New Yorkers Provided Tools to Prevention

On Valentine's Day of this year, New Yorkers were encouraged by the Health Department to “Get Some.” The unveiling of free latex condoms throughout New York City's railways was an example of marketing at its best, courtesy of the city's Health Department and its Metropolitan Transportation Authority (MTA). These condoms are of the highest-quality (purchased from the LifeStyles corporation) and bare the logos of New York City trains on their wrappers. The design is intended to attract New York's straphangers in hopes that they will help themselves to prevention. Health Commissioner Thomas Freiden doesn't mind a little gliltz for a good cause. He acknowledges, “[b]rands work. They increase use.” Health officials hope a fun, sexy and free marketing approach will result in the decline of sexually transmitted infections (STI) among New Yorkers.

The instant where parasite meets host-cell has translated into enduring health struggles many people living in New York. Studies of the Centers for Disease Control and Prevention predict over 100 million people who ride the MTA (in a given day) are unaware they are infected with the HIV virus. HIV/AIDS infections have reached epidemic measures throughout the city. Prevalence of STI's in New York City are consistently among the highest in the country. The actions of New York's Department of Health reflect that of a responsible public office. It has allotted its citizens access to life-preserving tools by following the preceding endeavors such as, BYOC (bring your own condom), where high-traffic atmospheres (ie, restaurants, retailers, bars, clubs and.... the subway) are used to the advantage of contraceptive distribution.

Or, are they encouraging “inappropriate sexual activity?” Catholic leaders have expressed concerns of New York's agenda to increase condom distribution. Edward Cardinal Egan and Brooklyn Bishop Nicholas DiMarzio have voiced criticism against the city's decision to distribute 26 million condoms, regarding it as “tragic and misguided.” They have voiced concern for the integrity of New York's “societal standards” and reject the “blanketing”of neighborhoods with condoms. Their concerns were heard by New York City's Mayor Mike Bloomberg who disagreed with the views. "This is not an issue of faith - this is a health issue for the city.” “[T]he Health Department has to work with the real world of people not practicing protected sex, not practicing abstinence, and this is a way to keep people alive.”

Surprisingly, I am in agreement with Mayor Bloomberg. As the issue demanded, he has come to understand the gravity of the HIV/AIDS epidemic in New York and has recognized time as a crucial factor. His response to reality, and neglect—if only temporary—of ideology is a deviation from his typically conservative perspective. While ethical concerns are appropriate, they will likely remain secondary to the reality of a public health crisis.

Having observed New York's efforts first hand, I feel an effective pursuit will be more aggressive. I've yet to see any NYC condoms and have heard little of them outside of media reports. For more enduring effect, efforts should continue to strive to permeate the public. I would urge the Health Department to join forces with club owners and promoters to educate the public and distribute contraceptives throughout New York's nightlife. I feel the public would embrace such efforts and will increasingly become involved in the maintenance of their health.

Here are several articles reflecting media coverage of NYC condoms:
NY Daily News:http://www.nydailynews.com/news/local/story/498292p-420070c.html
Yahoo News: http://news.yahoo.com/s/afp/20070214/hl_afp/afplifestyleus;_ylt=Ar.GIjZvcEI2wJJHn23oi83VJRIF

Couple of Busy Weeks for Us -- Back with some interesting stories soon!

This has been a couple of busy weeks for us here at the Women's Bioethics Project -- between speaking at the National Press Club, giving a talk at the Association for Women in Seattle, lecturing at Columbia Medical Center on the status of women yesterday and today, participating in the IHEU Appignani Bioethics Center UN Panel on HIV/AIDS and female genital mutilation, or organizing an lecture on why women should care about bioethics in coordination with the Dana Foundation’s Brain Awareness Week, we have had an extremely business few weeks here at the Women's Bioethics Project and things don't show any signs of slowing down! We 'll be back shortly with news and interesting stories...

Religion, Morality, and Women's Health: A Question of Professionalism

I guess news travels more slowly to the West of NA… Last night the Reno Gazette Journal contained a disturbing piece of news (thanks, Jamie) that I have since learned has been reported in the Washington Post and other places on Feb 7 with a follow up in the NY Times on Feb 13 and letters to the follow-up in the Feb 18 edition. The news begins with the publishing of an article entitled, “Religion, Conscience, and Controversial Clinical Practices” by Farr A. Curlin, Ryan E. Lawrence, Marshall H. Chin, and John D. Lantos in The New England Journal of Medicine Vol 356:593-600. Here the authors present the results of a survey they conducted asking 2000 practicing US physicians (1144 responded) about their views on controversial medical practices and their clinical responses to a physician being asked by a patient to perform a procedure or prescribe a medication to which they were morally or religiously opposed. Of the three questions asked of the physicians in the survey, two involved issues of women’s reproductive rights: contraception and abortion. 42 percent objected to prescribing birth control for adolescents without parental approval, and 52 percent opposed abortion for failed contraception. While a majority of the physicians surveyed believed that it is their responsibility to refer patients to other physicians who would be willing to perform procedures or prescribe medications that they, because of moral or religious beliefs, would not be willing to do themselves, 18% maintained that they were under no professional or ethical obligation to do so. Physicians who described themselves as very religious were much less likely to believe they were obligated to present all options to a female patient about contraception or abortion or to refer patients to someone who did not condemn contraception or abortion. This means that millions of women are being taken care of by physicians whose religious or moral views could be compromising their health and their lives. Of the bioethicists interviewed for the news reports of this survey which I have read, none were women or men known particularly for their work on women’s health issues.

Why Women Should Care About Neuroethics

Advances in neuroscience are going to pose some of the most important ethical questions yet about what it means to be human, and will challenge our concepts and viewpoints on gender and genetic determinism, free will, and what sets us apart from other species. This year, we will be launching several exciting initiatives designed to encourage women to engage on these issues.

The first, in coordination with the Dana Foundation’s Brain Awareness Week, is a lecture on Why Women Should Care About Neuroethics. Our featured expert will be Judy Illes, Ph.D., Director of the Program in Neuroethics at the Stanford Center for Biomedical Ethics, founding member of the Neuroethics Society, and editor of “An Anthology in 21st Century Neuroethics” published by Oxford University Press.

Please email info@womensbioethics.org for registration information. Seating is limited for the March 16th Seattle area luncheon. For those who can’t attend, the lecture will be available via podcast.

UN Panel on HIV/AIDS and female Genital Mutilation

Who: IHEU -- Appignani Center for Bioethics, Population Communications International and Femmes Afrique Solidarite

What: UN Panel on Health and Empowerment: The Impact of HIV/AIDS and FGM

Where: 777 UN Plaza, New York City

When: Wednesday, Feb. 28, 2007 12:00 PM-1:45 PM

Contact: 212-687-3324 (tel) | 212-661-4188 (fax) | www.iheu.org/bioethics | E-mail: AnaLita@iheu.org

On Wed, Feb. 28, 2007 a panel of bioethicists, physicians and activists will discuss "Health and Empowerment: The impact of HIV/AIDS Epidemic Worldwide and Female Genital Mutilation in African Diaspora Communities" at the United Nations under the auspices of the Division for the Advancement of Women, Commission on the Status of Women.
The panel will discuss the health and empowerment of women, focusing on the international HIV/AIDS epidemic, female genital mutilation (FGM) in Africa and immigrant communities living in Western nations.

Although the practice of FGM is viewed by many within the international community as a human rights violation, FGM is reportedly still performed on three million women annually. It is estimated that 130 million girls alive today have undergone FGM.

The U.N. has challenged the world to fulfill eight Millennium Development Goals by 2015 that would drastically improve living standards around the world. The panel will address FGM within the context of these goals, FGM's relationship to the HIV-AIDS epidemic and directions for the future.

Speakers include:

Wayne R. Cohen, M.D., Ph.D is chairman of Obstetrics and Gynecology at Jamaica Hospital NY, visiting professor Dept. of Ob--Gyn and Women's Health at Albert Einstein Bronx, NY. He was the Obstetrician and Gynecology-in-Chief Sinai hospital of Baltimore Maryland. He wrote an important book entitled Complications in Pregnancy, published by Lippincott Williams&Wilkins 2000 (the 5th edition).

Adrian Sângeorzan, M.D., a specialist obstetrician and gynecologist and a full-time attending and faculty adviser at Jamaica Hospital, New York. A graduate of the Medical School at the University of Cluj, Transylvania, Sângeorzan worked as a doctor in Romania until immigrating to the United States in 1990. His prizewinning, best-selling volume of memoirs and fiction, ,Between Two Worlds-- Tales of a Women's Doctor, is published in Romanian and English.

Zeinab Eyega, M.Sc, executive director and founder of Sauti Yetu, an organization seeking to empower women to exercise, advocate and protect their rights based in New York City. Previously she was a program director for the African Immigrant Program at Research, Action and Information Network for the Bodily Integrity of Women (RAINBO), a program that examined the needs of circumcised women and girls in New York City. In addition to teaching and public speaking, she has facilitated numerous cross-cultural competency workshops for health care providers and reproductive health promotion seminars for African immigrant and refugee communities throughout the U.S.

Tata Traore, director of intervention for the Bondala Department of the Harlem United Community AIDS Center, a community-based organization providing a unique continuum of care for over 2,300 clients per year. She works to integrate socially and economically disenfranchised people into a healthy and healing community, offering clients access to a full range of medical, social, and supportive services.

Ana Lita, Ph.D., director of the IHEU-Appignani Center for Bioethics in New York City. She holds a Ph.D. in Applied Ethics and Social Philosophy from Bowling Green State University. The author of numerous conference presentations and publications in the fields of education, ethics and bioethics, Ana Lita is a Women's Bioethics Project Scholar and
the recipient of a Soros Foundation Fellowship and a National Association Fellowship for International Scholars.

Michael Castlen, executive director of PCI --Telling Stories, Saving Lives in New York City. He has an extensive background building organizational capacity in non-profit organizations, specifically those involved in international development. He served as Chief Operating Officer at the Foundation for a Civil Society and worked with NGOs in the Czech Republic and Slovakia to strengthen civil society organizations and nurture local corporate philanthropy. At Holt International he worked in Romania on strengthening child-welfare.

The IHEU-Appignani Center for Bioethics focuses on raising awareness of bioethical issues confronting the international. The Center is a new initiative of the International Humanist and Ethical Union (IHEU), an international umbrella organization for humanist, ethical culture, rationalist, secularist and free-thought groups. IHEU holds a special consultative status with the U.N., a general consultative status with UNICEF and the Council of Europe as well as operational relations with UNESCO in Paris.

PCI -- Telling Stories, Saving Lives (Population Communications International) is dedicated to the promotion of education and health, including reproductive health and informed choice; sensitivity to national and local cultures; and the principles put forth by the U.N. Millennium Development Goals. PCI develops entertainment-education programs and social marketing strategies that support targeted health and poverty alleviation initiatives. For more than 20 years, PCI has worked in over 27 countries, producing more than 75 radio and television programs, training hundreds of individuals, providing technical assistance to more than 100 international organizations. Central to PCI's long-running Kenyan radio drama Ushiwapo Shikamana was a storyline about the health consequences of female genital mutilation (FGM).

In the fall of 2006, PCI and the IHEU-Appignani Center for Bioethics launched a new program, the Women's Health Center, aimed at supporting grassroots women's health organizations develop their own resources to address the global status of women's health. The Women's Health Center enables these organizations to merge their resources and develop new, innovative strategies to improve the lives of the world's most vulnerable women.

The Future of Health Care?

I recently watched a three part series, 2057, that was on the Discovery Channel. The series makes an educated projection on what life will most likely be like for in 50 years. The predictions are based on current technological developments that for the most part need only to be refined and expanded slightly. Part one of the series titled The Body focuses on potential medical developments in the near future.

Part one of the series predicts numerous advances that will benefit our lives and help us to live longer. Response times will be faster because of car sized VTOL or vertical take off and landing vehicles which are able to fly to and from the hospital in order to avoid traffic congestion. Responding emergency personnel will know all of your vitals, injuries, and medical history immediately. They will even be able to put you into temporarily suspended animation until and while they work on you and hospitals will be able to print you a new organ if necessary.

These advances sound incredible unfortunately, it comes at a price. In order to have all of your vital information immediately, everything you own from your refrigerator to your toilet will be connected to a computer system which not only the heath care system but also your medical insurance company will have access to. Urine and stool samples can be tested and the results supplied to your insurance company with each trip to the bathroom. They will know what is in your cupboards and refrigerator. So they will know what you have been eating and drinking, with particular interest in your not so healthy choices. There will be smart shirts and clothing that can supply private data including your location, heart rate, and breathing.

In this scenario privacy will be a thing of the past and we will all live in fear of our insurance companies. I believe that the best way to avoid this unfortunate consequence of advancement would be to enact some form of legal privacy protection limiting the access of insurance companies to our personal information and the creation of a universal heath care system. After all what would be the point of creating technologies to save countless lives when control of these technologies belongs to insurance companies. Do we all want to be slaves of the insurance companies?

Eat fish for a smarter child!

Good news from the UK for mothers-to-be and those of us whom aspire. A British-American study found that children whose mothers consumed at least three servings (12oz.) of fish a week during pregnancy, score higher on mental functioning tests. Conversely, occurrences of low verbal IQ and suboptimum social behavior, motor activity, and communication were far more common in the children of women who consumed less than 12 ounces of seafood during pregnancy.

This report contradicts previous advice from two prominent US government agencies: the Environmental Protection Administration (EPA) and the Food and Drug Administration (FDA). In 2004, they released warnings to the public against possible risks of ingesting mercury contained in seafood.

The source of intellect seems to be high levels of omega-3-fatty acids in fish, which also exists in walnuts and flaxseeds. Scientists believe adequate amounts of long-chain fatty acids are essential for children's cognitive development.

The study declares, "the beneficial effects of the nutrients in fish far outweigh the risk." Although the EPA and FDA have been briefed on the study, neither group plans to change guidelines on the basis of one report.

Despite the possibility of mercury toxicity, mothers-to-be who eat three servings of seafood a week greatly assist the cognitive development of their unborn children. The study found no evidence in its research, nor its results supporting the possibilities of mercury toxicity. Since the fish in England generally have a higher methyl-mercury content than the fish in the US, Americans can be confident that the claims of the report are applicable to them as well.

Medline Plus. Fish During Pregnancy Helps Child's Development. Available at: http://www.nlm.nih.gov/medlineplus/news/fullstory_45386.html. Accessed February 20, 2007.

Privacy of the Health Network? What Privacy?

Many moons ago, before departing the Silicon Forest for the Ivory Tower, I worked for a company that was trying to design a way for patients and doctors to have internet office visits. Several large companies in my field has discovered that most of the time they lost to employees going to the doctor was spent in driving and waiting. The obvious solution was to make little internet kiosks on campus, where you could video conference with your doc. It was an interesting idea, although a bit ahead of its time.

One large aspect of my job was to wrestle with HIPAA guidelines, specifically making sure that all of the patient records we had were safe. Defining safety in terms of the internet is not easy, as the Bush Administration is now learning. It seems that the GAO has discovered that the Administration plan for a network linking health care providers and insurance companies has no strategy to address security concerns. This is a big woops! It sounds like there is a systematic and uncomprehensive strategy towards privacy and security at HHS.

Speaking from long hours of personal experience and many HIPAA-induced headaches, generating compliant security online is a constantly shifting game of playing catch-up. The technology is constantly changing, and what is cutting edge today will be obsolete security next week. Online medical records, in any sort of centralized system, is going to require not a couple of people doing security, but an entire department of health record security, able to mobilize on a moment's notice to protect those records.

Right now, it sounds like what we have is a far cry from that, and I'd be highly apprehensive of any effort to import my medical records into their currently existing "system".

Diagnosis Cancer: Let's Talk About Sex

A February 17th article on Medical News Today (www.medicalnewstoday.com) reported that the lack of communication about sexuality and intimacy is a prime issue for caregivers of patients with cancer. This finding was based on a study conducted by University of Western Sydney researchers who sought to evaluate how caregivers discuss and negotiate sexuality and intimacy when caring for a partner with cancer and to gauge the most effective cancer support services.1

In this study, caregivers completed questionnaires (n=131) and detailed interviews (n=20). Results from this study demonstrated that 80% of respondents indicated that a cancer diagnosis had a detrimental impact on their sexual relationship with their partner. Both male and female caregivers (86% and 76%, respectively) reported that cancer had affected their sexuality. Caregivers indicated that lack of communication both between the couple and with healthcare providers was a major issue. Failure on the part of healthcare providers to discuss sexuality and intimacy concerns with a couple made it difficult for caregivers to communicate their feelings. According to the study’s lead researcher, Dr Emilee Gilbert, “Part of the willingness to raise the topics of sex and intimacy probably stems from not being given the license to talk about it. Those feelings left them feeling angry, upset, and resentful of healthcare professionals.”1

When healthcare providers did not approach the subject of sexuality and intimacy, caregivers believed they could not mention this subject or voice their concerns. If this sensitive topic was mentioned by healthcare providers, it was only briefly touched on or discussed during an inappropriate time (eg, after the diagnosis of cancer was made). Conversely, when healthcare providers raised the topic of sexuality and intimacy and allocated sufficient time for questions and discussion, caregivers reported an excellent experience.1

* * * * * *
Human sexuality is a complex, multifaceted phenomenon with biologic, psychologic, physiologic, interpersonal, and behavioral components. While sexuality varies by patient and partner(s); age; gender; religious, personal, and cultural values; and life experiences; it is apparent that some type of standardized assessment or discussion should be facilitated by providers.2 “Breezing” over this topic, or omitting it altogether negatively affects patients’ health outcomes, as well as their sexual partners’ lives. Are healthcare providers ignorant or merely negligent when it comes to the sexual health of patients with cancer and their partners? Do they generalize that older patients or those with certain cultural or religious beliefs do not have sex or would be offended if sexuality was mentioned, even in a clinical setting? Does a diagnosis of cancer mean abstinence?

In Gilbert and colleagues’ study, healthcare providers did not discuss sexuality because they felt that it would have been “intrusive” or “disrespectful.” Other factors that may have prevented both provider and patient and caregiver from discussing sex included age, gender, and culture.1 Regardless of the reason, it seems from this study that healthcare providers are holding back because of their emotions or assumptions of their patients and their partners.

Complete healthcare should be just that: evaluating biologic, behavioral, psychologic, and sexual health. For healthcare providers to omit or casually mention sexual health is equivalent to examining only half of the body, taking only one blood pressure reading, or describing only the positive benefits of a respective treatment. Therefore, providers are offering incomplete healthcare. Healthcare providers cannot expect that patients or their caregivers will automatically mention sexual health issues, particularly in the healthcare setting. While some healthcare providers may feel that conversations about sexuality may be taboo in cancer, what about having this same conversation with patients postpartum? Do providers refrain from discussing sexual health and offering guidance to women and their partners after delivery?

A diagnosis of cancer prompts several concerns and questions in the minds of patients and their partners, including prognosis, adverse effects of treatments, ability to work, and participation in activities of daily living. Sexual health might not be an immediate concern, but one that the healthcare provider must discuss and anticipate down the road. While cancer cannot be cured, scientific and medical advancements within the past decade have increased survival, remission rates, and quality of life. Therefore, healthcare providers are now viewing certain forms of cancer not as a “life sentence” but rather a “chronic condition.” When caring for patients with chronic conditions, particularly diabetes, are there not protocols, guidelines, algorithms, regularly scheduled assessments of global health, disseminated education, and health discussions driven by healthcare providers? In men with diabetes, do providers initiate discussions regarding the potential for erectile dysfunction and other sexual issues? Essentially, patients and their caregivers hope for a return to some sense of normalcy, one that entails their lifestyle routines, including sexuality and intimacy.

Sexual dysfunction in the presence of different tumor types is well established and highly prevalent. Across tumor types, prevalence ranges from 40% to 100%. Causes of sexual dysfunction in cancer can been both physiologic and psychologic.2,3 Furthermore, compared with the physiologic side effects of cancer therapies, sexual problems do not tend to resolve within the first few years of disease-free survival. In fact, they remain constant and fairly severe.2 Not only are sexual problems bothersome, they prevent a return to normal posttreatment life.2,4

My recommendation is to treat sexual health as a component of global health; one that is evaluated, discussed, and followed during the long-term. Perhaps it would behoove healthcare practitioners to standardize a sexual health questionnaire for patients and their caregivers to complete. After reviewing their responses, providers could segue into a dialogue about the biologic and behavioral aspects of cancer and cancer treatment and their effects on sexual health. Next, just simply ask the patient and their partner if they have any questions or immediate or long-range concerns about their sexual health. Finally, offer guidance and additional literature, and follow-up with the patient and their caregiver to ascertain if their needs have been met, or if they require referral. This approach has appeared to work for other chronic conditions, why not cancer?

Sources
1. Danninger L. Intimacy and sex: the unspoken casualties of cancer. February 17, 2007. Available at: http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=63224. Accessed February 2007.
2. National Cancer Institute. Sexuality and reproductive issues (PDQ®). Health professional version. January 23, 2007. Available at: http://www.cancer.gov/cancertopics/pdq/supportivecare/sexuality/HealthProfessional/page1/print. Accessed February 2007.
3. Derogatis LR, Kourlesis SM. An approach to evaluation of sexual problems in the cancer patient. CA Cancer J Clin. 1981;31:46-50.
4. Bokhour BG, Clark JA, Inui TS, et al. Sexuality after treatment for early prostate cancer: exploring the meanings of "erectile dysfunction". J Gen Intern Med. 2001;16:649-655.

Following up on Tennessee's Abortion Death Certificate Bill

I was going to post a catch-us-up on the Tennessee bill requiring death certificates for all abortions, including the interesting tidbit that the state does issue death certificates for certain miscarriages, those at 22 weeks gestation or 500 grams, and how if this criteria were applied to abortions, less than 2% of the abortions performed would qualify for reporting. But over at the Women's Health News blog, Rachel does a great, and comprehensive, initial post, and then follows it up with a look at Rep. Campfield's blog and response to criticism. Why reinvent the wheel, when it's been done so well the first time around?

Tennessee Bill Proposes Fetus Death Certificate

A Republican legislator in Tennessee has proposed a bill that would require doc's to file a certificate of death for aborted fetuses. Rep. Stacey Campfield says that this would give them a way to track the number of abortions performed every year. The thing is, the Office of Vital Records already tracks and makes this information public. What it doesn't track, or make public, is who - which would be on the death certificate. At least the woman's social security number, if not also name.

Of course, this is blatantly problematic, for the HIPAA violation if nothing else. Abortions are a medical procedure, and thus are covered by the HIPAA privacy laws; you cannot identify who had one on those grounds alone. HIPAA excluded, it's still an invasion of privacy. And on top of all of that, it grants a sort of back-end moral agency to a fetus. A death certificate implicitly requires the ability to die, dying requires status as a human life, not a potential human life.

And this is of course not to knock the view of those who do think a fetus is a moral agent, or a human life worth according all the rights of every human to. But the fact of the matter is, right now our law does not grant those rights to a fetus, and this seems like a very underhanded way to do so.

The obliteration of privacy is certainly the more pressing concern, though - it seems like a tactic designed to strongarm women to either not have abortions, flee to other states, or to unlicensed/unscrupulous abortion providers for an under the table (so to speak) abortion. Do we really want to return to those days? Can anyone see any validity to this law other than the extension of a right to life due to assigning human status to a fetus? (And again, I grant that this is a view many people hold, and realize many people would like abortion to be illegal based on this alone. Am I missing something aside from this?)

For Medicinal Purposes (only), Roll a Joint

From Rick Weiss in the Washington Post this morning: AIDS patients suffering from debilitating nerve pain got as much or more relief by smoking marijuana as they would typically get from prescription drugs -- and with fewer side effects -- according to a study conducted under rigorously controlled conditions with government-grown pot.

In a five-day study performed in a specially ventilated hospital ward where patients smoked three marijuana cigarettes a day, more than half the participants tallied significant reductions in pain.

By contrast, less than one-quarter of those who smoked "placebo" pot, which had its primary psychoactive ingredients removed, reported benefits, as measured by subjective pain reports and standardized neurological tests.

The White House belittled the study as "a smoke screen," short on proof of efficacy and flawed because it did not consider the health impacts of inhaling smoke.

But other doctors and advocates of marijuana policy reform said the findings, in today's issue of the journal Neurology, offer powerful evidence that the Drug Enforcement Administration's classification of cannabis as having "no currently accepted medical use" is outdated. To read on, click here.

On the Brighter Side: Strike one up for Nurture

I've been hearing some rather dismaying arguments recently about how important biological ties are -- that family is biological, not social -- a form of what I view as genetic determinism -- and it's a view that seems to miss the point that our choices to love and form relationships is one of the things that distinguishes us from other mammals (generally). So I was heartened to see the recent study that showed that adoptive parents invest more time and financial resources in their children than biological parents.

The study, published in the new issue of the American Sociological Review, found that couples who adopt spend more money on their children and invest more time on such activities as reading to them, eating together and talking with them about their problems.

The researchers examined data from 13,000 households with first-graders in the family. The data was part of a detailed survey called the Early Childhood Longitudinal Study, sponsored by the U.S. Department of Education and other agencies. The entire report can be downloaded here: http://www.asanet.org/galleries/default-file/Feb07ASRAdoption.pdf.

This week's theme: the commodification of life

Two articles have appeared recently in the last week that demonstrate the need to consider how a market-driven economy and the notion of human dignity and beneficence are not always compatible:

From Reason Online: Who Owns Your Body Parts? ... Alistair Cooke's body lay cold in the embalming room of an East Harlem funeral home, suspended in the brief limbo between death and cremation. A "cutter" soon arrived to make a collection. He sliced open Cooke's legs, sawed the bones from the hip, and took them away. The quintessentially British presenter of Masterpiece Theatre and Alistair Cooke's America—the face of genteel, urbane Albion to millions of Americans—was being carved up for parts. For more on this story, click here.

And an Op-Ed from Michael Crichton in the NY Times: Patenting Life - One-fifth of the genes in your body are privately owned, and the results have been disastrous:

YOU, or someone you love, may die because of a gene patent that should never have been granted in the first place. Sound far-fetched? Unfortunately, it’s only too real.

Gene patents are now used to halt research, prevent medical testing and keep vital information from you and your doctor. Gene patents slow the pace of medical advance on deadly diseases. And they raise costs exorbitantly: a test for breast cancer that could be done for $1,000 now costs $3,000.

Why? Because the holder of the gene patent can charge whatever he wants, and does. Couldn’t somebody make a cheaper test? Sure, but the patent holder blocks any competitor’s test. He owns the gene. Nobody else can test for it. In fact, you can’t even donate your own breast cancer gene to another scientist without permission. The gene may exist in your body, but it’s now private property. Click here to read on.

OWLs Report: More Kinds of Life Support

For our moms, sisters and daughters:

According to the 2006 Older Women's League (a/k/a OWLs) report on women and long-term care, "about two-thirds of the 80,000 people living in assisted care residences nationwide are women. A touching commentary on Women's E-News points out the growing need to create a network, a community of medical and social programs that truly supports our elderly; that there are millions of seniors, mostly women, who don't need institutional care yet still need assistance.

At a palliative care case conference I attended recently, I found out that it is the eldest daughter who is the one who usually provides the most care (emotional, physical, and financial) for frail and aging parents -- the burden clearly falls upon women and we, as a society, need to step up to the plate and recognize that it is a burden we should all be sharing.

Surgeons Transplant Ovary

Surgeons have transplanted an ovary from one sister to another, in an attempt to regulate hormonal function and enable pregnany, post-cancer therapy. Apparently the pioneering surgeon, Dr. Sherman Silber, has been working on transplanting strips of ovarian tissue between twins facing similar early menopause situations, but this is the first transplant of a full ovary. Additionally, this transplant was between sisters, not twins.

The point does seem to be twofold: one, to regulate hormones, and perhaps slightly more importantly, to regain fertility. (The patient was not married or involved with anyone at the time of her cancer treatment, so could not bank embryos.) This is slightly different from uterine transplants, in that the surgeons are actually talking about things like the toxicity of immunosuppresent drugs on pregnancy. Right now, they're only transplanting the tissue between twins, or people in the Chaney/Lagos sisters, where there will be no immune response due to shared marrow. (This forgoes the need for the immune response suppressing drugs.)

For better or worse, one of the best things about the article is how it's written. It's not sensationalist or over the top. It's not promising a cure for thousands of distraught women, it emphasizes the trial nature of the procedure, talks (albeit briefly) about the issues around transplants and pregnancies, sets limits, and frankly discusses the emotional motivations behind the principle participants.

Kind of a sad commentary on our media when that's novel, eh?

Gardasil, Assumptions, and Men

I was speaking with someone this morning about the Gardasil vaccine, and she made a very interesting point. Everything around the vaccine is very heteronormative. There's an assumption that everyone is going to be straight! So vaccinate the women, protect them.

But what about the gay men? Anal cancer is caused by the same strains of HPV that cause cervical cancer, yet we don't see people flocking out to advocate vaccinating boys. Because there is an inherent undercurrent that the boys don't need it, they don't develop HPV-related cancers, only [straight] girls get that.

If we are going to act on the presumption that children will become sexually active when they're older, regardless of the morals their parents try to institute, shouldn't we also avoid the presumption of heterosexuality and vaccinate both genders equally, to confer to both protection?

While the vaccine is currently limited by the FDA to women, why are we not discussing the broader implications and potentials of vaccinating everyone?

Portugal fails to overturn strict abortion laws

Voters had the option to overturn strict abortion laws in the conservative Roman Catholic country of Portugal, but failed to do so because of low voter turnout. While 60% of voters did support allowing abortion up until the 10th week of pregnancy, Portugal's laws require that at least 50% of the population must vote in order for the process to be valid. For whatever reason, voter turnout was only around 44%, so the referendum will not pass. However, the Prime Minister is saying he's not going to be deterred by the turnout, and will instead create legislation legalizing early abortions.

I wonder if we'd ever get anything done if we had that sort of restriction on our own (American) election days. It would certainly at least prevent some of the issues we have now, though undoubtedly create others.

[Editor's note: Despite low voter turnout, Portugal's Socialist government said on Monday it would take immediate steps to decriminalise abortion after a referendum in which voters approved the liberalisation of one of Europe's most restrictive laws...
José Sócrates, the prime minister, said new legislation emulating the "best practices" of several European countries would be put before parliament as a matter of urgency. More here.]

Harvard Names First Female President

What has been rumoured for a few days became official this afternoon: Drew Gilpin Faust will be the new president of Harvard, and in addition to its first female president, the first president since 1672 who did not receive a degree from the institution.

Also notable is that Dr. Faust was involved in the aftermath of former Harvard president Lawrence Summers ' comments about women not having an aptitude for science and math. Prior to his resignation, she led committees to balance out the number of women recruited and retained on the campus.

While initially this might not seem like it's big bioethics news, I think it's certainly important news for women. It's another glass ceiling being broken, and as the president of Harvard, Dr. Faust (and oh, I can already see the jokes) is going to be a very important figure in science and the humanities.

Besides, it's just kind of cool.

Rent-A-Womb

We tend to think of surrogate mothers as someone having a baby for a friend or one who really enjoys being pregnant and wants to give back in that way. The surrogate would be artificially inseminated by the father's sperm, carry the child, and then turn the child over to the couple. With assisted reproductive technology, we can now harvest an egg from one woman, fertilize it outside the womb, and then implant it into a surrogate womb for gestation. Certain states don't allow women to enter into surrogacy contracts, yet others, such as California, do. An unintended consequence of all this is that increasingly minority and immigrant women as well as women from developing countries are serving as "host wombs" for wealthy (often white) couples. Is that reproductive freedom or economic exploitation?

Rent-a-womb in India fuels surrogate motherhood debate

Date: Sunday, February 04, 2007
Source: Reuters
Author: Krittivas Mukherjee

MUMBAI (Reuters) - Jyoti Dave is pregnant, but when the 30-year-old gives birth in March the baby will not be taken home to bond with her other child, but will instead be handed over to an American couple unable to conceive. For her trouble, the Indian surrogate mother will be paid. She won't say how much, but she says it's money she desperately needs to feed her poor family after an industrial accident left the family's only breadwinner unable to work.

"My husband lost his limbs working in the factory," Dave told Reuters. "We could not manage even a meal a day. That is when I decided to rent out my womb." Surrogate motherhood is among the latest in a long list of roles being outsourced to India, where rent-a-womb services are far cheaper than in the West. "In the U.S. a childless couple would have to spend anything up to $50,000," Gautam Allahbadia, a fertility specialist who helped a Singaporean couple obtain a child through an Indian surrogate last year, told Reuters.

"In India, it's done for $10,000-$12,000." Fertility clinics usually charge $2,000-$3,000 for the procedure while a surrogate is paid anything between $3,000 and $6,000, a fortune in a country with an annual per capita income of around $500. But the practice is not without its critics in India with some calling it the "commoditisation of motherhood" and an exploitation of the poor by the rich.

"It's true I'm doing this for money, but is it also not true that a childless couple is benefiting?" said Rituja, a surrogate mother in Mumbai, who declined to give her full name. For the surrogates -- usually lower middleclass housewives -- money is the primary motivator.