Bigger than Stem Cells

Chris Mooney points out that even California's biggest paper sees the key science story of the past year as the politicization of science. "...Bigger than stem cells, the tsunami, the X-prize, hobbit-sized humans, and so forth."

Physician-Assisted Suicide: Is Vermont Next?

The State Legislature of Vermont may reconsider the issue of physician-assisted suicide in the upcoming session, the Brattleboro Reformer reports. A "Death with Dignity" bill, which would have allowed doctors to help terminally ill patients die, was introduced in the last session. Sponsored by a variety of representatives from all political parties, the bill never made it out of committee. Supporters of the bill have pledged to reintroduce the bill this month and continue seeking support for it. Dr. Robert Orr, president of the Vermont Alliance for Ethical Health Care and bioethicist at Fletcher Allen Health Care in Burlington, Vermont, testified against the bill in front of the legislative committee last fall: "It's not needed...We can do an adequate job of taking care of people at the end of life." The debate promises to continue and cross party lines. Currently, Oregon is the only state that has legalized physician-assisted suicide for terminally ill patients. -- Linda Glenn

They Learned it from Justice Thomas

The U.S. House of Representatives (note to foreign readers: this is where the really conservative Americans go to learn to run the government) has taken the smart path out of its past few years of ethics scandals, which, after all, only involved marginal political figures like Majority Leader Tom DeLay. Nothing drastic planned, just a simple reform intended to prevent America from hearing over and over again about corruption in the House. Ethics classes? No. Try "new rules."

The proposal being circulated among House Republicans would end a general rule against any behavior that might bring "discredit" on the chamber, according to House Republican and Democratic leadership aides. House members would be held to a narrower standard of behavior in keeping with the law, the House's rules and its ethics guidelines.

Don't ask. Don't tell.

Much Greater Scrutiny of Judicial Nominees' Ethics Positions

Pittsburgh Trib-Review writes that candidates in Pennsylvania in particular and in 38 other states to some degree there will be much greater scrutiny of the ethical positions that they hold, now that the Supreme Court has stricken a Minnesota rule that barred judicial candidates from expressing opinions on issues. Opines Duquesne law professor Joseph Sabino Mistick:

"It's a different ballgame now. You can no longer hide behind the ethical requirements that judges and judicial candidates not comment. Prior to this, voters were expected to base their decisions on a sense of a candidate's character," he said. "Now they are able to find out how the candidates actually stand, keeping in mind that once sworn in as a judge, it's still your duty to uphold the law as it exists."

The Ethics of Bioethics

The American Society for Bioethics and the Humanities, and Albany Medical College, of Union University, and Union's Graduate College and Union College are jointly sponsoring this conference that deals with the issue that comes up over and over in this blog: What is the difference between ethical and unethical bioethics? Are bioethicists (whatever that means) supposed to be ethical people, and if so what does that mean? For example, bioethicists support their work with funds from all sorts of sources: universities built with tobacco money, federal grant money and foundation money that is heavily laden with government philosophy, and, yes, from companies, including pharmaceutical companies.

If you believe some critics of bioethics, most notably Carl Elliott of Minnesota, being remotely close to at least one of these sources, big pharma, is an unforgivable sin. If you believe the most aggressive defenders of working with and for companies, it is thickheaded to turn down corporate research in bioethics out of repugnance while you seek a tenured guarantee of a salary (from a health system) funded largely by corporations. And then there is the matter of bioethicists and politics: Howard Dean has a bioethicist, and some (including me) say that the President's Council was used as a political tool in the last election. Bioethicists campaigned for Proposition 71.

Bioethicists have been sniping, arguing, and posturing about these issues, and there has been some real struggle to figure them out.

Finally there will be a big pow-wow - a major conference about bioethics' "big sins," including the worst mistakes made by bioethicists and some of the strategic errors made by bioethics centers. But the big goal for this meeting isn't to identify those mistakes, but to avoid new ones - it is maybe the most important issue in bioethics' recent history. The conference will attract a whole lot of scrutiny by the media and by bioethics' critics - will be setting standards for ethical conduct by bioethicists. There will be fireworks and there will be good intentions, and with any luck there will be progress. Save the dates: April 7-9. If you want to speak, there is an [PDF] invitation to you to make a 250 word proposal. Hope to see you in the NY capital in the spring! - gm (soon to be of AMC myself)

Prescription: Take Some of This, and Die

In an LA Times piece entitled 'Doctor, Reread Your Oath', Arthur Zitrin of NYU describes the situation in Kentucky, where Governor Ernest Fletcher signed a death warrant for a likely insane convicted murderer named Thomas Clyde Bowling. He writes:

Fletcher, by signing the death warrant, violated not only the AMA code but Kentucky law as well (KRS 431.220), which echoes the code: No physician shall be involved in the conduct of an execution except to certify cause of death provided that the condemned is declared dead by another person.

In March 1994, the American College of Physicians, the AMA, the American Nursing Assn. and the American Public Health Assn. issued a joint statement calling for state licensure and discipline boards to treat participation in executions as grounds for disciplinary proceedings. The organizations wrote that participation in state executions contradicted the fundamental role of the healthcare professional as a healer and comforter.

The state - and the Governor of Kentucky's own lawyers - argue that the Governor is not acting as a physician, and thus does not have the obligation to comply with his profession's mandates in that capacity. Writes Zitrin: "If Fletcher wanted to forgo that obligation, he should have surrendered his license when he was elected."

Tommy Thompson's Parting Words

Chris Mooney blogs Thompson's last comments on stem cell research before he is to depart his Bush administration role. MSNBC/Newsweek covered the final conference by Thompson.

Pennsylvania on State Stem Cell Money

"Us too." But perhaps money isn't enough in Pennsylvania, where destruction of an embryo seems to be a class 3 felony. Efforts to change that law (in my [Glenn's] state-based bioethics class at Penn, in cooperation with Pennsylvania State Senator Alison Schwartz) fell flat on their face; she was even threatened with retribution.

An AIDS Vaccine that Works??

Nature Medicine reports that a French research trial fuels hope for prevention and mollification of the effects of HIV infection. Even as preliminary data, this is promises to be the biggest news in the history of HIV & AIDS research and will be cause for much discussion about next steps. The sample size is very very small and it is very important that the results not be blown out of proportion, which no doubt they will - although at the time of this posting lots of American papers are clueless about this finding. But let's just say that the research pans out ... what happens then? Let your mind wander back to the early science and policy wars over the way in which AIDS research is prioritized, and then consider a political world in which gay marriage might have been the defining issue in an election that brought to power a president who "owes" fundamentalist protestants and despises the UN...

Choice? What Choice?

Arlen Specter is up for Chair of the Senate Judiciary Committee, which is one place many in Washington (and lots of other places) expect W to spend some of his "political capital" on limiting or even reversing Roe v. Wade. Specter is on record as being pro-choice. So, already the key Republican in favor of embryonic stem cell research, he decided he'd be clear with the media about his view of Roe. You can just guess what the conservative protestants thought about that idea - they decided maybe the Senator would not be the best guy to run the nomination process for new judges. National Review suddenly called him 'our own worst enemy', and LifeSite said he 'Borked himself'. Conservative Voice said he would be a disaster in the role. And these are just stories from the past three days. But remember, Specter is a prosecutor by training and long experienced. So he adroitly responded to Karl Rove's phone calls by talking to Judy Woodruff on Monday and let Bush and us know that:

I led the fight to confirm Justice Thomas and I almost lost my seat as a result of it in the United States Senate. And every one of President Bush's nominees I have supported in the committee and on the floor.

The fate of Roe is at maybe its most delicate point since the Casey decision that came out of Specter's home state. Here's hoping the Senator fights for choice half as hard as he will have to fight to get this job.

Bush Science Advisor & the Second Term Critics

Newhouse News Service somehow got John Marburger, the president's science advisor, to comment on the specific allegations of critics of Bush's first (and likely second) term science priorities and alleged allegiances. But his answer is nothing surprising.

William F. May on George W. Bush

William May, recently retired from Southern Methodist University, will speak on the Bush administration's likely position on stem cell research going forward. May, who was not reappointed to the President's Council on Bioethics, is now in residence at UVA.

w-2: Searching for Good News in a Bush Victory

It is difficult to overstate the damage that George Bush can do to the nation's health care and biomedical science in his second term. Long after the shock of a Bush victory - yes, he did win this time - has faded in the minds of Americans, the world will have to cope with this election. What are the implications for medicine and science? Hint: you won't like any of them ... this term, Bush is empowered, under pressure from conservative protestants, and a lame duck to boot.

Kiss pharmaceutical reform goodbye. There is no way George Bush will do any less for pharmaceutical companies than he has done for oil companies. In fact, if anything, the election will draw a more direct analogy between oil and drugs: Bush now has no reason to fear reprisals from those who oppose the drug industry's extraordinary pricing structure in the United States. Bush's cronies may not yet directly profit from the drug industry in the way that they do from Haliburton, but you can bet plenty of Bush appointees are thinking seriously about their future in biomedical lobbying. Pharma will need the President as its collusion with FDA officians and others comes to the fore. Pharma knew what it was buying with Bush, "make no mistake." Any reform effort that included drugs from Canada, including the one Bush said he was "looking at," and any effort to seriously curtail the price of drugs for seniors, will fall prey to the three million vote margin of victory. Drugs will cost more and fewer people will be able to afford them.

International efforts to, well, do anything that Bush opposes are in real trouble. Unfettered international drug research is part of the bargain. Advocates for research subjects have lobbied the WHO and the UN - and those organizations have lobbied the US - to stop the most lopsided and colonialist drug industry research efforts in developing nations. How many research programs in Africa have really rewarded research subjects with any kind of improvement in healthcare quality, even for the disease being researched? Not many.

Healthcare access and insurance reform? Look, no one wants to be pessimistic. Health insurance reform is long-overdue and we in the U.S. have to find a way to provide affordable healthcare to tens of millions of U.S. uninsured. Here's a great Bush solution that lots of Americans seem to support: tort reform! All we have to do is stop those big lawsuits against physicians, and we can save a whole lot of ... wait ... what? Only 3% of the cost of healthcare is in any way related to lawsuits? Ok, wait, so maybe stopping patients from recovering the damages juries want to award them in cases of malpractice won't have much financial effect ... except on physician and lawyer salaries. But Republican voters aren't weeping about that. What they will cry about is the bills that they, and all of us, will have to pay as we watch emergency rooms continue to be the provider of healthcare for the poor, the sick and the legions of uninsured - hundreds of millions of dollars in unnecessary treatment. Those costs have to come out of somewhere. Just watch your premiums skyrocket, guys. Red states will also bleed red ... ink. Maybe there will be a direct correlation between insurance increases and prices at the gas pump! Who knew anything but college tuition could go up so fast?<[> Enough has been written about Bush's war on science to establish beyond question in the mind of anyone in a blue state that Bush, as a final-term president with uniform control of the U.S. government, will be able to quietly support all sorts of insidious efforts around the nation. Just as gay marriage is quietly being outlawed around the nation, look for Bush to lend support of several kinds to state efforts to roll back protection of women's reproductive healthcare. Bush could care less about evolution, but the "intelligent design" movement can rest easy that Oklahoma's new senator and many other new elected officials around the nation are supporters of creationism in the classroom.

There is still one winable battle, although I fear it is not in Ohio or Iowa. The battle is to reform or reject the President's Council on Bioethics. Leon Kass is no doubt gearing up to lead all the President's ethicists for another term of 'moral seriousness'. He must be put on notice that bioethics cannot afford four more years of feckless, xenophobic neocon posturing, even if it is delivered with austerity. Kass should have apologized to the nation for selling the proceedings of his Council through a for-profit, conservative commercial press. He should not have abused the reputation of one of the world's most prestigious biomedical scientists, Elizabeth Blackburn, named by Bush to the PCB and then shown the door under the pretense that she did not attend enough meetings. Blackburn was by all accounts one of the most active participants in the dialog about stem cell research, emailing Kass and others constantly. Kass could not find another way to defend the PCB against the charge that it sat idly by while the Bush administration (or he) fired one of two moderate scholars, and "retired" the other one, replacing both with ultraconservatives. So Kass resorted to distortion and blame in broad public view. To this day he has neither apologized nor attempted any kind of rapprochement with Blackburn or for that matter with anyone more moderate than William Kristol.

The new generation of conservative bioethicists seems dedicated to the proposition that debate is the enemy, or more accurately that opponents are best left ignored. The PCB virtually ignores the bioethics literature in its writing and anthologies. There are passing references to those who agree with them on matters at hand, most noticeably Carl Elliott, but it has become a hallmark of Bush Bioethics that no position is argued by the PCB while there are people 'in the room' with whom one must argue, unless absolutely necessary. This Council must go, or at least be made to play a peripheral role in the bioethics scene, unless it is radically remade with voices from both sides of the aisle. Supposedly even Wesley Smith agrees that there should be such voices. Now it is time for the American Enterprise Institute's Hertog Fellow Leon Kass to act with courage so that we really can have a "richer" bioethics.

It is a pretty terrible day for those of us in bioethics who supported the right to choose, hES research, and dozens of other areas I have not taken the space to discuss. But the real tragedy would be if bioethics did not take from this mess the lesson that not all battles must be fought nationally. State-by-state we will see the new changes made in bioethics-relevant law. California's Proposition 71 is just the beginning of some very important new shifts that deserve some real pragmatic consideration. Bioethics may not be as prestigious when it is fought out in the states, but that is where the battles now lie, at least for four more years. - Glenn McGee (UPDATED 11/3;11/20 )

Proposed Protest at ASBH Against Kass

From MCW Today a Proposal to Protest Leon Kass, which comes right on the heels of an international media conversation about how the President is misusing bioethics, an argument made in nature. The protest idea is from Rosamond Rhodes:

Dear ALL,

When ASBH first announced the inclusion of Leon Kass and Francis Fukuyama on the meeting program, I privately voiced my objections. Nevertheless, their spot on the program remained and the ASBH website promotes it as "A notable two-hour Keynote session."

I had considered boycotting the session. I have decided that an invisible protest might allow me the illusion of clean hands, but as a bioethicist I have a moral responsibility to do more.

Professional meetings are usually inappropriate venues fr political action. Yet, the inclusion of the Chairman of the President's Council on Bioethics, on the ASBH program Thursday, 1:15-3:15, is political. I shall be protesting Kass & Fukuyama's positions, actions, and inclusion on the program with silence (NO APPLAUSE). Protest signs (my favorite so far is "SAVE LIVES, CLONE STEM CELLS.") or leaving in the middle of the speech are other possibilities. I invite you to share your ideas in this forum as well.

Yours, Rosamond Rhodes

Rhodes' is accessible by email at Rosamond.Rhodes@mssm.edu. Alex Capron and others have argued that a protest would be inappropriate or unseemly. McGee has replied that a protest is right on target and on time.

Chris C Mooney - Kerry Speech

Chris C Mooney is always on top of everything. He blogs the Kerry speech, which included an introduction by Reeve's widow.

National Review on Kerry on Abortion

Dr. Kathleen Raviele, a Georgia obstetrician, on Abortion & Election 2004 on National Review Online.

Updated: Leon Kass on Playing Politics?

Playing Politics With the Sick is the title of Leon Kass' editorial concerning politics and stem cells. Given the title of his Op Ed, it is particularly interesting that he does not distance himself or recuse himself from his official political role or from the opinions of other members of the Presidential Bioethics Council. In fact his affiliation in the piece is listed as chairman of the President's Council of Bioethics. Kass is speaking at ASBH this month; it will be interesting to see if that is raised. Is it a problem?? UPDATE: Chris Mooney argues that Kass' use of science in the editorial is ironic and incredibly misleading.

Blogging the "Healthcare & Science" Aspects of the Debate

You know blogs have come a long way when the best debate coverage concerning healthcare - hands down - is on the blogs. The partisan stuff includes The Official Kerry-Edwards Blog and The Official Campaign Blog of Bush/Cheney. But virtually every analyst has a blog - most have a special blog for the debate! The most popular blogs are also the most anachronistic - yet they demonstrate why they are popular in that they all have much more polling and other information than CNN or MSNBC websites. See the DailyKos and of course, at your own risk, Wonkette.

MSNBC - Stem-cell research a pawn in election politics

Art Caplan's MSNBC.com editorial on stem cell research is easily the clearest defense of hES research during the election cycle, and has already caused a huge stir among Bush supporters and campaign staff.

Blogs and Politics - The Paper of Record

NYTimes Magazine has at long last staked out a position on the increasing importance of blogs. This is an interesting piece particularly in terms of the potential role of blogging in biopolitics.