More Good News for Java Lovers and Women...

As someone for whom coffee plays a transcendental role in my life, I was thrilled to hear, according to Women's ENews that in Peru, female coffee growers have partnered with a U.S. import company to market their own brand of organic, fair-trade coffee. In addition to gaining more economic control, the women are finding their work is changing their culture as well.

As soon as I obtain permission to reprint the article, I'll post it in full here.

Does this mean I can eat deep-fried ice cream with hot fudge?

A $415 million federal study that involved nearly 49,000 women ages 50 to 79, who were followed for eight years, found that a low-fat diet does not reduce the risk of getting cancer or heart disease.

The study however, did not make a distinction between saturated fats and poly, mono , or unsaturated fats; so there remains a question as to whether or not the much touted 'Mediterrean diet' is beneficial, although some medical specialists emphasized that the study did not mean people should abandon low-fat diets.

"What we are saying is that a modest reduction of fat and a substitution with fruits and vegetables did not do anything for heart disease and stroke or breast cancer or colorectal cancer," said Dr. Nanette K. Wenger, a cardiologist and professor of medicine at Emory University School of Medicine in Atlanta. "It doesn't say that this diet is not beneficial."

A Ban on Animal-Human Hybrids: When Pigs Fly?

The President called for a ban on Animal Human hybrids in his state of the union speech, prompting a lot of googling of the term 'human animal hybrid' and comments by Jon Stewart -- the President could follow Canada's lead in this matter, who banned cloning and the creation of human-animal hybrids in Bill C-13.

Problem is, if Bush follows Canada's lead, it would allow for the use of embryos leftover from IVF clinics -- yet this law has been heralded as a reasonable middle path, a compromise that allows for stem cell research to proceed, without commodifying of embryos.

Any chance we could reach such an agreement in the US? -- one can only hope...

Cultural differences in end-of-life care: a matter of trust?

The LA Times has an excellent article on how cultural differences affect approach to end-of-life decisionmaking. As I"ve written before, and as Marjorie Kagawa-Singer has written before, more recognition needs to be given and more research needs to be done the cultural differences and what impact they have on health care.

The Trouble with "boys will be boys"

Teacher Deborah M. Roffman writes about how the phrase 'boys will be boys' enforces a less=than-desirable stereotype:

"Not too long ago, I confiscated a hat from a student's head that read, "I'm a Pimp." This once-derogatory term is a complimentary handle these days for boys whom girls consider "hot." I asked the boy whether he would wear a hat that said "I'm a Rapist." Totally offended, he looked at me as if I had three heads. "Duh," I said. "Do you have any idea what real pimps do to keep their 'girls' in line?" Yet the term -- like "slut" for girls -- has been glamorized and legitimized by TV, movies and popular music to such an extent that kids now bandy it about freely."

Yet from her perspective, adults are often clueless about how destructive these ubiquitous images and messages can be for boys. She notes that it too often takes patient coaching for them to see "boys will be boys" for what it is -- an insidious and long-neglected character issue: People who think of and treat others as objects, in any way, are not kind, decent people. It's bad enough that boys are being trained by the culture to think that behaving in these ways is "cool"; it's outrageous and much more disturbing that many of the immediate adults in their lives can't see it, and may even buy into it.

What's not always said in the debate about evolution vs intelligent design

Excerpts from a Washington Post article by Shankar Vedantam that cuts to the heart of what really going on in the intelligent design vs evolution:

While the controversy over intelligent design is superficially about scientific facts, the real debate is more emotional. Evolution cuts to the heart of the belief that humans have a special place in creation. If all things in the living world exist solely because of evolutionary competition and natural selection, what room is left for the idea that humans are made in God's image or for any morality beyond the naked requirements of survival? Beneath all the complex arguments of intelligent design advocates, Georgetown theologian John Haught agreed, "there lies a deeply human and passionately religious concern about whether the universe resides in the bosom of a loving, caring God or is instead perched over an abyss of ultimate meaninglessness."

Which is rather puzzling to me, especially since we had reported on this blog earlier, the Catholic Church has rejected the teaching of intelligent design.

Of note: Shankar Vedantam will be fielding questions and comments about this article Monday at 1 p.m. at washingtonpost.com/liveonline.

Hunting for "Good" Eggs in Eastern Europe

Suzanne Leigh's article, "Hunting for Good Human Eggs", examines the work of Dr. Sanford Rosenberg, founder of GlobalARTusa, an organization that performs IVF and reduces its cost by creating an international egg donor program. Leigh explains that the usual IVF process, from finding a donor or agency to waiting for results, which at times come back unsuccessful, can cost close to $30,000.

Rosenberg's organization allows Americans to select Romanian egg donors from an online database. Sperm is then sent to Romania where IVF is performed in a lab in Bucharest, the capital of the country. Once the procedure is complete the frozen embryos are delivered to the United States. The cost for 6 eggs, or half an ovulation cycle, is $8,000, or one can buy 12 eggs, an entire ovulation cycle, for $13,000. Many critcs feel that the GlobalARTusa program is unreliable because it does not verify the credentials of the women who are donating.
However, to this declaration, Rosenberg rebuts that the women are college educated girls in their twenties who are absolutely screened before approval.

Leigh concludes with a quote from the doctor who simply states that he wanted to help women by creating a program that can get them pregnant without paying exorbitant sums of money to make it happen.

Read more

More on Conscientious Objections in health care

From Eureka Alert and brought to our attention by Diana Zuckerman of the National Research Center for Women and Families:

Julian Savulescu, Director of the Uehiro Centre for Practical Ethics at the University of Oxford, UK, argues that doctors who compromise the delivery of medical services to patients on conscience grounds should be punished through removal of licence to practise and other legal mechanisms.

He recognizes that values are an important part of our lives. But values and conscience have different roles in public and private life, he writes. They should influence discussion on what kind of health system to deliver. But they should not influence the care an individual doctor offers to his or her patients.

The door to "value-driven medicine" is a door to a Pandora's box of idiosyncratic, bigoted, discriminatory medicine. Public servants must act in the public interest, not their own, he concludes. For the full article, check out the British Medical Journal (subscription required).

The Pro-Roe, Anti-Abortion, Pro-Contraception Majority: Abortion is Bad

As colleague Art Caplan notes in the AJOB Editors blog today, a fascinating exchange by William Saletan and Kate Pollitt captures the conflicting feelings and complex nature of the abortion debate in the US today. It confirms what many polls show: that while most people are anti-abortion, they also feel that the best way to stop abortion is through education and contraception, rather than an overall legal ban.

The Politics of Violence Against Women: A South African Perspective

We have a new guest blogger, Debbie Marais, a young graduate student working in South Africa on her Masters Dissertation. Here's her first post:

2005 was an interesting year for South African politics. (It was also an eye-opening time for gender relations in South Africa – more on that to follow). As someone who pays less than close attention to the intimate political workings of government, some events of last year triggered an uncharacteristic scrutiny of news items pertaining to one particular Member of Parliament: ex-Deputy President, Jacob Zuma. Headlines about corruption seem to be peppering our newspapers with increasing frequency.

More alarming, perhaps, is the more than occasional revelation of the alleged involvement of top political leaders and government officials in corruption cases. Alarming, or encouraging? Corruption most likely occurs in most governments around the world and it is certainly not new to South Africa. What is encouraging is the transparency with which these cases are reported, indicating a transparency within our current government that was remarkably absent in the governments of our former apartheid state. We may not condone corruption but we do commend the speed at which such cases come to light.

It was our former Deputy President’s alleged involvement in the Schabir Shaik corruption case that led President Thabo Mbeki to fire Zuma - the man widely considered to be Mbeki’s most likely successor in 2009 - in June last year. Enter the first event that was a milestone of particular, personal significance to me: the appointment of our first woman Deputy President, Phumzile Mlambo-Ngcuka. A proud day in South Africa’s democratic history and one that had many of us – women in particular – saying to ourselves and each other, “How far we have come!”

Then the news broke: a 31-year old AIDS activist, reportedly a family friend of the former Deputy President, had brought a rape charge against 63-year old Zuma – alleging that the attack took place in November during the 16 days of activism against women and child abuse campaign.

Following the rape allegation, reports began to indicate that support for Zuma, still strong despite the corruption charges, was dwindling.

And yet: shortly after the new year dawned came the announcement that Zuma would still be allowed to campaign for the ruling ANC in upcoming local elections on 1^st March (with temporary suspension of this participation in February when he stands trial for rape) . With Zuma facing two charges of corruption and one of rape, and Mbeki having just announced that the ANC will up its efforts in stamping out corruption in local municipalities, one reporter has quite aptly commented that “the situation is not simply confusing, it is bizarre” .

But it is not the politics of these proceedings that has sparked my fervor. It is the content of an article written by Nicola Jones that has “filled (my) heart with fear” (Words to fill your heart with fear): The perpetuation of sexual violence by the cultural endorsement of gender inequalities seems to be fuelled by support for a powerful politician such as Zuma who, apparently, can do no wrong: “Why do they make such a big thing about this rape thing?” says one supporter on the Friends of Jacob Zuma website “He is not some ordinary person – he is JZ! If he wants he must get.” Add to this Nicola Jones’s reporting of the “huge antipathy towards merely the concept of a woman president – and women and white people in general – on the Friends of Jacob Zuma website” and one realizes how far we have not come in eradicating the gender inequalities and the “sex as entitlement, sex as power” culture that has made South Africa a country with one of the highest incidences of rape in the world. Some have attributed to the legacy of apartheid the social ills that have transformed male identity into something typified by aggressiveness, risk-taking, sexual prowess and dominance over women – notions of masculinity that have now become entrenched (Sayagues, 2004: South Africa: Helping men become men. Inter Press Service, September 19 2004). In spite of the remarkable achievements of our young democracy in promoting and constitutionally entrenching human rights, the daily experience of inequality by women, and the violence perpetrated against women by men continue unabated (Abrahams, Jewkes, Hoffman & Laubsher, 2004; Jobson, 2005; Sideris, 2005). “Because of our patriarchal system, power is in the hands of men. Women do not have much say in decision-making, societal issues, and even more sadly, in their intimate relationships. Men control their sexual rights. Women cannot choose when, how and with whom they can have sex” (Memela, 2005, p.98).

“Without role models and little social support for constructing different practices, appealing to culture may represent as much an avoidance of anxiety as a defense of privilege. Cultural constructions of what it means to be a man not only legitimize male authority but also provide men with a set of regulations that spell out the rights, duties and obligations that accompany paternal authority. Reverting to this framework is one way of escaping the personal uncertainty that change induces” (Sideris, 2004, p.30). And what about existing role models? What about Zuma and his masses of loyal supporters? An indication of the entrenchment of these cultural attitudes (towards women and their secondary status in society) in the population at large is evident in the support that continues to rally around Zuma, in spite of (or, shockingly, because of?) his rape charge. The ANC Youth League (ANCYL) remains loyal to Zuma still, promoting that the ANC and the country should be headed by the same person - and that person should be Zuma.

Political support for a leader is one thing; support for the perpetration of violence (sexual or otherwise) against women entirely another. Does such support exist? Reading one Zuma supporter’s comment on the Friends of Jacob Zuma website, I fear that it does: “If they say Msholozi (Zuma) is a rapist then we are all rapists. Let’s show them how.”

Debra Leigh Marais, 2^nd February 2006

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References:

Abrahams, N., Jewkes, R., Hoffman, M., & Laubsher, R. (2004). Sexual violence against intimate partners in Cape Town: prevalence and risk factors reported by men. Bulletin of the World Health Organization, 82, 330-337.

Mail & Guardian online – see links above

Memela, L. (2005). The role of culture and society in shaping gender inequalities. Agenda Special Focus: Gender, Culture and Rights, 96-99.

http://www.agenda.org.za/images/stories/journalpdf/Lungiswa%20Memela%20p96-99.pdf

Jobson, M. (2005). 5,25 million minutes: Gender and culture after 10 years of democracy. Agenda Special Focus: Gender, Culture and Rights, 14-23.

http://www.agenda.org.za/images/stories/journalpdf/Majorie%20Jobson%20p14-23.pdf

Sideris, T. (2004). “You have to change and you don’t know how!”: Contesting what it means to be a man in a rural area of South Africa. African Studies, 63, 29-49.

Sideris, T. (2005). Post-apartheid South Africa – gender, rights, and the politics of recognition: continuities in gender-based violence? Agenda Special Focus: Gender, culture and rights. 100-109. http://www.agenda.org.za/images/stories/journalpdf/Tina%20Sideris%20p100-109.pdf

The Witness online – see links above

Emerging Neurotechnologies as Lie Detectors

Last year, the American Journal of Bioethics published an issue devoted to emerging issues in neurotechnologies with a target article entitled 'Emerging Neurotechnologies for Lie-Detection: Promises and Perils'.
Now, the Washington Post confirms that this technology is well on its way to being used routinely in an article about fMRIs and brain scan interrogations.
Hank Greely, a law professor who directs the Stanford Center for Law and the Biosciences, said that this development indicated a " significant change in our ability ... to invade what has been the last untouchable sanctuary, the contents of your own mind..It should make us stop and think to what extent we should allow this to be done."

Very true, Hank -- it does make me wonder if the current administration would consider adopting and using (or abusing) this technology for its 'war on terrorism'.

More on Enhancements...

For a somewhat satirical (and sometimes, crude) look at America's love affair with drugs and popping pills check out the following link, set to the music of Billy Joel's 'We Didn't Start the Fire.'

Hormone therapy trial was flawed

Although this was initially reported in Decemberby the news media, it is story that is certainly worth of continuing interest and follow-up: A 2002 study showing that hormone replacement therapy raises the risk of heart disease and breast cancer -- scaring many women away from the drugs --was fundamentally flawed, according to new research.

"Women are now being told not to take hormones for heart disease prevention, and that may be totally wrong,” said Dr. Edward Klaiber, a Worcester, Massachusetts endocrinologist and lead author of the study. Klaiber is hopeful that a multi-center trial launched last year by the Phoenix-based Kronos Longevity Research Institute will eventually show that hormone replacement therapy is not risky in women who are just beginning to go through menopause.

Exploitation of Women in Ova Donation for Research

Today WBUR, one of the NPR radio stations in Boston, played an in depth piece by Alan Coukel called “Donor Payments and Stem Cell Research” about the ethical debate surrounding the prohibition of payment to women for ova for stem cell research in Massachusetts.(Note the similar policy in California and the in the recommendations of the National Academies in their"Guidelines for Human Embryonic Stem Cell Research".) This week, Robert Steinbock has an article in the New England Journal of Medicine that addresses the ethical issues of ova donation/sales for research purposes. Neither of these reports addresses the worry that I and others have about the potential exploitation of women in this exchange. And this exploitation appears not because women will be paid, but because they will not.

What seems to be at issue in this debate is commodification. "Commodification" refers to the association of a thing or a practice with attitudes and behaviors that accompany typical market transactions. Today there are commercial and non-commercial markets for human blood, sperm, organs, and other body parts. But for the idea of there being a market for ova, human embryos and fetal material is repugnant to many. This reaction is supported by a belief that there are certain kinds of things that should never be commodities or treated like commodities.

The issue is not a quibble about price. If we put a price, any price, on bits of the human body, the worry is that in so doing we are saying that it is acceptable to treat some persons (the donors/vendors) in the same manner that all manufactured objects are treated. So fertile women who exchange ova for money would be treated like toasters and laundry detergent.

Human tissue, like ova, is needed to continue stem cell research. And stem cell research promises to be a therapy to treat for all sorts of horrible diseases. So ova have more than intrinsic value. They have the potential to be really good for other things, like helping people. Because of this, and the toaster concern, people claim that exchange of human tissue should be motivated by altruism and given in the form of a gift. Thus, embryos and fetal tissue, ova and sperm, (as well sex and surrogacy) may be given to others, for others, but only if the giver does not get paid for it. The exchange is this: a woman gives her ova freely and in exchange she get the satisfaction that she is helping the greater good.

But these tissues are extremely valuable for other reasons besides the greater good. They are market commodities. Their value derives from what researchers and companies are willing to pay for the development of therapies, the potential profit to be made from the products derived from the tissue, and from the patents that that biotechnology companies and universities can obtain on these tissues.

According to Curtis Naser and Sheri Albert, “[t]he use of human tissues and cells is …the foundation upon which much of the current biotechnological revolution has been based.” The interests of the person supplying the tissue and of researchers or firms may conflict. This potential conflict is usually put forward as conflict between the interests of the individual tissue supplier and those of scientific progress, of “researchers in freely pursuing scientific knowledge.” To be sure, new breakthroughs have the potential in principle to benefit all humankind, but it is not outrageous to point out that the medical biotechnological industry has a great financial incentive for developing therapies and products.

And here is my concern for the exploitation of women if they are not paid for ova: To be forced to give something away for free and not even to have a say as to where it goes when others make significant profit from it is to grossly exploit the giver. This for-profit part of the picture is missing from the current debate over ova donation.

Citation:
Curtis Naser and Sheri Albert, “Genetic Information, Ethics, Ethical Issues in Tissue Banking and Human Subject research in Stored Tissues,” Encyclopedia of Biotechnology, Volume 1 Thomas H. Murray and Maxwell J. Mehlman, eds. (New York: Thomas Wiley, 1999): 363-389.

Personalized Medicine (PGx)

A major obstacle in the pharmaceutical treatment of depression is the long and bumpy road to finding a drug regime that works for the patient. Bad drug side effects are a major reason for patient noncompliance with drug therapy. Roche Pharmaceuticals, I mean, Roche Diagnostics, has recently announced a new genetic diagnostic instrument that is designed to help doctors treat depression called the “AmpliChip CYP450 Test”. It was approved by the FDA last year and is just available. According to the Roche site, it is the world's first pharmacogenetic microarray-based test approved for clinical use.

Now what is pharmacogenetics? Pharmocogentics emerged in 1950’s when it was noticed drug reactions run in families and researchers started to correlate genetic variation with response to specific meds. It was thought that if a physician would use a genetic test to predict how each patient would respond to the drug before prescribing it, she could tailor make a pharmaceutical regimen that would work best for that particular person; work best would mean that the drug would not harm (reduce side effects) and the drug would help. The goal of pharmacogenetics is personalized drug therapy based on diagnostic tests to predict patient’s response to specific drugs based on genetic profile

Closely related to pharmacogenetics is pharamogenomics. It combines pharmacogenetics with genomic studies. This research started when it was realized that people vary in response to prescribed meds and people vary in response to getting certain diseases. Research studies in pharmacogenomics aim to reveal how different drugs interact with multiple gene populations. Matching drug candidates with patient populations by pharmacogenomic screening will reduce time and cost involved in drug discovery. Lots of money is to be saved by pharmaceutical companies here.

Pharmaceutical industry people say that, “This [pharmacogenetics] is not a fad," (Gualberto Ruano, CEO of Genaissance Pharmaceuticals); "It's a major tidal wave changing the entire pattern of health care."

However, a major report recently offered by The Royal Society (UK), “Personalized Medicine: Hopes and Realities”, says that the impact of personalized medicine is at least 15 years away. The three objectives of PGx combined are to : 1) Reduce drug side effects and improve drug efficacy; 2) Lead to prevention strategies by estimating risk of getting disease; 3) Reduce cost and time of drug development process. The technological, clinical, and ethical obstacles, however, are great.

There is no cheap single molecule DNA test in existence. Recently, however, J. Craig Venter, the genomics entrepreneur who paced the U.S. government to the completion of the Human Genome Project, announced that he hopes to offer $10 million as a prize (he originally pledged $500,000) for automated DNA sequencing technology that can decode a human genome for $1,000. Clinical and ethical challenges include: What level of knowledge is adequate for the patient and the physician to go ahead with the procedure? How will this potential treatment affect other treatment choices? A physician may think that a novel, expensive drug treatment not appropriate, and the health insurance company may not pay for it. But a patient who is dying may think it is worth taking for the slight chance it offers. Who should decide? Who will administer the genetic test, where will the genetic information on the patient be stored, and who will have access to it? As we well know, the nature of data is that it is pervasive and permanent. In order for informed consent to be realized, a patient will have to understand among other things the relationship between DNA and disease, will we have enough genetic counselors trained to do the job? What about the issue of returning benefits to persons or communities whose genotypes made the drug development possible? For more see the World Health Organization (WHO) Human Genetic Programme: Review of Ethical Issues in Medical Genetics.

But even if we had the an adequate knowledge of the genome, a cheap DNA test, a battalion of trained at the graduate level people to explain tests and their meaning to patients, and effective laws in place to secure privacy, what this information means at a diagnostic level is still open. According to Technology Review, while several new genetic diagnostic tests have hit the market in the past two years, doctors will need to learn how to incorporate them into their clinical practices, and scientists will have to figure out what kind of guidelines doctors need to do this properly.

Objections to Proposed Conscience Laws: A Right Not to Treat?

Washington Post's Rob Stein reports on a disturbing surge of legislation in the states that reflect the intensifying tensions between asserting individual religious values and defending patients' rights and providing truly informed consent: More than a dozen states are considering new laws to protect health workers who do not want to provide care that conflicts with their personal beliefs.

The problems with such legislation are numerous: First of all, patients are a captive audience, a vulnerable population. An individual who feels that they need the protection of the law because t because they don't want to engage in some healthcare practice that they find morally repugnant, is saying 'my rights supercede the rights of the patient'. In healthcare, where the healthcare provider is put in a position of power and trust and the relationship is inherently unequal, this is an abuse of power. R. Alto Charo, bioethicist at the University of Wisconsin, gives a good example in the Post article: Doctors opposed to fetal tissue research, for example, could refuse to notify parents that their child was due for a chicken pox inoculation because the vaccine was originally produced using fetal tissue cell cultures, and be immune from state disciplinary action and malpractice suits.

Could you imagine? A doctor refusing to treat an AIDS patient because she/he finds that the patient's lifestyle is 'morally repugnant'. The American Medical Association has addressed this in its Principles of Medical Ethics: “the physician has an ethical obligation to help the patient make choices from among the therapeutic alternatives consistent with good medical practice” (Opinion E-8.08, “Informed Consent”).

From a legal standpoint, this legislation could be challenged on a variety of levels: Aside from affecting an employers unfettered right to hire someone 'at will', this legislation is attempting to create a protected class when there is none – you can’t give more rights to one group by taking away rights from another group (particularly a captive audience or vulnerable population).
On a constitutional level, other challenges include violation of the interstate commerce clause, and denial of individual liberties (a possible 42 USC section 1983 action, based on the state nexus of licensing boards.)

Currently, employers are dealing with the issue on a case-by-case basis -- does the heavy hand of the law have a place in this?

[Updated Feb 16, 2006] Check out what our partner blog, Business Ethics, has to say about this and Walmart.

Fur Goodness Sake!

Here's a great opportunity for women who are no longer comfortable wearing their furs -- donate them to the Women's Bioethics Project . The WBP will make them into keepsake items like fur-lined wooden jewelry boxes and sell those items to support women's research.

Will enhancements help or hurt?

In bioethics, where we are concerned with allocation of scarce resources, one of the questions that needs to be discussed is access to enhancement technologies. Scientists at the World Economic Forum are concerned that cognitive enhancement, IQ boosters and drugs designed to attack genetic weaknesses may increase competition in the future and create a playing field that is far from equal. Sounds like a place for the Gund Institute of Ecological Economics to weigh in.

A Vulnerable Population?

Blogger Chris MacDonald (no relation to me, except perhaps in some mysterious serendipitious way) argues (tongue-in-cheek, I hope, anyway) that nerds need to be protected from scantily clad purveyors of technology of the female persuasion. Hmmm... a new classification of vulernable population? I don't think so....

What's wrong with this picture?

The EPA has set up regulations to allow testing of pesticides on humans -- so why are three California Democrats, Sen. Barbara Boxer and Reps. Henry Waxman and Hilda Solis, denouncing the rule? The three had led an effort in Congress to require that the EPA outlaw the use of pregnant women and children as subjects and that the agency incorporate ethical guidelines from the National Academy of Sciences and the post-World War II Nuremberg Code. Congress stepped in last year to impose a moratorium after Boxer and Sen. Bill Nelson demanded that the EPA cancel an industry-backed pesticide study in which the families of 60 children in Duval County, Fla., would receive children's clothes, a camcorder and $970 for participating.

"The fact that EPA allows pesticide testing of any kind on the most vulnerable, including abused and neglected children, is simply astonishing," Boxer said.

Susan Hazen, the EPA's principal deputy assistant administrator for the Office of Prevention, Pesticides and Toxic Substances, said Monday the new rule for accepting tests won't allow "intentional pesticide dosing studies of children and pregnant women," but one of the questions that remains is what does that mean? Senator Boxer explains that according to the language of the proposed rule manufacturers could still conduct testing on pregnant women and children as long as they could convince the EPA that the researchers didn't intend to submit the results to the agency at the outset of the study.


To be continued....

The War on Women....

On AJOB's blog, Sean Philpott talks about the perceived "War on Boys" (tongue-in-cheek) -- and although some of the comments try to define this as a liberal vs conservative issue, the real point is being missed. When I was in India a few years back as part of a Rotary Club exchange program, one of the lawyers who graciously hosted us, told us this about the role of women and baby girls in India and Southeast Asia: That each family in India or Southeast Asia needed to have eight children, because out of eight, four would die of childhood diseases. Out of those four, two would be girls and therefore, "worthless" (because you have to pay a dowry to get them married off) and out of the two remaining boys, one was bound to be lazy or shiftless, leaving one boy to support the entire family.

Ouch -- what a commentary on the status of women. Will this change as the sex ratio shifts? Reports are that they already have. Some argue that this will make a women a precious commodity and lead to the abduction and trafficking of women in prostitution.
The restrictions on the use of ultrasound for the purposes of termination of pregnancy based sex selection don't seem to be working; making abortion illegal won't turn things around either -- especially since female infanticide is not uncommon. Aside from the obvious answer of "education", I'd really like to hear and learn about what can be done to stop this devaluation of women.

A Call for Dialogue...

Kathryn Hinsch, founder of the WBP, writes a provocative op-ed piece in Seattle's Post Intelligencer, entitled "Too important to leave to bioethicists". She asks "How do we as a society with a variety of religious traditions, secular experiences and individual needs, develop an ethical framework that allows us to embrace technological advances, while also recognizing and anticipating their potential impact on our society and culture?". She points out that technology will challenge our underlying belief systems, whether progressive, moderate, or conservative and that we have an obligation to not to cede all things moral to a self-appointed few (like bioethicists).

No one is saying that this will be easy, but I agree that this is an important process to pursue -- to engage in respectful discussion and to find common concerns and values -- that is the moral high ground.

Abortion and the US Supreme Court: Listening to the Middle

The United States Supreme Court continues to struggle with the issue of abortion.
In the case of Ayotte, Attorney General of New Hampshire vs Planned Parenthood of Northern New England, soon to be retiring Justice Sandra Day O'Connor writes (emphasis added):

"As the case comes to this Court, three propositions are established. First, States have the right to require parental involvement when a minor considers terminating her pregnancy. Second, a State may not restrict access to abortions that are “ ‘necessary, in appropriate medical judgment for preservation of the life or health of the mother.’ ” Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833, 879 (plurality opinion). Third, New Hampshire has not taken issue with the case’s factual basis: In a very small percentage of cases, pregnant minors need immediate abortions to avert serious and often irreversible damage to their health. New Hampshire has conceded that, under this Court’s cases, it would be unconstitutional to apply the Act in a manner that subjects minors to significant health risks."

And so the court remanded the case to the lower court, holding that "If enforcing a statute that regulates access to abortion would be unconstitutional in medical emergencies, invalidating the statute entirely is not always necessary or justified, for lower courts may be able to render narrower declaratory and injunctive relief."

In a manner akin to Edward A. Langerak's essay Listening to the Middle, this decision is a reflection of the delicate balancing act that the US Supremes are trying to accomplish in listening to the middle. In a similar vein, more pro-life activists are going for gentle persuasion, foregoing politics for quiet talk.

Despite sometimes harsh rhetoric from both sides, it's important to remember that that is there is common ground and that the dialogue must continue for any progress to be made.

Gonzalez vs. Oregon: Not a Ringing Endorsement of Physician-Assisted Suicide

Will the the decision rendered by the US Supreme Court yesterday in Gonzalez v. Oregon pave the way for other states to enact laws allowing physician-assisted suicide? Probably not, according to an article in the NY Times today. In Vermont, one of the states that has considered PAS legislation, Dr. Robert D. Orr, the president of the Vermont Alliance for Ethical Healthcare, said "I don't think its impact will be great ... Some have misunderstood the Oregon case as a challenge to the Oregon statute itself."

According to the Washington Post, conservatives reacted angrily to the ruling. Jay Sekulow, chief counsel of the American Center for Law and Justice, a nonprofit litigation group founded by Pat Robertson, called it "a disturbing and dangerous decision that can only lessen the value of protecting human life." But assisted-suicide initiatives have not fared well in recent years: State referendums and proposed legislation supporting assisted suicide have failed in California, Maine, Maryland, Michigan and Washington.

From a more legal viewpoint, the case presents an interesting tension between the philosophical approaches in strict constructionalism vs interpretationalism. Traditionally, conservatives favor strict constructionalism, but in this case the Bush administration argued for a more expansive, liberal interpretation of the federal Controlled Substances Act (CSA). The majority opinion, written by Justice Kennedy, looks to the text and structure of the CSA:
" The Government does not suggest that its interpretation turns on any difference between the statutory and regulatory language. The CSA allows prescription of drugs only if they have a “currently accepted medical use,” 21 U.S.C. § 812(b); requires a “medical purpose” for dispensing the least controlled substances of those on the schedules, §829(c); and, in its reporting provision, defines a “valid prescription” as one “issued for a legitimate medical purpose,” §830(b)(3)(A)(ii). Similarly, physicians are considered to be acting as practitioners under the statute if they dispense controlled substances “in the course of professional practice.” §802(21). The regulation uses the terms “legitimate medical purpose” and “the course of professional practice,” ibid., but this just repeats two statutory phrases and attempts to summarize the others. It gives little or no instruction on a central issue in this case: Who decides whether a particular activity is in “the course of professional practice” or done for a “legitimate medical purpose”? Since the regulation gives no indication how to decide this issue, the Attorney General’s effort to decide it now cannot be considered an interpretation of the regulation. Simply put, the existence of a parroting regulation does not change the fact that the question here is not the meaning of the regulation but the meaning of the statute. An agency does not acquire special authority to interpret its own words when, instead of using its expertise and experience to formulate a regulation, it has elected merely to paraphrase the statutory language."

Does anyone else see the irony in this?

US Supreme Court upholds Oregon law, 6-3

Just in: The Supreme Court has rejected a Bush administration attempt to punish doctors who help terminally ill patients die and upheld Oregon's one-of-a-kind physician-assisted suicide law.

Justice Anthony Kennedy, writing the majority opinion said that the federal government does have the authority to go after drug dealers and pass rules for health and safety, but power was not intended to extend to the Oregon law. Kennedy said the "authority claimed by the attorney general is both beyond his expertise and incongruous with the statutory purposes and design."

The majority opinion included retiring Justice Sandra Day O'Connor and Justices John Paul Stevens, David Souter, and Ruth Bader Ginsburg, and Stephen Breyer.

Roberts and Justices Clarence Thomas and Antonin Scalia dissented. Scalia commented that the court's ruling "is perhaps driven by a feeling that the subject of assisted suicide is none of the federal government's business. It is easy to sympathize with that position."

More on the court's reasoning as soon as the bench opinion becomes available.

Update: Decision available here.

Thoughts on Alito and the US constitution

As I watched the confirmation hearings for the Supreme Court nominee Samuel Alito on C-Span, it struck me that this was a man who would confirm the philosophy that law operates by looking through the rear-view mirror -- and everyone knows it's hard to move forward when you're only looking in a rear-view mirror. He is, by most accounts, a strict constructionist --In legal circles, this term refers to a philosophy of judicial restraint that calls on judges to interpret laws according to their original meanings. Strict constructionists don't want to meddle with theories of evolving community morals, divine natural law, or seek out "penumbrae." Theirs is a code of strict adherence to the words on the page. Never mind at looking at the spirit of the law. Justice or doing what's right be damned. What's law is law, and what isn't law -- well, get back to us after you've had it enacted by your local legislature.

The problem with strict constructionism is that it leads to decisions like the Dredd Scott case . And for someone like me, who has been promoting "evolving notions of personhood" (since emerging technologies will challenge our traditional notions of personhood) and trying to forge a path between pro-choice and pro-life activists, this is not good.

The question, as I see it, is do we want to see the U.S. Constitution as an empowering document or as a limiting document? So with confirmation of Alito are we really preparing to face the difficulties emerging technologies present (ranging from privacy of our own thoughts to the artificial womb to new life forms) or are we beating a hasty retreat to feel safe and snug in our straightjackets?

And Healthcare for All?

One of my favorite bloggers, Karama Neal, sent me this post about access to and concerns about healthcare: The US Agency for Healthcare Research and Quality has just formed the Citizens' Health Care Working Group (citizenshealthcare.org). Karama points out in her blog how you can get involved and make your concerns known. I love the way she ends her post:
"Of all the forms of inequality, injustice in health care is the most shocking and inhumane." - Martin Luther King, Jr.

Better Drug for Breast Cancer Treatment?: Femara

It's official: Femara beats tamoxifen in preventing breast-cancer recurrence. For anyone who has a sister or mother or female friend or colleague battling breast cancer, this is exciting news.
A large scale clinical study has shown that patients admininstered Femara showed a 27% reduction in the risk of distant recurrence (metastases) with Femara as compared with tamoxifen. Both of these drugs have been effective in treatment of Estrogen-receptor-positive tumors (tumors that grow in the presence of estrogen).

Femara is a potent member of a new class of drugs called aromatase inhibitors; these drugs almost totally shut down the body's ability to make estrogen. But each drug carries the risk of side effects: Women taking Femara had higher cholesterol and a higher incidence of heart trouble than women taking tamoxifen. (It's not clear whether this is due to a side effect of Femara or a possible protective effect of tamoxifen). But at least there are some more choices for women.

new book: The Savvy Woman Patient

The Society for Women's Health Research has just published The Savvy Woman Patient. The book provides information on all major health conditions that affect only women, or affect women differently than men, illustrated with real-life stories; instructions for developing a comprehensive family history by sex (useful in understanding possible genetic risks); the latest research in women's health; and information on how women can--and why they should--be involved in medical research.

You can preorder the book on their website (and there's a nifty 25% discount available right now).

Clinical Trials in India

While Europeans interested in medical research have, ventured into India before, modern-day globalization has washed a wave of researchers and multinational drug companies onto India’s shores. According to Sean Philpott, managing editor of The American Journal of Bioethics, this wave recalls the gold rush frontier. Not only are research costs low, but there is a skilled workforce to conduct the trials. Though drug companies are undoubtedly enticed by the prospects such as bringing down the price of testing by 60% - their work arguably takes advantage of both India’s educated workforce and individuals mired in poverty, who act as guinea pigs under informed consent after lures of 100 US dollars.

While it may not be for outsiders to judge the significance of such sums to South Asia’s impoverished, many, including Philpott, who cautions that individuals may not even realize they are being coerced, worry that the testing borders on exploitation. Pharmaceutical companies conducting research have come under criticism before. In 2004, before the anti-generic drug rules were enacted, two India-based drug companies, Shantha Biotech and Biocon came under scrutiny for conducting illegal clinical trials without proper consent, actions that led to eight deaths.

Although South Asia’s poor are somewhat used to being enticed by the medical community (particularly when it comes to the sale of vital organs), such testing was not always as prevalent in the region. In the past scientists used foreign produced reverse-engineered drugs, a practice halted after March, when India submitted to pressure by the World Trade Organisation to prohibit local companies from creating generic versions of patented drugs. Considering both relatively lax government oversight and the removed threat of domestic competition, many drug companies are now taking advantage of cost-effective testing ground. By 2010 total spending on outsourcing clinical trials to India could top $2 billion, according to Ashish Singh, vice president of Bain & Co., a consulting firm that reports on the health care industry.

To read more, click here.

An epidemic of bad blood...

We face a slow, emerging crisis in the epidemic facing the country: Diabetes. A lengthy article in the NY Times points out that our current health care system is good at dispensing pills and opening up bodies, but it has proved ineffectual at stopping this disease. One in three children born in the United States five years ago are expected to become diabetic in their lifetimes, according to a projection by the Centers for Disease Control and Prevention. The forecast is even bleaker for Latinos: one in every two.

The Times article points out that there is an underappreciated truth about disease: it will harm you even if you never get it. Disease reverberates outward, and if the illness gets big enough, it brushes everyone. Diabetes is big enough.

Predicting the path of a disease is always speculative, but without bold intervention diabetes threatens to hamper some of society's most basic functions.

For instance, no one with diabetes can join the military, though service members whose disease is diagnosed after enlisting can sometimes stay. No insulin-dependent diabetic can become a commercial pilot.

As more women contract diabetes in their reproductive years, more babies will be born with birth defects. Those needy babies will be raised by parents increasingly crippled by their diabetes. Needless to say, this would be a tremendous drain on Medicare and Medicaid.

Stopping this epidemic is obviously something our government and policy leaders need to make a priority.

the ethics of prophylactic mastectomy

As I was reading this article by Jane Brody in yesterday's NYT, I began thinking about the notion of prophylactic mastectomy for women at increased risk of breast cancer. It's mentioned only in passing in this article ("Total mastectomy with reconstruction is becoming an increasingly popular choice, among women with breast cancer and among those with an unusually high risk of developing it."), but it seemed worth more thought.

Women can now be tested to determine whether they have the genetic mutations in BRCA1 and BRCA2 that are known to increase the risk of breast cancer. This testing isn't currently recommended for the general population--clinical breast exams and mammography are the standard screening recommended for the general population--but it might make sense for women who have a family history of breast and/or ovarian cancer. But some women do get tested and, upon finding out that they do have a very high risk of developing cancer, choose to have their breasts surgically removed. Some may also choose to have their ovaries removed, as the same genetic mutations that cause breast cancer can also cause ovarian cancer.

Random thoughts this rainy Saturday: Are there circumstances under which we could all agree that prophylactic mastectomy/oophorectomy makes sense? Would we base our decisions on clinical criteria, or other reasons? And are there other situations in which we would contemplate removing a body part because it could become diseased in the future?

Say we do agree: there are times it's a good idea to remove a so-far-healthy breast or two. What if a person finds out that she *doesn't* have an increased genetic risk, but is so frightened of breast cancer that she wants a mastectomy anyway? Should a surgeon refuse to do the procedure? If the surgeon refuses, and the woman later develops breast cancer, does she have a case against the surgeon?

Should insurance pay for the surgery in an average-risk woman? Could insurance require the surgery in high-risk patients? Could they say that a high-risk patient who refused surgery would be dropped from the plan? Might they say that if a high-risk patient opted not to have the mastectomy (which the insurer would pay for), and then developed breast cancer, it wouldn't pay for treatment?

As we move more and more toward a "personal responsibility" view of healthcare in the United States, we need to remain cognizant of the bigger picture. Today, the view that people are responsible for the unhealthy choices they make (smoking, drinking, using drugs, etc.) and should bear the burdens of their decisions is becoming more and more popular. It may turn out that when we began to think about this issue in terms of "health problems you choose for yourself," we may unwittingly have opened the door to such ideas as mandatory (if you want to stay insured) mastectomy.

Norms, Values, and Science

In 2000 Vioxx promised arthritis sufferers a way to ease pain with less trauma to the stomach than naproxen, an older and cheaper drug in such products as Aleve. Merck, the respected drug giant that created Vioxx, funded the VIGOR study, headed by Claire Bombardier, Director of Rheumatology at the University of Toronto, and this study was published by the prestigious New England Journal of Medicine in November 2000 (Claire Bombardier, et al. “Comparison of Upper Gastrointestinal Toxicity of Rofecoxib and Naproxen in Patients with Rheumatoid Arthritis,” NEJM Volume 343:1520-1528.) The study revealed that Vioxx users had four times the rate of heart attacks as naproxen users. The higher risk came about, the study explained, because naproxen protected the heart, not because Vioxx hurt it. But the authors have been accused of withholding evidence about the drug's heart risks by editors of the New England Journal of Medicine. It was found that three heart attacks out of a total of 20 were omitted from the data just two days before the article was published. Were they included, the study would have revealed an even higher risk of heart attacks among Vioxx users. Merck stopped selling Vioxx last year because another study found that patients taking the drug for more than 18 months doubled their risk of heart attacks and strokes. Since then more than 7,000 people have sued Merck, blaming Vioxx for injuries or deaths. Recently, Dr. Gregory D. Curfman, Executive Editor of the NEJM, said that he should have been more aggressive in challenging the research when it was first submitted for publication. An editorial by Gregory D. Curfman, Stephen Morrissey, and Jeffrey M. Drazen, the editors of NEJM, appears in print in the today's issue of NEJM.

This incident is the latest to raise troubling questions about selective disclosure of data in industry sponsored clinical trials. To be sure, there will always be risks and contraindications with any medication, but health care regulators, providers, and patients can't assess those risks if they aren't given all the information. (See the latest regulatory contibution, note this registry is voluntary.) Important questions that emerge in this case are ones that Jerry Avorn asks us to think of as “pharmacoepistemological”. Epistemological questions are those that involve the nature and the scope of knowledge, truth, and justification of claims. Thus pharmacoepistemological questions have to do with how it is that we-- regulators, patients, and providers-- know that a drug is effective and safe enough to use. How do we --regulators, patients, and providers--get drug information and how can we determine if the information is trustworthy? It is the norm that the most trustworthy sources are scientific articles written in prestigious peer-reviewed journals by experts in the field who work at accredited institutions of higher learning. But in this procedure there is the assumption that people who submit the manuscripts will be telling the truth and not fudging data.

The fraudulent data announcing the creation of human embryonic stem cell lines that were submitted to and published by the world respected journal Science again reminds us that we get to know about empirical data as they are presented to us by trustworthy sources. But all along the chain of transmission of data, from lab investigator to department chair to external funding agency to the editorial board of the journal, we find human beings. And human beings have interests. Bias and interest are not the same thing. Bias can occur because of some interest or other that is contrary to the interest of the truthful and full transmission of data. The problem is not that there are values and interests inherent in the scientific project. This in itself does not make science “subjective." The values of truth telling and full disclosure are essential to good science. Thus, it is the kinds of values and human interests that affect the process that invite scrutiny. We have to ask what values are being advocated and whose interests are being served.

The Bioethics-meets-Jerry-Springer debacle (otherwise known as the Korean Stem Cell Fiasco)

I have been watching in horrified silence and disbelief as the entire story of Hwang Woo Suk and the deceptions surrounding his research and so-called 'findings' has unfolded. The story has all the elements a bad Jerry Springer episode: lies, deceit, betrayal -- the only that is missing is someone ripping off their clothing. And just when you think things can't get much worse, another layer of untruthfulness is revealed; colleague and fellow blogger Glenn McGee is right: it's like peeling an onion -- and it's enough to make you cry. Hundreds of blogs are following the story -- and not surprisingly, opponents of stem cell research are feeling righteous indignation and justification. The consequences of this Hwang's actions will be felt for a long time to come: public faith has been lost and future stem cell research will face heightened scrutiny. The best thing that can come from this fiasco is facing up to what we must learn from this painful lesson -- the importance of teaching and enforcing truthfulness and transparency in research.

The Controversial Virgin Territory

"It's the ultimate gift for the man who has everything." This is what Ms. Yarborough, a 40 year old medical assistant felt about her recent 17th anniversary gift - a surgery to reattach her hymen, making her appear a virgin again - to her husband. This controversial medical procedure, hymenoplasty, originally intended to protect females in the Middle East and Latin America, is gaining popularity in the U.S. for cosmetic reasons. “Last year, 9.2 million cosmetic procedures were performed in the U.S., 24% more than in 2000, according to the American Society of Plastic Surgeons.” The booming popularity of this procedure seems to reflect a wider trend of cosmetic surgery’s increased visibility and society’s increased acceptance of it. Visibility is achieved by various means-hymenoplasty adverts can be seen in magazines, local newspapers, online, and even on billboards. Troy Robbin Hailparn, an obstetrician and gynecologist, advertises vaginal cosmetic surgery on 23 billboards around San Antonio. EdwardJacobson, a Greenwich, Conn., OB-GYN, offers international patients vaginal-makeover “packages” that include airfare, limousine travel and hotel accommodation. "Revirgination" can cost over $5,000, but at Ridgewood Health and Beauty Center, a spa and cosmetic-surgery center in the New York City borough of Queens it costs as little as $1,800. The center's owner, Cuban-born Esmeralda Vanegas, has given away hymenoplasties on a Spanish-language radio station. Ms. Vanegas isn't a doctor and doesn't perform the procedure, but rather leases space to five plastic surgeons.

However, not everyone is excited by such prospects. Many religious groups that value abstinence until marriage say hymen repair is a deception. Devout Roman Catholics consider sex before marriage sinful and equate female virginity with near divinity. Hymen replacement is "misleading and misguided," says Kathleen Raviele, a gynecologist and vice president of the Catholic Medical Association in Needham, Mass. "The best thing is to remain chaste until marriage and then have that genuine experience on your wedding night."

For many Muslims, sexual purity, especially for women, is a way of maintaining the family’s sanctity. But Islamic law also prohibits lying and frivolous cosmetic surgery, says Uzma Mazhar, a St. Louis psychotherapist known for her Web site, CrescentLife.com, which provides Islamic perspectives on Western issues. "What people forget is that Islam teaches us to be honest and fair,"Ms. Mazhar says. "A family should think about this before they present a woman as a virgin when she's not."

Other criticisms of hymenoplasty include questions of the procedures legitimacy and safety. The ethics committee of the American College of Obstetricians and Gynecologists, concerned about the marketing of revirgination, has not taken a formal position on the matter, but has expressed concern over the lack of information in the medical literature regarding the procedure, a fact that may mean performers of the procedure are improperly trained. Marco Pelosi II, an obstetrician and gynecologist in Bayonne, N.J. had this to say about hymenoplasty: "no one used to talk about it, but that's changing," "Really, it's not like a heart transplant-it’s a very simple procedure."On the contrary, Thomas G. Stovall, a recent president of the Society of Gynecologic Surgeons, says "hymen repair is a totally bogus procedure." In general, he says, surgery marketed to improve one's sex life rarely works. As for hymen replacement, "most importantly, it doesn't make you a virgin again."

Despite this fact, women are enticed by the ability to tighten their vaginal walls and even redesign the look of their private parts; participating women often indicate that such measures were meant to boost their own confidence levels or please their partners. A 51-year-old patient-a Manhattan attorney and mother of three-had her hymen reattached her hymen and her vaginal walls tightened in 2003. "I thought it would add that extra sparkle to our marriage," says the woman. However, a 26-year-old Latin American woman who lives in New York's Queens who had a hymen repair in 2001 says it took almost two months for her to feel comfortable again. It took even longer for her to enjoy sex. Despite her discomfort, the married mother of two says she’s still glad she had the surgery. She says her husband wanted to experience intercourse with a virgin, explaining that "if a woman isn't a virgin when she gets married, a man can always put her down for that."

Such attitudes irk feminists, who say hymen repair is a manifestation of bigger social pressures that keep women subservient to men. "It comes with a whole set of norms of a macho culture," says Silvana Paternostro, Colombian-born author of "In the Land of God and Man: Confronting Our Sexual Culture." Some feminists liken hymenoplasty to female genital mutilation, a procedure that often forces women to endure genitalia alterations that Western women now pay for.

Read more: “U.S. Women Seek A Second First Time Hymen Surgery Is on the Rise And Drawing Criticism", AMY CHOZICK, THE WALL STREET JOURNAL; December 15, 2005

The Medicare drug "benefit"--benefits whom, again?

So there, I said it. This morning's story on NPR nicely illustrates two important points about the new Medicare drug benefit, which has been touted by its supporters as an improvement for elderly Americans.

Point number one: It's going to be a disaster. The people it's supposedly helping are being asked to choose from a bewildering number of plans, which can differ in cost by thousands of dollars, depending on a given person's (current!!) medications. The NPR story features an interview with a woman who does this for a living--and it takes her about an hour and a half to figure out what is the best choice for a particular person. Oh, and the tools people are supposed to use for this? The Internet. . . and while many of us know tech-savvy elders, it's simply irresponsible for the Internet to be positioned as the primary resource here. There are toll-free numbers set up for assistance, to be sure, but reports indicate that it's hard to get through to a live person. And we're not even talking yet about the actual implementation of this behemoth. Why did we do this, again? Oh, yeah--so that pharmas would have an opportunity to maximize profits. What part of "safety net" don't we understand?

Point number two: Given the inadequate support being provided for elders, guess who is supposed to leap in to fill the gap? The "adult children" of these folks, that's the plan. Let's be honest, folks: that's daughters and daughters-in-law. Just one more example of uabsolutely essential work (unpaid, "caring-centered," time-consuming, and invisible) that ends up on women's plates by fiat and assumption. Externalized costs, anyone?

More controversy on embryonic stem cell research

Embryonic stem cell research might now be more potentially viable for the UK Stem Cell Bank, which learned that samples from 150 random human embryos, far fewer than previously thought, might be able to generate materials beneficial for two thirds of the population. Embryonic stem cells can mature into various types of tissue that can potentially be used to replace “diseased or damaged tissue in conditions such as diabetes and neurodegenerative disorders.” A University of Cambridge team studying such potentialities has explained that the tissues generated from a mere ten samples of specific genetic makeup could theoretically support a UK bank. Researcher Professor Roger Pederson points out that a selective process as described would require “additional regulatory review.”

Displeased opponents say "false hope" is being raised among "desperate patients". Disregarding such criticisms, many scientists welcome stem cell research from spare IVF embryos as offering the possibility of a more cost-effective and practical alternative to therapeutic cloning. The scientific team calculated that cells from 150 random embryos would be enough to provide the best possible match for 13% of recipients, a favourable level of match for 65%, and some use for as many as 85%. Surprisingly, just 10 types of specifically selected genetic material would be enough to provide a favourable level of match for 78% of recipients.

At present the UK bank contains stem cells suitable only for research. Professor Pedersen told the BBC News website that “this research tells us is that the number of lines needed to achieve a significant clinical value is in the practical realm.” Professor Pederson also said that researchers were already working from spare IVF embryos. Dr Glyn Stacey, director of the UK Stem Cell Bank, acknowledged the importance of recent findings, but admitted researchers were still “a long way away in terms of establishing the basic cell culture methods” and do not know “whether all stem cell lines will give the full range of tissues." The charity Life argues that research had shown adult stem cells preferable to embryonic stem cells fro the purposes of treating disease. Spokesman Matthew O'Gorman said: "The UK stem cell debate is obscured by hype which only serves to raise false hope among desperate patients. “Embryonic stem cell research involves destructive experiments on tiny human beings, which is why it has been outlawed in the majority of countries worldwide.” Read more:

A Pill for Alcoholism?

NPR reported this weekend that the University of Virginia is conducting a study on a new drug to help alcoholics who are trying to quit drinking. The drug called topiramate (Topamax®) has shown some remarkable successes, but has not yet been approved by the FDA to treat alcoholics. To date, three medications--disulfiram (Antabuse®), naltrexone (Trexan®), and acamprosate (Campral®)--have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of alcohol dependence, but barely 20% of people who need them, use them. Recently, however, there has been research supporting a more central role for medications in the treatment of alcohol-seeking behavior. This behavior appears to be related neurobiologically to dopamine and other neurotransmitters that can alter dopamine function. Topiramate was originally synthesized as a potential anti-diabetic agent and was found to be similar to anticonvulsants. It used for example in the treatment of adult migraine headache. It is a GABA-receptor agonist (GABA is the predominant inhibitory neurotransmitter) and a glutamate antagonist (glutamate is a predominant excitatory neurotransmitter). In a chronic alcoholic state, GABA is decreased while glutamate and dopamine are increased. Work done in 2003 by Dr. Bankole Johnson and his team at the University of Texas at San Antonio have shown that topiramate blocks the glutamate receptors and increases the GABA effect; this combined effect produced a decrease in heavy drinking days and alcohol craving (a person can have one drink and not crave the second third, fourth, fifth, etc.) with an increase in non-drinking days.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) claims that almost 18 million people in the USA abuse or are addicted to alcohol. According to BusinessWeek, this abuse and addiction costs the USA around $185 billion a year in medical services, lost wages, and law enforcement resources. The NIAAA also claims that alcohol affects women differently than men. “Women become more impaired than men do after drinking the same amount of alcohol, even when differences in body weight are taken into account. This is because women's bodies have less water than men's bodies. Because alcohol mixes with body water, a given amount of alcohol becomes more highly concentrated in a woman's body than in a man's. In other words, it would be like dropping the same amount of alcohol into a much smaller pail of water. That is why the recommended drinking limit for women is lower than for men… In addition, chronic alcohol abuse takes a heavier physical toll on women than on men. Alcohol dependence and related medical problems, such as brain, heart, and liver damage, progress more rapidly in women than in men.” For information on alcoholism science go here.

Women's Bioethics Blog Nominated for 2005 Medical Weblog Award

Medgadget is hosting their Second Annual Medical Weblog Awards and this very Women's Bioethics Blog is a nominee. The awards are designed to honor the very best in the medical blogosphere, as decided by the readers. The categories are: Best Medical Weblog; Best New Medical Weblog (established in 2005); Best Literary Medical Weblog; Best Clinical Sciences Weblog; Best Health Policies/Ethics Weblog; and, Best Medical Technologies/Informatics Weblog. Nominations will be accepted until Friday, December 30, 2005. Polls will be open from Tuesday, January 3, 2006 and will close at midnight on Sunday, January 15, 2005 (PST).
Awards will be announced on Wednesday, January 25, 2006. Check it out and vote.
http://www.medgadget.com/archives/2005/11/the_2005_medica.html

Frozen eggs, anyone?

Interesting Slate article and blog.bioethics.net post about how a young economist at the University of Virginia found that a woman in her 20s will increase her lifetime earnings by 10 percent if she delays the birth of her first child by a year. Part of that is because she'll earn higher wages—about 3 percent higher—for the rest of her life; the rest is because she'll work longer hours. For college-educated women, the effects are even bigger. For professional women, the effects are bigger yet—for these women, the wage hike is not 3 percent, but 4.7 percent.

Do you throw--make that think--like a girl?

In this story on NPR's Science Friday broadcast yesterday, Ira Flatow and his guests talk about claims regarding gender differences in cognitive abilities. This is a panel held in conjunction with the American Psychological Association's Science Leadership Conference in Washington, DC, in a forum with DC high school students.

Nora Newcombe, a professor of psychology, says that while there is evidence of differences, there's no evidence of one sex being smarter than the other (overall). In general, women are better at writing, at memory tasks, some fine motor tasks, and speech. Men tend to be better at spatial imagery,. In general, women tend to do better with "book learning" type tasks, and men do better with "fluid tasks," meaning extracurricular learning and novel problem-solving.

Stem cell agency in California hassles court to dismiss lawsuits

Eager to progress with its stem cell project, the newly implemented California Institute of Regenerative Medicine pleaded with a judge to dismiss lawsuits that have impeded it from borrowing $3 billion to be used to fund research grants. Newly created by Proposition 71, the stem cell institute has been hindered by two lawsuits that have challenged its constitutionality and intimidated potential leaders. Filed by politically conservative groups, these lawsuits have delayed the agency’s work, according to deputy attorney general Tamar Pachter. For example, rising interest rates since the agency was first prepared to borrow have cost the state an estimated $15 million. The lawsuits question the authority and intentions of the agency’s managers, many of whom, they allege, are not state officials but employees with individual agendas. The agendas of the filers of such lawsuits have been questioned as well. One of the filers, the People's Advocate and the National Tax Limitation Foundation, which opposes abortion and the “right-to-die,” has admitted its disapproval of stem cell research, but claims its motivations are moral, not religious. The group maintains that only state officials should be able to dole out public funds.

The second lawsuit was filed by a newly created nonprofit called the California Family Bioethics Council, self-described as a “stem cell research watchdog group.” Bioethics lawyer David Llewellyn claims that the selection process, whereby elected officials and college administrators select members of the institute's Independent Citizens Oversight Committee, creates a “conflict of interest.” Human embryonic stem cells are created in the first days after conception and give rise to all the organs and tissues in the human body. Scientists hope to someday use stem cells to replacement diseased tissue. Such prospects anger many social conservatives, including President Bush, because embryos are destroyed during research. President Bush’s 2001 restriction on the use of federal money to fund stem cell work has kept the field infantile, according to scientists.

The pending litigation discourages potential leaders, fearful of the potential futility of their investments. The agency has been kept afloat and has opened a permanent headquarters thanks to a $5 million charitable donation from sound pioneer Ray Dolby and a $3 million loan from the state. Even though it has little money, the agency in September awarded 16 grants totaling $39.7 million to universities and nonprofit medical organizations in California. Rulings on the lawsuits are expected at a later date.

IVF-->slight increase in risk of birth defects

According to a new study from the University of Iowa, babies conceived through in vitro fertilization (IVF) have a slightly increased risk of major birth defects (eg, heart or muscle and skeletal defects) compared with babies made the old-fashioned way. The increase is slight--a risk of 6.2% for babies conceived through IVF, versus 4.4% for naturally conceived infants--but may be worth considering. It is not known whether the increase in risk is the result of IVF, or the result of some other factor; other characteristics of women/couples seeking IVF could account for the rise. In addition, the study addresses only congenital defects--not problems that might arise later in life. Here's the link to the abstract in PubMed.

Women's Health and Intimate Partner Violence against Women

While violence against women is recognized as a major health and economic problem, as well as a human rights issue, a lack of comparable and reliable data on root causes and magnitude has hindered public policy makers. In 1997, in order to collect such data, WHO initiated a study, the initial results of which were published last week as the “WHO Multi-country Study on Women's Health and Domestic Violence against Women”. This report is based on interviews with 24, 000 women in Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia and Montenegro, Thailand, and Tanzania by carefully trained interviewers. (Countries in North America and Europe were not included as they had been the subject of previous studies.) It says the percentage of women reporting having been physically or sexually assaulted, or both, in their lifetime ranges from 15% in Japan to 71% in rural Ethiopia. Alarm was expressed at this figure in regard to the spread of HIV and Aids. (See also this article.) It was discovered that violence was more prevalent in poorer countries and that women who lived there were more likely to think the violence was justified. Researcher Lori Heise said it was not clear what was behind the differences between richer and poorer countries, but many of the areas with higher rates were more rural, traditional communities where the problem had remained largely hidden: up to half of the women surveyed had never spoken of their situation to anyone. This report shows that research and policy on women’s health, and indeed promotion of women’s health, including psychological and reproductive health, must consider intimate partner sexual and physical violence against women.