The Year in Medicine, from Time

A Synopsis of The Year in Medicine 2008: From A to Z

The financial world blew itself up, the political world turned upside down, but in 2008 the world of medicine just kept chugging. In good times and bad, science doesn't sleep, and every year brings breakthroughs, setbacks, reasons for worry and reasons for joy. TIME's annual alphabetical roundup of a sampling of those stories gives you an overview of the year behind and a hint of what might be in the one ahead.

A

Alzheimer's
And Diabetes:Lethal Partners

People with diabetes have a higher risk of developing Alzheimer's disease--and doctors don't know why. But researchers have found that compared with Alzheimer's patients who never developed diabetes, those who had both conditions and received diabetes therapy had 80% fewer brain-clogging amyloid plaques, a physical sign of Alzheimer's. It's not clear why the treatment had this effect, but the hope is that diabetes drugs could reduce symptoms in some and provide clues to new treatments.

Appendectomy: No Cuts, No Scars, No Sweat

Get ready for the "natural orifice" technique. Settle down, it's a surgical procedure. Rather than cutting through skin and tissue to reach organs deep inside the body, surgeons are increasingly experimenting with going through natural openings such as the mouth, vagina and colon. A team at the University of California at San Diego performed the first such operation in the U.S. in March, removing the appendix of a brave graduate student through her vagina. Surgeons say the technique, which uses in-body camera systems to guide doctors, will reduce the number of incisions made through the skin, which in turn should reduce scarring and infections and improve recovery. Depending on the type of surgery, doctors may need to make some incisions through inner tissues and organs, but because those cuts are not exposed, they often heal faster and more cleanly than those made through the skin. And as a bonus, they tend to be less painful as they heal.

Abortion: Rates Down for Some

Fewer women are choosing to have abortions, according to a report by the Guttmacher Institute, a nonprofit organization that has studied abortion rates for more than 30 years. From 1990 to 2005, the total number of abortions in the U.S. fell from 1.6 million to 1.2 million. Despite this drop, the study found that more than 1 in 5 women will have an abortion at some point in her lifetime; however, that rate does not apply equally to all women. Teenagers and young adults ages 20-24 were responsible for much of the decline, while rates increased for women in their 40s. Race also made a difference. In 2004, only 11 out of every 1,000 white women had abortions, compared with 28 per 1,000 Hispanic women and 50 per 1,000 black women.

Autism: Debate Rages over a Rare Case

With her crimson curls and angelic face, little Hannah Poling, a 9-year-old girl with autism, hardly looks like a pioneer. But the Georgia native is the first to receive a mea culpa of sorts from federal health officials, who acknowledged that routinely recommended vaccines she received as a toddler might have contributed to her autism. Poling's case is unique in that she received five injections in one day in order to catch up after falling behind the recommended vaccination schedule. More important, she also has a rare mitochondrial condition that disrupts normal cellular function; this, experts believe, was worsened by the immunizations, causing brain changes. It's one more data point in the continuing war over whether childhood immunizations are linked to autism; scientific studies to date and the Centers for Disease Control and Prevention find no consistent cause-and-effect relationship.

B

Bisphenol-A: A Chemical Found in Plastic Could Be Dangerous

Dustin Hoffman in The Graduate may be the person who was most famously reminded of the ubiquity of plastics, but a worried band of modern-day scientists are taking up the cry. The investigators are concerned about the health effects of bisphenol-A (BPA), a component in some plastics--including bottles and the lining of aluminum cans--that can easily migrate into the bloodstream. The chemical industry argues that the average dose of BPA is far too low to be harmful--and the Food and Drug Administration (FDA) has agreed. But animal studies have connected even low-dose BPA exposure with cancer and other ills, and the chemical can mimic the hormone estrogen, which can cause feminizing changes in developing fetuses and infants. After the FDA ruled the chemical safe, research published in the Journal of the American Medical Association found that higher levels of BPA in people were associated with greater incidences of cardiovascular disease, diabetes and liver problems. In Octobe
r, a review panel commissioned by the FDA's science board found that the federal agency's original assessment was flawed. It's up to the FDA to determine how to respond, but parents may want to avoid BPA when they can.

Brains: How Gay and Straight Differ

Ever since scientists realized that the seat of love and lust is not the heart but the brain, they've been looking for how the brains of homosexuals and heterosexuals differ. Researchers in Sweden have new clues. Studying brain scans of 90 subjects, they found that the right hemisphere is slightly larger than the left in both men and women who are attracted to women. Men and women attracted to men, on the other hand, have brains that are more symmetrical. Brain symmetry isn't the whole story, and other researchers have found that additional variables as diverse as genes and birth order can play a role.

C

CT Scans: Just How Safe Are They?

Computed tomographic (CT) scans help doctors zoom in on everything from head trauma to kidney stones. But some researchers are worried that unnecessary scans may increase your lifetime cancer risk. Long-term studies investigating a tumor connection are under way, but in the meantime, patients may be getting some serious radiation exposure. A study of 1,243 randomly chosen hospital patients showed that, on average, they had been exposed to 45 millisieverts (mSv) of radiation (the typical chest X-ray delivers 0.02 mSv), and 12% had been exposed to more than twice that amount. And not all of this exposure may even be necessary. Earlier studies have suggested that some doctors order duplicate scans, while others prescribe CTs in an abundance of caution, just to rule out potential diseases.

Cigarettes: Quitting Causes a Chain Reaction

Diseases are contagious, and so, it turns out, are behaviors like quitting smoking. Researchers at Harvard and the University of California at San Diego have found that a person in one part of a social network was 20% more likely to quit smoking if a person in another part of that network quit, even if they were several degrees removed from each other, or even--remarkably--if they didn't know each other at all. The person quitting influences others who eventually influence you.

CPR: One, Two, Three, Four, Stayin' Alive

Properly performed, CPR can triple the chance that someone survives a heart attack, but even the best-trained Good Samaritans can have trouble finding the right rhythm and pace for the chest compressions. Unless, that is, they're disco fans. A 15-doctor study found that teaching CPR to the tune of the Bee Gees' song "Stayin' Alive" (the snappy anthem of the movie Saturday Night Fever) helped students perform the compressions at the proper speed and pace on a test five weeks later. Who said disco was dead?

Cerebral Palsy: Epsom Salts Lower Risk

Advances in neonatal care make it possible to save more and more premature babies, but while the preemies' lives are spared, their brains may not be. Preterm birth accounts for about a third of all cases of cerebral palsy (CP), a developmental disorder that strikes 2 out of every 1,000 U.S. newborns. Some experts predict that as the number of preemie survivors climbs, the population of kids with CP will move in lockstep. But a study of 2,241 pregnant women has delivered encouraging news. Researchers found that if mothers take magnesium sulfate--commonly known as Epsom salts--just hours before giving birth at 24 to 31 weeks of gestation (40 weeks is full term), the odds that their infants will develop moderate to severe cerebral palsy drop by almost half.

D

Day Care: A Weighty Choice

Parents have long anguished over whether they should send their preschool kids to day care, and thus far, the mixed bag of research hasn't been much help. Some studies show that day care boosts academic performance, while others say toddlers have fewer behavioral problems if they stay home. For parents, the should-we-or-shouldn't-we decision only got tougher in July when a paper published in the Archives of Pediatric and Adolescent Medicine found that over a nine-month period, babies in day care gain 0.4 lb. more than those who stay home. The researchers--who studied more than 8,000 9-month-olds--suspect that infants in day care are heavier than those cared for by a parent because they have less structured eating habits. Sometimes weight gain can be a good thing for infants who are underweight, but for others, it could be a risk factor for developing childhood obesity.

F

Fertility: New research yields fresh insights into courtship, conception and when our baby-making years stop

MEN

Women aren't the only ones with a biological clock. New studies show that men have one too--and it may slow down early, around age 24. As with women who conceive past their peak, older men also increase the odds of having a child with an abnormality like autism or Down syndrome. One study of couples undergoing fertility treatments found that the father's age had as big an effect on conception and miscarriage as the mother's. Another study showed that men older than 40 were more likely to have a child with bipolar disorder.

MENOPAUSE

Every woman over age 35 is mindful of menopause, but it's impossible to know how fast it's coming. That may change soon, thanks to scientists at the University Medical Center Utrecht in the Netherlands. Earlier this year, they discovered that a simple blood test that detects the anti-Mullerian hormone (AMH)--a chemical that helps track egg supply--can predict when a woman will enter menopause. A high AMH level shows that the woman's ovaries are still releasing lots of eggs. By comparing levels of the hormone in women ages 25 to 46 with those of postmenopausal women 58 to 70, the researchers were able to establish cutoff points that could portend when the change will occur and, by implication, suggest how many years of fertility are left. More research still needs to be done, but it may not be long before women are able to predict their fertility timetable much more accurately.

WOMEN

Listen up, especially if you're thinking of having a child: a UCLA study has shown that women's voices get higher (and more alluringly feminine) as ovulation (and increased fertility) approaches. Researchers recorded the voices of 69 women during high- and low-fertility phases and found that as fecundity climbs, so does pitch. Surprisingly, voice changes occurred only when the women spoke an introductory sentence ("Hi, I'm a student at UCLA") and not when they pronounced vowels. This could suggest that the variation happens just when people are conveying a message, and so it's done, unwittingly, for effect. The research adds to a chorus of studies demonstrating that humans exhibit other cues, such as dressing differently, around ovulation. As for women who are ovulating and don't want to advertise that fact? Try e-mail.

G

Gardasil: Vaccine Battle?

It's the first vaccine for the sexually transmitted human papillomavirus, which causes genital warts and cervical cancer. But girls vaccinated with Gardasil since 2006 have experienced some serious side effects, including seizures and fainting, and 27 teens died after receiving the shot. An ongoing study is investigating whether these events were caused by the vaccine; health officials say the shot is safe.

Global Warming: A Hot Earth Could Worsen Allergies and Kidney Stones

It may not rank with rising sea levels and crippling drought, but hay fever is one more thing global warming is likely to make worse. A study in the September Journal of Allergy and Clinical Immunology found that increasingly early pollination of olive trees in Spain led to higher pollen counts overall. Similar outcomes can be expected in temperate areas elsewhere as the earth warms. That's bad news for everyone--particularly the 300 million asthmatics around the world. Research published in the Proceedings of the National Academy of Sciences also links rising temperatures to an increase in kidney stones--a condition related to dehydration. In 2000 some 40% of Americans already lived in warm parts of the country considered kidney-stone risk areas. That number is expected to reach 70% by 2095. There has also been an increase in the number of children with kidney stones over the past year. But don't blame global warming: the real cause may be too many salty snacks.

Genetically Modified Foods: China Has the World Worried

China is charging into the 21st century--but its food-inspection system is mired in the 19th. Last year saw a series of tainted-food scandals. But consumers are just as concerned about genetically modified (GM) crops. The country is pumping funds into genetic research in the hope that better crops will help the land of 1.3 billion people feed itself. Given the gaps in China's food-safety net--and the potential for GM food to get out of control--that possibility is worrisome.

Gymnastics: Graceful, Exciting--And Disturbingly Dangerous

Gymnastics can be the most nail-biting event of any Olympics--but the worry isn't always over who'll win the gold. The first national study of gymnastics injuries, conducted by Nationwide Children's Hospital in Ohio, shows that gymnastics is among the most perilous sports for girls. Analyzing records of patients ages 6 to 17 who were treated in emergency rooms from 1990 to 2005, the study found that an average of 5 out of every 1,000 young gymnasts each year--about 27,000--required medical attention for injuries ranging from sprains to nerve damage. Safer equipment and better training methods, however, may be making a difference. Injuries fell 25% over the 16-year period.

H

HIV: The Hunt for the Elusive Vaccine Goes On--and On

The road to an HIV vaccine hit another gully when the U.S. government canceled a trial of its most advanced experimental formula to date. The two-shot injection was similar to one that Merck developed and scrapped in 2007, after initial results showed that not only did it fail to protect against HIV, but in some cases it actually increased the risk of infection. Both vaccines were designed to test a new approach, one based on activating the body's cell-based immunity, in which killer immune cells take a more dominant role than antibodies in attacking HIV. Experts now believe not enough is known about this strategy to make a large-scale trial useful--yet. Researchers are hopeful the approach still holds promise; smaller studies are under way to work out how best to harness the body's virus-fighting cells.

I

Inflammation: Putting Out The Fire in the Heart

If you've struggled to lower your cholesterol levels to some presumed "safe" zone, you might have wondered how much good all that work did when you learned that half of all heart attacks occur in people with normal cholesterol. The good news is, researchers have fingered a culprit: inflammation, which may be as important as cholesterol in causing heart disease. The better news is that a test for something called C-reactive protein (CRP) can tell you your risk. If it's high, the same statins that help control cholesterol can lower CRP as well. In one study, people with high CRP who took a particular statin had 54% fewer heart attacks than those given a placebo.

K

Knee Surgery: Doubts About A Popular Procedure

One more reason to think twice before you have arthroscopic knee surgery for osteoarthritis: a study published in the New England Journal of Medicine suggests that the procedure does no better at relieving symptoms than physical therapy or anti-inflammatory drugs. What's more, patients who do feel improvement after surgery may merely be experiencing a placebo effect. This finding echoes a 2002 government study showing that outcomes were similar whether a patient underwent real arthroscopic surgery or a sham procedure in which an incision was made but no actual work was done. That study prompted Medicare to drop coverage for the surgery as a treatment for osteoarthritis.

L

Lung Cancer: Genes Identified

Smoking is the leading cause of lung cancer, but how is it that so many smokers never develop the deadly disease? A collection of reports in the U.S. and Europe may have found an answer in the genes. Researchers identified two gene variants in 34% of the population that code for cell-surface proteins that in turn bind to nicotine molecules. Clamp nicotine to the cell this way, and dramatic changes can result, including amplified growth of blood vessels in the lungs, which can create an environment particularly well suited to greedy cancer cells. The studies determined that smokers who had one of the gene variants were 28% more likely than other smokers to develop lung cancer, and those with both had a staggering 81% higher risk. What's more, researchers found that smokers who have either of the gene variants may have a greater tendency toward nicotine addiction and are likely to smoke more often during the course of a day.

M

Math: Girls Catch Up with Boys, And the Gender Gap Disappears

We've all heard it before: boys are simply better at math than girls are. But according to a new study published in Science, the math gender gap has vanished. Previous studies showed that boys start to outscore girls in math once they reach high school. Information gathered last year from the math tests of 7.2 million kids in Grades 2 to 11 in 10 states, however, revealed that there are no longer any significant differences between boys' and girls' average scores. Similarly, an equal number of both sexes were found to perform so well that they ranked among the highest mathematical achievers. Scientists say the results show that more girls are taking math courses and, most important, sticking with them as they get older.

Malaria: The Global Tally Drops

Good news--well, sort of. Earlier this fall, the World Health Organization cut its global tally of malaria cases in 2006 at least 40% from the previous year's estimate--but that still means there were 247 million cases in 2006. The drop had less to do with a real improvement in health than a simple change in number-crunching. Once figures from India and elsewhere in Asia were updated, the numbers fell. In November 2007, the U.N. came under fire when it overestimated the number of HIV cases worldwide by more than 6 million, an act that critics say was used to spur donations. No matter how the calculations are done, epidemiologists warn that the math will always be tricky.

O

Obesity: You Can Beat Your Genes

Everyone who has struggled with losing weight knows that sometimes the spirit is willing but the genes are weak. Still, there's hope: a study of the Amish found that even people with a genetic predisposition to gain weight can control their body size. Some subjects carried a fattening variant of the FTO gene associated with obesity. The Amish FTO carriers were indeed an average of 7 lb. (3.2 kg) heavier than people without the gene. Even within this subgroup, however, some were able to avoid getting fat--thanks to simple exercise. The catch was that it took a lot more physical activity for people with the gene variant to stay slim than for those without it. Still, in this one case, we can apparently nurture nature.

Obesity: Levels Hit Plateau for The First Time in Decades

Finally some headway in the fight against childhood obesity. For the first time in nearly three decades, the epidemic may be leveling off. Last May, a study published in the Journal of the American Medical Association found that the prevalence of overweight and obese kids in the 6-to-11-year-old age group appeared to have hit a plateau of about 32% from 1999 to 2006. Experts say that the leveling off may be due not to better diet and exercise but to the possibility that we've hit a sort of genetic ceiling, with the entire population of children susceptible to gaining too much weight having done so.

R

Reading: A Novel Way to Lose Weight

How do you convince overweight kids to get serious about losing weight? Get them to read. Dr. Sarah Armstrong, director of the Healthy Lifestyles Program at Duke Children's Hospital, enrolled 31 obese girls in a six-month comprehensive weight-loss program and had them read a novel whose protagonist is an overweight teen who learns to eat and live more healthfully. Another group of girls in the study read a book that did not have an overweight heroine, and a third group read nothing. At the end of the weight-loss program, the girls who had read the book about the overweight character lost more weight than did those in the two other groups. Sometimes, it seems, the most persuasive voices don't have to come from the real world at all.

S

Statins: Grade-School Kids On a Middle-Age Drug

With obesity rates among youngsters remaining high, the American Academy of Pediatrics took a drastic step by recommending cholesterol-testing for kids as young as 2. The move is targeted at children whose families have a history of elevated cholesterol and who might benefit from cholesterol-lowering drugs known as statins. Some doctors view the move as a defense against the possibility of a generation of unhealthy kids living shorter lives than their parents did. Others worry that the policy could expand the use of statins to kids without giving them the chance to make tough changes in the behaviors that led to their weight and cholesterol problems in the first place.

Salmonella: A One-Two Punch

It took nearly four months for the FDA to clean up the damage from the largest outbreak of food-borne illness in more than a decade. The culprit: some contaminated jalapeNo and serrano peppers that were exported from Mexico to the U.S. early last spring. In the end, at least 1,440 people in 43 states became sick from salmonella, a potentially life-threatening bacterium. By August, the FDA had finally lifted its warning on the peppers and some tomatoes and promised consumers it would tighten safety regulations. Not long after that crisis passed, a milder one struck. Thirty-two people in 12 states came down with salmonella in October after failing to cook a brand of frozen chicken dinners--which appeared to have already been cooked--thoroughly enough.

Stem Cells: Brave New World

Score one for the scientists. Seven years after the Federal Government banned the use of most embryonic stem cells, investigators have found ways to generate stem cells without using politically and ethically charged embryos at all. For the first time, scientists at Harvard developed motor neurons from a patient with Lou Gehrig's disease, using just some skin cells and four genes. And in another first, their colleagues managed to generate insulin-producing cells from pancreatic cells simply by manipulating the two to switch identities, bypassing the stem-cell step altogether. Both are research milestones that also make it possible for scientists to watch diseases unfold in a petri dish and eventually, they say, develop new cures.

T

Testosterone: Does It Make You Money?

Testosterone levels among traders were higher on days when they made better earnings, and the higher their morning levels were, the more money they tended to make by the end of the day. But chronically high levels blur the perception of risk--and after the crash of 2008, we know what that can do.

Transplants: Get the Organ And Hold the Drugs

Few things are more tragic than desperate transplant patients who finally receive a long-awaited organ only to have their bodies reject it. Now there may be a way to prevent that. In a study of five kidney-transplant patients whose donors were not exact matches, doctors primed the recipients' immune systems by lowering their level of protective T cells, then gave them some of the donor's bone marrow at the time of surgery. This created a sort of hybrid immune system. Four of the patients accepted the kidneys and were able to go off immunosuppressive drugs within a year of surgery.

Television: A Teen-Pregnancy Link

Television's influence on young viewers is a perennial hot topic. Now a Rand Corp. study gives parents one more reason to worry: too much TV may be associated with teen pregnancy. On the basis of phone surveys with 718 teens ages 12 to 17, researchers found that girls and boys exposed to high levels of sexual content on TV were twice as likely to be involved in a pregnancy by age 20 as were kids who watched less. This follows research that revealed a link between exposure to sexy TV and earlier initiation of intercourse. The investigators point out that not only do TV characters obsess about sex but they also don't think much about contraception--a reckless message for impressionable kids.

V

Vytorin: Science Vs. Hype

If one cholesterol-lowering drug is good, two must be better. That was the thinking behind Vytorin, a combination of Merck's Zocor and Schering-Plough's Zetia. Not so, it turns out. A study of 750 patients showed that while the combination did lower bad cholesterol, or LDL, it did little more to reduce the dangerous buildup of plaque than Zocor alone did--which costs far less than the combination drug Vytorin.

Z

ZZZ: Don't Let This Keep You Up

Troubled sleep can cause problems for anyone, but for women, the consequences may be even more dire. In a study of 210 men and women, Duke University researcher Dr. Edward Suarez found that women who slept poorly had elevated levels of several risk factors for heart disease and diabetes--including cholesterol, insulin, glucose, inflammatory proteins and the clotting agent fibrinogen--but men who tossed and turned did not. The reason may have something to do with testosterone. Men who reported the most difficulty sleeping also had the highest levels of testosterone, which is known to reduce concentrations of heart-damaging inflammatory proteins. It's not certain if testosterone somehow contributes to the sleeplessness or if it's somehow released protectively in men who don't get enough z's. No matter such details; for both sexes, better sleep will almost always mean better health.

From Across the Pond, along with Mary Poppins, Paracetamoxyfrusebendroneomycin!

[Hat tip to Dr. Joan Bushwell's Chimpanzee Refuge blog, for bringing this Amateur Transplants masterpiece to our attention and with all apologies to all those who know have the Mary Poppins tune stuck in their heads.]

And wishing you a very funny New Year!

On Ending Periods...

American Journal of Bioethics' Editor-in-Chief Glenn McGee writes a thoughtful, fascinating. and provocative column on human nature and the end of periods in the Scientist today:

"For decades, fertility research has successfully decoupled sex from reproduction, forever altering women's position and power in the developed world. Among all methods of contraception, none is as well known or influential as 'the pill.' Now, its power has been kicked up a notch, and the pill is poised to do what some say will disrupt the very nature of the XX sex. This leaves us with one question: In the next step of the evolution of women's contraception, should we eliminate the last major physical manifestation of the reproductive cycle, menstruation?"

For the complete article, click here. And to let us know what your thoughts are on this matter, take our survey (to the right) or comment here on our blog.

On Youth, Beauty, and Lipodiesel.

An odd configuration of stories, all with bioethical implications:

Youth: COULD artificially raising levels of a key enzyme hold back the effects of ageing? A step closer to the fountain of eternal youth?

Beauty: For many cancer patients undergoing mastectomies, reconstructive breast surgery can seem like a first step to reclaiming their bodies.

Lipodiesel: ~ The Love Handle Express?: Former Beverly Hills doctor powered his SUV with fat removed from his patients. (Without their consent, I dare say.) Ewww. His Lipodiesel website is no longer online and he's packed up shop and moved to South America. Sounds like a plot line for Nip/Tuck.

Week in Review

Whatever it is you may celebrate at this time of year, we at the Women’s Bioethics Project wish you a happy and healthy holiday! Here is our week in review:

~ Rat embryonic stem cells created; genetically engineered rats should follow soon, providing new models of human disease.

~ AAAS workshop report recommends how to address education for scientists about biosecurity and the dual use dilemma for federal government, research institutions, and scientific organizations (co-authored by Mark Frankel).

~ An analysis of biosecurity policy in the context of gene synthesis. How much is too much regulation?

~ Biodefense Research: A Win-Win Challenge. An editorial proposing the optimal level of oversight of life-sciences research—coauthored by a number of National Science Advisory Board for Biosecurity (NSABB) members, including Susan Ehrlich.

~Pfizer must pay $38.7M for stealing data from research center. Hope it was worth it, guys.

~Top 10 hospital hazards linked to medical devices. This one’s a delight. They’ve even got a special name for articles left behind in you during surgery. Retained medical devices and “unretrieved fragments.”

~ Oregon Health & Science University study shows that a nurse-managed, computerized system extends the lives of elderly patients.

~ Stopping ovarian cancer by blocking proteins coded by notorious gene.

~ FDA verdict could determine future of personalized medicine.

~ Mice that inhaled cigarette smoke 5 hours daily avoided lung damage by ingesting a drug. Smoke ‘em if you got ‘em? No ~ Still not a good idea.

~ Genes affect tissues differently—and this could affect how likely a person is to get a disease.

~ Bowel cancer link to stem cells.

~ Even with additional education, the public may not trust and accept that nanotech is safe. No small task ahead of nanotech to gain acceptance and support.

~ AstraZeneca considering move into “biosimilars.” Could be part of a trend—Merck and Lilly have revealed similar plans.

~ State cord blood bank nearing reality in Indiana.

~ Rep. Pete Stark (D - Calif) says no health reform vote is likely in ’09. Just too many other things to get to.

~ Budget cuts threaten disaster plans for pandemics, natural disasters, and bioterrorism. The sad irony is progress had been made in the quality of plans.

~ Speaking of pandemics, HHS says health, emergency staff should get drugs first in the event of a such public health challenge.

~ Next steps for progressive stem cell politics.

~ Obama’s stimulus plan to include healthcare IT.

~ Leaflets accompanying new prescriptions inconsistently provide consumers with key safety data and other information. Apparently, the quality of these things is all over the map, and not regulated.

~ Some toddler deaths from cold drugs due to nontherapeutic use. In other words, the drugs were deliberately given to sedate or kill (as opposed to accidental overdoses).

~ Wine may boost omega-3 levels, despite fish intake or lack thereof. Well, cheers to you this holiday season!

~ Strange sleep disorders. Yes, folks, nightmares can kill. And REM sleep disorders could be an early sign of Alzheimer’s or Parkinson’s.

~ Incest may not be best, but marriage bans should be rolled back, scientists say. (Any Biblical prohibitions notwithstanding.)

[Thank you to Lisa von Biela, JD candidate, 2009, UMN, Editor of the BioBlurb, from which this content is partially taken and edited. BioBlurb is a weekly electronic publication of the American Bar Association's Committee on Biotechnology, Section of Science & Technology Law. Archived issues of the BioBlurb, as well as further information about the Committee on Biotechnology, are available here.]

Top Ten Neuroscience Trends in 2009

[Cross posted from Brainwaves.corante.com] Here are ten emerging areas of neuroscience that will impact the future of treatments for brain and nervous system which were published as a result of the cutting edge research being presented at the Society for Neuroscience Conference held in Washington DC last month. Top 10 Trends of 2009:

1. Epigenetics leading to new treatment targets: New research highlights the critical interactions of genes and the environment in brain health and development revealing new treatment strategies and potential therapeutic targets for obesity, memory loss, addiction and mental illness.

2. National Neurotechnology Initiative Act: Momentum for this recently introduced legislation which provides $200M a year for federal R&D aimed at accelerating translational neurotech innovation and improving the effectiveness of FDA review process for neuroscience drugs, devices and diagnostics grows.

3. New Sources of Stem Cells: The discovery of new sources of neural stem cells are opening up new avenues and potentially whole new treatment strategies for stroke, vision loss, hearing loss, Parkinson’s, Alzheimer’s, and ALS.

4. Deep Brain Stimulation: New clinical research into the use of deep brain stimulation devices for the treatment of neurological diseases and psychiatric illnesses continues to provide new hope to those suffering from drug treatment forms of these illnesses.

5. Addiction advances: New research that clarifies the role of impulsivity in treating cocaine addiction and synaptic plasticity in the control of inhibitory circuits could potentially lead to new treatment strategies for this epidemic impacting over 1.1 billion worldwide.

6. Stress prevention: New research shows that even a few hours of stress can reduce neural connectivity and that chronic stress, in particular early in life, can shrink critical areas of the brain. These findings may lead to new treatment strategies for PTSD and other anxiety-related disorders.

7. Traumatic brain injury advances: Early detection proves important for effective treatment while new research into inflammation may provide new treatments for people with brain injuries and stroke.

8. Get your sleep: More research points to the critical role that a proper night’s sleep plays in the memory consolidation, learning and mental illness further validating the need for effective therapeutics which engender healthy sleep patterns.

9. Discovery tools underpin innovation: New imaging techniques coupled with advances in neuroinformatics, image-based neural circuit analysis, and neural computation are accelerating the pace of neuroscientific discovery beyond what was imagined a decade ago.

10. Neuroscience infiltrates society: From neurofinance, neuroeconomics to neuroesthetics to neuroethics and neurolaw, the influence of neuroscience on society continues to grow.

AND if you are interested in more, check out the Neuroscience Summer Boot Camp 2009 for Non-Scientists, Aug. 2-12, 2009 at Penn.

Water Fluoridation in Burlington

Greetings bioethics bloggers and thank you Linda for the invitation to post here. I have been a casual reader for some time now, but this will be my first contribution. For those who don't know me, my name is Kevin Hurley and you can read more about me here. I moved to Burlington about three years ago with the intention of getting involved in the production of educational/environmental media.

When I think of the word "Fluoride" I immediately think of healthy teeth. The word sounds harmless and friendly. Originally, I was very supportive of water fluoridation. I became interested in the issue about three years ago and have since spent a good deal of time traveling the country and world interviewing an array of professionals on the issue. I've interviewed toxicologists, fetal-toxicologists, neuro-toxicologists, dentists, doctors, politicians, lawyers, risk assessment scientists, etc. Among those interviews were three of the panelists from the National Academy of Science's National Research Council charged with reviewing the current EPA standards on fluoride. I must now humbly admit that I was wrong in my previous beliefs about water fluoridation. It appears that most of the new evidence about this practice shows that the risks of fluoride exposure to ourselves and our children are just not worth it.

Let's take a look at some recent developments:

1. In 2006 the National Research Council released a report entitled: Fluoride in Drinking Water. This report reviewed a huge body of old and new science relevant to water fluoridation and concluded that the allowable limits of fluoride are too high. It concluded that infants/children may be getting 3-4 times the dose of fluoride that adults do. It also identified "vulnerable subsets" of the population, including infants, diabetics, kidney patients, and seniors who more at risk of problems due to fluoride toxicity.
   
2. In response to this report, the American Dental Association changed their position on the use of fluoridated tap water ad infant formula in a warning stating that: "If using a product that needs to be reconstituted, parents and caregivers should consider using water that has no or low levels of fluoride.
3. In 2008 the National Kidney Foundation discontinued their support of water fluoridation stating that: "Individuals with CKD (Chronic Kidney Disease) should be notified of the potential risk of fluoride exposure..."
   
4. 23 new studies indicating that children from areas of higher fluoride exposure experience I.Q. deficits were acknowledged by the NRC. The panel found that the research seemed to be consistent enough to warrant further investigation.
   
5. In 2006, Elise Bassin's Harvard report was published. It showed a definite link between young boys who are exposed to fluoride during the ages of 6 and 8 and a 4-fold increase in their chances of developing osteosarcoma. The study found no link with girls. The study was described by the Washington Post as the most rigorous fluoride/cancer study ever done. It is known that fluoride is mutengenetic and therefore is a likely candidate for being carcinogenic as well.
   
6. Dr. Jennifer Luke's research found that fluoride was readily depositing in the human pineal gland ("The seat of the soul" or "The thousand petaled lotus") at the highest concentrations in the body (20,000ppm - more than 10X the concentration of fluoride in your toothpaste). This is especially alarming considering that this calcifying gland produces Melatonin and is so intimately connected with everything circadian. She thinks there maybe a connection between fluoride depositing in the pineal and the findings of the Newburgh-Kingston study showing that girls in fluoridated Newburgh were reaching puberty on average six months before girls in non-fluoridated Kingston.

There is little dispute that fluoride reduces tooth decay. Its primary effect, however, is topical. It works by brushing it onto the surface of the tooth using toothpaste or gels/varnishs given in the dentist's office. According to CDC and Department of Health and Human Services data, however, water fluoridation has NO correlation to healthy teeth. Sometimes health officials will argue: "Look at the rate of tooth decay in Burlington compared to Brattleboro. Obviously fluoridation makes a difference!" Obviously? Obviously we have not taken into account access to good dental care, or even the general socio-economics of the areas. When looking at two very specific cities, there are too many variables that could influence the average health of teeth. Again, this is why it is important to look at the whole population. I've yet to find any proof that water fluoridation is effective.

So what does all of this have to do with bioethics? Let me pose some questions.

• Let's pretend that water fluoridation does help to prevent tooth decay. Remember, fluoride has no other purpose in the water other than to prevent the disease, dental caries. It is not used to kill the bugs and make the water safe to drink, only to prevent a disease. U.S. law defines any substance intended to treat, mitigate, cure, diagnose, or prevent disease as a drug. Even if water fluoridation did reduce tooth decay, what are the ethics of using the public drinking water to deliver an uncontrolled dose of a medication? Does this set a precedent?
  
  
• If the distribution of fluoride chemicals to Burlington residents via the public drinking water is, in fact, the distribution of a drug, how do we account for the vulnerable people in our community who are more at risk for the adverse effects? Now that we know that infants are not supposed to receive fluoridated water, what are mothers in the low-income range supposed to do? What are kidney patients supposed to do now they we know they are more harmed by fluoride in the water? Can we ethically justify forcing this chemical into the drinking water of everyone, for the purpose of reducing tooth decay in a small population when 1) We know that it is ineffective at reducing tooth decay, and 2) we know that it poses increased risks to vulnerable people in our community?
  
  
• Let's not forget the actual chemical we, here in Burlington, add to the municipal water. Hydrofluorosilisic acid, is an industrial waste byproduct of the phosphate fertilizer manufacturing industry. Without communities willing to purchase this for water fluoridation it would be regulated by EPA as a hazardous waste. Claims by health authorities that it completely dissociates in water and thus behaves the same as the pure fluoride ion are unsubstantiated and untested so far as I can see. Science on these silicofluoride compounds is sparse, but what science does exist indicates that they do not behave the same way in water. Silicofluorides have been linked to increased lead up-take in children and increased violent behaviors in children (Masters Coplan).
  
  
• 32% of children in the United States have a condition called dental fluorosis according to the CDC. Dental fluorosis is white or brown flecks on the surface of the tooth that is caused by ingesting too much fluoride. Some consider this a disease, however the CDC considers it a "cosmetic defect". Regaurdless of what we call it, it is damage done to the tooth as a result of overexposure to fluoride. You might call your local dentist and as them how pricey it is to repair a single tooth that has fluorosis. At a minimum, do we have the right to add something to the water that we know causes damage others?
  

Being in opposition to water fluoridation is not a popular position in the US. But the fluoridation chemicals that we use in the water do not respect these politics. The words "safe and effective" and "sixty years of research" can not be repeated enough to convince the fluoride ion to stop depositing in the pineal, or to stop damaging the teeth and bones. Does the inertia of a policy justify its continuation now that we know its harmful effects? I understand that science and politics move slowly, but remember, at one point 9 out of 10 dentists recommended smoking Viceroys. Once upon a time things like lead, asbestos, and DDT were safe too. We do have the ability to be wrong, but we also have the ability to correct those errors when new information becomes available. If we really believe that fluoride is "safe and effective" based on the science than, by all means, let us keep adding it. But if you haven't researched it, I would highly urge you to do so.

Thank you.
Kevin Hurley

LIfe Imitating Art: Twenty seconds into the future

I just had flashback to the eighties when I saw this headline:

Dreams may no longer be secret with Japan computer screen.

Does anyone else remember the Max Headroom episode entitled 'Dream Thieves.', where unscrupulous entrepreneurs steal people's dreams and sell them to the highest bidders? (as visions of privacy lawsuits danced across my head.)

What next? Neurostim, a device to directly stimulate the brain and bypass the need to use television for advertising? Naaahhh, too sci-fi, right? Or not.

The Dignity of a Person

The Catholic Church released their Dignitatis Personae on Friday, which is an update of the 1987 Donum Vitae. Dignitatis Personae is the most up-to-date view of the Catholic Church on assisted reproductive technologies, and it spells out clearly what and why the Vatican approves (or in this case, largely disapproves) of most modern reproductive options.

It's been 21 years since Donum Vitae, and technology has made incredible leaps forward: IVF, intracytoplasmic sperm injection, all kinds of surrogate motherhood, PGD, etc. And most of these leaps are condemned by the Church.

It's my own personal opinion that it's necessary for everyone involved in bioethics to understand the Catholic position, regardless of your personal or professional inclinations. The Church has a powerful lobbying group, especially in states in the northeast of the United States, and this document has the ability to affect many people simply because it does clear up a lot of the grey areas that existed in Catholic doctrine.

Reading the Dignitatis Personae is an exercise in patience and self-control; it's hard to resist the urge to go wake someone up to have someone to discuss such wince-inducing logic as this: This ethical principle, [ed- that life begins at conceptions] which reason is capable of recognizing as true and in conformity with the natural moral law, should be the basis for all legislation in this area. I can tell you with full certainty that such 'reasoning' (a term I use loosely) would fail a philosophy 101 test. But if you can get through the document, you'll learn that the fresh-off-the-newstands update to Catholicism forbids any reproductive act that does not result in fertilization and implantation happening as a result of the sexual act between a married couple. Or put more simply: if the technology assists in intra-uterine conception, YAY! If conception occurs outside the uterus, BOO!

For better or for worse, the Catholic position is at least internally consistent - and for this I certainly give credit where it's due. There's very little cherry-picking of preferences; life begins at conception, all conceived embryos deserve full moral status of a human, etc. But aside from theological and philosophical differences, two things in the Dignitatis Personae stand out to me as worthy of further discussion and debate.

The first is the idea that

"The origin of human life has its authentic context in marriage and in the family, where it is generated through an act which expresses the reciprocal love between a man and a woman. Procreation which is truly responsible vis-à-vis the child to be born “must be the fruit of marriage”.

Put plainly, and as I said above, children must be conceived through sexual intercourse. Their conception at fertilization in the woman's body is when they become ensouled. What then, does this mean, theologically, for the multitudes of people now being born outside of this very narrow definition of procreation? It's not an answer I have, it's not an answer that is clear in the Dignitatis Personae, and it's definitely not an answer that anyone my local Catholic Conference has been able to answer. So it is a lingering question, and one that should be answered.

The second, and much larger issue, is the chapter on "The use of human “biological material” of illicit origin". This chapter discusses the obligation of researchers to refuse to use materials of illicit origin - that is, human cell lines obtained from stem cells, aborted fetuses, etc. Many, if not most, news outlets are reporting this to mean that the Vatican has said that Catholics may not use vaccines which are grown on human cell lines created from the lung tissues of aborted fetuses (the Meruvax rubella vaccine, at the very least).

Reading the chapter, though, instead of relying on news reports, gives a slightly different interpretation. While the document is clearly against researchers using any biological material of so-called illicit (theologically) origin, and suggests that ethical researchers will refuse to use these mediums, it draws a different line for the general public. The document allows that

Grave reasons may be morally proportionate to justify the use of such “biological material. Thus, for example, danger to the health of children could permit parents to use a vaccine which was developed using cell lines of illicit origin, while keeping in mind that everyone has the duty to make known their disagreement and to ask that their healthcare system make other types of vaccines available.

Unfortunately, this again raises more questions than it solves. If there is such a thing as a single grave reason that may be morally proportionate to justify the use of illicit biological material - vaccinating your child from a deadly disease - then why are there not other grave reasons? Isn't this suddenly a large degree of "wiggle room" that will allow individuals an out, who can say that this document is not intended for the lay Catholic but the scientist Catholic, the researcher who spends their life in this and thus needs to consider ethics and morality at a different level than the average person (or at least average Catholic)?

As I said, more questions. But in all fairness, I can't say more questions than answers, since the document clearly gives answers that people have been wondering about for the last 21 years.

Give it a read this morning over your coffee, tea, breakfast, and see what you think the impact of this document will be.
-Kelly Hills

Engage with Grace about end-of-life wishes

It's the holiday season, and many of us will be spending time with family and friends. At some point between the wassail bowl and the mistletoe, you might find yourself in a conversation about what matters to you and your loved ones. Perfect opening for this: the Engage with Grace project, a public-service campaign designed to help all of us communicate with those who are dear to us about our--and their--end-of-life wishes.

Why have this conversation? Because, while most of us want to die at home, many of us don't. And while most of us believe (or at least tell opinion surveyors) that our loved ones know what we would want, they don't.

The solution? Talk with your loved ones!

Engage with Grace's 5 questions is a great starting point.

For Just a Dollar a Day...

Could you feed yourself for a dollar a day? That's the question two social justice teachers in California asked themselves in September, and they blogged the month long results.

This might not be news for a lot of people, since it seems like the couple received some pretty significant press. But I can do a good job at hiding from the media when I want to, and I managed to miss this particular story. In part, I find myself intrigued by the idea of cutting cost and unhealthy ingredients from my diet, as well as reducing portion sizes. It's hard to argue with the idea that as a country and on the whole, we eat too much, and too much of the wrong things.

The things Christopher and Katie discovered won't be a shock to anyone who's read Michael Pollan. Fresh fruits and vegetables will disappear from your diet, and if you want to genuinely find something even moderately healthy, you will have to make it - from scratch - yourself. It takes time and saps energy.

While this might just seem like a stunt to get attention, keep in mind that living in poverty is defined as living off $1 a day for food. Also keep in mind that Pablo Monsivais and Adam Drewnowski of the University of Washington have recently determined that as junk food becomes cheaper ($1.76/1,000 kcal), the cost of nutrient-rich, low calorie foods continues to skyrocket ($18.16/1,000 kcal).

The holidays tend to be a time of excess when it comes to food, so it might not be the best time to suggest looking at your own grocery budget. But it might be eye opening to figure out just how much it costs you to live per day, at least when it comes to food and liquids. Eye opening doesn't necessarily mean change, but a spot of awareness never hurts.
-Kelly Hills

On our nonprimate relatives...

For those interested in animal personhood, there are two must-see Wired Science links: here and and here. It seems that canine cognitive scientists at the Clever Dog Lab have demonstrated that dogs have a well-developed sense of fairness vis a vis unequal rewards for the same behaviour, leading to agitation in the dogs that perceive themselves to be on the short end of the stick. The top ten amazing animal videos are all charming and worth the few minutes it takes to scroll through the You Tube videos. My favorite? Jessica the hippo.




- Terry Tomsick

[Editor's note: And if you are wondering what, if anything, is unique about us, researcher Bekof of the first link notes that 'we're the only species I know of that cooks food and w[e have an] incredible propensity for evil.' The comments following that are also worth the read.]

NYTimes: The Evidence Gap. The Pain May Be Real, but the Scan is Deceiving

Gina Kolata has an interesting piece in the NYTimes right now, looking at the gap in evidence between use of scanning technology like MRIs and CAT scans to track down causes of pain, the discovery of a problem, and whether or not fixing the problem found via scan fixes the actual problem.

This hits home for me, because several years ago I went through a long series of scans to see what in the world was possibly causing the severe pain in my right arm. The MRI eventually discovered a disc bulge very high up in my c-spine, at an area that would have significant risks attached to surgery. Thankfully, my primary care physician, anesthesiologist and neurologist held a joint meeting with me and took the time to explain not only how to read MRIs, but the number of people who have something "wrong" with them without that "wrongness" being the cause of their pain.

In my case, terror about the risks associated with surgery high on my spinal column evaporated, and I was left with a different diagnosis and management routine for the disease.

But many people aren't so lucky, and go through unnecessary surgery because they have a pain, a scan shows a deviation, therefore the deviation must be linked to the pain. They have surgery, expecting to feel fine after your typical recovery period, and instead, no dice. (And if someone is unlucky enough to have some kind of pain condition that likes to spread when nerves are injured, things could be made even worse.)

Because of this, it's nice to see people - reporters and medical folks alike - are actually taking a look at the prevalence of "abnormal" scan results. Results that, in the end, are not so abnormal after all. However, it would have been nice to see whether or not doctors who realize that disc bulges or torn meniscus's aren't necessarily related to the pain you're feeling treat the pain, rather than the absence of a fixable issue. Knowing you have arthritis and that's the cause of your pain issues means very little if you're not getting pain relief.

Moving away from a concept of a single norm for the body is good - but hopefully as we make that transition, people recognize that simply because there is not a fixable cause to pain, doesn't mean the pain itself cannot be successfully treated.
-Kelly Hills

Five Misconceptions About Health

Here's a brief summary of an article Shannon Brownlee and Ezekiel Emanuel wrote for the Washington Post (reprinted in the Minneapolis Star Tribune):

1. America has the best health care in the world.


Let's bury this one once and for all. The United States is No. 1 in only one sense: the amount we shell out for health care. We have the most expensive system in the world per capita, but we lag behind many developed countries on virtually every health statistic you can name.


2. Somebody else is paying for your health insurance.


Nope. Even when your employer offers coverage, he isn't reaching into his own pocket to cover you and your fellow employees; he's reaching into your pocket, paying you lower wages than he would if he didn't have to pay for your health insurance.


3. We would save a lot if we could cut the administrative waste of private insurance.


The idea that we could wring billions of dollars in savings this way is seductive, but it wouldn't really accomplish that much. For one thing, some administrative costs are not only necessary but beneficial. Tracking the rate of heart attacks from drugs such as Avandia, for instance, is key to ensuring safe pharmaceuticals.


4. Health-care reform is going to cost a bundle.


Only if you think that covering the uninsured is our only priority. Yes, making health care available to all citizens is the right thing to do. But it isn't the only thing to do. We also have to fix the spectacularly wasteful and expensive way doctors and hospitals deliver care.


5. Americans aren't ready for a major overhaul of the health-care system.


A recent study published in the New England Journal of Medicine found that only 7 percent of Americans rate our health-care system excellent. Nearly 40 percent consider it poor. A whopping 70 percent believe it needs major changes, if not a complete overhaul.

I strongly suggest everyone go and read the full article. It's not terribly long, and it offers some pretty eye-opening information. For example, did you realize that the average family of four spends $29,000 a year for health care via taxes, lower wages and out-of-pocket medical expenses? While I knew it was taken out of wages, taxes, etc, I had no idea it was that high.

A lot of these things are part of the broader discussion I've seen in comments on this and other health blogs, so they're worth considering as we go into what will hopefully be a new era of health care in America.
-Kelly Hills

10 Gift ideas for your favorite academic in bioethics.

1. Motivational (or de-motivational, if you want to apply the precautionary principle) poster, to keep your priorities straight.

2. Motivational mug (akin to the poster, the pessimistic's mug, fashioned by the perpetually miserable)

3. Fingerless Gloves, for your favorite bloggers or technophiles.

4. A power tie, to keep you connected, or a Bio-scarf, that features your favorite doomsday scenario.

5. From medical tourism abroad to cultural diversity, a Travel book (on the Touristic Guidings to Glorious Nation of Kazakhstan)

6. Computer accessories to make your desk more, umm, interesting?

7. Genome family pack from 23andme.com (who could resist that?)

8. If you were a fan of Indecision 2008, you might enjoy a Colbert Christmas Yule log.

9. More computer accessories, courtesy of your favorite IVF clinics.

10. The Perfect pet (a lot tidier than the old-fashioned kind and no transgenics involved!)

Montana Ruling Legalizes Assisted Suicide

Late Friday night, a Montana judge ruled that physician-assisted suicide for the terminally ill is legal. According to Judge Dorothy McCarter, "The Montana constitutional rights of individual privacy and human dignity, taken together, encompass the right of a competent terminally (ill) patient to die with dignity."

While the Montana attorney general plans to appeal the ruling next week, for at least the time being, the state joins Oregon and Washington in allowing terminally ill patients the choice of when and how they die.
-Kelly Hills

The Week in Review

Embryo adoption reopens controversy. Back to the question of when does human life begin, and so what are our responsibilities toward all those frozen embryos out there.

Sports gene test available for little kids. So little Johnny has the genes to be a sprinter, push him in that direction (whether he enjoys it or not)? One can also think of more disturbing uses, like using such a test for embryo election (excuse me, I’ve been in a reproductive rights course this semester, so these issues are top of mind!).

Overseas clinical trials under the microscope—concern whether medical and ethical practices are being adhered to in developing countries. Out of sight, out of mind?

Studies show arrogance and abusive behavior by doctors contributes to
medical mistakes, preventable complications, and even death.

More fallout from the economic crisis—rising stress levels, linked to increases in vulnerability to a long list of illnesses and viruses.

Acupuncture beats aspirin for chronic headache. OK, ancient biotech in
this one!

Computer technology can cut into personalized patient care. Need to enter that data before giving that injection! Admittedly, tech can bring efficiencies, but during an actual patient visit, the tech can interfere in a range of ways. Some inconvenient, yet somewhat comical, like the doctor and nurse huddled over the PC trying to find the code for FluMist before giving it to me. Some rather dehumanizing, like the doctor using up half the precious visit time staring at the computer screen and reading aloud the prior entries before even casting an eye or ear in my direction for the day’s visit.

U.S. study weighs lifetime cancer risks from CT scans.

Fibroid growth differs by race and age.

Gene silencing drug shown to block heart failure in mice (targets a
particular strand of RNA).

British team leads stem cell heart surgery that could end need for
transplants. Patch and rebuild that heart!

Stem cells injected into the brain help stroke patient. Incredible.

Bipartisan report finds U.S. vulnerable to bioterrorism attack. Scary stuff.

FDA sets “safe” levels for melamine in baby formula, despite not being able to say what level is really safe. Does that sentence disturb you as much as it does me? Hey, the levels are significantly lower than the Chinese formula, so that is something.

FDA staff says Solvay’s enzyme pill carries pig virus risks. Comforting.

The more incompetent your boss, the greater your risk for heart attack. Probably not a big surprise, but here you go, study results to back up that gut feeling!

And on a positive note, study shows that happiness is contagious! Spread the joy!

[Thank you to Lisa von Biela, JD candidate, 2009, UMN, Editor of the BioBlurb, from which this content is partially taken and edited. BioBlurb is a weekly electronic publication of the American Bar Association's Committee on Biotechnology, Section of Science & Technology Law. Archived issues of the BioBlurb, as well as further information about the Committee on Biotechnology, are available here.]

The TOP 10 Medical/Bioethical Movies You’ve Probably Never Seen

By Emily Stephens

When I got the challenge to write a “Top Ten 2008’s Best…(something)” list, the film major in me cartwheeled, back flipped, and triple-lutzed for joy. This would be a great opportunity to recommend the best medical/bioethical movies of the year.

So, I opened a pristine white word document, stretched my fingers like a concert pianist over my ergonomic keyboard, and then….nothing. I’ve been so busy this year that my list of watched movies reads like this: Dark Night…and…um…Dark Night. (Yes, I saw it twice. And, yes, I’m not ashamed to say so.)

Wow! I really don’t have a life. Some film major I am.

Therefore, I decided to create a Top Ten List for my Favorite Medical and Bioethical movies that you MUST SEE before 2009. So Net Flickers, queue up your lists for some stirring, thought-provoking silver screen moments, ‘cause here I goes:

10. The Smith Family – PBS Documentary 2002

“On her ninth wedding anniversary, Kim’s perfect life is shattered when she learns that her husband Steve has been having affairs with men. Three years later, she discovers she is HIV-positive.”


9. Matewan – 1987
Chris Cooper, James Earl Jones

“Mingo County, West Virginia, 1920. Coal miners, struggling to form a union, are up against company operators and gun thugs; Black and Italian miners, brought in by the company to break the strike, are caught between the two forces. Union activist and ex-Wobbly Joe Kenehan, sent to help organize the union, determines to bring the local, Black, and Italian groups together. Drawn from an actual incident.” - Mitchell


8. Little Man Tate – 1991
Jodie Foster, Dianne Wiest, Harry Connick Jr.

“Dede is a sole parent trying to bring up her son Fred. When it is discovered that Fred is a genius, she is determined to ensure that Fred has all the opportunities that he needs, and that he is not taken advantage of by people who forget that his extremely powerful intellect is harbored in the body and emotions of a child.” - Chapman


7. Lorenzo’s Oil – 1992
Nick Nolte, Susan Sarandon

“Until about the age of 7, Lorenzo Odone was a normal child. After then, strange things began to happen to him: he would have blackouts, memory lapses, and other strange mental phemonenons. He is eventually diagnosed as suffering from ALD: an extremely rare incurable degenerative brain disorder. Frustrated at the failings of doctors and medicine in this area, the Odones begin to educate themselves in the hope of discovering something which can halt the progress of the disease.” - Chapman


6. The Insider – 1999
Al Pacino, Russell Crowe

“This film tells the true story of Jeffrey Wigand, a former tobacco executive, who decided to appear on the CBS-TV News show "60 Minutes." As matter of conscience partially prodded by producer Lowell Bergman, he revealed that, the tobacco industry was not only aware that cigarettes are addictive & harmful, but deliberately worked on increasing that addictiveness. Unfortunately, both protagonists of this story learn the hard way that simply telling the truth is not enough as they struggle against both Big Tobacco's attempts to silence them and the CBS TV Network's own cowardly preference of putting money as a higher priority over the truth.” - Chisholm


5. Paths of Glory – 1957
Kirk Douglas, Adolphe Menjou
(An oldie, but a goodie!)

“The futility and irony of the war in the trenches in WWI is shown as a unit commander in the French army must deal with the mutiny of his men and a glory-seeking general after part of his force falls back under fire in an impossible attack.” - Loh


4. The Manchurian Candidate – 1962
(No, not the lousy Denzel Washington version.)
Frank Sinatra, Angela Lansbury, Janet Leigh

“After Raymond returns from the Korean War as a decorated hero, the other members of his platoon can't really remember what he did to win his medal. Two of the soldiers start having recurring nightmares, and one of them decides to investigate Raymond’s current activities. What dark and sinister secrets are being withheld by the Government and the Army ?” - Tinto


3. The Mighty - 1998
Kieran Culkin, Sharon Stone, Gillian Anderson (like you've never seen her)

“This tells the story of a strong friendship between a young boy with Morquio's syndrome and an older boy who is always bullied because of his size. Adapted from the novel, Freak the Mighty, the film explores a building of trust and friendship. Kevin, an intelligent guy helps out Maxwell to improve his reading skills. In return, Kevin wants Maxwell to take him out places since he is not allowed out unauthorized. Being the social outcasts of the town, Kevin and Maxwell come to realize that they are similar to each other and accept that they are "freaks" and nothing will stop them.” – Thorpe89


2. One Flew Over the Cuckoo’s Nest - 1975
Jack Nicholson, Christopher Lloyd, Danny DeVito

“McMurphy thinks he can get out of doing work while in prison by pretending to be mad. His plan backfires when he is sent to a mental asylum. He tries to liven the place up a bit by playing card games and basketball with his fellow inmates, but the head nurse is after him at every turn.” -Tinto


1. Wit – 2001 HBO
Emma Thompson, Christopher Lloyd

“Based on the Margaret Edson play, Vivian Bearing is a literal, hardnosed English professor who has been diagnosed with terminal ovarian cancer. During the story, she reflects on her reactions to the cycle the cancer takes, the treatments, and significant events in her life. The people that watch over her are Jason Posner, who only finds faith in being a doctor; Susie Monahan, a nurse with a human side that is the only one in the hospital that cares for Vivian's condition; and Dr. Kelekian, the head doctor who just wants results no matter what they are.” - McCurry

Here’s four great flicks that didn’t make my Top Ten list, but certainly came close… Evita (1996), Pi (1998) (hard to watch, but fascinating for anyone who gets migraines), Go Toward the Light (1988 TV), and Dad (1989).

Gestational surrogacy in the NYT

I'm surprised none of my fellow bloggers has posted this yet, so here goes. The cover story of last Sunday's NYT Magazine was "Her Body, My Baby," style reporter Alex Kuczynski's account of her experience hiring a gestational surrogate to bear a child conceived with Kuczynski's own egg and her husband's sperm.

The story has raised quite a flap in the blogosphere. On one side are ardent defenders of Ms. Kuczynski. Their comments tend to express sympathy for the writer's struggle with infertility, IVF, and miscarriages; support the absolute right to self-determination in matters of reproduction, assisted reproduction included; gratitude for the author's open and honest description of her experiences; and encouragement of the "you go, girl" type. On the other side are sharp critics, who question Kuczynski's motives and values, seeing her decision as driven by "narcissism" and fueled by "too much money," and in some cases, drawing parallels with Kuczynski's adventures in cosmetic surgery.

What should we make of all this? And what accounts for the vehemence of the commentary, on both sides?

The most obvious answer, in my mind, lies in the featured photos. The one on the left is of the author, babe in arms (not facing the camera), and the baby's brown-skinned, uniformed nurse, standing outside the author's well-appointed home. The one on the right is of Cathy Hilling, the gestational surrogate, barefoot and pregnant, sitting with her dog on the front porch of her home, which could use some new paint and maybe some landscaping help. The images clearly juxtapose differences in class and race.

I don't want to start (yet another) flame war about the article--there are enough of those out there already. (Maybe this is why the NYT has shut down comments on the article, having received 404 since Sunday.) I do think there is still room for civil discussion of some more important questions, though ... Anybody game?