Monday, June 30, 2008

Daycare: The Strong Will Survive

By Leane Scoz

A recent article in Newsweek suggests that children who attend daycare are healthier than kids who do not by the time they enter kindergarten.

According to columnist, Claudia Kalb, more than 7 million children are enrolled in daycare. Everyone who has ever had a child in daycare knows that they and their child will probably contract a wide variety of illnesses within the first year of their child's attendance. The illnesses run the gamut, from the common cold and earaches to more sever infections such as RSV and the flu. With all of the pain and suffering parents and children have to endure, does the light really shine at the end of the tunnel after daycare?

Researchers at the University of California, Berkeley, say yes. An analysis of their studies revealed that daycare children have a 30 percent lower risk of developing childhood leukemia due to the increased exposure to infections. University of Arizona scientists carried out research over the last 10 years and found that although kids in daycare get twice as sick as their non-daycare counterparts, they have a third fewer illnesses by the time they enter elementary school. The research also showed that daycare children are less likely to develop asthma.

However, parents of children who do not attend daycare should not be discouraged. By the time children are teenagers, researchers report that no difference exists in either group of children because their immune systems catch up with each other.

The bottom line--allow the circle of illness to continue and do not worry too much about children in daycare. Everyone equals out in the long run.

Sunday, June 29, 2008

No More Monkey Business

By Randy Hendrickson

Do the advancement of science and the possibility of finding new therapeutic options for disease justify “offending the dignity” of animals?

According to Nature (June 12, 2008; 453(7197):833), the local administrative court in Zurich, Switzerland recently banned several research experiments on macaque monkeys that were being performed jointly by the University of Zurich and the Federal Institute of Technology Zurich (ETHZ). Macaques are the most widespread genus of primates and are found in northern Africa as well as parts of Asia. The brains of these monkeys are closely related to those of humans in structure, and they make an excellent research model for studying neurological function and dysfunction.

The aim of the experiments was to study how the cortex of the brain adapts to change. One experiment involved depriving the monkeys of water (or any other drinks) for long periods of time so that they would value the reward of apple juice more when they performed a task correctly. Another experiment required that the monkeys be sacrificed after the experiment in order to examine the microcircuitry of the cortex of the brain. These experiments were previously approved by the Swiss National Science Foundation; however, an external animal experimentation advisory board challenged the right to continue the research on the grounds that it would “offend the dignity” of the monkeys.

Swiss law mandates that the benefits to society must outweigh the burden to the animals. In addition, a new court interpretation of the law demands that there must be immediate benefits gained from the research. According to the court ruling, “society is unlikely to see the benefits of the research during the 3-year funding period approved, and thus the burden on the animals is not justified.”

Conversely, according to PETA, the British government automatically rubber stamps most animal research, even when the benefits are vague or intangible. The main difference between the Brits and the Swiss is that the Swiss require that the benefits be immediate, whereas the Brits only have to show that there may possibly be benefits further down the road. Unfortunately, this has led to more than 3 million animal experiments in Britain annually despite obvious scientific failings.

The Swiss researchers feel that the use of the “immediate benefit” requirement is completely unrealistic and will impede progress in preventing and treating neurologic conditions such as Parkinson’s and Alzheimer’s diseases. Both the University of Zurich and the Federal Institute of Technology Zurich are planning appeal the lower court’s decision in hopes that they can continue their research.

Saturday, June 28, 2008

Electrosmog, Cell Phones, and Cancer.... Oh My!

By Emily Stephens

“The Earth is being engulfed in electrosmog!”
Arthur Firstenberg is one of the growing number of electromagnetic hypersensitive (EHS) people who suffer physical and psychological symptoms reportedly caused by electromagnetic fields. Imagine terrible headaches, nausea, or heart arrhythmia whenever being near Wi-Fi, a computer, a cell phone, or electric lights. Firstenberg, along with a handful of others are fighting to stop a plan to install Wi-Fi in all Santa Fe public libraries and government buildings. His argument seems to be falling on deaf ears.

Santa Fe’s city attorney determined EHS is not covered by the federal Americans with Disabilities Act. Furthermore, there is no legal precedent where Wi-Fi has ever been identified as the cause of EHS. So far, the Santa Fe City Council remains undecided.

Proponents of Wi-Fi insist there is no proven, causal link between the medical symptoms and wireless technology. The World Health Organization agrees with them: although the symptoms of EHS "are certainly real" and disabling for those affected, "there is no scientific basis to link EHS symptoms to EMF (electromagnetic field) exposure." So, is the etiology of EHS simply psychosomatic?

In 1988, 60 Swedish employees of an Ericsson subsidary company developed EHS after a mobile phone base station was installed on their office building’s roof. At first, the company tried to keep quiet about the whole ordeal. After receiving a $1 million grant from the Swedish Working Life Fund, they decided to go public and change the working environment. Unfortunately, most of those who were affected are still hypersensitive.

Interesting to note, Sweden is the only country in the world that accepts electrosensitivity as a physical impairment. Over 2.4% of their population is registered as having some form of EHS. Apply that ratio to the US population, and one could extrapolate that as many as 6.5 million Americans experience wireless symptoms.

Nikola Tesla is the first person suspected of having EHS. Recognized as one of the greatest technological scientists of all time, Tesla developed a severe illness late in life that many believe was caused by repeated exposure to high levels of electromagnetic fields.

"To doctors [Tesla] appeared at death's door. One of the symptoms of the illness was an acute sensitivity of all the sense-organs. His senses had always been extremely keen, but this sensitivity was now so tremendously exaggerated that the effects were a form of torture. The ticking of a watch three rooms away sounded like the beat of hammers on an anvil. The vibration of ordinary city traffic, when transmitted through a chair or bench, pounded through his body."
-The Life of Nikola Tesla by John J. O'Neill

Whether or not you believe in EHS, wireless technology has actually been proven dangerous. This last February, Dr. Seigal Sadetzki found a link between chronic cell phone usage and the development of benign and malignant tumors within the salivary gland. Those who used cell phones heavily on one side of the head were found to have an increased risk of 50% for developing main salivary gland (parotid) tumors, as compared to non-users.
Sadetzki's study, which investigated nearly 500 people diagnosed with salivary gland tumors, also found those who live in rural areas have an increased risk for cancer. Rural areas typically have fewer cell phone towers and antennas, so cell phones must emit more radiation in order to work.

“While I think this technology is here to stay,” Sadetzki says, “I believe precautions should be taken in order to diminish the exposure and lower the risk for health hazards.” Her recommendations?

1. Use hands-free devices at all times.
2. When talking, hold the phone away from one’s body.
3. Call less frequently.
4. Shorten the length of your calls.

The moral of the story? Beware of electrosmog, cell phones, and cancer. Hmmm. I guess now we know. And knowing is half the battle, right?

There are Bugs in My Food

By: Jenny Walters

A recent report on National Public Radio (NPR) entitled “Getting the Goods on ‘Good Bacteria’” by Allison Aubrey and a recent article entitled “Eat Your Germs” by Sanjay Gupta, MD discussed the new trend of probiotics in yogurt.

“A probiotic is any substance containing live organisms that, when ingested, have a beneficial effect on the host by altering the body’s intestinal microflora.”[1] Probiotics are often referred to as the “good” bacteria and can be found in yogurt, kefirs, and in pill-form as dietary supplements. The “good” bacteria can include Lactobacillus reuteri, Lactobacillus rhamnosus, and Bifidus regularis.[2]

The theory behind probiotics is, “certain strains of these living organisms – or good bacteria—can displace bad bacteria in the gut.”1 One trial dealing with the popular Activia yogurt split healthy volunteers into two groups: one ate Activia and the other ate an inactive form of Activia product with no love bacteria. At the end of the study, the volunteers who ate the Activia with live bacteria experienced a 21% decrease in colon transit time (meaning food passed more quickly out of their bodies).1

According to Dr. Gary Huffnagle: “In the digestive tract the bacteria help to regulate and restore peristalsis, the rhythmic motion of he intestine that pushes digested food through…Doesn’t matter if you are constipated or the opposite…these bacteria can help make you regular.”2

In addition to aiding in regularity, the “good” bacteria can also battle numerous forms of allergies, irritable bowel, and pediatric diarrhea.1,2 In a recent study, researchers gave Lactobacillus GG, sold under the brand name Culturelle or VSL-3, to pregnant women with a history of allergies and then to their infants. The study revealed babies who received Lactobacillus GG developed a significantly lower rate of allergic eczema than the control group that did not take the product.1 However, in other studies in children with well-managed Crohn’s disease, probiotics did not reduce gastrointestinal flare-ups.1

Currently, because probiotics are categorized as dietary supplements, the Food and Drug Administration (FDA) does not approve them.1 In addition, there are some people who should not take probiotics. According to Dr. Gupta, those with weakened immune systems and those who are critically ill should not ingest foods with live bacteria.2 Furthermore, probiotics can take some time to adjust to. If one suddenly began to ingest large amounts of probiotic products, there is a possibility of developing uncomfortable bloating.2

As Dr. Huffnagle reports: “You have just started a civil war in your intestines between good bacteria and bad bacteria….Fortunately the war is usually over in one to two weeks and the good guys win.”

Dr. Gupta suggests plain yogurt remains the best product for added bacteria because it has three things the bugs absolutely love: lactose, fat, and water. However, with more than $100 million in sales in Activia’s first year in the U.S. alone, the “good” bacteria idea seems to be paying off.2 Due to successful sales of Activia, other companies are beginning to market probiotic yogurt drinks, fortified beverages, and chocolate bars.

I am not yet sold on the idea of probiotics. Personally, I prefer to stick with plain old yogurt instead of the super infused bacteria yogurt.

[1] Aubrey A. Getting the good on ‘good bacteria.’ July 2006. Available at: Accessed on Jun 28, 2008.
[2] Gupta S, M.D. Eat your germs. May 2008. Available at:,28804,1703763_1703764_1725938,00.html. Accessed on June 28, 2008.

The lives of children in unstable nations

By: Jenny Walters

A recent article posted on entitled Kids’ lives are nightmares in unstable nations, UNICEF reports, focused on the emerging number of child related crimes taking place in unstable nations, such as Haiti.

According to a recent United Nation’s Children’s Fund report: “More than 50 children have been abducted in Haiti since the beginning of the year, adding to a trend of kidnappings in countries affected by violence.”[1]

Children in countries, such as Central African Republic, Democratic Republic of Congo, and Iraq, which are affected by war, food shortages and poverty, have become targets for armed groups who see them as commodities. In Haiti, UNICEF and local officials report that kidnapped children are being rapped, tortured and murdered. Currently, the United Nations Stabilization Mission in Haiti is working with the national police force to try to put a stop to such crimes.

In the Dominican Republic as many as 2,000 children a year are trafficked, often with the parents’ support.1 Another 1,000 children are working as spies, messengers or soldiers for armed gangs in the Haitian capital of Port-au-Prince.

In Iraq, children have been recruited by militia and insurgent groups. “Girls are increasingly subject to murder, kidnapping and rape, or are being abducted and trafficked within or outside Iraq for sexual exploitation.”1

In the Central African Republic, armed gangs terrorize farms and communities, kidnapping children and holding them ransom.1 Souleimane Garga, in Paoua, told UNICEF, “Bandits broke into his home nearly two years ago and kidnapped his wife, newborn, baby, and two other children, after killing older family members including an uncle and a grandfather.” For two-years, two of his children were held in bush camps, as he was “financially broken” after paying to free his wife and newborn and could not pay the ransom for his other two children. Souleimane’s children are home now, but wake with nightmares and cries remembering what they endured in the bush camps.1

Earlier this month, following the murder of a 16-year-old hostage and the rapping and lynching of other hostages, including infants, a demonstration was held in Haiti’s capital. UNICEF’s Haiti representative stated: “There is no acceptable motive or rationale for these crimes, as there is no acceptable excuse that they should be allowed to continue with flagrant impunity.”1

In July 2006, UNICEF’s report on child soldiers in the nation, reported “as many as 30,000 children may be associated with armed forces or groups as fighters.”1 Of those children, “30 to 40 percent of children associated with armed forces are girls.”

After reading this report, I was almost in tears. The thought that children and families are put through such unimaginable acts, is both disturbing and unsettling. Yet, this type of cruelty takes place in all parts of the world on a daily basis. I look in my daughter’s eyes everyday and could not imagine my world without her.

[1] Kids’ lives are nightmares in unstable nations, UNICEF reports. Available at: Accessed on June 21, 2008.

Friday, June 27, 2008

If i were a rich man, could I buy a pancreas?

Our friend and colleague, Art Caplan, explains in his latest column why cash for kidneys is a scheme that won't work:

Need extra livers hearts or kidneys to transplant because the demand is greater than the supply? The answer, say proponents, is simple. Put a price on kidneys and livers and people will be falling all over one another to sell them. Set the price high enough and hordes will amble into hospitals, sign binding agreements to let themselves be sawed into transplantable bits for cash upon their demise, the thinking goes.

In fact, the American Medical Association recently called for pilot studies on financial incentives for organ sales.

Sounds good, right? Not so fast. Despite the AMA’s enthusiasm for testing a cash-for-parts scheme, it will never work in America.

The market of supply and demand has its place. When it comes to things like cars and paperclips, what we pay for them goes, in part, to helping make more. But when it’s impossible or difficult to create more of the item that’s in high demand, markets simply hike prices to ration access to whatever resource exists. If you don’t believe me, visit a gas station or a ticket scalper.

The supply of transplantable organs is very limited. Despite the AMA’s hopes, we are not going to get a lot more simply by putting a price tag on them.

Not so easy
Becoming an organ donor when you die is actually a very difficult thing to do. About 2.5 million people died in the U.S. last year. But only about 25,000 transplants were done using cadaver organs. While it may seem like there’s plenty of potential to get more organs if the price is right, which is what the AMA apparently is thinking, getting a big boost in the supply from cadavers would be very hard.

You can only be an organ donor if you die in a hospital on life-support. Very few of us do. And you need to be in fairly good shape except for a traumatic injury to your brain. Add to that the fact that donors cannot have any serious communicable diseases and the number of possible donors in that 2.5 million pool shrinks to a fraction.

Many of those who haven’t already signed up to be a potential donor probably have little interest in doing so. The prospect of legally auctioning off their useful remains to the highest bidder when their number is up is not likely to change their minds.

Money and body parts don’t mix
Whether for religious or cultural reasons, some Americans don’t like mixing money and body parts. Some just don’t trust the health care system and fear being rushed off to their maker prematurely if they indicate a willingness to be a donor — a fear not likely to be assuaged if paying for organs makes people worth more dead than alive. Others think markets in body parts smacks of treating bodies as property in a way akin to slavery — something this nation fought a horrendous war to eliminate. And still others know their religion does not permit treating the body as property — what is a gift from God cannot be sold but only stewarded.

If this country were to allow financial incentives for organs, the money would presumably go to the family or the deceased’s designee. But if these people have their hand on the life-support plug and know they stand to make good money as soon as the owner of the valuable body parts is dead, how hard are they going to try to keep that owner alive? While offering money for organs might persuade a few more to donate, it is more likely to turn off those now willing to consider giving out of fear or knowing there’s a reward for their death. Net result: A loss in the overall number of organs available.

The same story applies to using money to encourage living donations. Unless things take a really unethical turn, we are only talking about kidneys and parts of liver or pancreas. But having surgery to remove those organs, and living without them, carries real medical risks. Are there really lots of Americans who are going to line up to sell their parts knowing that potentially nasty complications and even a slight risk of death will follow? I doubt it. And even if some are willing, it won’t be long before prices start to inch up, opening a bidding war for scarce organs and leaving all but the richest with no shot at a transplant. Add in the incentive for potential sellers to lie about their health status as prices begin to climb and you have created a mess, not a solution.

A better way
Perhaps the best argument against markets is that there is another option that has yet to be tried in the U.S. In Spain, Italy and Belgium, laws creating presumed consent or what I prefer to call “default to donation” have been enacted. In those countries, people who don’t want to be organ donors upon their deaths have to register on a computer, carry a card or tell their loved ones they don’t want to donate. Otherwise, the presumption is that you want to be a donor.

No, this is not a socialist plot to give the state control over your body. Under “default to donation” no one’s rights are taken away. You don’t want to donate? Just say so. Default donation is basically the same system we have now except that instead of opting in using a card or drivers license you have to opt out using a card or a driver’s license.

Based on the European experience, we’d likely see a significant jump in the number of organs available to dying Americans. Spain has donor rates two times higher than in many parts of the United States. The default plan could bring a boost in organs for transplant without creating the headaches, fears and misdistribution of a financial market. Doesn’t it make more sense to try a low cost plan that has a chance of working then a high priced market that won’t?

Url Link:

Wednesday, June 25, 2008

Do You Tip Your Doc for Botox®?

In the last few years, an increasing number of General Practitioners, Family Practitioners and OB-GYNs in the United States, Canada, and Australia have added revenue-enhancing cosmetic procedures to their core practice. Because 91 percent of cosmetic procedures are performed on women, OB-GYNs have a ready-made client base—but is the integrity of the physician-patient relationship, the practice of medicine, and ultimately the care of patients compromised when physicians offer cosmetic procedures and products that don’t increase the health and welfare of their patients?

“We are physicians who limit our practice to women,” writes David Levine, MD in the Journal of Minimally Invasive Gynecology, an OB-GYN and outspoken proponent of the practice, “and these same women are responsible for the bulk of the $6 billion per year spent on cosmetic treatments, it seems natural for us to consider offering these treatments.”

Levine’s argument seems logical on the surface, but in medicine, what makes sense financially is not always what makes sense ethically. We must face the fact that there are deep ethical implications of the rapidly increasing trend of General Practitioners (GPs) Family Practitioners (FPs) and OB-GYNs adding revenue-enhancing cosmetic procedures and products such as skin rejuvenation, Botox®, Radiesse®, liposuction, breast augmentation, and mesotherapy to their core practice.

As GPs, FPs and OB-GYNs continue to add cosmetic product lines and menus of cosmetic procedures to the general fare of PAP smears and annual checkups, they risk demeaning their profession by creating a public image that physicians are mainly businesspeople working to increase their income. This trend makes it easy for patients to wonder whether their health and safety is the priority or whether the physician’s income is the priority.

Daniel Frank, MD, an internist in Seattle, established his primary care practice in 2002. At the time other primary care practices were starting to offer cosmetic procedures, but he rejected the idea, “When setting up the practice, we were called upon by a number of sales people who wanted us to offer cosmetic procedures. I believe if there is too much of a financial incentive to offer a procedure or service, then my objectivity could be comprised, and even the best and most diligent and objective among us can’t help but be swayed by the economic factors, particularly in primary care. We did not want to detract from our primary mission, which is the care of our patients, so we declined.”

Until the medical community does something about this trend, we as consumers of healthcare need to raise awareness in our GPs, FPs and OB-GYNs. We need to let them know of the potential moral harms of adding cosmetic procedures to their practice, and we need to lobby for reform. Trust is central to the patient-physician relationship and little is more destructive to patient care than a widespread degradation of the public trust in the medical profession.

The integrity of the physician-patient relationship, the practice of medicine, and ultimately the care of patients is compromised when physicians offer cosmetic procedures and products that don’t increase the health and welfare of their patients. Let’s work to make this trend-line spike down.

Read the full Women's Bioethics Project white paper here.

*Question on Yahoo! Answers forum: Do you tip the doctor who does your Botox? How much? Answer: Docs are not supposed to get tipped as it conflicts with their Code of Ethics.

Tuesday, June 24, 2008

On a Lighter Note...

On a lighter note…

By Michael Leshinski

Not kidding, the seemingly progressive Japanese government has begun the early stages of weight control for its population. The New York Times recently reported that a law requiring all individuals age 40 through 74 must have their waistlines measured during an annual doctor visit. Government officials hope that the recently instituted laws will help accomplish their goal of reducing the number of overweight citizens. Japan is also hoping to reduce the risk of weight related diseases such as diabetes and stroke. To enforce the law, the government has placed strict rules on many companies that provide health insurance to its workers. Employees of a company falling into the age bracket must all have their waistlines measured. The cutoff is 33.5 inches for men and 35.4 inches for women. If you fall above the respective cutoff lines, then it is your employer’s job to make you lose the weight. If they are unsuccessful, the government will impose strict fines that will presumably lead back to the employee and his/her imminent firing. Other citizens, such as retirees, are actually sent a summons letter by the local government to attend special checkups. Even the local government will be held accountable by the national government if they are unable to control the weight of their citizens.

I wonder if the famous Sumo wrestlers are subject to waistline measurement. If so, I wouldn’t want to be the guy who had to enforce those rules. Those with a waist size being greater than the national law will be recommended to undergo weight education in order to drop a few pounds. Violators have 3 months to lose weight or be forced to receive dieting guidance, and then even more education will be imposed after another failed “weigh-in”. The national average for American man’s waistline is 39 inches, almost 6 full inches above the new Japanese standard. I seriously doubt that these standards would fly in the USA. Isn’t it the right of citizens of a free nation to be as fat as they want? It may not be the best good idea, but who are they to choose? FYI the new word for fat in Japan is “metabo”, short for metabolic syndrome. Experts in Japan have coined this condition, characterizing it with similar symptoms as diabetes, including obesity and high levels of blood-sugar. One question remains for the Japanese citizens. Are we really being look after by our government, or have these laws been put in place for political reasons?

  2. - 04-15-2008

Sunday, June 22, 2008

Heaven on Earth for Researchers

by Leane Scoz

Most people have heard of the largest charity in the United States, the Bill and Melinda Gates Foundation, but few are probably familiar with the second largest, the Howard Hughes Medical Institute (HHMI). A recent news segment on the CBS show, 60 Minutes, profiled the charity. Located in Chevy Chase, Maryland, the non-profit medical research institute invests about $450 million per year in biomedical research.

Howard Hughes is remembered as an aviator, engineer, film producer/director, playboy, and bazaar billionaire who suffered from obsessive-compulsive disorder. However, few think of him as a founder of one of the nation's largest private medical research organization. The institute was founded in 1953 by Hughes for the purpose of basic medical research "to probe the genesis of life itself."

Initially, the institute was thought to be the refuge for Hughes' fortune since non-profit organizations are tax exempt. However, after Hughes' death in 1976 and several years of court proceedings to determine the fate of his fortune, the institute experienced incredible growth. Today, it employs more than 2,600 people throughout the country and has an endowment of $18.7 billion.

What makes this organization more appealing to medical researchers than government agencies, such as the NIH? According to the HHMI, the institute is guided by the principle of "people, not projects." It supports researchers who take risks, think about big problems, and explore things that they would not otherwise be able to do if they were federally funded. Researchers are not responsible for huge amounts of paperwork to defend their need for funding. Instead, they are encouraged to spend more time in the laboratory and follow their ideas through to fruition no matter how long it takes.

The institute spends about $1 million per year per investigator and currently funds over 300 investigators. Because the HHMI is a private institute, researchers are permitted to work on controversial topics such as stem cell research from human embryos, which federal grant holders are not permitted to do. Scientists can change the course of their study if they so choose, such as leading stem cell and diabetes researcher, Douglas A. Melton, Ph.D., who switched from frog development research to juvenile diabetes research after his two children were diagnosed with the disease.

At the time of conception, Hughes probably never imagined his organization to be funding research on society's biggest health concerns. Today, the HHMI supports research on subjects ranging from AIDS, diabetes, and cancer to climate effects on cholera and malaria. The research possibilities and funding seem endless.

"Don't Ask, Don't Smell"

by Emily Stephens

Love Potion 69? Weapon of Ass Destruction? Have you heard of the “gay bomb”? It’s a weapon—or rather the theory of a potential nonlethal weapon—that has gay activist groups and anyone with half a brain up in arms. News of an United States Air Force “Gay Bomb” began circulating way back in 1994, when the Sunshine Project (a now-disbanded Berkeley watchdog group who tracked government spending) obtained a 3-page proposal written by the Air Force Wright Laboratory in Ohio for future non-lethal chemical weapons.

According to the proposal, “One distasteful but completely non-lethal example would be strong aphrodisiacs, especially if the chemical also caused homosexual behavior.” Wright Laboratory asked for $7.5 million to fund research and development of the project. It also proposed other non-lethal weapon ideas such as a sweating bomb, a flatulence bomb, and spraying the enemy with bee pheromones and releasing beehives into the combat area. The gay bomb certainly takes the cake, however. “The notion was virtue of either breathing or having their skin exposed to this chemical...soldiers would become gay,” explained Edward Hammond of the Sunshine Project.

Department of Defense claims to have dismissed the idea at a very early stage, but Hammond doesn't believe them. “The truth of the matter is, it would have never come to my attention if it was dismissed at the time it was proposed. In fact, the Pentagon has used it repeatedly and subsequently in an effort to promote non-lethal weapons, and they submitted it to the highest scientific review body in the country for them to consider.” Nonetheless, government officials insisted again in June 2007 that no funding was awarded to the project.

It’s hard not to be fascinated by non-lethal weapons. Imagine fighting a war where nobody dies. But a gay bomb? Really? There are so many inherent problems and assumptions within this formula, it is actually terrifying to think something like this might be possible. After all, it would mean human beings, like mindless drones, are incapable of controlling their actions. And, personal agency, or free will, is totally out the window. It also assumes that gays make ineffective soldiers at best. “Throughout history we have had so many brave men and women who are gay and lesbian serving the military with distinction,” said
Geoff Kors of Equality California. “So, it’s just offensive that they think by turning people gay that the other military would be incapable of doing their job.”

Is there any medical truth behind the “gay bomb”?

Two compounds long suspected of being pheramones were tested: a testosterone derivative produced in men's sweat and an estrogen-like compound in women's urine. The estrogen-like compound activated smell-related regions in women and the hypothalamus in men. Basically, the hypothalamus governs sexual behavior and the pituitary gland’s release of hormones. Conversely, the male sweat compound activated the hypothalamus in women and the smell-related regions in men. However, when the study was repeated with homosexual men, it was discovered that gay men responded the same way as women—as if the hypothalamus’s response was determined by
sexual orientation. A similar study was performed with lesbian women where they partly shared activation of the anterior hypothalamus with heterosexual men.

Scent can influence how our brain fires, but can it control how we act? Perfumes and body spray advertisers would like us to think so. Many aphrodisiac substances contain human sexual pheromones in order to stimulate the opposite sex. “Copulins” were patented in the 1970s as
products that release human pheromones following questionable research on
rhesus monkeys. However, no data has ever supported that pheromones cause “rapid behavioral changes, such as attraction and/or copulation.” [1,2]

How Wright Laboratory planned on overcoming the small hurdle of forcing a rapid behavioral change is unclear. Their efforts were not ignored, however. The lab won the 2007
Ig Nobel Peace Prize for the “gay bomb.” Ig Nobel Prizes, a parody of the Nobel Prizes, are given away at Harvard University around the time the recipients of the genuine Nobel Prizes are announced. Ten achievements are awarded each year that "first make people laugh, and then make them think." Needless to say, the gay bomb made for a perfect nominee. By the way, no one from the DoD bothered to attend the ceremony or accept the Ig Nobel prize.

What's this mean for our military's future? I guess I should start working on my proposal for pillow fights, whoopie cushions, and water balloon grenades: Operation You Gotta Be Kidding. Do you think the DoD will give me $7.5 million?

1. Wyatt, Tristram D. (2003). Pheromones and Animal Behaviour: Communication by Smell and Taste. Cambridge: Cambridge University Press. p. 298 Quoting Preti & Weski (1999) "No peer reviewed data supporting the presences of...human...pheromones that cause rapid behavioral changes, such as attraction and/or copulation have been documented."

2. Bear, Mark F.; Barry W. Connors, Michael A. Paradiso (2006). Neuroscience: Exploring the Brain. p. 264 ...there has not yet been any hard evidence for human pheromones that might [change] sexual attraction (for members of either sex) [naturally].

Saturday, June 21, 2008

Pro-Life Drugstores: A Trend for the Future?

By Randy Hendrickson

According to the Washington Post ( “Pro-Life Drugstores Market Beliefs” June 16, 2008), no methods of birth control will be sold in DMC Pharmacy, based in Chantilly, Virginia. This faith-based pharmacy will open in August, however, no birth control pills, morning after pills, condoms, or any other forms of contraception will be available, even with a prescription. This may be the beginning of a new trend in pharmacies that are refusing to sell products that the health care providers (pharmacists in this case) find morally objectionable. “[S]uch methods can cause what amounts to an abortion, and contraceptives promote promiscuity, divorce, the spread of sexually transmitted diseases and other societal woes…. This allows a pharmacist who does not wish to be involved in stopping a human life in any way to practice in a way that feels comfortable.” Some pro-life pharmacies do not sell contraception products only, whereas others also refuse to sell tobacco, pornography, rolling papers, or other commodities that are deemed morally questionable. The patient has the option of going elsewhere to another pharmacy if she does not share this philosophy.

In traditional pharmacy practice, the legal and moral obligations have always involved ensuring that the proper medication ordered by the prescriber is properly delivered to the patient. Physicians, not pharmacists, hold the ultimate responsibility in making sure that the final treatment outcome is achieved. However, according to the American Association of Colleges of Pharmacy’s Commission to Implement Change in Pharmaceutical Care, the definition of ‘pharmaceutical care’ now focuses on “the pharmacists’ attitudes, behaviors, commitments, concerns, ethics, functions, knowledge, responsibilities, and skills on the provision of drug therapy with the goal of achieving definite outcomes towards the improvement of the quality of life for the patient.” How does provision of contraceptive products fit into this view of pharmaceutical care?

Bioethicists have mixed feelings about this issue. Some hold that the needs of the patients should come before the beliefs of the health care professional.

Nancy Berlinger of the Hastings Center for Bioethics Research, claims that “if you are a health care professional, you are bound by professional obligations,” and you can’t refuse to do what is required by the profession.
R. Alto Charo, a University of Wisconsin bioethicist, also fears that pro-life pharmacies may proliferate in the future, especially in rural areas, “creating a separate universe of pharmacies that puts women at a disadvantage.”

Others have differing views:

Loren E. Lomasky, a bioethicist at University of Virginia, states that finding a niche market based on ethical beliefs and “product differentiation expressive of differing values is a very good thing for a free, pluralistic society."
Similarly, Pharmacists for Life International, which is dedicated to the pro-life philosophy, supports the pharmacist’s right to refuse to fill prescriptions for birth control products.

Several other issues are also at stake. Many pro-life pharmacies do not have signs indicating that they will not dispense contraceptives. As a result, women who need the morning after pill may be wasting valuable time finding a pharmacy that will fill her prescription. This would also be a major concern for rape victims. There have also been reports of pharmacists who not only refuse to fill the prescription, but also refuse to return the prescription to the patient so that she could have it filled at another pharmacy. This, however, is extreme, but it has been reported.

A few states, including New Jersey, California, Illinois, and Washington, have laws that require pharmacies to fill all prescriptions for contraception products OR help women find other means to fill their prescriptions, such as recommending other available pharmacies. The state of Virginia, however, has no such restrictions and no intentions to adopt any such prohibitions.

Because of the societal issues that are constantly evolving, the ethics of pharmacy (and medicine in general) has changed tremendously over the past few years, and these changes make the need for an ethical framework more vital today than it has been in the past. Health care providers need to be cognizant of both the expanding ethical responsibilities as practitioners, but also the traditional moral obligations to patients. Hopefully a balance can be achieved that will benefit all involved.

"These Are Early Days"

Stem cells, bioethics, and…vacations to Thailand?

Those were some of the hot topics last week at the Pennsylvania Convention Center, where the International Society for Stem Cell Research held its sixth annual meeting. The ISSCR kicked off the week with a public workshop and symposium highlighted by some of the world’s leading stem cell experts.

The workshop provided an overview of stem cell biology, which was particularly useful to me because I don’t have a background in science (there were many moments, however, when the discussion passed over my head at a much higher altitude).

Dr. Jonathan Epstein, co-director of the Institute for Regenerative Medicine at the University of Pennsylvania, provided a fascinating look at the potential of stem cells to help regenerate heart tissue. Our bodies can regenerate some organs, such as the liver—so why not hearts? Epstein presented a video showing functional heart tissue generated with stem cell technology. The new cells could be seen beating under the microscope, then continuing to beat in unison as they developed into a larger piece of tissue.

Below is a clip showing beating heart cells derived from human embryonic stem cells similar to the one Epstein presented:

For me, Epstein’s presentation magnified the potential of stem cell research. It was only one example of the latest research happening in the labs of researchers around the world. As Epstein was quick to point out, “these are early days.”

Some researchers can’t wait to tap into the potential. As a result, stem cell tourism has popped up in Thailand, China, India, and elsewhere around the globe. The ISSCR unveiled a set of guidelines to halt what its president, Dr. George Daley, calls “the snake oil we’ve seen in medical fraud for centuries.”

But what lies ahead? Dr. Jonathan Moreno, medical ethicist at the University of Pennsylvania, discussed the ethical issues surrounding stem cell research. The moral and metaphysical debate about the status of the human embryo has permeated the political arena over the last decade, and it is likely to continue with the election of a new American president in November. Moreno noted that both Barack Obama and John McCain support stem cell research but have yet to articulate the details and conditions of their policies.

Having made 140 trips to Capitol Hill to educate elected officials about stem cell research, Dr. John Gearhart often finds himself in the center of the political storm. Gearhart remembers his first trip to Congress vividly: “the first person I met asked what it felt like to kill the smallest Americans.” Amy Comstock Rick, president of the Coalition for the Advancement of Medical Research, is also no stranger to members of Congress. CAMR wants to reverse President Bush’s policy on stem cell research, and “will not stop until we get new legislation,” according to Rick.

Whether new legislation is imminent or not, the stem cell debate will no doubt remain heated at the nexus of politics and science.

Wednesday, June 18, 2008

Consumer Protection as a Check on the Genetic Era

We have most definitely entered the "gene age."  With the unraveling of the human genome, it became clear that it only would be a matter of time until each of our individual genomes became both knowable and available.  That time is virtually upon us with the recent surge in direct-to-consumer genetic-testing startups.

However, with the genetic epoch, we also have been ushered into -- perhaps unwittingly for many -- an era of extremely heightened caveat emptor, given the serious potential for misinterpreting, misunderstanding, misusing, and abusing such complex, sensitive, personal information.  Fortunately, it appears that the time of consumerism has not passed us by.  In fact, consumerism is alive and well, as evidenced by the consumer-motivated response by government officials in New York and California to these novel service providers.  To learn more, check out:  "Genetic-testing Start-ups Asked to Stop Selling in Calif." by Stefanie Olsen, available at (June 17, 2008).

Sunday, June 15, 2008

Messing with our Minds? - Smart drugs and the ethics of neuro-enhancement

The ABC (Australian Broadcasting Company) interviewed neuroethicists Walter Glannon and Barbara Sahakian about the the ethical concerns of neuroenhancements – are we just ‘messing with our minds’, challenging our authentic selves?

And what about long term risks, particularly for children, when brain chemistry is still in formation? Is brain-doping cheating? One of the interesting ethical and societal questions about neuroenhancement is whether or not we, as a society, will use them ‘smart drugs’ to our benefit, to create a healthier balance in our lives – e.g., finish our work early so we can go home and spend time with our families and loved ones or just have a more balanced life in general -- or will we use them to become manic, nonstop, super-productive working machines?

Listen to the podcast here and let us know what you think.

We may be more than stardust --

In a quick drive-by post, scientists are saying that genetic material from outer space found in a meteorite in Australia may well have played a key role in the origin of life on Earth. Turns out, we may all be space aliens. Check out the link here.

Saturday, June 14, 2008


By Emily Stephens

"In the eyes of the speechless animal, there is wisdom that only the truly wise can understand." – from a Native American legend

Meet Natividad (that’s Spanish for “birth”). He used to be one of the countless mange-covered, sickly, emaciated street dogs in Nicaragua rummaging through human waste in order to stay alive. Last October, Natividad was found by Costa Rican “artist” Guillermo Vargas Habacuc in an alleyway of Managua, and then displayed in Vargas’ "Exposición N° 1" in the Códice Gallery. Natividad was not given food or water during the duration of the show. Behind him, the Spanish words 'Eres Lo Que Lees' or ‘you are what you read’ was written on the wall in dog biscuits. The Sandinista anthem played backwards, and 175 pieces of cocaine burned in a massive incense burner nearby. Most disturbing are the pictures of the patrons who visited the show—uncaringly looking away from heart-wreching Natividad and consumed by other artwork. No one knows who took the photographs, nor the photographer’s intentions.

The director of the Códice Gallery insists the dog was fed regularly and only tied up for three hours on one day before it escaped. Hmmm. Vargas wouldn’t say whether the dog survived the ordeal, but he pointed out no one tried to free the dog, give it food, or call the police. The “artist” hoped to cast light on people's hypocrisy because “no one cares about a dog that starves to death in the street.” Vargas was inspired by the death of Natividad Canda, a Nicaraguan addict killed by two Rottweilers in Cartago Province, Costa Rica, while being filmed by the news media in the presence of police, firefighters, and security guards. After Vargas was recognized for his work and asked to participate in the 2008 Bienal Centroamericana in Honduras, an online petition started, which currently boasts over 2.5 million signatures from around the globe.

Here’s where the facts get hazy. Internet postings claim Natividad was tied up in the gallery until he died a few days later. Vargas plans on murdering another street dog in the 2008 Bienal Centroamericana art festival. Vargas has signed the petition to ban him from the Honduras festival in mockery of it. Oh, and the people heading the Bienal Centroamericana are ignoring the worldwide petition and fully supporting Vargas’s art choices. Are these things true? I was able to track down a letter from the World Society for the Protection of Animals (WSPA) to Snopes (who was trying to debunk the whirlwind of speculation surrounding this story.)

WSPA is aware of the situation and also that misconstrued allegations appear in many articles. “It involved one dog, and this dog was not replaced by another after it had died.” A story about a dying street dog didn’t exactly spur on the local press, so very little coverage is available. “It was never made clear whether the dog actually died, how long it was there, and why nobody did anything if it was suffering.”

Unfortunately, there are no animal cruelty laws in Nicaragua, so Vargas’s mistreatment of Natividad was not breaking the law. “As far as we are aware, he is not planning on doing this exact same thing again, but the controversy now lies in the fact that he has been chosen to represent Costa Rica at the Central American Biennial, set to take place in Honduras this year, with an exhibit apparently not involving a dog this time. The WSPA Costa Rica office…contacted the Ministry of Art and Culture, to urge them to consider disallowing Vargas from representing Costa Rica at the Central American Biennial. The response was that since Vargas was participating at the Biennial with a different exhibit, they could not ban him from attending. We will, however, continue to monitor the situation in case further action can be taken at any time.”

My opinion?

Art is to create, not to destroy.

Natividad is a statement. A grotesque, violent statement to the world about so many things. The desperate condition of dogs in third world countries. The hypocrisy of our outrage when we don’t even take care of our own homeless domesticated animals. The irony of valuing the life of a dog over the poverty of a people. I do not support this “art” in any way, shape, or form, but like the rest of the world, it has me thinking. We are an interconnected society for better and for worse. How does the way I live my life, the values I uphold, and the hypocrisies I hide, impact the rest of this world? Yes, researching this story made me cry. Sure, I could sit back, shake my head at society, be outwardly and inwardly appalled—or I can do something. I can make a difference.

To be honest, I am overwhelmed by the good causes out there, but that doesn’t mean I shouldn’t participate. Dying willow trees need money, featherless parrots need charity, overly large grasshoppers require aid--give to this, give to that. My head starts to spin and I develop a form of learned powerlessness where I don’t do anything but promise that when the right thing comes along I will act.

I have lived too many years inactively. I can and will help now, no matter how small. I can’t save everybody, but I can make a difference. I can feel better about this world. Here’s one suggestion how:

1. Begin with your signature. Awaken parts of the world that have no animal cruelty rights :

2. Check out Casa Lupita, a grass roots non-profit group recognized for their efforts in saving and improving the lives of Nicaraguan street dogs like Natividad:

3. This video was made by “Frenchie,” a teenager who volunteered at Casa Lupita:

4. To help animals worldwide consider:

5. Finally, go hug a dog…or cat…or chinchilla. I know I will.

P.S. It’s interesting to note that this type of “art” has spread into the human world. Gregor Schneider, a German artist, is planning to display a person dying as part of an exhibition.

Thanks for your sacrifice ...

Following up on the thread started by Jenny below comes a piece on the Associated Press newswire about health care for female veterans.

Women make up a significant and increasing percentage of soldiers - about 200,000 women currently serve, representing nearly 15% of the military personnel. Yet the Veteran's Administration is still behind the curve on recognizing that these fighting women have different medical needs and expectations than their male counterparts.

As the AP article notes, not only is there a dearth of physicians specializing in women's health but many VA facilities even lack the basic equipment and infrastructure to meet the needs of female soliders. For example, the report mentions a lack of female bathrooms or female-only changing facilities, leading me to suspect that most VA hospitals are actually converted athletic stadiums.

Don't even ask about women-only group counseling options, even for those who are suffering post-traumatic stress as a result of sexual abuse (a military tradition). Of course, the Bush Administration has been arguing that our veterans are not necessarily entitled to mental health care, so this may be one of the few examples of gender equality in the VA medical system.

Friday, June 13, 2008

“America’s Medicated Army:” The Future of our Soldiers and How they Cope with War?

By: Jenny Walters

In recent months, reports about rising suicide rates for our soldiers in Iraq and Afghanistan have been on the rise.

An article entitled, America’s Medicated Army, by Mark Thompson, focused on medicating our soldiers with antidepressants “to calm nerves strained by repeated and lengthy tours in Iraq and Afghanistan.”[1] According to the Army’s fifth Mental Health Advisory Team report, an anonymous survey of U.S. troops in fall 2007 revealed about 12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help cope with the stress of war. Unfortunately, due to the stigma surrounding antidepressant use and the need for mental help among soldiers, the above numbers are more than likely a vast underestimate of the actual number of medicated soldiers.1

The increase in the use of antidepressants and sleeping pills reflects the “heavy mental and psychological price being paid by soldiers fighting in Iraq and Afghanistan.”1 A recent Pentagon surveys suggests 70% of soldiers deployed to war zones manage to “bounce back to normalcy;” while 20% will suffer from “temporary stress injuries” and the remaining 10% are affected by “stress illnesses.” According to the Pentagon, stress injuries or illnesses begin with mild anxiety, irritability, difficulty sleeping, and growing feelings of apathy and pessimism. As the symptoms progress, they worsen to include panic, rage, uncontrolled shaking, and temporary paralysis. When the soldier returns home, escalating symptoms can further lead to broken marriages, suicides, and psychiatric breakdowns.1

In 2008, mental trauma has become so prevalent among soldiers in Afghanistan and Iraq, the Pentagon is now considering expanding the list of “qualifying wounds for a Purple Heart…to include posttraumatic stress disorders (PTSD).”1

The use of medications to cope with wartime stress has been debated for years among insiders in the service. According to a book entitle Combat Stress Injury: “No magic pill can erase the image of a best friend’s shattered body or assuage the guilt from having traded duty with him that day. Medication can, however, alleviate some debilitating and nearly intolerable symptoms of combat and operational stress injuries and help restore personnel to full functioning capacity.”1 Ultimately, medications keep the soldiers fighting and deployed, and save the Army money on training and deploying replacements.1

One military doctor remarked: “Boy it’s nice to have these drugs…so we can keep people deployed.” Whereas, professionals such as Dr. Frank Ochberg, a veteran psychiatrist and founding board member of the International Society for Traumatic Stress studies, doubts the use of medications stating: “Are we trying to bandage up what is essentially an insufficient fighting force?”1

As side effects of antidepressants become more prevalent, the Food and Drug Association (FDA) pushed for a “black box” warning stating “the drugs may increase the risk of suicide in children, adolescents…and went on to include young adults ages 18 to 24,” the average age of the military force fighting the war in Afghanistan and Iraq.1

As of May 29, 2007, 115 soldiers killed themselves last year, including 36 in Iraq and Afghanistan.1 This was the highest military suicide rate since 1980. According to Thompson: “Nearly 40% of Army suicide victims in 2006 and 2007 took psychotropic drugs-overwhelmingly, selective serotonin reuptake inhibitors (SSRIs) like Prozac and Zoloft.” The army reported the primary reason for the above suicides to be due to “failed relationships.” However many civilian experts “sense a link between suicides and prescription drug use.”1

As medicating U.S soldiers becomes more and more prevalent; it is important to understand some of the facts about what the soldiers are faced with on a day to day basis. According to a recent mental-health survey conducted by the U.S. Army: “while nearly two-thirds of the soldiers surveyed in Iraq in 2006 knew someone who had been killed or wounded, fewer than 15% knew for certain that they had actually killed a member of the enemy in return.” This “imbalance” leads soldiers to experience “a haunting mismatch in combat life….and contributes to feelings of intense fear, helplessness, or horror.”1

According to military psychiatrist, because our soldiers are faced with horrors we could not imagine, thousands are being driven to take antidepressants just to cope with day to day life of wartime in Iraq and Afghanistan.1

Thompson stated: “If troops do not get sufficient time away from combat…antidepressants and sleeping aids will be used to stretch an already taut force even tighter. Lawrence Korb, Pentagon personnel chief during the Reagan Administration went on to state: “This is what happens when you try to fight a long war with an army that wasn’t designed for a long war.”1

Marc Thompson’s article on the medicating of today’s Army was compelling, riveting, and disturbing. Ultimately, the U.S. Army appears to be medicating our young soldiers just to keep them sane enough so they can fight another day in Iraq and Afghanistan. What I don’t understand is: why aren’t we hearing more about this; how dose the Army justify this; and what will become of our young troops?

As stated above, the average age of our troops is 18 to 24. To many of us, the soldiers are just children. Many of these soldiers are coming home with immense amounts psychological trauma. However, instead of receiving combined therapy with counseling and, if required, medication; they are administered their monthly prescriptions for some “happy pills,” in hopes the medication will cover up and/or help to ease their pain.

Ethically, the Army’s concept of medicating our troops to keep them deployed and fighting longer does not work. What is happening in Iraq and Afghanistan is alarming. As we approach a new presidential term, I can only hope for a better future, and maybe, just maybe someone will step in and put an end to this travesty and bring our troops home.

[1] Thompson M. America’s Medicated Army. Time. June 2008. Available at:,8599,1811858,00.html. Accessed on Jun 08, 2008.

Motherhood, the Elephant in the Laboratory: Women Scientists Speak Out

Motherhood, the Elephant in the Laboratory: Women Scientists Speak Out
Edited by Emily Monosson & published by Cornell University Press
232 pages

I recently contributed to this wonderful book that includes 34 stories from women who have juggled both their careers in science with the 24/7 demands of raising children. These are challenges many of us have to face regardless of whether we are seeking tenure in a philosophy department, working in a lab, or teaching part-time. There is strength in numbers, and strength in letting our voices be heard. We don't whine, but we do discuss some of the personal and institutional barriers that need to come down in order for women to feel supported in their careers and in raising the next generation. Another goal of the book was to encourage more women to join the discussion and advocate for meaningful change. You can contribute by adding your two cents to the book's blog.

Amazon is selling it at a great discount. The editor and authors would welcome reviews of the book for blogs, journals, etc. If you are a book reviews editor and want a review copy, please contact: Jennifer A Longley at Cornell University Press.

A. Pia Abola, biochemist, writer, and editor
Caroline (Cal) Baier-Anderson, University of Maryland, Baltimore; Environmental Defense
Joan S. Baizer, University at Buffalo
Stefi Baum, Rochester Institute of Technology
Aviva Brecher, U.S. Department of Transportation, Volpe Center, Cambridge, Massachusetts
Teresa Capone Cook, American Heritage Academy
Carol B. de Wet, Franklin & Marshall College
Kimberly D'Anna, University of Wisconsin-Madison
Anne Douglass, NASA Goddard Space Flight Center
Elizabeth Douglass, Scripps Institute of Oceanography
Katherine Douglass, George Washington University
Deborah Duffy, University of Pennsylvania
Rebecca A. Efroymson, U.S. government research laboratory
Suzanne Epstein, Food and Drug Administration
Kim M. Fowler, Pacific Northwest National Laboratory
Debra Hanneman, Whitehall Geogroup, Inc. and
Deborah Harris, Fermi National Accelerator Laboratory
Andrea L. Kalfoglou, University of Maryland, Baltimore County
Marla S. McIntosh, University of Maryland
Marilyn Wilkey Merritt, George Washington University
Emily Monosson, toxicologist and writer
Heidi Newberg, Rensselaer Polytechnic Institute
Rachel Obbard, British Antarctic Survey, Cambridge, England
Catherine O'Riordan, Consortium for Ocean Leadership
Nanette J. Pazdernik, independent author and molecular biologist
Devin Reese, National Science Resources Center
Marie Remiker (pseudonym)
Deborah Ross, Indiana University-Purdue University Fort Wayne
Christine Seroogy, University of Wisconsin-Madison
Marguerite Toscano, independent geoscientist, writer, and editor
Gina D. Wesley-Hunt, Montgomery College
Theresa M. Wizemann, Merck & Co., Inc.
Sofia Refetoff Zahed, University of Wisconsin-Madison
Gayle Barbin Zydlewski, Cove Brook Watershed Council, Maine; University of Maine

Wednesday, June 11, 2008

Guest Authoring and Ghost Writing

In their April 16, 2008 issue, the Journal of the American Medical Association (JAMA) published an article titled Guest Authorship and Ghostwriting in Publications Related to Rofecoxib: A Case Study of Industry Documents from Rofecoxib Litigation based on documents discovered during lawsuits against Merck related to their brand-name drug Vioxx (rofecoxib).

Two of the major issues raised in this article are guest authoring and ghostwriting. These issues often go hand in hand.

Guest authoring occurs when an individual who does not meet authorship criteria is listed as a named author for an article. Many journals, including JAMA, follow the guidelines for authorship identified by the International Council of Medical Journal Editors (ICMJE). These authorship guidelines require that a named author be involved in the design of the study, conduct of the study or analysis of the data, and writing or substantively reviewing/revising the manuscript. Only those individuals meeting all three criteria should be listed as authors; anyone else who contributed to the manuscript should be listed appropriately in the acknowledgments section.

Ghostwriting occurs when an unacknowledged individual writes most or all of a manuscript, which is then submitted with other individuals as the named authors. The American Medical Writers Association (AMWA) has published a Position Statement on the Contribution of Medical Writers to Scientific Publications that recommends including a statement in the acknowledgments section to indicate when a medical writer or medical editor has provided assistance in writing or preparing a manuscript for submission to a journal as well as acknowledging the source of funding for these services. By including this information in the acknowledgments section, transparency is maintained. When this information is not included, then in effect the medical writer is acting as an unnamed ghostwriter for the named authors on behalf of the pharmaceutical company.

The recent JAMA article indicates that some of the rofecoxib manuscripts submitted for publication were written by Merck staff or by medical publishing companies on behalf of Merck. After the manuscript were drafted and a target journal chosen, then selected academic researchers or key opinion leaders were contacted about being named authors on these articles; this constitutes guest authoring. The recent JAMA also indicated that some manuscripts were written by staff at an external communications company at the request of the pharmaceutical company using paid medical writers; this constitutes ghostwriting.

From an ethical standpoint, it is more beneficial to the reader to know who was involved in designing and conducting a clinical study as well as who paid for it. When it comes to publishing the results, it is also important for the reader to know who analyzed the results and wrote the manuscript that result in the published article that they are reading. If a well-respected leader in a therapeutic area conducted an independent study, analyzed the results, and presented his conclusions in an article that was published in a scientific journal then readers would have a great deal of confidence in the information presented. On the other hand, if a pharmaceutical company designed and conducted a clinical study assessing the efficacy of one of their own products, had their staff statisticians analyze the data, and their internal medical writers or an external communications company write a manuscript, then readers might have less confidence in the presented material.

It is possible, however, that neither scenario is ideal. The thought leader could be so convinced that his hypothesis is true that he analyzes the data in such a way that skews the results. Or the staff at the pharmaceutical company could be striving to be as transparent, conscientious, and protective of patient health and well-being as is possible, rather than focusing only on their profits. The reality is likely somewhere in between. Transparency in terms of who did the work, who paid for it, and who is telling the scientific community about the results makes it more likely for individuals to have some trust in the presented data.

Named authors should have participated in the designing or conducting the study, analyzing the results, and writing or substantially revising the manuscript. Medical writers involved in preparing manuscripts should be acknowledged in the published article. Statisticians who analyzed the study data should also be acknowledged. The source of funding for the author, investigators, medical writers, and statisticians should also be included in the acknowledgments section.

The Mexico Option

“If you drink this, you will die.”

Those were among the last words Shirley Justins says she spoke to her long-term partner, Graeme Wylie, in March 2006. Moments later, according to Justins, Wylie poured a lethal dose of Nembutal into a glass and drank it. The Australian died a short time later.

Justins told her story during a controversial trial before the Supreme Court in New South Wales in which she is accused of murdering the 71-year old Wylie, a former Qantas pilot. During testimony last week, Justins admitted to assisting Wylie commit suicide but denied being part of a murder plot. Caren Jenning, a friend of Justins who purchased the Nembutal in Mexico, is charged with being an accessory to murder.

The case is controversial for several reasons. Wylie suffered from Alzheimer’s disease, which led to the denial of his application for legal euthanasia in Switzerland. He also changed his will a week before his death, leaving nearly all of his $2.4 million estate to Justins, who rejected that she had a conflict of interest. In addition, Jenning admitted lying to police to avoid investigation into Wylie’s death.

The trial has also featured testimony from Australia’s top euthanasia advocate, Philip Nitschke. The founder of Exit International advised Wylie, Justins, and Jenning on possible methods of suicide in 2005. Nitschke taught them about euthanasia tourism, a thriving industry in Mexico that provides an opportunity to purchase Nembutal in pet shops under lax regulations. Some advocates call it “the Mexico option.”

Nembutal is popular among euthanasia campaigners because it causes painless death in humans in less than an hour. Veterinarians around the world use it to anesthetize and euthanize animals, but the drug is not readily available to the general public—except in Mexico.

Do humans have the right to a peaceful death? Nitschke and Jack Kevorkian think so. As the Australian courts determine the fates Justins and Jennings, advocates for euthanasia will continue to fight for the right to die on their own terms.

And they’ll go to pet shops in Tijuana to do it.

Resetting the odometer?

In the health section of today's New York Times is a disturbing article on the increasing number of hymenoplasties - the surgical version of "reclaiming one's virginity" - being performed in Europe and elsewhere. It seems that some young Muslim women are driven to undergo this medical procedure to conform with what many might consider outdated cultural expectations of purity.

Of course, it doesn't help that these expectations are reinforced by misguided court decisions like the one reported in the Times piece. It seems that a divorce court in Lille annulled the 2006 marriage of two French Muslims because of "breach of contract." Apparently, on their wedding night, the groom found his bride was not the virgin she had claimed to be.

Cultural implications and arguments aside, I find it disturbing that the simple lack of blood on the nuptial sheets was sufficient proof for the groom to announce to the entire wedding party of his bride's fallen status. Sounds like someone needs an anatomy lesson.

Rapture of the Geeks: Don't Get Left Behind

Hoping for immortality? More specifically, the arrival of the singularity—that crucial moment when machines attain superhuman intelligence and we will be able to upload our brains to achieve indefinite life spans (although it may not be life as we currently know it)? In a riff on the best-selling "Left Behind" series, IEEE has issued a special edition exploring the likelihood of the Singularity occurring within our lifetimes -- with tantalizing titles such as The Consciousness Conundrum, Rupturing the Nanotech Rapture, and The Singularity: Neither Heaven nor Hell.

Whether or not you are a “believer”, it is definitely worth the read.

[Illustration: Bryan Christie Design]

Monday, June 09, 2008

Dangerous to Your Health? Media Coverage of Health Issues

By Randy Hendrickson

The Public Library of Science (PLoS) recently reported a study of the quality of media coverage of health issues, including treatments, tests, products, and procedures, in the United States. The study (“How Do U.S. Journalists Cover Treatments, Tests, Products, and Procedures: An Evaluation of 500 Stories” by Gary Schwitzer at the University of Minnesota School of Journalism) evaluated how U. S. journalists are reporting health issues. Over a two-year period, the study rated the accuracy, balance, and completeness of news stories from a variety of media. A rating instrument that included 10 criteria was used to evaluate each of the 500 news stories. These criteria look at how well each story:

1. Adequately discusses costs
2. Quantifies benefits
3. Adequately explains and quantifies potential harms
4. Compares the new idea with existing alternatives
5. Seeks out independent sources and discloses potential conflicts of interest
6. Avoids disease mongering
7. Reviews the study methodology or quality of evidence
8. Establishes the true novelty of the idea
9. Establishes the availability of the product or procedure
10. Appears not to rely solely on a news release

This study showed that “….journalists usually fail to discuss costs, the quality of evidence, the existence of alternative options, and the absolute magnitude of potential benefits and harms.” This raises the issue of the quality of the information that reaches consumers. Because this information can have a dramatic, and possibly harmful, effect on consumers, Schwitzer and colleagues are working with news organizations and editorial executives to make them aware of these problems and to correct the imbalanced view that is often portrayed. The results of each evaluation were emailed to the journalist who wrote the article or news segment. The shortcomings of the news stories were mainly attributed to a lack of time and space. Those journalists who had more time to research and write the articles and more space in which to publish them or airtime tended to produce more balanced and complete stories. “We hope that our evaluation of health news will lead news organizations—and all who engage in the dissemination of health news and information—to reevaluate their practices to better serve a more informed health consumer population.”

Sunday, June 08, 2008

Vain Cain Wasn't Abel

By Emily Stephens

Let me introduce you, before the story starts--
A Gigi is a girly-girl, the kind that never farts.
They love clothes, malls, and a muscley stud,
And squeal when confronted with boogers and mud.
High heels, short skirts, and lotsa thrills--
The kind that gives the good boys chills.
She’ll steal away the boy of your dreams,
With flirtation bursting from her seams.
No brains, all laughs, pouty lips, tight butt.
The kind our grandmums called a slut.
Buried ‘neath mascara, lipstick, powder, polish–
And a waistline rather smallish,
Past the fake-n-bake orange and yellow skin,
You’ll find a girl who’ll always win.
Plain, smart girls simply can’t compare,
To the Gigi’s looks, the Gigi’s hair.

At the age of twenty, I’d still never been kissed,
See a Gigi stole his heart away; he never knew what he had missed.
She bounced in with her boobies, her makeup all aglow,
She shook her head and giggled like there was nothing she did know.
Her lips were rouged with redness.
Her talent? She could flirt.
Man, next to her, I know it’s true; I looked no more than dirt.
And so that’s when I started to hatch a plan so cruel.
I’d sneak into the Gigi lair, and attack right after school.
Underneath the cover of stormy summer nights,
I’d overcome the Gigi Queen and proclaim Normal Girl rights!
If I could find her weakness, I’d get her where it hurt…
A Gigi hates mud, slime, and yes, they really do hate dirt.
Perhaps a chemical reaction could destroy her makeup glow?
I know, yes, of course! I’d attack with H-2-O!

I ran quickly to my closet, and pulled from the depths therein
A water gun from Target, neon orange with hot-blue trim.
I filled it up with water, nice and cold at first,
Then realized red food coloring might end my vengeful thirst.
Gun ready, I looked into the mirror and gasped in the light,
I’m too obvious, too Caucasian, too gosh darn freakin’ white!
Black shoe polish was all I owned, therefore it had to do.
I covered my arms, my legs, my face, my neck was dark black, too.
Grabbing my gun, I ran into the night,
Yelling and howling and filled with delight.
Revenge would be mine, and the Gigi would wish
She’d skipped over my village, stayed away from my dish.
Chadwick Schmet was his name and gone was his heart,
But that Gigi would pay, that Gigi would smart!

High-pitched giggles echoed through the air,
And I knew I’d arrived at the Great Gigi’s lair.
Quickly, I hid in a green prickly bush,
While watching for Gigi, I pulled thorns from my tush.
At the smell of perfume, I gasped in delight.
The Queen Gigi was there, and still giggling--how trite.
Chadwick was nearby, consumed by her chest,
A massive upheaval of what boys like best.
Her body looked twisted, bent out in contortion--
It’s not normal to grow boobs in such a proportion!
Poised and ready I sat, growing more and more mad,
Then I burst from the bushes screaming, “EEE-GAD!”
The Gigi spun round, terrified by my cry,
As my gun exploded water right into her eye.
I barked like Xena, did a She-Woman dance,
Then squirted some more so it looked like peed-pants.
Swooping away as quickly as in,
I left her in tears and knew I did win!
She strutted around with what beauty was left,
The boys laughed as she cried, her ego bereft.
Yes, Queen Gigi did most certainly regret,
Entering my village to steal Chadwick Schmet.

Thunder cracked above as I fled from the scene–
“Oh my gaa!’ was her wail, “Am I, like, totally bleeding?”
I laughed to myself as I escaped into night,
My clever plan had filled the Gigi with fright.
Storm clouds above gave way to rain,
And I danced in the droplets like a girl gone insane.
Looking down at my arms, I ended my scoff,
Rain dropped on my skin, beaded up, then ran off.
Tiny streams made their way from my foot to my head,
I only meant to camouflage, but was water-proofed instead.
Shoe polish clogged my pores, covering skin with its grit.
Heavens to Betsy, I was such an idiot!
I ran home rather quickly—to the bath, jumped right in.
Scratching and scraping black from my skin.
I tore at my stained flesh all through the night
And when the sun rose, I looked down in fright.
Despite all the paint that I left in the tub,
My skin stayed black through the scratch, scritch, and scrub.
It took weeks--the natural sluffing of skin cell--
To remove the horrid curse. Goodness gracious, it was hell.

Believe it or not, this is a true story. Overlooking all my dramatic license, the psychology and neurology of revenge is a fascinating topic. In fact, according to
Dr. Michael McCullough, a psychologist at the University of Miami, ''The best way to understand revenge is not as some disease or moral failing or crime, but as a deeply human and sometimes very functional behavior. Revenge can be a very good deterrent to bad behavior, and bring feelings of completeness and fulfillment. Think of the urge as kind of hunger, a lust, a deficit the brain is seeking to fill, and you can see why revenge fantasies can be so delicious.''

Dr. Eddit Harmon-Jones, a neuroscientist from the University of Wisconsin used brain-wave technology to monitor where anger and vengeance originates within the brain. Quite surprisingly, insulted people showed bursts of activity in the left prefrontal cortex—the same location where hunger and cravings are processed. According to Dr. Harmon-Jones, “[This brain activity] seems to reflect not the sensation of being angry so much as the preparation to express it, the readiness to hit back.”

We walk a fine line (consciously and subconsciously) to control our impulses after being wronged. Research shows vengeance is most often sought in a covert manner. Several
forgiveness studies found that when men were asked to recall offenses committed against them they were less vengeful toward the offenders. Women, on the other hand, began at a lower baseline for vengeance, were equally unforgiving as men, but magnified the offenses they received. Apparently, “hell [really] hath no fury like a woman scorned.”

Spreading rumors, stealing boyfriends, dagger-like stares—it’s all very familiar, admit it. However, few of us want to appear malicious. The ideal is to ruin our enemy without repercussions, without anyone able to link us to the crime. Interestingly, men gain more
satisfaction when witnessing retribution than women. The University College London monitored the brain activity of both sexes as they watched people they liked and disliked suffering pain. Women tended to empathize even with those they hated, while men enjoyed the suffering of foes.

Many anthropologists believe retaliation keeps individuals in line where formal laws or rules do not exist. Retaliation can be a sort of cultural mediator that keeps us from breaking tacit taboos. Whether or not vengeance is acceptable, there are ways to assuage intense feelings of retaliation. For example, protesting injustice can be an empowering process.
Dr. Harmon-Jones studied brain-wave patterns in students who were told tuition had increased dramatically. “They all got angry,” he said, “but signing a petition to block the increases seemed to give many some satisfaction.”

So, next time…

I learned from this lesson, though it took many months
For the polish and shame to leave the skin of this dunce,
Tho’ a little bit’o’water might cause a Gigi dismay,
Sweet revenge ain’t so sweet when karma gets in the way.
Perhaps retaliation isn’t what it’s cracked up to be;
Next time I’ll consider some old-fashioned charity.

Or maybe I’ll start a petition…