Wednesday, August 31, 2005

The Answer to Welfare is Marriage???

National Public Radio is running a series this week on Marriage Education. The first part of the series examines a federally-backed marriage education curriculum required of some women on welfare in Oklahoma. This twelve hour course is funded by a 1.5 billion dollar initiative to promote marriage. That 1.5 billion is carved out of the Temporary Assistance to Needy Families Program. The rationale is that a healthy marriage stabilizes emotional and economic life. That can also be translated as marriages reduce the welfare load. The stated goals of the Oklahoma program include “reversing generations of divorce” and “creating productive relationships that end in marriage.” Topics include selecting a mate and developing communication skills.

Few people can argue that teaching communication skills or supporting marriages are bad things. But like anything, the real test is how we put the plan into action. What is interesting about this program is that the women in it are not married, there are only women in the class and the class is required as part of their welfare eligibility. These facts raise a number of questions ranging from how effective marriage education can be without both partners or indeed for single people, and whether there any men out there who have to take the course. The more interesting philosophical question is why link marriage and welfare reform at all? Are we trying to solve one set of social problems just to create another? And my favorite question – do homosexuals get to opt out?

Who gets to create knowledge?

Thanks to Karama Neal for this lead: a good NPR story on women in science.

Should be of interest to anyone who was incensed by Lawrence Summers' remarks about women just not having the smarts for science.

Tuesday, August 30, 2005

Cognitive liberty and the Supreme Court

The article by Jeff Rosen in the New York Times about Roberts expresses concerns about the future of privacy rights in front of the United States Supreme Court, and rightfully so. As I have written in one of the recent American Journal of Bioethics issues, in this current atmosophere of a "war on terrorism" (oops - it's now a "war on extremism"?) it is easy to see why the current administration would endorse the use of new neurotechnologies as a useful too in weeding out terrorists -- however,
what concerns me is the seeming lack of concern by the public in safeguarding our liberties . As the The Center for Cognitive Liberty & Ethics notes, "the right to freedom of thought is situated at the core of what it means to be a free person....The civil rights battles of today and tomorrow must now focus on protecting the fundamental right to brain privacy, autonomy, and choice (i.e., 'cognitive liberty')."

Benjamin Franklin said in 1759 that “They that can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety." And as history has shown, people who give up their liberties in exchange for security end up with neither. And as history has shown, we need to be vigilant about protections of our liberties -- and this means asking nominee Roberts the tough questions about what future technologies may mean in terms of our precious rights and liberties.

Sunday, August 28, 2005

Judge Roberts v. the future--today's NY

Today's NYT magazine has an article by Jeffrey Rosen on the questions legislators should be asking John Roberts. Rather than limit the scope of their digging to the nominee's reading of Roe v. Wade, Rosen suggests that the panel ask--you guessed it--bioethics questions:

What does he think about the use of functional MRI in criminal investigation, and what might be the implications of such "brain fingerprinting" for the right to privacy?

Where does he come down on genetic screening and procreative liberty? Should social sex selection be banned outright, or is "family balancing" acceptable? If parents have the right to use prenatal screening to select against fetuses with Down syndrome, why would they not have the right to use the same technology to select for higher intelligence?

As our growing understanding of genetics collides with our already cloudy concepts of race, what will be the implications for affirmative action and nondiscrimination policies?

What about access to, and payment for, the genetic therapies that are likely to emerge from the laboratories at precisely the time the demand will increase--as the Boomer generation enters its twilight years? And how about the same question, only with narcotics and marijuana for relief of chronic pain, say, for severe arthritis?

And how about intellectual property rights and living things? Ought investigators and industry be granted patents on DNA and genetically engineered organisms?

China Outlaws Sexual Harassment

Even though equality between the sexes has been a part of the CCP's agenda from its early days, "women hold up half of the sky," only after today will women in China be protected from sexual harassment by law. Wu Changzhen, Professor at the China University of Political Science and Law, headed the draft team of the amendment of the Law on Women's Right Protection and summed up the committee’s concern for victims of sexual harassment thus: “although sexual harassment is not as severe as rape, it could bring physical injury and emotional pressure. In the serious situation, sexual harassment sufferers will lose love-making ability and become world-weary.” Besides lack of libido and malaise, the team should not forget the abuse of women and female children because of China's family planning policy or the country's high rates of domestic abuse and trafficking in women, etc. Women in China have one of the highest rates of suicide in the world.

Chickie-Nobs, anyone?

Maybe it's just me, but every time I see this headline, I can't help but think of the genetically engineered chicken-nugget-producing creatures in Margaret Atwood's dystopian novel Oryx and Crake. (shudder . . . . )

Now, I'm no Jeremy Rifkin, but something tells me that meat "manufacture" isn't too far out in the future. (See Linda's post below.) Can't help but wonder: is it really a smart idea for us to eat manmade animal parts? And. . . . how would we know?

Saturday, August 27, 2005

The myth of "moral hazard"

Malcolm Gladwell has a nice piece in this week's New Yorker on the difference between social insurance and actuarial insurance in health care. In social insurance models (like Social Security), participants in the risk pool pay into the fund independent of their current risk of needing to draw against the pool. Young, healthy people, in effect, subsidize the health care of older, sicker people--on the understanding that when they are old and sick, the next generation of young, healthy people will pick up the tab. Contrast this with actuarial insurance models--what most US employers and individual-insurance purchasers have to contend with these days--in which a person's (or a group's) risk of drawing on funds is what defines their premiums. That is, a person who is already old or sick, or a small employer that has a couple employees diagnosed with cancer, will find insurance rapidly priced outside their reach.

"Moral hazard" is the rationale insurers and policy makers use to justify actuarial models. It's basically the idea that if you have insurance--if you don't have any money at risk--you behave less carefully than you would if you had to pay full price for the consequences. The argument might make sense for rental cars, or homeowners' insurance; but most people don't decide to have surgery for fun, as a lark, or (as Uwe Reinhardt colorfully comments) as an alternative to golf.

"Science Friday" on stem cells

Caught Science Friday on KUOW last night and heard Ira Flatow interview Mark Noble, a stem-cell researcher at the University of Rochester (NY), about the Harvard team's creation of a "fused" stem cell (see below). You can listen here for a good lay-language explanation of what the researchers actually did--and didn't--do.

One of the more interesting points of the debate was when a caller who opposes human embryonic stem-cell research called in to ask why only one side of the debate (the pro side) was represented; she hadn't caught the previous show with Leon Kass, head of the President's Council on Bioethics.

Yeah, but does it taste like chicken?

Tissue Engineering, which holds the promises for solving the ethical dilemmas of embryonic stem cell research and organ donation, may now also provide a solution to the ethical dilemma of animal slaughter -- humane mass production of meat reared not on the farm, but in the laboratory. University of Maryland researchers explain that, theoretically, enough meat to supply the world, and in a way that's better for the environment and human health (not to mention the animal's health!). Now that's progress!

Friday, August 26, 2005

You Can’t Keep a Good Social Darwinist Down

Once more Richard Lynn, Pioneer Fund scholar, is trying to convince us that women are naturally stupider than men. In November, British Journal of Psychology will publish a study by Lynn, emeritus professor of psychology at Ulster University, and Paul Irwing, a senior lecturer in organizational psychology at Manchester University. The study purports to show that men not only have larger brains but also have higher IQs, on average by about 5 points, than women. Further, their study claims that 3 times more men than women have IQs over 130 and 5 times as many men than women have IQs over 145. Irwing said to the Herald that "[t]hese different proportions of men and women with high IQ scores are clearly worth speaking of and may go some way to explaining the greater numbers of men achieving distinctions of various kinds for which a high IQ is required, such as chess grandmasters, Fields medalists for mathematics, Nobel prizewinners and the like."

It is not news that IQ tests measure, above all else, class, sex, and ethnicity. And the American Psychological Association and the folks at the Human Genome Project are hoarse from repeating that the concept of intelligence, let alone a genetically heritable intelligence, is complex and that reductionism is scientifically irresponsible.
(references) But here is the rub. Even if we suppose for sake of argument that intelligence is immutable and even if this means that no educational program will be able to raise intelligence levels, is there any kind of necessary social policy or ethical treatment of the people based on their intelligence that follows from these facts? Are we logically compelled to assert with Professor Lynn, that “What is called for here is not genocide, the killing off of the population of incompetent cultures. But we do need to think realistically in terms of the 'phasing out' of such peoples.... Evolutionary progress means the extinction of the less competent. To think otherwise is mere sentimentality" ? Of course not. Politics and values, not questionable, or even unquestionable, science, support such social policies.

[thank you to our newest guest blogger, Marin Gillis!~ Marin is an Assistant Professor of Health Care Ethics and Philosophy and Co-Director of the Medical Humanities Research Group at the Massachusetts College of Pharmacy and Health Sciences. Currently she is working on the ethics of embryonic stem cell research with a particular concern for the commodification of women’s reproductive material and she has scholarly interests in the teaching ethics to students in professional health programs. She has graduated from graduate programs in philosophy in Belgium (LPh. Higher Institute of Philosophy, KU Leuven) and Canada (PhD U of Calgary). She held a Social Sciences and Humanities Research Council of Canada Doctoral fellowship at Calgary and is a Steering Committee Member of the Association for Feminist Ethics and Social Theory, a member of the American Philosophical Association, The Society for Philosophy and Technology, the Feminist Association of Bioethics, and the American Association of Practical and Professional Ethics.]

Sure beats an ultra low calorie diet...

Interesting article in the Washington Post today about a hormone in mice that can extend life span. -- Although it is years away from human testing, prior to this, the only way to extend life span was to severely restrict caloric intake.

Thursday, August 25, 2005

Another painful issue...(I didn't think anyone was doing episiotomies any more!)

EurekaAlert reports on a study published in the September 2005 issue of Birth: Issues in PreNatal Care that rates of episiotomy are still high despite recommendations by obstetric, midwifery, and nursing bodies to limit the use of this procedure. A recent JAMA (Journal of the American Medical Association) article found that routine episiotomies provide no benefit, and, in fact, harm women -- The same information is repeated at the American College of Nurse-Midwives and the Maternity Center Association, who gives tips on how to avoid an episiotomy. I don't know why so many are still being done, but it sure emphasizes how important it is to be your own advocate...

Wednesday, August 24, 2005

When Treating Women like Men Creates Inequality

Both ABC News and Newsweek reported on a story regarding women and lung cancer this past week. The rate of lung cancer among women is growing more than seven times faster than in men and the fastest growing group is non-smoking women. No one understands the reason behind this phenomenon but fledgling hypotheses point to hormones, particularly estrogen. Though lung cancer kills more women each year than breast, ovarian and uterine cancer combined, lung cancer has not been traditionally identified as a women’s health issue. In fact, there may be many diseases that affect women differently than men. Some we know about, such as heart disease, and others are yet undiscovered. As “evidence-based medicine” becomes the paradigm of 21st century health care, we need to ask very pointed questions about the origins and demographics of that evidence. Are women being treated on the basis of how men have responded in clinical trials? Some have hailed evidence-based medicine as a force of justice – equalizing treatment for everyone. But treating everyone by the same guidelines is not just if those guidelines are tailored to one group and exclude another. Much of the evidence used by physicians to guide current prescription and treatment practices is based on the physiological responses of white men.

One force to change the status quo can be found at the National Institutes of Health. NIH’s
Office of Research on Women’s Health was formed in 1990 to encourage the inclusion of women in clinical research and develop policies requiring the inclusion of women in NIH funded research.

[thanks Kristen Nelson!]

Tuesday, August 23, 2005

A Painful Issue...

The Washington Post describes a controversial article published in JAMA; researchers at University of California San Francisco reviewed dozens of studies and medical reports and said the data indicate that fetuses likely are incapable of feeling pain until around the seventh month of pregnancy, when they are about 28 weeks old. Other researchers have claimed that evidence indicates that the capability of feeling pain can occur as early as 20 weeks. The reason this is of significance is that there has been proposed federal legislation that would require doctors to provide fetal pain information to women seeking abortions when fetuses are at least 20 weeks old, and to offer women fetal anesthesia; apparently several states have enacted similar legislation. One thing is for sure: We will hear more about this as neuroimaging and neuroscanning techniques improve. For the link to the article at JAMA (Journal of the American Medical Association click here.

Monday, August 22, 2005

Navy wife loses abortion case

Last Thursday, the Ninth Circuit Court of Appeals ruled against the wife of a Navy sailor who had aborted an anencephalic fetus. The woman, identified only as Jane Doe, thought that her military insurance plan should pay for the abortion. (Anencephaly, by the way, means no brain--and, in the case of Jane Doe's fetus, no skull. It is one of the conditions referred to in medicine as "incompatible with life.") The Northwest Women's Law Center, a non-profit group working to advance legal rights for women, represented Doe in court. Lisa Stone, executive director of the Center, commented, "The rational basis behind the prohibition on the termination of pregnancy is the preservation of potential human life. With an anencephalic fetus, there is no life. Therefore, it's irrational, and I would say cruel, to apply the restriction in a case like Jane Doe's." Read more here.

Like the debate around embryonic stem cell research, this case hinges on payment. That is, the government didn't prohibit Doe from having the abortion; it just said it wouldn't pay for it. Supporters of such policy decisions tend to say things like, "You may have a legal right to do it, but that doesn't mean the state has to support it." Sounds reasonable, on the face of it. Thing is, while scientists do have other options for finding money for hES research, the Jane Does of the world--even those lucky enough to have insurance--are on their own.

Researchers successfully "reprogram" adult cell

Today's Washington Post reports that a team of Harvard researchers have successfully fused an embryonic stem cell with an adult skin cell. So far, the hybrid cell appears to have the characteristics of an embryonic stem cell. Next step is to find out whether it retains same when the embryonic DNA is removed. (Scientists don't yet have this bit figured out.)

Big Blue and the Simulated Brain

Sounds like the title of children's book, doesn't it? -- But seriously, Switzerland's École Polytechnique Fédérale de Lausanne (part of the National Center for Competence in Research) is aiming to simulate the structures and functions of the brain, neuron by neuron.

A few years ago, the novel The Footprints of God, by Greg Iles, explored some of the ethical issues associated with re-creation or simulation a human brain and since then, we actually do now have the technology to monitor and reproduce brain activity at the quantum level. Some of the interesting questions include whose brain should be used as a "model" and what differences in the male and female brain will this technology reveal? Will this simulation have its own "mind" -- we don't really understand how consciousness arises, so will this give us some insight?

This is definitely a development to follow....

Friday, August 19, 2005

Apparently, this IS a joke....

Scientists from the Evangelical Center For Faith-Based Reasoning are now asserting that the long-held "theory of gravity" is flawed, and they have responded to it with a new theory of "Intelligent Falling". And now, the Evangelical Center and other Christian conservative action groups are calling for public-school curriculums to give equal time to this "Intelligent Falling" theory.
Makes you wonder what the next "intelligent" theory will be...and it reminds of the bumper sticker I've seen that says, "Beam me up, Scotty! There's no intelligent life on this planet."
(thanks to bonni, from Melbourne, Australia, for setting us straight on the fact that this really is a joke!)

Thursday, August 18, 2005

I Sing the Body Electric...

As a recent edition of Popular Science illustrates, we're facing emerging technologies ranging from exogenous pregnancies to implantable brain chips. How will these affect the physical well being and roles of women and men? Possible implications range from affecting the abortion debate to end-of-life decision making -- and although many of these technologies are made with the intention of improving quality of life, has our quality of life really improved? Do we make the time to enjoy Walt Whitman's poem or Ray Bradbury's anthologies? Some questions to ponder...

Wednesday, August 17, 2005

A Transcendental Experience?

One of the more interesting blogs launched recently is Numenware, a blog about Neurotheology. Is God a function of our brains or was the need for spirituality (or feeling connected to a higher power) implanted by God in the process of evolution? Stayed tuned for new neural imaging techniques to measure spiritual experiences...

Monday, August 15, 2005

Ok, so maybe Male pregnancy isn't such a great idea...

We had posted earlier a reference to Male Pregnancy , encouraging discussion about male moms, but a recent article in Popular Science, that quotes our fellow bioethicist, Glenn McGee, from Albany Medical College, suggests that there would likely be serious risks associated with such a procedure. (But it does make you wonder, how do the male seahorses and pipefish manage?)

Study suggests long term consquences of women's choice

Freakonomics: a rogue economist explores the hidden side of everything has spent the last 17 weeks on the NY Times’ nonfiction best seller list. It has the country abuzz with, of all things, talk about economic studies. Full of conversation starters, the book is a serious attempt to apply and explain economic theories in relation to contemporary cultural phenomena such as cheating the IRS, real estate advertising and the hierarchy of drug gangs. What has some people boiling, however, is the 1999 study by the author, economist Steven D. Levitt, suggesting a causal relationship between the availability of abortion and the recent drop in violent crime. Levitt, who conducted the study in 1999 with John Donohue III, concludes that the availability of legalized and safe abortions after Roe v. Wade in the 1970’s has directly resulted in the decrease in violent crime since the 1990’s. Their findings support the hypothesis that keeping unwanted children from being born reduces the number of children who would later engage in criminal activity since those children are more likely to have been unwanted, born into poverty, and born to teenaged mothers.

That poverty, teenaged mothers and lack of other social resources are precursors to criminal activity is a widely accepted fact. That the availability of abortion mitigates this phenomenon is highly contentious. And the moral implications of this conclusion, if true, may be highly repugnant. After all, if we can just get rid of criminals by aborting them, it is a small step to claiming that we ought to get rid of them that way. If Roe v Wade is responsible for such a social phenomenon, then perhaps we are morally culpable as a society for creating a eugenics movement, albeit unintentionally. Or perhaps Roe v. Wade inadvertently institutionalized a racist and classist response to unwanted pregnancies that would have been better served by attending to social inequities. But you won’t find any of these ideas mentioned in public responses to Levitt’s study or book. Curiously, reaction has focused more on discrediting the research than on engaging the moral debate. It is, after all, easier to deny the facts than to argue intelligently and reflectively about how we should respond to such potentially significant conclusions.

Decide for yourself.

(thank you to one of our new guest bloggers, Kristen Nelson, a clinical ethicist at Rush University Medical Center in Chicago)

Improving care for super-preemies

Another interesting NYT piece yesterday, this one on improving care and conditions in neonatal intensive care units (NICUs). Advances in medical technology have made it possible to save babies born at earlier and earlier stages of development. At the same time, as IVF becomes more common and more women deliver multiple early fetuses (as a result of implanting multiple embryos), the number of preemies is rising.

Scientists are working to develop an enviromnent that more closely replicates that of the mother's body, in hopes that this will help these babies' brains successfully complete the wiring that usually happens in utero. Studies show that preemies face health complications and, often, developmental delays. The hope is that a calmer, quieter NICU will help reduce these problems.

Turns out it's hard to build an artificial womb. . .

For more detail on just how hard--and the current state of the science in this effort--see this recent article in Popular Science.

Sunday, August 14, 2005

Respect for autonomy, or patient abandonment?

Today's New York Times has a featured piece on patients' role in treatment decisions. In the old days, the doc was the expert: he (they were pretty much all guys back then) might tell you what was wrong with you, and he would definitely tell you what he was going to do about it. You, the patient, were simply to do as you were told. Then came the revolution, powered by the rise of public distrust in the professions, the patient empowerment movement (especially around women's health), the increasing availability of health information from other sources (including drug companies and websites of various provenance), patient distrust of managed care's bottom-line focus, and reports of medical error coverups and conflicts of interest.

Patients demanded more control in decisions about their care. Studies showed that what the physician thought the patient wants, or should want, and what the patient actually wants aren't always the same: patients value outcomes differently. For example, while prophylactic mastectomy indubitably reduces a woman's risk of breast cancer, most women who have tested positive for a predisposing genetic mutation for breast cancer don't choose surgery.

Today, physicians are trained to consider the patient's preferences and values in decisions about treatment. They are taught that patients have the right, and perhaps the responsibility, to take an active role in health decision making. But where's the line between providing the opportunity to decide--if the patient wants it, she can take it--and dumping the decision in the patient's lap? Should the physician lay out the options and make the patient choose? Or should she describe the range of options and recommend the one she thinks makes most sense for the patient, together with a rationale for that choice?

The impact of this question for women goes beyond their own medical care. Studies show that women tend to be the healthcare decisionmakers for their families: spouses, children, and, increasingly, elderly parents.

Monday, August 08, 2005

It pays to have friends in the legal profession

The Women’s Bioethics Project has obtained some heavy artillery in the form of pro bono services from the major global law firm Milbank, Tweed, Hadley & McCloy LLP. Being a recovering lawyer myself, it warms my heart and give me hope to see a global firm like Milbank lending a hand to the WBP -- I think Lisa Stone JD, Executive Director of the Northwest Women’s Law Center says it best when she explains that people "assume that bioethical issues are largely medical or theological issues rather then legal concerns. But technology has fundamentally altered the formulation of questions balancing rights and responsibilities." We look forward to working with Attorneys Richard Wight, Elizabeth Hardin, and Sally Agel - A deep and hearty thank you to Milbank, Tweed, Hadley & McCloy LLP.

Tuesday, August 02, 2005

More on the hudood laws ...

In a post dated June 28, we had posted information about oppressive hudood laws, that treated women as property, rather than persons -- Nicholas Wade of the NY Times updates us on the plight of Dr. Shazia of Pakistan, the rape victim who was exiled for daring to stand up to authorities. A practicing physician, Dr. Shazia was forced to leave the country under threats of harm to her and her family if she had any contact with journalists or human rights groups. Kudos to Dr. Shazia and Nicholas Wade for bringing this horrific action to the light of day.