tackled or even thought to consider (or worry about).
People have been worried about nanotechnology for quite some time now; nano-asbestos, advanced nano-enabled weapons, and self-replicating "gray goo" nanobots that accidentally go out of control. But what if everything goes right? What if nanotubes and nanoparticles are functionalized to stay out of the ecosystem? What if there are no major wars? What if nanoreplicators are never built, or if they are, they use modern error correction software to never mutate? What happens if nanotechnology fulfills humanity's desires perfectly?
In the next decade or so, a new type of desktop appliance will be developed--a nanofactory that consists of very many productive nanosystems--atomically precise nanoscale machines that work together to build bulk amounts of atomically precise products.
The Foresight Technology Roadmap for Productive Nanosystems has identified a number of different approaches for building these atomically precise systems of machines that can produce other nanosystems. These approaches include Paul Rothemund's DNA Origami, Christopher Schafmeister's Bis-proteins, Joe Lynden's Patterned Atomic Layer Epitaxy, and Robert Freitas and Ralph Merkle's Diamondoid Mechanosynthesis . Each of these approaches has the potential of building the numerous nanoscale electronic, mechanical, and structural components that comprise productive nanosystems.
The ultimate result will be a nanofactory that can build virtually anything--limited only by the laws of physics, the properties of the input feedstock, and the software that controls the device.
The concern is that this relatively primitive application--if successfully deployed as expected--will pose significant challenges, even if nobody accidentally makes a mistake or puts it to evil ends. Consider the simple, safe, and optimistic possibilities made possible by a nanofactory that can build a wide variety of atomically precise, large-scale products out of a few different input elements (say carbon, hydrogen, oxygen, iron, silicon, germanium, boron, phosphorus, and titanium) . The factory itself would not not nano-sized; it would be an appliance that is approximately the same size as a desktop printer. However, its multi-material 3D output products would be atomically precise at the nanoscale.
The first and most valuable product of a nanofactory will be another nanofactory. The second most valuable product will be a system that refills the nanofactory's "inkjet cartridge" using inexpensive feedstock, and the third will be a machine that turns sand into photovoltaic solar cells (with which to power the nanofactory). It is not clear what would one would print next. Programmable material for a holodeck? Wearable supercomputers? A few pounds of medical nanobots?
In any case, a few months to a few years after the first commercial release of a nanofactory, almost everyone will have one. It is not clear what the price might be--perhaps $1000. The price could not drop to zero, though it might approach the cost of dirt, sunshine, and the time required to print a nanofactory.
Diamond and it's carbon-based relatives are an engineer's best friend; being 50 times stronger than steel, only their atomic structure differentiates it from coal. Once people have a printer that can inexpensively make arbitrary, atomically perfect diamondoid nanostructures out of carbon, they are going to make everything out of it--from wearable supercomputers and skyscrapers that reach Low Earth Orbit to medical nanobots and flying cars--anything that doesn't violate the laws of physics and has a CAD file description available on the web. Therefore, any cheap sources of carbon will be snatched up quickly.
Because human desire is essentially infinite, the demand for carbon will reach very high levels fairly quickly.
Air is free, and so is the carbon dioxide in it.
If taking carbon dioxide out of the air became economically favorable (and with inexpensive solar power it probably will be), then the result will be a 'tragedy of the commons'. This would solve CO2-caused global warming with a vengeance, but would result in global freezing--and worse. If enough carbon dioxide in the air was removed, plant life would start to die.
Futurist Keith Henson has predicted that to counteract this outcome, the Sierra Club will frantically strip-mine all the coal under Wyoming and burn it as dirty a manner possible to save the rain forests. If Henson is correct, then Congress might pass laws that make it illegal to take CO2 from the air. But how will the government enforce a ban against unauthorized CO2 extraction?
Nanotechnology, of course.
Unfortunately, a government with unfettered nanotechnology-enhanced enforcement powers would likely be a dictatorship that makes the totalitarian regime of Orwell's 1984 look like a kindergarten playground.
An alternative to a dictatorship would involve ownership of air. This sounds strange and preposterous until we remember that the American Indians thought that land ownership was strange and preposterous.
A more jarring alternative might involve the re-engineering of plants so that they can live without carbon dioxide, perhaps by using silica as a structure material (as diatoms do). Do we really trust ourselves to recreate Earth's biosphere in such a drastic manner? Some optimists will tell us not to worry about such drastic genetic modification on the ecosystem; we will back up the whole thing on the web somewhere, and use modern software revision-tracking software to keep it safe.
Admittedly, these scenarios seem rather far-fetched. However, as Foresight Institute co-founder Christine Peterson put it, "If you look out into the long-term future and what you see looks like science fiction, it might be wrong. But if it doesn't look like science fiction, it's definitely wrong" .
We are not yet at the level of technological maturity at which we can confidently assert that widescale nanofactory development and distribution is inevitable. Of the four main approaches to Productive Nanosystems, only the most rudimentary lab demos have proven the concepts. Therefore, the suggestion that nanofactories will alter the conditions of anthropogenic global warming may be met with skepticism -- as it should. However, in light of the exponential progress in nanotechnology in the past few years, it is likely that some version of the carbon dioxide tragedy of the commons will happen in some form or another. Researchers, policy makers, and the public at large must become aware of these possibilities, and thoughtfully analyze them. Otherwise disruptive events may cause panic, as most scenarios predict a quick transition from initial invention to wide distribution of these technologies.
Ultimately, this prediction means two things. First, that wasting precious time, money, and effort on stopping global warming will increase the risk of other, more serious catastrophes. Second, we will need to set aside any conservative values regarding the preservation of the Earth's ecosystem as it currently exists. Change will happen. The good news is that a Space Pier and other low-cost methods to orbit will be available for conservatives who are intent on preserving the status quo biosphere elsewhere in the solar system. Of course, these are the same people who are probably the most emotionally resistant to leaving, which might lead to conflicts.
Howard Bloom gently points out that "Nature is not a motherly protector". Putting it more bluntly and extending the anthropomorphism, Mother Nature is a brutal psychopath who uncaringly tortures and slaughters her children. She does not build nice little eco-friendly Gardens of Eden. In fact, there have been 148 major die-offs, and six much bigger mass extinctions (in which over 90% of species on this planet were wiped out--each and every time). Those die-offs resulted from natural physical disturbances in a universe that is fine-tuned to allow carbon-based life to emerge. It's a mixed message, but the message is simple: Adapt or die. Nanotechnology will not change that message. However, it will provide us with better biotech tools that will enable us to (for better or worse) manipulate our bodies and brains.
As the nanotechnology revolution begins, we will need to think hard about its secondary effects and ethical implications. The sheer magnitude of changes will cause us to consider carefully our ultimate role in the universe, our essential nature as human persons, the meaning of our lives, and what we really, really desire.
Tihamer Toth-Fejel, PhD
General Dynamics Advanced Information Systems
Michigan Research and Development Center
Your Out! Auf Wiedersehen to the Doctor's White Coat
They never were fashion-forward, but the AMA had a much better reason to vote out the traditional doctor's white coat this week. The long sleeves have been proven to spread infection when brushing across sick patients for hours at a time.
The key: getting hospitals and notoriously stubborn doctors stuck in their routines and the imagined power of the white coat to get over themselves and slough off the old rag in favor of other less infectious garb.
That was, in fact, the entire point. The resolution was not just to do away with the iconic coat, but also to get rid of "long sleeves and ties for medical staff coming into contact with patients", as the WSJ Health Blog said today. Germ-spreading doctor-wear be gone.
The likelihood of this is pretty slim, but doctors in Scotland have already taken the plunge, so why not here in the States? It does open up a whole new world for fashion designers to create good looking, non-infectious clothing for the hospital. I'm envisioning Project Runway: Hospital coming soon to television screens near you.
Summer Johnson, PhD
Stuart Laidlaw is Going to Get Me [a] Shot from Merck
I couldn't be more pleased that [insert gratuitous but sincere praise:] outstanding Toronto Star writer Stuart Laidlaw has been rigorously following the Merck/Elsevier scandal. It's practically flattering that he's listening to bioethics' and in particular bioethics' publishing voices, and he's quoted The American Journal of Bioethics Editor's Blog [that'd be the fancy-pants name for blog.bioethics.net] on his own Toronto Star Medical Ethics blog. However...the old adage that "the enemy of my enemy is my friend" may not apply to taking on the admittedly incredible ethical missteps by Merck ... and its publishing mules, comprising a whole fleet of bogus journals made to fool academics and clinicians.
You'd think that Merck would have learned from Vioxx and their New England Journal mistake (oops, forgot to send that data...) where publishing is concerned. You'd think ANY publishing company would learn that presenting the appearance of peer review for sale, then refusing to be transparent about just how much it COSTS to buy a peer reviewed journal. But you'd be wrong.
The thing is ... Stuart ... these guys are not, well, did you see the movie The Insider? [note to pharma lawyers and publishers of all kinds: I live on a small island in the Pacific...really...]
Summer Johnson, PhD
Cultural Sex Selection: No Harm, No Foul?
Emily Willingham asks an important question as to whether the apparent cultural preference toward having a male child in the family among Asian-Americans represents a harm--either to Asian-American girls, or simply to women generally. I'm inclined to think the latter. But we'll let you decide:
A New York Times story reports that data on birth rates among Asian Americans hint at a bias for boys. According to the report, some Asian-American families appear to be particularly prone to selection for a boy child if they had a girl the first time around. With each successive girl, the odds that the next child will be a boy increase. Of course, the odds should be 50:50 for each birth, but by the third child, if the first two were girls, the ratio of boys to girls among Asian Americans climbs to 1.51:1, in favor of boys. The article states that this outcome results from families having opted for sex selection, either through abortion or in vitro fertilization, to ensure that they'd have a boy.
For families that opt for those interventions, all I have to ask is, "What, exactly, is wrong with having girls?" The feminist in me cries out, "Girls are just as good as boys!" And we are. End of story.
A doctor quoted in the article recognizes the cultural associations of these choices among the Asian-American population, and one expert predicts that with assimilation, the ratio will subside to the near 1:1 that Nature, in her infinite wisdom, intended. China is already having to grapple with its 120 males for every 100 females as a result of such selection. But the doctor, Jeffrey Steinberg, who is the medical director of a fertility clinic that performs sex selection procedures, also is quoted in the NYT piece as saying, "Whether we agree with it, it's not harming anyone."
I beg to differ. As a former girl and current woman, I'd say that countenancing these choices with an excuse like that perpetuates biological sexism. It relegates girls to second-class citizens and second-class biological entities even before conception. It's one thing to fight for equality as a full-grown, existing woman. It's another thing to have to view the battle as beginning pre-conception or in utero against an elusive foe of culturalism or casual acceptance of sexism, especially when we must also struggle against the unsupported assumption that artificial sexual selection does no harm. Ask China if it does harm. Ask a girl if she finds these attitudes harmful. It does do harm, harm to what should be about half of the population, if Nature were allowed to have her way.
Botched Prenatal Test = Botched Knee Surgery? I Don't Think So.
But if you as Susan Wolf, professor at the University of Minnesota, she would tell you that suing for one screwed up procedure is no different than suing for another. Except for one small detail: when you screw up a prenatal test, the outcome can be that you have a child with anything from a mild to incredibly severe disability.
Then the question remains: what is a parent to do? Whom do they hold accountable for the medical care, the unanticipated struggles and tough choices that lie ahead in their own lives and the life of their child--and what, if in the case of one particular Oregonian couple, they wouldn't have had the child in the first place had the test not been botched?
Although such "wrongful life" cases are rare, they do happen--and they are very difficult, intellectually and emotionally to tackle. They are not as simple as equating an incorrectly performed genetic test with other kinds of medical tests because the outcome is a human life that cannot be taken back, ameliorated with secondary procedures (like with a bad knee surgery), or a "do-over" as with other kinds of tests. A child is born and someone--whether the parents or the state--must care for him or her, as in the case of the 2 year old daughter of Deborah and Ariel Levy, who was born with Down's Syndrome after a botched genetic test.
So, in our litigious society, these parents have chosen to do what seems probably like the only real option--to seek damages from medical center that performed the testing to the tune of $14 million dollars to "cover the costs of raising her and providing education, medical care, and speech and physical therapy for their daughter". The lawsuit seeks additional monies to cover her life-long care needs as well as for both parents' depression and emotional stress.
The parents, if they are awarded this money, hopefully will be able to provide the very best life possible to a child that they would have never had--had they been given the correct test result. Whether or not one agrees with that moral choice, it is their choice to make and they were denied it by a medical mistake.
At the very minimum, this is the least society can do to help these parents adjust to a life that they otherwise would not have chosen and to ensure that over the life course of their child she has the care she needs. Of course, the Levys will adjust and cope and like most parents who have children with disabilities, their daughter's life will offer joys and experiences that they could have never imagined.
But undoubtedly, they have been forced into a situation by a medical mistake that never should have happened that is life altering and that does in fact cost millions of dollars for medical care and therapy. Is their daughter's life a "wrongful life"? In the initial shock of her birth and the aftermath, it may feel like it to them and it may not have been what they would have chosen for their lives as parents. However, absent that choice and given that they have two older children to raise, they must do the best they can. Demanding reparation for a 99% accurate test doesn't seem all that unreasonable when the results of being wrong last a lifetime for parent and child.
Summer Johnson, PhD
BioEdge and Charo's "Conspiracy of Hype"
One can hardly be surprised to find that Michael Cook's BioEdge blog would jump at the chance to take Alta Charo's remarks about the "hyping" of stem cell research as an all-too-easy chance to suggest that embryonic stem cell research generally has been oversold. To make the implication that a "conspiracy of hype" has surrounded embryonic stem cell research from one of the strongest political and ethical proponents of embryonic stem cell research is something that advocates of adult stem cell research dream about. Too bad, they really didn't listen to what Charo said.
While Cook quotes Charo's comments made at the Milken Institute Global Conference in late April, taken on face value, her comments are really nothing more than an honest appraisal of a field of research mixed with politics that over the last 8 years that has done its best to survive in a world with limited public funding, fierce political in-fighting, and ambitious scientific researchers.
If one goes back to the original source from which the conference's proceedings were originally discussed and posted, the Faster Cures blog, a much more even-handed assessment of the entire conference is presented, as well as the context in which Charo made her comments.
There is nothing to suggest, as BioEdge would lead us to believe, that the take-home message from Charo's discussion was the "conspiratorial" nature of the state of stem cell research or even its media coverage, or its advocacy groups. Rather, awareness about these various factors at play in the on-going political, social, and scientific progress being made in stem cell research is essential.
Without such awareness, we would be duped into thinking that new, huge scientific advances were being made in stem cell research daily, that stem cell cures were around the corner, that we should all fly off to China to be cured of whatever ails us, etc...
Creating such awareness about what is real and what is not, in fact, one of the roles of a bioethicist. Charo was doing precisely that--not suggesting that embryonic research is propped up by a "conspiracy of hype." If anyone is being conspiratorial, it's those who oppose embryonic stem cell research and who are looking for any gap in consistency in argument or logic among their opponents and to use their words against them. In this case, those like Michael Cook have again failed to do so.
Summer Johnson, PhD
