Monday, January 29, 2007

Some articles we're looking at today

The weekend and this morning is just chock full of interesting bioethics news tidbits, so we thought we give you a sampling of these:

World's Oldest New Mom Lied to Clinic

The Associated Press
Sunday, January 28, 2007; 4:56 PM

LONDON -- A 67-year-old woman who is believed to be the world's oldest new mother told a British Sunday newspaper she lied to a U.S. fertility clinic _ saying she was 55 _ to get treatment.

Carmela Bousada said in her first interview since she gave birth to twin boys on Dec. 29 that she sold her house in Spain to raise $59,000 to pay for in vitro fertilization at a California clinic, The News of the World reported.

Someone (Other Than You) May Own Your Genes

By DENISE CARUSO

THE Food and Drug Administration’s recent declaration that food from cloned animals is safe was a fresh reminder of how poorly the biotech industry and its regulators have managed the field’s portfolio of innovation over the years.

A recent survey found that Americans overwhelmingly distrust government and industry to provide truthful information about biotech’s risks and safety. Yet equally important as risk — and more often overlooked — are the public’s equally real and unaddressed concerns about who is looking out for its interests as the genes of plants, animals and microbes, as well as entire organisms, become privatized through the patenting system.

Can Food From Cloned Animals Be Called Organic?

By Rick Weiss

Washington Post Staff Writer
Monday, January 29, 2007; Page A06

There's nothing like a tender steak from a free-range, grass-fed, hormone-free, antibiotic-free, organic and -- oh, yes -- cloned cow.

Or is there?

That's a question being raised by scientists, activists and government bureaucrats since the Food and Drug Administration concluded in December that meat and milk from cloned animals should be allowed on the market.

In the opinion of some in the biotechnology arena…

Cancer drugs: too toxic?

Side effects of newer lifesaving medications are too much for many breast cancer patients.

By Shari Roan, LA Times Staff Writer
January 29, 2007

Side effects of newer lifesaving medications are too much for many breast cancer patients.

New drugs developed in the last decade can dramatically cut the chances that breast cancer will return. But as many as one-third of women stop taking the drugs before the end of the recommended five-year course of therapy, often because of the side effects.

The poor compliance worries doctors, who say women could be reducing their chance of survival.

"These are lifesaving drugs for these women," says Dr. Cary Presant, a clinical professor of medicine at USC and the author of a recent study on the side effects of these medications. "We want to see women continue taking them."

Like tamoxifen before them, the drugs, known as aromatase inhibitors, benefit women with estrogen-specific breast cancer, which constitutes about 80% of all breast cancers. In this type of disease, the tumors are fueled by the hormone estrogen.

Conservative Judicial Activism? Inventing a constitutional right to "medical self-defense."

by Robert F. Nagel
02/05/2007, Volume 012, Issue 20, The Weekly Standard

Do you have a bright idea (albeit a controversial one) that you would like to see implemented as national policy? Would you prefer to achieve this without the inconvenience of having to persuade Congress and the president, let alone the American people? Well, here's how to do it.

Japan's health minister criticized for calling women 'birth-giving machines'

By Carl Freire

ASSOCIATED PRESS

5:39 a.m. January 28, 2007

TOKYOJapan's health minister described women as “birth-giving machines” in a speech on the falling birthrate, drawing criticism despite an immediate apology.

“The number of women between the ages of 15 and 50 is fixed. The number of birth-giving machines (and) devices is fixed, so all we can ask is that they do their best per head,” Health, Labor and Welfare Minister Hakuo Yanagisawa said in a speech Saturday, the Asahi and Mainichi newspapers reported.


A Wheelchair That Reads Your Mind

by Emmet Cole|

02:00 AM Jan, 29, 2007

Patients who suffer from disease or injury that leave them unable to move have little hope of independent mobility. But that may be about to change. Researchers are developing a thought-controlled robotic wheelchair.

Spanish scientists have begun work on a new brain-computer interface, or BCI, capable of converting thought into commands that a wheelchair can execute.

Other researchers have already had some success with hard-wired brain computer interfaces, but they're powered by large computers and are physically plugged into the brain.

The Spanish researchers hope to develop a small, mobile interface that works with electroencephalogram electrodes, or EEG, placed on the scalp.

"We are planning to use non-invasive devices to record the rhythms from the surface of the skull," says Javier Minguez, a researcher at the University of Zaragoza in Spain. "We also plan to use this system with a school for disabled children that we collaborate with and (we) prefer to use non-invasive techniques with these children."

The Spanish Ministry of Education and Science has invested 180,000 euros in the "Biomedical Evaluation Of Robots to Assist Human Mobility" project. The goal is to bring mobility and a degree of independence to people with limited motor capabilities as the result of injury, disability or old age.

http://www.youtube.com/watch?v=GqxccQGI0gM

Saturday, January 27, 2007

If not the FDA, who?


Brought to our attention by R. Alta Charo:

January 24, 2007
FDA: Embryo Broker Not Our Problem
By THE ASSOCIATED PRESS

Filed at 1:46 p.m. ET

SAN ANTONIO (AP) -- The Food and Drug Administration has ended an investigation into a broker offering ready-made embryos to prospective parents, concluding the agency had no jurisdiction. The FDA has not disclosed what laws or regulations were the focus of the investigation into Jennalee Ryan's Abraham Center of Life. The agency's statement Wednesday said ''the investigation determined the facility was not currently engaged in practices that fall under FDA jurisdiction.''

Ryan's service involves a physician who uses donated eggs and sperm to create embryos that cost $5,000 a pair. Clients can review the donors' characteristics, including their ethnic and educational background and, in some cases, their photos. Some critics have said Ryan's business may be crossing ethical lines by marketing a better baby. But Ryan said she's just trying to help couples or single women, for example, who may not be able to have a biological baby.

My question is, if not the FDA, who does have jurisdiction over these thorny ethical questions? See our bioethics bookclub series on "designer babies" for ideas on how to consider the policy implications of our free market baby industry.

Wednesday, January 24, 2007

The Agony and the Ecstasy -- Part Three

We posted about the use of MDMA (a/k/a Ecstasy) a few times before, but it is worth mentioning again, as it being considered as a prescription drug. This time, in Slate, Amanda Schaffer brings us up to date on what's happening:

This year, the drug MDMA, otherwise known as ecstasy, could take a step toward medical respectability. Researchers in South Carolina have begun experimenting with MDMA for patients with post-traumatic stress disorder. At Harvard, a long-awaited pilot study will begin on whether the drug can help relieve anxiety and pain in terminal cancer patients in connection with psychotherapy. And studies will also start in Switzerland and Israel, where a former chief psychiatrist of the Israel Defense Forces will oversee work with people whose PTSD stems from terrorism or war.

Ecstasy gained notoriety as a party drug in the 1980s and 1990s. (Recall teenagers at raves with sparkly eyes and pacifiers rolling and dancing all night; a revival appears to be under way in England.) Enthusiasts say the drug makes them feel relaxed, energetic, and mentally clear. One likened it to a six-hour orgasm. In rare cases, however, users died after dancing for hours and overheating, or after taking mixtures of ecstasy and other drugs. Animal studies have shown that long-term, heavy ecstasy use can be risky for the brain. Human studies have found some ill effects in chronic users, as well. The government classifies MDMA (or 3,4-methylenedioxymethamphetamine) along with heroin, LSD, and marijuana as a Schedule 1 drug, which means that it's illegal and has no recognized medical uses.

But research has not proved that moderate or low doses of ecstasy are particularly dangerous. And avant-garde psychiatrists have long argued that in a controlled clinical setting, low amounts can play a role by reducing fear, without sedation, and so encourage openness and emotional insight. "There is nothing else like this in psychiatry—a fast-acting anti-anxiety medication that makes people alert and talkative," says Julie Holland, a psychiatrist at NYU Medical Center. If available to treat patients, "It would be incredibly useful." Some mental-health professionals interested in exploring MDMA's therapeutic uses protested when the government made it illegal 20 years ago. Stories of the drug's power to combat the psychological effects of terminal illness have continued to surface over the years. But proponents have had little but anecdote to go on. The current wave of studies should bring new rigor to answering an old question: whether MDMA deserves to be a prescription drug.

To read on, click here...

Tuesday, January 23, 2007

How 'bout that spiffy new ASBH logo?

You might have noticed the splendiferous new logo of the American Society for Bioethics and Humanities. Cool, huh?

Sure, it replaces the earth-toned coffee-stain graphic that was the former visual identity for ASBH. But did you notice the way the color gradations both distinguish and relate the B (that's for "bioethics") and the H (um, "humanities")? The artful use and echoing of the plus sign, uniting the disciplines? The clean, modern lines? And wait--there's more--it can cut pennies in half! Ok, no, not really. But still . . .

C'mon, say it with me: it's way cool. The new graphic won a design contest sponsored by the folks over at ASBH ("Pimp My Logo," I think it was called) and while the folks over at Seattle HQ are too modest to mention it, I have no such qualms. Our very own Gina Sullivan and Kathryn Hinsch, graphic artist and marketing whiz, are the women to congratulate.

Monday, January 22, 2007

Altruism and the Brain


"Are you a giver? Brain scan tells the truth."

Or so the headline of a recent MSNBC.com article on altruism and the brain declares. With the recent hype around gender differences and the brain, and the fact that many fMRI studies include men only, I thought it was prudent to find out if women were part of this 45 person study, and if so, did the researchers find any gender differences.

One of the authors of the study published in Nature, Scott Huettel, Ph.D, responded to my email inquiry:
Our subject sample - not all college students, although all were 35 and under - comprised 25 males and 20 females. We looked at gender effects, but found no significant influence on either brain activation in key regions or on the relation to altruism. Now, of course, this does not mean that there are no gender differences in altruism nor in the function of these regions; it just means that our study doesn't provide any evidence for such gender effects.

Thank you, Dr. Huettel.

As with my previous post on the importance of including women in heart clinical trials, it is critical that we study the female brain as well. We don't want to wake up twenty years from now, as we have with heart disease, and need to promote a "National Wear Grey Day" because we didn't have the data we needed on how to treat women for depression, Alzheimer's, and a whole host of other neurological diseases.

"The Heart Truth"

I recently received an email asking us to help promote National Wear Red Day (February 2, 2007) which is part of the National Heart, Lung and Blood Institute's "Heart Truth" campaign to make women more aware of the danger of heart disease. The campaign's goal is to "give women a personal and urgent wake up call about their risk of heart disease".

This is a worthy campaign and if you are inclined to wear red, go for it. But I think there is another "heart truth" that needs to be told. We didn't just magically find out a few years ago that heart disease in women typically follows a different course than it does in men (risk factors as well as diagnosis and treatment.)

We have this critical data because women's health activists, women Congressional leaders, especially Olympia Snowe (R-Maine) and Patricia Schroeder (D-Colorado), and members of the medical community led by Nanette Wenger, MD challenged the prevailing notion that women were "mini-men" and insisted that women be included in clinical heart study trails. Until the early nineties, men were the model subjects in most funded biomedical studies.

Medical and women's history buffs can check out the article "Coronary Artery Disease in Women: A Historical Perspective" by Joan L. Thomas, MD and Patricia A. Braus, MPH published in the AMA Journal of Internal Medicine (Feb 23, 1998) for more exacting details.

But the bottom line from their study: "Pressure from women concerned about the emerging knowledge about the adverse effects of heart disease in women helped to persuade a group of public officials of the importance of funding research related to women and heart disease."

Now that is the heart truth.

The Ethics of Convenience

We are in the midst of Bears mania here in Chicago and while most of the excitement is focused on the actual football team, this story has been making headlines as well: Wife induces labor so husband can go to Bears game

My favorite quote comes from the mother, Colleen Pavelka:
I thought, how could [Mark] miss this one opportunity that he might never have again in his life?

It's not clear here whether she's talking about the birth of her son, or the fact that the Bears haven't made a Super Bowl since 1985.

While this story has provided us with amusing water cooler talk, it does bring up ethical questions over whether or not medical care should be altered at the convenience of the patient and/or the patient's family.

Specifically, there has been a documented rise in the number of C-sections in the last few years and it has been noted that many of these are being requested as a matter of convenience.

This trend is disturbing considering the recent studies that show the risks to newborns born by voluntary Caesarean sections.

NYT Article here
(login required):

Researchers have found that the neonatal mortality rate for Caesarean delivery among low-risk women is 1.77 deaths per 1,000 live births, while the rate for vaginal delivery is 0.62 deaths per 1,000.
It appears Colleen Pavelka did not undergo a Caesarean, however induced labor is not without its risks either.

Hopefully such events will prompt discussion about the pros and cons of voluntary C-sections and delivery that is scheduled strictly as a matter of convenience. We live in a time where for many, every minute of the day has been scheduled ahead of time. Perhaps some things should still be left up to nature.

On a lighter, more personal note, had I been in Colleen's position the headline Sunday morning would have read: "Husband's life spared after suggesting inducing labor early so he could 'make it to the game' "

Direct to Consumer Advertising Showdown

Drug advertising aimed at consumers, a fast-growing category that reached $4.5 billion last year, will face hard scrutiny in the new Congress, according to industry critics in both the House and Senate, according to a NY Times article published today.

The consumer ads will be on the griddle early in this session at hearings on the user fees that manufacturers pay to speed the reviewing of new drugs by the Food and Drug Administration. The user fee law will die in the fall unless Congress acts to renew it.

The pharmaceutical industry, which often gets what it asks for from Congress and the executive branch, seeks to renew the law and add a new set of user fees that would be pay salaries for additional F.D.A. employees to evaluate all consumer drug ads, before they are shown on television.

Both the industry and its critics agree that there should be a pause before the advertising starts — to allow time for doctors to learn about a new drug. The companies want the delay to be left up to them, but critics say the F.D.A. should require a wait of up to two years. Criticism of direct-to-consumer advertising has intensified since 2004, after Merck withdrew Vioxx, a heavily advertised painkiller, after a clinical trial showed that it sharply increased the risk of heart attacks and strokes.

To read more, click here.




One Nation, with liberty and justice, perhaps healthcare coverage, for all

From the Washington Post this morning:

Universal Health Coverage Attracts New Support:
Onetime Foes Become Unlikely Advocates, Citing Rising Costs and Tougher Access

By Christopher Lee

Harry and Louise have had a change of heart.--Thirteen years after television ads from the insurance industry featuring the fictional middle-class couple helped kill the Clinton health-care plan and make universal coverage politically radioactive, comprehensive proposals for expanding coverage to millions of uninsured Americans are flowering again inside the Beltway and around the country.

And this time, advocates hope, the political climate is right for the best ideas to grow, in large part because many business groups that opposed earlier efforts now agree that rising health-care costs and increasingly tougher access to insurance are unsustainable trends. To read on, click here.

Teenage pregnancy myth dismissed

From the BBC: The perception that teenage girls with unwanted pregnancies have been less careful about contraception than older women has been dismissed by a study.

Doctors at a Glasgow hospital analyzed the birth control attempted by nearly 1,000 women requesting abortions.

They found the proportion of older women who had used no contraception at all was roughly similar to the percentage of teenagers.

The findings are published in the journal BJOG. To read on click here.

Sunday, January 21, 2007

The Anniversary of Roe vs Wade and Abortion Under Attack

In light of upcoming anniversary of Roe vs. Wade, I thought it was fitting that I had the pleasure and opportunity of interviewing Krista Jacob, the editor of Abortion Under Attack, a book which addresses the spectrum of personal and social influences, ranging from dealing with remorse to the impact that economics, race, and culture have on a woman's right to choose. Krista takes the stance that advocates of a woman’s right to choose are losing the battle—in part because those working to protect that right are ignoring a complicated truth: Many people who support legalized abortion do so with differing personal philosophies and varying levels of conviction. Today, young people are better able to grapple with the nuances of emotion and experience about this difficult issue because they’ve grown up in a post-Roe America. In her new book Abortion Under Attack: Women on the Challenges Facing Choice, Krista Jacob has compiled an impressive collection of essays by pro-choice advocates that addresses the spectrum of personal and social influences, ranging from dealing with remorse to the impact that economics, race, and culture have on a woman’s right to choose.

Here are some of the questions and answers from her interview:

Q. Society has been inundated with the abortion debate for the last few decades—hasn’t everything already been said? Don’t people already identify with one of the two camps, “pro-life” or “pro-choice”?

Krista: It’s true that a lot has been said (and said again) about abortion over the past few decades. Unfortunately the debate has become so vitriolic in both public and private spheres that many reasonable people shy away from this issue, that is until if affects them personally.

That said, regardless of a person’s personal experiences, there are millions of people who have feelings and opinions about abortion that fall under the rubric of “pro-choice,” yet shy away from identifying as such because they perceive the pro-choice position as dangerously simplistic and monolithic. Many have expressed to me that they have felt alienated in some pro-choice circles because they may have ambivalence or moral conflict with abortion itself, or they may even feel remorse or regret about their own abortion.

Q. There are so many books that address the topic of abortion—how is this one different? Why did you put this book together?

Krista: My vision for Abortion Under Attack was informed primarily by my work counseling women and couples coping with unplanned pregnancies. In this work, I found a significant disconnect between the realities of these people’s experience and the public discourse surrounding abortion. Abortion Under Attack is somewhat of a heretical pro-choice book. It tackles some of what have been treated as taboo subjects within the pro-choice movement, such as the question of fetal pain, grief or remorse after an abortion, late term abortion, and the problematics of “choice” rhetoric when placed within the context of race and poverty. I hope this wonderful collection will open minds and build bridges where they can be built.

Q. Where do you see that bridges can be built?

Krista: I think there are many opportunities to build bridges with people who are morally conflicted or ambivalent about abortion itself, yet still share our same vision of reducing the number of unplanned pregnancies through promoting comprehensive and accurate sexuality educational programs and through increasing access to birth control for all women and couples. I believe this is a significant percentage of people whose participation would greatly strengthen our movement.... There is an excellent essay in my book entitled, "The Rhetoric of Abortion: Reflections from a Former Pro-Life Activist," in which the author shares her experience as a member of the anti-choice movement and how she came to be a supporter of reproductive rights. It's an excellent essay and illuminates the importance of reaching out to this group of people.

Q. What is the “new dialogue” that contributors address in this book? What new ideas are brought to light?

Krista: What I refer to as the “new dialogue” in Abortion Under Attack includes the vast array of views and experiences surrounding abortion that I would still term “pro-choice,” yet haven’t always been welcome in traditional pro-choice circles. There are people who believe that abortion kills a life but still work actively to protect a woman’s right to choose what is right for her and her family. There are deeply religious and conservative women who have abortions. And there are women who grieve deeply for the pregnancy they aborted, and who desperately need supportive, non-politicized resources. This is the new dialogue I’m talking about, and I wanted to present it in a unified way in order to help change how abortion is talked about in the mainstream. Essentially this new dialogue is a movement within a movement, one that started at the grassroots level, in women’s health clinics, among women sharing stories about their abortions, and is slowly changing and broadening the vision and strategy of the larger pro-choice movement.

Q. If you could only elucidate three kernels of information that you discovered in researching your book, what would they be?

Krista: The personal is still political and the political must embrace the plurality of personal experience. I understand that political messages must be concise but they needn’t be overly simplistic and they mustn’t be developed at the cost of excluding marginalized people.

People are extremely ready for and open to a new dialogue about abortion, and now is the right time to cultivate this dialogue. Abortion is under serious attack and unless we can change the tone of our dialogue, on a large scale, we risk losing legal abortion completely.

Our movement must be responsive to a changing and evolving society. As I say in my Introduction, it is as much our right to have varying opinions about abortion as it is our right to have access to safe, legal, and dignified abortion.

Saturday, January 20, 2007

Virginia considers requiring girls to get HPV vaccine

A bill has been introduced in Virginia that would require girls to receive their first vaccination against HPV prior to their entry into middle school, or have parents apply for an exemption after reading the literature on and being educated about the vaccine. The bill would add HPV to the list of immunizations needed for school attendance, and make the state one of the first to require the vaccine.

On the face of this, it sounds good - but digging a bit further in to it, a few questions are raised. While I initially wanted to cheer to see that a Republican was sponsoring the bill, it turned to dismay and, well, suspicion as I read the following:
Hamilton said pharmaceutical company representatives approached him about submitting the bill, probably because he chairs the House Committee on Health, Welfare and Institutions. Drug companies have been among the largest contributors to Hamilton's election campaigns.
So the companies that have financed most of his campaigns now want him to make a vaccine, which is not covered by all insurance companies (and runs around $350), mandatory for all girls?

Hmm. Strikes me as a bit ethically questionable.

Of course, one thing that many people are saying is ethically questionable is vaccinating girls against a sexually transmitted disease, something that doesn't raise any questions for me. Why? Here are a couple of reasons:
  • 1) At the age people are talking about (9-13), most kids aren't being given specific and detailed information about what the shots they're receiving do - it's just part of the evils of going to the doctor. It's not like anyone is sitting down saying "alright, now you won't get measles, mumps, or cervical cancer so you can be sexually promiscuous now!"

  • 2) Hepatitis B is a required immunization, and is sexually transmitted (among other ways)

  • 3) We're talking something that kills. There are 10,000 new cervical cancer cases diagnosed every year, and something like 3500 women die every year. Given that we know most people do not abstain from sex until marriage (and we know this has been true for a long time), safety really seems like it should trump anything else. Or put another way: do you want to be the parent whose daughter tells you she has cervical cancer, knowing you could have prevented it through three simple shots?


I know parents hope that their children will adhere to their morals, and I support teaching your children your values and beliefs. But I also think there's the necessity to be realistic; if you can prevent disease via a combination of teaching morals and actual protection, why would you choose otherwise?

I remain skeptical of Hamilton's motivations for proposing this bill, but I suppose that sometimes, the ends do justify the means.

Friday, January 19, 2007

Jobs of the Future (that will require ethics training?)


An interesting article in the Globe and Mail asks how these jobs would look on your business card:

Bioaesthetic coach

Experience designer

Health-enhancement mentor

Intercommunity farmer

Personal genome optimizer

Chief health officer

Manager of faith-based relations and initiatives

Chief innovation officer

Executive chef, space airline

Global work process co-ordinator

Skycar mechanic

Underwater hotel manager

Vice-president of experiences

They may sound farfetched, but these are the kinds of jobs that workplace experts gazing into the future expect today's children, and their children, will hold down.

For the past several years, Washington-based World Future Society has been publishing articles in its Futurist magazine about what tomorrow's workplace will look like...

The article goes to explain that one category of jobs will focus on enhancing the human body by keeping it well, reversing the signs of aging, or implanting tiny computers that extend the brain's memory and expand cognitive powers. Human bio-enhancement promises to be a big field, with crazy-sounding opportunities, such as bioaesthetic coaching, somaelectronic integration, experience design, and personal genome optimization.

To read on, click here.



Change in prenatal Down syndrome screening recommendations

The American College of Obstetricians and Gynecologists (ACOG) recently issued new guidelines regarding prenatal screening. The new recommendation is that all women--regardless of age--be offered prenatal testing for Down syndrome. Until now, more invasive diagnostic testing (amniocentesis and chorionic villi sampling, or CVS) was routinely offered to women starting at age 35. Age is no longer to be used as a cutoff for these tests; and ACOG anticipates that the availability of ultrasound testing will help decrease the use of invasive tests for prentatal diagnosis of Down syndrome. You can read more about the recommendation here.

I've written here before about the disability-rights critique of eliminating disability by preventing birth. With regard to Down syndrome, there are a few additional issues to consider. One is that some number of women will receive this test without really understanding ahead of time what they might be getting themselves into. A positive screening result would indicate a higher-than-average risk that the fetus has Down syndrome. This forces a choice of whether to pursue diagnostic testing. A positive diagnostic test then forces a decision about whether to continue the pregnancy, in light of this information.

I worry that testing will be ordered routinely--especially as less invasive options become available--and some doctors will not take the time to explain to women the choices they will face if the screen comes back positive.

And given that many, if not most, medical practitioners view abortion for Down syndrome as an appropriate choice, how will they guard against inappropriately influencing patients' decisions? A doctor I know once referred to abortion in this situation as "a no-brainer. " I wonder what, if anything, she would say about screening for Down's to a woman who's 15 weeks into her pregnancy.

Thursday, January 18, 2007

The Call for Genetic Privacy

WASHINGTON, Jan. 17 — President Bush on Wednesday urged Congress to pass long-stalled legislation to safeguard genetic privacy, a measure experts say would encourage millions of Americans to undergo testing that could lead to prevention and treatment of cancer and other diseases.

“If a person is willing to share his or her genetic information, it is important that that information not be exploited in improper ways,” Mr. Bush said at the National Institutes of Health. “And Congress can pass good legislation to prevent that from happening.” He added, “We want medical research to go forward without an individual fearing personal discrimination.”

For years, scientists and patients’ advocates have pushed for legislation barring employers and insurance companies from discriminating based on the results of genetic tests. A so-called genetic discrimination bill passed the Senate unanimously in 2003, but died in the House. To read on, click here.

Tuesday, January 16, 2007

Bioethics and Women: Across the Life Span

It's a snow day in Seattle (three whole inches!) so all my meetings were cancelled. This unexpected gift of time gave me the opportunity to read Mary Briody Mahowald's recently published book: Bioethics and Women: Across the Life Span (Oxford University Press). I had the privilege of meeting Dr. Mahowald last March when she participated in the WBP/Ford Foundation sponsored planning meeting in Washington, D.C., to organize the first-ever Bioethics Seminar for Women State Legislative Leaders.

Dr. Mahowald's book is not "bioethics-lite." Reading the first chapter transported me back to my graduate school days. In the first 30 pages alone it seems as though she touches on every critical philosophical underpinning of bioethics. Always a teacher, she has a delightful habit of including little explanatory notes in the text - in case your memory is a little fuzzy on Latin terminology or you aren't up on the latest medical interventions.

I went to Amazon.com to get a book cover image and found an editorial overview so much wiser than one I could craft. Here is an excerpt:
All persons, while different from one another, have the same value: this is the author's relatively uncontroversial starting point. Her end point is not uncontroversial: an ideal of justice as human flourishing, based on each person's unique set of capabilities. Because the book's focus is women's health care, gender justice, a necessary component of justice, is central to examination of the issues. Classical pragmatists and feminist standpoint theorists are enlisted in support of a strategy by which gender justice is promoted.

Two features of the book are unique: (1) the topics presented cover the entire life span of women, not just those related to reproduction; (2) a range views about moral status are applied not only to fetuses but also to individuals already born.

While delineating and defending the book's perspective, the first section provides an overview of bioethics, critiques prevalent approaches to bioethics and models of the physician-patient relationship, and sketches distinguishing aspects of women's health care that are prevalently neglected. The second section identifies topics that are indirectly as well as directly related to women's health, such as domestic violence and caregiving. Brief cases illustrate variables relevant to each topic. Empirical and theoretical considerations follow each set of cases; these are intended to precipitate more expansive and critical examination of the issues raised.

The last section is devoted to an egalitarian ideal that may be pursued through an ethic of virtue or supererogation rather than obligation. By embracing this ideal, according to the author, moral agents support a more demanding level of morality than guidelines or laws require.
Bioethics professors - take note: This book would be a great addition to your syllabus.

If I Only Had a Brain

Reproductive technologies seem to be getting all the press these days: from designer/deformer babies, made-to-order embryos, to womb transfers. And while these issues are of critical importance to women, I believe neuroscience is the emerging field we need to keep an eye on (and drive the policy debate.)

Advances in neuroscience are going to pose some of the most important ethical questions yet about what it means to be human – challenging our concepts of free will, gender and genetic determinism, and what sets us apart from other species. Many believe that it will displace genetics as the leading edge of scientiļ¬c discoveries in the 21st century.

I was pleased to learn about an upcoming conference on the implications of neuroscience - see details below. The Institute on Biotechnology and the Human Future has recruited an impressive range of scholars and policy makers including:

Marsha Darling, Ph.D., Professor of history and interdisciplinary studies and director of the African American & Ethnic Studies Program at Adelphi University;

Andrew Imparato, J.D., president and CEO of the American Association of People with Disabilities;

U.S. Representative Brad Sherman, J.D., CPA, (D-CA), member of the House Committee on Science;

Patricia Smith Churchland, Ph.D., professor of philosophy at the University of California San Diego and author of Neurophilosophy: Toward a Unified Science of the Mind-Brain;

Linda MacDonald Glenn, J.D., L.L.M., faculty member in the Alden March Bioethics Institute at Albany Medical Center and in the University of Vermont’s College of Nursing and Health Sciences

Conference details:
A Spotless Mind? Policy, Ethics & the Future of Human Intelligence
Friday, February 16, 2007 - 8:30 a.m. – 5:00 p.m.
National Press Club, 529 14th Street N.W., Washington, D.C.
RSVPs are required. There is no charge for the event.
E-mail: rsvp@thehumanfuture.org

I'll be there and will be reporting live from the conference.

First U.S. Uterus Transplant Planned -- Is the Risk Justified?

From the Washington Post:

-- A New York hospital is taking steps to offer the nation's first uterus transplant, a radical experiment that might allow women whose wombs were removed or are defective to bear children.

The wombs would come from dead donors, just as most other organs do, and would be removed after the recipient gives birth so she would not need anti-rejection drugs her whole life. To read on...

We've blogged about this before -- but two big questions arise that no one seems to want to answer: What about the impact of anti-rejection drugs on the fetus during development? From what I understand, anti-rejection drugs are teratogenic or embryocidal. Does a woman's desire to bear a child justifiably outweigh the likely harm to the fetus? And if you decide that a woman could justifiably exercise her autonomy in such a manner, why not allow male pregnancy? (which we've blogged about before, too, here and here.) Either through a womb transplant or via an embryo implanted in the peritoneal sac? (some sort of flexible mesh that would allow growth of the embryo/fetus and yet prevent the endometrial and placental tissues from attaching to major organs would have to be devised).

I could imagine some argument about this being a women's natural role, but pu-leeze, do we really want to go there?





(image courtesy of http://www.malepregnancy.com -- an artist's rendition)

Saturday, January 13, 2007

A Taste of US Family Life, A Tale of International Heartache

We've been talking about Chinese adoptions lately, and the new guidelines China has put in place. Today, the New York Times has a heartbreaking story about international adoptions from other countries, with a focus on the Ukraine and Russia. As strict as the Chinese adoptions are, they at least are not this manipulative*! The story is just a nightmare of things done wrong: bribes paid to directors, organizers, and agencies, older children being sent on "hosting tours" to potential adoption parents so that the parents can, and I quote, have a "trial run" at the children, only for everyone to become attached - and then the prospective parents find out that the child is not available for adoption, or is being fought over by multiple families, or that if they do want to adopt, they must come to the originating country and be shown a portfolio of available children which may or may not include the child that "toured" with them.

And this isn't even taking into account the child, who is often told upfront by the agencies that they are auditioning for their "forever family"! Many children "test" well, and so are repeatedly sent to different families, yet never actually made available for adopting - the hope appears to be that they will lure the families in to adopt other children.

The United States is in the process of attempting to ratify an intercountry adoption treaty with several countries, which supposedly includes a code of ethics to prevent these kinds of systematic abuses, but I have to wonder at how effective that will really be. And for too many people, prospective parents and children alike, it's way too little, way too late.

*At least from what I saw, as close friends adopted their daughter several years ago, and are now going through the process - following the new rules - to adopt a second girl. And as my "niece" is absolutely adorable, and has me wrapped completely around her finger, I am in no way impartial or objective about adoptions because of it.

Wednesday, January 10, 2007

And I thought the MegaMillions Lottery was bad enough ...

An interesting article appeared on the BBC website yesterday (http://news.bbc.co.uk/2/hi/health/6243705.stm). An association of British plastic surgeons is criticizing a company in the Czech Republic for running a lottery in which the grand prize is a cosmetic surgery package worth £6,000 (over $10,000 US), describing it as a marketing gimmick. I could rant for pages about medical marketing, medical tourism, or unrealistic media-driven notions of beauty but my brain is still oxygen-starved after my daily run ... according to the latest issue of Men's Health, I'm a little too fat thanks to my holiday overindulgence.

Borrowing a page from the environmental activist playbook, who often purchase hunting licenses for species like mountain lions but simply not use them, I have already bought a couple of lottery tickets. If I win, I plan to donate the prize package to someone truly needy, such as a burn victim, breast cancer survivor, or a child born with a cleft palate. If you'd like to do the same, you can buy your lottery tickets here: http://www.europa-international.net/

Tuesday, January 09, 2007

More on the “Pillow Angel” case--Sci Am asks 3 bioethicists to weigh in

Scientific American asked “three of the country's most esteemed bioethicists" to give their professional opinions on whether the ‘Ashley Treatment’ was a wise decision.
http://www.sciam.com/article.cfm?chanId=sa003&articleId=F41E496C-E7F2-99DF-33E40A7C8187563C

The above link includes the unedited transcript of e-mail dialogue between the participants:

Joel E. Frader, MD, is division head of general academic pediatrics at the Children's Memorial Hospital, Chicago, as well as a professor of pediatrics/medical humanities and bioethics at Northwestern University's Feinberg School of Medicine.

Norman Fost, MD, MPH, is a professor of pediatrics and bioethics as well as director of the program in bioethics and vice chair of the Department of Medical History and Bioethics at the University of Wisconsin Medical School.

Benjamin Wilfond, MD, is director of the Treuman Katz Center for Pediatric Bioethics at Seattle Children's Hospital and a professor at and chief of the Division of Bioethics, Department of Pediatrics, University of Wisconsin Medicine.

Sunday, January 07, 2007

AFS Cells: A Non-controversial source of pluripotent cells?

There is a new report out today that suggests there is a new, non-controversial and "ethically sound" source of pluripotent stem cells: amniotic-fluid stem cells, which, as the name indicates, are stem cells found free-floating in the amniotic fluid. They are also apparently present in the placenta.

According to Dr. Anthony Atala, the specialist at Wake Forest University who led the research team, these cells are neither embryonic stem cells nor are they adult stem cells. They're something in between, fully flexible like embryonic stem cells, but non-controversial. And this is where I take issue. Dr. Atala is saying, and I quote from the above article,
the amniotic cells can be taken easily and harmlessly from the placenta or from pregnant women by amniocentesis
while David Prentice, a senior fellow in life sciences at the Family Research Council, (who strongly oppose embryonic stem cells) says that the AFS cells come with "little ethical baggage". But anyone who's been through amniocentesis knows that there is actually a risk of miscarriage with every insertion of a needle into the womb; according to the CDC, it's a risk of one in 200 to one in 400 women will miscarry, depending on the skill of the person performing the procedure.

This is not harmless. This is not easy. This is not little ethical baggage. If it's so bad, so wrong, to create embyronic stem cells because of the loss of potential life, how can anyone justify the potential miscarriage of a developing, in utero fetus?

Wednesday, January 03, 2007

Cancer Study Determines Cost in Patient Time

How much a disease costs society plays a role in social policy-making so getting the price right is a concern. What do we count in our costs? According to Len Lichtenfeld, MD of the American Cancer Society, “Cancer is more than just the dollars and cents for the medicines and the treatments and the doctors. It is also the lost opportunities for patients.” In a study to be published today in the Journal of National Cancer Institute, researchers examined the records of 763,000 cancer patients covered by Medicare 1995 to 2001 to determine the time people typically invest fighting 11 forms of cancer in the first year of diagnosis. They estimate, for example, the average hours a woman diagnosed with ovarian cancer spends is 368, those diagnosed with lung cancer, 272, and people with kidney cancer, 193. Patients with ovarian cancers lost the most time. The monetary value researchers attach to the time spent waiting in offices for doctors, scans, and tests, and having in patient and hospital treatment, is 2.3 billion dollars (US); this amount was determined by assigning an hourly wage of 15.23/hr, the median US wage rate in 2002. This time does not include that spent at home recovering from surgery or chemo, for example. The NY Times notes that the study did not look at the value of time spent by members of a patient’s family

China's Henan Provence Bans Abortion Drugs

In their continuing effort to stem their increasingly gender imbalanced population, China's Henan province has banned abortion drugs, after admitting that sex-based abortions (despite being illegal) are still widespread.

Unfortunately, I suspect this will simply do one of two things: either make abortions more dangerous by making them back alley (even if drug-based back alley), or increase the number of female babies abandoned in orphanages.

Congratulations to us for being named Time's Person of the Year!


TIME magazine has named us (and you and our fellow bloggers) as Persons of the year...It's about all of us who have an online presence, helping to shape the blogosphere and drawing attention to issues that affect us... as Time puts it, "It's about the cosmic compendium of knowledge Wikipedia and the million-channel people's network YouTube and the online metropolis MySpace. It's about the many wresting power from the few and helping one another for nothing and how that will not only change the world, but also change the way the world changes."

Nice to know that we are making a difference!
If you wish to become part of blog team, and make a difference, please email linda (at) biomedlaw.com or khinsch (at) womensbioethics.org.

Singing the Body Politic...

Paul Abrams of the Huffington Post outlines the science of stem cells and summarizes a talk he gave for the Women's Bioethics Project: Can Stem Cells Help Heal the Body Politic?: To understand "stem cells", and the debates about them, a simple analogy may be useful. Imagine that you have an 8 year old child who is a spectacular athlete, who can run, jump, swim, skate, play tennis, do acrobatics...she has the potential to be anything, but has not yet chosen. To read on, click here. Thanks, Paul!

Call for Abstracts - Ethical Issues in Biomedical Engineering

SUNY Downstate Medical Center and Polytechnic University are sponsoring the Fourth International Conference on Ethical Issues in Biomedical Engineering, April 20 - 22, 2007

Suggested topics for presentations include:

  • Animal testing for medical devices
  • Code of ethics for bioengineers
  • Clinical trials of biomedical devices
  • Ethics of genetic engineering and cloning
  • Ethics of implant use and marketing
  • Ethical issues in bioengineering research ethical issues in clinical engineering
  • Privacy and bioinformatics
  • Ethics of nanobiotechnology ethical issues in tissue engineering


Abstract submission deadline January 15, 2007

Notification of abstract acceptance February 15, 2007

For more info, check out the website

OR contact:

Subrata Saha, Ph.D. Conference Chair
Department of Orthopaedic Surgery & Rehabilitation Medicine

SUNY Downstate Medical Center
450 Clarkson Avenue - Box 30
Brooklyn, New York 11203

Email - subrata.saha@downstate.edu

Office – (718)-613-8652 Fax – (718)-270-3983