The Logic or Rationale of the DNR Order

Whether we've discussed it or not, we've all thought about the prospect of Do Not Resuscitate Orders (DNRs). In most instances the need for them is no mystery nor does it require rocket science to understand when they become necessary. But now, in 21st century medical science comes the question: when do they not make sense?

See one perspective on a controversial ethics issue here.

Reality check: health disparities

I'll just warn you right up front: election season is getting to me.

We Americans may all be created equal, but substantial -- and shameful, in my view -- disparities in health status exist in the United States. Racial and ethnic minority groups, as well as rural and other underserved populations, bear a disproportionate burden of cancer, heart disease, and myriad other health problems. They have less access to health care, and when they do manage to get care, it's of lower quality.

Yes, it's complicated, and yes, there are lots of factors that contribute. But there's just no getting around the hard numbers on this one. Just to give you an idea of what we're talking about, according to the 2006 National Healthcare Disparities Report:

• Hispanics received poorer-quality care than non-Hispanic Whites* for 77% of core measures. Blacks* received poorer care than Whites* for 72% of core measures. American Indians and Alaska Natives are behind by a mere 41%. What are the "core measures"? Oh, silly little things like whether a woman gets breast cancer screening, or whether kids get dental care.
  
• Here's a shocker: across the board, poor people had worse access to care than the well-off. You really should check out the graph--it's a plain solid bar, representing 100%.
• Health care providers were less likely to inform obese Blacks and Mexican Americans, along with people with less than a high-school education, that they were overweight. These are populations with a higher prevalence of Type 2 (adult-onset) diabetes--perhaps those who could most benefit from a little counseling on this point.
  

The list goes on. Those who want to learn more can check out the National Partnership for Action To End Health Disparities. Meanwhile, here's a question you might want to keep in mind as we learn more about the candidates' plans for health care reform: Is it really acceptable for the richest country in the world to allow this kind of inequity?

When you hear people say that we don't, and won't, and can't allow health care rationing, and that choice is the most important thing, please remember these statistics. We absolutely do ration health care in this country. We just don't talk about the criteria we use to decide who gets it and who doesn't. People who are on the "don't" list don't have any choices at all.

*That's the Feds' classification.

Pain and personhood

Yesterday's NYT Magazine ran a long article about whether fetuses feel pain. The author, Annie Murphy Paul, is working on a book about how our early experiences shape development, and she asks some interesting questions about what effects pain and stress might have on fetuses. The pain question is an interesting one, and experts disagree about whether, to what degree, and at what point in time fetuses can experience pain.

If fetuses can experience pain, it seems not only reasonable but morally necessary that they receive sufficient anesthesia when they undergo painful procedures (such as blood transfusions or surgical interventions--which, believe it or not, can actually be done in utero in certain specialized centers in the U.S.). Such a claim doesn't rest on assertions of personhood, only of sentience. I would never let a veterinarian do surgery on my dog without anesthesia, but that doesn't make him a person.

As Paul notes, some anti-abortion activists have seized on research that shows fetuses displaying a physiological response to painful stimuli. They want to use this information as an emotional weapon, making sure that women know that if they have an abortion, the fetus will feel pain. Therefore, the argument goes, they should not abort. But while such a statement might make a woman feel worse, I have a hard time imagining that it would really change the mind of a person who'd made a firm decision to abort. It might cause her to ask that anesthesia be provided, though, which seems like a good thing.

Setting aside the abortion debate, pain is awfully tricky. We tend to understand pain as a subjective phenomenon: two people exposed to the same painful stimulus might well have different responses. So what does it mean to talk about pain for the fetus, who can't rate pain on a scale from 1 to 10, or even point at a frowny face? What do measures of cortisol or other stress hormones, or changes in blood flow, tell us about what the fetus is experiencing?

If we say that increases in certain metrics or decreases in others correlate with pain, what would it mean if we saw similar indications in a person in a persistent vegetative state? Paul comments that it might cause one to reconsider active euthanasia in such a situation, as a means of sparing suffering. But the connection between pain and suffering, between objective physiological measures and life as experienced, forces us to think about consciousness, about personhood, about respect for living beings (human and not), and about mercy. I can't do the article justice here, but it's definitely worth a read.

Endocrine Disruptors Skewing Birth Ratio in US and Japan

From the polar ice cap to the middle of the world, comes study after study linking synthetic chemicals and their lethal properties, to a reported steady decline in the number of boys born each year.

In an article written by Elizabeth Barker for the February 2008 issue of Whole Life Times, a recent report from the National Institute of Environmental Health Sciences determined a significant decline in the ratio of male-to-female births in the US and Japan, resulting in 250,000 fewer boys being born since 1970.

Last year, a team of Scandinavian researchers in the Arctic reported twice as many girls as boys being born in that region, identified as a "pollution sink" for the rest of the planet. Both studies blamed environmental pollutants as the most likely causal factors in the male birth shortages.

Read the entire article here.

Embryonic Stem Cell Trials in Humans Could Begin in Months

If all goes as planned, a California biotech firm will begin human testing using human-based embryonic stem cells by Spring of 2008.

Dr. Thomas Okarma, CEO of Geron, said the firm plans to conduct embryonic stem-cell studies in subjects with spinal cord injuries, involving up to 40 patients. The planning, of course, is pending the greenlight to proceed from the FDA, which is said to be setting a "high bar" on regulations governing what is certain to be one of the most significant pioneering research procedures of the century. Economic analysts predict the regulatory process alone will be daunting, and time-consuming because these are uncharted waters. It will be the first time that the FDA reviews a human embryonic stem-cell application.

Controversy has raged on both sides over the debate of stem cells and the ethical use in human therapeutic applications. In 2001 President Bush placed limits on federal funding of experiments involving then-existing human-derived stem cell lines, and in 2007 vetoed an attempt by Congress to lift those restrictions. No doubt the impending research will only raise more ire, questions and a major regulatory conundrum of the likes never witnessed before.

Some News Items Worthy of Taking Note

A quick summary of some of the newsworthy items that appeared in the news in the past week:

Alexis Madrigal of Wired's Science blog writes about a report published by the Committee for Economic Development, a nonprofit, nonpartisan thinktank in San Francisco, that prescribes openness in medicine, including open-access publishing of research data, as a means for improving the healthcare system. For a copy of the full report, click here. For more on Alexis' article, click here.


Sara Robinson does a great job of blasting the straw bogeymen in her first of her series, Mythbusting Canadian Healthcare, where she refutes the ten biggest myths about Canadian health care. [Hat tip to Mike the Mad Biologist, who blogged about it first and commented in his blog: "Despite conservative claims to the contrary, we do ration healthcare: many lower middle-class and unemployed people don't get to have any."]. Full article here.


Want to learn more about what makes you unique? Check out New Scientist's Personality Factors: "[F]ive key thermostats account for most of the variation in personality. These big five - extroversion, neuroticism, conscientiousness, openness and agreeableness - define five axes along which all individuals fall. Your personality, as measured by one of the many available questionnaires, consists of five different scores. Since each axis is continuous and they are independent of one another, there are countless unique personality configurations." For the whole enchilada, click here. (Subscription required)

And although, this article from New Scientist isn't related to healthcare ethics, it does bring up some fascinating philosophical questions: Will 2008 be the year of time travel? , like if you had a chance to go back in time and stop horrific things from happening (the classic example is eliminating Hitler to avoid WW II), should you? (Subscription required).

Happy Reading!

JUST SAY ‘NOETIC”

Earlier last week, we featured a delicious (if dubious) little item titled “The Mind-Body Connection via Intentional Chocolate.” According to The Institute of Noetic Sciences, a recent study found that adding positive intentions to chocolates resulted in significantly enhanced mood in those subjects who ate the “intentional’ confection compared to the controls.

Leaving aside the question of whether this actually works (and if so, how I can get my hands on some?!), I have a question for you:

Off the top of your head, do you know what “noetics” means? At dinner Saturday evening, someone stumped me with this. None of us, all post-college educated, reasonably literate people, could do more than guess. Now I was curious. I decided to look into it, and here’s what I found out. First of all, the dictionary definition of noetic (adj.): “of, relating to, originating in, or apprehended by the intellect. [Greek noetikos , from noesis , understanding].” And then, an interesting extension noted in the Online Medical Dictionary: “noetic anxiety: In existential psychotherapy, anxiety caused by confusion or loss of meaning in life.” (Or perhaps not enough chocolate? But I digress…)

And as for the Institute of Noetic Sciences (or IONS, the evocative acronym they often use):

“IONS is a non-profit research and education institution dedicated to advancing the science of consciousness and human experience to serve individual and collective transformation. Founded in 1973 by astronaut Capt. Edgar Mitchell, IONS was created to explore the interface of science and spirituality and to promote forms of consciousness that shift humanity from separation and conflict to collaboration, forgiveness and inter-connectedness.”

I’m feeling better already!

Informed Consent in Clinical Medicine as a Concern for Ethicists

The always excellent Kaiser Foundation's Daily Health Report http://www.kaisernetwork.org/daily_reports/rep_index.cfm calls attention to a startling new research finding--apparently "most patients don't read the forms they sign before undergoing surgery or medical treatment." What I find interesting, though, is that the Wall Street Journal Article that Kaiser quotes from concludes that hospitals are studyng this in an effort "to improve their informed consent processes amid 'mounting concern about patient safety and lawsuits arising from botched communications.'" At least the priorities are in that order. As a lawyer/bioethicist is is always interesting to me to see that despite the visceral hatred doctors have for the concept of civilian oversight (which is an accurate description of the current medical malpractice system which relies on lay juries for final decision making)combined with a reflexive support of any "tort reform" legislation which makes it harder for patients to sue. This support is unrelated to realities that medical malpractice litigation is not a factor in rising medical malpractice rates.

And this is of special interest to women how? Because of two phenomena. First, because women are still battling for true informed consent when it comes to issues such as breast conservation surgery and caesarian sections http://blog.healthcommunicationresearch.com/search?q=women
and second because efforts to make it harder to sue for medical malpractice ("tort reform") are harmful to women. See Professor Linda Finley (Lucinda M. Finley, Female Trouble: The Implications of Tort Reform for Women, 64 Tenn. L. Rev. 847 (1997) [hereinafter Finley, Female Trouble]; Lucinda Finley, The Hidden Victims of Tort Reform: Women, Children, and the Elderly, 53 Emory L.J. 1263 (2004) .

While bioethicists think more about the ethical issues in the informed consent process of clinical research, in fact the informed consent issues in day to day medical treatment are just as important. Although it may seem as if consent for medical treatment is less problematic because unlike areas of clinical research where the interventions may not benefit the patient these interventions seem designed only for the patient's benefit, in fact medical care is not so simple. There is always a range of options when it comes to medical treatment and one of the least understood of these options (to patients at least) is the option of doing nothing. Another frequent problem is that patients are not informed of the range of options but only those options available through their doctor or health care center.

There is an entire field devoted to communicating with patients and this blog http://blog.healthcommunicationresearch.com/search?q=women
provides many interesting examples of how the way women receive information can impact their health care decisions.

It would be ideal if the kind of improvements to informed consent such as moving away from handing over sheets of typed paper to sign towards a more interactive process that included different ways of presenting information, could be made without any need for the penalties of either civil litigation or administrative fines. However, there is nothing in recent history to show that informed consent is such a basic good that it would always be a priority without these incentives.



I would encourage all of us interested in informed consent to think more about its role in medical treatment in general and women's health care in specific from the ethics or human rights perspective rather than just to see this as yet another imposition of the legal system on the already over-burdened health care system.


Wall Street Journal Examines Efforts by U.S. Hospitals To Improve Informed Consent Processes[Feb 06, 2008]
The Wall Street Journal on Wednesday examined how U.S. hospitals have begun to improve their informed consent processes amid "mounting concern about patient safety and lawsuits arising from botched communications." According to the Journal, researchers have found that "most patients don't read the forms they sign before undergoing surgery or medical treatment." In addition, more than "half of those who do read the forms don't understand them, and only a quarter of forms include all of the data patients need to make an informed decision," the Journal reports.In response, some hospitals have begun "offering explanatory videos and diagrams" to patients when they complete consent forms, as well as "translating medical lingo into simple English" and "offering materials in other languages" to explain medical procedures and provide information about alternative treatments, according to the Journal. Some hospitals also have begun to use new technologies, such as online databases that calculate the risk of medical procedures for patients before they complete consent forms and electronic forms to address problems with lost paper forms that can delay procedures and increase costs.CMS recently issued new guidelines that require hospitals to develop "patient-friendly" informed consent processes, and facilities that do not comply could lose their eligibility to participate in Medicare. The Joint Commission, which accredits hospitals nationwide, also has advocated improvements to the informed consent processes used by the facilities (Landro, Wall Street Journal, 2/6).

A Gourmet Q&A

We're unashamed fans of Michael Pollan around here, so it when I came across this Q&A with him on Gourmet's website, sharing it was a no-brainer. Pollan is doing the interview rounds talking about his new book, In Defense of Food (currently sitting on my nightstand awaiting a few hours of spare time), and in this particular interview talks about the inspiration for the new book, why cliche's about food matter, and uh... apparently how to survive on a diet of primarily whale blubber. Well worth the read - after all, you never know when you'll be stuck in the arctic wilderness with nothing but a whale carcass.
-Kelly

The Mind-Body Connection via Intentional Chocolate

If you've ever wondered what makes it your mom's chicken soup so special, this study, brought to you by the Institute of Noetic Sciences, suggests that it is the intentional love that goes into making of it:




And with Valentine's Day coming up, what a great gift (I would like to think)! Or is it just a scam? I'll be curious to hear if the scientific community reacts to this as a dose of 'woo' or if the findings will be validated? Either way, those love truffles look great! Let us know what you think by taking our survey.

Ethics and biodefense

Following the attacks of 9/11 and the subsequent anthrax mailings (dubbed Amerithrax by the feds), funding priorities in basic research changed. Research money became available for projects to characterize infectious agents that could be deployed in bioterror attacks, as well as efforts to develop countermeasures, vaccines, and rapid detection and diagnosis methods. Under the terms of the international Biological and Toxin Weapons Convention, to which the US is a signatory, the development of offensive weapons is prohibited.

But, some point out, the same research that could be important in developing treatments or other positive public-health approaches to protect us could -- in the wrong hands -- be misused to cause harm. Finding the gene that makes a given bacterium especially virulent could help the good guys develop a way of reducing virulence; but it might also give the bad guys a way of making the bug more dangerous. This issue is referred to as "the dual-use problem," and it raises a number of ethical questions.

For starters, what work can/should be justified with regard to defensive bioweapons research? Does rehearsing bioterror scenarios increase the likelihood of their occurring, and if so, is it unethical to release such information? Should this work be classified, or is an "open-source" approach to information sharing actually a more effective means of protecting the public?

Want to learn more? Check out this podcast from the producers of a new PBS program on bioweapons research in the United States.

Novels for Teaching

Over the past two years my "inner English major" has been emerging and I have been integrating novels into my health law classes including bioethics and public health. It has been going amazingly well--the students have engaged with the characters and plots in these books in a way that second and third year law students do not usually engage with the material. They are excited, passionate and curious (something that law school can breed out of students). When I have taught medical students it is much harder to use novels because the courses are usually shorter. I, personally, don't enjoy short stories, however, so I wanted to try this since I have a whole semester with each class. Also, I thought you might be interested because although there is a canon of bioethics and medicine literary works, there are fewer interesting novels which combine law and medicine.

The books I recommend so far are "My Sister's Keeper" by Jodie Picault and "Intuition" by Allegra Goodman.

"My Sister's Keeper" is a very compelling story about a 14 year old girl who walks into a lawyer's office and says she wants to be legally emancipated from her parents so she can make her own decision about donating her kidney to her sister who is dying of cancer. One of the many twists in this story is that the girl (Anna) was selected by her parents as an embryo to donate cord blood to her older sister. It is a great story which is told from the perspective of all the characters, Anna, her mother, her father, brother (who is ignored in the face of his older sister's illess), lawyer and others. We are always trying to introduce our young students to life situations they have yet to experience and this book does so from the first page to the melodramatic conclusion (yet full of teachable topics).

The unpromising setting of "Intuition" a basic science research institute in which there is an allegation of research misconduct, is, against all odds, another engaging story. It is written by Allegra Goodman who has written several very good works of serious literary fiction and this among them. I am teaching a course on legal and ethical issues in clinical research and for the past week, had a room of 14 law students arguing passionately about the contents of a research notebook. Here, again, is a world with which my law students may have had no experience. By portraying how truly intense and competitive the life of research scienctists can be, the novel puts in context the horror stories they hear about research studies in which investigators seem to have ignored the fundamentals of ethics and common sense. My students are shocked that people with Ph.Ds. are treated like servants by the directors of the lab.


I think what is different about these books from the usual fiction in bioethics is that they are not classics--no WilliamCarlos Williams; no Camus; no Arrowsmith. These are contemporary, well researched and written compelling stories that quickly put students into a new world where they can better understand difficult ethical and legal situations.

(And yes, we did read "Wit" (which has become a staple of the medical school humanities curriculum) and then saw the DVD. Few law professors have to handle a seminar room full of crying students (men and women) and it has really enhanced and energized my experience as a teacher).

I am well aware I am far behind the vanguard of those using literature in bioethics or even literature in law school to teach health law (There is a great article on this by Professor Stacey Tovino which I will link tomorrow), but I wanted to relay my experiences, since they have been so positive, and to bring these two books to your attention. I look forward to giving you an update what students get out of a book I enjoyed very much "Wickett's Remedy" by Myla Goldberg which involves the 1918 flu and an actual research experiment with prisoners which took place on Deer Island in Boston harbor.

Should The HPV Vaccine Be Mandated?

We've discussed the HPV vaccine and why we think it should (or should not) be a mandatory vaccination - for both women and men (an argument we were making long before last week's study showed definitive proof of the need to vaccinate men). And on Tuesday night, when most of us were eying the results of Super Tuesday, our own Linda MacDonald Glenn was on a panel discussion hosted by Vanderbilt, on the same debate.

The video was streamed live, but for those of you who missed it, Vanderbilt should have the archived film up some time this week. The panel format makes it especially useful for people in teaching situations, who'd like to show their students a range of opinions in a civil debate.
-Kelly

Is Schizophrenia Passed on From Mother to Newborn?

When I was carrying my daughter Samantha, it was, as the saying goes, "the best of times and the worst of times."

While excitedly anticipating the birth of my first child and enjoying all the first-time experiences that come with carrying a new life, I was also dealing with an in-progress divorce that grew nastier and more bitter with each passing day. I often wondered if the baby could sense the stress I was under, and my obstetrician warned me on more than one occasion that the stress was not good for my pregnancy. I would often sense connections between negative events that were taking place around me, and the baby's character and degree of activity.

Now, according to a study conducted by a team of British and Danish researchers, severe emotional stress in the mother, experienced during the first trimester of pregnancy, may increase the risk of the child developing schizophrenia in later life.

The study, appearing in this week's Archives of General Psychiatry examines the impact of maternal stress — of the extreme variety — on the central nervous system/mental health of the unborn. The research suggests a causal link between extreme stress in the mother, to an increased risk of schizophrenia.

A link between maternal stress and its impact on fetal development was analyzed in a study appearing in the Lancet in 2000, which suggested a relationship between extreme emotional stress in the mother, experienced during the first trimester of pregnancy, and an increased risk of congenital brain malformations that could lead to permanent impairment in the neurodevelopment of the unborn child.

Read the complete article from Time.com

Would Paying for Organs Help--a review of Michelle Goodwin's terrific book

iThis is a link from my collegue Gerry Beyer's trusts and estates blog to an abstract of a book review/essay I just published in 33 J. Health Pol. Pol’y & L. 117 (2007) discussing Michele Goodwin's terrific book: http://lawprofessors.typepad.com/trusts_estates_prof/2008/02/the-body-part-m.html. I am trying to get a non-proprietary full text copy.
Professor Goodwin-who is a rock star in the field of law and organ donation- has written a compelling, well researched book which I would recommend for use in a college or graduate school class (as well as leisure reading (non-required reading?) ) as the starting place for someone who wants to understand the current legal state of the organ procurement and distribution system both in the United States and globally.

After the overview, Professor Goodwin builds her argument that people should be paid for donating their organs from the premise that African-Americans are a disproportionate share of the donor pool and, in the case of kidneys, have receive less than their share of donor organs. She then confronts and rejects the argument that this fact strengthens the argument that paying for organs is unethical because it would constitute slavery.
She thinks it would not and further thinks it is racist to deny African-Americans the choice to sell their organs. In reading her book, I did a lot of thinking about why people don't donate and started reviewing the medical literature on this topic. What I found looked to me like a very classist picture of non-donating families as selfish people -unmotivated by altruism-who would be motivated by money.
In this essay, then, I question whether paying people for organs really would increase the supply or whether we are mischaracterizing the motives of families who choose not to donate. I wonder if there isn't something at least classist if not racist in how the medical community views families who choose not to donate. Professor Goodwin has done her own research to delve deeper into the African-American community's reluctance to donate and not suprisingly, found a distrust of the medical system and a fear of being used as a research subject. I urge you to read her book and stay tuned as I rework into a real article the parts of this review which strayed from her book.

"In Black Markets: The Supply and Demand of Body Parts, Michele Goodwin (Everett Fraser Professor of Law, University of Minnesota Law School) examines the problems that arise because of a shortage of organs.
Here is a description of her book:
In direct response to indefinite delays on the national transplantation waitlists and an inadequate supply of organs, a growing number of terminally ill Americans are turning to international underground markets and brokers for organs. Offering a contemporary view of organ and tissue supply and demand, Michele Goodwin explores the legal, racial and social nuances of current altruistic institutionalized procurement schemes. It is understandably not publicized that Chinese inmates sitting on death row and the economically disadvantaged in India and Brazil are the most often compromised co-participants in the negotiation process and supply kidney and other organs for Americans as well as other Westerners willing to shop and pay in the shadow of the law. Goodwin suggests that the best alternative model for organ procurement is a market approach or one based on presumed consent and provides an alternative way of studying how to increase the supply of organs and other body parts as well.
Jennifer Bard (Alvin R. Allison Professor of Law and Director, Health Law Program ) has recently published a somewhat critical review of this book in 33 J. Health Pol. Pol’y & L. 117 (2007). Here is an excerpt from the review's abstract:
Black Markets: The Supply and Demand of Body Parts is an important contribution to the body of scholarship and policy analysis about one of the most difficult problems facing contemporary health policy, public health, and bioethics: the fact that the demand for donor organs far outstrips supply. In this book, Michelle Goodwin systematically reviews the general ways in which the United States' current organ-donation and transplantation system negatively affects potential donors and recipients, particularly African Americans. She proposes solving these problems by changing the current system that prohibits payment for organs to one that allows it. However, I argue that the entire discussion of a market-based solution to the problem of a shortage in supply in donor organs suffers from a flaw far greater than the inability to predict how such a market would work, because of a lack of reliable evidence that an offer of compensation would be effective in changing the minds of people who currently decline to donate the organs of their loved ones. "

More on BioBanking

According to BBC news, the UK may allow researchers to clone cells from human tissues donated for research purposes ... without the express consent of the donor.

Supporters assert that being able to clone cells from diseased tissue (eg, from tumor or other pathology samples) would allow researchers to learn more about those conditions -- and could speed the translation of basic-science research into clinically beneficial knowledge and treatments.

Opponents comment that sidestepping informed consent -- particularly for cloning, which creates copies of the donor's cells -- is a plain violation of research participants' rights to decide whether to participate in such studies. And, given the range of public opinion regarding cloning, it is conceivable that some research participants would oppose the use of their donations for this purpose.

This is another version of the question I've blogged about with regard to biobanking: just what should be the scope of allowed activities under a "blanket" or "one-time" consent? Also, should the research imperative (and perhaps the common good) outweigh individuals' preferences ion such cases?

News: Kansas Court Blocks Records Request

The Kansas Supreme Court has temporarily ruled on an appeal filed by Dr. George Tiller's attorneys, blocking the grand jury from obtaining semi-redacted medical records of patients that had late-term abortions.

Tiller's attorneys had asked that the court squash the subpoenas and disband the jury, primarily citing serious concerns about patients' privacy, and the power and reach of the Kansas grand jury system. The Center for Reproductive Rights of New York has filed a second petition with the court, also asking that the case be dismissed on behalf of the patients affected by the records subpoena, again citing patient privacy laws and expectations of medical privacy.

The spokeswoman for Kansas For Life, one of the groups behind the grand jury formation, has said that the ruling is extremely disappointing and that

there is no way to determine if the reasons for these late abortions were done within the narrow legal criteria without looking at the records themselves. His lawyers say they are worried about women's privacy. They are worried about protecting Dr. Tiller.

Those presiding over the grand jury have until February 11 to file their objections with the Kansas Supreme Court, who then plan on issuing a ruling by the end of February.
-Kelly

following up: banning food for the obese

Yesterday I wrote about the Good Idea/Bad Idea legislation Mississippi was considering that would make it illegal to serve obese people food. Since I wrote about it, the news wires have been flooded with people picking up and reporting the story in wider circles, which means more details have come out (for example, it's a cosponsored bill, two Republicans and one Democrat). But most noticeable in the new coverage is the seemingly pervasive comment that I'd like to address here: that not serving an obese person food in a restaurant is the same thing as not serving a drunk person alcohol in a bar. It's apparently the analogy du jour.

Well, okay. First, let's take a look at the law itself:

Any food establishment to which this section applies shall not be allowed to serve food to any person who is obese, based on criteria prescribed by the State Department of Health after consultation with the Mississippi Council on Obesity Prevention and Management

The analogy to alcohol starts immediately. How do you know someone is obese? Well, how do you know someone is drunk? The bartender knows based on a series of signs, including slurred words, loose body movements, uncoordination, loudness, etc. It would appear that they'd like this same vague "knowing" to apply to judging someone's weight - except, weight isn't that easy to determine. Looking at me, you wouldn't guess I weigh what I do (it even surprises my doctor), and I certainly would never be a candidate for withholding a meal in a restaurant...based on my looks. But at one point in the recent past, my BMI certainly was in the category that qualified for obese.

So then, what - wait staff are supposed to take their average best guess on someone's weight, BMI, fat versus muscle mass, and etc? Can we say lawsuits based on discrimination? (I thought we might.)

The problem here, and the way that as much as it might be nice to draw parallels between drunkenness and obesity, is that drunkenness does typically have the same basic set of signs no matter who you are. It doesn't matter how tall or short you are, your genetic history, your medical history - nothing. Being drunk is the same thing, and therefore relatively easy to determine (and especially the ones who should be completely cut off).

Being obese is not the same thing. Your rate of obesity does vary on size, on body type, your genetic history, your medical history. Everything. Obesity is a matter of your physical body and its relationship to your environment and your culture, and therefore not at all easy to determine (and certainly not by inexperienced wait staff).

Finally, and perhaps the clearest distinction, and hole in the argument being made, is that if you don't cut off someone who's drunk, their potential for death goes up that night - as does their potential to kill someone else. Even if someone who's obese eats themselves to death, they're not going to kill another person as they do it. They're not going kill another person with them or through their mistaken judgment. Time is on the obese person's side, it's not on the side of the drunk person trying to drive.

Perhaps it's a rather strict utilitarian view, but it does seem to me that if you choose not to cut off someone who's drunk, and they go on to hurt or kill another person, you are at least to some degree at fault for not trying to stop the drinker. But the chances of someone who's obese not being cut off from their food and then going out to hurt or kill another person seems... unlikely, to say the least. This is not to say there are not consequences from being obese, but they are a different set of consequences, and primarily affect the obese individual rather than a person who's suffering at the hands of a drunk driver.
-Kelly

New Gene Research Exciting...and Risky

While news of the research has yet to be published, British scientists announced the creation of human embryos containing DNA from two women and a man. The scientists say the goal of the research is to one day obtain the ability to produce embryos free of genetic disease.

Presented at a recent scientific conference, and funded by the British Muscular Dystrophy Campaign, the researchers employed a process that basically took normal embryos with defective mitochondria in the woman's egg, and replacing it with an egg donated from a second woman with healthy mitochondria. Errors in the mitochondria's genetic code is what results in diseases such as muscular dystrophy, strokes and epilepsy, for example.

Supporters of the research say the procedure offers hope for families facing the heartache of unavoidable inherited disease. Opponents fear genetically modified babies.
Read the details of the research here:

Why Girls Need Science (1955)

Via Prelinger Archives comes a 1950s educational video explaining just why girls need more than a single year of science in high school. High school daughter Betty doesn't see the point to taking science in her senior year of high school - she, after all, is going to get married and have a family, just as soon as she finds the right catch! But, her mother and father have something else to say about that (via the Prelinger Archives):


It's always interesting to see exactly what stereotypes existed and were being worked against in earlier time frames. The science fiction news site io9 has a great article collecting clips from the 50s that reassure women they can be scientists without being seen as mannish. Mary Summerfield, Ph.D., reassures "girls" that science won't render them "unfit spinsters", so made sure to always stress she was a scientist and a homemaker, and that "Cosmic rays and cake baking are both lots of fun." Also in the io9 list:

• Dr. Gladys Hobby tends "thousands of flasks--as solicitous about her molds as an anxious mother might be about a sick infant." The same article in Woman's Home Companion says that pharma companies research chemical compounds "in the hope that they will have valuable properties--just as an experimental cook will invent a new cake in the hope it will taste good."


• Seventeen magazine told girls that, if they were good in the kitchen, they might also make good chemists - it's just a different sort of baking, after all!


• Another article in Seventeen has male scientists reassuring the magazine that women make great lab techs; nimble fingers for fine motor skill tasks, and they're so good and nurturing with the animals.

Of course, as io9 notes, for the most part, if women wanted to be more than lab technicians they were out of luck - it was the rare woman, like Dr. Summerfield, who did become researchers in science fields, and even when they did, they did their best to emphasize their femininity, to assure girls they wouldn't lose something by pursuing that traditionally masculine field. I can't decide if this is an early indication of feminism, or if it's a sad example of the era, and the need to keep women in very gendered roles.

And as many things are, this is personal - my aunt very much wanted to be a veterinarian, but was told that being a doctor of any sort was "not a woman's job." By whom? Her parents, and specifically her father. It's hard for me, only a short 40 years later, to even understand that sort of mindset, but it's the mindset that turned her into a nurse, rather than pursuing the career she actually wanted.

I think that might be why I find these retro pieces, be they educational videos or magazine articles, TV shows, etc, so fascinating. For women my age and younger, it's hard to see, and remember, just how different the world was such a very close time frame ago.

-Kelly (with help from io9)