Thursday, June 18, 2009

Empire State will pay for human eggs for research use

According to The Scientist, the Empire State Stem Cell Board determined last week that it's ethical to pay women to obtain eggs for use in stem-cell research.

The ESSCB points to the practice of paying women who donate eggs for reproductive purposes, which is not prohibited under New York law, and argues that donation for research purposes is not meaningfully different from that practice. You can read the ethics board's statement here.

An interesting difference in this case, however, compared with the reproductive instance, is that ESSCB will be using taxpayer funds to buy eggs. (Yeah, yeah, they're careful to say they're not buying eggs ... they're paying donors. Anybody buy that distinction?)

Some articles on our radar screen this past week...

Autonomy and Authenticity of Enhanced Personality Traits

Abstract: There is concern that the use of neuroenhancements to alter character traits undermines consumer's authenticity. But the meaning, scope and value of authenticity remain vague. However, the majority of contemporary autonomy accounts ground individual autonomy on a notion of authenticity. So if neuroenhancements diminish an agent's authenticity, they may undermine his autonomy. This paper clarifies the relation between autonomy, authenticity and possible threats by neuroenhancements.

Tech-assisted reproduction growing worldwide:
Worldwide report shows increase in assisted reproduction: 250,000 babies (approximately) born in 1 year.
Assisted reproductive technology (ART) is responsible for an estimated 219,000 to 246,000 babies born each year worldwide according to an international study. The study also finds that the number of ART procedures is growing steadily: in just two years (from 2000 to 2002) ART activity increased by more than 25%. As this technology becomes more accessible to more people, will this encourage the ART industry to go further in their efforts and should more regulation be considered?

Boy or Girl? As early as 10 weeks gestation, a new at-home test has an 80% accurate predication rate. But will this result in more female fetuses being terminated?

Wednesday, June 17, 2009

Should Politics and Values Be Removed from Science?

Associate executive director of the Center for Genetics and Society and WBP supporter, Marcy Darnovsky argues in a new article in the Democracy Journal that for too long progressives have built a bioethics around opposition to the religious right, and have thus failed to explicate a positive vision. In an article complementary to the WBP’s report (downloadable here), Darnovsky outlines a framework for just such a vision, one that balances individual autonomy with the real social concerns raised by biotechnological advances, such as how will human biotechnologies reshape our sense of ourselves, our relationships, the shape and feel of the world we occupy together? Who will profit, who will lose, and who will survive?:

“For many progressives and liberals, President Barack Obama’s March 9 announcement on stem-cell research affirmed the now-conventional wisdom that virtue lies in protecting science from the interference of politics. Fulfilling a campaign promise, the president repealed his predecessor’s stem-cell funding restrictions and pledged to ensure that ‘scientific data is never distorted or concealed to serve a political agenda–and that we make scientific decisions based on facts, not ideology.’

Scientists and stem-cell research advocates celebrated. The president of the Christopher & Dana Reeve Foundation said he was thrilled that the new Obama policy will ‘remove politics from science.’ A vice president of the Juvenile Diabetes Research Foundation lauded the commitment to ‘keep politics out of science.’ John Kessler, director of the Northwestern University Stem Cell Institute, recalled Bush’s funding limit and labeled it a ‘really, really unwelcome intrusion of politics into science.’

The policy is certainly a victory for progressives. But the assumptions embedded in its reception deserve close examination. Embedded assumption number one is that Bush’s restriction on federal funding of embryonic stem cell research was part of a broad ‘anti-science’ agenda. Assumption number two is that this policy constituted an illegitimate incursion of politics into science. The third assumption–and the one of greatest import as progressive politics tries to keep pace with scientific developments–is that we want to insulate science from moral values and political commitments.”

For access to the complete article, click here (free registration required).

Monday, June 15, 2009

Obama at the AMA: The cost of inaction is greater

(Some key excerpts: the entire speech can be seen here.)

Today, we are spending over $2 trillion a year on health care – almost 50 percent more per person than the next most costly nation. And yet, for all this spending, more of our citizens are uninsured; the quality of our care is often lower; and we aren’t any healthier. In fact, citizens in some countries that spend less than we do are actually living longer than we do.

Make no mistake: the cost of our health care is a threat to our economy. It is an escalating burden on our families and businesses. It is a ticking time-bomb for the federal budget. And it is unsustainable for the United States of America....

...But let there be no doubt – the cost of inaction is greater. If we fail to act, premiums will climb higher, benefits will erode further, and the rolls of uninsured will swell to include millions more Americans.

If we fail to act, one out of every five dollars we earn will be spent on health care within a decade. In thirty years, it will be about one out of every three – a trend that will mean lost jobs, lower take-home pay, shuttered businesses, and a lower standard of living for all Americans.

And if we fail to act, federal spending on Medicaid and Medicare will grow over the coming decades by an amount almost equal to the amount our government currently spends on our nation’s defense. In fact, it will eventually grow larger than what our government spends on anything else today. It’s a scenario that will swamp our federal and state budgets, and impose a vicious choice of either unprecedented tax hikes, overwhelming deficits, or drastic cuts in our federal and state budgets.

To say it as plainly as I can, health care reform is the single most important thing we can do for America’s long-term fiscal health. That is a fact.

And yet, as clear as it is that our system badly needs reform, reform is not inevitable. There’s a sense out there a

The question now is, how do we finish the job? How do we permanently bring down costs and make quality, affordable health care available to every American?


So let me begin by saying this: I know that there are millions of Americans who are content with their health care coverage – they like their plan and they value their relationship with their doctor. And that means that no matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what. My view is that health care reform should be guided by a simple principle: fix what’s broken and build on what works.


The second step that we can all agree on is to invest more in preventive care so that we can avoid illness and disease in the first place. That starts with each of us taking more responsibility for our health and the health of our children. It means quitting smoking, going in for that mammogram or colon cancer screening. It means going for a run or hitting the gym, and raising our children to step away from the video games and spend more time playing outside.

It also means cutting down on all the junk food that is fueling an epidemic of obesity, putting far too many Americans, young and old, at greater risk of costly, chronic conditions. That’s a lesson Michelle and I have tried to instill in our daughters with the White House vegetable garden that Michelle planted. And that’s a lesson that we should work with local school districts to incorporate into their school lunch programs.

Our federal government also has to step up its efforts to advance the cause of healthy living. Five of the costliest illnesses and conditions – cancer, cardiovascular disease, diabetes, lung disease, and strokes – can be prevented. And yet only a fraction of every health care dollar goes to prevention or public health. That is starting to change with an investment we are making in prevention and wellness programs that can help us avoid diseases that harm our health and the health of our economy.

But as important as they are, investments in electronic records and preventive care are just preliminary steps. They will only make a dent in the epidemic of rising costs in this country.

Let me be clear: identifying what works is not about dictating what kind of care should be provided. It’s about providing patients and doctors with the information they need to make the best medical decisions.


But alongside these economic arguments, there is another, more powerful one. It is simply this: We are not a nation that accepts nearly 46 million uninsured men, women, and children. We are not a nation that lets hardworking families go without the coverage they deserve; or turns its back on those in need. We are a nation that cares for its citizens. We are a people who look out for one another. That is what makes this the United States of America.

Now, even if we accept all of the economic and moral reasons for providing affordable coverage to all Americans, there is no denying that it will come at a cost – at least in the short run. But it is a cost that will not – I repeat, not – add to our deficits. Health care reform must be and will be deficit neutral in the next decade.

There are already voices saying the numbers don’t add up. They are wrong. Here’s why. Making health care affordable for all Americans will cost somewhere on the order of one trillion dollars over the next ten years. That sounds like a lot of money – and it is. But remember: it is less than we are projected to spend on the war in Iraq. And also remember: failing to reform our health care system in a way that genuinely reduces cost growth will cost us trillions of dollars more in lost economic growth and lower wages.

That said, let me explain how we will cover the price tag. First, as part of the budget that was passed a few months ago, we’ve put aside $635 billion over ten years in what we are calling a Health Reserve Fund. Over half of that amount – more than $300 billion – will come from raising revenue by doing things like modestly limiting the tax deductions the wealthiest Americans can take to the same level it was at the end of the Reagan years. Some are concerned this will dramatically reduce charitable giving, but statistics show that’s not true, and the best thing for our charities is the stronger economy that we will build with health care reform.

But we cannot just raise revenues. We also have to make spending cuts in part by examining inefficiencies in the Medicare program. There will be a robust debate about where these cuts should be made, and I welcome that debate. But here’s where I think these cuts should be made. First, we should end overpayments to Medicare Advantage. Today, we are paying Medicare Advantage plans much more than we pay for traditional Medicare services. That’s a good deal for insurance companies, but not the American people. That’s why we need to introduce competitive bidding into the Medicare Advantage program, a program under which private insurance companies offer Medicare coverage. That will save $177 billion over the next decade.

Second, we need to use Medicare reimbursements to reduce preventable hospital readmissions. Right now, almost 20 percent of Medicare patients discharged from hospitals are readmitted within a month, often because they are not getting the comprehensive care they need. This puts people at risk and drives up costs. By changing how Medicare reimburses hospitals, we can discourage them from acting in a way that boosts profits, but drives up costs for everyone else. That will save us $25 billion over the next decade.

Third, we need to introduce generic biologic drugs into the marketplace. These are drugs used to treat illnesses like anemia. But right now, there is no pathway at the FDA for approving generic versions of these drugs. Creating such a pathway will save us billions of dollars. And we can save another roughly $30 billion by getting a better deal for our poorer seniors while asking our well-off seniors to pay a little more for their drugs.

So, that’s the bulk of what’s in the Health Reserve Fund. I have also proposed saving another $313 billion in Medicare and Medicaid spending in several other ways. One way is by adjusting Medicare payments to reflect new advances and productivity gains in our economy. Right now, Medicare payments are rising each year by more than they should. These adjustments will create incentives for providers to deliver care more effectively, and save us roughly $109 billion in the process.

Another way we can achieve savings is by reducing payments to hospitals for treating uninsured people. I know hospitals rely on these payments now because of the large number of uninsured patients they treat. But as the number of uninsured people goes down with our reforms, the amount we pay hospitals to treat uninsured people should go down, as well. Reducing these payments gradually as more and more people have coverage will save us over $106 billion, and we’ll make sure the difference goes to the hospitals that most need it.

We can also save about $75 billion through more efficient purchasing of prescription drugs. And we can save about one billion more by rooting out waste, abuse, and fraud throughout our health care system so that no one is charging more for a service than it’s worth or charging a dime for a service they did not provide.


I want them to benefit from a health care system that works for all of us; where families can open a doctor’s bill without dreading what’s inside; where parents are taking their kids to get regular checkups and testing themselves for preventable ailments; where parents are feeding their kids healthier food and kids are exercising more; where patients are spending more time with doctors and doctors can pull up on a computer all the medical information and latest research they’d ever want to meet that patient’s needs; where orthopedists and nephrologists and oncologists are all working together to treat a single human being; where what’s best about America’s health care system has become the hallmark of America’s health care system.

That is the health care system we can build. That is the future within our reach. And if we are willing to come together and bring about that future, then we will not only make Americans healthier and not only unleash America’s economic potential, but we will reaffirm the ideals that led you into this noble profession, and build a health care system that lets all Americans heal. Thank you.

Friday, June 05, 2009

Bioethics Student Scholar Forum

As part of the Women’s Bioethics Project’sFresh Voices Initiative” we are launching the Bioethics Student Scholar Forum featuring outstanding commentary by bioethics graduate students from around the world. Student scholar Jennifer deSante, University of Pennsylvania, wrote the inaugural commentary. In the wake of Octomom, Jennifer explores whether physicians have an ethical obligation to screen IVF applicants:
Can We Screen IVF Applicants?
The birth of Nadya Suleman’s octuplets captured the interest of the country and media. What began as amazement quickly turned to disbelief, then condemnation, even outrage. Hardly anyone could understand what would motivate a woman to use in vitro fertilization (IVF) to have fourteen children. The media became obsessed with Ms. Suleman: following her around town, releasing child services records, even sending Dr. Phil to her house. As it became clear that this woman had little emotional or financial support to raise these children, people began to attack her for being irresponsible. But how much responsibility falls on the physician that provided Ms. Suleman with her many cycles of IVF?
You can find her provocative and well-written paper here. Congratulations to Jennifer – we welcome your fresh voice to the bioethics dialogue. And many thanks to her bioethics mentor, Arthur Caplan, Ph.D. for recommending Jennifer's work. If you are currently an enrolled bioethics graduate student and would like to have your paper considered for publication, please ask your bioethics mentor to nominate your work by emailing info (at) (include paper abstract and contact information.)

Wednesday, June 03, 2009

Udo Schuklenk on the Murder of George Tilly

Colleague and friend Udo Schuklenk agreed to do a guest post/cross-link from his blog about the recent murder of physician George Tilly:

Another murder aimed at furthering the 'pro-life' agenda

It had to happen, the pro-life affirming loonies in the USA have taken yet another person's life. George Tiller, MD, a medical doctor specialising in reproductive health services, including medically indicated late-term abortions, was gunned down outside a church service in his home town. I'm probably as shocked about this killing as most reality based people. However, there's a deeper issue about this, at least to my mind.

The religious ideologies that triggered the murder of Tiller (and, in the past, others like him) want their adherents to subscribe to the view that from the moment of biological conception (marriage and all, you know the drill) the developing embryonic cell mass is of infinite value and should be treated as if it was a person. Well, persons - all other things being equal - are usually seen to have a right to life. At a minimum this is understood as a negative right, ie I must not interfere with such a person's right to life (by way of killing that person).

Let me be clear: I do think the view that something that has no central nervous system, that has no capacity to suffer, and that has no higher brain function has a right to life, makes no sense at all. What harm could possibly have been done to such a thing if it is destroyed? None at all, at least as far as I can see. It is for that reason that I reject the idea that we should treat the developing embryonic cell mass from the moment of conception as if it was a person. After all, it isn't a person, so why bother? It's a bit like saying that I should treat the leader of the opposition as if she was the leader of government. She might have the potential to be the next leader of government, but right now she is not. I surely cannot smuggle the right to be treated as if you were the leader of government into the potential to become the leader of government. A lot of potential things never eventuate (eg my potential to be an astronaut will not ever be realised).

However, and here is where I am troubled about this matter. IF someone really holds the barmy view that the embryonic cell mass after conception is infinitely valuable and should be treated as if it was a person from that moment onwards, it is only logical that you consider abortions murder. In turn it is perfectly reasonable for such a person to treat abortion providing health care professionals as if they were murderers. Surely it is not unreasonable (from such a person's perspective) to try to prevent further murders from happening. Ergo it should not come as a big surprise that Doctor Tiller was murdered by a 'good citizen' trying to prevent further murders at the hands of the good doctor.

So, the pro-life crowd's handwaving along the lines that the murderer is not one of theirs, makes not much sense. The ideology they propagate leads, to my mind inevitably so, to the killing of people like Tiller. Freedom of speech seemingly covers Catholic propaganda ministers freedom to spout lies about a supposedly ongoing 'genocide', whereby the deliberately and mistakenly refer to blobs of cells as 'children'. IF you really believe that propaganda, surely it's not unreasonable to conclude that in order to stop the genocide the perpetrators of the genocide must be stopped. Killing one person (eg Dr Tiller) is clearly seen by some of those on the pro-life side as the lesser of two evils. They are only able to reach this conclusion, however, because the church hierarchy continues to propagate outrageous nonsense about 'genocide' and 'holocaust' and whatnot when it comes to abortion. This is where the blame for Tiller's murder as well as that of others like him squarely belongs. You shouldn't be too surprised if some people at least do actually fall for your agitprop.

Living Better Through Matriarchy

Although it's not directly related to bioethics, I couldn't resist:

'Men Live Better Where Women Are In Charge'

How does a matriarchy really work? Argentinian writer Ricardo Coler decided to find out and spent two months with the Mosuo in southern China. "Women have a different way of dominating," the researcher told SPIEGEL ONLINE.

SPIEGEL ONLINE: Mr. Coler, you are from Argentina, where macho behavior is not exactly unheard of. What was it like living for two months in the matriarchical society of the Mosuo in China?

Coler: I wanted to know what happened in a society where women determine how things are done. How do women tick when, from birth onwards, their societal position allows them to decide everything? We men know what a man is, we put that together quickly -- but what constitutes a woman? Although, I didn't get any wiser on that point.

SPIEGEL ONLINE: Is Mosuo society a paradise for feminists?

Coler: I had expected to find an inverse patriarchy. But the life of the Mosuo has absolutely nothing to do with that. Women have a different way of dominating. When women rule, it's part of their work. They like it when everything functions and the family is doing well. Amassing wealth or earning lots of money doesn't cross their minds. Capital accumulation seems to be a male thing. It's not for nothing that popular wisdom says that the difference between a man and a boy is the price of his toys.

SPIEGEL ONLINE: What is life like for a man in a matriarchy?

Coler: Men live better where women are in charge: you are responsible for almost nothing, you work much less and you spend the whole day with your friends. You're with a different woman every night. And on top of that, you can always live at your mother's house. The woman serves the man and it happens in a society where she leads the way and has control of the money. In a patriarchy, we men work more -- and every now and then we do the dishes. In the Mosuo's pure form of matriarchy, you aren't allowed to do that. Where a woman's dominant position is secure, those kinds of archaic gender roles don't have any meaning.

SPIEGEL ONLINE: What astonished you the most?

Coler: That there is no violence in a matriarchal society...

To access the rest of the article, click here.

Tuesday, June 02, 2009

Of Mice and HuMice, Part Deux

We blogged about Clyven, the chimerical transgenic mouse with human intelligence, before; but now researchers have 'kicked it up a notch', by creating mice with the human version of a gene involved in language, called FOXP2. As the article in Discover magazine notes, "hile the mice didn’t exactly sit up and start reciting poetry about cheese, they did show some intriguing differences in both their vocal patterns and brain structure."

The region of the brain that was affected was the basal ganglia; the humanized mice grew nerve cells that had a more complex structure. Baby mice utter ultrasonic whistles when removed from their mothers; the researchers' findings that the baby hu-mice, when isolated, made whistles that had a slightly lower pitch, among other differences. Here the video with research Wolfgang Enard that provides a summary of the paper published in Cell:

So what does it mean when we 'uplift' animals? Colleague and friend George Dvorsky has some interesting thoughts on this here.