Monday, December 31, 2007

We Can Always Count on Art

One thing we can always count on is great bioethics commentary from Arthur Caplan, Ph.D., director of the Center for Bioethics at the University of Pennsylvania. Read his New Year's Eve column "2008 - A Year Already Worth Forgetting" here. Thanks Art!

Saturday, December 29, 2007

Kudos to Cato Institute

The Cato Institute has produced an outstanding policy analysis of the ethical issues surrounding live kidney donation and the use of incentives. Written by Arthur J. Matas, MD, it makes a compelling case for ethically appropriate ways to compensate kidney donors in order to overcome the dire shortage. He argues that "allowing the sale of kidneys from living donors would greatly increase the supply of kidneys and thereby save lives and minimize the number of patients suffering on dialysis."

Dr. Matas is a professor of surgery and director of the kidney transplant program at the University of Minnesota. Dr. Matas has been a practicing transplant surgeon for more than 25 years and is the immediate past prresident of the American Society of Transplant Surgeons.

You can read the full white paper here.

Friday, December 28, 2007

More Time to be Wise?

The potential to radically extend the human lifespan raises all sorts of bioethical questions from theologically based concerns (Is it moral to seek immortality?) to more practical considerations (Will radical life extension bring increased happiness or despair to the human condition?) "Radical Life Extension and Religious Evolution" by Sonia Arrison, TechNewsWorld, 12/14/07 offers a positive spin:
...not all scholars saw radical life extension as a negative development.

Professor Ron Cole-Turner of the Pittsburgh Theological Seminary discussed how life extension could benefit many religious orders. "Technology will inject competition into religion and force religious authorities to clarify what they mean by immortality." This is important, according to Cole-Turner because "there is currently a lot of evasiveness about what immortality means." This is a good point and, of course, the conversation is not a one-way street.

Religion will also serve to inject ethical competition into technology circles. If the future of evolution is now more in human hands, the religious question is: toward what end? In other words, if humans could live longer, what good should result? Perhaps the Buddhist scholar had the most clear and concise answer.

Professor Derek Maher explained that in Buddhism each person is responsible for their own karma which, taken care of properly, can bring one to a state of nirvana, which is the cessation of suffering. Buddhists, he explained, already embrace the idea of radical life extension because it "gives you more time to attain wisdom and advance spirituality." Essentially, it gives you more time in this life to improve your karma so you can reach nirvana.
Older and wiser? Maybe...

Thursday, December 27, 2007

Working out with Wii? Think Again

And finally, I come bearing some bad news. It seems that working out via Wii? Not really that great a work-out after all. While it looks like the Wii does help you burn more calories than a more sedentary game system, we're talking 180 calories an hour for something like tennis - only 20 calories more than the can of soda sitting next to me. In contrast, actual tennis burns around 320 calories an hour.

Now granted, more movement is good - but for all those parents who bought the Wii this Christmas with goals of getting their coach potato kids up and both moving and healthier? This is bound to be disappointing news.

Medical Googlers

Are you a medical Googler? This is the term used by a doctor to describe a difficult patient who used Google to both research her disease and options - and him. Apparently the fact that she used Google contributed to her ill-behaved child and rude manners, who knew?

Tongue less in cheek, of course there's a problem with relying too much on the internet for medical advice - if you're not a doctor (or medical personnel of some sort), chances are pretty good you can't sift out the good advice from the bad advice with 100% accuracy. A doctor has the training to do this; some, like the author of the rather paternalistic Time article, view this as the primary purpose of a doctor - to have the training to separate out good from bad.

But as others note, the problem doesn't appear to be a patient who Googles their condition, so much as it is a patient who doesn't laugh at his jokes, or place full trust and authority in the doctor's hands (like nurses, who are apparently the best patients for just this reason).

The doctor claims this woman tracked down so much information on him, she even knew where he lived. And if this is true, then the patient certainly stepped over a line from researching disease/provider offering treatment to "kinda scary stalker behaviour" - and it's understandable anyone would be creeped out by that. But researching your own disease, and being able to ask "excruciatingly well-informed questions" (a problem, according to the doctor), seems like the precise thing patient-advocacy groups advocate for: a well-informed patient who is making the most informed decisions possible.

Benazir Bhutto

The first woman to lead a Muslim government in modern times, Benazir Bhutto, was assassinated today at a rally in Pakistan.

Regardless of what one thinks of her policies, politics, or even the possibility that the corruption charges repeatedly raised against her were true, Bhutto focused attention on the social, health and human rights of women in a state that routinely treats women as second class citizens.

Critics charge she was all promise and no action, while supporters argue that she was hamstrung by opposing, conservative political parties at every turn. It might be impossible to ever untangle fact from fiction from political manipulation, but what is undeniable is that she was a very visible, female face in Islamic politics, in a region of the world not known for allowing women that type of power.

following up on the Nataline Sarkisyan case

Over the weekend, wreese wrote about the case of Nataline Sarkisyan, a 17 year old leukemia patient denied a liver transplant. Sarkisyan died shortly after her insurance company reversed their decision to not approve payment for the procedure, and now lawsuits and manslaughter charges are being thrown to the media.

At this point, in the slow news days post-Christmas, the media is converging like sharks in bloody water, and someone's finally mentioned "the R-word". Rationing. It's a concept no one likes to hear when medical care is being discussed, but the facts of the matter are simple: there is simply not enough to go around.

What "enough" is varies in cases and circumstances. In this particular case, it's organs for transplant. But in another situation, it might be a vaccine, or drugs to treat a deadly communicable disease.

In Nataline's case, it appears to be, at first glance, a situation where public outcry is being raised against a company being portrayed as evil, greedy, only seeking the bottom line, and not caring about the actual health of the individual. And while this might be the case - for-profit companies are almost always driven by the bottom line - it seems to conveniently overlook a lot of the details of the case. Details like her leukemia, the wildly varying reports of transplant's success in saving her life, her overall medical state. But even if these details weren't overlooked, I think the public outcry would still be there, and for that one simple reason: rationing. And in discussing the case, the Cigna representatives made the mistake of framing the dialogue in terms of limited care that not everyone can receive.

No one likes the idea of medical care being rationed, because everyone wants to believe that they'll be covered if something happens to them or their loved ones. Nataline's case clearly shows otherwise.

Ten Biggest Health Stories of 2007 (from Alternet)

Okay, I promise this is my last 'top ten' post (at least for today and mostly likely for 2007 -- Can you tell I love these lists?). For the next few days, I will be en route to Indonesia and East Timor, so you won't hear much from me, but I do hope to do some blogging in Bali!

From criminal health care to outrageous diet plans, these are AlterNet's most-read health stories of the year:

10. Even Republicans Hate Our Health Care System

9. Are You One of the Shrinking Americans?

8. I'll Have My Cosmetics with a Side of Infertility, Please

7. The Toxic Chemistry of Everyday Products

6. Private Health Insurance Is Not the Answer

5. The Stone Age Diet: Why I Eat Like a Caveman

4. Controversial Michael Moore Flick 'Sicko' Will Compare U.S. Health Care With Cuba's

3. The Frightening New Normalcy of Hating Your Body

2. You Call Yourself a Progressive -- But You Still Eat Meat?

1. Michael Moore Rips Wolf Blitzer on CNN: "Why Don't You Tell the American People the Truth" [VIDEO]

For links to all the above stories, click here.

Wishing you all a happy, joyous, and abundant 2008!

Top Ten Technologies that give you 'superpowers'

From BioSteel that gives you powers like to Spiderman to an invisibility cloak, this is a fun article from the SciFi network.

Editor's Note, added Jan. 31, 2007: Oops, here's the link. Thanks for letting us know!

Top 10 New GMOs for 2007

From Wired Science News, a countdown of the top 10 organisms that didn't exist on Dec. 31, 2006.

1. Ashera GD hypoallergenic cat (although there seems to be some questions as to whether these really have been created -- see this link.)

2. Butanol-producing E. coli

3. Artful fluorescent tadpoles

4. Insulin-producing lettuce

5. Super CO2-absorbing trees

6. Rapid vaccine-making button mushrooms (funded by DARPA)

7. Glow-in-the-dark cats

8. Cancer-fighting Clostridium bacteria

9. Schizophrenic mice

10. Yeast with poison-sensing rat genes

For the full article, click here.

Wednesday, December 26, 2007

Mandatory HIV testing for pregnant women in New Jersey

AP reports that New Jersey has passed a law that establishes a mandatory, opt-out program for testing pregnant women (and newborns at risk) for HIV.

New Jersey has about 17,600 AIDS cases, according to the Kaiser Foundation. Women represent 32.4 percent of the cases — the third highest rate in the nation. The national average is 23.4 percent.

The state has about 115,000 births per year and had seven infants born with HIV in 2005, according to state health department officials.

Bloomberg also reports:

Health-care providers will test pregnant women for HIV, the virus that causes AIDS, in their first and third trimesters unless they refuse, according to the new law. Newborns whose mother's HIV status is positive or unknown at the time of delivery also will be tested.

The rate of mother-baby HIV transmission has been dramatically reduced due to increased testing and preemptive actions:

The number of children in the U.S. reported with AIDS attributed to HIV transmission during childbirth declined to 48 in 2004 from a peak of 945 in 1992, primarily because of the identification of infected pregnant women and the effectiveness of preventative drugs in reducing mother-to-child transmission, according to the CDC report.

Some questions for consideration:

* Does a woman's right to informational privacy outweigh the state's interest in preventing HIV transmission to newborns?

* Does the incurable nature of HIV lend more weight to the latter?

* Does a woman cede certain personal rights when she decides to carry a pregnancy to term?

* On a finer point - which is more desirable in this circumstance: "opt-in" or "opt-out"?

Questions for Our Leaders

Yesterday, we wrote about our call for a presidential debate on science policy. When pulling together potential questions for the debate, I came across a compelling series titled “American Values and the Next President” in the Los Angeles Times (December 12, 2007, Part A; Pg. 30.) It touches on a few of the incredibly important issues our political leaders need to be prepared to address:
An excerpt from the "Life" essay:
…Last month's news that scientists in Japan and Wisconsin had modified adult skin cells to behave as embryonic stem cells seemed at first to have resolved this issue, but that's only true if you believe that the debate over stem cells, cloning and genetic modification is a subset of the debate over abortion.

It is not. It is, or could become, the central life debate of our time, and depending on your perspective, the questions it raises are either exhilarating or horrifying. If you could ensure that your children would never get melanoma, should you do that? How about nearsightedness? Should we be modifying humans in hopes of making them more fit for survival in a warming climate? How about for handling complicated technology, or space exploration?

If these ideas seem excessively science-fictional, consider that when Leon Kass, the conservative University of Chicago professor who would later serve as head of President Bush's Council on Bioethics, wrote a 1972 screed against the then-novel science of in vitro fertilization, he warned that it could someday make mothers of "single women, widows or lesbians." Yesterday's absurdity is today the mainstay of many lives.

Given the expected level of discourse in a presidential campaign, we may be lucky that the candidates are not keen to explore the frontiers of life. Still, it's a missed opportunity...
I would expand the life debate beyond reproductive technologies. Advances in nanotechnology, neuroscience, and robotics, to name a few, will also play an important part in defining "what is life."

My wish for the New Year is that we get beyond paralyzing partisanship, over the top religious rhetoric and the trivializing sideshow antics of the last year and focus the debate on how we can work together to achieve social justice, equity, human dignity and cultivate a critical optimism towards science in order to shape a better future for all.

Tuesday, December 25, 2007

News from the Nanoworld

From the UK Telegraph, cool news from the world of nano: The protein linked with Alzheimer's disease has inspired the design of "nanoyarns" that could be put to a vast range of uses, from body armour to parachutes and super strong nets.

Full story here.

Science Debate 2008

The Women's Bioethics Project, as well as bioethicists Thomas H. Murray (Hastings Center), Arthur L. Caplan (University of Pennsylvania), and Harold Shapiro (Princeton University), have joined Science Debate 2008, a coalition of scientists and concerned citizens, to call for a presidential public debate on science and technology policy.

The grassroots initiative states:
Given the many urgent scientific and technological challenges facing America and the rest of the world, the increasing need for accurate scientific information in political decision making, and the vital role scientific innovation plays in spurring economic growth and competitiveness, we call for a public debate in which the U.S. presidential candidates share their views on the issues of The Environment, Health and Medicine, and Science and Technology Policy.
To date, most of the coalition supporters are men. Let’s be sure that women’s voices and concerns don’t get lost in this debate. You can sign the petition yourself here.

Sunday, December 23, 2007

Global Warming spreads tropical disease

Chikungunya, a relative of dengue fever, is not something you would expect to contract it Italy, but a recent outbreak in Castiglione di Cervia is the first indication that a disease that had previously been seen only in the tropics is spreading because of global warming and globalization. According to a NY Times article today, Dr. Roberto Bertollini, director of the World Health Organization’s Health and Environment program, “This is the first case of an epidemic of a tropical disease in a developed, European country...Climate change creates conditions that make it easier for this mosquito to survive and it opens the door to diseases that didn’t exist here previously. This is a real issue. Now, today. It is not something a crazy environmentalist is warning about.”

Better cracking on those transgenic mosquitoes we had blogged about earlier.

Saturday, December 22, 2007

In the Case of Nataline Sarkisyan

My immediate reaction when first learning of this case, was one of outrage. How dare yet another bean-counting, uncaring, bottom-line thinking insurer, whose job it is to provide health coverage to paying policy-holders, how dare they allow a 17-year old child to die because of petty haggling over approval of a life-saving transplant procedure? How dare they? Particularly given the already tarnished image faced by most of the industry heavy-weights.

Yet, here we are, weighing in on yet another case that at first blush looks like the usual big-guy insurance-giant bullying the little-guy. But is it?
Here is the breakdown:
  • Nataline Sarkisyan, 17-year leukemia patient dies after being removed from life support following complications developed after a bone marrow transplant from her brother the day before Thanksgiving. The complications caused Nataline's liver to fail, placing her in a vegetative state.
  • Nataline's doctors at the University of California, Los Angeles Medical Center, appealed to the Sarkisyan's insurer, Cigna Corp., to reconsider an initial refusal of a liver transplant, which doctors said was crucial to her survival. Cigna initially refused to authorize the procedure, calling it experimental.
  • Cigna later rescinds the earlier decision, agreeing to the transplant in an 11th hour change of heart.
  • Nataline dies within an hour of being removed from life support.
Nataline's family has promptly filed suit against Cigna, retaining the legal services of Mark Geragos (remember him from the Michael Jackson and Scott Peterson trials?), who promptly blamed the insurer for Nataline's death. Geragos has asked the California District Attorney's office to press murder or manslaughter charges against Cigna, claiming, the insurer "maliciously killed" her because it didn't want to pay for her transplant and aftercare.

At issue is whether the procedure would indeed have saved her life. Doctors in the case stated the survival rate for patients in similar situations is six months at 65 percent. A complicated case.
Access the article here

Friday, December 21, 2007

Worth Noting

Stumbled across this gem of an article about 7 Medical Myths Even Doctors Believe from LiveScience. The British Medical Journal found out that when it comes to urban myths, doctors aren't immune. For example:

"Myth: We use only 10 percent of our brains.

Fact: Physicians and comedians alike, including Jerry Seinfeld, love to cite this one. It's sometimes erroneously credited to Albert Einstein. But MRI scans, PET scans and other imaging studies show no dormant areas of the brain, and even viewing individual neurons or cells reveals no inactive areas, the new paper points out. Metabolic studies of how brain cells process chemicals show no nonfunctioning areas. The myth probably originated with self-improvement hucksters in the early 1900s who wanted to convince people that they had yet not reached their full potential, Carroll figures. It also doesn't jibe with the fact that our other organs run at full tilt."

For the other six myths and the rest of article, click here.

Sea Cucumbers -- they're not just for dinner anymore

Far from being a mere oriental delicacy, Sea Cucumbers are turning out to be the hottest new miracle organism -- not only are they being investigated to help regenerate our organs and bring eyesight to the blind, they may be able to stop the spread of malaria with transgenic mosquitoes, which could save millions of lives. Genetic engineering at its best.

How cool is that?

EPA vs. States: Round 2

A followup to yesterday's post on the EPA:

Pennsylvania, New Jersey, Washington, and other states have announced that they will join California in the lawsuit against the EPA.

Maryland Gov. Martin O'Malley and Attorney General Doug Gansler, in a joint statement, said the Bush administration's decision is "thwarting the will" of more than a dozen states.

Vermont Gov. Jim Douglas, a Republican, said the EPA "is out of touch with the reality of climate change." New Jersey Gov. Jon Corzine, a Democrat, called the decision "horrendous," while Maine Democratic Gov. John Baldacci called the administration "obstructionist." Officials in New York, Connecticut, Arizona and Pennsylvania made similar comments.

The current investigation by the House Oversight and Government Reform Committee indicates that EPA Administrator Stephen Johnson disregarded staff recommendations that the EPA would lose a lawsuit should California file one.

Environmental Protection Agency Administrator Stephen Johnson overruled the unanimous opinion of his legal and technical staff in blocking California's effort to cut greenhouse gases from cars and trucks - a new revelation that California officials say shows his decision was based on politics, not the law.

House Oversight and Government Reform Committee Chairman Henry Waxman, D-Los Angeles, launched a probe Thursday into why Johnson made his decision even though EPA staffers reportedly warned him he would lose in court if he denied California's request.

…The EPA's legal staff reportedly prepared a PowerPoint presentation advising Johnson that if he denied California's waiver request and the state sued, the EPA was likely to lose, agency staffers told the Washington Post. If he granted the waiver and automakers sued, the staff wrote, "EPA is almost certain to win."

This issue has clearly left the environmental sector to stake out a spot in Constitutional Law. Stand by for a big rumble.

‘Twas the countdown to Christmas

Our health -- in fact, our survival -- is inextricably connected to the health of our environment: it's not just an issue, like poverty or world peace, it is the overarching issue. Which is why I decided to do things a bit differently this Holiday season. But instead of simply explaining what, I inflicted some derivative seasonal doggerel on my long-suffering fiends and relations...and now on you, dear reader of this blog:

‘Twas the countdown to Christmas and all through my brain

Danced visions of giving to loved ones again.

With credit cards handy and Christmas cards too,

‘Twas Xmas like always -- what else could I do?

But then, from my Mac there arose such a clatter

I sprang to the keyboard to check out the chatter.

And right there on U-Tube was Al Gore himself

With flipcharts behind him -- a right angry old elf!

He’d gained a few pounds and was long in the tooth

But none of that mattered, ‘cause he’d seen the Truth.

His points were all listed -- a litany of shame,

And he highlighted each as he called them by name:

“On climate, on flooding, on habitat loss!

On the things that we purchase, and play with, and toss!

On warming, and melting, and drowned Polar Bears,

On species extinction! (I covered my ears…)

Al’s finger was wagging, it pointed at me.

I looked left and right and got ready to flee…

But what to my wondering eyes should appear

But a handy “Escape Clause” that said “sign right here.”

“Will you change,” asks the Gorester?

Er, sure thing, you bet…

I won’t give this year and (gulp!) I guess I won’t get.

You'll give," says St. Albert, "and here's what you'll do.

You’ll give to your Mother (that’s Gaia to you).

And so, my dear people, tho’ I love you a lot

This Xmas I’ll put all my bucks in one pot

And send a fat check off to where there’s most need.*


And with peace and goodwill towards all women and men, Santa “Cause”

(A.K.A. Mary)

*Specifically: Conservation International, Amazon Conservation Team, and the Institute for Transportation and Development Policy

Thursday, December 20, 2007

FDA to require contraceptives to contain new warnings

According to a press release issued today, the FDA is requiring a new warning on all over the counter stand-alone vaginal contraceptive and spermicidal products. This warning is to inform the public that the spermicide nonoxynol 9 doesn't prevent the spread of sexually transmitted diseases, including HIV.

While this, on the one hand, makes sense - the clinical studies in Africa and Thailand that the press release refers to did show that nonoxynol 9 can irritate mucus membranes, actually increasing the risk for a variety of infections. But on the other hand, do people actually commonly believe, again as the press release suggests, that nonoxynol 9 is an effective barrier against STDs? They very clearly are a contraception, but doesn't our STD education - or even separate HIV education - explain the concept of bodily fluids transmitting infection?

So I admit that while I am neutral on the new packaging (I don't have a lot of faith that people read the directions and warnings in any great detail), I'm sort of baffled with its justification.

A simple Constitutional issue made murky by EPA

NYT reports that the EPA is now denying the right of states to set more stringent automobile emissions standards now that the new federal emissions standards were passed.


The Environmental Protection Agency on Wednesday denied California and 16 other states the right to set their own standards for carbon dioxide emissions from automobiles.

The E.P.A. administrator, Stephen L. Johnson, said the proposed California rules were pre-empted by federal authority and made moot by the energy bill signed into law by President Bush on Wednesday. Mr. Johnson said California had failed to make a compelling case that it needed authority to write its own standards for greenhouse gas emissions from cars and trucks to help curb global warming.

The decision immediately provoked a heated debate over its scientific basis and whether political pressure was applied by the automobile industry to help it escape the proposed California regulations. Officials from the states and numerous environmental groups vowed to sue to overturn the edict.

In an evening conference call with reporters, Mr. Johnson defended his agency’s decision.

“The Bush administration is moving forward with a clear national solution, not a confusing patchwork of state rules,” he said. “I believe this is a better approach than if individual states were to act alone.”

What we have here is, at the minimum, a desire for federal uniformity of a technological standard affecting local economies and health, placed against the right of states to democratically decide on stricter, more applicable standards for themselves. At the worst, we have a government that has corrupted a federal agency to pander to the interests of an industry. Believe what you will, but at the very least, this is a red flag for undermining the relationship between states and the federal government.

And science is not a factor in this decision:

Mr. Johnson, the E.P.A. administrator, cited federal law, not science, as the underpinning of his decision. “Climate change affects everyone regardless of where greenhouse gases occur, so California is not exclusive,” he said.

The Governator isn't going to take this abuse of federal power sitting down:

Gov. Arnold Schwarzenegger of California said the states would go to federal court to reverse the E.P.A. decision.

“It is disappointing that the federal government is standing in our way and ignoring the will of tens of millions of people across the nation,” Mr. Schwarzenegger said. “We will continue to fight this battle.”

He added, “California sued to compel the agency to act on our waiver, and now we will sue to overturn today’s decision and allow Californians to protect our environment.”

Twelve other states — New York, New Jersey, Connecticut, Maine, Maryland, Massachusetts, New Mexico, Oregon, Pennsylvania, Rhode Island, Vermont and Washington — had proposed standards like California’s, and the governors of Arizona, Colorado, Florida and Utah said they would do the same.

Cars do not have rights. Car manufacturers do not have an inherent right to economic protectionism. No fundamental human rights are being violated. This is a capitalist society: consumer demand spurs the market. And in California, Washington, and other states, the consumers have spoken; they want cars with higher emission standards, and it is not the place of car manufacturers, the EPA, or George Bush to question their democratic voices when they wish to exceed the (embarrassingly) bare minimum standards established by the federal government.

While more related to environmental policy than to bioethics, this breach of Constitutionally established precedent allowing states to choose more specific and strict regulation than that presented by the federal government will have direct impacts on bioethical policy. We have already seen the federal government overriding democratically established legalization of physician-assisted dying in Oregon state, and I am certain that more issues will be affected as bioethical issues become more and more visible in society. Some will be overridden on moral claims and are therefore potentially open to discussion. But as ethicists, we cannot stand for a breach of Constitutionality based on industry concerns with absolutely no breach of rights.

Stand by for a clash at the Supreme Court, on an issue that a high school civics student should be able to answer:

AMENDMENT X The powers not delegated to the United States by the Constitution, nor prohibited to it by the States, are reserved to the States respectively, or to the people.

New Technology in Tracing Cancer Cells

This came as welcome news to me--albeit too late for a loved one--that a new form of technology has now hit the forefront in medical research that may provide a much-needed breakthrough in stopping cancer from doing what it does so well: kill.

The technology comes in the form of a device that researchers say can detect, isolate and analyze the tiniest fragments of tumor cells still circulating in the blood. The cells, called CTC's are crucial in the occurrence of metastatic disease, because they have been extremely difficult to detect and trap, until it was too late for the patient. According to the research team responsible for developing the device, "Nine out of 10 deaths in cancer are due to the metastatic process...These are really the cells that end up killing people."

The technology will be significant in helping to arrest the disease, because the ability to monitor the existence and rate of growth of these cells would give doctors a significant advantage in detecting remaining disease following surgery or drug treatment.

Too late for my niece who waged...and eleven-year war against breast cancer--but possibly a ray of hope for those currently fighting the fight.

Access the complete Reuters article here.

Wednesday, December 19, 2007

Running for the shelter of the Mother's Professor's little helper

In this week's issue of Nature, Cambridge University neuroscientists Barbara Sahakian and Sharon Morein-Zamir have penned a commentary entitled "Professor's little helper," which explores, how cognitive-enhancing drugs (like Nootropics and Provigil) are starting to find their way not only the pharmacopoeia that students have relied on at university campuses, but into the lifestyles of medical professionals and academics, which raises some ethical eyebrows.

Has academia become that much of rat race? -- one phrase sums it up: Impact Factor Scores,
Read it and weep. As one modern day philosopher said, "What drag it is getting old."
Rest of the commentary here.

the adverts are right - Guinness IS good for you!

From Wil Wheaton's blog (yes, that Wil Wheaton) comes the fabulous news that Guinness? Is good for you!

According to a new study out of the University of Wisconsin, drinking a pint of Guinness a day gives the same healthy-heart benefits as an aspirin a day (keeps the heart attack away). Apparently something in Guinness - but no lagers - reduces the clotting activity... at least, in the dogs that were in the study. Something tells me recruiting human research subjects won't be difficult!

No one is really sure what in the Guinness causes this anti-clotting activity; maybe it's added anti-oxidants, maybe it's just the effect of alcohol (leading speculation as to why the lager wasn't as beneficial). I do know that many asthmatics are recommended they drink a glass of wine or pint of beer a day, to alleviate inflammation and constriction, and there are of course numerous studies on the benefits of red wine. So, this would not be the first time alcohol has shown to have potential medicinal benefits.

I don't know about the rest of you, but I think this deserves a drink.

[cross-posted to the AJOBlog]

Top Ten Holiday Gifts for Bioethicists

In the spirit of the season, the Women's Bioethics Blog team has some recommendations to bring some bioethics cheer to your Holiday Gift-Giving:

1.) A Copy of The Omnivore's Dilemma, for anyone who has given any thought to the phrase 'you are what you eat'.

2.) A DVD of Michael Moore's Sicko, for whatever ails you.

3.) Energy-saving light bulbs (How many bioethicists does it take to screw in light bulb?)

4.) Donate to Heifer International (seriously)

5.) Spray-on condoms (not-so-seriously-gag gift)

6.) B
iotech blooms - in vitro orchids -a sort of whimsically sweet gift for anyone interested in gardening/plants, or just novel things.

7.) A Grow-Your-Own-Skin Kit (just what I always wanted!)

8.) Med school in a box [game]

9.) Your very own pocket-sized version of the AMA Principles of Medical Ethics.

10.) anything from the Bodyworlds store! The book, however, is always a hit, and you couldn't pry mine out of my cold, dead hands. ;-)

Happy Holidays and Happy New Year to all of our readers!

[Editor's note, added Dec 19 2007 at 7:40pm -- I had to add a personal favorite to my wishlist --for sci-fi lovers, the darkly fascinating Blade Runner, The Final Cut.]

Quote of the Day: Being both pro-life and pro-choice

Anna Clark over at RH Reality Check wins the spot for "Quote of the Day" for the moving essay she has written about how she considers herself both pro-life and pro-choice -- She starts out:

"What if I told you that I used to call myself pro-life?

What if I said that I once believed abortion was murder, or that I suspected women used the procedure to bypass the consequences of sex?

If I told you, would I lose your respect? Would you be suspicious when I say that today I'm committed to the right to reproductive health, access, and choice?"

She then details her ambivalence, her journey and the realization of the complexity of the issue -- the quote that got me, though was this one:

"Pro-choice society, like democractic society, is predicated on space for those who disagree. When we play sides, we forget there are no enemies in the vision we pursue. Our inclusiveness of those who choose not to have abortions, and even those who judge abortion to be morally wrong, is our movement's power. When we approach anti-choicers as friends, not only do we act on the heart of our beliefs, but we create space for anti-choicers to become our allies."

What a poignant reminder -- Life -- it's a beautiful choice.

Tuesday, December 18, 2007

5 Books

It's that time of year again - festive lights, holiday smells, music, family. Of course, sometimes getting a lot of that requires the other thing this time of the year is known for: long lines at the airports, delays, layovers, crying children, extremely cranky TSA agents who don't take kindly to your traveling with a bunch of books on bioterrorism, and the definite need for some decent airplane reading material.

So without further ado, five recommendations of bioethics-related fictional books that I'd recommend to just about anyone. Some are very new, some are old, but all of them raise interesting issues wrapped in fictional fluff.

I Am Legend by Richard Matheson
Of course, it's hard to escape the name of this book right now, since the Will Smith movie by the same name just opened to the largest December box office ever, smashing the third installment of the Lord of the Rings by several million dollars. The Smith vehicle is actually the third remake of Matheson's classic novel (the first was the 1964 movie The Last Man on Earth and the other Heston's The Omega Man), but it is, from all accounts, the most accurate.

And movies are fine and good, but the original novel is well worth reading. Yes, it's a vampire science fiction novel, but the vampires are not Lestat; there's no dripping lace and pathos here. Instead, wrapped in the horror of plague and desperation is a thoughtful look at what it means to be normal, how we define different, and what we do about it.

Written in 1954 and set in 1976, some aspects of it are dated in ways you would expect, but it holds up much better than other science fiction/horror novels of its day. If you like Heinlein, Koontz, or King - an admittedly unusual group to see bunched together - or recent zombie movies like 28 Days Later, this is a must read.

The White Plague by Frank Herbert
Yes, that Frank Herbert, who brought us the spice, also wrote one of the first books on genetically engineered bioweapons. It is one of several books that I will pull off the bookshelf every year, just to reread and enjoy. Given it's content, it's probably strange to admit that this book is like comfort food.

And what is it's content? A very simple premise. What if women were an endangered species? What if someone, a renegade scientist driven mad, decided all women must die, and genetically created the virus to do it?

What would happen to society? How would religion, culture, politics shift and change in the face of the decimation of half the world's population - and the potential demise of the entire human race?

The book discusses all of this, but also addresses the potential for anyone with a modicum of skill to create disease. It takes a very precise epidemiological approach to distribution and spread of the virus, where are the vulnerabilities in our society that would allow infection to race unchecked, and perhaps most importantly - what in the world do you do in that sort of nightmare situation?

It's a thriller, a horror, a science fiction book - but also a mystery, so I'm afraid if I said anymore, I'd spoil it for everyone. But I can't think of a more ringing endorsement than "I read this at least once a year."

The Footprints of God by Greg Iles
How many fictional books, off the top of your head, can you think of that feature, as their main character, a professor of ethics? Chances are, if you haven't read this book, your answer is simple: none. (And if I'm wrong in this, please let me know.) And on the face of it, it's kind of understandable why: an academic isn't terribly interesting, and I'm not certain watching any of us sit around our offices and work, day in and out, would be at all fascinating. But Iles manages to pull this off, in the compelling character David Tennant, professor of ethics at the University of Virginia Medical School. Dr. Tennant is working on for the government on a top secret research project known as Trinity. They are attempting to build a quantum-level supercomputer, run by a neurological operating system.

And when that neurological operating system wakes up, everything goes to hell, and it's up to the ethicist to make it right.

But beyond a simple thriller in the vein of National Treasure, where an academic must step out of their comfort zone and become a hero, Iles infuses The Footprints of God with sophisticated philosophical and ethical questions about the nature of existence, man, and God.

Next by Michael Crichton
Until about 3 months ago, a list like this wouldn't have included any Crichton books for me. I have been - and still am - a fan of Crichton's earlier work, from the classic The Andromeda Strain to more contemporary works like Jurassic Park. But somewhere along the way, he segued into a thriller-esque genre more remniscent of Koontz-ean horror novels or the thrillers by Clive Cussler than the interesting technological and medical books he'd written in the past. Apparently my discontent grumblings were heard by someone, because the last few Crichton books have been a return to his roots, of technology, medicine, and the potential for great achievements and great harm they have.

It was a tossup between this book and Prey, but ultimately Next swayed me. Primarily because I read it on the plane this morning, I think - devoured it, really, reading the entire thing on the flight between Albany and Chicago. I simply couldn't put the book down. It has a complicated story arc of many more characters than you typically see in a fictional book, and the size of the book reflects this. Each story is slowly woven in to the stories around it, until everything merges together into a satisfying, yet simultaneously not over the top, finale.

At it's core, Next is about genetic engineering, corporate politics, and the history of research medicine. He very, very skillfully weaves in fact with fiction - in fact, the disclaimer says that everything in the book is fictional, except the stuff that isn't - and many people might simply assume it's all fiction.

What all? Crichton takes us on a history of the Bayh-Dole act, John Moore's spleen, the UCLA genetic empire, patenting genes and the race to patent, media sensationalism (such as the oft-repeated fear that blonde's will become extinct), the concept of single gene causes for anything from God to gay, decoding the human genome, gene banks, tissue theft, illegal bone harvests - the list goes on. Chances are good, if it's biotech and there has been a story about it in the last ten years, it's in this book.

And that in itself is half the fun - to read the book and recognize the homages, the send-ups, the pokes, and references. To say "hey, he's redoing the Moore case!" or "hmm, that researcher sounds suspiciously like..." - it becomes a fun game of guess the insider knowledge.

But from everyone I've talked to, if you don't have that knowledge, this is still a fun book. It's surprisingly educational and still entertaining; if Crichton was hoping to write a book that would educate the general public on very complicated science matters while still entertaining those who are "in the know", he did a fabulous job.

Darkness Falls by Kyle Mills
This last book dropped into my lap by happenschance, but the description caught my attention and I found myself devouring it on my last cross-country flight, back in October. For those of you who are familiar with Mills' work, Darkness Falls brings back his FBI protagonist Mark Beamon, but it doesn't read like any typical sequel that assumes knowledge of the character. Instead, the book stands solidly on its own, focusing on two other main protagonists.

The first is a maverick and radical environmentalist, Erin Neal. Neal is such not because he is radically anti-corporation, or inclined to chain himself to trees, but because he is a scientists who managed the neat trick of pissing off both conservatives and liberals with his no-holds barred book on oil reserves, energy consumption, and genetic engineering to manage the world's power supply/oil reliance problems.

But after the death of his lover Jenna Kalin, who moved from being an active part of environmental conservation to ecoterrorist, Neal stopped his work in the oil fields, dropping off the grid and out of sight. Until, that is, a bioengineered bacteria begins appearing in the world's oil fields, and Beamon bring Neal in - to determine if he's the cause of the genetic engineering, or can if he can help.

Mills uses this book to tackle a different sort of bioweapon - one that attacks a resource and not humanity. When we discuss bioterrorism, we tend to focus on the person and not the other ways we can be attacked and made vulnerable. Oil reserves, food supplies, water sources - all of these are at as much risk as anything else, yet we simply don't talk about it. And with our reliance on both internationally shipped agriculture and oil for everything from insulating wires to food to gasoline, it is an area of serious vulnerability.

The book, of course, covers much more than this, and again encompasses your typical thriller and action material. But the fact that it goes deeper is significant; it's well done, well written, and very thought-provoking. If you were a fan of Michael Pollan's The Omnivore's Dilemma, this book is a must read for you.

Check back later this week, when I'll give a rundown of top recommended non-fictional books, which ought to be a much harder suggestion list to make!

Pollan on Pollen-Patties and Porcine MRSA

Michael Pollan critiques the lip service paid to the word "sustainability" and shines a light on two larger crises that have roots in our food production system: "Our Decrepit Food Factories". (NYT)

He suggests that the rise of "community-acquired MRSA" (infections not from hospital exposure) stems from our excessive use of antibiotics in raising livestock, especially pigs. With 70% of the antibiotics used in America being fed to our livestock, it is certainly feasible that we are cultivating tomorrow's disease even as we grow today's dinner (UCS). What is so ironic is that comparisons between CAFOs (Confined Animal Feeding Operations) with humanely grown livestock end up with comparable cost-gain ratios, with the former spending less money on animal welfare and more on survival tactics like antibiotics, while the latter pays more up-front for smaller-scale operations but has considerably lower costs when fewer animals become ill from poor conditions. Not only should this serve as a call for a paradigm shift in how we expect our food to be produced, but it also shows a severe failure on the part of the FDA and other public health entities in letting this issue fall into their corporate-induced blind spot.

Pollan also explores the current decimation of our honeybees due to Colony-Collapse disorder, and points out the extreme stress that commercial monocultures like almond growing places on the bees. The stress reduces the effectiveness of their immune systems, and unchecked mingling of large numbers of hives from across the country at almond groves increases the chance of being exposed to viruses like Israeli Acute Paralysis Virus (implicated for causing CCD). In China, there are no more honeybees, and the only thing keeping their agricultural system running is a caste of nearly slave-class people whose job it is to hand-pollinate flowers of fruit trees. Fortunately for China (and for us, since much of our produce, including apples, is imported from there), they don't worry about niggling issues like worker rights and workers' compensation.

The running theme throughout stories like these are that the commodification of organisms and the hubris of complete disregard for the integrity of natural systems of checks and balances could be the source of our downfall. The irony is that each step we take to try to reassert our mastery of Nature is driving us further into this mire of public health threats and looming collapse of the agricultural economy.

Pollan concludes with this:

We’re asking a lot of our bees. We’re asking a lot of our pigs too. That seems to be a hallmark of industrial agriculture: to maximize production and keep food as cheap as possible, it pushes natural systems and organisms to their limit, asking them to function as efficiently as machines. When the inevitable problems crop up — when bees or pigs remind us they are not machines — the system can be ingenious in finding “solutions,” whether in the form of antibiotics to keep pigs healthy or foreign bees to help pollinate the almonds. But this year’s solutions have a way of becoming next year’s problems. That is to say, they aren’t “sustainable.”

From this perspective, the story of Colony Collapse Disorder and the story of drug-resistant staph are the same story. Both are parables about the precariousness of monocultures. Whenever we try to rearrange natural systems along the lines of a machine or a factory, whether by raising too many pigs in one place or too many almond trees, whatever we may gain in industrial efficiency, we sacrifice in biological resilience. The question is not whether systems this brittle will break down, but when and how, and whether when they do, we’ll be prepared to treat the whole idea of sustainability as something more than a nice word.

(Additionally, Pollan has a new book soon to be released: In Defense of Food: An Eater's Manifesto.)

Bioethics Throwdown!

How's this for a bioethics throwdown?: Ron Green vs. Michael J. Sandel
Carlin Romano of the Philadelphia Inquirer writes about "Two polar, persuasive stands on reproductive genetics." A review of Green's Babies by Design: The Ethics of Genetics Choice vs. Sandel's The Case Against Perfection: Ethics in the Age of Genetic Engineering .

One thing they both agree on -- that: "We all need much greater literacy in the ethical concepts and scientific information necessary to make informed decisions about these choices, especially given, as Green reports, 'how fast the science is moving.'"

To read the whole review, click here.

Monday, December 17, 2007

Why progressive technologies are important

"Scientists seek to help 'locked-in' man speak"

As soon as I read this article, I knew three things instantly. First, enhancement and progressive technologies are important and merit serious consideration. Second, this is why I am involved with organizations examining the ethics and real-life implications of enhancement technologies, such as the Institute for Ethics and Emerging Technologies (IEET). Third, I need to purchase The Diving Bell and the Butterfly by Jean-Dominique Bauby.

Well, I've purchased the book and it is a wonderful expression of the human will and mind. It has been an inspiration for my support and understanding of progressive and enhancement technologies that are being worked and thought on right now. For now, I will digress to focus on the specific enhancement technology discussed in this article.

That focus is mapping the brain as vowels and consonants are thought or spoken so that 'locked-in' individuals may speak. This enhancement, purely in conversation, seems impossible, but in actuality, the scientists have already made progress. This progress means these individuals who are 'locked-in' their bodies will finally be able to communicate with the outside world.

Thoughts abound on what that means for the rest of us if this succeeds. Going back to my first thought, progressive and enhancement technologies are important, not just for those they first impact but for the rest of us too.

Semen has Manly Enhancement Factors for HIV

Scientific American reports on a recent study that indicates semen appears to have a peptide that enhances the ability of HIV to infect cells 50- to 1000-fold. (The normal increase observed by enhancers is two to three times)

Kirchhoff and his team screened through many of the 900 proteins found in seminal fluid in their hunt for potential inhibitors and enhancers of HIV transmission. Among the enhancing factors uncovered were fragments of a protein called prostatic acid phosphatase that is secreted by the prostate gland. An analysis of the peptide's structure in semen indicated that it hooked up with similar fragments to create amyloid fibers (clusters of protein fragments that have also been implicated in diseases such as Alzheimer's). The scientists refer to the amyloid fibers as "semen-derived enhancer of virus infection" (SEVI). If they do not link to become fibers, the researchers report, the peptide segments remain inactive and do not enhance viral transmission.

When assembled, however, these fibers then act like ferries, trapping and shuttling HIV virus particles to target cells. The researchers found that HIV spiked into semen was more successful than the virus alone at infecting T cells and macrophages (immune system cells that are believed to be the infection's initial targets in the body). They also tested the threshold of virus needed to infect human tonsil cells, noting that in the presence of semen, far fewer HIV particles were needed for transmission.

Researchers injected both the naked virus and SEVI-treated HIV into the tails of rats that had been given human immune system cells. The HIV with the semen component was five times more effective at transmitting the virus. In situations where low levels of virus are transferred—as during intercourse—Kirchhoff says, SEVI can make HIV up to 100,000 times more likely to spread when compared with the virus alone.

(Yes, the title of the article is amusing.)

This suggests new directions for research into HIV prevention that focus on men's physiology rather than on women's. I hope this will result in a paradigm shift that does more than tell women to "just say no" to sex and shares the burden of HIV transmission more equitably between men and women. Oddly enough, this is reminiscent of the potential paradigm shift that must have happened when it was discovered that men, and not women, were responsible for the sex of their offspring (rendering all those executions of wives who "failed" to bear sons completely erroneous). Or, even better, we will be able to leave the moralistic "blame game" behind completely and focus on what actually works: access to condoms and medically accurate sex education and actual legal and societal empowerment of women to enable them to be proactive actors rather than passive defenders regarding their health.

Creation of New Life Forms: the next step for DNA?

This article fascinated me. Scientific breakthroughs, especially revolving around the use of DNA science--and the ethics of it--always gets my attention. But this article was a mixture of fascination, awe--and fear. There also remained the lingering question in my mind of whether this could really be true--that researchers are indeed considering taking this next step--or if just simply a rumor spawned by someone's overactive imagination.

You can read the Washington Post article, and decide for yourself: whether the prospect of creating new life forms--synthetic life forms--from artificial DNA should be considered a scientific breakthrough--or a major mistake, and what questions it raises about science, religion, ethics and the very essence of genetics.

Sunday, December 16, 2007

Birth Control to Reduce HIV in Africa

I don't know which to be more horrified about in this article entitled the 'Best-Kept Secret' for HIV-Free Africa:

- that researchers realize that birth control can have a great impact on reducing the number of children born with HIV in Africa, but they can't do anything about it, because of the PEPFAR's ban on distribution of contraceptives or family planning;

or the sentence where women are treated like a piece of property: "The man who, in accordance with local tradition, inherited her after her husband died refused to use condoms";

or the comments to the article that say that this is not 'our' (read 'America's') problem. As if we lived in a bubble.

It is a painful reminder of just how far we still have to go when it comes to basic human rights and mankind's inhumanity to man (and woman).

Rewarding the Kindness of Strangers (or Friends or Family Members)

While we wrote about Ashwyn last week and whether or not he was unduly influenced to give up a kidney, Sally Satel, a psychiatrist at Yale writes today in the NY Times magazine about desperately seeking a kidney and how her hopes for finding a donor were raised several times only to be dashed at the last moment because the donor changed his/her mind.

As a result of her experience, Sally is urging wherever she can — "in articles, in lectures, from assorted rooftops — that society has a moral imperative to expand the idea of 'the gift'" and to reward the kindness of donors.

She writes, "Altruism is a beautiful virtue, but it has fallen painfully short of its goal. We must be bold and experiment with offering prospective donors other incentives for giving, not necessarily payment but material reward of some kind — perhaps something as simple as offering donors lifelong Medicare coverage. Or maybe Congress should grant waivers so that states can implement their own creative ways of giving something to donors: tax credits, tuition vouchers or a contribution to a giver’s retirement account.

In short, we should reward individuals who relinquish an organ to save a life because doing so would encourage others to do the same. . . But unless we stop thinking of transplantable kidneys solely as gifts, we will never have enough of them."

Seems like a very sensible solution, and something we in the bioethics field having been talking about since the 80's -- but can we convince Congress to do something about it?

watching the cats that glow in the dark

A video followup to the posts about glowing cats:

[cross-posted to the AJOB blog]

A Smart Bra

A few years ago, researchers in Australia entered the "smart bra" market, trying to design a bra made of intelligent fabrics that would change the strength of its fabric, stiffen or relax cups or tighten and loosen straps as needed. This was primarily going to be for very large chested women who needed the support, especially while working out.

Well, now another researcher is working on a smart bra design, only this one is for detecting breast cancer. The UK researchers are using
a series of microwave antennae to detect temperature changes in the breast that point to early stage breast cancer.
This is known as thermography, and the hope is that the temperature change will spot tumours before they grow and spread to the surrounding tissue. The microwaves are passive - the same sort used in astronomy or in detecting submarines - not harmful to individuals (which I'd hope wouldn't have to be said, but sometimes...) - and the bra itself would chime a little alarm when wearers needed to see a doctor due to potentially dangerous changes.

Now granted, it's still in the design stage, and there are concerns over whether or not the alarm would be triggered by false positives (nonmalignant changes in breast tissue, for example), or if it would be truly effective in catching cancerous growths before they advanced far enough to be seen by a mammogram or felt during a breast exam. And beyond the practical functionality, there's a cost issue.

While this isn't addressed in the articles I've read on the subject, I would be concerned about the exclusivity something like this would naturally have. I can't imagine it would be an inexpensive device to wear, so it would lock out a large segment of the population for whom it might be most beneficial - those who can't afford yearly exams and screenings. But then again, given the recent study that showed how many cases of cancer radiologists miss, it would still be a good thing - just for a more limited group.

Saturday, December 15, 2007

Season of Giving: Should Ashwyn be allowed to donate his kidney?

An excerpt from this week’s WSJ touches on so many of the issues we face surrounding organ donation: informed consent, potential exploitation, donor motivation, as well as the very real problem of organ shortage.

What do you think? Should Ashwyn be allowed to donate his kidney?

For Religious Group,
True Charity Begins 
On Operating Table: Sect's Kidney Donations Pose Dilemma for Doctors - A Member's Mom Objects

December 13, 2007; Wall Street Journal, Page A1

Ashwyn Falkingham wanted to donate one of his kidneys but didn't know anyone who needed one. With the help of a Web site, he met a woman in Toronto who was seeking a transplant. The two were a medical match, and he traveled from his home in Sydney, Australia, to Canada for final testing and, he hoped, for the surgery. It's a "simple thing that can help someone," says Mr. Falkingham, now 23 years old.

But it wasn't simple, largely because Mr. Falkingham is a member of a tiny religious group calling itself the Jesus Christians. The group's 30 members, who eschew many of society's conventions, have embraced kidney donation: More than half have given a kidney. They describe the act as a gift of love that implements Jesus's teachings. But critics, particularly parents of members, call the group a cult and charge that members are under undue influence of its charismatic leader.

In the end, the hospital in Toronto had to decide whether Mr. Falkingham's offer was a simple expression of altruism, as he had represented it to be, or an offer from a man no longer capable of independent thought, as his mother and stepfather alleged. More than 460 people have given kidneys anonymously in the U.S. over the past decade, and many others have donated to strangers they met online, amid a huge shortage of available kidneys. Nearly 75,000 people in the U.S. are waiting for kidney transplants. Many hospitals aren't interested in donors who don't have an established, personal relationship with the recipient. That is partly because of fears that such donors may be secretly -- and illegally -- paid. Other concerns: Stranger donors may be psychologically disturbed, unrealistically hopeful that donating a kidney will improve their own lives, or likely to back out.

The University of Minnesota has handled 42 transplants involving anonymous donors, including two Jesus Christians. Catherine Garvey, a transplant coordinator there, says neither case caused concerns. "There's definitely a religious reasoning to it," she says, "but people often quote a spiritual or religious reason."

Friday, December 14, 2007

The Real Science Behind Fertility

You are what you eat...and so apparently is your ability to become fertile. That's according to a recent study done by Harvard doctors, whose findings suggest an apparent connection between women's diets and fertility.

Published last month in the journal Obstetrics & Gynecology, the study found a growing body of evidence linking diets to hormone levels particularly insulin, which impacts fertility.

This Los Angeles Times article details the study's findings and recommendations.

Deadly (Mis)Diagnosis

After nine years Audrey Serrano is a "free" woman.
A jury has awarded her $2.5 million in damages for HIV treatment she received over those nine years--powerful drugs she was given to treat an illness she does not have.

Serrano filed suit against the doctor who treated her, following a second diagnosis that revealed no presence of HIV in her blood. The misdiagnosis was based, according to Serrano's attorney, on presumptions by her former doctor about Serrano's lifestyle that tend to be associated with patients more likely to have HIV and AIDS.

See details of what's being called an "astonishing" case in this article from the Washington Post.

Why Look for God in the Brain?

If you've ever wondered which came first (does the brain physiologically induce spiritual experience? or do spiritual experiences physiologically affect the brain?), an article in Scientific American explains that it may not be such a crucial question:

"Such efforts to reveal the neural correlates of the divine—a new discipline with the warring titles "neurotheology" and "spiritual neuroscience"—not only might reconcile religion and science but also might help point to ways of eliciting pleasurable otherworldly feelings in people who do not have them or who cannot summon them at will. Because of the positive effect of such experiences on those who have them, some researchers speculate that the ability to induce them artificially could transform people's lives by making them happier, healthier and better able to concentrate. Ultimately, however, neuroscientists study this question because they want to better understand the neural basis of a phenomenon that plays a central role in the lives of so many. "These experiences have existed since the dawn of humanity. They have been reported across all cultures," Beauregard says. "It is as important to study the neural basis of [religious] experience as it is to investigate the neural basis of emotion, memory or language."

Author David Biello goes to explain that "Artificially replicating meditative trances or other spiritual states might be similarly beneficial to the mind, brain and body." But don't expect neuroscience to prove or disprove the existence of God, as Biello concludes: "Although atheists might argue that finding spirituality in the brain implies that religion is nothing more than divine delusion, the nuns were thrilled by their brain scans for precisely the opposite reason: they seemed to provide confirmation of God's interactions with them."

The rest of article can be accessed here .

Thursday, December 13, 2007

looking for cats that glow in the dark

Up over on the AJOBlog is a post about the latest in South Korean cloning: cats that have bee genetically modified to glow in the dark. It's certainly coming in under the wire for "coolest things to happen in 2007", but made it.

The practical part of my brain saw the pictures and immediately thought "what a wonderful way to find your cat when it's hiding!" ...but that just might be me.

User Guide: The Ethics of Bioethics

Stem cell research. Drug company influence. Abortion. Contraception. Long-term and end-of-life care. Human participants research. Informed consent. The list of ethical issues in science, medicine, and public health is long and continually growing. These complex issues pose a daunting task for professionals in the expanding field of bioethics. But what of the practice of bioethics itself? What issues do ethicists and bioethicists confront in their efforts to facilitate sound moral reasoning and judgment in a variety of venues? Are those immersed in the field capable of making the right decisions? How and why do they face moral challenge -- and even compromise -- as ethicists? What values should guide them?

In The Ethics of Bioethics, Lisa A. Eckenwiler and Felicia G. Cohn tackle these questions head on, bringing together notable medical ethicists and people outside the discipline to discuss common criticisms, the field's inherent tensions, and efforts to assign values and assess success. Through twenty-five lively essays examining the field's history and trends, shortcomings and strengths, and the political and policy interplay within the bioethical realm, this comprehensive book begins a much-needed critical and constructive discussion of the moral landscape of bioethics. "The Ethics of Bioethics is a milestone in the field of bioethics. It brings together all the right people, asking all the right questions and proposing answers to meet the challenges of our time. Anyone who is paid to do work in bioethics -- and, for that matter, anyone who takes bioethical inquiry seriously -- will need to read this book and engage the issues it raises." -- Matthew Wynia, Past-President, American Society for Bioethics and Humanities (from the book description.)

Death Casts a Shadow in the Classroom

The Chicago Tribune explores the heated life and death debate over the role of schools and DNR orders.

Read Katie's story and decide where you stand on the ethics of medical care for severely disabled/terminal children in the classroom.

Surviving Pioneer: Facing the Future with Courage

It is never easy being the "first". We've all experienced the gripping fear and paralysis that comes with deciding to cross the boundaries that lead us into the unknown. Yet we take the step--because it is worse not knowing what could have been. Especially when we know how dramatically life-changing taking that step could be.

When Isabelle Dinoire lost half her face in a horribly tragic dog mauling two-years ago, there were many who felt she was sentenced to a life of permanent disfigurement. When her landmark face-transplant surgery was later announced by French doctors, the list of detractors and naysayers was lengthy.

But no one can deny the surprising success of the procedure, the skill of her surgical team--nor her amazing courage for taking that first step into the unknown, and making medical history.

This article from the Washington Post traces the many challenges...and setbacks she faced, in choosing to undergo one of the most remarkable experimental therapies of our time.

Wednesday, December 12, 2007

Anorexia: blame in utero hormone exposure?

NYT reports that initial research findings suggest that anorexia may be influenced by exposure to female hormones in utero.

While there may be some connection between female hormones and the way self-perception and self-criticism in the brain occur, I am skeptical of a specific behavioral influence since ideal standards for body weight have varied so greatly over the years. Perhaps there may be a propensity toward being harder on oneself, regardless of the particular aesthetic standards of the time. I would like to see more research on in utero hormonal ties to other mentally-originating disorders, like OCD and depression to see if there is a more systematic effect.

This would be another interesting area of developmental research - the effects of development due to prenatal exposure to different hormones. Several years ago, there were some articles suggesting a connection between excessive androgen exposure and Autism and Asperger's.

To Fortify or not to Fortify, that is the question

NYT reports on the ongoing controversy surrounding regulations that would require U.S. flour to be supplemented with folic acid to prevent birth defects.

I have mixed feelings on this because I am not yet convinced that making folic acid a ubiquitous supplement to a universal staple like flour is has side effects benign enough to make it an ethical policy. There are suggestions that folic acid can mask other health problems, like vitamin B deficiency, making such conditions harder to diagnose and subsequently treat.

Ideologically, this outlook is bothersome in the same way as the CDC recommendation (via WaPo) urging that all women be considered "pre-pregnant" - this attitude is a dangerous one to start subscribing to for many reasons, not just because men make up (nearly) half of the population, but also because there are women who do not wish to have children, and to treat them as if they will can be seen as patronizing and insensitive.

From a cost-benefit perspective, there certainly are benefits to be had by ensuring pregnant women have access to folic acid supplements to avoid this easily preventable class of birth defects, and if there were no risk of side effects from folic acid intake for the general population, then increasing the presence of folic acid could make sense. However, the implied paternalistic statement that women are too stupid or incapable to take an easy-to-consume supplement (orange juice) and that that society will take steps to ensure the health of the ZEF (zygote/embryo/fetus) in her with or without her consent carries dangerous implications; why not also ban all women from activities that pose a clear risk to the ZEF as well? Is there a difference between prescribing and proscribing at this level?

A socio-economic perspective questions whether pregnant women would have at least an average likelihood of using this fortified flour in their diets - given that more and more of the economically disadvantaged population don't cook food at home and instead consume pre-made food, and that pregnant women are often more strapped for time than the general population, wouldn't it be more reasonable to fortify some other food source, perhaps one that pregnant women would be more likely to consume? How about adding folic acid supplementation/access to the WIC program, for example? This program is specifically targeted to women, especially lower income women who may be less aware of and less likely to have access to folic acid supplements - not only does it avoid the frustrations of federal governmental regulation (when the FDA can't even keep unapproved GMO crops out of our food system) and paternalism, but it is a more efficient use of existing resources that already target the group of people we hope to help.

Addendum: Upon further reflection, I wanted to emphasize that there is a whole gradient of possibilities to implement a "folic acid promotion" policy - anywhere from working with one flour producer to make a line of flour enriched with folic acid, to requiring at least one line without, to letting the free market determine how many producers would enrich (and be required to label positively or negatively), to everything in between. If a policy wonk actually wants to compare the relative effectiveness of such programs, be my guest.