A Different Take on the Maternal-Fetal Conflict in Pregancy

Women know that pregnancy can be wonderful, and that it can also be dangerous: Around the world, an estimated 529,000 women a year die during pregnancy or childbirth and roughly ten million suffer injuries, infection or disability. David Haig, an evolutionary biologist at Harvard, notes that while pregnancy is absolutely central to reproduction, it doesn't seem to work very well -- that pregnancy is associated with all sorts of medical problems. Why? Dr. Haig argues, a mother and her unborn child engage in an unconscious struggle over the nutrients she will provide it.

In a 1993 paper, Dr. Haig first predicted that many complications of pregnancy would turn out to be produced by this conflict. One of the most common complications is pre-eclampsia, in which women experience dangerously high blood pressure late in pregnancy. For decades scientists have puzzled over pre-eclampsia, which occurs in about 6 percent of pregnancies.

Dr. Haig proposed that pre-eclampsia was just an extreme form of a strategy used by fetuses, somehow raising the blood pressure of their mothers so as to drive more blood into the relatively low-pressure placenta.

Dr. Haig says that people seem to think that he must have a political agenda, but he explains that he's not talking at all about conscious behaviors -- he's just interested in these mechanisms and why they evolved.

They sell medical equipment on EBay, don't they?

A disturbing article in NY Times today notes that if the avian flu virus was to morph and lead to a human pandemic, the nation's hospitals would not have enough ventilators.

Right now, there are 105,000 ventilators, and even during a regular flu season, about 100,000 are in use. In a worst-case human pandemic, according to the national preparedness plan issued by President Bush in November, the country would need as many as 742,500.

To some experts, the ventilator shortage is the most glaring example of the country's lack of readiness for a pandemic.

"This is a life-or-death issue, and it reflects everything else that's wrong about our pandemic planning," said Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University. "The government puts out a 400-page plan, but we don't have any ventilators and there isn't much chance we're going to get them."

In a pinch, ambu bags can be used (which I found 12 of on EBay), but they would be be insufficient for a pandemic.

The 'Pimping' of Medical Students

The term 'pimping' is not a term that I've previously heard used in hospitals, medical schools, or clinical ethics rounds, but apparently is a term that's gaining popularity: it is being used in the medical profession to describe the process of enticing respect for the medical intern's superiors and to rid the intern of unwarranted self esteem.

The article, "The Art of Pimping" was published in the Journal of the American Medical Association in 1998 and then the website Neonatology on the Web, picked up the article in 2005: it suggests (tongue-in-cheek) that every 'newly appointed attending must teach himself how to pimp.'

The question is does grilling medical students with questions make them into better doctors? How do we, as patients, benefit from such a bizarre practice?

Steinem Speaks Out on New Abortion Laws

Renowned feminist and activist Gloria Steinem demanded a town hall audience of 900 in Seattle in taking a stand to protect a woman’s right to choose after the recent passing of legislation in South Dakota, banning abortions.

The ban forbids abortions in all circumstances, including rapes and familial copulation or, in other words, incest. The only exception is in the case where a woman’s life is in danger, which is yet to be clearly defined. Steinem says this legislation was passed without giving South Dakotans the chance to vote on the issue.

While the new law passed by twelve votes in the state Senate (23-12), Steinem believes the government is trying to gain control over a woman’s reproductive freedom. She also took a stab at the media for their inaccurate and minimal coverage of the legislation and the Bush administration’s policies on birth control and abortion.

Read more at seattlepi.com

Rabbinical students get crash course in IVF

Interesting story in today's NYT describes a group of graduate students studying infertility and Jewish law.

**excerpt**
"This is not like 'Star Trek' science," said Rabbi Brander, a dean at Yeshiva, which has the largest Orthodox rabbinical seminary in the country. "This is stuff that comes up every day. And if the rabbi doesn't understand reproductive technology he can't answer the questions effectively. If he doesn't know the Jewish law he can't answer them, either."

Wrongful life?

Yesterday's NYT Magazine included this story about "wrongful life. " The article talks about cases in which parents who give birth to severly disabled children were not informed of the fetus' status in time to procure an abortion--and they sue the treating physician.

The story quotes Adrienne Asch, who notes (here and in a number of thought-provoking journal articles) that there is a moral difference between abortion for general reasons that apply to the pregnant woman (her life plans, her health, etc.) and reasons specific to that particular fetus. On her view, women have the right to choose whether and when to give birth--but they ought not have the right to choose to abort on the basis of fetal characteristics. One argument against prenatal testing is that it's the beginning of a slippery slope--today it's Down syndrome, in some places it's (already) sex, tomorrow it might be intelligence or height or some other characteristic. Basing abortion decisions on a single characteristic is, Asch and her coauthors claim, confusing the part with the whole--seeing only that characteristic and nothing else. They also note that, in many cases, parents may be basing their decisions on an inaccurate or incomplete understanding of what it's really like to raise a disabled child. Moreover, they say, entering parenthood isn't like (and shouldn't be like) shopping: we should take what we get.

Another question worth considering, mentioned only briefly in this article, is whether there already exists a pro-abortion bias in the medical community in cases where genetic abnormalities are identified through prenatal tests. If this bias does exist--and my sense is that it does, at least in the minds of some physicians--are women really free to choose?

NYU: Law, Medicine and Morality -- Implications of the Terri Schiavo case

New York University Law School conducted a wonderful one day conference on Law, Medicine and Morality: Implications of the Terri Schiavo Case, with great speakers such as our Board Member Jonathan Moreno, Sylvia Law, Glenn McGee, Lisa Chiyemi Ikemoto, Rabbi Richard F. Address, Vanessa Northington Gamble and others too numerous to mention. One of the recurring theme of the conference was to establish a creative unifying agenda for bioethics. I've invited many of the speakers to post here on our blog and I look forward to reading their posts!

Do we trust our government to protect us against Avian Flu?

Billions of dollars have already been spent on fighting the Avian Flu pandemic, and the chances of it spreading are still quite high. However we will never have enough vaccines or medicines to fight off this disease if it indeed spreads. The two solutions that Caplan and McGee suggest are quarantine and rationing. For this to happen the public needs to trust their government officials with their health and life—which, right now, they do not.

The authors explain that if military men in gas masks invade people’s homes and communities the reaction will be panic and mass hysteria. In order for such a government response to run smoothly McGee and Caplan suggest educational classes and town meetings where officials explain what will need to be done if Avian Flu spreads widely to humans.

Read more: Arthur Caplan and Glenn McGee on Bioethics at timesunion.com

Fatherhood Suit: Roe vs Wade for Men?

Contending that women have more options than they do in the event of an unintended pregnancy, men's rights activists are mounting a long shot legal campaign aimed at giving them the chance to opt out of financial responsibility for raising a child.

The National Center for Men has prepared a lawsuit -- nicknamed Roe v. Wade for Men -- to be filed Thursday in U.S. District Court in Michigan on behalf of a 25-year-old computer programmer ordered to pay child support for his ex-girlfriend's daughter.

The suit addresses the issue of male reproductive rights, contending that lack of such rights violates the U.S. Constitution's equal protection clause.

The gist of the argument: If a pregnant woman can choose among abortion, adoption or raising a child, a man involved in an unintended pregnancy should have the choice of declining the financial responsibilities of fatherhood. The activists involved hope to spark discussion even if they lose.

Hands Off Our Ovaries and International Women's Day

March 8th, International Women's Day, a coalition of pro-choice and pro-life women, concerned at the growing exploitation of women in biotechnology will launch a new campaign against the harvesting and marketing of human eggs. The campaign. "Hands off our ovaries!" will highlight the short and long-term risks involved in egg harvesting and its significance for the health and dignity of women, an issue that has been addressed on this blog before and is a concern of the Women's Bioethics Project.

Concerned feminist representatives have joined together on this common ground, outraged by the casual attitude of the biotech industry towards the female body. Like-minded leaders and groups from around the world are invited to join a list which already includes representation from the USA Europe and Asia.

(hat tip to Jennifer Lahl)

No Gnome Liberation for Women

(Photo: Duncan Andrew, The Witness)

I have a question I’d like answered: Do you get female gnomes? There seems to be some confusion around this point, as the Cambridge Advanced Learner’s English Dictionary defines a gnome as a very small old man with a long beard and pointed hat. But other accounts and many garden gnome displays lend testimony to the fact that there are indeed both male and female gnomes.

Which brings me to the issue I want to raise, my point(ed hat) of contention, as it were. Having been alerted to the issue of garden gnome liberation by a cutting-edge journalistic piece appearing in our local newspaper this week, I did some investigation into the phenomenon. And what I found was alarmingly reflective of the discrimination perpetuated against women in (real) society.

As reported in The Witness this week, “garden gnome liberation is a worldwide phenomenon…a political movement dedicated to liberating gnomes from the gardens in which they are shackled…removing gnomes from gardens and either taking them out to the woods to release them or smashing them to set their spirits free.” A (g)noble cause, and one taken up in earnest by liberation movements around the world – like the Free the Gnomes group in the United States.

But if one looks more closely at the reports and photographic testimonies of the struggle for gnome civil liberties and rescue attempts around the world, one notices that the gnomes that are liberated all share one common characteristic: they are all male gnomes. What about the female gnomes? Could these liberation fronts be operating on the assumption that women are more contented to stay ‘shackled’ in floral domesticity, while men have the biological need and moral right to be set free, to run wild?

Caffeine and the Heart: Mixed Messages for Java Lovers

For someone whom coffee is a transcendental experience, this recent report is provocative:
heart attacks might be a risk for coffee drinkers with a common genetic trait that makes caffeine linger in their bodies. In a study published in the Journal of the American Medical Association, researchers found that individuals with a certain genetic profile that were "slow metabolizers" of caffeine -- slow-metabolizers, those who drank two or more cups of coffee daily were at least 36 percent more likely to have a nonfatal heart attack than those who drank little or no coffee.

How do you know if you're a slow metabolizer or fast metabolizer? Currently, there's no easy way to know if you're a fast or slow caffeine metabolizer. Staying awake all night if you drink coffee in the afternoon doesn't mean you're a slow metabolizer -- there is a genetic test that could answer the question is used in research, but is not commercially available at this time.

So, in the meanwhile, I'll guess I'll take my chances and enjoy my morning java ritual.

AMA Warns Girls Not to Go Wild

The American Medical Association is warning girls not to go wild during spring break. All but confirming what goes on in those "Girls Gone Wild" videos, 83 percent of college women and graduates surveyed by the AMA said spring break involves heavier-than-usual drinking, and 74 percent said the break results in increased sexual activity.

The AMA is trying to call attention to underage drinking among women because their bodies process alcohol differently and put them at greater risk for health problems -- Sizable numbers reported getting sick from drinking, and blacking out and engaging in unprotected sex or sex with more than one partner, activities that increase their risks for sexually transmitted diseases and unwanted pregnancies. The AMA said the findings highlight the need for alternative spring break activities.

British Woman Loses Frozen Embryo Battle

In a move similar to the Tennessee Supreme Court in the Davis case , the European Court of Human Rights has ruled that a British woman has no right to use frozen embryos to have a baby without the consent of the man who provided the sperm.

Evolving Notions of Personhood and Humanity

Nicholas Wade of the NY Times reports that researchers have detected some 700 regions of the human genome where genes appear to have been reshaped by natural selection, a principal force of evolution, within the last 5,000 to 15,000 years, providing the strongest evidence yet that humans are still evolving.

Traditional notions of personhood usually require humanity, but if we're still evolving then perhaps we should be considering evolving notions of personhood. Which brings us to another interesting question: should be trying to control our evolution (and, in fact, haven't we already have by so many improvements in medical technology and health care, at least in this country) or should we be letting nature takes its course?

A Day of Mourning: Dana Reeve dies at age 45

Dana Reeve, best known for her tireless efforts in supporting her late husband, Christopher Reeve, and their support of stem cell research to find a cure for paralysis, died yesterday of lung cancer.

She served as chairwoman of the Christopher Reeve Foundation and founded the Christopher and Dana Reeve Paralysis Resource Center.

Kathy Lewis, president and CEO of the foundation, said "Dana will always be remembered for her passion, strength and ceaseless courage that became her hallmark... Along with her husband, Christopher, she faced adversity with grace and determination, bringing hope to millions around the world."

She is survived by her father, Dr. Charles Morosini; sisters Deborah Morosini and Adrienne Morosini Heilman; two stepchildren, Matthew and Alexandra; and her son.

Board Member Hilde Lindemann On the South Dakota Ban

As we posted before, South Dakota's extremely restrictive ban on abortion has now been signed by the Governor Rounds. One of our newest board members, Hilde Lindemann, has posted a personally inspired and awesome commentary on the South Dakota ban on the new Hastings Center Bioethics Forum. Here is an excerpt that I found particularly powerful:

Significantly, what antiabortion legislation requires of women is quite different from what child-support legislation requires of delinquent fathers. To be sure, such fathers must pay child support, but they are never forced to what lawyers call “specific performance.” They aren’t required by law to change diapers, give baths, prepare and serve meals, help with homework, or take their children to soccer practice. All unwilling fathers have to do is pay up every month. Specific performance, in fact, is seen as a form of servitude that may lawfully be required only of conscripts when there is a clear and present danger to the state. It may not be imposed even on convicted felons. If a drunk driver smashes into your house, he might have to go to prison or (under certain victim compensation laws) pay for damages, but he doesn’t have to repair your brickwork or replace your broken door with his own hands. If your architect breaks her contract with you by failing to produce the agreed-upon blueprints, the court can impose a fine, but it can’t make her sit down at her drafting table and do the promised work.

And that, when all is said and done, is the difference the South Dakota legislators want to draw between actual fathers and expectant mothers. They want to hold pregnant women – who are innocent of any wrongdoing – to a punitive standard of specific performance, sentencing them against their will to the many kinds of hard work, physical discomfort, and outright danger that my daughter has undertaken to bring her wanted child into the world. No other class of people is held to this standard in peacetime. No woman should be held to it either.

Way to go, Hilde!

Is Drug Data Delayed, Drug Data Denied?

An annual report by the US Food and Drug Administration (FDA) admits that about two-thirds of the post-marketing drug studies it had mandated have never been finished. According to the Times, one such study was mandated in 1955.

US Representative Maurice D. Hinchey (Democrat- New York), "said while the agency insisted that it demanded that drug makers prove their medication safe, those demands 'continue to be blatantly ignored by the pharmaceutical industry.'"

In reply, Dr John Jenkins, director of the FDA Office of New Drugs, "emphasized that only 5 percent of promised drug trials were officially considered 'delayed.' In many cases, trials have been pending for more than a decdade but are not considered delayed because the agency never insisted on a specific timeline for them."

Fellow blogger Roy Poses has a good comment on this story:

I agree that potentially beneficial drugs should be put on the market as soon as possible with the least red-tape. Randomized controlled trials that have adequate statistical power to determine if a drug has benefits when compared to a placebo may not have enough power to determine all its important adverse effects. Thus it may make sense, when a drug offers important benefits beyond any treatment currently available, to allow it on the market without complete safety information, and then to require post-marketing studies, with more statistical power (but perhaps also with more methodologic biases) to assess its adverse effects. But patients and physicians need to know about the all important possible hazards of potentially beneficial medicines to make optimal decisions about whether to use them. So it is crucial that these post-marketing studies get done as quickly as possible.

I don't understand why the FDA has been mandating these studies, but not mandating any deadlines for their completion. Patients and physicians are ill-served by delays (whether officialy defined or not) in accomplishing these studies.

If pharmaceutical companies really want to increase their trustworthiness to patients and physicians, they ought to consider completing all pending post-marketing studies expeditiously. And in my humble opinion, the FDA needs to hold pharmaceutical companies accountable for their failure to complete such studies in reasonable amounts of time.

Parental Notification laws have little impact

Laws that require minors to notify their parents or get permission to have an abortion do not appear to have produced the sharp drop in teenage abortion rates that some advocates hoped for, an analysis by The New York Times shows.

Artificial Blood (Polyheme) Trials : King and Kipnis

Ethicists Nancy M. P. King, Ken Kipnis, and Robert Nelson were kind enough to give us permission to re-print their letter originally posted on the Medical College of Wisconsin listserve:

Date: 06-14-04 22:37

We - Nancy M.P. King and Ken Kipnis - have been doing research on the ethics of waived-consent clinical studies now permitted under 21 CFR Part 50. Such a study is underway: a well-publicized multi-center trial, sponsored by Northfield Laboratories and testing a hemoglobin-based oxygen carrier (PolyHeme) on trauma victims. One of us - NK - had noticed a possibly serious problem that seemed to have been missed, and Robert Orr, a physician evaluating the PolyHeme protocol at the University of Vermont, contacted KK about the same issue. This posting is a request for comments and information that might throw light on the concerns we set out below.

The Northfield protocol provides that trial subjects - trauma patients in hemorrhagic shock who are being treated by EMTs - randomly receive either saline solution or PolyHeme. Enrollment occurs in the field under the waived-consent exception, before arrival at the emergency department. The research subject/trauma patient is likely to be in a medically exigent circumstance and incapable of consent, either because of the injuries or because of the gravity of the situation and the complexity of the consent process. Apart from slowing blood loss and replacing fluids, hemorrhagic shock is not satisfactorily treatable in the field.

Once at the hospital, efforts are to be made to secure consent for continued participation either from the patient/subject or a legally authorized representative. However if formal withdrawal from the study does not occur, participation continues by default during a 12-hour period in the hospital. Patients/subjects in the control group receive standard treatment: saline and blood as needed. However patients/subjects in the experimental group continue to receive PolyHeme instead of blood for oxygen delivery: up to six units of PolyHeme for up to 12 hours, at which point their participation in the trial ends.

The study can be divided into two phases. The first (PolyHeme vs. saline) occurs in the field. The second phase (PolyHeme vs. blood) occurs for up to 12 hours after hospital admission.

We believe it is a serious problem that the special circumstances that justify waiver of consent in the field cease to obtain shortly after admission to the hospital. After they arrive, the patients/research subjects can be typed and transfused, complying with a standard of practice not available to EMTs. Provided that certain other conditions are satisfied, we accept that the use of an investigational product like PolyHeme, instead of saline, can be justified when blood is unavailable (as in an ambulance) and the medically exigent patient/subject cannot consent. But this same investigational procedure becomes deeply problematic if the optimal treatment - blood transfusion - is available but being experimentally withheld without consent.

We believe that, at a minimum, it is obligatory to separate the field trial (PolyHeme vs. saline) and the clinical trial (PolyHeme vs. blood). We think it is an ongoing mistake to be piggy-backing the latter onto the former, with its much weaker consent requirements.

Consider that it is inevitable that some hospitalized patients/research subjects on PolyHeme will die during the critical 12-hour interval when blood is available but being withheld. We expect that plaintiffs' attorneys will scrutinize these deaths in efforts to ground claims of liability. Putting the point most dramatically, these people will have died while being denied an available, standard medical treatment (blood transfusions) following unconsented-to enrollment in a research study. Despite the good results obtained in earlier trials, the use of PolyHeme is still an investigational procedure that can only be substituted for established practices with consent (except under circumstances that plainly do not obtain in the hospital setting).

We are aware of the risks associated with the use of allogeneic blood and appreciate that the availability of a safer oxygen carrier will be a medical advancement. But even though blood is less than ideal, it doesn't follow that it is "unsatisfactory" under the Federal Regs. If it did follow, the waiver could be applied whenever an investigator was sufficiently impressed by an experimental treatment that promised superiority to a less-than-perfect standard treatment. Hemorrhagic shock can be treated in the hospital using blood, though this standard intervention may not be as safe and effective as PolyHeme may someday be definitively shown to be. Of course there is a need for further clinical research comparing PolyHeme and blood, but only with the consent of the research subjects.

We have puzzled over the 12-hour clinical phase of the trial. Emergency departments participating in the Northfield study will typically receive patients/subjects less than one hour post-trauma. But the study is designed to mimic a 12-hour period without access to blood. Unlike remote areas and ships (which do not seem to be participating in this study), 12-hour delays are not common problems in the communities where the studies will be done. So why include this troubling feature? We believe it reflects the circumstances of combat-wounded soldiers when evacuation to field hospitals is impossible. The military could plainly benefit from this new technology, once it is approved. If military applications are the reason for the clinical phase of the study, than the additional risks imposed upon hospitalized civilian trauma victims are intended to benefit, neither the patients/subjects nor those subsequently injured in their communities but rather, soldiers fighting overseas. While both of us endorse the obligation to provide the highest-quality care to injured American troops, we think that duty cannot justify departures from ethical principles governing research on non-consenting civilian human subjects.

These reservations have already been communicated to Northfield but there has been no reply. Both of us are intent on keeping our minds open and that is why we post this message now. We welcome comments and suggestions that can throw light on the concerns we have raised above.

Thank you.

Kenneth Kipnis, Ph.D. (University of Hawaii)
Nancy M.P. King, J.D. (University of North Carolina)

A special issue on the Northfield trial will be forthcoming in AJOB with two pieces by King, Kipnis, and Nelson; they also published an article in the March issue of IRB, on problems that have emerged involving oversight of the PolyHeme study: "Trials and Errors: Barriers to Oversight of Research Conducted un ther Emergency Research Consent Waiver."

Affordable Stem Cell Therapy?

Merrill Goozner, Director of the Integrity in Science Project, says that the US3Billion stem cell research program in California (California Institute for Regenerative Medicine (CIRM)) may be the model opportunity for the US to regain leadership in biomedical innovation as well as provide for affordable stem cell therapies. His article is entitled, "Innovation in Biomedicine: Can Stem Cell Research Lead the Way to Affordability?" and will appear in the May issue of the Public Library of Science: Medicine. Government funded research has the mission to deliver affordable medical therapeutics to its citizens as well as be hospitable to innovation. But because of current patent policies, new technologies come to market at the highest prices. This is why it is reasonable to be concerned about putting public funds into new biomedical researches: Why should public money be invested in therapies only the wealthy will be able to benefit from?

A UK report claims that since 1994, 18,000 stem cell patents, two-third in the US, have been issued. This is described as a “patent thicket problem” and seriously slows the pace of innovative research and it promises costly therapies since companies want to recover money spent at the development level. Goozner wonders whether all grant recipients could agree to donate exclusive license to a common patent pool supervised by a new non-profit organization set up for that purpose. Patent pools have worked in other technologies, like open source software. Patent pools could also work in biomedicine.

While the article concerns developing new therapeutics in the advanced industrial world, it is applicable to developing drugs for neglected diseases.

On the Fringes of Health Care: Immigrants

From the NY Times series On Being a Patient:

Last year, about 80 bills in 20 states sought to cut noncitizens' access to health care or other services, or to require benefit agencies to tell the authorities about applicants with immigration violations. Arizona voters approved such a requirement in 2004 with Proposition 200. Virginia has barred adults without proof of citizenship or lawful presence from state and local benefits. Maryland's governor excluded lawful immigrant children and pregnant women from a state medical program for which they had been eligible.

Mean-spirited and short-sighted is the phrase that comes to mind.

Who's Afraid of Big Bad Pharma?

Not Indians, apparently: An article in Wired by Jennifer Kahn called A Nation of Guinea Pigs, describe how drug companies are conducting clinical trials in South Asia, using tens of thousands of poor Indians as "guinea pigs."

Fellow blogger Chris MacDonald does a nice job of outlining the ethical issues:

- Drug companies pay hospitals and doctors to enroll patients in drug trials. The potential for conflict of interest is clear: hospitals and doctors, far from wealthy themselves, may succumb to financial temptations to enroll patients inappropriately. Of course (and with a few important differences) the same worry applies here in North America.

- Most of the people being enrolled in trials are poor, illiterate, and culturally deferential to doctors. Their ability to give free and informed consent is questionable.

- Most of the drugs being tested are drugs that are irrelevant to the health needs of a nation like India; they're mostly medicines (like blood-pressure drugs) aimed at the North American & European markets.

Kahn points out that the path of medical progress is strewn with cases of questionable ethics, desperate practices, and misguided experimentalism, if not outright exploitation. And since patients with the fewest options are invariably the ones most likely to try (or be forcibly volunteered for) risky new treatments, be it an artificial heart, an unproven pill, or a radical lobotomy, they're also the ones who bear the brunt of medicine's experimental nature. In this light, outsourcing trials to a country where decent medical care is scarce, and medication scarcer, is just the globalization of an old equation. Can this really be justified?

Photo source: http://www.sights-and-culture.com/India-country/India-village1.jpg

Dopes Like You and I to Blame for Olympic Doping?

Art Caplan's article at MSNBC The losing battle against doping

The return of the Olympics has renewed questions about the use of drugs and medical science to enhance athletic performance. In the last Winter Olympics in Salt Lake City, the Nordic skiing and cross country skiing teams were beset with doping scandals. The biennial outbreak of doping tests, charges, lies and expulsions leads naturally to the question about the ethics of using drugs to improve performance. While improved technology has given us the ability to detect the subtle, stealthy drugs, the same technology is also allowing for the development of subtler, stealthier drugs. Caplan argues that most of these performance-enhancing drugs are dangerous, risky and unsafe to use and using them to cheat is wrong from a normative point of view.

Caplan contends that, at the end of the day, integrity, as much as technology, will keep the Olympics drug-free. But, if “your countrymen only see gold medals as making the competition worthwhile, and if you yourself are competing with one eye on the opposition and the other on your endorsement contract, then integrity is in trouble.” If fame, honor, and money go only to those who cross the finish line first, then no matter what, the athletes will cheat. Public opinion, as in you and I, are as much responsible for doping in Olympics as unethical athletes and coaches.

Read more

Too bad you’re gay…worse if you’re gay and black…fatal if you’re gay, black and female

South Africa made international news in December last year when it became the fifth country in the world and the first in Africa to legalize gay marriage. This, while homosexuality remains illegal in neighbouring African countries, is perhaps indicative of the atmosphere of tolerance that South Africa has prided itself on since its oppressive apartheid regime gave way to democracy in 1994.

But recent events raise the question: does the tolerance towards the gay community reflected in South Africa’s legislation on gay marriage extend to the daily, lived experiences of gay men and women? Tolerance, acceptance, and personal freedom are themes far removed from the events that have made headlines this year regarding gays and lesbians.

First, there was the South African National Blood Service’s (SANBS) decision to exclude all sexually active homosexual men from donating blood, following a statement asking gay people not to donate blood if they have had sex (safe or not) in the past five years, which sparked outrage among the gay community. While the SANBS stuck by its decision, claiming that “international medical reports indicate that men who have sex with men show increased risk of infection with HIV and other blood infections,” members of gay activist and human rights groups argued that the SANBS’s position was not based on local HIV statistics and contributed to the stigmatization and marginalization of the gay community.

If the comments of some African leaders are anything to go by, being gay and black invites more palpable discrimination. Zimbabwe’s president, Robert Mugabe, for example, “called homosexuals ‘worse than pigs and dogs’ and a Namibian minister urged a group of police constables to ‘eliminate’ gays and lesbians from the country.” Even within the borders of South Africa’s democracy and liberal constitution, black, gay individuals face discrimination, prejudice and ostracism daily. And, more than occasionally, violence.

Being black, gay, and female apparently makes you a target for even more savage acts of homophobic hatred: early last month, a 19-year-old lesbian from the Khayelitsha township was clubbed, kicked and beaten to death by a mob of young men. And the slow reaction to her murder amongst the media and police has not been met with much surprise by township gay men and lesbians, who face verbal and physical abuse, rape and intimidation on a daily basis, and for whom “police inertia over hate crime is par for the course” (Marianne Thamm, “Not just another murder” in print edition of Mail&Guardian, Feb 24 – March 2).

Here is another problem generated by a patriarchal belief system, it seems. According to Dawn Betteridge, director of the Triangle Project, “…adopting the clothing and behaviour typical of a ‘butch lesbian’ or the ‘effeminate male,’ is perceived as a threat to masculine dominance…Lesbians who mimic men are seen to be challenging male superiority. Rape and violence against lesbians is common…men who perpetrate such crimes see rape as curative and as an attempt to show women their place in society.”

“Corrective rape, where men try to ‘cure’ a lesbian by forcing her to have sex, still happens, according to gay activists.” Nineteen year-old Zoliswa Nkonyana did not receive this cure. Instead, she, and her lesbian ‘threat’ to masculinity, were simply eliminated. Perhaps the legal team for members of the mob who beat her to death will argue in their defense that, for these youths, ‘prevention’ seemed better than cure...

Isn't preventing unintended pregnancies a good thing?

The Guttmacher Institute came out with a report yesterday that showed that from 1994 to 2001, 33 states have made it more difficult or more expensive for poor women and teenagers to obtain contraceptives and related medical services; these states cut funds for family planning, enacted laws restricting access to birth control and placed tight controls on sex education.

So query, at a time when policymakers have made reducing unintended pregnancies a national priority, and there is such a huge push to restrict access to abortions, why this schizophrenic approach? As Sarah Brown, director of the nonpartisan National Campaign to Prevent Teen Pregnancy, said "The most powerful and least divisive way to decrease abortion is to reduce unintended pregnancy... "If we can make progress reducing unintended pregnancy, we can make enormous progress reducing abortion."

The War on Science and Plan B

Susan F. Wood, former assistant commissioner of women's health at the Food and Drug Administration, has an op-ed in the Washington Post this morning in which she has some very powerful things about the responsibility of federal health agencies, evidence-based medicine, and Plan B:

"At every stop I am reminded that whether it is the environment, energy policy, science education or public health, the American public expects our government to make the best decisions based on the best available evidence...

Time and again in my travels I am asked, "What happened to derail Plan B?" I have to answer honestly that I don't know. The manufacturer agreed to take the "controversial" issue of young teens' access to emergency contraception off the table in 2004; now we are talking only about adult access to safe and effective contraception. Over 98 percent of adult women have used some form of contraception. So what is the objection?

Perhaps it is that posed by a small but vocal political minority that insists on labeling emergency contraception as abortion, or at least confusing the two. One of the main questions I hear is, "Does this pill cause an abortion?" In fact, the only connection this pill has with abortion is that it has the potential to prevent the need for one. Emergency contraceptive pills work exactly the same way as other birth control pills, and they do not interfere with or harm an existing pregnancy. Emergency contraception is simply a higher dose of daily birth control pills; it is not RU-486, the "abortion pill." Indeed, emergency contraception has been used as a method to prevent unintended pregnancies for decades by women who had physicians advise them on how many pills in their regular pill pack to take. So people who are comfortable with oral contraceptives as methods of contraception should be just as comfortable with emergency contraception."

It is a disturbing commentary that such a small but vocal group has such pervasive influence that it can effectively cause well-educated individual to ignore scientific evidence... how does one combat this?

An Economist Looks at the Fertility Industry

Debora Spar, a professor of business administration and an associate dean at the Harvard business school, has recently published Baby Business: How Money, Science and Politics Drive the Commerce of Conception. She is interested in trends in economies and rules of exchange that come in the wake of new technologies, like satellite television, the Internet, and now, IVF. At first, she says, “people get all excited, where there are no rules, and which creates new markets. Over time, these technologies become regulated because people want and need rules.” And the infertility business is interesting to her because in the US is a 3-billion-dollar-a-year sector. According to the author, in this interview anyway, there is nothing more to this business but supply and demand: 15% of the population is infertile, and this represents a high constant demand, and the price of ova, especially those of Harvard grads, has remained high because there is short supply. The average cost of a baby is well over $50,000.

More messy questions include that of whether the therapies ought to be considered enhancements because most infertility is not a disease of the woman who undergoes the treatment. For example, a couple’s infertility may be attributed to male factor infertility, in a heterosexual couple; and, a single woman or a woman in a same sex partnership desiring to be pregnant requires assisted reproduction, IVF being the most common, in order to conceive . Thus a woman who undergoes IVF treatment may herself be reproductively healthy. One could also hold the view that most female infertility may be a social construct; a position that gains support in light of the billion dollar IVF industry in the US, that most women in heterosexual infertile couples would be willing to adopt a child, and the message that having a biological child is considered necessary in order for a woman to realize her "true" potential as a woman.

In the end, even if one considers women’s infertility a disease of the woman who undergoes the treatment, therapy for IVF is time consuming, invasive, and potentially harmful, costly, and most likely is will not be successful. Maybe economists haven't been looking at what supports the billion dollar infertility industry and IVF, but ethicists have.

Global governance needed for species-changing and species-endangering procedures

A summary of Governing Biotechnology
by George Annas

Professor George Annas of Boston University believes that the test for the 21st century is to create a way to govern biotechnology that will lead to the improvement of human life as opposed to destroying it. He explains that biotechnology has had a bumpy back-and-forth road, with issues such as bioterrorism pushing it back and practices like somatic cell nuclear transfer pushing it forward. Annas feels that the first necessary reform is to make clear to lay persons the difference between reproductive cloning and somatic cell nuclear transfer. Somatic cell nuclear transfer is not harmful and therefore cannot be categorized as destructive to humans; rather, it improves the lives of humans. Annas also argues that we need to create a global rules system that includes various governments, industries, NGOs and the public.

Read more

Got Calcium?

The Women's Health Initiative (WHI), a 15-year federally funded study involving more than 36,000 women ages 50 to 79, found that taking calcium (1,000 milligrams daily) and vitamin D (400 international units daily) improved hip bone density, but didn't decrease the risk of hip fractures.

But experts are saying don't stop taking those calcium supplements yet -- in other bone studies involving frail older women, calcium supplementation appeared beneficial. Researchers say additional study is needed to provide more conclusive results.

Got Health Care?: Privatization of Canada's health care

aCanada's publicly financed health insurance system — frequently described as the third rail of its political system and a core value of its national identity — is going to have to move over to make room for private care as well. Critics are complaining that it will lead to disparities in health care, but what's not being said in this article that in the US we also have disparities in health care and a two-tier system -- either you have insurance or you don't.

States' Tug of War on Plan B

Nearly every state is or soon will be wrestling with legislation that would expand or restrict access of the "morning-after" pill.

The makers of the morning-after pill, known commercially as Plan B, asked the FDA for the right to sell the drug over the counter in April 2003, four years after it was first approved for use. The agency's staff and an advisory panel strongly favored the application, saying that unprotected sex often occurs when it is difficult to get a doctor's prescription. They said that easier and faster access to the drug would reduce the number of abortions.

More than 60 bills have been filed in state legislatures already this year; the resulting tug of war is creating an availability map for the pill that looks increasingly similar to the map of "red states" and "blue states" in the past two presidential elections -- with increased access in the blue states and greater restrictions in the red ones.

Some bills expand access -- in Maryland, New York, Kentucky and Illinois specially trained pharmacists would have the right to dispense emergency contraception without a prescription. Other bills require pharmacies to stock and distribute the drug, and to ensure that the pill is made available to women who come into emergency rooms after a sexual assault.

But some bills would make it more difficult for many women to get emergency contraception, which is effective for only 72 hours after a woman experiences a contraceptive failure or unprotected sex. Legislation in New Hampshire, for instance, would require parental notification before the drug is dispensed, and more than 20 other states will consider bills that give pharmacies the right not to stock the drug and pharmacists the right not to dispense it, even to women with valid prescriptions.

Bad to the Bone: Body Snatchers

The owner of a biomedical supply house and three others were charged with selling body parts for use in transplants in a scheme a district attorney called "something out of a cheap horror movie."

The indictment was the first set of charges to come out of a widening scandal involving scores of funeral homes and hundreds of bodies, including that of "Masterpiece Theatre" host Alistair Cooke, who died in 2004.

The investigation has raised fears that some of the body parts could spread disease to transplant recipients.

Rose Gill Hearn, commissioner of the NY City's Department of Investigation, said "It was shockingly callous in its disregard for the sanctity of human remains."

Prosecutors said the defendants took organs from people who had not given consent or were too old or too sick to donate and forged consent forms and altered the death certificates to indicate the victims had been younger and healthier.

X-rays and photos of recently exhumed cadavers show that where leg bones should have been, someone had inserted white plastic pipes -- the kind used for home plumbing projects, available at any hardware store. The pipes were crudely reconnected to hip and ankle bones with screws before the legs were sewn back up. (Watch how X-rays provided clues -- 1:18)

Designer Microbes, the Human Genome Project and Alternative Fuels

J. Craig Venter, the man who is known for mapping the human genome, is proposing to create a new form of life that can help create alternative fuels. He hopes to create designer microbes -- the heart of a biological engine -- from scratch, then adding genes culled from the sea to turn crops such as switch grass and cornstalks into ethanol.

While he's at it, he'd like to modify or devise microorganisms to produce a steady stream of hydrogen.

Venter also now sports an extensive collection of genetic material scooped from the sea from a three year Darwinesque journey around the world -- and that's the raw material for his alternative fuel project. With $15 million from Mexican venture capitalist Alfonso Romo Garza, he has launched a new company in Rockville called Synthetic Genomics Inc.

This is pretty exciting -- a chance to conserve the earth's limited resources and create alternative fuels -- on the other hand, what sort of risks might be associated with creating such new life form?

Separating Fact From Spin in the Abortion debate

NPR does a excellent job of explaining the facts behind late-term or 'partial birth' abortion, explaining why it is so controversial, why is the procedure was developed in the first place, and how it relates to the entire abortion debate:

"Activists on both sides of the issues see the constitutionality of the Partial-Birth Abortion Ban Act as pivotal to the larger debate. Abortion-rights backers say the ban is a first step toward trying to outlaw all abortions. Even some supporters of the ban say that if it is upheld, they could then move on to try to outlaw the far more common D&E procedure, whose description is nearly as unpleasant as that of the D&X.

The court could also use the law to address the 'health' exception currently required for all abortion restrictions. Abortion foes say the current health exception upheld by the court is so broad -- encompassing mental health problems as well as physical ones -- that just about any abortion-procedure ban would have to be invalidated. But abortion-rights supporters say that without a health exception, women could be forced to carry to term fetuses with no chance at life, but whose birth could leave the pregnant women unable to carry a later pregnancy, or could exacerbate serious ailments such as diabetes."

South Dakota: Gunning for Roe

South Dakota lawmakers passed the most restrictive ban on abortion, in the hopes of getting Roe vs. Wade overturned. The measure, which passed the state Senate 23 to 12, makes it a felony for doctors to perform any abortion, except to save the life of a pregnant woman. Proposed amendments to include exceptions for rape and incest were defeated. Assuming the Governor signs the bill, it is scheduled to become law July 1st.

The law is so restrictive that even many pro-life advocates don't think that it will pass constitutional muster.

Ethical Entertainment

“Oscar has developed a social conscience this year, with weighty real-life themes ranging from ethics in big business and media to racial tensions, dominating the movies vying for the big prizes” writes Los-Angeles-based Marc Lavine in the Mail & Guardian this week.

The Oscars are just around the corner. And people here in South Africa are paying special attention – not only because our Charlize is once again up for an award, this time for her role in North Country, but because a local film, Tsotsi, has also been nominated for an Academy Award.

Ethical, moral and social issues seem to be the order of the day if one considers those films that have scooped the nominations this year. Which, according to Hollywood Reporter columnist Marty Grove, is unusual, given that, a few years ago, the serious film would have been the odd-man out. But this year, many of the films that are up for various awards – Capote, Good Night, and Good Luck, Crash, Munich, The Constant Gardener, Syriana, Brokeback Mountain - deal with issues that Hollywood once thought too serious and too dark for mainstream movie-goers, including homophobia, freedom of expression, journalistic ethics and media censorship, terror in the Middle East and the morality of avenging terrorism.

In a rather more cynical view, Brian Johnson of Canada’s Maclean’s magazine claims that these movies collectively represent a landscape of (white) liberal guilt, populated by tortured male protagonists. Never in the history of the academy have issue-oriented films so thoroughly dominated, he writes.

Which got me thinking: South Africa may be a relative new-comer to the Oscar’s list of nominees, but it has a long(er) history of producing films that have highlighted ethically-weighty and socially-conscious issues. In Tsotsi’s “raw and compassionate depiction of Johannesburg’s criminal underworld, where poverty and AIDS are mainstays of existence,” there is an “almost mythic sense of reclamation and redemption…an insightful glimpse of post-apartheid life, from its most violently severe to its most culturally vibrant.”

Tsotsi follows in the film reel of other powerful depictions of apartheid’s legacies of racial inequality, injustice, bitterness, outrage, hope, and forgiveness: Cry, the Beloved Country is one; Country of My Skull another. Cry, the Beloved Country’s portrayal of the “path of tolerance and compassion” and Country of My Skull’s portrayal of “how a country goes about resolving its pain” run parallel to the themes of redemption and reconciliation that have punctuated South Africa’s reality.

And then there are those that have placed women on centre stage. Zulu Love Letter shows the “desperate and emotional journey of two mothers searching for their daughters” while the main character grapples with the “haunting images and unrelenting grief of the past”, and aims her “barely suppressed rage…not directly at White South Africans so much as those around her for not dwelling on what she and millions of others endured during the apartheid era.” Yesterday, South Africa’s first ever Oscar-nominated film in 2005, deals with AIDS as other movies have dealt with apartheid, depicting “what AIDS does to people, families, and communities without being overly dramatic or too emotional about it.” It is a film about one woman’s survival, courage and determination, with the lead character, Yesterday, fighting against AIDS, and refusing to die before she completes her mission: seeing her daughter go to school.

Like the gritty roles that have seen a transformed beauty, Charlize Theron, nominated for Oscars – Monster and North Country - these films convey some of the harsh messages that emanate from what, to so many of us who live here, is a very beautiful country, with an extraordinary people.

Sex as entitlement, sex as power?

“A man…stabbed his wife in the neck because she would not have sex with him and then proceeded to have sex with the bloodied woman…”

In a previous blog post earlier this month (see below, The Politics of Violence Against Women: A South African Perspective, posted Thursday 2nd February), I wrote about how the daily experience of inequality by women and the violence perpetrated against women by men continue unabated in South Africa. “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).

As if drawing a line under the issues highlighted in that post, an article in one of our local papers today offers an all-too real and tragic example of the cultural belief that sex is a man’s right and a woman’s obligation – and of the violent consequences of women’s refusal to submit: “…the couple had quarreled that evening because the accused wanted to have sex and his wife did not. The two eventually went to bed and the argument continued. The husband then went to the kitchen, fetched a knife and stabbed his wife.”

Abortion and US Supreme Court again

The US Supreme Court Supreme Court agreed yesterday to decide whether a 2003 federal ban on the procedure that critics call "partial birth" abortion is constitutional, setting the stage for its most significant ruling on abortion rights in almost 15 years. The issue: whether the constitutional right to have an abortion means that any law regulating this procedure must contain an exception to protect a woman's health.

In 2000, in the case of Stenberg vs Carhart, the Supremes struck down a Nebraska ban on this procedure, in a 5 to 4 ruling that it was so vaguely written that it could also criminalize other procedures, and that it lacked an exception for the woman's health.

The federal Partial-Birth Abortion Ban Act of 2003 banned the procedure except when necessary to save the life of the woman, deliberately omitting an exception to protect the woman's health. The law formally declared that such an abortion could never be necessary to preserve health.

Food for thought: Is this 2003 Act by Congress an attempt to practice medicine like they did in the Terri Schiavo case?

Promote stem cell research ... donate your baby's umbilical cord

For those who object to the use of leftover IVF embryos and therapeutic cloning for embryonic stem cell research, there is another alternative: Donate your soon-to-be born baby's umbilical cord for public storage so that it can be used for research or to treat or save the life of an unrelated person.

The Institute of Medicine of the National Academy of Sciences issued a report last year calling for the establishment of a National Cord Blood Stem Cell Bank Program; what the National Marrow Donor Program is doing is the first step.

[thanks, Karama Neal!]

Ethical Concerns Halts Death Penalty Execution

Prison officials in California postponed indefinitely the execution of a condemned killer, saying they could not comply with a judge’s order that a medical professional administer the lethal injection.

The ethical showdown came to a head when two anesthesiologists refused to participate in the execution after learning they would be expected to tell prison officials whether or not the prisoner needed more sedation or possibly even give him more medication, thereby allowing the execution to proceed. Prison officials couldn't find a doctor, nurse, or other person licensed to inject medications to give a fatal dose of barbiturate.

The AMA and many other medical groups have long opposed doctors having any role in executions, including monitoring a prisoner’s vital signs or giving technical advice.

Women on Board(s)

Chris MacDonald, author of partner blog, Business Ethics, has commented on and pointed out some interesting studies on women and corporate boards.

WBP Announces East Coast Advisory Board

SEATTLE – The Women’s Bioethics Project (WBP) today announced that it has established an East Coast Advisory Board, which has attracted some of the most prestigious and respected leaders in the fields of bioethics, medicine and reproductive rights. The advisory board will provide guidance and strategic direction to the WBP as it continues in its mission to serve as a bridge between scholarship and policy-making, ensuring that women’s voices, health concerns and unique life experiences are brought to bear on ethical issues related to health care and biotechnology.

The members of the newly formed WBP East Coast Advisory Board include:

R. Alta Charo, J.D., visiting professor of law, University of California, Berkeley; Knowles Professor of Law & Bioethics, University of Wisconsin Law and Medical Schools

Nancy Chilton, public relations consultant; Council of Advocates, Planned Parenthood of New York City

Katie Danziger, chair, board development, Planned Parenthood of New York City

Robin N. Fiore, Ph.D., Adelaide R. Snyder Professor of Ethics, Florida Atlantic University

Maureen Jerome, corporate manager, art historian; principal ARTLIFEdesign. LLC

Frances Kissling, president, Catholics for a Free Choice

Hilde Lindemann Nelson, Ph.D., associate professor of philosophy,

Michigan State University

Linda MacDonald Glenn, J.D., LLM, associate adjunct professor, University of Vermont, lawyer, and consultant

Mary Mahowald, Ph.D., professor emerita, Department of Obstetrics and Gynecology, University of Chicago; MacLean Center for Clinical Medical Ethics

Jonathan Moreno, Ph.D., senior fellow, Center for American Progress; Emily Davie and Joseph S. Kornfeld Professor of Biomedical Ethics; director, Center for Biomedical Ethics, University of Virginia

Laura Philips, Ph.D., MBA, chief operating officer, NexGenix

Pharmaceuticals

Rosemarie Tong, Ph.D., distinguished professor of Health Care Ethics in the Department of Philosophy; director, Center for Professional and Applied Ethics, University of North Carolina, Charlotte.

Leslie R. Wolfe, Ph.D., president, Center for Women Policy Studies

“The addition of so many recognized and thoughtful individuals to our East Coast Advisory Board will significantly strengthen our position as an authentic and important voice within current and emerging bioethics debates,” said Kathryn M. Hinsch, founder of the WBP. “We are so pleased that they have agreed to join us in our efforts. The newly established East Coast board will work closely with our West Coast advisory board, which was established in 2004 and has guided the organization from its inception.”

Denmark in the News for Something Else

Denmark is the only country in the world with an established National ART reporting system that counts all ART treatments, including in vitro techniques and intrauterine inseminations. Recently a “Summary The European Society for Human Reproduction and Embryology (ESHRE)” has been published. This report contains data on Assisted Reproduction in Europe since 1997. In Denmark in 2002, a total of 20, 837 treatment cycles were performed. The result was that 6.2% of all infants were born after assisted reproduction.

More on Marriage and Financial (Dis)Incentives...

And in a similar vein to our previous post, Slate has an interesting article that provides an argument that polygamy can benefit women economically. (Although Tim Harford kinda misses the whole demeaning aspect of the men-buy-women-sell dowry thing).

Still, Harford does rightfully point out: "When men are taken out of the marriage market by war or by prison, women suffer. The reverse is probably true, too: When women are taken from the marriage market, men suffer. In China, the policy of one-child families coupled with selective abortion of girls has produced "surplus" males. Such men are called "bare branches," and China could have 30 million of them by 2020. Perhaps polyandry—women with multiple husbands—would be the logical response to the situation in China."

[thanks again, Sean Philpott!]

The Show-Me-The-Money Approach to Prostitution and Marriage

Wife or whore? It's as simple as that according to an economic analysis in Forbes online. : Two well-respected economists created a minor stir in academic circles a few years back when they published "A Theory of Prostitution" in the Journal of Political Economy. The paper was remarkable not only for being accepted by a major journal but also because it considered wives and whores as economic "goods" that can be substituted for each other. Men buy, women sell.

To be fair, economists Edlund and Korn admit that spouses and streetwalkers aren't exactly alike: a key differentiator in Edlund and Korn's model is reproductive sex. Wives can offer it, whores can not.

Just gives you sort of a warm, fuzzy feeling, doesn't it? Reminds me of J. G. Raymond's essay on women as reproductive conduits and incidental incubators.

[thanks Sean Philpott for bringing this article to our attention]

Gazzaniga on Cloning

Michael Gazzaniga, author of The Ethical Brain, and member of the President's Commission on Bioethics, make an argument for the therapeutic cloning in the NY Times today, saying that "The president's view is consistent with the reductive idea that there is an equivalence between a bunch of molecules in a lab and a beautifully nurtured and loved human who has been shaped by a lifetime of experiences and discovery. His view is a form of the 'DNA is destiny' story."

Pregnancy Discrimination in the Workplace

From Women's ENews, an outrageous example of discrimination against pregnant women in the workplace: A female employee was told that her pregnancy was costing her company too much money and that it would pay for her to have an abortion. It's an extreme example, but advocates say the workplace is still tough on pregnant women.

Human (Un)Kindness

While trying to decide on my blog topic for this week, I came across this book review. Contact Wounds by Jonathan Kaplan is featured as the Read of the Week in this week’s Mail & Guardian. As someone who is unable to resist books or reviews thereof of any kind, I followed the temptation on this one, and am glad I did. Kaplan is a war surgeon who grew up in apartheid South Africa. According to the reviews, the book follows Kaplan’s journey from his early youth in a more subtle context of war – that of apartheid South Africa’s “burning injustices”, “police searches of non-whites, states of emergency, and gunshots in the night” – to war-ravaged Angola and Iraq. As one reviewer notes, “Jonathan Kaplan is a soldier in his own private war. Expatriate by choice from his home in South Africa, he wanders the world looking for other people’s wounds to stitch.”

My interest in this book stems from a close connection to my country’s history, the inhumane cruelty of people against people during apartheid, and my attempts to piece together the reality of those years from whatever sources I can. Kaplan’s distancing from the land of his birth, and “his inability to feel comfortable with the routine of everyday life, an urge to generate meaning and excitement by plunging into worthy causes, and the feeling that life is at its most elemental surrounded by death,” led him to places where human cruelty was even more acute. In his literary review of the book, John Sweeney writes, “Kaplan’s stories about the horror of Angola are so vivid that I found a couple of them hard to stomach. The narratives move to Iraq, and the chaotic mess created by an American superpower which is profoundly ignorant of the matters abroad…with an eyewitness account of how such a good cause as the removal of Saddam’s tyranny could have been so horribly bungled.”

“The terrorist outrages in New York, Madrid and London have changed the stature of Kaplan’s own trade: he now teaches doctors in the big Western capitals about triage, and how to flick through multiple cases, sorting out who may live and who is going to die.” And yet there seems to be, inevitably, a narrative of goodness that emerges from the horror and the cruelty. In an interview with Kaplan, Paul Comstock asks him why his deep cynicism for governments does not extend to individuals, and what inspiring acts of humanity he has witnessed. Kaplan replies that he has been “struck by how people in the worst circumstances transcend human limitations and show a generosity of spirit more selfless than any god...(people) trying to save the children of people they have never met…digging graves for the bodies of unknown dead in order that they should be treated with appropriate respect…”

“This is a book for realists, graveyard comedians and armchair saw-bones. Maybe it will inspire someone to get out of their chair and follow in Kaplan’s intrepid and erratic footsteps.” I, for one, have already ordered my copy. And I have no doubt that reading it – and books like it – will continue to move me to look deeper into the lives of people whose experiences have been vastly, violently different to mine, and to treat every person who walks across my path with humanity and compassion.

Moral Police Burn Valentine's Day Cards in India

Summary:
Moral Police Burn Valentine's Day Cards in India

St. Valentine’s Day caused outrage in India for Hindu and Muslim radical groups who burned greeting cards as a symbol of resistance of this western tradition. The rise of the celebration of Valentine’s Day is fairly new to secular India. It has given small business owners the chance to make profit off teddy bears and cards; however this has led to violent behavior by certain groups. In Kashmir a group of Muslim women protested that Valentine’s Day corrupts their children and similarly in Bangalore 50 Hindu activists burned cards near a local university.

Read more

Death with Dignity or Duty to Die? The Devil is in the Public Policy Details.

Guest blog by Kathryn Hinsch:

A headline story in the Seattle Times featured former Washington State Governor Booth Gardner and his desire to die in the same manner as he had lived his life; as a powerful man in control of his life. To that end, Governor Gardner is serving as the figurehead for an effort to legalize “physician assisted death” in Washington State. I urge all of us, as we debate the merits of this legislation, to examine these issues from every angle. Otherwise, like the politicizing and polarization of the embryonic stem cell debate, this important bioethical issue will be reduced to sound bites.

Most people fear death and decline, and this explosive topic touches some of our most deeply held beliefs. Much of the “assisted death” debate gets reduced to two questions: “Do people have a right to commit suicide?” and “Should we allow physicians to assist in hastening death?” But before we tangle with those tough public policy questions, it is important to ask “how might people’s different life circumstances impact the issue?”

Looking at these questions from a gender perspective will be imperative as we move forward in crafting new laws. There are some key facts that make a woman’s end-of-life decision quite different from a man’s—women on average live longer than men. Additionally, women are more likely to be impoverished, receive inferior health care, experience poorer pain relief, and are two times as likely to suffer from depression as men. Women, who have often lost their life partner by the time they face debilitating disease, may feel a stronger cultural pressure not to be a burden on their families. All these factors must be considered when crafting a policy to allow “physician assisted death.”

Looking at gender implications is just one step in a thorough public policy analysis of this issue. We also must look at the implications of physician assisted death for disabled, poor, and minority populations. From some groups, the fear that death with dignity could quickly lead to duty to die is not an unfounded fear and something we must be vigilant to prevent.

The point of this exercise is to highlight the fact that before we enact a law that would allow Governor Gardner to control the time and manner of his death, we must consider the implications of such a law on people who don’t share his life circumstances and may not have access to the same level of care.

Kathryn Hinsch is founder of the Women's Bioethics Project, a non-partisan, non-profit public policy think tank based in Seattle.

Droids, Destruction, and Dweebs

Sounds like the stuff of sci-fi, but Dr. Daniel H. Wilson says that "If popular culture has taught us anything, it is that someday mankind must face and destroy the growing robot menace." In his book " How to Survive a Robot Uprising," Dr. Wilson offers detailed — and hilariously deadpan — advice on evading hostile swarms of robot insects (don't try to fight — "loss of an individual robot is inconsequential to the swarm"); outsmarting your "smart" house (be suspicious if the house suggests you test the microwave by putting your head in it); escaping unmanned ground vehicles (drive in circles — they'll have a harder time tracking you); and surviving hand-to-hand combat with a humanoid (smear yourself with mud to disguise your distinctive human thermal signature and go for the "eyes" — its cameras).

He's now waiting to hear if Hollywood wants to make a movie out of his book.

More on the Anti-Abortion, Pro-Contraception Crowd...

E.J. Dionne of the Washington Post speaks about finding the middle path in an article entitled, "Bridging the Divide on Abortion", confirming what we've noted in this blog before: there is a large ambivalent middle ground of public opinion that is uneasy with abortion itself and also uneasy with a government ban on the procedure. The middle path? New York's Thomas Suozzi announced nearly $1 million in county government grants to groups ranging from Planned Parenthood to Catholic Charities for an array of programs -- adoption and housing, sex education, and abstinence promotion -- to reduce unwanted pregnancies and to help pregnant women who want to bring their children into the world. Calling his initiative "Common Sense for the Common Good", he was joined at his news conference by people at both ends of the abortion debate.

Sex-ed Should be Based on Science - Not Hypocrisy

SUMMARY OF:
Abstinence-only sex-ed defies common sense
Education policy spreads ignorance, sends confusing message to teens
COMMENTARY
By Arthur Caplan, Ph.D.

In the above article, Arthur Caplan criticizes the “hypocritical” focus of the majority of Americans on the obviously unsuccessful abstinence-only sex education programs. Recent surveys show that 70 percent of U.S. teens have engaged in oral sex by the time they reach 18, and more than 45 percent have had intercourse at least once – not to mention the number of rape cases. More than 70 percent of young women and 80 percent of young men approve of premarital sex, according to a study published recently in the Review of General Psychology.

Everyone agrees that sex education is necessary at the junior high and high school level, but the specific guidelines as to the content of sex education vary by state. In South Carolina, state law severely restricts discussion about contraception, abortion, and homosexuality. The current government, firmly in the abstinence-only camp, is wasting billions of taxpayers’ dollars on abstinence-only sex education programs. The rising spread of STDs (sexually transmitted diseases) among teens reported by the CDC proves, in part, the failure of such programs. Dr. Caplan claims that many parents who preach abstinence-only-until-marriage while their children are in high school, and promptly change their tune when the same kids begin college, themselves had premarital sex with their prospective spouses. Dr. Caplan concludes that science and common sense should be the basis of sex education rather than hypocrisy and wishful thinking.

Read more

Promoting Science and Technology in the Interest of Humanity

The above is the motto of the Student Pugwash USA, the student affiliate of the Nobel Peace Prize Winning Pugwash Conferences on Science and World Affairs. Student Pugwash USA is hosting a series of conferences to help educate science and ethics and in order to make socially responsible sciences the focus of their academic and professional endeavors. The first conference will be in the Midwest region March 31st and April 1st at Purdue University, the focus of which will be the integrity of science and engineering. The keynote speaker will Dr. Arden Bement, Director of the National Science Foundation and leading one of the workshops will Brian Rappert, a British ressearch who will be leading a number of workshops in the US and at home on bioweapons and codes of conduct for biologists.

And since science is in need of more women in the field, we look forward to hearing more!

iPledge . . . not to have sex (or, if I do, to use 2 forms of birth control)

This article in yesterday's NYT describes the measures required of women who wish to take Accutane, a powerful anti-acne medication. The medication can cause severe birth defects, so the FDA and the drug's manufacturers have agreed on mandatory prescribing rules. To have their prescriptions filled, women must either (a) promise--in writing--not to have sex with a man (or men), or (b) use two forms of contraception, one of which must be deemed "highly effective," such as Depo-Provera injections. They must also document this on a website, iPledge. Others who are prescribed the drug but who cannot become pregnant (including men) are also required to register.

National (US) Children's Study "Defunded"

The National Children’s Study was set up to examine the effects of environmental influences on the health and development of more than 100,000 children across the United States, following them from before birth until age 21. The study is lead by Edward B. Clark, Medical Director at Primary Children's Medical Center and Chair of Pediatrics at the University of Utah. It would have been the largest longitudinal study of children in US history. It was to follow a representative sample of children from early life through adulthood, seeking information to prevent and treat such health problems as autism, birth defects, diabetes, heart disease, and obesity. It promised be one of the richest information resources available for answering questions related to children’s health and development. But President Bush’s FY2007 budget contains no funding for the study. The Office of Management and Budget this week announced that "The National Children's Study planning activities that are ongoing in FY2006 will be brought to a close by the end of the fiscal year. There are no plans for the NIH to continue the full-scale study in FY2007." Louise Collins reports Dr. Clark saying that “the expected cost — about $70 million this coming year to get going and another $150 million a year to carry it out, seems like a small amount compared to the billions that are spent each year on children's health problems. I really think a country that fails to invest in its children is morally bankrupt.” According to Clarke, who has just started to hire staff, he has not been told to stop working and he plans to lobby Congress for support of this project.

The study would have searched for environmental influences on human health, and their relationship to genetic constitution, and researchers planed to examine such factors as the food children eat, the air they breathe, their schools and neighborhoods, their frequency of visits to a health care provider, and even the composition of the house dust in their homes.

Kudos to the CBC...

Kudos to Jennifer Lahl, Director of the Center for Bioethics and Culture, who attended the initial launch of WBP in Seattle in 2004: One of Jennifer's goals has been to bring together pro-choice and pro-life feminists and work towards finding common ground -- a topic that has been discussed on this blog before. Jennifer interviews M.L. Tina Stevens, Ph.D., author of Bioethics in America and Diane Beeson, Ph.D., a medical sociologist and professor emerita in the Department of Sociology and Social Services at California State University, East Bay, and probes the potential building blocks for common projects, such universal health care, safety of women's health, exploitation of women and their eggs and other topics.

A New Face, A New Lease on Life... Hopefully

The tragic story of Isabelle Dinoire revealed a new level of medical intellect in France where she received the world’s first partial face transplant. Dinoire, who had her chin, mouth and nose chewed off by a dog while in an unconscious state, is now able to eat and show facial emotions, which she was unable to do prior to her transplant. Her accident left her incapable of opening her mouth more than a few millimeters; even after physical therapy she was unable to open it more than three-quarters of an inch. The transplant in Dinoire’s own words has given her a “second life”. The doctor handling her case, Dr. Jean-Michel Dubernard, believes there is a possible risk of Dinoire’s body rejecting the transplant, however additional medication is helping her. Dr. Dubernard has requested the allowance of five more operations similar to this one by the French health authorities.

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Ethics of Omission: AIDS, AZT and the Power of Denial

Just say yes, Mr President: Mbeki and AIDS, is a new book in the publication pipeline, authored by South Africa’s most prominent AIDS dissident, Adv Anthony Brink. Brink’s denialist claims about the HIV/AIDS pandemic have moved from arguments that HIV does not cause AIDS, to the widely publicized conviction that scientifically proven treatments for HIV/AIDS, specifically AZT, are ineffective and severely toxic. He is the founder of the Treatment Information Group (TIG), the engine of AIDS dissent in South Africa. It was Brink’s first manuscript, Debating AZT: Mbeki and the AIDS drug controversy, that caught Thabo Mbeki’s attention shortly after he became president, marking the beginning of an ongoing and controversial association between government and the cohort of AIDS dissidents.

After years of ambiguity, and vocal action by the Treatment Action Campaign (TAC), the government announced its provision plan for the nationwide roll out of ARVs in 2003. Hardly silenced by this decision, Brink teamed up with Dr Matthias Rath, who claims that the vitamins he produces, Vitacor, are a cure for AIDS. This, despite reports that his products, while claiming to have medicinal qualities, have not been approved by the necessary clinical trials; certain countries do not permit the sale of his products; and Rath’s insistence that his vitamins can be substituted for ARV drugs has already proved fatal for some willing volunteers. And our government continues to fuel the controversy by refusing to publicly distance itself from the AIDS dissenters. Rath is “undermining the government’s ARV programme and confusing people in a cynical bid to sell his products,” but our Health Minister, Dr Manto Tshabalala-Msimang, seems to be encouraging his efforts.

It is hard to quantify the likely costs of the government’s silences and delays with respect to the controversy enshrouding HIV/AIDS and the drugs produced to treat it. Some claim that the President still seems reluctant to speak about the ARV programme, “perhaps because he still supports the dissidents, or because it is difficult for him to admit he was wrong.” Indeed, the issue of HIV/AIDS was given negligible air time in the President’s State of the Nation address last week. Which begs the question: how intentional – and ethical – is omission?