Women's Health Care Unsatisfactory Nationwide, National Women's Law Center Report Card Says

Women's health care in the U.S. is unsatisfactory overall, according to a report card on the state of women's health released Wednesday by the National Women's Law Center and the Oregon Health and Science University, CQ HealthBeat reports.

The report card, titled "Making the Grade on Women's Health: A National and State-by-State Report Card," measured women's health in all 50 states and Washington, D.C., by using 27 health benchmarks designated by HHS' Healthy People 2010 campaign. According to the report, the U.S. overall fails to meet 12 of the 27 benchmarks, up from nine in 2004 (Bartolf, CQ HealthBeat, 10/17). Only three of the 27 benchmarks -- women receiving regular dental care, women ages 40 and older receiving mammograms and women ages 50 and older receiving colorectal cancer screening -- were met, Michelle Berlin, an associate professor at OHSU, said.

None of the states received a "satisfactory" grade in women's health. Three states -- Massachusetts, Minnesota and Vermont -- received a grade of "satisfactory minus," a decrease from 2004, when eight states were considered "satisfactory minus." Eleven states and the district received failing grades in women's health status, compared with six states in 2004. The 11 states are: Alabama; Arkansas; Indiana; Kentucky; Louisiana; Mississippi, which ranked last; Oklahoma; South Carolina; Tennessee; Texas; and West Virginia. The remaining states received "unsatisfactory" grades, Reuters reports (Steenhuysen, Reuters, 10/17).

Benchmark Disparities
The report found that several benchmarks -- including the percentage of women receiving prenatal care, infant mortality and the percentage of uninsured women -- varied significantly by race. American Indians and Alaska Native women were twice as likely as white women to be uninsured, the report found. Among white women, 16.9% were uninsured, compared with 22.7% of black women and 37.8% of Hispanic women, according to the report. The percentage of uninsured women increased by 1.7% since 2004, according to the report (CQ HealthBeat, 10/17). Minnesota had the lowest percentage of uninsured with 9.1%, and Texas had the highest percentage at 28.1%, the report said (Reuters, 10/17).

The report found 85.7% of white women received prenatal care, compared with 70.8% of American Indians, 75.9% of blacks and 77.5% of Hispanics. According to the report, the percentage of women nationwide who received prenatal care increased by 5% since 2004 but is still unsatisfactory. The report found that white women have an infant mortality rate of 5.7 deaths for every 1,000 live births, compared with 13.5 deaths per 1,000 live births for blacks and 5.6 per 1,000 live births for Hispanics. The overall infant mortality rate has remained the same since 2004.

The percentage of obese women increased in all states and the district (CQ HealthBeat, 10/17). Hawaii had the lowest percentage of obese women at 16.7%, and Mississippi had the highest percentage at 31.5%. The percentage of women ages 40 and older who received mammograms improved in all states (Reuters, 10/17).

The number of states with parental notification policies for minors seeking abortion decreased, as did the number of states that have mandatory waiting periods for abortions, the report found. The number of states that provide public funding for abortion for low-income women has remained constant since 2001, according to the report.

Comments
"The outlook for women's health is nowhere near approaching the nation's goals for 2010" set by the Healthy People campaign, Berlin said, adding, "Failing to meet these goals undermines not only the health and well-being of women, but the well-being of our country as well." Judy Waxman, vice president for health and reproductive rights for NWLC, said, "It's nothing to cheer when only a handful of states are meeting at least half of the policy goals" (CQ HealthBeat, 10/17).

Waxman called on states to implement policies to improve women's health (Reuters, 10/17). "It is evident that our health system needs mending," Waxman said, adding, "Lawmakers must take a comprehensive, long-term approach to meeting women's health needs" (CQ HealthBeat, 10/17).

The report is available online.

Reprinted with permission from kaisernetwork.org. You can view the Kaiser Daily Reports online, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/. The Kaiser Daily Reports are published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

More than Pens and Pizza

Reduced salaries, perceived diminished social status due to the entry of minorities, foreign trained doctors, and women into the field, lack of autonomy due to increased oversight by insurance companies and corporate health care cost containment initiatives. Who wouldn’t blame a physician from seeking a little extra compensation on the side whether a free lunch or vacation from a fawning pharmaceutical rep? Besides, when else are they going to have time to learn about drug X’s off-label uses?

I’m kidding, of course. It’s wrong and we should not permit gifts (large or small) to physicians by pharmaceutical companies and I support Stanford’s recent decision to ban such things. Yet, I find the simple solution of “let’s ban the pens and food along with the vacations and lucrative consulting fees” naïve and not recognizing the bigger problem of the weakening of physicians’ duty to keep their patient’s health primary.

The WJS recently did a series of articles on two disturbing trends. One described how more and more physicians have a financial interest in the laboratories they refer patients to for tests. The other is on the trend of primary care physicians offering services such as Botox and liposuction that have nothing to do with a patient’s health but everything to do with the physician’s bottom line.

These practices undermine patients' confidence in their doctors to have their best interests as a top priority. Now that is a moral dilemma bioethicists need to speak out against, not just pens and pizza.

Excerpts from the WSJ articles cited:

Medicare Moves to Cut 
'Self Referral' Practice
Proposed New Rules Target The Rise in Doctors Sending Patients to Centers They Own
By DAVID ARMSTRONG
WJS September 12, 2007; Page B1

In recent years, many physicians have become wealthy by investing in magnetic resonance imaging, or MRI, facilities, surgery centers and diagnostic sites -- and then sending their patients to them. A recent McKinsey & Co. study pegged doctors' profits from this practice, known as self-referral, at $8 billion a year. Critics say self-referral fuels the ordering of unnecessary exams or procedures as the doctors stand to profit from the increased business. Supporters say that doctors' investment in new facilities improves medical services, especially outside metropolitan areas, where patients might not otherwise be able to access the latest technologies.

Small Firms Are Taking
On Second Jobs: FranchisesAdd-On Business Fills
Gap During Slow TimesAnd Expands Clientele
By RAYMUND FLANDEZ
WJS October 16, 2007; Page B5

Brian Fox wanted to give his general-practice clinic, Fox Medical Center, a face lift by providing additional services to patients. So he added a scaled-down version of a Dermacare Laser & Skin Care Clinics franchise. Patients can make regular medical appointments as well as schedule treatments like Botox, laser hair removal and skin resurfacing. He says the franchise brings in about $35,000 to $60,000 per month, on average doubling his monthly intake. There's little new overhead or inconvenience since Dr. Fox and his staff use the same exam rooms for laser and injectable services and medical examinations."The benefit that I've been able to develop out of this is not just from the financial end," Dr. Fox says. He says he finds the Dermacare procedures fun and a break from attending to sick patients or dealing with insurance companies.

Legal Rights for Embryos?

Attorney and reproductive rights expert Jessica Arons has written a compelling analysis of a bizarre piece of legislation granting individual rights to embryos. According to Arons, "The state of Louisiana has assigned to human embryos a legal identity with rights that can be litigated in court—regardless of whether the embryo is in a Petri dish in a lab or in a womb, so long as rights have attach[ed] to an unborn child. The statutes go on to provide the fertilized ovum with an entitlement to sue or be sued. The implication of this provision is that an embryo should be thought of as a child. But embryos and children are patently not the same and the law should not treat them as such." The article is published in the Center for American Progress’ exciting new science policy journal called Science Progress. You can read the complete article here.

Whose Organs are They Anyway...?

The shortage of available and viable organs for transplant both in the U.S., and across the globe, is at a critical mass stage.

We're all aware of the efforts enacted by various states across this country, designed to encourage consistent organ donation on a voluntary basis. In these instances, potential donors have to consent to having their organs harvested. However, the medical community in the United Kingdom is seeking to change that, by moving to an "opt-out" system.

Under the new system doctors would assume that everyone wants to be a donor after death, unless a request has been made ahead of time, either in writing or by notifying relatives, requesting to opt-out.

What do you think? Whose organs are they anyway?

http://tinyurl.com/3bheem

Deinstitutionalisation, Institution, Psychiatric

Last night, at about 0-dark-30 hours, on a PBS station, I observed a show documenting the life of a mentally retarded 18 to 19 year old. Apparently, the mother knew somewhere in the middle of her pregnancy that her son in the womb was in all likelihood have extreme deficiencies. Rather than undergoing an abortive procedure, she kept the child, to term. With her husband, she raised this child to about 14 years or so. (To be clear, there seems to be a problem with this child in terms of perception of the signals from his sense organs. In other words, as an example, Wernicke's and Broca's do not function; however, the sensory pathways from skin and sight are firing, with the exception that they do not then communicate to the integrative areas. The boy cannot feed himself, speak, or really do anything productive.) At this point, caretakers were recruited to spend all their waking hours tending to this child, feeding, wiping, and cleaning up after. Gradually, the parents came to a consensus with the caretakers, wherein they would take the child and move him to a separate house to live permanently with the caretakers. The parents responded as if a mountain had been lifted from their shoulders.

Before the mid 1960's, most likely the child would have been brought to a psychiatric hospital. After the 60's, however, there was a movement to deinstitutionalise the hospitals. Most likely it was related to the advent of the phenothiazine class of antipsychotic drugs (e.g. thorazine). It is almost as if once they transitioned, they never looked back at the benefit of what the hospitals had to offer. As an example, Pennsylvania Hospital here in Philadelphia had a psychiatric hospital up on 48th and Haverford. What was interesting is that it was technologically interesting -- each patient room had huge windows, an individualized heating and cooling vent, and most importantly, there was custom treatment for individuals of all tiers of mental deficiency. This means that individuals who suffered from Down syndrome would have all the medical staff and psychiatric staff as necessary.

I'm not suggesting that progress has not been made in treating some individuals - in fact, we have come far with the atypical antipsychotics. However, not everybody is deserving of medication. Realistically, the boy being discussed will never be able to receive medication to palliate his symptoms. Rather, the fundamental wiring is incomplete. Would it be a bad idea to have a trained staff of professionals interacting with this child in a Hospital setting? Barring any corruption (which happened in a few hospitals (e.g. molestation of patients)) I think he may be able to benefit. Look at the situation he is in now, wherein he is removed from his home and has "caretakers". Would it not be more prudent to have trained professionals to deal with the child instead?

Additional Information:
http://www.pbs.org/wnet/brain/
http://en.wikipedia.org/wiki/Wernicke%27s_area
http://en.wikipedia.org/wiki/Broca%27s_area

Abortions Decline With Access to Contraception

[Cross-posted from the American Journal of Bioethics blog...]

In what my friend Mickey would call "whattya know, water is wet" news, a new study released in The Lancet's current issue, which focuses on the health of women and mothers worldwide, shows that abortion rates have declined worldwide. According to the Guttmacher Institute, one of the authors of the report, abortion rates fell most significantly in Eastern Europe, "a trend that corresponds with substantially increased contraceptive use in the region." Also of note is that the abortion rate fell the most in the regions where abortions are safe and broadly legal.

When thinking of maternal health, especially in developing countries, abortions must be taken into account. Dr. Paul F.A. Van Look, the director of WHO’s Department of Reproductive Health and Research, says that "nearly half of all induced abortions are unsafe, putting the lives and health of women at major risk. Each year, about 70,000 women die due to unsafe abortion and an additional five million suffer permanent or temporary disability."

Echoing Dr. Sharon Camp, we know that the best way to reduce abortion is to reduce unwanted pregnancies, which is easiest done by the simple method of increasing access to contraception. And the only way to improve the health of women who do have abortions is to make them safe, and provided by a skilled professional.

-Kelly Hills

Is that a pistol, or are you just happy to be seen?

A new airport scanner provokes controversy due to explicit viewing of passengers.

CNN Article.
AP Article (via Google).

I have concerns about this technology, just as privacy and civil liberties advocates do; also the irony of making such explicit imagery a routine part of security measures calls into question many conventions in our society on modesty, nudity, and privacy, especially when women are being banned from airplanes for dressing "indecently" and a little cleavage on a politician provokes outcry. While I do not believe that women are delicate flowers who need to be protected, I have to wonder if this technology was developed and advocated by heterosexual men who have never known what it is like to be leered at, harassed, or surreptitiously photographed from compromising angles. I recommend we send those officials through the scanner and tell them that their scans were being carefully scrutinized by Larry Craig or Mark Foley. Then let us see if they are as excited about this breakthrough.

Returning to Ashley

There are two stories of note that follow on the Ashley growth attenuation surgery case.

The lead physician, Dr. Daniel Gunther, died of carbon monoxide poisoning on Sept. 30. It was recently ruled a suicide.

More chilling, a family in Britain is considering removing their disabled daughter's uterus to "spare her the pain, discomfort and indignity of menstruation."

I agree with the findings of the ethics committee reviewing Ashley's case that it was unethical on many levels. And I am disturbed that this type of procedure is being considered again. While I do not believe that hypothetical reproductive viability ought to outweigh one's health, the drastic measures taken (removal of organs) for ease-of-care purposes was an example of poor judgment and skewed priorities.

DNA Testing Without Consent

An article by Chicago-Kent's Law Professor and Novelist, Lori Andrews, in this week’s Parade magazine discusses the science and ethics of DNA testing on historic or popular figures. Scientists have already performed DNA testing on a number of famous deceased persons, such as Albert Einstein (potential genetic predisposition to aneurysm), Beethoven (possible lead poisoning), Francesco Medici (arsenic, rather than malaria, was the likely cause of death), and Thomas Jefferson (paternity of a child of one of his slaves).

Proposed new testing includes Abraham Lincoln’s blood, looking for Marfan syndrome, and the body of what is allegedly Billy the Kid. There is also a cottage industry of selling celebrity locks of hair and other artifacts (gum chewed by Arnold Schwarzenegger, a pumice stone used by Britney Spears). The collection of locks of hair has long been a tradition among some collectors, but the other artifacts have been disallowed by Ebay, as part of their ban on the trade of body parts.

Regarding still-living celebrities and popular figures, it seems to me to be a direct invasion of privacy to test discarded items for DNA, as these could show genetic mutations that could affect insurance or the celebrity’s standing, or they could demonstrate illicit drug use. This one seems like an easy call to make for most reasonable human beings, especially if they consider being in that position themselves .

However, regarding long-dead historical figures, should there be a statute of limitations, after which it’s okay to perform genetic testing? Should it only be in cases where there is a legitimate scientific inquiry? But what constitutes ‘legitimate’? And what if descendants are unhappy with the perceived invasion of privacy? Can you invade the privacy of someone long dead? And what about grave-robbing and testing of mummies and other remnants of long-dead cultures? Is it okay if no one complains and not okay if descendants are uncomfortable with the perceived desecration of the remains? When does scientific inquiry and curiosity trump individual or cultural concerns, and does the passage of time shift this continuum?

Some Summaries from NY Times

The New York Times on Tuesday in its health section published several articles related to women's health:

• "Heart Health: Panic Attacks Seen as Risk in Postmenopausal Women": Women ages 51 to 83 who have panic attacks are four times more likely to have coronary heart disease than postmenopausal women who do not have such attacks, according to a GlaxoSmithKline-funded study of 3,300 women enrolled in the Women's Health Initiative and published in the October issue of the Archives of General Psychiatry, the Times reports. The study found that compared with women who did not have panic attacks, women who had such attacks had a 75% higher mortality rate and were more likely to smoke and have high blood pressure, diabetes, a history of cardiovascular conditions and symptoms of depression (Bakalar, New York Times, 10/9).
  
  
• "In the Battle Against Cancer, Researchers Find Hope in a Toxic Wasteland": Two compounds discovered in a hole filled with toxic waste in Butte, Mont., by Don Stierle, a professor at Montana Tech of the University of Montana, and Andrea Stierle, a chemistry researcher at MTUM, have shown initial success in killing NIH-developed breast and cervical cancer cell lines, according to two papers recently published in peer-reviewed organic chemistry journals, the Times reports. Although Andrea Stierle said the research is at an early stage, she and Don Stierle have been negotiating with a pharmaceutical company to possibly develop new cancer medications from the compounds (Maag, New York Times, 10/9).
  
  
• "Antidepressants Emerge as Coolant for Hot Flashes": An increasing number of women are taking antidepressants to treat hot flashes and other symptoms of menopause as more women and doctors are seeking alternatives to hormone replacement therapy, the Times reports. According the Times, studies are highlighting a "wide variation" of responses among women taking the drugs to treat hot flashes (Parker-Pope, New York Times, 10/9).

Reprinted with permission from kaisernetwork.org. You can view the Kaiser Daily Reports online, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/. The Kaiser Daily Reports are published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Kurdish Officials Seek To End 'Honor' Killings Related to Out-of-Wedlock Pregnancies, Sex Outside Marriage

A reminder of the status of women in third world countries from the Kaiser Daily Women's Health Policy Report:

Officials in the Kurdish region of Iraq are seeking to end so-called "honor" killings, the murder of a woman by a relative to protect the family's honor because she became pregnant while unmarried, or engaged in premarital or extramarital sex or other actions that could affect the family, the AP/Miami Herald reports. According to the AP/Herald, honor killings are an ancient tradition in the Kurdish areas of Iraq, Iran and Turkey, as well as in tribal areas of Pakistan and some Arab societies.

Kurdistan's Parliament in 2002 revoked Iraqi laws that dismissed charges or allowed leniency in cases involving honor killings. The British government earlier this year arranged for a delegation of Iraqi Kurds to meet with Pakistani officials to discuss their experiences in combating the practice. "Killing under the pretext of protecting honor is murder," Nechirvan Barzani, the region's prime minister, said in July.

Advocates against honor killings have welcomed the regional government's efforts to halt the custom by publicly condemning it and warning about harsh penalties for those who commit the act. Runak Faraj -- head of the Rewan Women's Center in Sulaimaniyah, one of Kurdistan's main cities -- said that the attitude toward honor killings could be changing in part because of an increased Western influence in the region. "Western culture is growing here and is in contradiction with the old tradition that honor is something sacred," she said. Some advocates added that more education about the custom, as well as law enforcement, is needed.

According to officials who attended the meeting with Pakistani officials, there are several hundred honor killings and related suicides annually in Iraqi Kurdistan, but reliable statistics are not available because of ineffective law enforcement and a lack of cooperation among tribal communities. The number of women who committed suicide by setting themselves on fire increased from 36 in 2005 to 133 in 2006, and the number of women murdered increased from four to 17 in the same time period, according to a report by Kurdistan's Human Rights Ministry. The report did not specifically mention honor killings (Torchia, AP/Miami Herald, 10/7).

Reprinted with permission from kaisernetwork.org. You can view the Kaiser Daily Reports online, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/. The Kaiser Daily Reports are published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Patient-Reported Outcomes vs Empirical Evidence in Clinical Trials

An article in The Scientist discusses the FDA’s decision to require patient-reported outcomes from some pharmaceutical companies during the drug development process. Over the last few years, the FDA has moved to require patient-reported outcomes such as results of validated patient questionnaires from more drug developers. In 2006, the FDA issued a 32-page draft guidance for designing questionnaires, capturing patient feedback, and analyzing data.

Patient-reported outcomes are measurements of responses during the clinical trial that cannot be obtained through other types of clinical testing or questioning, such as reduction of pain or fatigue and quality-of-life improvement. While the FDA director for the study of end points and label development states that a patient-reported outcome can be more reliable and less variable than a clinician’s assessment, others argue that the questionnaires are subjective and a perception of “pain” can vary widely from patient to patient. In addition, when questionnaires are completed on behalf of children or elderly patients, how can validity of the results be guaranteed? Who would monitor the investigator and ensure that he/she does not complete questionnaires on “behalf” of patients, thereby potentially skewing the results of the study?

The potential burden on the drug developers to add patient-reported outcomes if requested by the FDA may add a year or more to the drug development process. It is also an additional financial consideration, as development and validation of a questionnaire can cost $500,000 or more. On the other hand, there is a strong advantage to having validated data with positive patient outcomes in the drug’s product labeling. The drug developer has a valuable opportunity to use the patient-outcomes data for promotional purposes in promotional and educational materials and also in reimbursement negotiations with managed-care payers or government agencies.

Source: Silverman E. Whether drug companies like it or not, the FDA is pushing patient-reoprted outcomes in trials. So what are they good for? The Scientist. 2007;21:64. Available at: http://www.the-scientist.com/article/print/53617.

Medical Dramas- the New Reality TV?

We touched on this topic briefly during a class session, discussing the challenge involved in trying to provide accuracy as a knowledgeable professional, while dealing with television producers whose job it is to provide drama and excitement for the viewer. Often accuracy goes out the window. After 25 years of dealing with the same myself on the news side, I can relate personally.

This article, from Forbes.com, addresses the issue of how these programs frequently make mistakes in the information ultimately shared with viewers, despite their reliance on any number of experts and consultants there to provide accurate representations of diseases, and medical procedures. With a more sophisticated consumer/viewer, there's little concern that these shows are seen as nothing more than entertainment. However, a number of studies have published data that this perception may be far from reality.

It's no secret that many lay people get and rely more and more on information gleaned from popular media, and less from reliable sources. These studies, published in several scholarly journals, presented findings that showed viewer perceptions and beliefs about procedures such as cosmetic surgery, to organ donation, that were directly attributable to these programs.

So what do you think?
Is this unfolding trend the result of blatant disregard for the facts on the part of TV networks, who use creative license beyond its purpose--in other words taking entertainment too far--or are the studies over dramatizing the issue and "making something out of nothing"?

Owning Life -- Artificial and otherwise

J. Craig Venter believes he has a functioning artificial chromosome based of Mycoplasma genitalium, giving it a label of M. laboratorium. Yes, it is significantly more synthetic compared to other cultured and transgenic species, but that is not the problem. What is objectionable in the situation is the fact that Dr. Venter plans on patenting the organism that he has created. I can understand certain specific genes being protected - they are the result of labor and development - manhours. However, this organism is a much more than a sum of its parts. Indeed, it has a cluster of reproductive genes, genes for metabolism and others. What happens when that species conjugates with another bacterial species? Can Dr. Venter still say M. laboratorium is still "his"?


The same issue will be faced with truly artificial life in the form of a learning, electronic neural network. When that object becomes much more than what it was when it was created, and begins the process of sentience, can it be labeled as property? (See Star Trek:The Next Generation, Season 2, Episode 9 - "The Measure of a Man" for a fantastic depiction of this scenario)

The fact is, even in this minuscule scale, this confronts humanity with very fundamental questions, and will lay framework regarding our values. Some things, especially when it concerns life even in the smallest sense cannot be held for profit's sake. Granted, the patenting process allows credit and respect where due for certain processes or products made. It does not, however, allow a human being to claim ownership on an organism, no matter its scale.

Full article here.

What We've Been Reading This Week...

You may have noticed that our blog has slowed down a little bit, due to the demands of the new school year -- but that won't stop us from bringing the most interesting and timely bioethics news! Here are a few of the articles that have caught our attention in the last week:

3D Images You Can Touch
(Which leads to the question 'can virtual intimacy be far behind?')
The first time you gazed at a high-definition display, you may have thought to yourself, “Wow, that image looks so real; I feel like I could reach out and touch it!” What if, one day, there was a display that let you turn that perception into reality?
Researchers at NTT Comware in Japan have developed a prototype of just such a system, called the Tangible-3D display...the glove provides a tactile sensation that makes you feel like you’re touching solid objects. [Full article here.]

Pfizer faces $8.5 billion suit over Nigeria drug trial
(Reuters) Nigeria alleges Pfizer deceived patients and caused the death of 11 children in 1996 when it performed clinical trials for a new drug. With the northern state of Kano, it is suing the company for $8.5 billion. [Full article here]

Connecticut Catholic Bishops Agree To Comply With Law Requiring Hospitals To Dispense EC To Rape Survivors -- Connecticut's Roman Catholic bishops on Thursday said that the state's four Catholic hospitals will comply with a law (SB 1343) that takes effect Monday and requires all hospitals in the state to dispense emergency contraception to rape survivors, the Hartford Courant reports...[Full article here]

The Pill, For Men: Two kinds of oral contraceptives and a sperm blocker are being developed - With condoms and vasectomies, men take responsibility for a third of contraception in the United States. But health officials would like to see that figure grow. [Full article here]

Americans Seek Common Ground on Abortion
(MSNBC/Newsweek) Long a black-and-white issue, abortion is now seen more as an argument to be fostered, not settled -- Although plenty of people are passionate about abortion, few of them would spend 16 years and $7 million of their own money making a movie about it, especially one that tries not to take sides. [Full article here]

Judge had no right to ban homeless couple from procreating, New York appeals court rules - A family court judge overstepped her authority by ordering a drug-addicted homeless couple to have no more children, a state appeals court ruled Friday in overturning the ban. [Full story here]

Exoneration Using DNA Brings Change in Legal System
State lawmakers across the country are adopting broad changes to criminal justice procedures as a response to the exoneration of more than 200 convicts through the use of DNA evidence.
All but eight states now give inmates varying degrees of access to DNA evidence that might not have been available at the time of their convictions. Many states are also overhauling the way witnesses identify suspects, crime labs handle evidence and informants are used. [Full story here.]

Woman Suing IRS Over Sex-Change Tax Claims

(Washington Post) After years of painful soul searching, Rhiannon O'Donnabhain -- a former construction engineer from a devout Irish Catholic family in Boston -- decided to surgically change his sex to female in 2001. The struggle was equally tough financially -- hormone treatments and medical procedures set her back $25,000, a burden she felt could be partially offset by taking a $5,000 tax deduction for medical costs. [Full story here]

Has Artificial Beauty Become the New Feminism? [hat tip to James Hughes of IEET.org] This spring, Sideways star Virginia Madsen became a spokesperson for Allergan Inc., the maker of Botox." Quoted in People magazine, Madsen asserts that she's made "a lot of choices" to keep herself "youthful and strong": "I work out. I eat good foods. And I also get injectables." [Rest of the story here.]

The pill: new evidence shows it helps protect against cancer

The contraceptive pill actually protects women against cancer in later life, according to the largest study ever set up to evaluate the risks and benefits. [Full story here]

Stem cells make new heart valves

The scientists, at Harvard-affiliated Boston Children’s Hospital, grew the valves from a type of stem cell that normally gives rise to the inner lining of blood vessels. They used a biodegradable scaffold to give the cells shape and a mix of proteins and growth factors to stimulate the cells to grow into the proper tissue type. [Full story here]

Quote of the Day: "rats and mice get greater protection as research subjects in the United States than do humans"

“In many ways, rats and mice get greater protection as research subjects in the United States than do humans,” said Arthur L. Caplan, chairman of the department of medical ethics at the University of Pennsylvania. Dr. Caplan is quoted in the NY Times today, in response to a report due to be released Friday by the inspector general of the Department of Health and Human Services, Daniel R. Levinson. The report finds that Food and Drug Administration does very little to ensure the safety of the millions of people who participate in clinical trials.

Art points out that "Animal research centers have to register with the federal government, keep track of subject numbers, have unannounced spot inspections and address problems speedily or risk closing, none of which is true in human research."

"Because no one collects the data systematically, there is no way to tell how safe the nation’s clinical research is or ever has been."

To read the full article, click here.

[Editor's note: Art has written an MSNBC column about the report -- here's an excerpt:
"When a bridge collapses in an American city or a mine implodes, it does not take long before government gets in motion to figure out what to do about the problem. We see the carnage and demand action.

When a federal agency charged with protecting your health and safety is found grossly deficient, the response, sadly, is mainly talk.

When a bridge collapses in an American city or a mine implodes, it does not take long before government gets in motion to figure out what to do about the problem. We see the carnage and demand action.

When a federal agency charged with protecting your health and safety is found grossly deficient, the response, sadly, is mainly talk.

That is because it is hard to see where the victims are and, without them, it is hard to get the problem fixed. But when it comes to the Food and Drug Administration, we had better demand repairs.

A new report from the inspector general of the Department of Health and Human Services paints a very grim picture as to how well the FDA protects Americans who are subjects in human experimentation. The FDA is called on the carpet for not knowing how many experiments are actually being done in the United States. The report also faults the FDA for inadequate audits of research sites and a failure to ensure compliance with its orders when FDA inspectors find something amiss at a research site.

The problems discussed in the report are not new. They have been festering for years. Who is to blame?" The rest can be read here.

'Sexy' Issues in Health Care (or Let's Talk About Sex)

[Hat tip to R. Alta Charo for this] Slate is running their Sex and more sex issue, and prurient curiosity aside, there are very several interesting articles that might be of interest to bioethicists:

In the article Cancer Sluts, Meghan O'Rourke examines the proposition that a cervical-cancer vaccination would "promote promiscuity" among teenage girls.

In the article Naughty Nursing Homes, Daniel Egber examines the potential benefits of more sex for the elderly in nursing homes vs. the administrative nightmare of protecting a patient that isn't able to consent to sex at all, which could amount to a new elder version of 'gray rape'.

And from Juliet Lapidos (aka 'the Sexplainer'), an article asking Is Mad Cow an STD? , and explaining that the government seems to think it is, when it comes to FDA ban on sperm from all European countries with exposure to mad cow.

Happy reading~!

Testing Your Sanity

The NY Times is chockablock full of goodies this morning, including this little gem: A new web site helps you figure out just how mentally stable you are: www.sanityscore.com. Full article and explanation here.

Another Quote Worth Noting

“All I knew before was that you could get cancer from it,’’ she said. “I didn’t know you could get very ugly."-- talking about smoking, in a NY Times article about how Tyra Banks and America’s Next Top Model are going smoke-free.

Of Animal Eggs and Human Embryos

We've blogged several times about issues with the donation of eggs before, but this week the NY Times has an unusual editorial about a possibly 'elegant solution to the vexing egg donor problem.':

"Stem cell research in the United States has been hobbled for years by severe and misguided restrictions on federal funding. But now a vexing additional problem is slowing even privately financed research. There are distressingly few women willing to donate their eggs for experiments at the frontiers of this promising science..."

To read the rest, click here.

Was John Paul II Euthanized?

From Time magazine this week, an article that made raise my eyebrows:

"In a provocative article, an Italian medical professor argues that Pope John Paul II didn't just simply slip away as his weakness and illness overtook him in April 2005. Intensive care specialist Dr. Lina Pavanelli has concluded that the ailing Pope's April 2 death was caused by what the Catholic Church itself would consider euthanasia. She bases this conclusion on her medical expertise and her own observations of the ailing pontiff on television, as well as press reports and a subsequent book by John Paul's personal physician. The failure to insert a feeding tube into the patient until just a few days before he died accelerated John Paul's death, Pavanelli concludes. Moreover, Pavanelli says she believes that the Pope's doctors dutifully explained the situation to him, and thus she surmises that it was the pontiff himself who likely refused the feeding tube after he'd been twice rushed to the hospital in February and March. Catholics are enjoined to pursue all means to prolong life."

To read on, click here.

The Healing Power of Playfulness

We've blogged about laughter being the best medicine before and now, one of our readers brought this extraordinary and tender audio slide show about play, to our attention. The slide show and podcast were put together by Stuart Brown, MD, the director of the National Institute for Play. Dr. Brown and his board of advisors say that "pleasurable, purposeless activity prevents violence and promotes trust, empathy, and adaptability to life's complication." The Institute studies the cutting-edge science of human play, and draws on a rich universe of study of intelligent social animals.

It reminds of a novel I read not too long ago, by Dean Koontz, called One Door Away From Heaven. And although I think Dean Koontz has the wrong impression about 'bioethicists', he does get dogs right -- towards the end of the book, he talks about dogs and their connection to a "playful Presence." Here's the quote:

"Every world has dogs or their equivalent, creatures that thrive on companionship, creatures that are of a high order of intelligence although not of the highest, and that therefore are simple enough in their wants and needs to remain innocent. The combination of the innocence and their intelligence allows them to serve as a bridge between what is transient and what is eternal, between the finite and the infinite.

"...For those who despair that their lives are without meaning and without purpose, for those who dwell in a loneliness so terrible that it has withered their hearts, for those who hate because they have no recognition of the destiny they share with all humanity, for those who would squander their lives in self-pity and in self-destruction because they have lost the saving wisdom with which they were born, for all these and many more, hope waits in the dreams of a dog, where the sacred nature of life may be clearly experienced without the all but blinding filter of human need, desire, greed, envy, and endless fear. And here, in dream woods and fields, along the shores of dream seas, with a profound awareness of the playful Presence abiding in all things..."


So take a deep breath and think, when was the last time you played?

Discounts on IVF for Egg Donors in UK

Newcastle Fertility Centre is offering women in northeastern England a £1500 discount on their IVF bills if they donate some of their eggs for therapeutic cloning and stem-cell research purposes. A spokesperson for the Centre commented that this will reduce the cost of IVF for some women, and that the donation poses no risks beyond those that accompany the IVF procedure; critics call the scheme "lunacy" and worry that it will pressure less wealthy infertile women into research donation. Britain's Human Fertilization and Embryology Authority has approved the practice, and the BBC reports that the Centre is receiving Medical Research Council funding for its "egg-sharing" scheme. The BBC report appears here.

Vatican Says Vegetative patients have moral right to food, hydration

[Cross-posted from blog.bioethics.net]

The Vatican has released a ruling clarifying the Catholic position on food and hydration to patients in persistent vegetative states who are not expected to recover from their injuries.

The Vatican said that patients in a vegetative state, with few exceptions, have a moral right to artificial food and hydration. “In this way suffering and death by starvation and dehydration are prevented,” according to a statement released by the Vatican and approved by Pope Benedict XVI.

Nutrition and hydration support are not obligatory when such care becomes “excessively burdensome” or when patients cannot assimilate food and liquids “so that their provision becomes altogether useless,” the Vatican’s Congregation of the Doctrine of Faith wrote in a statement.

At the basis of the ruling is the moral belief that tube-feeding those near death is an "ordinary" state, and that the basic human dignity of the patient means that care should not stop.

The clarification becomes important because although Catholic doctrine does oppose euthanasia, it allows for the cessation of heroic, futile (extraordinary, and potentially painful) efforts. At question, then, has been whether or not tube-nourishment constitutes extraordinary or heroic efforts that are therefore optional under Catholic doctrine.

Ultimately, this affects more than "just" Catholics - many hospitals around the world are run by Catholic organizations who will feel bound by the ruling, and will enforce the decisions stemming from it regardless of whether or not the patient themself is Catholic.

-Kelly Hills

"Autonomous Killing Machines"

This post is in response to "Engineering Politics" by Christopher Csikszentmihalyi in the Sep/Oct 2007 issue of Good Magazine

http://www.goodmagazine.com/section/Provocations/engineering_politics

I liked this article because it is why I got involved with the IEET in the first place. I think the author's concerns are valid, I held similar ones myself, but his understanding of the effort to communicate to the general public comes up a bit short. (DARPA excluded from this, what they are doing, well, only those involved know). Christopher refers to the military’s drive to come up with "autonomous killing machines”, and while I don’t doubt that somewhat (always err on the side of caution), the military drives quite a bit of the emerging technologies that we have in our lives today. Hummer’s were not made for the suburbs or driving to the mall, they were made for combat, like Jeeps. The military had a need and the scientists, engineers and thinkers fulfilled that need. Once it became commonplace for the military and they worked most of the kinks out, they sell commercially, because some people fell the need to drive a ginormous tank of gas to take their kids to school.

I don’t necessarily have a problem with the military pushing for "autonomous killing machines”, ok, so I have a problem with the “killing machines” part. But after this summer, I have a more belief in the engineers behind it, and those that I don’t, again that’s why the IEET is around. It’s for the “Ethics and Emerging Technologies” to think and do for the technology and society, to talk about it openly and question things beforehand. Christopher writes that “Progressives need to get involved in research, design, and production” we are, the general public on the other hand, may not be interested in paying attention however.

For one, the websites that I have been too are full of open information; anyone who is interested can read about, say, what happened this weekend at the Singularity Institute for Artificial Intelligence about the Singularity. It’s not a secret. Jamais Casico put out his transcripts from his speech on his blog, not just what he thought he would say, but what he actually said, because he went back to revise it and repost. This is open. After Transvision 2007, George Dvorsky took and wrote reflections on several of the speakers on his blog, and got quite a response to it all.

What I see is that there is an effort to disseminate what information is available to the public. If the public was interested they could've went to two very affordable conferences, Human Rights for the 21^st Century (East Coast) and SIAI conference (West coast), and TV07 (Midwest, whoo!), which was more expensive, but worth the price for the celebrity speakers and numerous other notable presentations, not to mention other speeches out there that have been available across the country and globe from the fine people that are part of the think tanks and engineers of the emerging technologies. They travel a lot to give speeches and disseminate what they spend the rest of their time learning and knowing, primarily knowing. They are the doers, not those sent on their behalfs.

Christopher's conclusion in the article is “But such changes will only take place if we work to connect models of a just society to specific technical directions. And if we find more progressives who aren’t afraid of a little math.” I’m honestly afraid of a little math, but that isn’t enough to stop me from caring about all of this and becoming involved. I disagree that it is the engineers alone who “determine whether a product abets democracy or totalitarianism, whether it treats its user as a worker or as a human being.” True they are the creators, but there is interest before the creation, in the conceptual stages when ideas are being tossed around, while the technology is in process of being created.

If anyone was interested in the engineering stages, they had opportunities this summer to get up to a microphone and question the creator of their choice, which was taken advantage of by several in the audience at TV07. Or, if these same questioners sat in the audience and listened to the speeches that were given and heard what I heard they may have a different understanding of those out there making this technology reality. What I didn’t hear was that the technology was being created to destroy ourselves in the future. And if this was the case, they put on a pretty good show of convincing me of the opposite. I heard that they were aware of this concern and talked about it and included it as part of the discussion. As a skeptic of “autonomous AI” I understand other’s fears of the technologies on a personal level, however, becoming an engineer isn’t happening for me in the near future, and this is what Christopher didn’t include in his discussion, options. That just knowing, being aware of the conversations, or in them, is also an option that may help change and affect the overall larger picture.

Don't think me too harsh, I must applaud him for hopefully starting a dialogue for the magazine’s audience. The audience appears to be a younger and more open-minded group. This is the type of press that is both helpful and hurtful to communicators within the emerging technologies community. Referring to my above statement of information being out there and open, it happens mainly on the internet. Eventually, the discussion needs to be viewed by the general public which means off the net and into the mass media and popular culture, and I know that this may irk some of you, since it is an academic arena. Again, as someone, who is submersed in learning more about this daily, I need to learn more. The article tells others, unfortunately not that the IEET is out there, but that the technological evolution is.

Most people I speak with are not completely comfortable about all of this. It is unfortunate, but the only comfortable place there is to discuss is online, thus my urge to franticly type this. If I talked to anyone else there is an eye roll and a “uh-huh” complete lack of interest. It is troubling that the general public is not aware, but the technology is sneaking in to their daily lives. I read Our Molecular Future by Douglas Mulhall last year and was fascinated by the future technologies he discussed. And then I went to the dreaded Wal-mart last week, another topic for another day in itself, in the make-up aisle, what did I see?? Why the electronic paper I thought I wouldn’t see for quite awhile. It was on a L’Oreal or Revlon section (not too effective as I didn’t remember that part). I stood and stared and looked behind it for the plugs, cables, etc. and none. I was astonished that it was moving and just like a screen from a computer and as thin as a coin. I watched and no one else that I saw took pause, it was another ad in a sea of make-up.

I guess overall, the communication is out there, just not in the way that people notice, the technology is out there, again, just not in a way to notice, the problem is that when they do notice, as things will evolve, there will be questions. Maybe not on the small things that are the build-up to the greater technologies, but to the "autonomous killing machines” that, like the Hummer will eventually make to a commercial state where they can protect ones home. Or there will be questions when something happens in a negative manner, a mistake or a learning curve, if you will, like how we learned about the Hindenburg or Titanic. This is what causes me to be involved. Everything has trials and tribulations. I like to think however that, with people like those in the IEET, the discussion of the ethics will go out to the public before the commercialization.

Brain implants relieve Alzheimer’s damage (in rats, anyway)

More cool news from the Harvard Gazette:

Genetically engineered cells implanted in mice have cleared away toxic plaques associated with Alzheimer’s disease.

The animals were sickened with a human gene that caused them to develop, at an accelerated rate, the disease that robs millions of elderly people of their memories. After receiving the doctored cells, the brain-muddling plaques melted away. If this works in humans, old age could be a much happier time of life.

Alzheimer’s involves a protein called amyloid-beta, which makes up gooey clots or plaques that form in the brain. These toxic clumps, along with accessory tangled fibers, kill brain cells and interfere with memory and thinking. The situation has been compared to a build-up of cholesterol in coronary arteries.

“Delivery of genes that led to production of an enzyme that breaks up amyloid showed robust clearance of plaques in the brains of the mice,” notes Dennis Selkoe, Vincent and Stella Coates Professor of Neurologic Diseases at Harvard Medical School. “These results support and encourage further investigation of gene therapy for treatment of this common and devastating disease in humans.”

The first published report of the experiments, done by Selkoe and other researchers from Harvard-affiliated Brigham and Women’s and McLean hospitals, appeared Aug. 27 on the Web site of the Public Library of Science.

To read on, click here.

Girl's heart regenerates thanks to artificial assist

Cool news from the Canadian Broadcasting Company today (CBC) today:

A 15-year-old girl has become the first Canadian to have an artificial heart removed after her own heart healed itself.

Melissa Mills arrived at Edmonton's Stollery Children's Hospital last year after a sudden illness made her critically ill and a candidate for a heart transplant.

Doctors at the hospital implanted the Berlin Heart, a portable mechanical device that keeps blood pumping in an ailing heart, so she could survive until a transplant became available.

But over the next few months, Melissa's overall condition improved dramatically, and her heart muscle regained much of its strength. After 146 days on the Berlin Heart, Melissa underwent surgery to have the device removed.

Full article access here.

Savaging Spears

Continuing my somewhat thematic coverage of obesity/weight/perception and the media, this morning everyone but me apparently woke up to newspapers around the country savaging Britney Spears for her "comeback" performance at MTV's Music Video Awards last night.

And while her performance is part of the talk, the big bit is not what she did, but what she wore - or, rather, didn't wear, and the body she displayed.

A sampling of the headlines: Chubby Britney Fails, Britney's Mommy Pack, Please Don't Give Me More, Bump in the Night, and perhaps my 'favourite', Lard and Clear.

The Seattle PI is asking whether or not it's fair to attack Spears for her shape. Her performance certainly seems up for grabs, but her body - in its imperfect size ten, after bearing two children - is that a target, too? Did she "ask for it" by wearing a revealing black bikini? Or is she just following the suit in fashion in Hollywood now - criticizing Angelina Jolie for her stick like limbs, and embracing America Ferrara for her soft, shapely form.

The PI story continues,

Talk of Spears' physique comes amid an increasingly critical focus on overly skinny actresses in Hollywood, who've largely replaced supermodels as the world's fashion plates. It's hard to pick up a celebrity magazine without a critical photo of, say, Angelina Jolie's birdlike arms. And curvy actresses are getting positive attention, from Oscar-winner Jennifer Hudson of "Dreamgirls" to Golden Globe-winner America Ferrara of TV's "Ugly Betty."

In the fashion industry, there's been an effort to promote healthier-looking models. "Girls aren't looking as skinny this season as they did," said Suze Yalof Scwhartz, executive editor-at-large for Glamour Magazine. "There's food backstage. They're looking sexier." At Glamour, she noted, a model won't be featured "if she shows too much clavicle."

The nastier headlines about Spears are uncalled for, Schwartz said, but at the same time, "when you walk around the stage in a black bikini in front of millions of viewers, people are going to notice." She added that though Spears doesn't have the perfect body she once did, "Most women would die for the body she has now."

Frankly, if this is fat, sign me up!

Federal Judge To Hear Arguments on Missouri Law re Abortion Clinics

U.S. District Judge Ortrie Smith on Monday is scheduled to hear arguments in a case concerning the constitutionality of a new Missouri law (SB 370) that would upgrade facilities in the state that perform some abortions, the Kansas City Star reports (Kansas City Star, 9/10).

The law designates facilities performing second- or third-trimester abortions or more than five first-trimester abortions each month as "ambulatory surgical centers," which are subject to increased regulation from the state Department of Health and Senior Services. It also requires that hallways at the facilities be at least six feet wide and doors at least 44 inches wide. The clinics must also have separate male and female changing rooms for staff and a recovery room with space for a minimum of four beds with three feet of clearance around each bed. The health department has said the law requires that three clinics in the state be licensed.

Planned Parenthood of Kansas and Mid-Missouri last month filed a lawsuit that asks a federal court to block enforcement of the law. The suit alleges that the new regulations are unnecessary and are not meant to improve safety, but rather to interfere with a woman's constitutional right to abortion. PPKM in the suit also is asking that its Columbia and Kansas City clinics be exempt from the law because they were open before the law was passed. Smith last month issued a temporary restraining order blocking implementation of the law, which was scheduled to take effect Aug. 28. Smith last week ruled that physician Allen Palmer -- who operates the Women's Care Gynecology clinic in Bridgeton, Mo. -- can join the lawsuit (Kaiser Daily Women's Health Policy Report, 9/5). According to the City Star, Monday's hearing could lead to a preliminary injunction against the law (Kansas City Star, 9/10).

Comments
Planned Parenthood argues that the law is burdensome because standards required under it would drive abortion providers out of business and make abortions less accessible to women in the state, the Los Angeles Times reports. The law is "ludicrous," PPKM President and CEO Peter Brownlie said, adding, "There's a desperate quality to it." Michelle Trupiano, a lobbyist for Planned Parenthood, asked, "How is expanding the doorway size [in the clinics] going to improve women's health?"

Supporters of the law argue that women seeking abortions should receive treatment in modern facilities with doors wide enough to accommodate gurneys and paramedics in case of emergencies. "We're applying the same standards of health care to abortion clinics as we are to other medical facilities," Pam Fichter, development director of Missouri Right to Life, said.

Although Smith is "bound" by a 1992 U.S. Supreme Court ruling that prohibits states from putting an "undue burden" on women seeking abortions during the first trimester, there is "a lot of room for judicial interpretation," according to the Times. Carl Tobias, a law professor at the University of Richmond, said, "What may be an undue burden for one judge may not be for another," adding, "It's a very flexible standard" (Simon, Los Angeles Times, 9/10).

Reprinted with permission from kaisernetwork.org. You can view the Kaiser Daily Reports online, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/. The Kaiser Daily Reports are published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Denying Children's Health Care

There's a reason that the movie Sicko had such an impact when it was released and there is a reason that we've blogged about Sicko and universal health care so much previously -- the issue resonates with the public and it is a major concern of many Americans - so, it's not surprising to see this scathing editorial in the New York Times today:

"The Bush administration reached a deplorable, preordained verdict yesterday when it denied New York State permission to expand a valuable health insurance program to help cover middle-class children. The administration, which makes no effort to disguise its disdain for government insurance programs, imposed new, excessively stringent requirements last month that not only guaranteed New York’s denial but will make it nearly impossible for any state to expand coverage.

The denial shows the White House at its most ideological and intransigent. Unfortunately, tens of thousands of children in New York — and many more nationally — will end up paying the price." To read the rest of the article, click here.

So time for a reminder -- Let's push for all candidates, from county seats to presidential, to seriously address this issue, and lead us toward a new health care system.

Breaking Up is Hard to Do

From Science Daily: — “Breaking Up is Hard to Do” is advice from a popular 1970s song, but older women going through a relationship breakup may have health problems to go along with their broken hearts, a University of Alabama researcher has found.

Dr. Bronwen Lichtenstein, UA assistant professor of criminal justice who specializes in women’s issues, recently completed a study of the health risks women over age 35 faced when they returned to the dating scene after the breakup of a long-term relationship. To read on, click here.

Biological Difference in Tumors Likely Cause of Black Women's Increased Mortality for Breast Cancer, Study Finds

Black women are more likely than other women to develop tumors that do not respond to common hormone-based treatments, according to a study to be presented at an American Society of Clinical Oncology conference that begins on Friday, the AP/Los Angeles Times reports (Marchione, AP/Los Angeles Times, 9/5).

The study, led by M. Catherine Lee, a clinical lecturer at the University of Michigan Comprehensive Cancer Center's department of surgery, is the largest to indicate a biological factor as the cause of black women's increased mortality from the disease, according to the Newark Star-Ledger. Previous research has attributed fewer mammograms and less aggressive treatment to the racial disparity (Stewart, Newark Star-Ledger, 9/6). Black women are less likely than white women to develop breast cancer but are more likely to die from the disease.

For the study, Lee and colleagues analyzed data on more than 170,000 breast cancer diagnoses from 1998 that were included in the American College of Surgeons' National Cancer Data Base. Ten percent of the cases were among black women.

Researchers focused on 95,500 women whose cancers were invasive rather than confined to a milk duct. They found that roughly 39% of such tumors in black women were estrogen receptor-negative, or ER-negative, compared with 22% of tumors in white women. ER-negative tumors are resistant to common hormone-based therapies like tamoxifen and are more difficult to treat, according to the AP/Times (AP/Los Angeles Times, 9/5). The high prevalence of ER-negative tumors among black women was consistent regardless of the age or stage at which they were diagnosed, the study found (Newark Star-Ledger, 9/6).

The study also found that black women were diagnosed at an average age of 57, compared with 62 for white women. Black women's tumors also were more advanced than white women's, with 29% of black women having stage 1 tumors that had not yet spread, compared with 42% of white women.

Lee said, "Differences in tumor biology have a significant impact on survival," adding, "The fact that breast cancers in black women are more aggressive biologically suggests that we need to focus more of our research energy on developing better treatments targeting ER-negative tumors." She said the "findings also point to a need for improved cancer education and screening in black women, particularly those in younger age groups" (Fox, Reuters, 9/5).

Reprinted with permission from kaisernetwork.org. You can view the Kaiser Daily Reports online, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/. The Kaiser Daily Reports are published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Mind Matters: Beliefs, Emotions & Self Identity

Check out our new series, Mind Matters --

Women should care about neuroethics because advances in neuroscience are going to pose some of the most important ethical questions yet about what it means to be human—challenging our concepts of free will, gender and genetic determinism, and what sets us apart from other species. To help us address those issues, we have developed a new program called Mind Matters: Beliefs, Emotions & Self Identity, which will include interviews, podcasts, recommendations for essential readings and the latest in neuro-news.

For more info, click here.

Requiring the Meningitis Vaccine for Students

Our friend and colleague, Art Caplan, has a new column at msnbc.com on requiring meningitis vaccines for students as he fittingly points out, Americans hate to be told what to do, but we hate losing our kids more:

COMMENTARY

By Arthur Caplan, Ph.D.

Which is scarier to you - coming down with deadly bacterial meningitis or being required to get a vaccination against it? The disease itself should scare the living daylights out of you, especially if you are an adolescent or the parent of one. Yet it is the idea of mandatory vaccination that strikes fear in many.

We need to get our priorities straight when it comes to mandating or requiring vaccines. When there is a fatal disease that is easily prevented by a safe vaccine, the shot ought to win out every time over our dislike of being told what to do.

Bacterial meningitis, an infection of the fluid in the spinal cord or the tissues that surround the brain, can kill within hours. One in 10 victims dies and up to 20 percent of those who survive suffer hearing loss, deafness, brain damage, amputations or other serious complications. Around 3,000 people a year get the disease and it can kill within hours. Almost all of that is preventable with a vaccine.

Teens and young adults ages 15 to 24 are at especially high risk for bacterial meningitis since it can be spread by coughing, sneezing, kissing, sharing drinking glasses and other behaviors where people are in very close contact. College students are particularly at risk since they live in tight quarters and often have weakened immune systems due to lack of sleep.

In January 2005, the Food and Drug Administration approved a new vaccine against bacterial meningitis. The MCV4 Meningococcal Conjugate Vaccine, marketed under the name Menactra, protects against four very common bacterial strains and is longer lasting and more effective than earlier meningitis vaccines. The Centers for Disease Control recommends that everyone ages 11 to 18 should get it, as well as those headed off to live in college dorms or going into the military. But in 2006, only 12 percent of teenagers got the vaccine.

So why isn't everyone in this age group getting vaccinated? The answers are the same ones that continue to haunt vaccines - unjustified safety concerns, resistance to mandates and cost.

When Menactra first appeared, some cases of Guillain-Barre syndrome were reported. This is a serious disease in which the body's immune system attacks nerves and leads to gradual, temporary paralysis.

Those opposed to vaccination - and there are many in the United States and other countries - quickly pointed to the 20 cases that were reported as a reason not to get vaccinated. But, Guillain-Barre occurs in about one in 100,000 people in the United States. Vaccination is almost never the cause. In fact, when the 20 cases cited by vaccine critics were closely examined, none were associated with the meningitis vaccination.

23 states require shots
Today, 23 states mandate the vaccine for college freshmen.
Americans are generally leery of requiring or mandating vaccines. They value informed choice. But do you really want to leave an issue as important as vaccination left up to busy college freshmen to think about? Menectra is safe, so it's hard to know why anyone living in a dorm or close quarters would not want to get vaccinated.

And if you don't get vaccinated then you are not only putting yourself at risk but others whom you come in contact with on and off campus as well.

What is really startling is that mandating vaccines really only means strongly urging young people to get them. Most states recognize the right of anyone to refuse a vaccine on religious grounds. And even the states that have required or mandated vaccination allow someone not to do so if they sign a statement saying they have seen information about meningitis vaccine but still don't want the shot.

Getting insurance to pay
The real reason to mandate meningitis vaccine is to get it into the heads of kids and parents that this is an important thing to do and to help force government and insurance companies to pay the cost. If you don't mandate vaccines then insurers often won't pay for them. In our screwy world of health care, mandates have more to do with reimbursement then they do the police blocking access to the dorm until you show your vaccination card.

Americans do love choice. But they also hate to lose a child, a sister or a granddaughter. Sometimes choice ought to yield to common sense and evidence. We ought be doing all we can to get young people vaccinated against meningitis and to make sure that the costs of doing so are covered.