Pimp My Pride; More on the 'pimping' of medical students

A guest post by Alice Herb on topic we had blogged about before:

Medical students are a special concern to me so when I recently read Barron Lerner’s essay in The New York Times, I hoped to get a clue about what happens to medical students in the course of their education. Dr. Lerner, a physician and historian, described what he believes to be a vanishing form of teaching known as “pimping.” This peculiarly named practice is one where students are peppered with questions about diseases, patients, identification of vital organs, etc. while on patient rounds or attending surgeries. As Dr. Lerner pointed out, these practices, depending on the personality of the attending senior physician, can in fact be educational but can also be humiliating, embarrassing and undermining.

I first encounter future medical students when I interview them for admission. At that time, while admittedly trying to make a good impression, they are nonetheless brimming with enthusiasm, idealistic and eager to learn how they can best help the ill and infirm and in the process “make a difference.” They have all spent an inordinate amount of time volunteering both in medical settings and in their communities. Their energy seems boundless. Yet by the time they are in their fourth year of medical school, I find that too many of the students have become cynical, uninterested in the human side of medicine and reluctant to sit still for something as unimportant as bioethics. What has happened to them? Is this what we do to our best and brightest? What is it in the medical school environment that graduates doctors who have lost or turned off human instincts? If we are to fix our health care system we need to remember to nurture the softer, more compassionate traits of our practitioners.

[Thanks, Alice!]

Cognitive Liberty in an Age of Neurotechnology

Top Bioethicists. Physicians & Psychologists to speak at UN Panel to discuss "Cognitive Liberty in an Age of Neurotechnology"

Contact: Ana Lita (212) 687-3324 | AnaLita@iheu.org


IHEU - Appignani Center for Bioethics to host panel, Friday, Dec. 1, 2006

NEW YORK – On Friday, Dec. 1, 2006 a panel of leading bioethicists and physicians will discuss cognitive liberty at the United Nations, to be held on the 2nd floor of 777 UN Plaza in New York City, from 6:00 p.m. to 8:00 p.m.

Growing knowledge in the neurosciences, enhanced by exponential advances in pharmacology and neurotechnologies that monitor and manipulate the brain, is rapidly moving brain research and clinical applications beyond the scope of purely medical use.

These emerging neurotechnologies offer expanded intelligence, memory, and senses, giving us greater ability to understand and control our own minds. But they might also expand the avenues for possible coercion and invasion of mental privacy.

What, then, is the state of cognitive liberty today? What steps might be necessary to protect cognitive liberty, mental privacy and freedom of choice in light of these neurotechnologies?

Speakers include:

James Hughes Ph.D. is the author of Citizen Cyborg: Why Democratic Societies Must Respond to the Redesigned Human of the Future. Dr. Hughes teaches Health Policy at Trinity College in Hartford Connecticut, and serves as Trinity's Associate Director of Institutional Research and Planning. He is the Executive Director of the World Transhumanist Association and its affiliated Institute for Emerging Technologies. Dr. Hughes will moderate the panel. Home page: http://www.changesurfer.com/Hughes.html

Elizabeth Phelps Ph.D. is currently a Professor of Psychology and Neural Science at New York University. Her laboratory has earned widespread acclaim for its groundbreaking research on how the human brain processes emotion, particularly as it
relates to learning, memory and decision making. Dr. Phelps is the recipient of the 21st Century Scientist Award from the James S. McDonnell Foundation and a fellow of the American Association for the Advancement of Science. Home page: http://www.psych.nyu.edu/phelpslab/

John P. Morgan M.D. is a physician and professor of pharmacology at the City University of New York Medical School. Dr. Morgan has published approximately 100 articles, book chapters and books, largely focused on the clinical pharmacology of psychoactive drugs. His latest book, Marijuana Myths, Marijuana Facts (The Lindesmith Center, New York, 1997) reviews the latest
scientific and medical research and debunks the common marijuana myths.
Home page: http://www.norml.org/index.cfm?Group_ID=5831

Bradley Lewis MD, PhD teaches cultural studies at the Gallatin School at New York University, with affiliated appointments in the Department of Social and Cultural Analysis and the Department of Psychiatry. He is the author of numerous articles published in academic journals, is the cultural studies editor for The Journal of Medical Humanities, and author of Postpsychiatry: Theorizing Psychiatry, Prozac, and DSM.
Home Page: http://www.nyu.edu/gallatin/about/faculty-bios.html

The IHEU-Appignani Center for Bioethics promotes a human-centered approach to bioethical issues. For information, visit: www.iheu.org/bioethics.

Research that hangs on stem-cell politics

McGill scholar Abby Lippman speaks out in the Globe and Mail against the commercialization of women's eggs:

Your latest call for research cloning in Canada once again makes no mention of the serious concerns raised by the technique. Even if the promises by scientists and politicians of cures for patients and boosts to the economy were realizable, this approach to embryo stem cell research requires a continuous supply of fresh human eggs. To get these eggs, women must be given large doses of powerful hormones to hyper-stimulate the ovaries. This is not just uncomfortable, but potentially very risky.

Scientists have called research cloning a wildly inefficient process requiring hundreds of eggs to produce just a single clone. And to date, there have been no validated reports that this actually can happen.

The approach you urge is likely to mean paying women for eggs and the start of a commercial market. To avoid turning women into egg farms, let's continue to support research within the law.

Abby Lippman, PhD
Professor, McGill University
Chair, Canadian Women's Health Network

[Editor's Note: Thanks for letting us know about this, Abby!]

Kudos and Double Kudos!

Kudos to our board member, R. Alta Charo -- she was recently elected to the Institute of Medicine, an arm of the National Academies.
But she didn't stop there! She was also recently chosen as a fellow to the World Technology Network, along with Art Caplan and Jonathan Moreno, both of whom are also Women's Bioethics Project supporters! Way to go, girl! Way to go, guys!

Stem cell research and its powerful role in the elections

Michael J. Fox, a well known actor who is suffering from Parkinson's disease, appeared in a TV ad backing a pro stem cell research candidate, in a close race for a Senate seat. The ad, which is both emotional and difficult to watch, shows the actor shaking uncontrollably and highlights his deteriorating health condition. Fox's goal is to persuade the electorate in Missouri that by voting for the candidate who supports stem cell research they offer suffering people like himself a hope for recovery.

According to MSNBC, the Michael J. Fox ad stirred a strong response from voters in Missouri, where a constitutional amendment on the ballot would legalize embryonic stem cell research. The race in Missouri is very close and the incumbent republican senator is facing a tough battle mainly because his opponent, a democrat, is pro stem cell research while he is not.

Arthur Caplan, Director of the Center for Bioethics at the University of Pennsylvania, argues that stem cell research has become a focal point in heated Congressional races across the country (including New York, Florida, New Mexico and Virginia, among others) and democratic candidates are using their pro stance on this issue to gain ground against republicans, who in general oppose public funding for such research. What's noteworthy is the emergence of a powerful group that is backing the pro stem cell candidates and funding these multimillion-dollar TV ad campaigns. Caplan indicates that this is not a small interest group pushing a narrow agenda, rather a well organized effort by lobbyists from a broad set of disease and disability organizations, representing people suffering from cancer, paralysis, heart disease and various other illnesses. These groups have pulled together and with their significant money raising ability they are helping pro stem cell research candidates win important votes.

Furthermore, by focusing their efforts on the ethical arguments in favor of public funding for embryonic stem cell research, it seems these interest groups are changing the minds of politicians on both sides of the political spectrum. To this point, Congress, which was strongly against stem cell research in 2002, recently came close to overriding President Bush's veto which blocked public funding for such research. Therefore, through their access to significant funding, increasing lobbying power and sheer control of votes (as they represent a large constituency of people suffering from a broad set of diseases) these disease advocacy groups are putting stem cell research in the spot light and can significantly influence the outcome of elections on Nov. 7 and beyond.
Read more:

Editor's note: McCaskill Upsets Talent for Mo. Senate

Late Night Election Round-up

As it often does for me, curiousity over a couple of key ballot issues gave way to needing to see the reults before I could shut my brain off for bed (thus explaining being awake at 3:45am EST). Jim Fossett, of the AMBI/Rockefeller Institute Federalism and Bioethics Initiative, gave a great pre-election summary of races directly or indirectly influnced by the stem cell debate over at the AJOB editors blog, which I referenced frequently over the course of the evening.

I figured, since I'm up, it might be fun to beat Jim and the AJOB blog to the punch, and post a basic roundup of election results and key issues. Call it a little late night competition, all in the name of fun and insomnia.

In his great election roundup, Jim listed out a couple of the key Senate races where candidates had announced and different positions on stem cell research, but it was not likely to be the decisive issue of that state election. At last check*, four of those five races have gone to the pro-stem cell research candidate: Cardin (Maryland, D), Brown (Ohio, D), Klobucher (Minnesota, D), and Menendez (New Jersey, D). Virginia's Senate race was not yet called, but with 99% of districts reporting, Webb (D) had garnered 50% of the vote, with a lead of approximately 6500 votes. Close, likely to be challenged, but closer races have been called over the course of the night. (Since it is one of the last races to be called, and the result will tip the balance of power in the Senate, CNN and other sources are taking longer than otherwise normal to call the results in this race.)

And of course, Missouri was ground zero for stem cell politics this election, with McCaskill and Talent both weighing in on the issue, Amendment 2 over whether to allow stem cell research, and the now-infamous Michael J. Fox advertisement. Although I've not heard if he's conceded, yet, CNN and several other media outlets are calling the race close, but in McCaskill's favour. And maybe more importantly, in a very close race (51%/49%, with 97% of districts reporting), Missouri voted to allow stem cell research! This particular amendment result flipflopped over the course of the evening, and is the main reason I'm still awake at this hour - I became emotionally invested in finding out the result! What will be interesting is the research that will come out over the next couple of weeks, indicating whether or not Fox's advert did indeed get people out to vote.

In other key ballot issue news:
Banning Same Sex Marriage
Same sex marriage bans were on the ballot in eight states, with Colorado having two referendums, one to ban gay marriage and one to allow domestic partnership. To say the results are disappointing is an understatement:

• Arizona, Proposition 107: Yes, 49%, No, 51%, 97% precincts reporting


• Colorado, Referendum 43: Yes, 56%, No, 44%, 82% precintcs reporting


• Idaho, Amendment 2: Yes, 65%, No, 35%, 72% precincts reporting
  
• South Carolina, Amendment 1: Yes, 78%, No, 22%, 99% precincts reporting


• South Dakota, Amendment C: Yes, 52%, No, 48%, 96% precincts reporting


• Tennessee, Amendment 1: Yes, 80%, No, 20%, 98% precincts reporting


• Virginia, Ballot 1: Yes, 59%, No, 43%, 99% precincts reporting


• Wisconsin, Referendum 1: Yes, 59%, No, 41%, 95% precincts reporting

With Colorado banning gay marriage, in a separate referendum (#1) they also banned domestic partnerships, which would have legalized

domestic partnerships, providing same-sex couples the opportunity to obtain the legal protections and responsibilities granted to married couples under Colorado law. The measure specifies that domestic partnerships are not marriage and do not change the public policy of the state, which defines marriage as only the union of one man and one woman.

This particular referendum flipflopped back and forth as tallies came in, but finally seems to have settled on not passing, with 53% of the precincts voting no.

Affirmative Action
In controversial and interesting news, Michigan's Proposition Two, a proposed amendment to the state constitution to

"prohibit the University of Michigan and other state universities, the state, and all other state entities from discriminating against or granting preferential treatment based on race, sex, color, ethnicity or national origin."

was passed (58% yes, 42% no). This, of course, stemmed from a 2003 University of Michigan case (Grutter v. Bollinger) that went to the Supreme Court. The Supreme Court, to the public opposition of the Bush Administration, ruled in favour of affirmative action. Do our resident lawyers know if this proposition, being passed, can be challenged legally, or is this proposition a response to the Supreme Court ruling, in an effort to legally ban affirmative action?

Abortion
In issues pertinent to women's health, California and Oregon both similar measures attempting to enact parental notification laws for minors seeking abortions. This was Proposition 85 in California, and Measure 43 in Oregon. They had similar language, both wanting to

prohibit abortion for a minor until 48 hours after a physician notifies her parent or legal guardian, except in cases of medical emergency or a parental waiver.

In addition, Measure 43 defined medical emergency to not include incest or rape. Neither of these passed, with voters in both states voting 54% no, 46% yes.

South Dakota's extremely controversial complete ban on abortion, signed into legislation by Gov. Rounds back in March as an intentional challenge to Roe v. Wade, was rejected by voters, with 55% voting no on Referendum 6 (ban on abortion). Interestingly, Gov. Rounds was not voted out of office for signing the legislation, but was instead voted back into office with nearly 70% of the vote.

I'm sure there were other very interesting races and issues in yesterday's election, but these are the things that caught my eye. Oh! And one other thing. While I was passing the time waiting for election results to come in, I decided to see if there was any truth to the truthiness of Stephen Colbert's claim that all of the Congressmen/women up for re-election who had appeared on The Colbert Report in the last year were re-elected. As you may or may not know, both Republicans and Democrats were strongly advised to not appear on Colbert's show, with to-be Speaker Pelosi's video clip advising fellow Democrats to avoid the show getting heavy rotation in most media outlets. And behold, there was indeed truth in the truthiness. Of the 26 Congressional districts that have been featured on the show and up for re-election, all 26 incumbents who appeared on the show were re-elected.

However, if you were a challenger featured in the Better Know a Challenger segment of the show (airing the last two months, as incumbents from both sides of the political spectrum avoided Colbert), the news isn't so good. Only one of the six challengers won their seat - so congratulations to New York's 19th Congressional District (the fightin' 19th!) John Hall (D) for bucking that particular trend. Good news for him, bad news for anyone hoping that there was an actual political bump to appearing on The Colbert Report.

*All facts and numbers in this post come from CNN's Election 2006 coverage, accessed around 03:45EST, unless otherwise noted. Most numbers are unlikely to change at this point, but several elections are close enough that they are likely to be challenged and ballots recounted in the next few days.

UK Scientists Ask for Permission to Create Chimeras

According to the BBC News, researchers from Newcastle University and Kings College, London, have asked the Human Fertilisation and Embryology Authority for permission to create embryos by fusing human DNA with cow eggs. These chimeric eggs would be used for embryonic stem cell research, destroyed after the stem cells are extracted. This appears to be their way around the short supply of human eggs to use in embryonic stem cell research, but the thing is, these would be chimeric embryos; they're saying 99.9% human. Does that other .1% matter?

While I can understand the idea of test runs before moving on to more valuable (rare) human eggs, I'm not necessarily convinced that this sort of test run needs to be done. We know the technology works, we know how to use it - what, entirely, is the point?

(Then again, I'm not convinced of the opposition argument by Calum MacKellar, of the Scottish Council on Human Bioethics, which basically says there is a line of separation between humans and animals, and to blur that line undermines the distinctions between the species, as well as running the risk of underming human dignity.)

Food. Lies and Videotape (or whatever medium you prefer)

Do you want lies with that? I love it when Hollywood displays a conscience -- this time, Hollywood tackles the ethics of the fast-food industry in their flick, Fast Food Nation:

Inspired by the bestselling book that exposed the hidden facts behind America's fast food industry, the movie traces the birth of an everyday, ordinary burger through a chain of riveting, interlocked human stories - from a hopeful, young immigrant couple who cross the border to work in a perilous meat-packing plant, to a teen clerk who dreams of life beyond the counter; to the corporate marketing whiz who is shocked to discover that his latest burger invention - "The Big One" - is literally full of manure and how he deals (or doesn't) with the lack of ethics in this field -- it unveils a provocative portrait of what lies inside that America is biting into.

Videos by vMix Member:Fox Searchlight

Imaging the Speaking of Tongues

The cat has my tongue this morning, so I'll let the NY Times say it:

A Neuroscientific Look at Speaking in Tongues

By BENEDICT CAREY

November 7, 2006, NY Times

The passionate, sometimes rhythmic, language-like patter that pours forth from religious people who “speak in tongues” reflects a state of mental possession, many of them say. Now they have some neuroscience to back them up.

Researchers at the University of Pennsylvania took brain images of five women while they spoke in tongues and found that their frontal lobes — the thinking, willful part of the brain through which people control what they do — were relatively quiet, as were the language centers. The regions involved in maintaining self-consciousness were active. The women were not in blind trances, and it was unclear which region was driving the behavior. To read more, click here...

Male Contraception -- an option in the works

All I can say is "Isn't it about time?":

Contraception as an Option for the Man

By MICHAEL MASON

Published: November 7, 2006, NY Times

Ben Kleinman plans to marry next year, and already he looks forward to starting a family. But he knows, too, that there will come a day when he and his wife do not want more children, and that she may grow weary of shouldering the burden for contraception. To read more, click here...

Are 'Partial Birth' Abortions Ever Medically Necessary?

On Nov. 8, 2006, the U.S. Supreme Court revisits the Partial Birth Abortion issue again in the cases of Gonzales v. Carhart and Gonzales v. Planned Parenthood. The Supreme Court had addressed in this issue 2000, in Stenberg v. Carhart, where a 5-4 decision struck down a state statute in part because it contained an exception only in cases where a woman's life is in danger and did not allow a similar exception to protect a woman's health. Nebraska legislators have re-drafted the legislation to declare that 'partial-birth' abortions are never medically necessary, hoping that the Supreme Court will find this law to be constitutional. (Query: If a legislature declares something to be a fact, does that automatically make it true? Like if the legislature declared Omaha, Nebraska to be the center of the universe, does that make it so?)

The Pew Forum on Religion and Public Life has done a thorough job of delineating all the background on the partial-birth abortion issue, if you'd like to download the 12 page document.

And NPR interviews Obstetricians who challenge the notion that so-called 'partial birth' abortion is never medically necessary.

Fox and Counter Fox revisited

Stephen Colbert on the Rush Limbaugh, Michael J. Fox Affair

too funny to pass up -- The Last Word on shameless Fox hunting on The Colbert Report (pronounced 'rapport').

We're afraid it's come to this

At first it was an occasional hurtful/racist/sexist/hateful comment. We would pull the comment and hope for the best. Then the "crazy" bloggers found us, posting wild rants. We moved to a "moderated" comment format. But while we were protected from inappropriate comments, we lost the immediacy of the back and forth exchange that makes our bioethics community so powerful. We went back to an “unmoderated” system. But alas, the Internet stalkers have found us - last night we had six random postings in the space of a few minutes. We are going to reinstate the "moderated" comment option. We aren't the only blog with this challenge - Bioethics.net implemented the same policy a few months ago. We'll do our best to "publish" comments quickly, but unfortunately, we are not always online. Thoughts?

Should severly disabled kids be kept small, so that they are easier to care for?

I don't know what to think about this one -- I cannot imagine having to make such a decision and cannot imagine the tears and agony of these parents:
From Reuters:
6-year-old given hormones to stunt growth so parents can care for her.

New York - In a report published in a medical journal this month, two doctors describe a 6-year-old girl with profound, irreversible developmental disability who was given high doses of estrogen to permanently halt her growth so that her parents could continue to care for her at home.

The controversial growth-attenuation treatment, which included hysterectomy, was requested by the child's parents and initiated after careful consultation and review by an ethics committee.

In their report in the Archives of Pediatrics and Adolescent Medicine, Drs. Daniel F. Gunther and Douglas S. Diekema, both at the University of Washington in Seattle, explain the reasoning behind what they hope will generate a healthy debate.
To read on, click here.

No Kidneying Around

On the evening of September 26, 2006 I was sitting down to watch an episode of Nip/Tuck and the opening scene pertained to my ethics class. One of the characters was bought drinks, then drugged, and woke up to a phone call telling her she would be fine but that the medicine would wear off soon. As she looked down she noticed a large ice pack on her side, and sure enough her kidneys had been removed. Throughout the rest of the show they investigated other cases, stating that black market kidneys can often seel for as much as $200,000 or more. The kidneys were then shipped off to other countries such as India and Tokyo. Although, this seems very real it also lead me to think that they were playing up an urban myth. I researched it and found that there is an urban myth like this, and that the show might have been laying that up. However, kidney stealing is a SERIOUS issue...so I did my own research, and what I found didn't surprise me.
According to National Geographic News is 2002 doctors performed 24,900 life saving organ transplants. However, for every one person given a transplant another two people were put on a waiting list. Now, over 80,000 people in the US are waiting for organs. Every 14 minutes someone is added to that list, and in 2002 6,000 people died waiting for organ donations.
In December 2003, police broke up an international kidney trafficking ring. Brazilian police stated that people were being flown in S.Africa and having the removal surgery. Some of the participants paid up to an astounding amount of $100,000.
With Americans fearing death more than anything else it's not surprising the lengths that one would go to, to move their name up on that list. Or what they would do to come in contact with an organ in illegal ways. In the situation of money versus life, money doesn't appear to be a significant factor. People are doing what it takes, even going to other countries to have the surgery done. This makes me wonder, what about when it is our time to go? What if your body is saying no more? How do we take the natural courses of life into consideration when we can go out and buy more parts to fuel us? What about altruism? How are we to tell if people are really going to donate their organs for the joy they get in helping others or who is doing it for money? Prohibiting payment for organs allows allows us to ensure the quality of the organ and makes sure that it is a six out of six match. If we had every random person who needed the money donating organs who can tell what kind of "shape" they are in. Also, doesn't it make this society even less equal than in already is? The poor sell their kidneys or other organs and the rich pay absurd amounts for them, to save themselves or their poor children who may die inevitably due to their life plan. Are body parts not determining our net worth? There are so many questions that all have so many different answers.
I suppose I don't have a clear and concise answer to any of these questions that I posed, and although I have brainstormed an enormous amount and looked at many different angles of the situations, there is no right or wrong answer. How do you tell someone no, when they are dying? Or tell them "it is your time to go?" Or tell a loving father that because he doesn't make enough money he can't buy the kidney transplant for his daughter? You can't, just like I can't come up with an answer. All I can do is base it on the situation at hand. Each and every case needs to be looked at from every different angle and researched thoroughly. Each transplant needs to be done in a proper and ethical way. Selling kidneys for me only takes away from our self worth and makes us more of a piece of meat than society is already forming us into. If we can't do things the right way, why do them at all?

[Editor's Note: The BBC just published an article on Iran's Desperate Kidney Traders:
On streets and in town squares in Iran, young men and women can be seen holding signs offering their kidneys for sale.]

A Prescription for Trouble

Those of you who attended the ASBH conference in Denver last week may have come to the mock trial of the Law and Bioethics Affinity Group which included marvelous performances by Erin Egan, Judy Illes, Peter Cohen and Katie Watson. Also, a sense of courtroom decorum was greatly enhanced by our two judges, Terry Tomsick and Alice Herb, who did a wonderful job with the rulings, too! The fact pattern involved the use of neuroimaging for purposes of lie detection in a product liability case against a major drug company who marketed a COX-2 inhibitor that increased the chances of serious heart problems.

The irony is that just yesterday, the Managing Editor of Boston magazine, Jennifer Johnson, sent me a link to this article in Boston (about the Vioxx scandal) with an intriguing summary:

Its reports on new drugs put billions in pharmaceutical company profits and untold lives at stake. So it’s a very big deal when the New England Journal of Medicine gets something wrong. With the powerful publication still reeling from a scandal it can’t seem to shake, editor Jeffrey Drazen’s plan for fixing things is less a sure-fire cure than a leap of faith.

It just goes to show what a small world it is (especially when it comes to bioethics)! Thanks, Jennifer

Universal Health Care Ethics

One of the largest health problems facing the nation today is access to medical care. With around 50 million people uninsured, our country struggles with providing health care to many individuals. Because the scope of this problem penetrates all facets of life, it needs to be tackled at many different levels. Deciding our values as a society about health care requires answering difficult ethical questions. The means by which we begin to create and implement a national health care system necessitate that we define what those values are. Addressing the challenges of providing national health care is inherently part of the discussion around this dilemma.
One initial question that must be asked is: How responsible is an individual for the status of their health? Factors that contribute to one’s health include their environment, genetics, socioeconomic status, behavior, and the actual health care obtained. Because of the variability of these factors for each person and the unpredictable nature of individual health, responsibility should ultimately be shared among families, communities and society. It is known that approximately 10% of the population accrues 70% of total health care costs. The financial burden this poses on individuals with acute, chronic, or terminal illness is substantial. Do we want to live in a society where access to health care is determined by socioeconomic status? Aside from social responsibility, we have personal interest in creating a system where the burdens of this financial risk are spread across the population; our health circumstances are just as uncertain as everyone else’s.
The costs of health care are significantly rising at an unsustainable rate. Maintaining a healthier population not only benefits the individuals but also the payers (insurance companies, employers, government) of the expenses. How do we incorporate individual responsibility into the equation? What financial contribution should individuals make? Should it be experience based; should individuals pay premiums based on their health care history? Or should the payments be based on a community rating, where everyone pays the same regardless of their health status? Or should it solely be based on ability to pay, a tax financed system? How do we promote healthier lifestyles while recognizing the injustices that exist? It is less likely that someone living in poverty would have access to a fitness center. This person may also live in an unsafe area, making it difficult to take walks after work. This person may not be able to afford healthier foods, relying on foods with less nutritional quality to feed him or herself. The more we recognize the barriers that exist, the more responsibility we feel to help create a system that provides for everyone.
Even once we recognize that universal health care is essential, there are more questions to be answered. How would we go about implementing universal health care? What role should government play? The current structure allows for minimal governmental regulation and relies highly on free-market economics to regulate the system. Increasing governmental regulation would inevitably decrease our choice (as it has been observed in countries where it has been implemented such as Canada). We must decide that we value access for all over choice for those privileged enough to have this conversation.
Increasing access of information to individuals, determining what values as a society we have, implementing a system that insures health care to all individuals, and deciding how to finance this system are significant challenges regarding this issue. However, recognizing that access to health care is an ethical issue is a critical step in the process.

For more information: http://www.everybodyinnobodyout.org/FAQ/fqIndResp.htm

Fox and Counter-Fox

[Hat tip to R. Alta Charo for the title]...

Making Stem Cell Issue Personal, and Political

Alessandra Stanley does a great job of teasing out the fact from fiction in her column in the NY Times this morning about the contentious comments of Rush Limbaugh regarding Michael J. Fox's ads about stem cell research:

The plea is as disturbing — and arresting — as a hostage video from Iraq. In a navy blazer and preppy Oxford shirt, the actor Michael J. Fox calmly asks viewers to support stem cell research by voting for several Democratic candidates in Maryland, Missouri and Wisconsin, while his body sways back and forth uncontrollably like a sailor being tossed around in a full-force gale...
In short, Mr. Fox’s display of the toll Parkinson’s disease has taken on him turned into one of the most powerful and talked about political advertisements in years.
Rush Limbaugh rushed in to discredit Mr. Fox, though he mostly hurt himself. Rush Limbaugh, the conservative radio talk show host, told his listeners that the actor either “didn’t take his medication or was acting.” Mr. Limbaugh later apologized for accusing Mr. Fox of exaggerating his symptoms, but said that “Michael J. Fox is allowing his illness to be exploited and in the process is shilling for a Democrat politician.”

Republicans cobbled together a response ad attacking the ethics of embryonic stem cell research, including testimonials by the actress Patricia Heaton (“Everybody Loves Raymond”) and James Caviezel, who played Jesus in Mel Gibson’s “Passion of the Christ.” At least in the advance version shown on YouTube last night, Mr. Caviezel’s introduction seemed either garbled or to be in Aramaic.


Michael J. Fox

Fox Stem Cell Video

Live from Denver! ASBH

Kathryn Hinsch and I will be blogging from the annual ASBH conference in the Mile High City of Denver -- let us know what you'd like to hear about!

Genetic Guilt

There was an interesting article about genetic testing and breast cancer today in The Independent, profiling a family and their decisions to undergo mastectomies.

http://news.independent.co.uk/uk/health_medical/article1880078.ece

Aside from the fact that this is an important tale of both the benefits and difficulties of discovering your own genetic susceptibility to cancer, what caught my eye was this quote:

Despite all this, Julie was devastated when her 29-year-old daughter, Jenny, was found to have the mutated gene. She will undergo a double mastectomy in January. Julie says: "I feel guilty, which I know is not rational. But it is my fault. I passed it on to her."

As if “mommy guilt” wasn’t multi-faceted enough! It’s not hard to imagine that many women (and men) may feel compelled to do whatever it takes to eliminate genetic abnormalities in their children, provided the opportunity to do so.

(Thanks to Dr. Hsien Hsien Lei’s “Genetics and Health” blog for pointing me in the direction of this article.) Published by Emilie Clemmons.

Bioethics for the Rest of Us?

Can you recommend a good book on bioethics for a beginner? I am often asked that question and until now I haven’t had a very satisfying answer. As much as I love it, I don't feel comfortable recommending the American Journal of Bioethics with its grim graphics and complex cover stories (this month’s: “Damage Compounded: Disparities, Distrust, and Disparate Impact In End-of-Life Conflict Resolution Policies” and "Altruistic Discourse in the Informed Consent Process for Childhood Cancer Clinical Trials.") Not exactly layperson friendly. Fortunately, Art L. Caplan has come along to save the day. His recently published book titled “Smart Mice, Not So Smart People: An Interesting and Amusing Guide to Bioethics” is a great introductory book which covers a stunningly wide range of topics. It is easy to read, doesn’t pretend to be “objective” and helps the reader ponder the key bioethics issues of our time. I'll be giving it out as Christmas presents this year.

Calling all Bioethics Bloggers

Are you a bioethics blogger and attending the American Society for Bioethics and Humanities annual meeting next week in Denver? We are planning a special bloggers meeting to discuss, well, blogging and bioethics. Not sure of the time nor venue yet but we'll opt for an open slot in the conference schedule (and hopefully we'll scrounge up some pizza and beer.) Interested in participating? Please contact me for further details.

The Scientist & the Ethicists Podcast Series: Nerd Girrrrls Rule!

In an effort to help the public make sense of an escalating number of news stories about “designer babies,” genetic engineering and cloning, the Women’s Bioethics Project launchs it's first series of podcasts, titled “The Scientist & the Ethicists.” Check it out.

The Breastfeeding Rodeo

The U.S. Department of Health and Human Services and the Office on Women’s Health have been actively promoting an ad campaign over the past few years to increase awareness about the benefits of breastfeeding.

http://www.womenshealth.gov/breastfeeding/index.cfm?page=adcouncil

Educating women about the benefits of breastfeeding—getting that information out there (because many were unaware)—is an extremely important endeavor and the DHHS and OWH should be commended for their efforts…for the most part.

Their print and radio ads are generally informative and amusing and (I feel) effective in that they provide important scientific information about the benefits of breastfeeding without criticizing the actions or choices of mothers.

Their TV spots, however, have generated some controversy. Each depicts pregnant women (fictionally) engaging in a dangerous activity, including log rolling and riding a mechanical bull, then equates the activity with failing to breastfeed your child.

This approach seems counterproductive on at least two fronts: 1) it falsely implies that feeding your baby formula is as dangerous to its health as bull-riding while pregnant and thus feeds misinformation to its audience and 2) it serves to criticize and alienate women who choose not to or cannot breastfeed for a variety of reasons.

Let’s give women the best information we have on breastfeeding and on other women’s health topics to help them make the best decisions for their families. Frightening them with false analogies is both unethical and counterproductive.

Lastly, if the U.S. government is truly interested in breastfeeding for our children and for public health, they need to encourage our workplaces and the general public to support breastfeeding and to provide women with comfortable places to nurse their children. Many moms I know (myself included) have plenty stories to share about breastfeeding or pumping while sitting on the toilet in a workplace or public bathroom, or stories about being heckled for discreetly breastfeeding in public.

Currently, the womenshealth.gov website information appears to address workplace breastfeeding solely by encouraging women to make it work. They say:

“Let your employer and/or human resources manager know that you plan to continue breastfeeding once you return to work. Before you return to work, or even before you have your baby, start talking with your employer about breastfeeding. Don't be afraid to request a clean and private area where you can pump your milk. If you don't have your own office space, you can ask to use a supervisor's office during certain times. Or you can ask to have a clean, clutter free corner of a storage room.”

Thanks for the tips, but I want to know: do DHHS and OWH have a plan to educate our workplaces or maybe that man on the airplane who was so “disgusted” by my breastfeeding that he asked to change seats?

Emergency Contraception for those under 18

Student blogger Kirti Shah comments on a previous post re emergency contraception:

Recently the Government of Chile announced that they are going to provide emergency contraception to any one over 14 at no cost. What a revolutionary idea from a Catholic country. We in the U.S. now have made it available over the counter to anyone over 18 but they still have to pay. This was blocked on political grounds ( religious grounds) a number of times by questioning its safety ( rejecting all the evidence) and the usual abortion arguments.

The current law permits the pharmacist to sell it to anyone over 18. Any person over 18 can then give it to a person under 18 but a pharmacist cannot. This makes the pharmacist a policeman and potentially liable in case of some kind of a mistake. This can potentially introduce a third party in the distribution chain. We need to change this law to accommodate any minor and this would at the very least allow a health professional to advise the patient on the proper use of this medication.. The “ morning after” pill has a 89% efficacy if taken within 72 hours of unprotected sex and is more effective if taken in the first 24 hours. Reducing the waiting time should be of utmost importance.

We should clarify what emergency contraception is. It is a backup method of preventing pregnancy or reducing chances of pregnancy after unprotected sex. Examples of unprotected sex would be a broken condom, if one forgot to take birth control pill for 2 or more days ( which happens a lot) , or if one was sexually assaulted. Plan B is not RU-486 ( the abortion pill) because plan B is used to prevent pregnancy. It will not work if you are already pregnant and it will not affect an existing pregnancy. Plan B is also safe and it is a larger dose of normal birth control pill. Plan B will decrease the chances of pregnancy by 89% if taken within the first 72 hours of unprotected sex. It works better if taken within the first 24 hours after unprotected sex. When birth control pills first came out their doses were very high almost similar to plan B.

Arguments have been and will be used against plan B with misleading and false arguments and a conscious effort has to be made to educate the public. Condoms were once sold behind the counter and today they are available all over and serve a useful purpose. We cannot deny services to people who need it using false arguments and we need to loosen up the law that will free up the pharmacist or any other health care professional to be able to provide these services in good faith.

Vaccines on Trial

[Guest post by Amrita Desai]

I came across a very interesting article on One of the largest ever vaccine studies which is underway in Kolkata, India. Paroma Basu, who is a freelance writer based in Madison, Wisconsin, uncovers the benefits and difficulties of inoculating 60,000 people against cholera and typhoid fever out of population of 14 million. In the poorest areas of this city, residents live in homes jammed together along winding sewage-littered pathways and rely on shared toilets and drinking water. Typhoid fever and cholera are endemic in India, and are chronic problems in Kolkata. This state of West Bengal is often called as “homeland of cholera”.

The vaccine industry has always been reluctant to commit resources to the development of vaccine for world’s poorest people. But a grant of US$40 million from Bill & Melinda Gates Foundation is helping to introduce affordable vaccines to cities like Kolkata. The money has funded the five-year Diseases of the Most Impoverished Program (DOMI). DOMI is studying the social, economic, and clinical effects of introducing vaccines. Since 2000 it has launched two cholera studies, six projects investigating typhoid fever.

In a unique research effort 60,000 Kolkata slum-dwellers will participate this summer in phase III trials of an oral cholera vaccine. Last November researchers injected the same population with vaccine against typhoid fever. Typhoid vaccine was donated by GlaxoSmithKline and cholera vaccine by Dukoral.

The road blocks encountered during this trial in Kolkata are an example of the difficulties of caring out such a program from political and religious tensions and burocratic delays to mistruths spreading like wild fire among the largely illiterate trial participants. The institute had to get an endless list of clearances from National health ministry committee, local councilors, ethics and human right groups, Hindu priests, Muslim imams and community thugs. During the typhoid vaccine trials rumors were spreads that the scientists were injecting cancer cells in to people. Others believed that they were being sterilized. There was mass panic.

About 65% of the targeted study group eventually gave their consent and receive the typhoid jab. A big reason for this level of success was Dipika Sur, director of epidemiology who employed 250 slums, dwellers as community health workers, field supervisors and sample collectors. The strategy paid of largely because of staggeringly high unemployment levels in the slums. Today a health worker goes door to door sending patients with persistent symptoms of diarrhea or fever to one of seven “health outpost”, where patients received free blood test and medicines if diagnosed with cholera or typhoid. Here people can see a doctor and be treated right away. Families who share a room with 11 members are aware how important it is to keep the bathroom clean and not to drink polluted water.

India is becoming an increasingly appealing location for undertaking clinical trials. A trial in India costs half as much as in the United States, and India has a high prevalence of diseases, such as diabetes and heart disease, that predominantly affect the developed world. But India's future as a centre for 'outsourced' clinical trials could be in jeopardy. Despite its advanced hospitals, the country is struggling to find enough trained staff to run the clinical trials and lacks a central database to track them once they are underway. There are several recent cases where researchers did not comply with ethics regulations. Trial participants were, without their knowledge, given drugs that had not been approved by the health ministry or been tested adequately in animals.
If the government fulfils its promise to tighten regulations, India could benefit greatly not just from the revenue generated by these trials, but also from the new drugs being tested in its population. At least 2 million persons succumb annually to enteric infection, and in countless other patients, diarrhea disease aggravates malnutrition and susceptibility to other infections. Prevention of enteric illness by virtue of improved hygiene and provision of sanitation and water treatment is impractical in most developing countries, where morbidity and mortality rates are highest. For this reason my opinion is that development of vaccines against the most important gastrointestinal infections remains a high priority.

The biotech companies from whole world should unite and help each other by eliminating the spread of deadly diseases and bring awareness among people and live life in a clean environment.

Marijuana may stave off Alzheimer's

Another news item in the category of "needs rigorous clinical trials"~ From Reuters this morning:

Good news for aging hippies: smoking pot may stave off Alzheimer's disease.

New research shows that the active ingredient in marijuana may prevent the progression of the disease by preserving levels of an important neurotransmitter that allows the brain to function.

Researchers at the Scripps Research Institute in California found that marijuana's active ingredient, delta-9-tetrahydrocannabinol, or THC, can prevent the neurotransmitter acetylcholine from breaking down more effectively than commercially marketed drugs.

THC is also more effective at blocking clumps of protein that can inhibit memory and cognition in Alzheimer's patients, the researchers reported in the journal Molecular Pharmaceutics.

The researchers said their discovery could lead to more effective drug treatment for Alzheimer's, the leading cause of dementia among the elderly. To read on, click here.

Photo: (AFP/Getty Images/Ron Wurzer)

The Feminization of Medicine

[Hat tip, Sean Philpott] From the Boston Globe, an article about the changing face and character of medicine:

Over the last quarter-century, women have entered the field of medicine in unprecedented numbers, changing not only its face but its character...

Nearly half of medical school students nationwide are now female, and as they enter the profession, they are making patient care friendlier and therefore may be less likely to get sued than male physicians. Women physicians also are more likely to serve minority, urban, and poor populations and are twice as likely to go into primary care....The implications for the physician workforce are significant. .. To read on, click here.

(Boston University Alumni Medical Library photo)

Organ "Donations" from Chinese Prisoners

The darker side of bioethics. This video is heart-retching and could not argue louder for a Universal Declaration on Bioethics and Human Rights. Watch it and weep.


http://www.youtube.com/watch?v=TklqtWzNn_A

From the BBC:

Organ sales 'thriving' in China

Chinese officials say the prisoners volunteer to donate their organs. The sale of organs taken from executed prisoners appears to be thriving in China, an undercover investigation by the BBC has found. Organs from death row inmates are sold to foreigners who need transplants. One hospital said it could provide a liver at a cost of £50,000 ($94,400), with the chief surgeon confirming an executed prisoner could be the donor. China's health ministry did not deny the practice, but said it was reviewing the system and regulations.

'Present to society'

The BBC's Rupert Wingfield-Hayes visited No 1 Central Hospital in Tianjin, ostensibly seeking a liver for his sick father. Officials there told him that a matching liver could be available in three weeks.

Thanks to bioethics.net for bringing this to our attention.

Google Results for Bioethics Penis: 79,700

Now for the lighter side of bioethics:

I spent much of the day working on optimizing the Women’s Bioethics Project blog and website to increase our readership. (Yes, the glamorous life of running a public policy think-tank.) My husband, who is a software engineer, suggested that rather than the tedious process of linking to appropriate websites or writing content that will be picked up by widely read newsgroups, I should just add “penis” to my keyword list and be done with it.

Rather than indulge in such a gratuitous attempt to increase our Google ranking, I did some crack research so I could offer two recent postings from the prestigious American Journal of Bioethics and the venerable Hastings Center on the topic:

Penis Transplants in China
http://blog.bioethics.net/2006/09/insert-penis-here.html

Proof that I Like Penises
http://www.bioethicsforum.org/20060310adreger.asp

I think that about covers (or uncovers it.) Back to neuro-ethics.

Call for Papers: Women's Health Conference

The Pennsylvania Hospital, Philadelphia, will host its second annual
History of Women's Health Conference on Wednesday, April 11, 2007. We invite interested persons to send a two page proposal or abstract of your topic by Wednesday, November 15, 2006 for consideration. The History of Women's Health Conference focuses on women's health issues from the late 18th century to the present. This conference encourages interdisciplinary work. Topics of interest include, but are not limited to, obstetric and gynecology issues (fertility, infertility, birth control methods, menopause), adolescence (health, cultural influences, body image), mental health topics, geriatric concerns, overall women's health, access to health care, minority health and more.

Please submit your proposals/abstracts to:

Stacey C Peeples
Lead Archivist, Pennsylvania Hospital
3 Pine East, 800 Spruce St.
Philadelphia, PA 19107
(215) 829-5434 (v)
(215) 829-7155 (f)

Where the Rubber Meets Roe

William Saletan argues that the abortion debate is morphing: Either you're for reducing the numbers or not:

The issue that never changes is finally changing.

If you're one of the millions of Americans who don't like abortion but also don't like the idea of banning it, good news is on the way. In the last three weeks, two bills have been filed in the House of Representatives. Without banning a single procedure, they aim to significantly lower the rate of abortions performed in this country. Voluntary reduction, not criminalization or moral silence, is the new approach.

How do you stop abortions without restricting them? One way is to persuade women to complete their pregnancies instead of terminating them. The other is to prevent unintended pregnancies in the first place. And there's the rub—or, in this case, the rubber. The two House bills used to be one proposal, backed by an alliance of pro-life lawmakers and organizations. The alliance split because one faction wanted to fund contraception and the other didn't. Read on.

The Value of Life: War vs Embryos

[Hat tip to Josh Perry for this alert] Scathing Slate article on Bush's faulty reasoning on embryonic stem cell research by Michael Kinsley:

It was, I believe, Rep. Barney Frank, Democrat of Massachusetts, who first made the excellent, bitter, and terribly unfair joke about Ronald Reagan: that he believed in a right to life that begins at conception and ends at birth. This joke has been adapted for use against various Republican politicians ever since. In the case of President George W. Bush, though, it appears to be literally true.

Bush, as we know, believes deeply and earnestly that human life begins at conception. Even tiny embryos composed of half a dozen microscopic cells, he thinks, have the same right to life as you and I. That is why he cannot bring himself to allow federal funding for new stem-cell research, or even for other projects in labs where stem-cell research is going on. Even though these embryos are obtained from fertility clinics where they would otherwise be destroyed anyway, and even though he appears to have no objection to the fertility clinics themselves, where these same embryos are manufactured and destroyed by the thousands, the much smaller number of embryos needed and destroyed in the process of developing cures for diseases like Parkinson's are, in effect, tiny little children whose use in this way constitutes killing a human being and therefore is intolerable.

But President Bush does not believe that the deaths of all little children as a result of U.S. policy are, in effect, murder. He thinks that some are, while very unfortunate, also inevitable and essential.

You know who I mean. Close to 50,000 Iraqi civilians have died so far as a direct result of our invasion and occupation of their country, in order to liberate them. The numbers are actually increasing as the country slides into chaos: more than 6,500 in July and August alone. These numbers are from reliable sources and are not seriously contested. They include many who were tortured and then killed, along with others blown up less personally by car bombs and suicide bombers. The number does not include the hundreds of thousands who have died prematurely as a result of a decade and a half of war and embargos imposed on the Iraqi economy. Nor does it include soldiers on both sides, most of whom are innocent, too. Last week the number of American soldiers killed in Iraq and Afghanistan surpassed the number of people who died in the terrorist attacks of Sept. 11, 2001.

To read on, click here.

Top Ten Places for Moms to Work

Our friend and fellow blogger, Chris MacDonald, has done a post on the Top Ten Places for Moms to Work -- check it out!

Thanks, Chris!

A Career In Business Isn't For Every Gender...

From my favorite satirical website, The Onion:

I've been in this field a long time. I've seen what it can do to someone who's not thick-skinned enough to bear the slings and arrows, and believe me, it's not pretty. The business world can be a cold and unforgiving place, and to make it here, you've got to be one tough cookie. It may sound harsh, but the truth is, not every gender's cut out for this line of work.

Day in and day out I watch young people with nothing more than a graduate degree and a few years of experience try to break into upper management, and almost exactly half of them find out they don't have the correct reproductive organs to hack it. They might bitch and whine and initiate litigation, but folks, them's the breaks.

Here's the long and short of it: Some people have the proper chromosomal pairing to seal the deals, and some people just plain don't.

I'm talking about survival of the fittest here, and the truth is, nobody gets a free lunch, especially when it comes to equal opportunity in hiring practices. Sure it'd be great if we were all blessed with the genitalia it takes to succeed in business, but the real world doesn't work like that. We can't fill America's boardrooms with people and genders unfit to be there just because we don't want to hurt their feelings.

What kind of society would we be living in if we gave everybody a chance, regardless of whether or not they had the right hormonal levels to get the job done? To read the rest of article, click here.

The Male Brain (of Mice and Men)

We recently wrote about how neuroscience is a burgeoning field; some say that it will displace genetics as the leading edge of scientific discoveries in the 21st century. Significant ethical issues come along with discoveries about how our brains work.

Fortunately, thanks to the vision and generosity of Paul Allen, scientific researchers will now have the tools they need to unlock the brain's mysteries. From today's Seattle Times:

The type of brain map that used to grace high-school biology texts looked like a quilt: A pink chunk labeled "vision" bumped up against a blue blob that was the seat of language and a yellow swath representing motor perception.

Those crude representations were the result of centuries' worth of painstaking dissection, coupled with case studies of people suffering from brain damage and disease.

It took only three years for a Seattle lab founded by Microsoft mogul and philanthropist Paul Allen to revolutionize the landscape of neuroscience by creating a map of the brain that goes far beyond topography to pinpoint the workings of individual cells.

Allen, who donated $100 million to the lab, said he is so pleased with the results that he will consider similar, large-scale science projects in the future.

"This was a great opportunity to do something here that made a difference, and that we could do quickly," he said. "We'll certainly look for more opportunities like this."

Experts say the Allen Brain Atlas, which will be formally unveiled today, will boost understanding of brain circuits and chemistry — and what goes wrong in conditions ranging from schizophrenia and autism to Parkinson's disease and drug addiction.

The initial mapping will be done on male mice. While we applaud their efforts, it is important not to assume discoveries based on male models (mice or men) can be directly translated to the female gender.

We found this out with heart disease. Paul: Remember the ladies!

Sex and the Single Brain

I'm not sure if this book that the Washington Post reports on is really a thoughtful discourse or just adding fuel to the gender stereotype fires -- the article in the Post suggests the latter:

According to pop psychiatrist Louann Brizendine, author of the best-selling new book "The Female Brain," men and women come equipped with completely different operating systems -- not only below the belt but between the ears.

Like bath towels, there are his-and-her brains -- that there is no such thing as 'unisex brain.'

Brizendine insists this is a scientific fact. Males and females may perform similar calculations, but they use different "circuits." Woman is Mac. Man is PC. Blame the brain.

For Brizendine, it's all about the hormones --"The female brain is so affected by hormones, they control her very perception of reality," says the doctor. "Her values, her desires, what's important to her, even whom she loves." For him, brain awash in testosterone, it's all about sex and aggression...

But some of her critics say that what Brizendine did was overstate the science. In part, it may be the style that Brizendine adopts when she speaks and writes. When science looks for differences, it finds them in the average male and average female -- meaning that if six in 10 women show an advantage in one area, so do four in 10 men. But this gets lost
in the prose.

n a 2001 National Academy of Sciences report, the authors write: "Sex matters. Sex, that is, being male or female, is an important basic human variable that should be considered when designing and analyzing studies in all areas and at all levels of biomedical and health-related research."

I'd like to get Martha Farah's or Judy Illes's take on this supposed scientific research, two women who have been among the founders of The Neuroethics Society, a brand new interdisciplinary group of scholars, scientists and clinicians who share an interest in the social, legal, ethical and policy implications of advances in neuroscience.

Pet Cloning

Should we worry about pet cloning? I was asked that question the other day by a woman who had just heard about CC the cloned cat and the Genetic Savings and Clone company. And while it might seem like a trivial, sideshow kind of issue, a quick internet search revealed that they follow a set of internally developed bioethical code of conduct. I was impressed - wish all biotech companies had such transparent guidelines.

Whether you support pet cloning or not, I think her question reveals the core anxiety we all feel about emerging technologies: Could we? Would we? Should we? And why it is so important to always ask the bigger question of "what kind of a world do we want to live in."

Stem Cell Wars

I just read a newly released book called “Stem Cell Wars: Inside Stories from the Frontlines” by Eve Herold. I don’t like the use of war metaphors, especially in the time of real war, even for politically contentious issues. But Palgrave Macmillan knows more about selling books than I do, so I won’t hold it against the book.

More a chronicle of events than hard hitting analysis, Herold methodically provides the reader a primer on stem cell research and cloning, the politics of science during the Bush administration, and the inside story of the South Korean scientific fraud. For those of us who have watched this issue closely, Herold’s account doesn’t provide any new information but her eyewitness reporting style will have appeal to those who have been watching from the sidelines (and wondering what the heck is happening.)

I think the book could have benefited from a more rigorous examination of the ethical issues surrounding stem cell research beyond the “moral status of the embryo.” Perhaps a forward by bioethicists Laurie Zoloth or R. Alta Charo rather than Harvard physician George Q. Daley would have better served the reader. While Herold does touch on it briefly, she seems genuinely confused why some on the political right continue to equate stem cell research with abortion, because, as she correctly points out, stem cell research could continue unabated even if all abortions were outlawed. Or perhaps her editors decided it wasn’t appropriate to further explore how the stem cell war is also about the abortion war, contraception and IVF war, assisted suicide war, Terri Schiavo war and the broader bioethics agenda of the political right.

The most delightful surprise was learning the story of Bernard Siegel, Founder and Executive Director of the Genetics Policy Institute. It is a fascinating story of how one man, compelled by his concern for the welfare of a supposedly “cloned” child, exposed the Raelian media hoax. All in all, the book is an easy read, puts a human face to the issues, and is an important call to stop the politicizing of scientific research in the US.

More Than A Choice

Often, the "pro-choice" versus "pro-life" debate fails to acknowledge the reality of women's lives and is reduced to meaningless sound bites that make good fundraising copy but lousy public policy. Jessica Arons, Director of Women's Health and Rights at the Center for American Progress has just published a compelling new whitepaper: "More Than A Choice - A Progressive Vision for Reproductive Health and Rights." Arons, who is known for her ability to bring together diverse voices and craft a vision for the future, has produced a progressive blueprint for reproductive health and rights.

From the report:
"The core values that ground a progressive understanding of reproductive health and rights in the United States are easily stated but necessarily complex. At the Center for American Progress, we embrace equally the rights to have or not have children, with a partner of one’s choosing, in a time and manner that honors one’s conscience and life circumstances. So many factors shape such weighty decisions that it may be difficult to tackle them all simultaneously, but, at a minimum, it is critical that the reproductive health and rights policies supported by progressives address the reality of people’s lives and the context in which such decisions are made.

The decision to have a child, for instance, is connected to plans for education and career, as well as family. A healthy pregnancy requires quality medical care, a safe environment and emotional well-being. Parents must be able to provide love, attention and stability to their children, facilitated and supported by decent housing, schools, employment, child care, health care, and other societal structures that strengthen family life. In order to prevent or plan for parenthood, people need reliable education about sexuality and access to safe and affordable contraception and abortion care.

Simply put, reproductive rights are about more than just abortion.

Check out the entire report.

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.