An Economist Looks at the Fertility Industry

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

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

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

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

A summary of Governing Biotechnology
by George Annas

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

Read more

Got Calcium?

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

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

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

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

States' Tug of War on Plan B

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

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

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

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

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

Bad to the Bone: Body Snatchers

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

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

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

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

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

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

Designer Microbes, the Human Genome Project and Alternative Fuels

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

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

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

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

Separating Fact From Spin in the Abortion debate

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

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

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

South Dakota: Gunning for Roe

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

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

Ethical Entertainment

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

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

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

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

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

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

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

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

Sex as entitlement, sex as power?

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

In a previous blog post earlier this month (see below, The Politics of Violence Against Women: A South African Perspective, posted Thursday 2nd February), I wrote about how the daily experience of inequality by women and the violence perpetrated against women by men continue unabated in South Africa. “Because of our patriarchal system, power is in the hands of men. Women do not have much say in decision-making, societal issues, and even more sadly, in their intimate relationships. Men control their sexual rights. Women cannot choose when, how and with whom they can have sex” (Memela, 2005, p.98).

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

Abortion and US Supreme Court again

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

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

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

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

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

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

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

[thanks, Karama Neal!]

Ethical Concerns Halts Death Penalty Execution

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

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

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

Women on Board(s)

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

WBP Announces East Coast Advisory Board

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

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

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

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

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

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

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

Frances Kissling, president, Catholics for a Free Choice

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

Michigan State University

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

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

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

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

Pharmaceuticals

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

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

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

Denmark in the News for Something Else

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

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

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

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

[thanks again, Sean Philpott!]

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

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

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

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

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

Gazzaniga on Cloning

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

Pregnancy Discrimination in the Workplace

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

Human (Un)Kindness

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

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

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

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

Moral Police Burn Valentine's Day Cards in India

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

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

Read more

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

Guest blog by Kathryn Hinsch:

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

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

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

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

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

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

Droids, Destruction, and Dweebs

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

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

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

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

Sex-ed Should be Based on Science - Not Hypocrisy

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

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

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

Read more

Promoting Science and Technology in the Interest of Humanity

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

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

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

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

National (US) Children's Study "Defunded"

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

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

Kudos to the CBC...

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

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

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

Read more

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

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

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

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

More Good News for Java Lovers and Women...

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

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

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

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

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

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

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

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

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

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

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

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

The Trouble with "boys will be boys"

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

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

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

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

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

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

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

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

Hunting for "Good" Eggs in Eastern Europe

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

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

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

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More on Conscientious Objections in health care

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

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

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

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

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

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

The Politics of Violence Against Women: A South African Perspective

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

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

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

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

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

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

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

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

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

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

Debra Leigh Marais, 2^nd February 2006

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References:

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

Mail & Guardian online – see links above

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

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

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

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

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

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

The Witness online – see links above

Emerging Neurotechnologies as Lie Detectors

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

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

More on Enhancements...

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

Hormone therapy trial was flawed

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

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