Friday, October 31, 2008

Who Knows What Evil Lurks in the Heart of Men?

A Special Halloween post:

No, not the Shadow - try Selmer Bringsjord, cognitive scientist at Rensselaer Polytechnic Institute. Although he admits it is 'creepy,' he is working on what is evil and how to formally define it. According to the article in Scientific American, Bringsjord says that to be truly evil, someone must have sought to do harm by planning to commit some morally wrong action with no prompting from others:

"Bringsjord's research builds on earlier definitions put forth by San Diego State University philosophy professor J. Angelo Corlett as well as the late sociopolitical philosophers and psychologists, Joel Feinberg and Erich Fromm, but most significantly by psychiatrist and author M. Scott Peck in his 1983 book, People of the Lie, The Hope for Healing Human Evil. After reading Peck's tome about clinically evil people, 'I thought it would be interesting to come up with formal structures that define evil,' Bringsjord says, 'and, ultimately, to create a purely evil character the way a creative writer would.' " His team has developed a computer representation of evil, a character called "E."

Peck described evil as "anti-love"and suggested that one of the dangers of studying evil that one may become tainted by it.

"Bringsjord acknowledges that the endeavor to create pure evil, even in a software program, does raise ethical questions, such as, how researchers could control an artificially intelligent character like E if "he" was placed in a virtual world such as Second Life, a Web-based program that allows people to create digital representations of themselves and have those avatars interact in a number of different ways.

'I wouldn't release E or anything like it, even in purely virtual environments, without engineered safeguards,' Bringsjord says. These safeguards would be a set of ethics written into the software, something akin to author Isaac Asimov's 'Three Laws of Robotics' that prevent a robot from harming humans, requires a robot to obey humans, and instructs a robot to protect itself—as long as that does not violate either or both of the first two laws.

'Because I have a lot of faith in this approach,' he says, 'E will be controlled.' "

If only the same could be said for everyday encounters with evil -- Sounds a like a great topic for a podcast.

The whole article in Scientific American can be accessed here.

Bioethical Sins?

Number 40 on Time Magazine's list of the best innovations of 2008:
The Seven New Deadly Sins

In March, the Vatican updated the traditional seven deadly sins with seven new social sins, to bring the list into line with the temptations of the modern world. The additions: bioethical sins, morally dubious experiments that harm human embryos, drug abuse, polluting, social injustice, accumulating excessive wealth and creating poverty.,28804,1852747_1854195_1854179,00.html

Hat tip to fellow blogger Andie Long for bringing this item to our attention.

Thursday, October 30, 2008

This Little Piggy Went to Market (or Not?)

We're pleased to have a guest post today by Jonathan Javitt, author of Capitol Reflections, who wrote this for the Women's Bioethics Blog:

Imagine a cleaner pig. Thanks to researchers at the University of Guelph in Ontario, you don't have to imagine – they've engineered them. It has nothing to do with their appearance – the look just like any other pig – but the difference can be found in their genetic makeup, specifically in their “cleaner” manure.

Your typical pig doesn't have the capacity to break down phytate - found in much of the food that pigs eat – thus going undigested, ending up in their manure and subsequently, in other places as well. It can get into the water supply, leading to algae growth, and it can get into the air – especially when a large number of pigs live together on ranches. In short it can cause real environmental problems.

In hopes of ending these problems, study leader Cecil Forsberg and colleagues genetically engineered pigs, dubbed Enviropigs, that can digest more phosphorus.

So how is it done? According to the study, “by introducing a bacterial gene for the enzyme phytase into Enviropigs’ genome, the pigs secrete the enzyme in their saliva and expel up to 60 percent less phosphorus in their manure than their non-transgenic counterparts.” These cleaner, environmentally-friendly pigs are just one genetically engineered animal living in experimental labs in North America. Others include fast-growing salmon, disease-resistant cows, and goats that produce antibacterial milk. All of them, right now, are awaiting FDA approval.

In my novel, Capitol Reflections, I talk about the complexities of FDA approval for modified foods – or animals – and the problems that arise because sometimes there aren't enough checks and balances in place (since genetically modified foods is based on relatively new science.) Those opposed to genetically modified organisms (GMO) worry that there isn’t enough information about them yet to safely bring them to market.

It's easy to see both sides of the argument. Items that are genetically modified typically serve a purpose for the “greater good” - faster growing grains for countries afflicted with famine, fish that would help end over-fishing, and of course, pigs that don't pollute – but is that a reason to give them fast track approval and open them up for consumption? Do people really know what could unfold if this type of technology is mismanaged or mis-applied?

With a heated political season upon us, it's interesting to consider the role of policies and politicians in the GMO debate.

Jonathan Javitt ( is the author of Capitol Reflections and a Washington insider, physician and scientist who has served as a senior White House health advisor in the past three presidential administrations. His book is available on at this link.

NYT: Women pay more for same health insurance

From the NYT:

Women Buying Health Policies Pay a Penalty

It has been found that women could be charged as much as 31 percent more than men when buying the same health care plan. With more and more deregulation of health care, more individuals have to shop around for plans offered by private insurance companies, who are free to set up their own standards for pricing. Justifications for charging women more include childbearing-related issues and higher frequency of going in for regular checkups.

“Women often fare worse than men in the individual insurance market,” said Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee.

Insurers say they have a sound reason for charging different premiums: Women ages 19 to 55 tend to cost more than men because they typically use more health care, especially in the childbearing years.

But women still pay more than men for insurance that does not cover maternity care. In the individual market, maternity coverage may be offered as an optional benefit, or rider, for a hefty additional premium.

Crystal D. Kilpatrick, a healthy 33-year-old real estate agent in Austin, Tex., said: “I’ve delayed having a baby because my insurance policy does not cover maternity care. If I have a baby, I’ll have to pay at least $8,000 out of pocket.”

In general, insurers say, they charge women more than men of the same age because claims experience shows that women use more health care services. They are more likely to visit doctors, to get regular checkups, to take prescription medications and to have certain chronic illnesses.

Marcia D. Greenberger, co-president of the National Women’s Law Center, an advocacy group that has examined hundreds of individual policies, said: “The wide variation in premiums could not possibly be justified by actuarial principles. We should not tolerate women having to pay more for health insurance, just as we do not tolerate the practice of using race as a factor in setting rates.”

This is akin to employers who will deny a woman a promotion or a critical job position because they perceive a potential for her to go on maternity leave or to leave the job completely. In addition to being discriminatory, this practice also does not reflect the real impacts of differential use of medical services. Other than for maternity issues, I predict that men tend to have more need for acute treatment because they tend to not be as regular about periodic screenings and checkups as women, and that would be more expensive or at least a wash in the long run.

Once again, a focus purely on profits is getting in the way of fairly providing services to human beings.

Wednesday, October 29, 2008

Off Label meds are the REAL worry, not placebos

Art Caplan brings us all up to speed in his latest MSNBC column:

Last week, a newly released study showed that half of all American doctors who responded to a nationwide survey say they regularly prescribe placebos to patients. This news captured a lot of media attention and elicited a round of ethical hand-wringing with many experts wondering if systematically deceiving patients by giving them placebos without telling them was right. But ironically, there is a paper out this week in Public Library of Science Journal that is getting nowhere near the same attention as the placebo study, but raises a far more serious concern: Doctors prescribing off-label medicines that may not work.

In 2001, the last year for which data is available, American physicians wrote 150 million prescriptions off-label to treat conditions for reasons other than the ones for which the drugs were approved. This represents 21 percent of all prescriptions written for 160 of the most common medications used in the United States. About three-quarters of all off-label prescriptions were written for conditions for which there was little or no scientific support to show that they worked.

The manufacturers of these drugs apparently believe the practice is ethical. In the article, two physician researchers, Dr. Adriane Fugh-Berman and Dr. Douglas Melnick, say that despite the fact that it is illegal for pharmaceutical companies to promote drugs for off-label uses, drugmakers still find ways to do so — primarily because there is so much money to be made from the practice.

Drug companies sometimes seek approval from the U.S. Food and Drug Administration for an obscure use for a new drug knowing that it is likely it will be picked up for much wider use off-label. A “decoy” indication for a rare or unusual condition may get a drug approved quickly while the company gears up a subtle campaign to suggest off-label uses for which no data has been given to the FDA.

Doctors not bound by same rules
The key to encouraging off-label use is to make sure no one working for the company suggests any such thing. But if prominent, respected physicians can be recruited to give talks for the company concerning a drug, they are free to say what they want about possible off-label uses.

Flooding medical meetings with abstracts, posters and other additions to programs that are not obviously sponsored by industry creates more buzz for possible off-label uses. These practices are so lucrative that some drug companies pursue them even at the risk of huge fines. In the past few years, Schering Plough, Cell Therapeutics, Purdue-Pharma, Cephalon and many other companies have paid billions in fines even as the practice of surreptitiously promoting off-label uses flourishes.

What we now have is a huge amount of money being spent on what are often placebos. The system for regulating off-label use is not working and needs to be toughened. And it makes sense for the next presidential administration to consider creating an agency that can serve as an independent, publicly funded source of data on the safety and efficacy of off-label use of drugs.

Until changes are made, what you really need to know from your doctors is not whether they are using placebos but whether the drugs they prescribe for you are off-label and why.

Tuesday, October 28, 2008

Yo, Vitter: knock it off!

So here's something I feel fairly outraged about, just 'cause it seems like unfair piling on: because of an anti-abortion amendment Senator David Vitter (R-Louisiana) attached to the reauthorization of the American Indian Healthcare Improvement Act, the Act is being held up yet again.

Some people think the writing has been on the wall for some time about this (you can read more about the history of this mess at Indian Country Today), but the reality is that the state of health care for Native American people on and off the reservations in this country is a national shame ... and to tie the fate of health services to the perennial third rail of politics is a travesty.

Hat tip to the Kaiser Health Disparities Report (which does a swell job getting you your weekly dose of reality and high blood pressure--as well as daily reports on health policy and other issues).

Monday, October 27, 2008

Halloween Ready: Glow-in-the-dark Kitty


Medical Ethics & Human Rights: Impact on the Doctor-Patient Relationship

Event Announcement

The Appignani Bioethics Center and NGO Health Committee are co-sponsoring a panel discussion on human rights and their impact on doctor-patient relationship.

Date & Place: Wednesday, October.29, 2008, 1:00 PM-3:00 PM, 777 UN PLAZA, 10th Floor, 10th floor - Conference Room, NY 10017

A 15 minutes documentary film will be presented entitled "Children of the Decree" by Romanian filmmaker Florin Lepan. In 2004 the film was selected for screening in NYC by the Margaret Mead Film & Video Festival. This documentary analyzes Romania's quest during Ceausescu's dictatorship to increase their population by over fifty percent in a single decade through imposing a ban on abortion from 1966 till 1989. It was a unique experiment in human reproduction infringing upon women's rights:


For more information, click here.

Sunday, October 26, 2008

Bioethics Questions for Obama and McCain

Our friends at the Hastings Center have published a great compilation of the candidates’ positions on a wide range of bioethical issues. Even more compelling, they have crafted a list of bioethical questions the candidates have not addressed but should:

What will you do to keep politics from biasing tough decisions on climate change, environmental protection, workplace safety, and other science issues?

Do you unequivocally condemn torture? Both of you have said so in speeches, but you have eliminated references to torture on your web sites.

Should the federal government take a more active role in regulating assisted reproduction (as other developed nations do), such as in protecting egg donors from exploitation and preventing clinicians from denying services based on marital status or sexual orientation?

What, if any, government regulation is needed on the use of embryos left over from fertility treatments and stored in clinics?

Would you consider legalizing a market for donated organs to reduce the shortage of organs for transplantation?

In the event of a public health emergency, such has the SARS outbreaks in 2003, what limits on liberty are justified, such as quarantine of infected individuals or other restrictions of movement?

What regulation is needed of the increasing practice of collecting of DNA samples from criminal suspects?

More than 300 million biospecimens are stored in U.S biobanks and used for research purposes; how would you oversee the ethical use of this material, including informed consent from donors, privacy, and ownership of intellectual property?

What role should the government play in supporting promising new technologies – nanotechnology, synthetic biology, and genetic engineering – while guarding against potential safety and environmental hazards?

If your proposals to control health care costs prove insufficient, would you consider rationing health care, such as the availability of costly drugs and technology?

Read the original post here. If you really want to dig deep, you can read the Hastings Center bioethics briefing book free online. It includes thirty-six backgrounders on leading bioethics issues including expert contacts and campaign positions.