Thursday, August 28, 2008

A Wholistic Approach -- Treating Women as more than reproductive conduits

I was surprised to see that many readers of the NY Times well blog felt that their doctors too often treated as "only as a breeding machine who should be regarded as 'pre-pregnant' at all times." Perhaps I've been lucky, but even before I was a bioethicist, I felt my doctors treated me more holistically -- but then again, I've been a lawyer a lot longer than I've been a bioethicist, and maybe that played a role.

I also spotted a phrase that I had not encountered before -- "bikini medicine' -- a phrase describing the treatment for women between the ages of 14 and 54, when medical care is reduced to looking at our breasts and reproductive organs and forgetting the rest of us (except, of course, in making sure one looks passable in a bikini). Sounds somewhat denigrating to both to doctors and women.

What do you think? Take our poll and let us know!

Tuesday, August 26, 2008

Quantity vs. Quality of Life

Reading the article The Artificial Heart: Not Just a Pump in Scientific American raised the issue of quality of life vs. quantity of life.

I knew that in the early 1980s an artificial heart, the Jarvik-7, had been successfully implanted into a man who would have died without the device beause of his own failing heart. What I hadn't realized before reading this article was what kind of quality of life Mr. Clark (the patient) had after receiving the artificial heart.

We all have this image in a heads, probably most from television shows, of a patients who undergoes a heart transplant and receives a donor heart, which gives him or her a second chance. The leave the hospital looking healthy and happy and go onto to live for 5, 10, 15 years, or more.

Unfortunately, this wasn't the case for Mr. Clark. He was never able to leave the hospital after the artifical heart was implanted. In fact, the compressor that powered the artificial heart was the size of a refrigerator and Mr. Clark was tethered to this compressor the entire time. During the 112 days that he survived after the surgery, he suffered convulsions, cognitive problems, kidney failure, and then died of massive organ failure. Because of the scientific and medical implications of this procedure, the press followed the story closely. The public watched Mr. Clark's progress and then his decline. His quality of life during this time was so poor that many Americans were turned against the idea of artificial hearts for the next decade.

While researchers would probably argue that every patient who undergoes a procedure such as this one furthers scientific and medical progress, what does it do for the patient himself? In the end, was it worth it to Mr. Clark? Would his quality of life at the end been better if he'd spent his final days with his family, rather than undergoing surgery and hooked up to so much medical equipment? Should researchers wait longer before performing such procedures on humans? At what point is the quantify of life worth the quality? Should a patient with terminal cancer be encouraged to try yet one more treatment, even if the chances of it improving their outcome are minimal, or should they go home and spend their final moments with their loved ones? These are sensitive issues and often best decided by the patients and families themselves.

Drug Ads vs. Scare Tactics

In The Wall Street Journal this week, there was an article titled Glaxo's HIV-Drug Ads Draw Critics that raised the notion that pharmaceutical companies might be using scare tactics to convince patients to stay on their current medications.

On the surface, this might not sound too bad. After all, scare tactics have been used in other health-related commercials. We all remember the screen with the frying pan and the cracked egg, and the voiceover that said, "This is your brain on drugs." Then there were ads in the 1980s and 1990s aimed at convincing teenagers of the dangers of having unprotected sex and contracting the human immunodeficiency virus (HIV).

However, the concern with these new ads, such as the ones from Glaxo featured in the article, is that they seem aimed more at convincing patients not to try new medications. For example, one Glaxo ad showed shark-infected waters and included the message, "Don't take a chance--stick with the HIV medicine that's working for you." Although the ads don't mention a specific medication by name, they do carry the Glaxo logo.

A patient's decisions about medical treatment should be an informed decision and ideally should be made after consultation with his or her own healthcare provider. The treatment regimen that might be right for one patient, might be totally wrong for another. As new treatment options are approved by the Food and Drug Administration and are made available to patients, they should be considered. Pharmaceutical companies shouldn't be trying to scare patients into staying on their own marketed drugs to avoid having them switch to a competitor's drugs. If the competitor's drugs are really better, then perhaps the pharmaceutical company tempted to run scare ads should focus more on their research and development and coming out with newer, better drugs of their own.

Many individuals are afraid to seek medical treatment, afraid to learn the truth about their condition, and afraid to hear the prognosis. They don't need to have more fear instilled in them about the actual treatment for their condition.

Access to Too Much Information

A recent article in The Wall Street Journal, Increase in Cases of Measles Tied to Fears Over Vaccine, reported a significant increase in the number of measles cases in the United States, the highest level in more than a decade. The increase appears to be associated with an increase in the number of patients refusing to having their children vaccinated.

For children attending state-supported public school, a clearly defined set of vaccinations must be completed and documentation provided before the child can be enrolled in school. However, for children who are home schooled, their parents can refuse vaccinations and there is no enforcement. Parents of children in public school can also seek an exemption to vaccination for religious reasons.

There have been 131 reported cases of measles so far this year; 122 of those children had not been vaccinated or their vaccination status was unknown. Although not perfect, the measles vaccine is considered to be highly effective at preventing measles.

Why are parents refusing to have their children vaccinated? Primarily due to fears of that autism is caused by measles shots, other childhood vaccinations, or a mercury-based preservative that used to be in most vaccines. There is no scientific evidence that autism is caused by any of these and in fact, the preservative has not been used in any vaccinations since 2001. However, news stories, law suits, and less official sources of information available on the internet have made parents aware that some fear a link between vaccination and autism. Some parents are making their decisions out of fear and possibly putting their children at risk. Of the 131 reported cases of measles this year, no children died, however, 15 of them did have to be hospitalized.

To counteract the potentially misleading information available online, pediatricians and the Centers for Disease Control and Prevention (CDC) are endeavoring to make more evidence-based information available to parents.

Should Healthcare Workers Control Access to Treatment

The Wall Street Journal recently published an article about proposed regulation to protect healthcare workers who oppose abortion, Rules Let Health Workers Deny Abortions.

How much protection do healthcare workers really need from women seeking medical treatment? The proposed new rules could potential cut off federal funding to states that force healthcare workers to perform, assist in, or refer patients to abortion services. It seems reasonable to expect that individuals who oppose abortion for moral or religious reasons should not be forced to perform them or even in assist in performing them. However, in my opinion, doctors and nurses should not be involved in denying medical care to a patient by refusing to refer them elsewhere. If they aren't willing to perform a procedure for personal reasons, then they should be willing to refer the patient to a different clinic or healthcare provider who will.

Opponents to the new regulation worry that the ambiguous wording would also enable healthcare providers to deny patient access to the morning-after pill and even some forms of birth control. Although supporters claim that the regulation does not affect the rights of patients to obtain any legal medical procedure, it's hard to deny that these changes would make it much more difficult for some patients to actually get the needed or desired medical treatment. Under the new rules, a woman presenting to the emergency room after being raped might not even be told about the availability of the morning-after pill, depending on the moral or religious beliefs of the healthcare providers treating her or the institution itself (such as Catholic hospitals). Isn't this tantamount to denying the patient access to appropriate and legal medical care?

When Are Doughnut Holes a Bad Thing?

A recent article in The Wall Street Journal titled Some Seniors Quit Taking Medicine When Medicare Doughnut Hole Hits discussed the affects on seniors of current Medicare drug coverage, or lack thereof.

You might be asking, "What does Medicare have to do with doughnut notes?" Well, Medicare beneficiaries receive prescription drug coverage up to $2400. However, after their costs for drugs exceed that amount, beneficiaries must pay for their prescription drugs out of their own pockets. There is not coverage again through Medicare until they've spent another $3850 for drugs. This gap is called the doughnut hole.

Many seniors are grappling with how to handle the way this gap in coverage affects their daily medications. Some pharmacies offer discounts to seniors on generic drugs, allowing them to fill some of their prescriptions during this gap interval for $5.00 per month. However, quite a few drugs don't fit in this category.

After a 40-year habit of smoking 3 packs of cigarettes per day, my mother developed deep vein thrombosis and had pulmonary embolism. Luckily, she survived; over 30% of individuals who experience PEs die. She quit smoking cold turkey while she was in the hospital; it's not like they gave her a choice. She was on oxygen 24 hours a day. To help with the withdrawal as well as her postdischarge recovery, her doctor prescribed Wellbutrin. She has been taking it twice-daily now for over 7 years. For her, it works well. She's never wanted to smoke again and it helps with depression as well. Unfortunately, there have been times that she has been switch to generics because of her healthcare coverage in order to save money. For her, the generics don't seem to be as effective; there are reports in the literature that this is true for other patients as well. Last year, my father retired and now my parents have Medicare prescription drug coverage and my mother's in the doughnut hole. She keeps threatening to stop taking the Wellbutrin because of the cost. Not good. It's a medication that she really needs. I keep encouraging her to continue taking it and help her out with the costs as much as I can. However, she's tempted to stop taking the medication altogether.

Many other seniors are facing the same dilemma. How beneficial is healthcare coverage which doesn't provide sufficient support for sick individuals to receive treatment on an ongoing basis?

Access to DNA Evidence

A recent article in The Washington Post titled Va. DNA Project Is in Uncharted Territory discussed the issues surrounding DNA testing for criminal cases from the past.

About three years ago, a $1.4 million project was launched by the State of Virginia to re-examine blood, semen, and saliva samples from approximately 400 rapes, murders, and other serious crimes from the 1970s and 1980s. The state is entering unchartered waters in terms of ethical and practical issues depending on the results of the DNA testing. The focus of the state's crime lab is the science of the DNA testing of samples. This project does not include determining guilt or innocence of the accused or wrongly convicted. That's being left up to the criminal justice system. Most of the convicts involved do not even know that this testing is being done.

This project raises a number of ethical issues. If evidence if found to implicate another individual, shouldn't the person convicted of the crime be informed? Shouldn't they be entitled to a new trial based on this evidence? Is it possible to rule out a suspect or someone convicted of a crime based on available evidence? Or does the investigation need to be reopened? Given the number of unsolved crimes, how much attention will these cases receive? If an individual was wrongly convicted and is found not guilty based on DNA evidence, what are their rights? Is a new trial required? Should they be pardoned automatically?

Friday, August 22, 2008


by Emily Stephens

This past June, Charleston High School in Mississippi held their first interracial prom. That was hard for me to believe considering the social progress I thought we had achieved as a free nation.

Despite integrating schools in 1970, many Delta schools maintained a system of separate proms for decades, one prom the white students and one for the black students, both organized privately. Morgan Freeman, a Charleston native, offered to sponsor an interracial prom for over ten years. The school finally took him up on it.

Chasidy Buckley, a student at Charleston described the prom as “a happy and comfortable night,” despite the fact that some white parents didn’t let their kids attend and even insisted on holding a private prom. “That night, when we stepped in that door, everybody just had a good time. We proved ourselves wrong. We proved the community wrong, because they didn't think that it was going to happen." Buckley hopes the entire town can be influenced by this interracial prom. “…once they see that blacks and whites can come together in school and have fun together, then they'll see that the community can change, too."

Disturbingly, a
study in 1990 found that the majority of whites rated African Americans and Hispanics as less intelligent than themselves. Whites also thought these two minority groups were prone to violence and would rather be on welfare than work. These attitudes are dangerous, and can lead to justification of destructive thinking and behavior.

American Psychological Association (APA) suggests a few possible reasons why we adopt racist and prejudiced behaviors. It is a natural cognitive mechanism for humans to feel better about themselves by finding faults in others and overemphasizing our uniqueness within or likeness to our “group”. We are also impacted by years of social conditioning where family, community, media, etc. influence our view of those who are different.

Did you know that individuals with particular personality traits are more likely to demonstrate group bias?
Children who were rated as “highly biased” at 6 years old showed bias differences from other children as early as 6 months of age. This suggests that personality differences influence prejudices at an age that predates the influence of our parents, and it poses an interesting question: Can a person be born prejudiced?

Whether or not we’re “born prejudiced,” we naturally begin to form stereotypes and prejudices throughout our lives about particular groups and people. We expect certain people to behave according to our preconceived notions about their race, religion, etc. The brain efficiently categorizes a black person as this, or a white person as that. I can’t help but wonder why the brain doesn’t correct inaccurate stereotypes when people behave differently than expected? In other words, why do stereotypes endure despite contradictory experiences?
Quite often we maintain stereotypes to feel better about ourselves. Why challenge our way of thinking if it supports our self-esteem and condones our real-world benefits and privileges? Psychologists found that people put a great deal of energy into maintaining inaccurate world views. We seek out experiences that support our prejudices, and disregard or belittle incidents that go against what we want to believe. In fact, the more strongly we hold a stereotype, the better we recall experiences that support it. We rationalize away contradictory events, making a black person who is articulate or a gay man who is not effeminate merely the “exception” to the rule.

Just coping with race is
mentally draining. White people--even those who are not greatly prejudiced--experience a mental capacity decrease after interacting with black men. Participants in one study felt strained because they were trying to remain race-neutral. Their brain activity increased when looking at pictures of black males--their right dorsolateral prefrontal cortexes to be exact--an area associated with thoughts and behaviors. Scientists believe this increased activity is an attempt at avoiding prejudiced behavior, thoughts, and emotions.

The Charleston situation really got me thinking… It made me evaluate myself, my own prejudices, fixed stereotypes, and racist attitudes. I’ll admit I’m one of those white people who don’t want to be racist, but who finds themselves occasionally thinking unwanted prejudiced thoughts.

I had the unique opportunity of growing up on an Indian reservation. My elementary school was called Chinook. Half the population was Muckleshoot and the other half was middle-class Caucasian. Then, there was one African American kid (Jason) thrown into the mix.

The school was definitely separated by invisible race lines. It wasn’t anything the teachers did or any fault of the curriculum--we participated once a week doing American Indian crafts, enjoying fry bread, or watching someone’s father perform dances or puppet stories of Muckleshoot folklore. However, there was always a silent, lengthy divide between the Indians, the white folks, and Jason.

The white kids seemed to be on top of the food chain when it came to home life, economic well-being, expectations, and privileges. The Indians fell a good distance behind, mostly because it seemed everyone was just waiting for them to get into trouble or drop out. And Jason?

Jason was alone at the bottom. I remember during a few walks home from school, the Indians would wait for Jason in the back alley so they could beat him up. I don’t think he ever did anything wrong. Mostly, he’d take his beating then walk home. Sadly, just like Charleston, it was the way of life, the unspoken natural order of things. I remember how disturbed I was by it all. I remember the futility of trying to change things, and then just finally accepting it.

It is disturbing to me that I accepted it. We are silent about too many things. I am glad that although race is much less spoken of these days, courageous people like the students at Charleston are breaking the mold. I think the only way to reverse our biased mindsets is to admit our prejudices (if only internally), make an effort to befriend those who are different than us, and then “walk a mile in their shoes.” (Thank you Harper Lee.)

We can allow people to be alien and different, and we can justify fearing them or remaining silent… Or we actually try to know those who are different, and challenge our inaccurate views.

Katz, P. A., & Barrett, M. (1997). The development of prejudice in children and adolescents. Paper presented at the annual meeting of the American Psychological Association, Chicago, August 18, 1997.

Pratto, F. Sidanius, J., Stallworth, L. M., & Malle, B. F. (1994). Social dominance orientation: A personality variable predicting social and political attitudes. Journal of Personality and Social Psychology; 67:741-763.

Tuesday, August 19, 2008

Brain Death vs. Cardiac Death in Organ Donors

A recent article in The Washington Post titled Infant Heart Transplant Controversy Continues reports the results of recent heart transplant surgeries using hearts from donors who experienced cardiac death.

We're familiar with organ donation after a patient has been declared brain dead. However, organs can also be used for transplantation after a patient experiences cardiac death--after life support is withdrawn, the heart stops. The controversy lies in how long after the heart stops beating before it is permissible to begin harvesting organs, especially the heart itself. Previously, the Institute of Medicine had recommended waiting 5 minutes in case the heart were to restart on its own. However, it has been recently suggested that cardiac death might be irreversible after only 1 minute.

Surgeons at a Denver hospital have recently reported results from heart transplantation surgery in 3 infants where the time between the heart stopped and organ retrieval started was 3 minutes in one case and 75 seconds in the other two cases. By decreasing the amount of time that the organs are deprived of oxygen likely increases the success of the transplantation procedure.

Ethicists argue that if a heart is transplanted from one patient into another and resumes functioning, then it is not possible for the first patient to have suffered from irreversible loss of cardiac function. Others agrue that in the case of these patients, none of them would die as a result of removal of their vital organs who would not have otherwise died after withdrawal of life support.

How and when questions about organ donation are raised at issue as well? One patient's death should not be hastened in order to save the life of another. Ethically, health care providers should not raise the issue of organ donation with the family until the decision has been made to withdraw life support. With this decision made, if the family then consents to organ donation, then perhaps more lives can be saved by increasing the number of available donor organs.

Saturday, August 16, 2008

Whose Rights Were Really Being Protected?

A recent article in the Wall Street Journal titled A Death in the Family tells the story of a son who murdered his mother after being discharged from a psychiatric hospital.

William Bruce had been committed to an inpatient psychiatric facility and diagnosed with paranonid schizophrenia after multiple incidents including attempting suicide, threatening two men with a loaded assault rifle, and assaulting both his mother and father. During his hospitalization, he refused to take medication and sought discharge from the facility by working with a government-funded patient advocacy group. According to the Wall Street Journal article, Bruce's medical records indicate that his doctor's thought he posed a threat to himself and to others if he was not medicated and treated for his psychiatric illness. The patient advocates fought for his right to remain psychotic and untreated, if that was his choice, and to be discharged. Unfortunately, after his court-ordered commitment term for assault ended, Bruce no longer met Maine's legal criteria for involutnary commitment, so he was released.

When Bruce was releasd, he returned home to live with his parents. Two months later, he murdered his mother by repeatedly striking her in the head with a hatchet while his father was at work. Bruce was found not criminally responsible by reason of insanity and committed indefinitely to the same psychiatric hospital where he'd been previously. Faced with the possibility of being restrained and medicated against his will, Bruce agreed to take a prescribed antipsychotic drug. Within a matter of weeks, his mental status had improved. Now, he says, "The advocates didn't protect me from myself unfortunately." At the time, he was just happy to have someone help him to get discharged from the hospital, but at that point he hadn't yet acknowledged that he had a mental illness and needed help. He went on to say, "There are times when people should be committed. Institutions can really help. Medicine can help."

Whose rights were the advocates trying to hard to protect? In addition to a patient's right to make their own decisions regarding medical treatment, patients also have the right to receive the appropriate treatment for their condition. According to superintendent at the psychiatric hospital where Bruce is committed, "...the advocates overstepped their bounds. William was relying on the people whose purpose it was to ensure his civil rights were being exercised, and unfortunately that interfered with his other right, which was to get medical care."

Now at least three lives have been ruined--William Bruce's, his mother's, and his father's, as well as other relatives and friends affected by his mother's death. If only Bruce had received the treatment that he needed during his first hospitalization, perhaps these life-altering events would never have happened.

Friday, August 15, 2008

Are Standards of Conduct Needed for Physician Weblogs?

By Randy Hendrickson

Pharmalot recently reported a study (“Content of Weblogs Written by Health Professionals” by Tara Lagu et al) that shows that there are serious ethical problems associated with physician weblogs. Although weblogs have emerged as a vital new way to share experiences and provide a connection between health professionals and the public, they do not have the same standards of conduct as medical books, peer-reviewed journals, presentations at medical conferences, and other more traditional forms of medical communication.

Patient Privacy

Funded by the Robert Wood Johnson Foundation and published in the Journal of General Internal Medicine, this study found that a total of:

  • 16.6% (45/271) of physician blogs contained information that allowed patients to identify either themselves or their doctor

  • 42.1% (114/271) of the blogs described individual patients

  • 15.9% (43/271) portrayed patients positively

  • 17.7% (48/271) portrayed patients negatively

  • 2.9% (8/271) showed patient radiographs with no other identifiable information

  • 1.1% (3/271) of the blogs showed recognizable pictures of the patients

Product Endorsement

Explicit product promotions appeared in a total of 11.4% (31/271) of physician weblogs; however, none of the authors provided conflict of interest information, which is the rule for any legitimate form of medical publishing. Additionally, 29% of bloggers have been approached by public relations firms to endorse a product, and of those, 52% actually wrote a post endorsing that product. Lagu explains that “these endorsements are not advertisements that appear on the website; they are written into the blog narrative, often without any acknowledgment that they are paid promotions.”

According to Lagu, “the ease of use of medical weblogs disconnects blog content from the editorial process common to books, journals, and conventional broadcasts. For the most part, blog authors have few incentives to maintain their credibility and integrity or, in contrast, to compromise it for the sake of ratings or sales.” Most medical literature is subject to peer review; however, weblogs can be written by anyone with an internet connection, regardless of their qualifications.

Although the content of some weblogs shows a lack of respect for the physician-patient relationship, patient confidentiality, and appropriate management of conflict of interest, there has been no formal response from the medical community about the need for standards of conduct for weblog content.

The results of this study show that this new means of medical communication is only going to expand in the future. It is critical that “[p]hysician-leaders and medical educators consider curricular development and educational forums that address the challenges, opportunities, and responsibilities that medical blog authors face, and the place for this new medium with norms of the medical profession.”

Decriminalizing Disease

By Michael Leshinski

A recent NY Times article reports on the 17th annual AIDS conference that was held last week in Mexico. The topic of the article was the decriminalization of certain instances in which the HIV virus is passed from one individual to the other. First of all, I didn’t even know that it was a crime for one person to give AIDS to another person. Although, I have always wondered what would happen to an individual who purposely and successfully gave the HIV virus to another human being. It also makes me think, what about other serious disease states. Types of Hepatitis, for example, can be deadly. When you think about getting the HIV virus, (that leads to AIDS), intravenous drug use and unprotected sexual relations with an infected person are the main reasons for contracting the disease. What about Hepatitis B, which is able to pass through sharing saliva?

Imagine that you made enemies with a person who has Hepatitis B. You’re sitting at lunch and you get up to go to the bathroom. You inadvertently leave your soda bottle sitting at the table. Your nemesis unscrews the cap on your favorite soda and then proceeds to wipe his/her saliva all over the portion that would come directly in contact with your own mouth. This is the way you contract the deadly disease which eventually leads to your death. Is the person ultimately responsible for your death punishable by law? By death? Now this story is obviously made up and a bit far-fetched, but I believe that it is still possible. Think about lesser disease like the common cold. Would that be punishable by fine? Would there be a scale to determine the disease to the punishment? Think about it.

A little Cuervo...

A little Cuervo Can Be Good for You

By Michael Leshinski

A little Cuervo in your life can actually help your liver instead of destroying it. No, I am not talking about the popular tequila maker, but rather about a molecular biologist who shares the same name. As reported by Wired magazine, Dr. Ana Cuervo is working on research that could possibly provide healthier livers to booze hounds in the future. Cuervo and her fellow researchers at Albert Einstein College of Medicine have been working with mice through genetic engineering. The altered mice are usually elderly, in mouse years, but have been altered so that their liver works as effectively as young mice (6 months old). The study focused on a protein found in the liver as well as other parts of the body. The protein collects cellular by-products, mainly appearing as damaged proteins, or garbage as they put it.

The group employs simple logic to back the research. If you take out the garbage properly, then the rest of the cell should work just fine. And it has been so far for these little furry test subjects. Besides the possibility for a healthier liver, the research could be breakthrough for Alzheimer’s disease, a disease also associated with the buildup of cellular by-products. But don’t start celebrating with the Cuervo shots just yet. The research being done is still in very early stages and the possible transformation into human medication has not even yet been thought discussed. Whether you’re a fan of consequence free alcohol consumption or someone who really cares about the advancement of research in these important issues, news can be welcomed by all.

Thursday, August 14, 2008

A Month Without Plastics

Over on the BBC website, reporter Chris Jeavans is blogging about her August challenge: to live a month without buying or accepting anything wrapped in or made with plastic. Why? Because even though we're all repeatedly implored to reduce, reuse and recycle, plastics are still one of the most common things to make it into our trash, our landfills, and our oceans. So she wanted to track exactly how life would change if she gave up plastics - first, of course, tracking how much plastics she and her family used over the course of one month.

The numbers were surprising:
603 items, including:

* 36 carrier bags
* 67 food packaging bags and films such as bread bags, cheese wrappers (and a jumbo pack of Maltesers!)
* 23 polystyrene tea cups with lids and 24 coffee cup lids
* 15 fruit punnets and vegetable trays
* 13 yoghurt pots
* 16 water bottles, 10 milk bottles, 7 juice bottles
* Two toothbrushes

Probably the least pretty aspect to my household's waste at the moment comes in the form of disposable nappies. Our 18-month-old son gets through four or so a day so that's about 120 a month, plus individual nappy sacks, nappy bin bags and wipes, which go straight into landfill.
Chris has blogged near-daily about her experiences, and it's interesting - not only to see how she is navigating shopping and childcare and the like sans plastics, but to learn more about plastics, where they're hidden in our food and consumer goods supplies, and how they're made.

And I'll admit, for just a moment, I thought it might be interesting to repeat her experiment on this side of the pond. After all, I live in an area rich with local farms, where coffee shops push bringing in your own mugs instead of using disposable cups, and nearly everyone has totes they use at least part of the time while grocery shopping.

Unfortunately, I realized relatively quickly that my cats require food and litter, which is automatically going to guarantee buying some plastics (bags of both generally are lined in plastic). The same for prescriptions. I have to order textbooks - no way to get around plastics there. And the more I thought about it, the more I realized that while I certainly can reduce consumption and focus on reusing, it would be nearly impossible for me to eliminate plastics from my life.

So what about it - given the significant environmental and health concerns around the use and production of plastics, could you give up plastics in your life? For a week, a month, or longer?

-Kelly Hills

Controversial Infant Heart Transplant Redefines Death

Surgeons in Denver are happily announcing a major break-through in infant cardiac transplants: using hearts from infants that have died of cardiac-related deaths. According to the Wall Street Journal,
Until now, it was thought that hearts from those donors were too badly damaged to be transplanted successfully. Only hearts from donors who were brain-dead -- and whose hearts were still functioning after they were declared dead -- have been considered suitable for transplant.

To make the donors' hearts more viable, doctors at Children's Hospital in Denver altered the standards for declaring the patients dead... The Denver researchers narrowed to as little as 75 seconds the time between when the donor was pronounced dead and when the heart was harvested. Current guidelines call for waiting up to five minutes as a way of making certain that the heart does not start beating again on its own. But removing the heart earlier increases the odds of a successful transplant since it limits the damage caused by a lack of oxygen to the organ.

Most professional medical types I know, be they bioethicists, doctors, nurses, etc, agree that there are significant and severe problems with how transplants are handled in this country, and that we need to do something to increase the number of available organs. Many people support Robert Veatch's suggestion that death not be whole-brain death but higher-brain death, opening up a much larger market for available organs; given that he's been advocating this for 35 years, it's not surprising that he's the bioethicist commenting on the NEJM article. Veatch questions whether removal of the heart after such a short period of time is even legal, saying
"If a heart is restarted, the person from whom it was taken cannot have been dead according to cardiac criteria... Removing organs from a patient whose heart not only can be restarted, but also has been or will be restarted in another body, is ending a life by organ removal."
While the law is certainly something to consider, I agree with a former professor of mine who said that the law should be known and acknowledged, but not actually influence consideration of whether or not a practice is ethical.

And so, is it ethical? In the case of the infants who died, the parents had opted to withhold or withdraw life support; all of the infants had severe neurological injuries but were not considered brain dead. So in this very particular, structured situation, parents had agreed to allow their severely injured infants to die - so removing the heart (almost) immediately after cessation doesn't appear to be terribly problematic; even if the heart did restart on its own, they would just allow it to stop again. There is no effort at saving, rather a withdrawal of treatment and then immediate reaction to the intended end result. And I can understand parents wanting to have their child's death mean something positive for someone else; a chance for a bit of their child to live on, a chance for someone else's child to live.

But I worry. I worry about the people who fear that because they are organ donors, they won't be treated the same, that they will be allowed to die so that they can be harvested - people who buy into the very utilitarian idea that one person dying to save many is okay, and that doctors do such calculus on a daily basis. I worry about over-eager doctors realizing that an infant or child will die, and being less willing to perform life-saving medical interventions because they realize it's futile in the long-term, even if it might buy slightly more time in the short term.

Mostly, though, I worry about a redefinition of death that is happening not via committee or discussion, but action. It smacks of asking forgiveness after acting, rather than asking permission. (I should clarify that I am certain the doctors involved followed their ethics and IRB committee's to the letter, and mean more general community discussion.) It seems like an on-the-fly redefinition that actually moves away from the way the discussion was moving - towards refining what it means to be brain dead - and back towards a much more traditional and potentially troubling definition of what it means to die.

-Kelly Hills (who really does remember how to use this thing, honest...)

Wednesday, August 13, 2008

Enhanced Athletes -- Is it Natural?

IEET fellow Andy Miah argues in the Washington Post that enhancement (barring the harms of steroids) of our athletes is only natural. What do you think? Take our poll and let us know your thoughts.

Informed Consent Issues May Restrict Stem Cell Research

By Randy Hendrickson

According to a recent article in Nature, Stanford University has run into informed consent issues for their human embryonic stem cell lines, and these lines may be restricted for use in research because of ethical concerns. The women who donated the embryos for these stem cell lines did not give adequate informed consent for their use in research. Bioethicist Robert Streiffer, from the University of Wisconsin, obtained copies of the informed consent forms of the donors of the 21 lines that the NIH approved for federal research funding, and none of the forms met the guidelines that were set by an advisory committee of the US National Academy of Sciences (NAS) in 2005. These guidelines covered the types of experiments that could be conducted as well as the proper treatment of the donors of the gametes and embryos. Streiffer’s review of the consent forms found that there were wide variations and discrepancies in the forms that were used. In many cases, the donors were in no way sufficiently informed.

Now, these stem cell lines were obtained before August 2001, when President George Bush mandated that only stem cell lines already in existence would be eligible for federal support. Story Landis, head of the NIH’s Stem Cell Task Force, stated that the NIH will not be taking any stem cell lines off its registry because these guidelines only came into existence in 2005. Landis claims that Streiffer’s analysis “deals with application of 2008 standards to cell lines that were put on the registry in 2001,” and that the registry lines meet the 2001 standards.

As a result of this conflict, “ethics oversight committees across the United States are questioning which lines should be permissible for research—hoping that another agency, such as the NIH or a state government, will make the decision for them.” Frank Sharples, director of the NAS advisory committee, stated that “the NAS will revisit the issue of which lines are acceptable at a meeting later this year.”

Tuesday, August 12, 2008

Because Women Need Lovin' Too

Listen up, ladies! If you are currently taking antidepressants and experiencing sexual dysfunction, a new study may have the answer to your problem. And, it may have been right under your nose in the medicine cabinet of your male counterpart all along. Yes, Viagra®, the savior drug for men, may also be beneficial for women.

According to CBS Evening News medical correspondent, Dr. Jonathan LaPook, sexual dysfunction affects about half of patients on antidepressants (women more than men). A small study on premenopausal women found Viagra helped to achieve the big "O". However, according to the research report published recently in the Journal of the American Medical Association, it did not improve other sex aspects for women, such as desire or arousal.

Although the study shows promise as a treatment for female sexual dysfunction, Pfizer Inc. (the company that manufactures the little blue pill) currently has no plans to pursue FDA approval of Viagra® use for women. The results of the company's own research proved the drug to be safe but inconclusive in treating women, leading to the study's end in 2004.

When is it going to be the women's turn? Sexual dysfunction treatments for men have exploded onto the pharmaceutical market in recent years. The search for a helper for women leads little to be desired. If Viagra® has the potential of helping depressed women achieve an orgasm, it should be explored further. Depression alone is a serious medical condition. When the treatment for depression is coupled with sexual dysfunction, the situation often worsens. Everyone deserves to be happy and sexually satisfied in life and should not settle for anything and women.

Monday, August 11, 2008

Digital Mammograms

By: Jenny Walters

A recent article on entitled “Do digital mammograms make a difference?” by Linda Saether discussed the details involved in a digital mammogram.

Although digital sounds great, according to Dr. Carl D’Orsi, director of breast imaging at Emory Winship Cancer Institute in Atlanta, “So far we have not been able to obviate the need for compression.” Therefore, as Saether remarked: “The ‘smoosh’ factor lives on.”[1]

With this being said, there are many positives involved in digital mammograms:1

1. The dose of radiation exposure is lower than in traditional analog mammography.
2. Digital mammograms can be stored better and shared more easily because they are computer files.
3. The digital image allows for a great deal of picture enhancement. Dr. D’Orsi stated “We can change the brightness, we can change the contrast, we can invert the contrast, we can magnify it, and we can demagnify.”

The down side to digital mammograms is they cannot detect cancer much better than the older analog type could. However, Dr. D’Orsi stated: “It is better than film in really one particular area, and that’s the woman with dense breast…By dense breasts, we mean a woman who has a fair amount of glandular tissue, breast tissue, related to fatty tissue that’s always present in breast.” He went on to state, “Studies have shown that digital mammography does detect the findings better [in the above] scenario.”1

No matter whether you will be getting a digital mammogram or an analog mammogram, Saether remarked, the best advice to follow is that of your doctor’s “Just do it.”1

Pam Keel, an eight-year veteran mammographer, said: “There are a few things women can do to make this picture-taking session more productive. First…lay off the caffeine for a week prior to your mammogram…caffeine can wreak havoc on breasts—dense or not.” In addition, Keel advises women who are highly pain sensitive to “take something such as over-the-counter pain reliever [prior to the mammogram].”1

Although mammograms are not the most comfortable thing women must go through, they are an invaluable asset we have for early detection of breast cancer.

[1] Saether L. Do digital mammograms make a difference” July 2008. Available at: Accessed on August 5, 2008.

Surgical Side Effects Decrease with Robotics

By: Jenny Walters

A recent article on entitled “Surgical side effects cut with robotics,” by Danielle Delloroto discussed the growing trend of robotic surgery.[1] Over the past four years, robotic surgery used to treat prostate cancer has increased from 10,000 in 2004 to 70,000 in 2008.

The advantages to using robots during surgery include fewer side effects and quicker recovery times. Such advantages have lead to the increased use of robotics for other surgeries, including hysterectomy, kidney cancer, and some heart procedures.1

According to Dr. Nikhil Shah, one benefit of robotic surgery is precision that far exceeds the human hand. Dr. Shah went on to state in prostatectomy: “the robot controlled scalpel works delicately around the nerves and blood vessels in the pelvic area, vastly reducing the risk of damage that can lead to incontinence or impotence.”1

Another clear advantage of robotic surgery in a prostatectomy is reduced blood loss. In a traditional prostatectomy, a 4 ½ inch incision is required. In robotic surgery patients have six dime-sized incisions in the abdomen and are often in the hospital for less than 24 hours.1

Dr. Shah stated, “Not everyone qualifies for robotic surgery…patients with excess abdominal fat and those with cancer that is not localized would not be the ideal candidate.” In addition, it is important to note, the surgery can cost up to $15,000 and is not always covered by insurance.1

Although robotic surgery is increasing in use, the American Urological Association (AUA) has not yet described the procedure as “the new gold standard of care.” According to AUA spokesperson Dr. J. Brantley Thrasher, chairman of urology at University of Kansas Medical Center: “The outcomes of robotics operations have been excellent…But to say we’ve seen a quantum leap in regards of one treatment being better than the other is premature.”1

Thrasher did acknowledge that robotics prostate surgery is the fastest growing surgical procedure. She also went on to state, robotic surgery is being driven by the consumer, “with patients requesting is like never before.”1

Overall, this article described what will be an increasing trend in all areas of surgery, not just for prostate cancer. My father recently underwent a prostatectomy. Unfortunately, he did not qualify for the robotic surgery because the cancer was not localized. Therefore, he had a lengthy recovery and had to miss 6 weeks of work.

It is important to remember what Dr. Shah said, robotic surgery is not for every patient. Although robotics surgery may sound quick and easy, there are risks and benefits involved in all types of surgery.

[1] Dellorto D. Surgical side effects cut with robotics. August 2008. Available at: Accessed on August 5, 2008.

Sunday, August 10, 2008

If the Members of the Chinese Women' Olympic Gymnastic Team are all 16, then so am I: Either way, is something being done to stop their growth?

Having just watched the preliminary rounds of the women's gymanstic's competition, I'm calling a foul. I may be just a law professor, not a pediatrician or an endocronologist or a gymnast or an Olympic official but I know what a sixteen year old looks like, and in my opinion, you just have to see the Chinese team and our team to know something is not right. Despite enough makeup to shame a drag queen, these girls are not convincing teenagers. Whether they're actually 16 and 17 or even if they're 15, 14, or 13--something is not right.
AFP/Getty Images
Deng Linlin, Jiang Yuyuan, He Kexin, Li Shanshan, Yang Yilin and Cheng Fei of China line up prior to a practice session in Beijing.

I'm not exactly the first person to notice this. Much is being made in the press of accusations that not all the girls on the Chinese Olympic Team are 16--the legal age of competition. No less an expert than Bela Karoyli, who is still pretty sore about the U.S. Team's loss in 2000 has opined that “This is a joke,” Karolyi said last week. “We are people who have had children of our own, so we know what a 16-year-old should look like. They should not look like they are 7 and maybe still in diapers.“;

He told AP today that ""What kind of slap in the face is this?" he asked. "They are 12, 14 years old, max. And they line them up for the world ... and having the government back them." Sounds like he cares, doesn't it?
Well, don't give him the child advocacy prize yet. He's just mad that the Chinese have found a way to get around the rules. He explained that "The solution, he said, is to not have any age limit."
Mary Lou Retton, who has seen a few young gymnasts in her day, also doesn't know whether the Chinese girls are underage. But it's clear what she thinks. "The girls are so little, so young," Retton said. Speaking of He, Retton rolled her eyes and laughed, saying, "They said she was 16, but I don't know.""The girls are so little, so young," Retton said. Speaking of He, Retton rolled her eyes and laughed, saying, "They said she was 16, but I don't know."

While I'm as interested in the U.S. scooping up Gold Medals as the next American, it's not the unfair competition by the Chinese that bothers the most about underage gymnasts--it's the whole primacy that gymnastics puts on delayed puberty and the possibility that some of these girls are being medicated so that they remain small. [this is a close relative to the well studied issue of height enhancement for children who are of normal height, but shorter than what their parents aspire to] While it's certainly true that the Chinese present an exceptional case of not looking anywhere close to 16, they are not alone. It's also true, that the gymnasts we end up seeing at the olympics are the ones who, for whatever reason, have a late puberty and that's not necessarily because they have been given medication. The onset of puberty is not all that well understood. It is well documented that intense physical activity, such as that of a young athlete, will naturally delay puberty. http://http//, but what if there are programs that don't want to wait to see who has a delayed puberty and who doesn't? What's to prevent intervention?

Ironically, the evidence of some kind of doping is much stronger if the Chinese are telling the truth than if they are not. So whether we believe the Chinese that all these girls are 16 and over or we don't (and the evidence of faking passports is pretty good), they are some kind of young teen and they don't look it. Something is going on and I have to wonder if doctors are involved.

What makes it likely that there has been some medical intervention (in China and for all we know everywhere else) is that the stakes are very high. The New York Times quotes an expert who explained that: "An advantage for younger gymnasts is that they are lighter and, often, more fearless when they perform difficult maneuvers, said Nellie Kim, a five-time Olympic gold medalist for the former Soviet Union who is now the president of the women’s technical committee for the Swiss-based International Gymnastics Federation. “It’s easier to do tricks,” Kim said." And then she said something else which is obvious, but should be bone chilling: “And psychologically, I think they worry less.” Worry less, perhaps, about hurting themselves and cause permanent injury? Reporting on a study on the epidemiology of injuries in women's gymnastics, published in the April 2008 issue of Pediatrics, the New York Times quoted Dr. Lara B. McKenzie, one of the researchers, as explaining that “We found that gymnastics has one of the highest injury rates of all sports,” .

OK, I hear people shifting in their chairs and saying that this is interesting and no doubt an ethical issue, but how is it a bioethical issue?

Well, it is if it involves medicine. There are many in bioethics who are interested in doping. Andy Miah just published an article in the Hastings Center Report about doping a whole blog devoted to the topic. http://http//

Usually, we think of doping as enhancing performance by making athletes faster or stronger. What concerns me here is a different kind of intervention--one that makes girls stop growing. And these are girls. "Oxymoron" has become used to the point of cliche, but truly the phrase "Women's Gymnastics" needs to go in the oxymoron pantheon with "Peace with Honor" and "PATRIOT Act."

-Lots of people have problems with girls' gymnastics.

In a recent highly critical Op-Ed piece in the New York Times Buzz Bissinger finds women's gymnastics creepy because of the relationships between very young girls and their adult male coaches. He said he would be watching the women's gymnastic competition with particular care because "I can’t think of any competition in the Olympics, or all of SportsWorld, more creepy and disturbing: these largely shapeless girls in their leotards and flaxen-waxen hair and bouncy-wouncy ponytails. 'They look like girls from the neck up,” I was told by Joan Ryan, whose 1995 book, “Little Girls in Pretty Boxes,” blew a sky-high lid off the sadomasochistic training regimens that young female gymnasts were being subjected to. She continued: “From the neck down they look like prepubescent boys.'"http://http//
But the creepiness extends further.

It's not hard to stop growth. There is a medical condition called "precoucious-puberty" in which children experience full puberty before the age of eight which may indicate a serious underlying condition but may also require treatment because of the emotional distress this causes children. The Mayo Clinic's website describes a treatment "called GnRH analogue therapy, [which] usually includes a monthly injection of a medication, such as leuprolide, which stops the HPG axis and delays further development. The child stays on this medication until he or she reaches the normal age of puberty. Once he or she stops receiving the medication, the process of puberty begins again.This treatment, called GnRH analogue therapy, usually includes a monthly injection of a medication, such as leuprolide, which stops the HPG axis and delays further development. The child stays on this medication until he or she reaches the normal age of puberty. Once he or she stops receiving the medication, the process of puberty begins again."

I doubt that any of these Olympians have been diagnosed with this rare condition.

Could this be cultural? Are Chinese women just smaller and more delicate? Maybe. But to look at these girls and to look at the Chinese Women's Swimming and Diving Team its hard to imagine that's a complete explanation.

Back to the bioethics issue. If indeed these girls have received medication to slow puberty (which I don't know), then some doctor somewhere prescribed it for a reason that was not in the best interests of their health.

Given that the parents of Ashley X (the "Pillow Angel") were criticized to the point of near tarring and feathering for taking steps to stop the puberty of their severely handicapped little girl, this should be more of a big deal in bioethics.

Before we all get too much on our high horses about what China is doing, listen to this. "Enrico Casella, the coach of the Italian women’s team, had an idea to do away with age questions: create weight classes. That way, gymnasts of similar weight could compete more equally against one another, and the age minimum could be scrapped.
Until then, he said, there will always be rumors that athletes are too young. Looks could be deceiving, he said.
“By looks, you could say that the United States is using doping,” Casella said. “They are so muscular. My gymnasts in Italy aren’t that big. You begin to wonder how they got that way.”

I don't know what's going on in the world of gymnastics either here or in China and I have no basis beyond my own eyes and what I read in the paper to make any accusations. However, I do know that if doctors anywhere are giving any medical treatment to children that is not needed to preserve or improve their physicial or mental health , then it should be of great concern to all of us who care about how the power to medicine can be misused when doctors put anyone or anything but their patients first.


It's certainly likely that some of them are not 16. The New York Times has come up with videos of the athlete's own statements about how old they were four years ago as opposed to the "offical" passports issued the girls by the Chinese Government Of course not everyone agrees that there's anything wrong. When asked about Yang's quote, [Bruno]Grandi [the head of the International Gymnastics Federation] said, "We have no basis to doubt the information the pasport [issued by the Chinese Government] of the athletes.",0,3941558.story. He was not asked about his beliefs in Santa, the Easter Bunny or the Tooth Fairy so it's hard to assess the depth of his credulity, but I digress.

Monday, August 04, 2008

Cheaters Never Win

The 2008 Summer Olympics is set to begin this Friday in Beijing, PRC. For the next two weeks, the world's greatest athletes will descend upon this ancient metropolis to showcase their talents. Well...the world's greatest athletes less the 37 disqualified for positive drug tests since April.

An article in USA Today reports that the anti-doping crackdown is expected to continue in the upcoming days as random tests are conducted at the athletes' village.

The only question that comes to mind is why?

Why do athletes use performance-enhancing drugs when they know the probability of getting caught is high?

Why does the number of athletes using performance-enhancing drugs continue to rise even when the consequences are known?

Why aren't athletes learning from past doping mistakes of fellow athletes?

If someone is a good enough athlete to qualify for the Olympics, why does he/she feel the need to use performance-enhancing drugs in the first place?

Why aren't doping athletes thinking about their status as a role model and what their status will become when they test positive?

Why wouldn't an athlete want to lose/win fairly than be branded a cheater for the rest of his/her life?

The Olympic games give the entire world a chance to come together for a brief moment in time for peace instead of war. They allow people the opportunity to cheer on and be proud of their countries and the great talent representing them. Why would anyone want to tarnish this event and shame themselves and their country by utilizing performance-enhancing drugs?

We’ll take only one baby please…

In-vitro fertilization (IVF) is a procedure used to treat infertility when other methods of assisted reproductive technology have failed. A major risk of IVF is multiple births because a common practice of treatment is multiple embryo transfer to boost the pregnancy rate. Since IVF is sometimes a last resort for a woman to get pregnant, many couples welcome the idea of multiple births since they were having trouble having one baby, let alone several. However, others are not so keen on the idea.

Recently, a lesbian couple in Australia attempted to sue their obstetrician for failing to ensure that a single embryo was implanted in the birth mother. The couple, now the parents of 4-year-old twin daughters, were seeking medical negligence in the amount of $382,000. According to an article in USA Today, the claim was to cover the cost of raising one of the children, including private school fees.

The judge overseeing the case ruled against the couple, citing that the birth mother had actually acted negligently by failing to ensure the IVF clinic staff were aware that she no longer wanted to have multiple embryos implanted. The couple are considering an appeal but the case leaves many, including the state president of the Australian Medical Association, wondering why such a suit was ever brought before a court in the first place.

Yes, multiple births are accompanied with increased risk of pregnancy loss, complications, prematurity, neonatal morbidity, and the potential for long term damage. However, when IVF results in the birth of healthy babies, why mess with it? IVF is an investment that people can spend years thinking about before deciding on treatment. It is not cheap and most expenses are paid out of pocket by the couple. If a couple has devoted that much time and personal resources for IVF treatment, shouldn't they have enough sense to set aside adequate resources for the end result? Or in this case...results?

Sunday, August 03, 2008

Chucking a Sickie

By Emily Stephens

Chucking a sickie. That’s Australian for “faking a sick day” at work.

There’s a new Australian-based
website where anyone can buy a fake sick note in order to be excused from work or get out of a bad gym membership. Medical authorities are warning employees against using the online company. The notes cost about $38 each and are perfect for those who work at companies that require a medical certificate whenever they take a sick day.

"It is clearly inciting and abetting fraud," said
Wayne Herdy, a doctor and lawyer from the Australian Medical Association in Queensland state. "It's a matter that even the police should be looking at.”

Nevertheless, it’s still kinda cool! Doctor-signed sick notes are available in Australia, New Zealand, and Great Britain, in as quickly as a 48-hour turn-around. Links on the website are provided for Canadian and American who want to purchase sick notes as well.

"Explain your time off work or school with our genuine doctors' medical certificates. Available blank or filled in. Available with or without a genuine doctors stamp,” the website boasts.

Of course the company insists that these notes are not to be used illegally and are considered a novelty gift. Tee hee hee. Yeah, right. I can’t help but smile.

Don’t get me wrong. I’m glad I have a job…but that doesn’t mean I enjoy in any way, shape, or form what I do. My 9 to 5 is purely a necessity, a means to an end. I’m not alone in job dissatisfaction, either. Many of us dream of doing something different, something more with our lives. According to a recent
Harris Interactive Survey, 55% of Americans are not satisfied with their jobs. Only 20% feel passionate about their jobs, 33% feel they’ve reached a dead end in their career, and 21% are eager to change careers.

Younger workers are the most distressed and the least likely to feel loyalty to their employers. (After being burned too many times by “The Man,” I fall into that category). Furthermore, a study sponsered by economists at the
University of Aberdeen uncovered that job satisfaction is the most critical factor for life satisfaction and well-being.

Which brings me to the subject of Europe. According to the
Ecomonist, many well-to-do European countries work less than 30 hours per week on average. “Flexible arrangements for part-time workers, generous welfare systems and a limit on the working week all contribute to western Europe's seeming indolence. But where more people work part-time the average working week is likely to be shorter.”

Why can’t the US be more like Europe?
I have a few theories. Maybe they simply enjoy a more relaxed society? Maybe their civilizations are older and wiser than ours and have figured out that unless you’re one of the few who actually live to work, that work really stinks and should be done in moderation.
Therefore, I propose a 30-hour work week, or five six-hour work days.

The concept of a
30-hour work week was raised in the US as early as 1922, during a national strike of coal miners. Amidst of the Great Depression, the Black-Connery bill was introduced in the US Senate with the hope that it would put millions of unemployed back to work. The bill would have required employers to pay time and a half after 30 hours, as well as established a minimum wage and set limits on child labor.

Even William Green, the conservative head of the American Federation of Labor, supported the bill. Unfortunately, the bill was nipped in the bud by President Roosevelt who caved to business pressure and withdrew support. The bill failed in the House only by the slimmest margins. The Fair Labor Standards Act of 1938 established the 40-hour work week—which sadly was a break for many employees who typically punched a 50-hour time clock.

Ever heard of
karoshi? That’s Japanese for “death due to overwork.” Believe it or not, compensation is actually awarded to families of those struck dead by fatal occupational diseases. Scientists there have linked ischemic heart diseases and cerebrovascular diseases to heavy workloads. Current studies show evidence of an association between overwork and cardiovascular diseases.

Imagine how different the world would be with a 30-hour work week. I actually believe I could get just as much accomplished at work in 30 hours, if not more, than what I typically achieve during a 40-hour work week. But, until then, how does this sound?

“Please excuse Emily Stephens for the next 8 days. She is suffering from a bad case of bubonic flu. Short-term disability should be awarded as her condition is very serious. Oh, and when she is ready to return to work, she should be given an office with a window, a new ergonomical keyboard, and paid leave during her daily massage therapy. A substantial raise wouldn’t be bad, too; since Emily is ill with a terrible flu, her eyes are red, her face is blue, alas, alas, what can she do.”

Dr. Seuss

Saturday, August 02, 2008

Your Very Own Personal Genome Project -- At What Cost?

By Randy Hendrickson

There’s an interesting article in Wired magazine ( “How the Personal Genome Project Could Unlock the Mysteries of Life” by Thomas Goetz). The Personal Genome Project (PGP), a successor to the Human Genome Project, was launched by George Church, an expert in synthetic biology from Harvard Medical School. The first phase of the study began with 10 volunteers, but a second phase using 100,000 participants is scheduled to begin later in 2008. It is an attempt to map the genetic sequences in the DNA and determine how they are connected to genetic-based diseases such as cancer, heart disease, and diabetes. According to Church, “the PGP will bring personal genomics to fruition and our genomes will unfold before us like road maps: We will peruse our DNA like we plan a trip, scanning it for possible detours (a predisposition for disease) or historical markers (a compelling ancestry).”
Just this past spring, Church perfected the technology that could analyze millions of sequences at once. The Polonator G.007 not only accelerated the process, but it also reduced the costs involved. The goal is to sequence a human genome for as low as $1000 and make this technology a part of standard medical care.
One of the important ethical issues surrounding this project is how to obtain informed consent from the study participants. At the request of the Institutional Review Board at Harvard Medical School, the initial 10 volunteers were to be educated stakeholders in the field of personal genomics, because they would understand the ramifications of the study and would be able to give highly informed consent that the general public would not be able to give.
The next phase of the study, which will include 100,000 participants, is more complicated. To ensure that all the participants understand what is involved, an online educational system is being set-up, and participants will be tested to see how well they understand the intricacies of the study. The testing will also determine how much information is released to them.
In addition to informed consent, other important social, legal, and ethical questions still remain, namely, how privacy and fairness is ensured in the use of personal genetic information by employers, schools, insurance companies, the government, and people making clinical and reproductive decisions? If this information is misused, it is possible that a genetic underclass could be created.
Additional issues that must be considered include:
· balancing the need for personal privacy against the need for openness for scientific research;
· the potential impact of personal genomics on medicine, insurance, and employment;
· potential risks of misinterpretation and explicit misuse of personal genomic information; and
· legal and policy issues concerning ownership of this information.
According to Church, one of the goals of the PGP is to determine whether it is possible to protect personal genetic information. “Successfully protecting privacy will reassure the public, but if patients find the information is used against them, people may reject this technology.”

Friday, August 01, 2008

Do We Need More Bioethicists?

The nation is adrift when it comes to bioethics, according to statements from several prominent medical officials, who have called on the National Institutes of Health to put forward a comprehensive plan to train more bioethicists. Without that effort, they warn, public confidence in medical research and practice could deteriorate.

Dr. Ezekiel Emanuel, chair, Department of Bioethics, The Clinical Center, National Institutes of Health, said, "We need a strategic plan to develop bioethicists. We need to commit ourselves to doing something about bioethics in a sustained way-not just here today, gone tomorrow."

Ezekiel also argues that the USA should also increase support for research on bioethical issues such as improving informed-consent procedures and whether research subjects should be paid, Ezekiel argued. He articulates a fourfold strategy for increased NIH support of bioethics:

(1) educate and mentor sufficient numbers of producer bioethicists in well-designed postdoctoral programs;

(2) support junior researchers with an increase in established K awards targeted at bioethics;

(3) commit sufficient resources to ensure high-quality empirical and analytical bioethics research; and

(4) develop dedicated study sections composed of qualified bioethicists to review bioethics-related grant proposals.

He also recommends an office, center, or authoritative body within the NIH accountable for bioethics-related activities to develop a strategic plan and to be accountable for generating high-quality research and scholarship.

Dr. Judith Salerno, former Deputy Director of the National Institute on Aging, has called for leadership to develop "a national agenda for bioethics training and research." At present, she charged, there is only a "crazy quilt of programs and courses in bioethics."

The full article can accessed in the journal Academic Medicine, here.

Bioethics and Film: We all love a good story, don't we?

Abstracts are requested for a session on "Bioethics and Film," a proposed panel for a major conference on "Film and Science: Fictions, Documentaries, and Beyond," Chicago, IL (Oct. 30-Nov. 2, 2008). Send a proposal, 200 to 400 words, on any aspect of the relation of film to bioethics, including topics such as:

- Depiction of Physicians, Practitioners, or Researchers, in Features, Documentaries, TV Series, "Art" Films, or Genres

- Changes or Trends in Bioethical Considerations, Appearing in Genres Over Time

- Philosophical Aspects of Bioethics and Cinema, e.g.
Bergsonian, Deleuzian, neo-Kantian, phenomenological concerns

- Race or gender, poverty or wealth in films

Deadline for Proposals is September 1, 2008.

Send abstract to: Dr. Connie C. Price, Depts. Of Philosophy and Bioethics, 44-314 Bioethics Bldg., Tuskegee University, Tuskegee. AL 36088 USA. For details, click here.