Functional MRI Raises Questions

As I write this the scientists at the Medical Research Council Cognition and Brain Sciences Unit (MRC) in Cambridge, England are conducting a test. They are using a new technique, called the functional M.R.I., to peer inside the human brain (Benedict NY Times). This new equipment is allowing them to map the regions of the brain that are stimulated when a patient is put to different tests. By comparing the reaction of a healthy, uninjured brain to that of someone who has been in an accident the scientists can tell what type of damage has occurred.
This brings a whole new level of diagnosing ability when it comes to brain damaged patients. For years physicians have had only the educated guess to rely on as a tool to determine whether a patient was cognizant of what was happening, could feel pain, or had any understanding of them self whatsoever. Through the use of this new software many of these questions can know be answered. The diagnosing physician can have real-time evidence as to the extent of a patient’s injury, and will therefore be better able to perform treatment.
If this new scanning technique can offer as much information as Dr. Adrian Owen, the MRC’s lead brain researcher says it will, then its going to force much of the medical community to rethink some major issues (Benedict NY Times). Specifically, the issue of physician assisted euthanasia, and many of the concerns regarding patient autonomy and the role of decision maker. If patients that previously were thought to be in a “vegetative” state can be shown to have a significant amount of brain function, should that change how they are cared for? Would a situation similar to that of the “Terri Schiavo Case” be handled differently if there could have been evidence of pronounced brain function?
Members of the medical community have differing opinions as to what the impact of the functional M.R.I. will be. It is undecided as to what extent this new technology should be used, and whether it can be fully trusted as a diagnosing tool. Anatomically speaking there is more going on in the brain then just electrical currents passing from neuron to neuron. Dr. Owen admits that this new software doesn’t solve the entire puzzle, but provides a significant piece (Benedict NY Times). Patients who suffer severe brain damage due to oxygen deprivation may show brain activity on the scan, but will never regain consciousness or function as normal, healthy human beings.
Regardless, this new technology gives the medical community a stronger scientific basis to make their case against what often times becomes a discussion of moral and ethical behavior. Euthanasia, the treatment of patients in a “vegetative” state, and even the level at which autonomy of the patient should be deciphered all have to be re-examined due to these recent breakthroughs. Dr. Joseph Fins, chief of the medical ethics division at NY Presbyterian Hospital, said it best, “For now I think what this study does is to create another shade of gray in the understanding of gray matter.”

-Peter A. Beaulieu

Mental Activity Seen in a Brain Gravely Injured, Benedict Carey, September 8, 2006: NY Times (http://www.nytimes.com/2006/09/08/science/08brain.html)

Genetics in Chicago

Quick heads-up for any of our readers who are in or near Chicago: the Illinois Humanities Council is hosting a Town Hall meeting on the topic, "Future Perfect: Conversations on the Meaning of the Genetics Revolution" on September 26, 6:00-8:00 pm, at the Museum of Contemporary Art Theater. The event is free and open to the public--and it kicks off a year-long program on genetics and society.

More info available here.

[Hat tip: Mark Sheldon at Northwestern]

The 'Moral Chaos' of the Twilight Zone, continued

Earlier, we had posted about how new neurotechnologies might change the way we look at MCS or PVS patients -- just a few days ago, Rob Stein of the Washington Post reported about a young woman was deep in a "vegetative state" -- completely unresponsive and unaware of her surroundings after a traumatic brain injury a little more than a year ago. But then a team of scientists in the UK decided to do an unprecedented experiment, employing functional MRI technology to try to peer behind the veil of her brain injury for any signs of conscious awareness.

What they found was surprising:

The researchers put the woman in a scanner that detects brain activity and told her that in a few minutes they would say the word "tennis," signaling her to imagine she was serving, volleying and chasing down balls. When they did, the neurologists were shocked to see her brain "light up" exactly as an uninjured person's would. It happened again and again. And the doctors got the same result when they repeatedly cued her to picture herself wandering, room to room, through her own home.

To read on, click here.

Chile: Birth Control Free for Women Over 14

Thanks to Chris MacDonald of the Business Ethics Blog for bringing this to our attention:

SANTIAGO, Sep 4 (IPS) - The Chilean government decreed that all public health centres must provide birth control, including emergency contraception, to adolescents and women over the age of 14 -- a measure that immediately drew the ire of the Catholic Church and the right-wing opposition parties.

"We applaud the decision of the Chilean Health Ministry, because we believe it safeguards the rights of women and gives us a chance to interrupt the cycle of poverty," Ximena Rojas, assistant director of the non-governmental Centre for the Development of Women (DOMOS), remarked to IPS.

After President Michelle Bachelet, a pediatrician, took office in March, Domos asked the Health Ministry to expand the distribution of emergency contraception.

The measure, announced Saturday by Health Minister Soledad Barría during the fifth Chilean Congress of Pediatric and Adolescent Obstetrics and Gynecology, forms part of the new "national norms on fertility regulation" that will begin to be applied this month in all public hospitals and clinics around the country.

Any teenage girl over the age of 14 will now be able to directly ask her doctor for a prescription for birth control, without authorisation from her parents, and the contraceptives must be provided free of charge by the public health system.

The new decree complies with the sexual and reproductive rights approved at the 1994 United Nations International Conference on Population and Development in Cairo.

The most controversial aspect of the Health Ministry decree is that it not only covers traditional birth control methods, but also emergency contraception, which up to now was only available free of charge in cases of rape, although it was available by prescription in the country’s pharmacies.

Although it is popularly known as "the morning after pill", emergency contraception can be taken up to five days (120 hours) after unprotected intercourse. The pill works by providing high levels of synthetic hormones, which interfere with ovulation and change the lining of the uterus, significantly reducing the likelihood of pregnancy.

The World Health Organisation (WHO) clarifies that emergency contraception is "not effective once the process of implantation has begun, and will not cause abortion."

But archbishop of Santiago Francisco Javier Errázuriz said the decision by the centre-left government was a blow to marriage, the birth rate, and the Chilean family.

"I was hoping for good news for Chile at the beginning of the month of the fatherland," said Errázuriz, referring to the fact that on Sep. 18 and 19, Chile will celebrate 196 years of independence, and will pay homage to the army. "But it is not good news for a country to be obsessed with contraception."

Several mayors from right-wing opposition parties also rejected the government decree, and threatened not to respect it. (Municipal governments are in charge of administering the public health clinics.)

To read on, click here.

Entering the Twilight Zone

Although the article in Wired this month about altering PVS (persistent vegetative state) patients consciouness' from persistent to minimal or more is entitled "Back from the Dead", I think a more appropriate title might be "Entering the Twilight Zone". Writer Gary Greenberg attempts to tackle the "moral chaos" that might arise if, in fact, we might be able to restore varying degrees of consciousness to PVS patients with a 'brain shock":

A small but passionate group of doctors say that electricity applied deep in the brain can jolt patients out of irreversible comas. That's when the real problems begin.

By Gary Greenberg

For someone left for dead 12 years ago, Candice Ivey seems to be doing pretty well. She's still got her homecoming queen looks and A-student smarts. She has earned a college degree and holds a job as a recreational therapist in a retirement community. She has, however, lost her ballerina grace and now walks a bit like her feet are asleep. She slurs her words a little, too, which sometimes leads to trouble. "One time I got pulled over," she says in her North Carolina twang. "The cop looked at me and said, 'What have you been drinking?' I said, 'Nothing.' He said, 'Get out here and walk the line.' I was staggering all over the place. He said, 'All right, blow into this.' Of course I blew a zero, and he had to let me go." (To read the rest of the article, click here.)

Designing Children: For Health or More?

The well-educated are significantly more open to the idea of "designing" babies than the poorly educated, according to a new study by psychologists at the University of East Anglia in the United Kingdom; the study had some interesting results including:

* The better educated prospective parents are, the further they are prepared to go to improve their children's IQ.
* Women interpret certain interventions in child rearing as "design acts" more readily than men.
* People over 50 interpret certain interventions as "design acts" more readily than people under 25.
* Because of "parental uncertainty" - the idea than women know for certain if a child is their's whereas men do not -- men show a significantly greater preference than female parents for their children to inherit their own characteristics.
* Parents see different physical, social and intellectual characteristics as desirable depending on the sex of the child.
* Older women and childless women are significantly more willing to "improve" the physical, social and intellectual characteristics of prospective children? (This can be explained by women seeking to increase their genetic heredity, particularly when their time to reproduce begins to decrease.)
* Both men and women see genetic engineering as acceptable primarily for medical applications.

A Carnival of Feminists: Women and Healthcare theme

I had not heard of a 'blog carnival' until blogger No-More-Nice-Girls-Nikki Giovanni (aka Lingual Tremors) sent us an invite to submit to the 23rd edition of the Carnival of Feminists to posted on September 20, 2006. The theme this year is Women and Healthcare, our favorite topic!

You can use the Blog Carnival submission form or email lingualx (at) yahoo. com. Submissions are due by 18 September 2006 at midnight.

Monsters and Motherly Mad (and Bad) Scientists

In mad science films, maternity is both danger and salvation, according to an article in the Scientist by J. Kasi Jackson, an assistant professor in the Center for Women's Studies at West Virginia University:

In my work on female scientists in B-movies, I explore the way that such films deal with our inclination to view science as masculine and nature as feminine. When men are doing the science, this isn't a contradiction; in these films, masculine, rational science dominates and controls irrational, feminine nature. Sometimes, the pattern is obvious, such as when a wild-haired, wild-eyed Frederick Frankenstein (Gene Wilder) from Young Frankenstein (1974) shouts that he will use science to "penetrate into the very womb of impervious nature herself."

But what happens when the mad scientist is a woman?

Instead of being portrayed as madly evil in the Young Frankenstein, messy-haired sense, B-movie female scientists are capable and feminine -- but with a bizarre twist: an emotional, intuitive and maternal drive channeled toward nature. Or as Stacy Alaimo puts it, she is "unfaithful" to those who trained her, "allying herself with the nature she is supposed to control."

A great example is Carnosaur (1993), in which Jane Tiptree (Dianne Ladd), fed up with humans messing up the environment, decides to wipe them off the face of the planet by genetically engineering a virus that causes women to give birth to dinosaur eggs. Although Tiptree is decidedly mad, she is also very feminine -- she alone sports manicured nails, plucked brows, and makeup. She is a maternal (not sexy) female figure, a vengeful Mother Nature who will destroy humanity to save the world. The dinosaurs are her children, literally -- she willingly sacrifices herself to her own virus and dies when a Carnosaur digs its way through her abdomen.

A theme I have noticed in B-movies is that, to escape madness such as Tiptree's, the female scientist must redirect maternal impulses she has about nature towards human children or a romantic partner. In Kingdom of the Spiders (1977), she does both. Scientist Dianne Ashley (Tiffany Bolling) and veterinarian Robert 'Rack' Hansen (played by a typically macho William Shatner) fight human-eating tarantulas. Ashley starts the film on nature's side -- she argues that the spiders kill large animals because pesticides have destroyed their prey, and her preferred solution is to let nature attain a new balance.

In one strikingly classy scene, Ashley, clad in a towel, finds a spider in her dresser drawer. As we wait in delicious suspense for the inevitable shrieks of fear, she instead picks it up and croons: "Well, hello there." But Ashley eventually abandons her inhuman alliance with nature and, along with it, her scientific role; she spends the last part of the film protecting and consoling Hansen's young niece -- and forgetting her initial objection to hooking up with Hansen.

Susan Drake (Ann Turkel) from Humanoids from the Deep (1980) is not so fortunate. Drake genetically engineers fast-growing salmon to replenish a depleted fishery. However, native coelacanths eat the salmon and mutate into half-man/half-fish monsters which are driven to mate with human women and kill all the men. As the voiceover in the trailer aptly summarizes, it's "a battle over the survival of the fittest -- where man is the endangered species and woman the ultimate prize." Drake helps the local people defeat the humanoids, but afterwards she helps the last remaining impregnated woman give birth to one of the mutant monsters, which kills the mother in the process and leaves sequels open to further madness.

In mad science films, maternity is both danger and salvation. If her maternal feelings are linked with nature, the female scientist will create monstrosities that will destroy mankind. The woman scientist who redirects her instincts to people, however, saves people from nature's wild ways, but she must sacrifice practicing science to achieve this. Either way, the choice to mother, and if so, what to mother, will define her.

The Vatican's Intelligent Designs?

My heart sank when I heard that the Pope was preparing to embrace theory of intelligent design ~ according to the Guardian, the Pope expressed concern when he raised the issue in the inaugural sermon of his pontificate, saying: "We are not the accidental product, without meaning, of evolution." ~ but I didn't think that Darwinian evolution necessarily "unseats humanity as master of a divine creation."

I just hope that the Vatican doesn't renege on its apology to Galileo.

To Clone or Not to Clone: Is that the question?

To Clone or Not to Clone: Is That the Question?

A Moderated Panel Discussion

The Women's Bioethics Project will present a moderated panel discussion titled “To Clone or Not to Clone: Is That the Question?” A compelling and broad look at cloning and related issues.

The event will be held in the ACT Theater's Bullit Room on Tuesday, August 29 from 6:00–8:00PM followed by a cheese and wine reception.* This is a free event and space is limited so please RSVP.

The rapid advance of emerging new technologies leave many people bewildered and concerned. This accessible and interactive event is for anyone who is curious about what science, ethics and the arts have to say about cloning and related issues. It will shed further light on the ethical issues raised by stem cell research and cloning.

Panelists:

Paul Abrams, MD/JD, former President and CEO of CEPTYR, who will talk about the science behind adult and embryonic stem cells, therapeutic and reproductive cloning. He will address the following questions: How does adult stem cell s compare to embryonic stems cells? How is stem cell research connected to cloning technologies? What is the difference between therapeutic and reproductive cloning? What is the reality of those technologies today?

Emilie Clemmens, Ph.D., Research Fellow, Women's Bioethics Project, who will discuss the ethical implications of these emerging technologies. She brings her perspectives as a woman, mother, scientist, and ethicist to these critically important questions.

Kurt Beattie, Artistic Director, ACT Theater, who will speak about what the arts have to say about emerging technologies including ACT's upcoming production of "A Number." He will discuss how theatre can shed light on these difficult and complex questions.

Moderators:
Kathryn Hinsch, Founder, Women's Bioethics Project

Petra Franklin Lahaie, Board Member of both Women’s Bioethics Project and ACT Theater

Quote from Kathryn Hinsch, Founder, Women's Bioethics Project: “A key part of the Women’s Bioethics Project’s mission is to help people understand the implications of merging technologies.” said Kathryn M. Hinsch, founder of the Women’s Bioethics Project. “To some, cloning might seem like science fiction. But, in fact, last year, more than 500 bills were introduced at the state level that related to cloning or stem cell research. Since there is currently no federal law banning human cloning, we expect it will be a hot topic in 2006. Just this past year, California, Connecticut, and Massachusetts each passed legislation banning human cloning, but permitting the technique for research purposes. It is something voters need to know about now”

For more, check out the WBP home page.

New technique for developing embryonic stem cells: Does it make a moral difference?

Big news on the stem cell front this week: researchers at Advanced Cell Technology this week reported that they've developed a method for culturing embryonic stem cells from a single cell removed at the 8-cell stage. Removing the cell doesn't harm the embryo or hamper further development; in fact, this is the process currently used for preimplantation genetic diagnosis.

Proponents of the new technology say that it eliminates the major objection of those opposed to embryonic stem cell research: it doesn't destroy embryos. Some disagree, however, arguing that the single cell that is removed also has a right to life. The Vatican, which has long opposed all IVF technologies, says that the new method is unacceptable.

Still others doubt that technological changes can answer the inescapable ethical/moral question of whether embryonic research should be permissible. As Art Caplan told the New York Times (see the third link below), "This isn't a technique that's going anywhere. This isn't an alternative to anything."

Read more all over the place: here, here, and here, for starters.

FDA Approves Plan B's Over-the-Counter Sale

From the Washington Post this morning:

By the end of the year, American women will be able to walk into any pharmacy and buy emergency contraceptive pills without a prescription as a result of a Food and Drug Administration decision announced yesterday.

The decision means women will not have to go to a doctor first as long as they can prove they are 18 or older to a pharmacist, who will keep the drugs behind a counter. Younger teenagers will still need a prescription, and the pills will not be sold at gas stations, convenience stores or other outlets that do not have pharmacists.

The approval marks the first time a hormonal contraceptive will be broadly available in the United States without a prescription. The pills, which will be sold as Plan B, will probably cost about $25 to $40 per dose, and men will also be able to buy them.

The announcement was aimed at resolving one of the longest and highest-profile health controversies of the Bush administration, but opponents said they are considering plans to block the decision, either in court or in Congress.

To read on, click here.

Is meat-packing better regulated than the tissue transplant industry?.

We've all heard a bit in the news lately about the need to better regulate the tissue transplant industry. Inadequate screening transplant tissues for disease and decomposition has led to several fatal events for transplant receivers, and new stories of illegal tissue harvesting have scared the beejezus both of potential receivers and kin of the deceased.

As organ and tissue transplantation has become more viable and more commonly practiced, the demand for donor tissues and organs has increased. An industry of companies that harvest and provide tissues for transplant has surfaced to meet this demand. Almost any kind of tissue may be handled by this industry, including organs, skin, and bone. So how exactly is it that companies who provided this service were not required to register with the FDA until 2004?

It seems that prior to 2004 regulation of transplant tissues paled in comparison to that of the meat-packing industry. How is it possible that tissues that we eat and pass through our bodies are better screened than those that are placed permanently in our bodies? While my knowledge of the immune system is far from up to par, it seems to make biological sense that its easier for my immune system to fight off a population of bacteria originating from a food that passes through the digestive system, as there it will at least be partly processed and degraded, unlike a bacterially infected tissue that takes permanent home with other bodily organs and tissue.

New developments have surfaced since first beginning this writing in July 2006. Just this month, the FDA ordered the human tissue recovery firm Donor Referral Services (DRS) to shut down its operations, finding “serious deficiencies in its manufacturing practices, including those governing donor screening and record keeping.” I find this astounding. It seems that at every suspect outbreak of mad-cow disease, there is a barrage of public health warnings and media hype, quickly followed by indications that the disease path as been tracked and the origination determined and quickly shut down. Amazingly, records and manufacturing processes for tissue recovery and donation seem much looser. Case in point is the instigation of the shut down of DRS: “FDA's inspection identified serious violations of the regulations, including the failure to establish and maintain procedures for manufacturing steps...FDA also found several instances where records provided by DRS to another HCT/P establishment were at variance with the official death certificates FDA had obtained from the state where the death occurred.”

The FDA's new regulations for tissue recovery and transplant services took effect in May 2005. “Among other mandates, the regulations require firms to properly screen and test donors and, when needed, they enable FDA to take swift action in the interest of public health.” Better late than never I suppose; but I can't help but suspect that both the industry and the FDA is saving face for not implementing preemptive regulation long ago.

New regulations for donor eligibility and screening can be viewed here: http://www.fda.gov/bbs/topics/news/2004/NEW01070.html

Press release on DRS shutdown: http://www.fda.gov/bbs/topics/NEWS/2006/NEW01433.html

Experimental treatments: a constitutional right?

From the London Times Online:

Giving unproven drugs to terminal patients won't save lives in the end.

Science Notebook by Anjana Ahuja

ABIGAIL BURROUGHS, a 21-year-old American, died from squamous-cell carcinoma of the head and neck in 2001. According to her father, Frank, she didn’t need to die. There were drugs in development that might have reined in the malignancy, but the experimental therapies were being tested on cancers in other parts of the body.

“She had the right cells in the wrong place, and she didn’t qualify for any of the clinical trials,” her father recalls. Shortly after her death, he founded the Abigail Alliance for Better Access to Experimental Drugs. This summer it scored a breathtaking victory in the courts against the Food and Drug Administration. The District of Columbia Circuit ruled, by two to one, that a patient with a terminal illness or untreatable disease had a “fundamental right” under the Constitution to experimental drugs that have passed only preliminary (Phase I) tests, and are thus a long way from approval.

The little-reported decision is already having deep repercussions in the medical world, and is likely to end up in the Supreme Court. While patients welcome the decision, regulators and clinical researchers fear that such early, wide access to experimental drugs will make it harder to obtain the clear, long-term data needed to prove efficacy. Patients may decide an unproven drug is a better gamble than ending up on a proven, but marginally effective, medication. An article in the New England Journal of Medicine this month points out that only 11 per cent of drugs — and only 6 per cent of cancer drugs — that enter clinical testing are ultimately approved; the rest are either too toxic or don’t work.

To read on, click here.

Quote of the Day: "Politicians sell terror and fear; pharmaceutical companies sell disease."

From the Christian Science Monitor: Drug ads sell a problem, not a solution
By Jonathan Rowe
POINT REYES STATION, CALIF. – It is an old saying in the advertising trade that you sell the problem, not the solution. That helps explain why the media today are awash with images of disease. Erectile dysfunction, depression, stress, attention deficit disorder, on and on - you can't escape them and the sense of looming peril that they conjure up.

Politicians sell terror and fear; pharmaceutical companies sell disease. Every state and stage of existence has become a pathology in need of pharmaceutical "intervention," and life itself is a petri dish of biochemical deficiency and need. Shyness is now "social anxiety disorder." A twitchy tendency has become "restless leg syndrome." Three decades ago the head of Merck dreamed aloud of the day when the definition of disease would be so broad that his company could "sell to everyone," like chewing gum.

That day is rapidly approaching, if it's not already here. "We're increasingly turning normal people into patients," said Dr. Lisa M. Schwartz of the Dartmouth Medical School. "The ordinary experiences of life become a diagnosis, which makes healthy people feel like they're sick."

In one sense, the ads have been successful. The Kaiser Family Foundation found that every dollar drug companies spend on ads brings more than four dollars in additional sales. But for most others, the result has been soaring medical insurance costs, toxic side effects, and new tensions between doctors and patients, who increasingly badger doctors for the drugs they've seen on TV.

One study found that 30 percent of Americans have made these demands. A Minnesota doctor complained recently that patients now push him for sleep medications "when maybe they just need to go to bed on a more regular basis."

But perhaps the worst part is that prescription drug ads have immersed us all in a pervasive drug culture that seems to have no boundaries. We are being reduced to helpless "consumers" who have no capacity to deal with challenges other than by taking a pill. Last month Tim Pawlenty, the Republican governor of Minnesota, called for a moratorium on prescription drug ads. It's about time.

For most of the past half century, there were tight restrictions on the general advertising of prescription drugs. These require doctors' guidance for a reason; so why should Madison Avenue get involved? But under heavy pressure from the drug and advertising industries, the government backed down in the late 1990s, and that started the tsunami.

Spending on drug ads for the general public more than tripled between 1996 and 2001. It is now some $4 billion a year, which is more than twice what McDonald's spends on ads. In 1994, the typical American had seven prescriptions a year, which is no small number. By 2004, that was up to 12 a year. Homebuilders are touting medicine cabinets that are "triple-wide."

The industry says this is all about "educating" the consumer. But an ad executive was more candid when he said - boasted, really - that the goal is to "drive patients to their doctors." Reuters Business Insight, a publication for investors, explained that the future of the industry depends on its ability to "create new disease markets." "The coming years," it said, "will bear greater witness to the corporate-sponsored creation of disease."

The Kaiser study found that drug ads increase sales for entire categories of drugs, not just the one in question. The ads really are selling the disease more than a cure.

Advertising is just one way the industry has sought to accomplish this goal. It also funds patient advocacy groups such as Children With Attention Deficit Disorder (CHADD), and doctors who push for expanded definitions of disease, among a host of other things. (When the definition of ADD expanded in the 1980s, the number of kids tagged with this problem increased by 50 percent.)

But advertising is the most pervasive and aggressive way of selling sickness. It also is the hardest to justify. Medicine is supposed to be about science, not huckstering; about healing people, not persuading more of them that they are sick. There are far better ways to inform the public about health issues than to spend billions of dollars a year pushing pills.

This is why more than 200 medical school professors recently called for an end to prescription drug ads, and why close to 40 health and seniors groups have joined them. Even the American Medical Association, many members of which have close ties to the pharmaceutical industry, has urged restrictions. Washington should listen to these doctors. As Governor Pawlenty put it, we need to put "the decisionmaking back where it should be - on an informed basis between the patient and the doctor."

Over 50? - No Flu Vaccine for you!

Is this good social policy? :

The question is raised in a provocative report by two government scientists about who should get scarce medical resources. They argue that the standard policy for flu vaccinations that favors older men and women over younger adults should be changed in preparation for a possible pandemic of avian flu.

Ordinarily, people over 65 and those who have chronic illnesses are given priority. As a group, they are the most vulnerable. Protecting the most vulnerable saves the most lives.

But avian flu is not an ordinary flu. Chances are, it will never turn into a global catastrophe, but if it did, some researchers speculate that it could lead to 90 million cases and 1.9 million deaths. There is no way to manufacture enough vaccine in time to protect everyone in the United States. So who should get the potentially lifesaving vaccine?

"This is a tragic choice," says bioethicist Ezekiel J. Emanuel at the National Institutes of Health, who with his colleague Alan Wertheimer suggested an alternative policy in a report in the May 12 edition of Science magazine.

Both the rebel authors and the traditionalists (that is, the government's National Vaccine Advisory Committee and the Advisory Committee on Immunization Practices) would give top priority to those working to manufacture and distribute the vaccine and to front-line health care professionals. And both would give preference to key government leaders. The fight is over what's left for the general public.

The rebels challenge the principle of saving the most lives. What about saving people with the most years yet to live?

Their formula is based on the principle that all people deserve the chance to live out their lives and grow old -- especially teenagers and young adults who have survived childhood and face many decades ahead. Twenty-year-olds, for example, are more "valued than 1-year-olds because the older individuals have more developed interests, hopes and plans but have not had an opportunity to realize them," write the authors.

Presumably, really older individuals -- those over 65 -- have had all the opportunities they need to realize their hopes and plans and interests -- so they are less valued than 20-year-olds.

In the new formula, the winning age cohort in the vaccine rationing sweepstakes would be healthy people 13 to 40. Next in line would be those 7 to 12 and people 41 to 50. After 50, forget it!

If women don't care, who will?

Interesting, if not somewhat distressing, post in the Australian Mercator that asks "if women don't care, who will?", suggests that there has been a 'decline in female altruism' and the 'feminine ethic of service'.

"This feminine ethic of service, marked by attentiveness to the person and concern for their integral (moral and cultural as well as physical) good, is the great contribution women can make to professional life and the workplace in general. To grasp this is to see a solution to the work-life dilemma. Once 'life' -- relationships in the family, with others -- is understood in terms of mutual service, work finds its proper purpose and place."

Who said women are the only ones who care? Shouldn't this "ethic of service" apply to both sexes?

Yet Another Reason to Support Universal Health Care Coverage: To Protect Our Future

From the Kaiser Network:
Colorado Children Without Private Insurance Have Higher Mortality Rate

In Colorado, uninsured children and children enrolled in Medicaid who are hospitalized at Children's Hospital in Denver are twice as likely as those with private insurance to die after hospitalization, according to a study published in the journal Pediatrics, the Denver Rocky Mountain News reports. For the study, two physicians at the hospital looked at hospitalization rates per 100,000 children ages six months to 18 years. The study finds that children enrolled in Medicaid are twice as likely as those with private insurance to be hospitalized for vaccine-preventable illnesses, complications of diabetes and asthma, and ruptured appendices (Brand, Denver Rocky Mountain News, 8/7). Regular preventive care visits by uninsured children and children enrolled in Medicaid would save Colorado $46 million, according to the study. The study also finds that the number of Colorado pediatricians who are willing to see Medicaid beneficiaries fell from 41.4% in 2000 to 23.9% in 2003. Eighty-three percent of Colorado pediatricians in 2003 said Medicaid reimbursements did not cover the cost of office visits (Auge, Denver Post, 8/7). Stephen Berman, head of general pediatrics at Children's Hospital and co-author of the study, said, "The paper, for the first time, provides the data that show there are huge potential savings in caring for these kids." Berman added, "The mortality rates are higher for children on Medicaid. They are higher because they are sicker, and they didn't get their primary care" (Denver Rocky Mountain News, 8/7).

An abstract of the study is available online.

America's New Comic Book Superheroine and the Cost of Caring

I love this concept!: America's first true female super-hero since Wonder Woman ~ Carrie Giver. Conceived for the Caregiver Credit Campaign,the feminist superhero will "have politicians and hairdressers, women and girls, hardhats and female executives, right along with caregivers re-thinking personal and social policy, including Social Security. Carrie Giver will be kicking butt in the name of hundreds of millions of people, especially mothers, who give care to the young and old alike each and every day."

More from the designer's website: "This timely comic book reflects the attention now being paid to America's rapidly growing mammogram generation (squeezed on both sides), soon to be in need of care themselves - e.g., aging baby boomers. The trend of first time Hollywood moms, posed against both a right wing view of motherhood-or-nothing and the career-first pressures of still many other women, make this the perfect time for media outlets to talk about the value of caregiving to both children and older people. It affects 100 percent of Americans, and is a worldwide concern as western nations age. We all come into the world in need of care. We all exit the same way. Sooner or later, most of us become caregivers."

An Act of Kindness and Conscience and equitable distribution of resources

Kudos to Gilead Sciences Inc., maker of the world's best-selling AIDS treatment: they are offering to help generic- drug makers in India produce the medicine, a move intended to get the life-saving pill to millions more people in the world's poorest countries.

Since 2004, Gilead has twice slashed its price for Truvada, a drug that combines the company's best-selling pill, Viread, and another medicine. Gilead now sells Truvada to poor African nations for 87 cents a day, compared with $24.51 in the U.S.

Still, only 45,000 to 50,000 of the 6.5 million people in poor countries who need AIDS drugs to stay alive are receiving any of Gilead's medicines. To get the drug to more patients, Gilead is handing over its manufacturing secrets to generic companies who may be able sell the drugs for even less.

``We think they can beat our prices and we would love to see that happen,'' said Gregg Alton, Foster City, California-based Gilead's general counsel, who is working on the negotiations with 10 Indian drugmakers. ``We're going to teach them everything they need to know to make the product.''

Women's Bioethics Project and Center for Women Policy Studies Organizations Launch State Legislative Advisory Board on Women and Bioethics

First Meeting to Convene at the National Conference of State Legislatures in Nashville

SEATTLE--(BUSINESS WIRE)--Aug. 7, 2006--The Center for Women Policy Studies and the Women's Bioethics Project (WBP) today announced the formation of the first-ever State Legislative Advisory Board on Women and Bioethics. The bipartisan 15-member board is made up of progressive state legislative leaders from around the country. The first meeting of the newly formed board will be held in conjunction with the annual meeting of the National Conference of State Legislatures (NCSL) on Monday, Aug. 14, 2006, 3-5 p.m. at the Gaylord Opryland Resort & Convention Center in Nashville, Tenn. The meeting is open to the public.

The advisory board meeting will feature a presentation by Dr. Robin N. Fiore, who is the Adelaide R. Snyder Professor of Ethics at Florida Atlantic University. Dr. Fiore's presentation will cover a full range of bioethics issues ranging from end-of-life issues and the effect of the Terry Schiavo case to stem cell research and its impact on women's reproductive rights and health. Following the presentation, the legislative leaders attending the meeting will assist the Center for Women Policy Studies and the WBP in planning a Bioethics Seminar for Women State Legislative Leaders, which will take place in 2007.

According to Leslie R. Wolfe, Ph.D., president of the Center for Women Policy Studies, "This meeting will provide a forum for state legislators to discuss the challenges they face in understanding the ethical implications of legislative issues pending at the state level." Wolfe, whose organization works with legislators on a range of key policy issues, noted that, "State legislators need support to preserve women's decision-making rights on all these complex issues."

"We are delighted to have such an impressive group of state legislators to advise us. We are focusing on the state legislative level because that's where many of these complicated bioethical issues tend to emerge," said Kathryn M. Hinsch, founder of the WBP. "We firmly believe that women's voices need to be heard, because women are uniquely affected by issues in biotechnology and healthcare. By providing legislative leaders with the support they need to champion these issues, we can help ensure that the entire spectrum of human experience is represented on these critical issues."

The founding members of the state legislative bioethics advisory board are listed here:

-- State Senate Majority Leader Lisa Brown, Wash.

-- State Senator Patrice Arent, Utah

-- State Senator Joan Bray, Mo.

-- State Senator Pam Brown, Neb.

-- State Senator Jennie Forehand, Md.

-- State Senator Karen Fraser, Wash.

-- State Senator Nia Gill, N.J.

-- State Senator Toni Harp, Conn.

-- State Senator Maggie Tinsman, Iowa

-- Former State Senate Majority Leader Lana Oleen, Kan.

-- State Representative Kathy Hawken, N.D.

-- State Representative Linda Lopez, Ariz.

-- State Representative James Roebuck, Pa.

-- State Delegate Jean Cryor, Md.

-- State Secretary of Administration Viola Baskerville, Va.

About the Center for Women Policy Studies

The Center for Women Policy Studies is a Washington, D.C.-based think tank and was founded in 1972. It works with policy makers on such women's human rights issues as reproductive rights and health, international trafficking of women and girls, and the alleviation of women's poverty. (http://www.centerwomenpolicy.org)

About the Women's Bioethics Project

The Women's Bioethics Project (WBP) is an independent, nonpartisan, public-policy think tank based in Seattle. WBP is dedicated to ensuring that women's voices, health concerns and unique life experiences are represented in discussions and decisions about ethical issues in healthcare and biotechnology. (http://www.womensbioethics.org)

Administration to set health care information standards

By David S. Broder

Washington Post Staff Writer
Monday, August 7, 2006; Page A04

The Bush administration will soon launch an ambitious effort to require that all providers of federally financed health care adopt quality-measurement tools and uniform standards for their information technology, Health and Human Services Secretary Mike Leavitt said Sunday.

The goal of the initiative, Leavitt said, is to reduce health-care cost inflation while increasing the quality of medical services individuals receive.

The executive order would affect doctors and hospitals serving the Medicare population of elderly Americans and people served by any other federally financed service.

It would require those health providers to join with the government to standardize the requirements for information technology systems coming into their facilities; set standards for care of specific health problems; and develop uniform methods of measuring and reporting the outcomes of treatments.

Distribution of Resources Curing Hunger and Malnutrition One Spoonful at a time

One area in bioethics that does not get enough attention is equitable distribution of resources -- maybe it is because it's bound up in politics, maybe because of human greed, but whatever the reason, it is heartening to see a story like this one:

Swollen bellies, orange hair, listlessness and dull eyes — these are the traits of child malnutrition in Haiti, the poorest country in the Western Hemisphere and where roughly one of every three children is chronically malnourished.

To try to change that statistic, Patricia A. Wolff, M.D., associate clinical professor of pediatrics. at Washington University School of Medicine in St. Louis, founded Meds & Food for Kids (MFK) in 2004, after she saw that medications and small amounts of the local staples rice, beans and corn weren't enough to nourish children back to health.

MFK works to combat childhood malnutrition and related diseases in northern coastal Cap Haitien, Haiti's second-largest city, by giving Ready-to-Use Therapeutic Food (RUTF) to malnourished children between 6 months and 5 years old. The mixture, known to Haitians as "Medika Mamba," or peanut-butter medicine, is a nutrient-rich mixture of peanuts, sugar, oil, vitamins, minerals and powdered milk. It is distributed in plastic containers for families to feed their children at home and can be stored for several months.

Children start to show visible signs of improvement about 1-2 weeks after receiving the peanut-butter mixture, becoming more active and growing new black hair. One course of the six-week treatment, which can be enough to renourish the child, costs under US$100.

For the rest of the article click here.

(the next step is to make sure that the women giving birth are adequately nourished!)

(Image courtesy of Washington University School of Medicine)

'Fresh Embryos' -- On Sale Now!

The American Society of Reproductive Medicine has been reluctant to invoke standards for fertility clinics, but maybe this latest development will prompt them:

Ethical row over world's first 'made to order' embryos

By Julie Wheldon, Daily Mail 21:46pm 4th August 2006

The world's first human embryo bank has been launched offering 'bespoke babies' for infertile couples.

For around £5,000 couples can buy ready-made embryos matched to their specific requirements - even down to choosing what eye and hair colour they would like their child to have.

In each case the embryos are made from eggs and sperm from two donors who have never even met. The moment of conception occurs in the laboratory and is determined by the genetic combination the clinic thinks will best meet the needs of the paying couples on its books.

'Special offers'

Ethical campaigners last night condemned the move as the "absolute commercialisation of human life." They said it was heart-breaking that babies are now being treated as the equivalent of a supermarket "special offer".

Currently in the UK where one partner is infertile a couple can use donated sperm or eggs to create an embryo to be implanted in the woman's womb. Some couples can also use left-over embryos no longer needed by others who have undergone IVF.

But the new service is totally different as it allows couples to buy fresh embryos that fit their requirements but which have no biological link to either of them.

The human embryo bank is being run by The Abraham Center of Life in San Antonio in Texas. Although the clinic is in the USA, British women are expected to fly over for treatment.

It boasts that its sperm donors all have doctorate degrees and most of its egg donors have college degrees, are under 25 and healthy. So far most of the couples on its waiting lists are happy just to get an embryo and have not set out detailed requirements.

Waiting list for Aryan children

However some have asked for - and been allowed to join list of recipients that will get - embryos made from blond haired and blue eyed donors.

To read the rest of the article, click here.

Who Will Care for the US Elderly, continued...

Thanks again to Lisa Eckenwiler:

Employers expand elder-care benefits
Thursday, July 27, 2006
By M.P. McQueen, The Wall Street Journal

As more Americans care for elderly relatives, companies are increasingly helping employees by adding workplace benefits similar to those that have been offered for child dependents.

About a quarter of all companies currently provide some basic elder-care benefits, mainly referrals that help employees find caregivers and legal services, a recent survey showed. But other companies, such as accounting firm KPMG LLP and Unilever PLC, the consumer-products concern, are going beyond this to provide employees with additional benefits, which can include extended leaves of absence and subsidized in-home care when emergencies arise.

Who Will Care for the US Elderly if the Borders are Closed?

Thanks to Lisa Eckenwiler for bringing this article to our attention from the Wall Street Journal:
(subscription required) Who Will Care For U.S. Elderly If Border Closes?
By BARRY NEWMAN
July 26, 2006; Page B1
PHILADELPHIA -- Forty years ago, Blanca Maldonado moved to the U.S. from Puerto Rico. She married and had 13 children, 28 grandchildren and 30 great-grandchildren. Now 76 years old and bedridden with bone disease, she is cared for by Xiomara Martinez, an immigrant who arrived in 1996 from the Dominican Republic. Luis Maldonado, a 43-year-old cook, sat at his mother's bedside on a visit to her small apartment here one afternoon. "We'd all love to be with her all the time, but we have to take care of our needs," he said of his family. "But we never stop thinking of Mama." Neither does Ms. Martinez. Her own mother entered the U.S. illegally in 1978 and eventually got a green card. After a long wait, her children joined her. At 47, Ms. Martinez earns $6.65 an hour, paid through a state agency, for taking care of Ms. Maldonado's needs, from baths to rice and beans.

The article goes on to say that in the immigration fight that continues to frustrate Congress and its constituency this summer, workers such as Ms. Martinez are examples that the issue cuts into something more basic: a demographic thundercloud moving over the country as baby boomers approach old age. Immigrants, whether legal or undocumented, make up a disproportionate share of those who care for the elderly -- and the need for such workers is set to explode in the coming years. Where will the extra helpers come from?

Plan B may become available OTC after all

Almost a year after ruling that the morning-after pill could not be sold over the counter, the FDA is reconsidering. Early reports suggest that Plan B may become available to women 18 and older only (women younger than that would still need a prescription.)

News from NYT here.
Here's an FAQ from FDA for those who missed the earlier stories about this one.

Intelligent Design: Is it really all about our place in the world?

This article by Robert Lee Hotz of the LA Times pinpoints what he sees as the underlying agenda of the 'intelligent design' promoters: Darwinian evolution unseats humanity as master of a divine creation. With its emphasis on the mechanism of natural selection, it puts people on equal biological footing with barnacles and baboons.

TIME: the truth about stem cells

Hat tip to R. Alta Charo for bringing this story to our attention: Stem Cells -- The Hope and the Hype. The debate is so politically loaded that it's tough to tell who's being straight about the real areas of progress and how breakthroughs can be achieved. TIME magazine summarizes the issues.

Living Large, Part Deux

Gina Kolata asks how long can living large and healthy go on?: Longer life. Less disease. Less disability. The trends have continued for more than a century as humans have become bigger, stronger and healthier. But can they — will they — keep going? Or is there some countertrend, obesity or an overuse of medications, perhaps, that will turn the statistics around?

Nice Rats, Nasty Rats: Genes and Behavior?

Nicholas Wade of the NY Times explores the question of whether or not a single gene that affects the timing of neural crest cell development underlie the whole phenomenon of animal and human domestication? :

On an animal-breeding farm in Siberia are cages housing two colonies of rats. In one colony, the rats have been bred for tameness in the hope of mimicking the mysterious process by which Neolithic farmers first domesticated an animal still kept today. When a visitor enters the room where the tame rats are kept, they poke their snouts through the bars to be petted.

The other colony of rats has been bred from exactly the same stock, but for aggressiveness instead. These animals are ferocious. When a visitor appears, the rats hurl themselves screaming toward their bars.

“Imagine the most evil supervillain and the nicest, sweetest cartoon animal, and that’s what these two strains of rat are like,” said Tecumseh Fitch, an animal behavior expert at the University of St. Andrews in Scotland who several years ago visited the rats at the farm, about six miles from Akademgorodok, near the Siberian city of Novosibirsk. Frank Albert, a graduate student at the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany, is working with both the tame and the hyperaggressive Siberian strains in the hope of understanding the genetic basis of their behavioral differences.

The two strains of rat are part of a remarkable experiment started in the former Soviet Union in 1959 by Dmitri K. Belyaev and his brother, who were geneticists who believed in Mendelian theory.

But implications go far beyond issues in animal domestication: The genes, if Mr. Albert finds them, would be of great interest because they are presumably the same in all species of domesticated mammal, maybe even including humans. Richard Wrangham, a primatologist at Harvard, has proposed that people are a domesticated form of ape, the domestication having been self-administered as human societies penalized or ostracized individuals who were too aggressive.

Human self-domestication, if it occurred, would probably not have exactly the same genetic basis as tameness in animals. But Mr. Albert said that if he could pinpoint the genetic difference between the tame and ferocious rats, he would compare the chimp genome and the human genome to see if they showed a similar difference.

One possibility is that a handful of genes — perhaps even just one — underlie all the changes seen in domestication. A structure in the embryo of all vertebrates, known as the neural crest, is the source of cells that constitute much of the face, skull and pigment cells, and many parts of the peripheral nervous system and endocrine system. If the genes in the neural crest cells were delayed just a little in coming into action, a whole range of tissues could be affected, including the maturation of the adrenal glands that underlies the first fear response of young animals, Dr. Fitch has written.

But aren't you on the payroll, doctor?

Health researchers haven't been faring too well in the news lately. The most recent revelations about scientific misbehavior concern the failure of several prominent health researchers to disclose their financial interests in the treatments they praised in print. Info in the NYT here, here, and here.

Why should the general public care about conflict of interest in professional medical and scientific publishing? Because this one of the main sources (other than online databases) postgraduate physicians use to get information about what's the best way to treat patients. So if an author recommends a certain medication or treatment on the basis of his own financial gain--rather than on what's best for patients--your doctor may (unknowingly, trustingly) recommend that treatment for you or for a family member. (Btw, both of these studies are about treatment for depression--and one includes data on treating depression in children. High-stakes stuff.)

In related news, have you seen the new ads for Lipitor (a cholesterol-lowering medication) featuring Dr. Robert Jarvik? Yes, that's Dr. Jarvik, as in the artificial heart. You can hear ethicist Katie Watson's NPR piece about it here, and read about it here.

And don't get me started on Hwang Woo-Suk. I predict his next blame-deflecting move will be to claim alien abduction.

It's My Body and I'll Decide if I Want To - You would too if it happened to you

Should a teen be forced to undergo chemo therapy? We need to be pay close attention to cases that pit "medical necessity against the explicit wishes of a competent (albeit in this case, a minor) patient." When I read Mr. Cherrix's quote "I can choose what is best for my body....If I don't have the right to do that, I don't have any rights at all" I could not help but consider the implications for reproductive choice including forced caesareans and abortion. Ethical considerations include not just what we "ought" to do but also "who decides”.

Here'e the full article:

NewsTarget.com printable article, Originally published July 25 2006

In health freedom fight, Abraham Cherrix to refuse court-ordered chemotherapy sentence

(NewsTarget) Abraham Cherrix -- the Virginia teen who has been court-ordered to undergo chemotherapy for his Hodgkin's Disease after opting to treat his condition with an herbal diet -- says he will defy the court's order and refuse chemotherapy.
Cherrix says he refuses to subject himself to chemotherapy, which he tried after his initial diagnosis. The chemo made him feel sick, though his cancer briefly went into remission before returning earlier this year. If Cherrix were to submit to the court order, the radiation level for his chemo would be increased.

"I think it's my body. I can choose what's best for my body," says Cherrix. "If I don't have the right to do that, then I don't have any rights at all anyway." Cherrix has been seeing American doctors based in Mexico for five months for guidance with his herbal diet, with the blessing of his parents. Cherrix says, "I feel good. I believe that in my heart, the treatment will cure me."
The Cherrix family's attorneys have filed a motion to stay and are fighting for a new trial in the Circuit Court.

Last Friday, a judge for the Accomack County Juvenile and Domestic Relations Court ruled that Cherrix must resume chemotherapy, and also found his parents guilty of child neglect. If the Circuit Court upholds the lower court's decision, Cherrix's father says he is prepared to face possible jail time. "I'm not going to be an obstacle to my son. If a judge wants to throw me in jail, then he's going to have to do that."

Critics of conventional medicine say Cherrix's situation could bring about an end to health freedom and the ability of every U.S. citizen to choose their own method of healing. Cherrix says his ongoing legal battle to keep his right to naturally treat his cancer is distracting him from healing: "I should be concentrating on my recovery. This case is taking me away from that."

"With this stand against the tyranny of modern medicine, Cherrix has squarely positioned himself as a champion of health freedom," said Mike Adams, health freedom supporter and critic of conventional cancer treatments. "Cherrix's move is brilliant. By refusing to comply with the court order, the court must either back down and recognize his right to refuse chemotherapy, or it must stick a gun in his face, handcuff him and force deadly chemicals into his veins in a Guantanamo-style torture scene.

Either way, Cherrix wins. He either regains his freedom or single-handedly exposes the true tyranny and destructive intentions of conventional medicine. The public backlash against such images would be unprecedented." Adams also added, "My advice to Cherrix and his family is that they document everything. Record audio, take pictures and film whatever happens. Faced with the prospect of daylight, these cancer industry evildoers will be forced to back down. The Judge who ordered the chemotherapy, by the way, should be charged with attempted murder."
###

Searching for a 'middle ground' in the malpractice crisis

From the Sorry! Works Coalition:

Many states have adopted or are considering 'apology laws' that exempt expressions of regret, sympathy or compassion from being considered as admissions of liability in medical malpractice lawsuits. The intent is to encourage physicians and other healthcare providers to apologize to patients when a medical error, accident or unanticipated outcome occurs without the apology being taken as an admission of guilt. The consensus is that healthcare providers have become reluctant to explain to patients and their families what happened when procedures go wrong because they fear the information will be used against them in court. Many healthcare providers have struggled with their desire to explain and apologize to their patient, but have often been strongly advised against such open discussions by their defense attorneys.

And I love being here in Vermont ~ we're proposing legislation that Sorry! Works says is a true road map for every other state in the union.

This is your brain; this your brain on a computer

From Wired: DARPA (Defense Advanced Research Projects Agency) has been funding new brain-computer-interface technology could turn our brains into automatic image-identifying machines that operate faster than human consciousness.

Researchers at Columbia University are combining the processing power of the human brain with computer vision to develop a novel device that will allow people to search through images ten times faster than they can on their own.

The technology would allow hours of footage to be very quickly processed, so security officers could identify terrorists or other criminals caught on surveillance video much more efficiently.

The "cortically coupled computer vision system," known as C3 Vision, is the brainchild of professor Paul Sajda, director of the Laboratory for Intelligent Imaging and Neural Computing at Columbia University. He received a one-year, $758,000 grant from Darpa for the project in late 2005.

The system harnesses the brain's well-known ability to recognize an image much faster than the person can identify it.

"Our human visual system is the ultimate visual processor," says Sajda. "We are just trying to couple that with computer vision techniques to make searching through large volumes of imagery more efficient."

The brain emits a signal as soon as it sees something interesting, and that "aha" signal can be detected by an electroencephalogram, or EEG cap. While users sift through streaming images or video footage, the technology tags the images that elicit a signal, and ranks them in order of the strength of the neural signatures. Afterwards, the user can examine only the information that their brains identified as important, instead of wading through thousands of images.

Legal, Medical, and Ethical Questions raised about the charges against healthcare providers during Katrina

Our Board Member R. Alta Charo is cited in a NY Times articles among the experts in medicine and ethics who have many questions about the accusations, to kmade on Tuesday by Louisiana’s attorney general, that a doctor and two nurses used lethal injections ill four critically ill patients in a flooded New Orleans hospital after Hurricane Katrina.

In interviews, several experts said that although they did not know the details of the case, they suspected that it had to be more complicated than the “plain and simple homicide” asserted by the attorney general, Charles C. Foti.

One possibility is that the patients were suffering and the only way to keep them comfortable was with high drug doses that may, incidentally, have hastened their deaths. It is not known, though, how much the patients were suffering.

Charo, a professor of law and bioethics at the University of Wisconsin, said: “The real dilemma here is in getting at the very precise facts of the case. I can say that, as a general matter, if you have a patient who is in distress and who needs pain relief and if the only level of painkillers that will relieve the pain also poses a high risk of death then it is permissible to give the pain relievers, provided the patient has consented to the risk of death.”

Even if the patient can no longer give consent, Professor Charo said, it is still ethical for doctors to treat the pain if they believe it is what the patient would want.

“If that was the case, then this is not simple homicide, and I can only hope the investigators were attentive to this,” she said.

Never Eat Anything Bigger Than Your Head and other guidelines to ethical eating

I love what Art Caplan has to say about shopping in the supermarket in this Washington Post article entitled, "Is there anything left to eat?": Caplan believes there's no need to have "a moral aneurysm" every time we go to the supermarket. Every person, he says, needs to establish a scale of ethical priorities. Is taste most important to you? Cost? The environment? Your health? Animal suffering? Pick one thing that matters most and let that drive your decisions.

For Caplan, No. 1 on his list is whether suffering was involved. "So I want happy chickens, no veal, no foie gras. After that comes environmental impact, and then labor. I have an ethical guide in my head that helps me through the store."

He also points out that, in a way, we should be grateful we are even considering all these ethical questions. "These are the dilemmas of abundance," he says. "If we were living in Darfur, the only answer to 'what to eat?' would be 'anything I can find.' "

Brainy Bots

At Stanford University computer scientists are developing a robot that can use a hammer and a screwdriver to assemble an Ikea bookcase (a project beyond the reach of many humans) as well as tidy up after a party, load a dishwasher or take out the trash.

Researchers at the École Polytechnique Fédérale de Lausanne in Lausanne, Switzerland, are building large-scale computer models to study how the brain works; they have used an I.B.M. parallel supercomputer to create the most detailed three-dimensional model to date of a column of 10,000 neurons in the neocortex -- it is known as the "Blue Brain" Project. (Anybody ever read The Footprints of God?)

Blue Brain researchers say they believe the simulation will provide fundamental insights that can be applied by scientists who are trying to simulate brain functions. Researcher Robert Hecht-Nielsen is seeking to build an electronic butler called Chancellor that would be able to listen, speak and provide in-home concierge services. He contends that with adequate resources, he could create such a machine within five years. (ooh, wouldn't you like one of those?)

Bush exercises his first veto on stem cell bill

The "veto bubble" has finally burst. Five-and-a-half years into his presidency, George W. Bush has ended his record stretch of bill-signings as he rejected legislation Wednesday that would expand federal funding of human embryonic stem-cell research.

Attempts in Congress to override the veto, which would require a two-thirds vote, were expected to fail.

According to the Christian Science Monitor, analysts agree that President Bush's veto was risky but unavoidable. Since the issue of stem-cell research arose early in his presidency, when Mr. Bush approved federal funding of preexisting stem-cell lines, he has remained adamant that no federal monies be used on newer cell colonies. The president believes the killing of human embryos, from which stem cells are harvested, is murder, says press secretary Tony Snow.

But an editorial from the Washington Post this morning poses an interesting argument: "We understand that people can in good faith disagree on this question. But we don't understand the logic of Mr. Bush's position. If using discarded embryos to extract stem cells is murder, how can he permit it to proceed with private funding?" (or IVF research to continue for that matter?)

What’s wrong with being an old mother?

A 62 year old woman became Britain’s oldest mother, and one of the oldest in the world, on July 5 when she gave birth to a baby boy.Patti Farrant, a child psychiatrist, underwent fertility treatment abroad in order to fulfill her 60 year old husband’s dreams of becoming a father.Farrant used invitro fertilization techniques and a donated egg to get pregnant.The baby weighed 6 pounds and 10 and a half ounces.Doctor Severino Antinori was the doctor who supervised the procedures.In the early 1990’s doctor Antinori helped a 62 year old Italian women give birth using fertility treatments and a donated egg.Since then Italy has created Europe’s strictest laws about invitro fertilization techniques and other assisted reproduction procedures, and Farrant’s case was carried out in a former Soviet republic.Fertility clinics in Britain will not use assisted reproduction techniques for women past the normal child birthing years. Liz Buttle was Britain’s oldest mother until now.In 1997 she gave birth at the age of 60. The world’s oldest mother is Adriana Iliescu, a Romanian woman, who became a mother at the age of 66.
Read more:

Veto pending...

From R. Alta Charo just off the presses:

Rumor has it that the president's veto of the stem cell bill will take
place around 2 pm today.

To express either support or opposition to this action, you may call the
white house at comment line at 202-456-1111.  other white house numbers are:


202-456-1414

202.395.3000

Living Large in Chicago ...

Catfish beignets, curly fries smothered in cheese, pierogies with sour cream, beer-battered artichoke hearts, and fried dough buried in berry sauce and whipped cream -- all part of the traditional Taste of Chicago and all contributing to Chicago's reputation for being one of the 'fattest' cities in the US. And if Edward M. Burke, Chicago City Councilman since 1969, has his way it will be illegal for restaurants to use oils that contain trans fats, which have been tied to a string of health problems, including clogged arteries and heart attacks.

But even Mayor Richard M. Daley, who often promotes bicycle riding and who not long ago appointed a city health commissioner who announced he was creating health “report cards” for the mayor and the aldermen, has balked at a trans-fat prohibition as one rule too many.

What do you think? I love Chicago, it's my favorite city, and I'll like to see it be more healthy -- but does this go overboard? Or is it in the same category as banning smoking in public places? It brings up a host of legal and ethical questions, what role does government play in regulating lifestyle? And if I consciously choose to smoke or eat trans fats, can I really expect society to pay for my care? I'd love to hear your thoughts on this matter...

Adult Stem Cell Bill Defeated

Another update via R. Alta Charo:

By KIMBERLY HEFLING, Associated Press Writer

WASHINGTON (AP) -- Sen. Rick Santorum, a conservative struggling to win reelection, suffered a political setback late Tuesday when the House rejected his bill to encourage adult stem cell research. The 273-154 vote fell 12 votes short of the two-thirds majority required under the rules. Opponents, mostly Democrats, said the bill would have given the Republican Santorum and other anti-abortion lawmakers political cover for opposing a related bill that instead would fund embryonic stem cell research. The bill had passed the Senate unanimously earlier in the day. Santorum likens embryonic stem cell research to abortion because a days-old embryo is destroyed in the process of extracting stem cells.

A spokesman for Santorum did not respond to requests for comment.

Stem Cell Research Act - Roll Call!

Thanks to R. Alta Charo for this link which colorfully depicts how the Senate voted on the Stem Cell Research Enhancement Act (HR 810.) You can click on your state to get details on how your Senator voted. To the 63 Senators who voted "yes" - thanks for putting partisan politics aside and doing the right thing.

Immoral Not to Support HR 810

At the Bioethics and Politics Conference in Albany, one of the neo-conservative speakers quipped in a Q/A session, “I wish liberals cared as much about the unborn as they do about the uninsured.” I was struck by the immense lack of compassion for those who are unable to receive the medical care they and their families so desperately need today. So I was delighted, in light of the political frenzy going on in Washington DC right now on the various stem cell bills, to find this statement from June Walker, National President of Hadassah:

In a statement today, June Walker, National President of Hadassah, appealed directly to Senator Bill Frist, Senate Majority Leader, who visited Hadassah Medical Center in May 2005, to do all he can to ensure Senate passage (of HR 810). “By passing this legislation, the Senate will definitively demonstrate that stem cell research is not an issue that divides Americans by political party or faith. This bill would affirm the sanctity of both human life and the spirit of free inquiry-two tenets of America’s spiritual and political life behind which the vast majority of Americans proudly stand. It is immoral for our families, neighbors and friends to suffer while Washington politics hold hostage treatments within our scientific grasp. A presidential veto would not reflect the American people’s political will.”

Now that's what I call being "pro-life". You can read the full statement at: Hadassah News.

Bioethics: Struggle for the control of life (and death)

I just returned home from the Bioethics and Politics Conference in Albany. I say “just” because a flight delay in Albany caused me to miss my connection home to Seattle, forcing me to spend Friday night at the airport in Chicago. United finally got me back to Seattle (via a DC connection!) late Saturday night. The travel glitch made me miss an important personal event in Seattle and had my friends asking me once again, why are you so committed to these seemingly obscure “bioethical issues?”

I don’t usually share my personal woes on the WBP blog. But I’m doing so because it gives me the opportunity to point out that the most important achievement of Glenn McGee’s historic conference is that it clearly demonstrated that bioethics is neither a collection of sideshow issues (Schiavo, Baby Doe, or media issue du jour) nor merely a sub-specialty of philosophy.

As many of the speakers (Charo, Zoloth, Cohen, Moreno, Smith, Doerflinger, Cameron, Wolpe – wow, what a line-up) powerfully indicated, at the core of this politicized bioethics, is the ultimate power struggle for the control of life (and death) and our sense of ourselves as human beings. And this, my friends, is worthy of devoting ones life too. Congratulations to Glenn and the other scholars who participated for an excellent conference.

PS. WBP board member Linda MacDonald Glenn spent much of the conference interviewing all sides of this debate and will be posting a series of fascinating podcasts. Thanks to Linda for her commitment to bring the conference to a broader audience.

More podcasts from the ASBH conference

As a Women's Bioethics Project scholar and newly appointed faculty member of the Alden March Bioethics Institute, I was able to interview a number of speakers from the ASBH Conference on the Future of Bioethics and Politics in Albany, NY, including Glenn McGee, Art Caplan, Eric Cohen, Nigel Cameron, Jonathan Moreno, and Jay Hughes and capture the interviews for podcast, available here.

I was also able to capture two of the lectures from the conferences, those of R. Alta Charo and Edmund Pellegrino, although the sound quality on those is not as good as those of the interviews, at least until I can figure out how to sound edit them.

Look for pictures from the conference to be posted shortly ~ In the meanwhile, happy listening!

Live from New York ! -- the ASBH Politics and Bioethics conference!

Listen to our podcasts (1 and 2) about the how the 'rumble' in Albany started off with a bang!

Fellow blogger Alison McCook had this to say about the conference:

Civility and civil disobedience

The Bioethics & Politics conference hosted by the Albany Medical College got off to a bang today, not a whimper. As participants trickled in, networking and finding old friends, another, uninvited group calmly filed in, parked in front of the room, and started shouting at the tops of their lungs.

The protesters, around 30 or so, were from Not Dead Yet, a disability rights group that is against legalized euthanasia and other forms of "medical killing," as they call it. The meeting hall became quickly filled with cries of "nothing about us without us." Members quickly distributed fliers to participants that explained they were upset that conference organizers had gathered people from both sides of the political spectrum, but failed to include advocates of the disabled.

Huh? I’m all about pluralism, but the conference is about politics, and with only a day and a half at our disposal, it makes sense to focus the discussion. However, the director of the AMC’s Alden March Bioethics Institute, Glenn McGee, to his credit, took the microphone and said the organizers had decided to give Not Dead Yet a chance to speak. (Glenn even managed to open with a joke: "As you can see, everything is going according to plan.") Representative Stephen Drake spoke for 10 minutes about how politics is not important to people at the front lines of hot button issues ("We live in a world where partisan lines aren’t that important"), and received as much applause as any pre-planned speaker did the rest of the day. After his speech, he and his colleagues left, and it was all very civil.

The experience clued me in to the fact that bioethicists are, by the nature of their purview, adept at handling heated debates and, hopefully, finding a compromise many people can live with. If only other discussions had such a happy ending as this one.

Diagnosing Medical Malpractice -- Curing the Ailment, not just treating the symptoms

Senate Majority leader Bill Frist's answer to runaway health-care spending is to cap jury awards in medical malpractice suits -- for the fifth time in four years, he tried and failed to cap awards at $250,000 during his self-proclaimed "Health Care Week" in May.

But how's this for a novel approach?: Sens. Hillary Clinton and Barack Obama also want to save on health care, but rather than capping jury awards, they hope to cut the number of medical malpractice cases by reducing medical errors, as they explain in the New England Journal of Medicine.

Supporting this approach is a recent study out of the Harvard School of Public Health that showed that the legal system does a good job of weeding out claims without merit.

World's First 'test-tube' baby set to give birth; baby conceived the 'old-fashioned' way

On July 25, 1978, Louise Joy Brown, the world's first successful "test-tube" baby was born in Great Britain. Now the world's first test-tube baby is expecting a baby of her own. Brown, 27, is due to give birth in January. She has been married for two years to a security officer, Wesley Mullinder, and their baby was conceived the old-fashioned way."This is a dream come true for both of us," Brown told Britain's The Daily Mail newspaper. The couple live outside of Bristol where Brown is an administrative assistant for a shipping firm. They made headlines in 2004 when they married. The pregnancy is yet another in a long list of headlines surrounding Brown's life that began in such an unusual way.

Access to Abortion as a Human Rights Issue

Women's E-news reports that a Polish woman, Alicja Tysiac, applied for an abortion a few years ago, but her medical grounds were refused. She wound up carrying the pregnancy to term and losing her sight. Now her case awaits judgment by the European Court of Human Rights.

Rudeness ok for docs, says court

At first glance, you might think this was a story from the National Enquirer, but you'd be wrong. Apparently a New Hampshire physician told an obese patient that she was so fat "only black men would want her." The patient sued.

The judge agreed that the remark was uncalled for, but said that the physician had a right to speak bluntly, writing, "It is nonetheless important ... to ensure that physicians and patients are free to discuss matters relating to health without fear of government reprisal, even if such discussions may sometimes be harsh, rude or offensive to the listener."

Sure, sure--docs have free speech rights the same as the rest of us. But it seems neither professional nor kind. . . . which I think are characteristics we'd like to see in our physicians, no? One hopes that some professional organization will have something more to say to the doc in question.

Johann Hari: Why I support liberal eugenics

Johann Hari of the Independent claims this has nothing to do with the evils of Nazi eugenics; it is entered into by parents and it is motivated by love.

Can anyone say "genetic idolatry"? Aren't we more than the sum of our genes? Or are we mere 'meatbots'?

Shades of "The Dead Zone" -- the rewired brain

Anyone who has watched the USA network's series The Dead Zone will be surprised (or maybe not) to hear that doctors contend that man's brain rewired itself after being in a minimally conscious state for 19 years. According to the Boston Globe, Terry Wallis awoke from a coma-like state 19 years after tumbling over a guardrail in a pickup truck and falling 25 feet into a dry riverbed. Now doctors armed with some of the latest brain-imaging technology think they may know part of the reason why.

Wallis showed few outward signs of consciousness, but his brain was methodically rebuilding the white-matter infrastructure necessary for him to interact with the outside world, researchers reported yesterday in the Journal of Clinical Investigation.

``I believe it's a very, very slow self-healing process of the brain," said Henning Voss, lead author of the study and a physicist at Weill Cornell Medical College's Citigroup Biomedical Imaging Center.

Wallis emerged from a minimally conscious state in 2003 at the age of 39 and uttered his first word since Ronald W. Reagan was in the White House: ``Mom." Since then, the onetime mechanic from Big Flat, Ark., has regained the ability to form sentences and recovered some use of his limbs, though he still can't walk or feed himself.

Using both PETscans (Positron Emission Tomography scans) and an advanced imaging technique called diffusion tensor imaging, the researchers examined Wallis's brain after he regained full consciousness, and found that cells in the relatively undamaged areas had formed new axons, the long nerve fibers that transmit messages between neurons.

``In essence, Terry's brain may have been seeking out new pathways to reestablish functional connections to areas involved in speech and motor control -- to compensate for those lost due to damage," said the study's senior author, Dr. Nicholas Schiff, a neurologist at the Weill Cornell Medical College in New York.