Vain Cain Wasn't Abel

By Emily Stephens

Let me introduce you, before the story starts--
A Gigi is a girly-girl, the kind that never farts.
They love clothes, malls, and a muscley stud,
And squeal when confronted with boogers and mud.
High heels, short skirts, and lotsa thrills--
The kind that gives the good boys chills.
She’ll steal away the boy of your dreams,
With flirtation bursting from her seams.
No brains, all laughs, pouty lips, tight butt.
The kind our grandmums called a slut.
Buried ‘neath mascara, lipstick, powder, polish–
And a waistline rather smallish,
Past the fake-n-bake orange and yellow skin,
You’ll find a girl who’ll always win.
Plain, smart girls simply can’t compare,
To the Gigi’s looks, the Gigi’s hair.

At the age of twenty, I’d still never been kissed,
See a Gigi stole his heart away; he never knew what he had missed.
She bounced in with her boobies, her makeup all aglow,
She shook her head and giggled like there was nothing she did know.
Her lips were rouged with redness.
Her talent? She could flirt.
Man, next to her, I know it’s true; I looked no more than dirt.
And so that’s when I started to hatch a plan so cruel.
I’d sneak into the Gigi lair, and attack right after school.
Underneath the cover of stormy summer nights,
I’d overcome the Gigi Queen and proclaim Normal Girl rights!
If I could find her weakness, I’d get her where it hurt…
A Gigi hates mud, slime, and yes, they really do hate dirt.
Perhaps a chemical reaction could destroy her makeup glow?
I know, yes, of course! I’d attack with H-2-O!

I ran quickly to my closet, and pulled from the depths therein
A water gun from Target, neon orange with hot-blue trim.
I filled it up with water, nice and cold at first,
Then realized red food coloring might end my vengeful thirst.
Gun ready, I looked into the mirror and gasped in the light,
I’m too obvious, too Caucasian, too gosh darn freakin’ white!
Black shoe polish was all I owned, therefore it had to do.
I covered my arms, my legs, my face, my neck was dark black, too.
Grabbing my gun, I ran into the night,
Yelling and howling and filled with delight.
Revenge would be mine, and the Gigi would wish
She’d skipped over my village, stayed away from my dish.
Chadwick Schmet was his name and gone was his heart,
But that Gigi would pay, that Gigi would smart!

High-pitched giggles echoed through the air,
And I knew I’d arrived at the Great Gigi’s lair.
Quickly, I hid in a green prickly bush,
While watching for Gigi, I pulled thorns from my tush.
At the smell of perfume, I gasped in delight.
The Queen Gigi was there, and still giggling--how trite.
Chadwick was nearby, consumed by her chest,
A massive upheaval of what boys like best.
Her body looked twisted, bent out in contortion--
It’s not normal to grow boobs in such a proportion!
Poised and ready I sat, growing more and more mad,
Then I burst from the bushes screaming, “EEE-GAD!”
The Gigi spun round, terrified by my cry,
As my gun exploded water right into her eye.
I barked like Xena, did a She-Woman dance,
Then squirted some more so it looked like peed-pants.
Swooping away as quickly as in,
I left her in tears and knew I did win!
She strutted around with what beauty was left,
The boys laughed as she cried, her ego bereft.
Yes, Queen Gigi did most certainly regret,
Entering my village to steal Chadwick Schmet.

Thunder cracked above as I fled from the scene–
“Oh my gaa!’ was her wail, “Am I, like, totally bleeding?”
I laughed to myself as I escaped into night,
My clever plan had filled the Gigi with fright.
Storm clouds above gave way to rain,
And I danced in the droplets like a girl gone insane.
Looking down at my arms, I ended my scoff,
Rain dropped on my skin, beaded up, then ran off.
Tiny streams made their way from my foot to my head,
I only meant to camouflage, but was water-proofed instead.
Shoe polish clogged my pores, covering skin with its grit.
Heavens to Betsy, I was such an idiot!
I ran home rather quickly—to the bath, jumped right in.
Scratching and scraping black from my skin.
I tore at my stained flesh all through the night
And when the sun rose, I looked down in fright.
Despite all the paint that I left in the tub,
My skin stayed black through the scratch, scritch, and scrub.
It took weeks--the natural sluffing of skin cell--
To remove the horrid curse. Goodness gracious, it was hell.

Believe it or not, this is a true story. Overlooking all my dramatic license, the psychology and neurology of revenge is a fascinating topic. In fact, according to Dr. Michael McCullough, a psychologist at the University of Miami, ''The best way to understand revenge is not as some disease or moral failing or crime, but as a deeply human and sometimes very functional behavior. Revenge can be a very good deterrent to bad behavior, and bring feelings of completeness and fulfillment. Think of the urge as kind of hunger, a lust, a deficit the brain is seeking to fill, and you can see why revenge fantasies can be so delicious.''

Dr. Eddit Harmon-Jones, a neuroscientist from the University of Wisconsin used brain-wave technology to monitor where anger and vengeance originates within the brain. Quite surprisingly, insulted people showed bursts of activity in the left prefrontal cortex—the same location where hunger and cravings are processed. According to Dr. Harmon-Jones, “[This brain activity] seems to reflect not the sensation of being angry so much as the preparation to express it, the readiness to hit back.”

We walk a fine line (consciously and subconsciously) to control our impulses after being wronged. Research shows vengeance is most often sought in a covert manner. Several forgiveness studies found that when men were asked to recall offenses committed against them they were less vengeful toward the offenders. Women, on the other hand, began at a lower baseline for vengeance, were equally unforgiving as men, but magnified the offenses they received. Apparently, “hell [really] hath no fury like a woman scorned.”

Spreading rumors, stealing boyfriends, dagger-like stares—it’s all very familiar, admit it. However, few of us want to appear malicious. The ideal is to ruin our enemy without repercussions, without anyone able to link us to the crime. Interestingly, men gain more satisfaction when witnessing retribution than women. The University College London monitored the brain activity of both sexes as they watched people they liked and disliked suffering pain. Women tended to empathize even with those they hated, while men enjoyed the suffering of foes.

Many anthropologists believe retaliation keeps individuals in line where formal laws or rules do not exist. Retaliation can be a sort of cultural mediator that keeps us from breaking tacit taboos. Whether or not vengeance is acceptable, there are ways to assuage intense feelings of retaliation. For example, protesting injustice can be an empowering process. Dr. Harmon-Jones studied brain-wave patterns in students who were told tuition had increased dramatically. “They all got angry,” he said, “but signing a petition to block the increases seemed to give many some satisfaction.”

So, next time…

I learned from this lesson, though it took many months
For the polish and shame to leave the skin of this dunce,
Tho’ a little bit’o’water might cause a Gigi dismay,
Sweet revenge ain’t so sweet when karma gets in the way.
Perhaps retaliation isn’t what it’s cracked up to be;
Next time I’ll consider some old-fashioned charity.

Or maybe I’ll start a petition…

Mothers' Little Helpers?

By Randy Hendrickson

A New York Times article ( “Experts Question Placebo Pill for Children” --May 27, 2008) raises the question of whether giving children placebo pills for minor childhood illnesses is an ethical practice. Based on the premise that pharmacologically inert compounds can actually produce improvements in some medical conditions, Jennifer Buettner, a mother of 3 small children, developed a cherry-flavored chewable dextrose tablet, the first branded, pharmaceutical grade placebo. The therapeutic effect is based on the power of suggestion. If parents use the placebo to “trick” their children into thinking that they are taking real medicine, the children will consequently feel better. The placebo, called Obecalp™ (placebo spelled backwards), goes on the market on June 1 and will be available in retail stores and on Efficacy Brands website. It is being advertised as being “invented by a Mommy.”

Several bioethicists speak out about the use of placebos in children:

• Howard Brody, MD, PhD, a medical ethicist at the University of Texas Medical Branch at Galveston, claims that there is no way to predict the response of placebos, especially in children. There may be a dramatic response in some children, whereas others may have no response at all. “The idea that we can use a placebo as a general treatment method strikes me as inappropriate.”

• Franklin G. Miller, PhD, a bioethicist for the National Institutes of Health, agrees. “As a parent of three now grown children, I can’t think of a single instance where I’d want to give a placebo.”

There is also the question of deception:

• Steven Joffe, MD, MPH, a pediatrician and bioethicist at Dana-Farber Cancer Institute, does not condone parents purposefully lying to their children. “It makes me squeamish.”

In addition, other physicians have expressed concern that giving children a pill for every minor ache or pain will lead children to believe that you can only get better by taking pills or medicine. They will not come to realize that most ailments will eventually resolve on their own. In most cases, what children really need is a little comforting, nurturing, and attention, rather than fake pills.

The Ethics Behind Drug Ads

By: Jenny Walters

Everyday, as we watch television, whether it is the home and garden or sports channel, we cannot help but be confronted with an infinite number of drug ads. In a recent article published in Time magazine entitled “Do Consumers Understand Drug Ads,” the author, Kate Pickert, discussed how the consumer perceives drug ads.

According to Pickert, drug makers spend nearly $5 billion a year on drugs ads; with every $1000 spent resulting in 24 new prescriptions.[1] From the Nasonex bee to the Lunesta butterfly, you cannot turn on the television without viewing a drug ad. However, this May 2008, during a House Commerce Committee meeting, lawmakers focused on “deceptive” drug ads produced by pharmaceutical companies such as Pfizer and Merck, and argued the need for tougher regulations.1 In addition, the U.S. Food and Drug Administration (FDA), which mandates and monitors the content of drug ads, met earlier last week to discuss the topic of the content of drug ads in detail.1

Pickert stated the aim of many drug ads is to: “leave you confused about the information.” According to the FDA, drug ads must present a “fair balance” of the benefits and risks of a drug. However, this “fair balance” is rarely seen; as pharmaceutical companies create drug ads to sell a product, not warn consumers of the risks of a product. Therefore, the risks and side effects portion of a drug ad is usually fast, complicated, and masked by visuals effects that distract the consumer from what is being said.1 In fact, many consumers find the risks and side effects portion of drug ads comical at times. A recent Saturday Night Live episode even poked fun at the drug ads style of the presenting risks and side effects in their skit about Annuale, a made up birth control pill.1

As public scrutiny grows, pharmaceutical companies continue with their marketing ventures and are now turning to medical device ads.1 In Nov 2007, Johnson & Johnson launched a new television ad for Cypher, “a drug-coated coronary stent, designed to prop open narrowed arteries.”1 Ads, such as the Cypher ad, target millions of consumers who lack the medical knowledge to make a decision on whether they require such a device.1 According to Pickert, the Cypher ad creates questions regarding the “social benefits of medical advertising.”

From my perspective, a nurse, a mother, a pharmaceutical employee, and a consumer, I can see all sides of the drug ad dispute. Drug ads can be helpful to consumers, as they do provide them with information they may have otherwise not been aware of. However, the confusion created and the blatant disguising of side effects of a drug, is of great concern for me. Although at times the drug ads may be comical, ultimately they show the need for pharmaceutical companies to promote their products, make money, and put the patient safety last. As stated above, the pharmaceutical companies are trying to sell products, not warn of the risks and side effects of the products.

[1] Pickert K. Do consumers understand drug ads? Time [serial online]. May 2008. Available at: http://www.time.com/time/printout/0,8816,1806946,00.html. Accessed on May 18, 2008.

Patients in search of VIP treatment

By: Jenny Walters

Most people have experienced “assembly line patient care.” The kind of patient care where you wait in an overcrowded office with 20-30 other patients; where you are seen an hour or later after your scheduled appointment by, a physician, but usually a physician assistant for all of a 5 minute visit; where you are lucky if the physician takes a minute, of that 5 minute appointment, to look up from his/her notes to make eye contact with you. If you haven’t experienced this type of patient care, consider yourself lucky….very lucky.

In an age of insurance company driven patient care, patients finds themselves in the “assembly line” situation more often than not. In fact, at times it may feel almost impossible to find a physician’s office that does not function on these premises. A recent article in Time magazine, written by Jeninne Lee-St. John, entitled Giving Patient the VIP Treatment, focused on the new emergence of VIP treatment physician practices.[1] According to Lee-St.John, many patients are choosing to pay immense out-of-pocket premiums to obtain more personalized attention.

In the more than 1,000 “concierge, or boutique, practices” that are open today, physicians are limiting the number of patients they see so they can devote more time to each or them.1 Concierge practices accept insurance for routine tests and treatment, but charge patients additional fees for extras like: no waiting, longer office visits, and round-the-clock availability via e-mail or cell phone.1

Many concierge practices are primary care offices. However, OB/GYN physicians are now beginning to enter the new area of concierge practices. Elite Obstetrics and Gynecology, in Ft. Lauderdale is one such practice. Elite charges patients an additional $15,000 on top of insurance, “for VIP prenatal care that includes add-ons like a fetal ultrasound photo at every visit, private birthing classes, one massage per trimester, optional home doctor visits, physicians home and cell numbers, e-mail addresses, and the guarantee that your physician will be at the hospital for your full active labor and delivery.”1 Elite is able to make the guarantee that each physician will be available for each of their patients birth by accepting obstetric patients by due date, and accepting no more than four woman due per month.

Critics argue concierge practices are for the wealthy; and high quality healthcare should be available to all patients, not just those who can afford it. However, many of the concierge physicians report: “Most of our patients are normal people who just care a lot about their health.”1 Dr. Lanalee Araba Sam, a physician from Elite OB/GYN stated: “Women seem to spend more time picking a hairdresser than picking who’s going to take care of them for nine months and be responsible for the baby.” For woman who are deeply interested in their health, but who cannot afford Elite’s fees, Dr. Sam will sometimes offer her services at a discounted rate or for free.1

As we draw closer upon the next presidential election, we are overwhelmed with claims and promises of better health care and health care or all. It is impossible to say what changes we will really see with our new president. However, one thing is clear, the current health care system must change in order to better accommodate patients. Patients shouldn’t be forced to pay immense out-of-pocket fees to obtain high quality patient care; and patients shouldn’t feel like a number in assembly line. Instead, high quality patient care should be available to all. The question is ….How are we going to make that happen?

[1] Lee-St. John L. Giving patients the VIP treatment. Time. May 2008. Available at: http://www.time.com/time/health/article/0,8599,1779338,00.html. Accessed on June 1, 2008.

Cervical Cancer Vaccine: Do we need it?

By: Jenny Walters

As you watch television, you cannot go a day or even a couple hours without seeing the commercial for Gardasil, “the first ever cervical cancer vaccine.” Gardasil claims to stop cervical cancer before is starts. The Gardasil vaccine is recommended for girls ages 11 to 12, but can be used in girls as young as 9. According to an article from the Mayo Clinic, written by Bobby Gostout, MD, and entitled Cervical cancer vaccine: Who needs is, how it works, Gardasil is the newest addition to the official childhood immunization schedule.[1]

Cervical cancer affects 10,000 women a year and leads to 4,000 deaths.1 In 2005, according to the World Health Organization, there were an estimated 500,000 new cases of cervical cancer. Cervical cancer is the leading cause of death in women, even with treatment.

Various strains of the human papillomavirus (HPV), are responsible for most cases of cervical cancer.1 HPV spreads through sexual contact. Gardasil specifically blocks two cancer-causing types of HPV: types 16 and 18. Gardasil also blocks types 6 and 11, which are associated with genital warts and mild Pap test abnormalities.

The Gardasil vaccine allows young girls immune system to become “activated before their likely to encounter HPV.” Vaccinating young girls also allows for higher antibody levels, which results in greater protection against cervical cancer.1

To see earlier positive effects of the Gardasil vaccine, the Center for Disease Control (CDC) recommends a “catch-up immunization for girls and women ages 13 to 26” be administered.1 Currently, the vaccine is not required for school enrollment, but may be in the future.1 Gardasil has been proven to be “remarkably safe.”1

Common side effects include: soreness at the injection site, low-grade fever or flu-like symptoms. There were no reports of clinical trial discontinuation due to serious side effects. So what does this all mean?

As a mother and wife, HPV is not a threat I worry about now. However, during nursing school, I had a class of about 18 girls. Of those 18 girls, almost every one of them had the HPV infection. It seemed as though each week I would hear of another student having an abnormal Pap test due to HPV. HPV is non-discriminating, it can affect anyone. If the Gardasil vaccine can help block HPV infection, than maybe one day cervical cancer will no longer be the number one killer of women.

[1] Gostout B, MD. Cervical cancer vaccine: who needs it, how it works. Sep 2007. Available at: http://www.mayoclinic.com/health/cervical-cancer-vaccine/WO00120. Accessed on Jun 02, 2008.

Is One-A-Day One Too Many?

By Leane Scoz

"Train, say your prayers, and eat your vitamins."--Hulk Hogan

If vitamins are good enough for the Hulkster, they should be good enough for all of us. And, most Americans agree. Vitamin supplements are a multi-billion industry. With over a third of American adults consuming them on a regular basis, the risks and benefits should be well known.

However, recent reports reveal insufficient evidence to support the beneficial effects of multivitamins. In fact, an NIH panel review and Mayo Clinic article both report beta-carotene supplements actually increase the risk of lung cancer in smokers. Also, a Harvard Men's Health Watch suggests that high doses of multivitamins may raise prostate cancer risk. The study had limitations since it was not originally designed to support this assessment, however, it does raise the question on whether or not our daily "helpers" are really doing their jobs or causing us more harm than good.

The NIH and the Mayo Clinic articles suggest another negative aspect for multivitamins is that the products are not strictly regulated, which implies that the labels may not exactly include everything contained in the bottles. However, both agree that studies do exist to support the use of folic acid supplements for pregnant women to prevent neural tube birth defects, calcium and vitamin D supplements to protect the bones of postmenopausal women, and antioxidants and zinc supplements to slow the worsening of age-related macular degeneration.

Most Americans assume multivitamins are safe and effective since they are readily available on store shelves and marketed heavily in the media. And why shouldn't we feel this way? Vitamins are found in nature in the foods we eat everyday. Vitamin supplements make us feel healthier and believe we will prevent chronic diseases, colds, and flu. We are taught that vitamin deficiencies can be extremely dangerous and hazardous to our health. We do not think that too much of certain nutrients can be harmful.

As always, people need to make an educated decision when it comes to multivitamin use. They need to carefully assess their health, consult their physician, and weigh out the possible benefits and risks before determining if a multivitamin is right for them. Maybe, Hulk needs to amend his slogan to say, "...consider eating your vitamins."

Saving Your Self: Backing Up Your Mind Files

As many of you know, the idea behind the Singularity is that someday we will be able upload our consciousness to machines; although we are at least a couple of decades away from that, Lifenaut.com is a project that starts the process -- a place to back up your mind files -- a digital self storage place, if you will.

Check out the cool video:




And look for our podcast soon interviewing Bruce Duncan about what they hope to achieve.

Old-Fashioned Science or Necessary Evil?

The international debate over animal testing got a shot in the arm last week when renowned primatologist Jane Goodall urged the European Union to find alternatives to experimentation on animals. Armed with 150,000 signatures and a lifetime of heralded research, Goodall called for the introduction of a Nobel Prize to reward research that avoids testing on live, sentient beings.

Goodall delivered her message as the EU prepares to update its 22-year old directive on animal testing. Scientists and animal rights campaigners also descended on Brussels to join the debate over how to proceed on the controversial issue.

Campaigning for animal rights is nothing new for Goodall (pictured), who founded the Jane Goodall Institute in 1977 to “advance the power of individuals to take informed and compassionate action to improve the environment for all living things.” Goodall also heads up Advocates for Animals, an animal rights organization in Edinburgh, Scotland.

It didn’t take long following Goodall’s call to action in Brussels for supporters of animal research to chime in. Colin Blakemore, professor of neuroscience at Oxford, argues that while strict controls should be required, animal experimentation is a necessary evil in the world of scientific research. Blakemore is no stranger to controversy; according to a 2003 article, he endured over a decade of attacks and abuse by animal rights campaigners for engaging in experiments that led to the deaths of newborn kittens.

The animal testing debate clearly raises important ethical questions (not to mention the blood pressure of its participants). Which procedures should be considered acceptable, and at what expense to the animals? How can we determine when animal suffering is “minimized?” Should animals be considered part of the polity?

Perhaps the most important question relates to the human mind. Goodall mentions that the “amazing human brain” should work to find new ways of testing that don’t involve animals. The brain’s capacity to reason gives humans an incredible gift—one filled with responsibility. As new methods of conducting scientific research evolve, the debate over that responsibility will define the future of animal experimentation.

Darwin v. God

"We now have it within our power to eradicate from the face of the earth that age-old scourge of mankind: malaria." The year was 1958. President Eisenhower announced his war on the devastating disease in his State of the Union speech. Malaria was a hot topic. Two-fifths of the world's population were at risk of contracting malaria, 200 million suffered malarial infections, and 2,000,000 to 2,500,000 died from infection each year. Ten years earlier, in 1948, chemist Paul Hermann Müller was given the Nobel Prize for his intensive research of a chemical called dichloro-diphenyl-trichloroethane, or DDT. The chemical provided Eisenhower with a toxic contact poison capable of killing the female Anopheles mosquito—the sole transporter of malaria. The World Health Organization plus sixty other governments joined President Eisenhower’s insecticide blitz campaign to obliterate the very existance of malaria by 1968.

How is it possible, then, that 50 years later, over one million African children die from malaria every year?

"As a result of the Campaign, malaria was eradicated by 1967 from all developed countries where the disease was endemic and large areas of tropical Asia and Latin America were freed from the risk of infection. The Malaria Eradication Campaign was only launched in three countries of tropical Africa since it was not considered feasible in the others. Despite these achievements, improvements in the malaria situation could not be maintained indefinitely by time-limited, highly prescriptive and centralized programmes." [1]

In 1972 ,William Ruckelshaus (administrator of the U.S. Environmental Protection Agency [EPA]) banned the use of DDT. However, only two years earlier he made the following statement to the U.S. Court of Appeals, "DDT has an amazing an exemplary record of safe use, does not cause a toxic response in man or other animals, and is not harmful. Carcinogenic claims regarding DDT are unproven speculation." [2] Furthermore, during the DDT hearings, the EPA hearing examiner, Judge Edmund Sweeney stated that "DDT is not a carcinogenic hazard to man... DDT is not a mutagenic or teratogenic hazard to man... The use of DDT under the regulations involved here do not have a deleterious effect on freshwater fish, estuarine organisms, wild birds or other wildlife." [3]

What is the truth about DDT? Is it as bad as they say? Does DDT truly cause cancer, mental retardation, birth defects? Does it threaten the environment, the bald eagle, thin the egg shells of wild birds, and indiscriminately kill helpful insects? Does DDT breed super mosquitos and super parasites impervious to our most powerful insecticides? And, ultimately, do these negative consequences outweigh saving the lives of over one million African infants and children?

Entire websites are dedicated to the pros and cons of DDT. Both sides are very convincing. They back up arguments with substantial and impressive studies. Unfortunately, hours of research has led me to no definite conclusion. If we eradicated malaria from most of the developed world, why can’t we rid Africa of the epidemic? I can’t point my finger at any one cause: the decision to ban DDT, the greed of pharmaceutical companies, the corruption of African governments, the misappropriation of donated monies, the lack of ability to successfully distribute mosquito nets and anti-malarials, or an unspoken and perhaps unrealized general opinion that Africa really doesn’t matter—or worse, that natural selection should take their lives.

Perhaps the greatest irony of this tragedy is that we have the cure. The deadliest strain of parasite, P. falciparum, is spread person-to-person by infected female Anopheles mosquitos. This insect was virtually erradicated in the United States by DDT and anti-malarials during the late 1950s and 1960s. Although DDT is the most affordable solution (which is especially appealing to poorer nations like Africa), strict environmental regulations and questionable longterm effects makes what was once a “quick-fix” for the U.S. in the late 1960s, a next-to-impossible scenario for the 350–500 million cases of malaria that occur worldwide.

In September 2006, The Washington Post published an article announcing WHO’s reversal of the 30-year-old policy to ban DDT in malaria-ravaged countries. According to Arata Kochi, the director of WHO’s malaria department, "WHO will use every possible and safe method to control malaria." Therefore, the organization plans to spray pesticide once- to twice-a-year on the inside walls of mud and thatched huts. Each application’s estimated cost is $5. Kochi continued, “I am here today to ask you, please help save African babies as you are helping to save the environment. African babies do not have a powerful movement . . . to champion their well-being.” WHO hopes DDTs impact will repeat the success of a 2000 study in Zambia where incidences of malaria lowered 35% in sprayed neighborhoods. Their decision that the benefits of the carcinogenic DDT outweigh the physical and environmental risks is a controversial one.

When discussing the epidemic with an average, Caucasian-American, God-fearing co-worker, I was surprised to hear her wonder aloud if these children should die. Believe it or not, there is strong argument for population control. In the 1960s, WHO even discussed malaria as important to the overpopulation problem. According to www.junkscience.com, a site dedicated to debunking false scientific allegations:

Population control advocates blamed DDT for increasing third world population. In the 1960s, World Health Organization authorities believed there was no alternative to the overpopulation problem but to assure than up to 40 percent of the children in poor nations would die of malaria. As an official of the Agency for International Development stated, "Rather dead than alive and riotously reproducing." [4]

My conversation with my co-worker branched into the Malthusian catastrophe, who to let live and who to let die, and finally, “what’s the point of saving African children if they will most likely later die of AIDS?” Whether or not you believe in population control, how is it ethical for us to save ourselves and not the people of Africa? Malaria was a deadly reality of our past. Did we second guess our decision to save ourselves? Why do we deserve to outwit “natural selection” and not do the same for those in Africa? How is it ethical to save our own children at the expense of the environment and then allow “natural selection” and “population control” to destroy the lives of over a million African children?

I have struggled with this blog because I couldn’t find any answers. My limited human brain is incapable of solving this huge, overwhelming problem. I have arrived at one decision, though. I believe it is a sacred human right to survive. God help us if we decide the earth is too populated and which of our populations deserve to die.

1. Bull World Health Organ,1998;76(1):11-6.
2. Barrons, 10 November 1975.
3. Sweeney, EM. 1972. EPA Hearing Examiner's recommendations and findings concerning DDT hearings, April 25, 1972 (40 CFR 164.32, 113 pages). Summarized in Barrons (May 1, 1972) and Oregonian (April 26, 1972).
4. Desowitz, RS. 1992. Malaria Capers, W.W. Norton & Company.

Got $100k? Enter to Win a Canine Clone

Do I hear $100,000?

$150,000?

$200,000?

For the right price, a California biotech startup will clone dogs for five lucky bidders in the world’s first commercial dog cloning program. BioArts International opens a series of online auctions June 18, when people around the world can bid to have their four-legged friends “duplicated.” Bidding starts at $100,000.

BioArts chief executive Lou Hawthorne, who recently succeeded in a decade-long quest to clone his family dog, spearheads the program. Hawthorne (pictured with his cloned dogs) partners with Hwang Woo-suk, a South Korean scientist who led the effort to produce the world’s first canine clone in 2005. Hwang is also known for a series of embezzlement and bioethics law violations linked to fake stem cell research.

News of the BioArts auction is sure to spark debate among dog owners for both its controversy and opportunity. One one hand, the Humane Society argues that commercial pet cloning has no social value and may lead to increased animal suffering. On the other, Hawthorne views biotechnology as path to happiness for pet owners.

But can the scientists at BioArts duplicate an animal’s personality? When I was young, my family’s dog passed away after a long battle with cancer. I was devastated; I had grown up with Sam around, and his unique personality was a big part of our family. Even if cloning were possible at the time, I doubt the process could have replicated Sam the way we knew him.

The debate over pet cloning also raises the issue of homeless animals. The Humane Society makes a strong case for animal adoption over animal replication. Wouldn’t pet owners be doing society (and the animals involved) a favor to adopt animals from shelters rather than pour hundreds of thousands of dollars into an attempt at producing a genetic duplicate?

Will Hawthorne and his team at BioArts oversee an international bidding war of dramatic proportions in June? Or will the price of cloning prove to be too high for an untested market? Whether pet owners have $100k to spare or not, the auction will surely get people thinking—and arguing—about the ethics of pet cloning.

Microbe Beat: A Huge Fan of Life at the Cellular Level

As Stephen Colbert admonishes the Martian microbes to remember 'who their friends are', I wonder how he would react if he knew that trillions of microbes live in our guts and other parts of our bodies, in a symbiotic relationship:




[Hat tip to Carl Zimmer]

Opening the black box ...

As reported in a news blurb that nearly escaped my attention because the major newspapers and websites either failed to report it or buried it deep, the US Food and Drug Administration (FDA) is proposing to replace its current pregnancy labels for a new system that clearly lists what is known and not known about use of particular drugs by pregnant or lactating women.

Under the old system, drugs were categorized into one of five categories - A, B, C, D and X – based on the amount of animal and human safety data available. Only a handful of currently marketed drugs fall into category A: safe for use based on extensive animal and human safety data. More drugs fall in category X: conclusive animal and human data demonstrating fetal risk.

The problem is that the vast majority of drugs fall into categories B and C. For most these compounds, there may or may not be data from animal models to suggest that the drug is safe and no good human studies to confirm these pre-clinical results. Use of these drugs by pregnant or lactating women is thus a crap shoot, with women and their physicians given little guidance to help them weigh the risks and benefits of these treatments. The new labeling rules would provide more information about the potential risks and benefits to pregnant or lactating women and their children or fetuses.

Still, I wonder whether the FDA realizes the Catch-22 that many researchers face regarding pregnant and lactating women. In the HIV prevention field, for example, microbicide and PrEP (pre-exposure prophylaxis) studies generally exclude pregnant and lactating women from enrolling, and study participants who become pregnant must discontinue product use. However, in the resource-poor countries when many of these trials take place, women spend approximately one-third to one-half of their reproductive years pregnant or breastfeeding. Not only do unexpected pregnancies adversely impact the power of these studies to detect a protective effect, but these restrictions also mean that a large number of women in the developing world who want to participate in these HIV prevention trials cannot. Alternatively, they be required to use a limited number of contraceptive methods that might otherwise be unacceptable to them.

Finally, it is unclear how HIV prevention researchers can collect the necessary data to demonstrate that these products are safe and effective for pregnant and lactating women to use. Most of these data come from pregnancy exposure registries, in which women who use category B, C and D drugs are monitored for the effect of these compounds on fetal development. But does it make sense to rely on such “natural experiments” rather than collect the necessary safety data in a controlled clinical trial using fully informed and willing participants? … particularly for compounds like topical microbicides and PrEP which, if effective, will be used primarily in countries in which collecting data for pregnancy exposure registries is likely to be difficult at best?

Warning: Tortured Bodies May Lie Ahead

As part of a settlement between the NY Attorney General's Office and the promoters of “Bodies: The Exhibition,” the following warning must now be presented at the exhibitions:

Warning: The body parts you are about to see may have come from Chinese prisoners who were tortured and executed.




The NY Times Cityroom blog writes that the exhibition has been the object of persistent criticism from medical ethicists and human rights advocates, who have questioned whether the remains were legally obtained.

You can access the full story here.

Ethics of Branded vs. Generic Drugs

On May 15, 2008, an article in the Wall Street Journal reported that a United States appeals court upheld a lower-court ruling striking down patents for Lovenox, an anticoagulant manufactured by Sanofi-Aventis. This may clear the way for generic competition.

When a pharmaceutical company discovers or develops a promising new compound, they apply for and receive patent approval, which provides for 17 years of patent protection and exclusivity. This gives them the sole right to sell the drug while the patent is in effect. However, as the patent nears expiration, other pharmaceutical companies are able to applications to the Food and Drug Administration to obtain approval to market generic versions of the brand-name drug.

The pharmaceutical companies claim that the period of market exclusivity enables them to recoup the cost of developing the new drug. However, pharmaceutical companies often try to extend the period of exclusivity by obtaining approval for their own generic version of the branded drug, which provides an additional 6-month marketing exclusitivity period. Also, they may try to obtain an extension on exclusivity by targeting special populations such as children.

The ethical dilemma raised here is how this marketing exclusivity for the pharmaceutical company affects the patients, those individuals with medical condition who need the drug. The availability of generic equivalents for brand-name drugs makes it easier for patients with low incomes or no health insurance to get the medications that they need. Very often, brand-name drugs are priced well beyond their means.

My mother had deep vein thrombosis and a pulmonary embolism 7 years ago and consequently has been on daily anticoagulation therapy ever since. She is at high risk for having another pulmonary embolism and approximately 30% of people who have pulmonary emboli die. When she was recently scheduled to have a hysterectomy, her hematologist recommended that she transition to Lovenox (enoxaparin, Sanofi-Aventis) during the week before her surgery and the week after the surgery. Subcutaneous Lovenox has a much shorter onset of action and half-life (12 hours) compared with the oral anticoagulant warfarin (4 to 5 days). So, this would enable her to receive anticoagulation therapy up to 12 hours before her surgery and again within 2 days after the surgery, reducing the amount of time that she'd be at risk for developing deep vein thrombosis or pulmonary embolism.

The real surprise came when my mother tried to fill her prescription for Lovenox. She is retired, but she does have prescription drug coverage. However, her co-payment for a 10-day supply of Lovenox injections was $900. That's right, $900. The insurance company was also paying $900. It turns out that Sanofi-Aventis does provide assistance for some patients who are unable to afford needed medication. However, when I downloaded the forms and helped my mother complete them, it turned out that her annual income was $1500 too much to qualify for assistance. So, she had to pay the $900 for the Lovenox. In her case, the risk was too great to go without the medication. However, now that she's had the surgery, she doesn't know how she's going to manage to pay her co-payment for all of the other related expenses--the hospital, the surgeon, the operating room, the anesthesiologist. She hadn't expected one medication to take all the money that she'd been setting aside in preparation for the surgery expenses.

So, I was pleased to read the news article about Sanofi-Aventis and to learn that generic versions of Lovenox might soon be available. Lower-priced generics will make it easier for patients like my mother to obtain the medication that they need for anticoagulation.
Hopefully, fewer patients will have to take pause to consider whether or not the risk of dying is worth the price of the drug.

A Walk to Beautiful...

In a follow-up to Sean's previous post on obstetric fistulas, PBS' NOVA has put together an award-winning video about three Ethiopian women on their journey to find a cure for injuries they sustained during childbirth that have left them incontinent and shunned by their husbands and the communities in which they live. You can watch the video, which has been broken down in six parts, online here and you can watch the preview below:

It would cost so little to do so much ...

... I'm currently in Mombasa for a meeting on building the capacity of local researchers and local research institutions, so that they are equal partners with US and European researchers in eveloping and implementing HIV prevention trials in developing countries like Kenya and Rwanda.

Although the jet lag is murder, as are the 11pm conference calls with colleagues back in DC, trips like this often give me the opportunity to catch up with all of the journal articles, news reports, and blog postings that have gone unread over the past couple of weeks.

In reviewing my RSS feeds, I was particularly struck by a recent post on The Root, looking at the often neglected problem of obstetric fistula in resource-poor regions of the world. Over 2 million women in the developing world suffer from obstetric fistula - a rupture of the tissue separating the vagina from the rectum or the bladder that occurs as a result of prolonged labor or sexual trauma. If uncorrected, this tear results in pain, incontinence and frequent genital tract infections. Affected women live in physical and psychological agony, and are frequently cast out of their homes and stigmatized within the larger community because of their inability to control the urine or feces that drip down their legs as a result of this condition.

Of course, the surgical procedure to repair a fistula has been around for over 100 years, and costs a mere $300 in a country like Kenya. That's less than the amount that most American taxpayers received as part of the recent economic stimulus package, and is much less than that Zegna Sport pullover I've been eying at Saks. But it's equivalent to the yearly income of most of the affected women in the developing world.

Just think of the positive impact on our dismal world standing if the US government was willing to set aside the necessary funds to provide treatment to all women suffering from fistula across the world: $600 million. Of course, that will never happen ... but individuals can still help by donating to groups like the Campaign to End Fistula.

Cost to repair a fistula: $300
Restoring a young woman's confidence and dignity: Priceless.

HRT: More Unpredictable than Hormones Themselves

Hot flashes. Insomnia. Mood swings. Decreased sex drive. Women between the ages of 45 and 55 describe it as pure hell. Menopause is a natural biological process that all women are forced to endure at some point in their lives. But, what is natural about it? Almost all women experience symptoms of menopause. For some, however, the symptoms are severe with no relief in sight, and women look to their doctors for help.

Hormone Replacement Therapy (HRT) came into the picture as a safe treatment for menopausal symptoms in 1942 with the marketing of Premarin™, followed by other treatments such as Prempro™. These medications contain one or more synthetic female hormones, commonly known as estrogen and progesterone. Premarin holds the crown for being the most widely prescribed drug in the United States because of its effectiveness in making menopausal women happy again.

The Women's Health Initiative (WHI) was a national health study launched in 1991 during the heyday of HRT prescriptions. According to the study, the clinical trials were designed to test the effects of HRT, diet, and supplementation on prevention of heart disease, fractures, and breast and colorectal cancer. The 15-year project involved over 161,000 women ages 50-79, and is considered one of the most definitive, comprehensive programs of women's health research ever done in the United States. Participants in the WHI trials were randomly assigned hormone medication or placebo. However, the NIH halted the study early because the health risks participants experienced outweighed the health benefits. Women taking the hormones did see some benefits, but they greatly increased their risk for breast cancer, heart attacks, strokes, and blood clots.

Menopausal women and their physicians felt betrayed. How could something with such a long standing history as being the women's miracle menopause cure now be proven to be unsafe? The results of the study compelled many physicians and women to abandon HRT and try to come up with alternatives with little to no avail. Think about trying to explain to a menopausal woman in mid-hot flash that if she dresses in layers and refrains from caffeine and alcohol, she'll feel back to her pre-menopausal self in no time...hide the knives!

Now, a recent ABC News article reports that an international panel of experts are giving the green light for HRT again. This change of heart comes after researchers revealed that the WHI was flawed. Participants in the trials did not accurately represent the menopausal population, with the majority being relatively old and suffering from other conditions that all boosted risk. The panel has agreed that HRT is safe and effective for short term use in early menopause.

With all the swings HRT is going through, what’s a menopausal woman to do? Hopefully, women won't become too hot and bothered and lose sleep over their decision to use HRT for some sought after relief.

Why I Hate Meth Heads

I don’t hate meth heads because they endanger entire neighborhoods with their toxic fumes. I don’t hate meth heads because they destroy the lives of abusers and their families. I don’t even hate meth heads because they made all the decent cold medicine disappear behind the Rx counter. I hate meth heads for one very intense, passionate, loathing, and entirely selfish reason… HAA—CHU!

I lived 27 years of my life oblivious to the hell of allergy sufferers. Now that I have settled down, bought a home in the desert, and started to grow roots, my world has turned upside-down. Juniper is my nemesis, and Albuquerque is surrounded by it. In an attempt to survive, I followed the same path millions of allergy suffers take: two months of Alavert (to no avail), two months of Claritin (complete waste of time), four months of Zyrtec (you’re joking, right?), and even three months of a self-prescribed cocktail of Benadryl and Sudafed, all of which proved pointless. These “remedies” might as well have been sugar pills. So, I went out on a limb and tried the “alternative medicine” tract. I tried Chinese herbs and acupuncture, I even dreadlocked my hair, burned strange candles, and prayed to my living room papa-san chair (I mistook Wicca for wicker). HAA-CHU!

I investigated allergy shots, but was quickly rejected as an ineligible candidate. To add salt to my wound, I am immunodeficient. When immune B cells and T cells are activated by an invader, they replicate into more antigen-fighting cells and something called long-lived memory cells. Long-lived memory cells are responsible for remembering exactly how the invader was destroyed, so the next time he comes around looking for some action—SMASH! WHAM! KABOOM! The long-lived memory cells knock him out of the picture. My immune system suffers from having “no anamnestic response,” or rather, no short-term memory. I lack the adaptive quality that healthy immune systems boast. My body cannot recall how to fight off the diseases and infections it has already conquered. So, every winter I catch a cold, take an unusually long amount of time to get over it, and then quite often catch the same cold again a week or so later. This same scenario is what prevents allergy shots from working in my body. The allergen is injected, my B and T cells do a little dance, and then…HAA CHU!

One blessed day, Providence led me behind the counter to something marvelous. Heralding angels rejoiced as the register tallied my bill, a $10.79 purchase of Drixoral. Schering-Plough Healthcare Products are the makers of Drixoral, an over-the-counter allergy and cold medicine that contains dexbrompheniramine (antihistamine) and pseudoephedrine (decongestant). Amidst the worst of juniper season, I finally found relief—as well as a little drowsiness (so what if I sleep from March until July? At least I can finally sleep). One pill allowed me to function in the world—albeit in a misty stupor. I was no longer sneezing. The irritated, itchy roof of my mouth went back to being unnoticed. My lungs also joined the land of the breathing, finding relief from asthma. Just like Moses and the Red Sea, my seemingly endless mucous parted, allowing my sinuses the forgotten sensation of inhalation. And, last but not least, the dark circles under my blood-shot eyes returned to a healthy pink.

All was fine and dandy until I took the last pill in my Drixoral package today. I stopped by Walmart’s local pharmacy on my way home from work and wasn’t worried that they were out of stock. I tried Walgreens—also out of stock, another Walgreens, then another and another. Six stores later, I realized Drixoral no longer existed within Albuquerque anymore—at least not in pharmacies (we have a rather large population of meth houses). The rumor circulating around town and beyond (my friend’s step-father is a pharmacist in St. George, UT) was that the Drixoral has been discontinued to prevent the illegal manufacturing of crystal methamphetamine.

A few startling quick facts about the people ruining my life:

1. One gram of their meth costs about $260, a price that has raised since last year’s $160 per gram…price gougers. Per pound, it costs $12,000 to $16,000 at the wholesale level.

2. It is a nationwide law that a valid I.D. and signature are required to buy cold and flu medications containing pseudoephedrine. Pharmaceutical companies compensated by introducing a string of new cold remedies containing phenylephrine instead, which can’t be used to make meth.

3. Some of the effects of meth abuse include: paranoia, brain damage, hallucinations, hypothermia, convulsions, cardiovascular collapse, and a condition called “tweaking.” Tweaking is when the abuser cannot sleep for days, is extremely irritable, and becomes violent without provocation.

4. A few of the warning signs that there is a meth house near you include: odor of solvents, blacked out windows, activity late at night, iodine-stained kitchen or bathroom, and excessive trash. Cleaning up a meth lab can cost the government up to $10,000.

Had I been privy to the memo forecasting the removal of Drixoral from the market, I would have loaded up on the product—even at the risk of appearing like a junkie myself. Is it fair to take such a needed product off the market because of a handful of drug dealers and producers?

So, I took to my next weapon—the internet—and searched for Drixoral for hours (this is a matter of life or death, you realize). I found nothing on Scherling-Plough’s website (http://www.schering- plough.com/schering_plough/pc/allergy_respiratory.jsp) claiming they were taking the drug off the market, but there were no links to order the product either. I finally decided to bite the bullet and call Schering-Plough to get the low-down on Drixoral myself. Straight from the horse’s mouth: Drixoral will be off the market for one year as Scherling-Plough relocates their manufacturing plant. I made them promise they would not discontinue the product. We spit on our hands and pinky swore…well, as best as two people can do over the phone. They took an oath and a Bible was involved. I think I promised the pharma company one of my future children... But, at least I know Drixoral, my saving grace, will return.

I guess I don’t have to hate meth heads anymore…

The Pistorius Effect

[Cross-posted from my Care to Elaborate blog]

A lot of discussion has been going around regarding Pistorius. Should he or shouldn't he be allowed to compete for a spot in the Beijing Olympics? If he makes it, should he or shouldn't he be allowed to compete. There’s concern over what this will do to sports in general; what kind of message is it sending out to others; and how it could throw off future comparisons within the sport, making some sports records incomparable.

In Art Caplan’s Opinion piece, he discusses Tiger Woods' laser eye surgery and how he now has better than 20/20 vision. This surgery allows him to continue to compete with vision, not just without glasses or contacts, as with the first surgery, but better than that. Caplan says, "That's why it cannot just be "advantage" that determines whether someone can use technology to compete. The deciding factor is whether something confers a significant, not a slight advantage."

But what about the other sports, like Major League Baseball? What about those players who have gotten the Tommy John surgery? Have these individuals been enhanced, do they have an unfair advantage to those that have not have the surgery? Or what about those players who like Tiger Woods have gotten the laser eye surgery, and are able to tell the difference between a curve ball and a fast ball better than others.

Caplan goes on

"We don’t expect to compare the performances of today to those of the ancient Greeks, but we do expect some ability to compare what happened today to be compared with what happened yesterday, a year ago, a decade ago or even 50 years ago.

It may be fascinating to see who can go the fastest on rocket-powered legs or throw a heavy weight the farthest using performance-enhancing drugs, or genetically engineered muscles. But what you have then is an exhibition or a show, not a sport. In some ways, this is what the professional wrestling and no-rules body building already are.

To be a sport you need something approximating a fair playing field, some boundaries on the attributes of those who compete so they are comparable to one another and some ability to compare today’s performance with those in the not-so-distant past.

That is why I am not sure Oscar Pistorius should compete.

He may not have a marked advantage, but his artificial limbs make him too different from those he competes against, and too unlike those who have raced before. It's not about giving him an opportunity. The issue is that Pistorius risks destroying exactly what he wants to do — compete in a sport."

The previously mentioned surgeries also offer advantages over both today and yesterday’s competitors. Situations arise where an athlete seriously injures himself and, with modern technology, instead of having to retire they are put back together. By putting them back together, and in some cases, back on the playing field as they were before or even better, technology is playing a part in the sports world. A search for 'surgery' on CBSsports.com produced 47,500 results, I acknowledge that not all of these individuals were undergoing corrective or elective surgery to return to the game, but it is still quite a lot.

There is discussion because he has an unfair significant advantage. He’s disabled and he can keep up, maybe not yet qualify, but he can keep up, regardless of his disability. The concern mimics the perspective I had of the American Gladiator. An average guy breaks the boundaries and competes, but hope is that the next competitor will be above average with potential to blow everyone else out of the water. Then, there is the potential for an unfair competition with not everyone being able to get or, rather, need the legs. It’s better to keep the competitors separate, the Paralympians and the Olympians, so they are on a level playing field.

The significant advantage everyone’s examining is still there for those willing to play regardless of the competition in the Olympics. Pistorius and others like him can still compete in the Paralympics with their “advantage”. Will the athletes of the Paralympics also be comparable within the past 50 years? Can the artificial limbs of 50 years ago be comparable to those of today in competition? Is the Paralympic committee ok with all of this lack of comparison or are their records already taking into account the differences in technology?

I have two scenarios; granted there could be more, please share them.

Scenario 1:

Pistorius competes in the Beijing Olympics, he places whatever. Others like him are inspired and also try out. Not guaranteed a position based on sympathy, but on capability, like everyone else. Those who can meet the competition minimums will compete, those who can’t won’t.

Scenario 2:

Pistorius competes in the Beijing Paralympics, he places whatever. Others like him are inspired by his attempt to participate in the Olympics as a result try out for the Paralympics. Not guaranteed a position based on sympathy, but on capability, like everyone else. Those who can meet the competition minimums will compete, those who can’t won’t.

Technological advances are driven by demand. Those who are already amputees are going to want better ones. Those who compete are going to want faster ones. Where will these individuals be competing? I go back to

“It may be fascinating to see who can go the fastest on rocket-powered legs or throw a heavy weight the farthest using performance-enhancing drugs, or genetically engineered muscles. But what you have then is an exhibition or a show, not a sport. In some ways, this is what the professional wrestling and no-rules body building already are.” (Emphasis added)

The Paralympics is an arena to compete in sports, even though they allow Cheetah Flex Foot for competition. Maybe they have an interesting show in their future.

“To be a sport you need something approximating a fair playing field, some boundaries on the attributes of those who compete so they are comparable to one another and some ability to compare today’s performance with those in the not-so-distant past”

The Paralympics offer a fair playing field for those with artificial limbs like Cheetah Flex Foot; where the Olympics offer a fair playing field for those with limbs (oh, and the special external technological advances they have, i.e. special swimsuits, clothing, shoes, and equipment. Which with the demand to be better will also advance)? Knowing that we aren’t going to get rid of artificial limbs like Cheetah Flex Foot, and knowing they are going to make an impact somewhere, which competitive arena will they be allowed to affect and advance?

This Sh** is Bananas

Over at the Daily Galaxy a very disturbing post about the likely fate of the fruit that changed the world, unless advancements in biotech can find an answer:

"It’s less sensational news than skyrocketing food and oil prices, but the beloved yellow banana may soon disappear forever. Bananas are even more heavily consumed in many parts of the world than rice or potatoes, but now a fungus called Panama Disease is turning them brick-red and inedible. Here’s the worst part: There is no cure for Panama Disease and it is spreading very quickly. Experts surmise that within the next three decades, the sweet and creamy food staple will be nonexistent."

You can access the full post here.

It's hard to imagine a world without bananas...
[Apologies to all those who now have Gwen Stefani's Hollaback Girl stuck in the heads.]