Sunday, December 30, 2007

Happy New Year

To all the readers of SHS, a wonderful, safe, healthy, and happy New Year. And remember, in the end we all destined to be yesterday's news--as the above photograph I took in Rome symbolizes. (You will, no doubt, notice that there isn't a photo. Blame Blogger: It won't upload. But hey, that's what imaginations are for.)

The end of a year is a kind of dying, and it reminds us that a time will come when we shall not be here to pop the champagne. Leon Kass believes--and I think he is entirely right in this--that our knowledge of death is, ironically, a crucial ingredient to our living better lives. He writes:

Could life be serious or meaningful without the limit of mortality? Is not the limit on our time the ground of our taking life seriously and living it passionately? To know and to feel that one goes around only once, and that the deadline is not out of sight, is for many people the necessary spur to the pursuit of something worthwhile. "Teach us to number our days," says the Psalmist, "that we may get a heart of wisdom"...

[T]there is the peculiarly human beauty of character, virtue and moral excellence [that can come from our knowledge of mortality]. To be mortal means that it is possible to give one's life, not only in the moment, say on the field of battle, but also in the many other ways in which we are able in action to rise above attachment to survival. Through moral courage, endurance, greatness of soul, generosity, devotion to justice--in acts great and small--we rise above our mere creatureliness, spending the precious coinage of the time of our lives for the sake of the noble and the good and the holy. We free ourselves from fear, from bodily pleasures, or from attachments to wealth--all largely connected with survival--and in doing virtuous deeds overcome the weight of our neediness; yet for this nobility, vulnerability and mortality are the necessary conditions. The immortals cannot be noble.

So, while we are here, let's make the most of it and give our posterity something about which to be proud. We won't get a second chance at this life, so it makes sense to do it right. And if there is a life beyond, well what we do here undoubtedly matters there, too.

And on that rather morbid but I think important note, I bid you a fond adieu until 2008. Y'all come back now.


Putting Privacy Over Patient Safety

The government's federal regulations about health care are rigidly pro-privacy. That is generally to be applauded, although I have heard (perhaps Apocryphal) stories of staffers not being able to tell a spouse that their beloved is in the hospital.

On the other hand, sometimes bureaucrats can be too literal in these matters. An important piece appears in today's New York Times by surgeon Atul Gawande, exposing how government bureaucrats shut down a promising experimental system for preventing hospital acquired infections--a real and growing problem in America and elsewhere. He writes:
A year ago, researchers at Johns Hopkins University published the results of a program that instituted in nearly every intensive care unit in Michigan a simple five-step checklist designed to prevent certain hospital infections. It reminds doctors to make sure, for example, that before putting large intravenous lines into patients, they actually wash their hands and don a sterile gown and gloves.

The results were stunning. Within three months, the rate of bloodstream infections from these I.V. lines fell by two-thirds. The average I.C.U. cut its infection rate from 4 percent to zero. Over 18 months, the program saved more than 1,500 lives and nearly $200 million.
Such a success cannot be tolerated: The Feds shut the pilot program down because it allegedly violated the privacy rights of "human subjects:"
Yet this past month, the Office for Human Research Protections shut the program down. The agency issued notice to the researchers and the Michigan Health and Hospital Association that, by introducing a checklist and tracking the results without written, informed consent from each patient and health-care provider, they had violated scientific ethics regulations. Johns Hopkins had to halt not only the program in Michigan but also its plans to extend it to hospitals in New Jersey and Rhode Island. The government's decision was bizarre and dangerous. But there was a certain blinkered logic to it, which went like this: A checklist is an alteration in medical care no less than an experimental drug is. Studying an experimental drug in people without federal
monitoring and explicit written permission from each patient is unethical and illegal. Therefore it is no less unethical and illegal to do the same with a checklist.

Only a bureaucrat could come to that conclusion.


Pro Hospice Article Cause for Concern

You would think that I would be delighted by this compassionate, well meaning, and finely written column by a hospice doctor named Michele Ferguson. She does an excellent job of describing the kind of benefits that hospice provides dying patients:

In my work, I am reminded every day that when terminally ill individuals receive expert, compassionate care from an interdisciplinary team of hospice professionals -- when pain is controlled, dignity is upheld, wishes and values are honored and fears and concerns are allayed--they can find richness and meaning in all the days that remain to be lived. Time and again, I've seen how physical suffering can be relieved, broken family relationships can be repaired and hope can be restored to those who are dying and their families. As a result, I've learned never to underestimate the healing power of hospice.

But there is a problem with the column, earlier in the piece than the section I quoted. She references Booth Gardner's desire for assisted suicide and his intent to get it legalized in Washington-State:

Working at HospiceCare, where honoring every patient's end-of-life choices is a core value, I have no dispute with Governor Gardner's desire to make his own decisions as life draws to an end.

That's a line right out of the script touted by the assisted suicide advocacy organization Compassion and Choices. Indeed, in my recent debate with Kathryn Tucker, the group's lawyer, she said the same thing almost word for word, that assisted suicide was just a bare nudge in policy and forms of care, merely an additional "choice" that should be honored.

I call this phenomenon terminal non judgmentalism: All choices are not equal. Some choices are harmful to patients, other similarly situated people who might be affected by the assisted suicide, families, and indeed, overall society. Hospice is supposed to see suicidal ideation as a symptom to be remedied, not a choice to be honored. It indicates that a patient is not receiving needed care.

Seeing assisted suicide as merely another choice is the end of hospice philosophy, at least as created by Dame Cecily Saunders who adamantly opposed assisted suicide as denying terminally ill patient's inherent dignity. After all, saying "It's your choice," when someone wants to kill themselves validates their worst fears; that they are a burden, that they will be allowed to die in pain, that their lives are indeed, not worth living any longer.

Hospice is supposed to be about valuing each patient's life equally, not the different choices they might want to make. I fear that Dr. Ferguson misses this crucial point in her compassionate desire to empower those for whom she gives such compassionate care.


Saturday, December 29, 2007

Adult Stem Cell Derived Drugs in Final States of Human Testing

Well, this is hopeful news. Drugs made from bone marrow stem cells are in their final stages of human testing. From the story:

Three pivotal Phase 3 trials--the last step before seeking Food and Drug Administration approval to market a drug--are under way already for Prochrymal, and some preliminary results will be available in the first half of the year. ..

Prochymal, administered as an intravenous drip, contains a particular kind of stem cells, called mesenchymal stem cells, from adult bone marrow. All stem cells, whether from adults or embryos, have the potential to divide and form more specialized cells.Mesenchymal stem cells, [CEO C. Randall] Mills said, normally help with tissue repair and inflammation control - processes that make them potentially useful for a variety of diseases."We don't ask the stem cells to do anything they don't normally do," he said.Two of the three pivotal trials are testing Prochrymal for graft-versus-host disease (GvHD), a severe, potentially fatal, condition that occurs when the immune cells in transplanted
bone marrow attack the recipient. One trial is as an initial treatment, the other as a fallback.The third trial involves Crohn's disease, an inflammation of the digestive tract.

Let's keep our fingers crossed.


The Mendacity of Missouri Coalition for Life Saving Cures

"What's that smell in this room? Didn't you notice it, Brick? Didn't you notice the powerful and obnoxious odor of mendacity in this room?" From Cat on a Hot Tin Roof

The line quoted above, uttered by Big Daddy to Brick, is one of my favorite lines in any play. It came to mind this morning when I read the latest mendacity emanating from the propaganda smokestack of Missouri Coalition for Lifesaving Cures.

It isn't that its leaders support human cloning research that gets my goat. I understand why people would believe that this research is the best way to go. But the human cloning issue is one of those rare controversies that are truly epochal. And in deciding how to proceed, basic respect for democratic processes requires accuracy in definitions and a clear respect for distinctions so that people will know what it is that is being discussed--and what is not being discussed--so that they can make ethical and political judgments based on facts--not lies.

But MCLC won't have that! It might lose. So, its advocates engage in the worst kinds of public deception--which shows utter disdain for those on behalf of whom they claim to be serving. The latest example is this op/ed piece by Donn Rubin, the chairman of MCLC. He writes:

Missouri Coalition for Lifesaving Cures lauds the stem cell advances occurring around the world as tremendous steps in medical science's ongoing battle to cure disease, and we eagerly await further discoveries as scientists continue the ethical exploration of this new medical frontier

An excellent example is last month's widely covered advances in Wisconsin and Japan where scientists were able to reprogram an ordinary skin cell to assume much of the versatility of embryonic stem cells. And, even more recently, this month scientists in London used embryonic stem cells to develop a stem cell "patch" to repair scar tissue from heart attacks and American scientists used embryonic stem cells as a novel way to test the safety of drugs...

If stem cell research opponents had their way, none of this outstanding science would have been possible. Ironically, they would have blocked the very groundwork that led to the technique they now seem to embrace--the reprogramming of ordinary skin cells into embryonic-like stem cells.

Well, at least Rubin used the term "embryonic" stem cell instead of the usual "early" stem cell euphemism generally employed by representatives of MCLC. And we won't get too deeply here into the far more dramatic advances in adult stem cells, including the treatment of heart disease in human patients, that are being made continually. (If you want to be startled, go to the Do No Harm Coalition Web page to see the many advances being made.) Be that as it may, the experiment Rubin is talking about with the heart patch is purely in Petri dishes, not in patients--a point he should have mentioned because an uninformed reader would think from his writing that the treatment is now available.

But more to the point of this post, if the opponents of Amendment 2 in MO had gotten 100% of their way, it would not have stopped the development of the new reprogrammed cells, the ESCR theoretical "heart patch," or the drug testing. None of that work directly or indirectly involved stem cells derived from human cloning (somatic cell nuclear transfer), which has not yet been done in humans. ESCR per se is not the subject of a proposed initiative to outlaw all human cloning in MO and hence all of the research successes Rubin mentions would have been unaffected. Those are scientific facts, not opinion.

Rubin's mendacity continues:
Those whose aim it is to ban all embryonic stem cell research in Missouri cannot have it both ways. They cannot continue to oppose the very research that is required to achieve the lifesaving goals that they now claim to embrace. Those who threaten to repeal Missourians' access to stem cell research should step back and allow scientists to conduct the work necessary to achieve the goals that I hope we all share--to cure disease and improve the lives of patients and families.
I repeat, there are no proposals to "ban all embryonic stem cell research" in MO. There is a plan to ban all human cloning in MO. That is not the same thing and Rubin knows it or he has no business being chairman of MCLC.

And the powerful and obnoxious smell of mendacity continues to fill the room...


Friday, December 28, 2007

Food Different Families Eat in One Week

This is a bit off topic, but I think it is worth pondering. This link will take you to photos of what different families eat in one week. The disparity is sobering. Here are a few samples:



Refugee Camp in Chad:

Pulling a Feeding Tube from a 16-Year-Old?

This is a terribly tragic case: Javona Peters has been diagnosed as being in a persistent vegetative state (a terrible name for a diagnosis, the only one I know of which contains a pejorative, a derivation of the V word). She became unconscious less than three months ago, and so the diagnosis seems rushed to me. In any event, from the story:

The emotionally shaken father of a 16-year-old girl in an irreversible coma at Montefiore Medical Center is wavering in his opposition to ending what's left of her life."I'm 85% changed in my mind now, but I don't know the legality," said Leonard Peters, whose daughter Javona Peters is in a permanent vegetative state after what was supposed to be a routine operation on Oct. 17. "I've got to think about it. I've got to talk to my lawyer," he said, a day after the Daily News reported on the teen's condition. "I mean, if nothing is working for Javona, I don't see the point now."

Until Wednesday, Peters opposed pulling the plug. "I don't give life and I cannot take a life," he told The News last week.

The reporter's hope killing "what's left of her life" comment aside, imagine the pressure this poor man is under to accede! Javona's mother, from whom he is estranged, wants the tube pulled. We know that too often medical teams and social workers pressure and cajole for such outcomes. But I would urge all concerned to hearken to the lessons we should learn from the Haleigh Poutre case. (More, here, here, here, and here.) She too was a girl diagnosed as permanently unconscious. The Commonwealth of Massachusetts, through its Department of Public Social Services, sanctioned by the MA Supreme Court had agreed to dehydrating her. But, before the deed could be done, Haleigh awakened--even though the doctors were sure she would never again be aware

My first question is: What's the rush? The story says the mother wants to sue the hospital, but that doesn't require Javona's death. So again, what's the rush?


Thursday, December 27, 2007

An Insider's Report of the Big Bush Stem Cell Funding Decision

An article in Commentary by former Bush Administration staffer Jay P. Lefkowitz is a very interesting read. It amounts to an inside story about how and why President Bush made his controversial stem cell funding decision that has caused "the scientists" and media so much heartburn. It is a long piece but a few points stand out. One, for example, is that prominent scientists told Bush things in private that they have rarely repeated in public. Lefkowitz writes:

On the hard science of embryonic research, the meetings reflected a greater ambiguity than boosterish media reports indicated was the case. Several scientists told Bush plainly that the efficacy of embryonic stem cells remained to be proved. As a result, some felt that only a few lines were needed to determine whether the field had genuine potential or was just a pipe dream.

Indeed, in an interview with the
New York Times shortly before Bush's August speech, Irving Weissman of Stanford stated that "a finite number [of stem-cell lines] would be sufficient. If we had 10-15 lines, no one would complain."
Of course, Weissman later changed his tune and many of "the scientists" so over hyped the immediate potential of ESCR that I believe the credibility of science has suffered a blow.
Toward the end of the piece, Lefkowitz summarizes his view of the Bush policy and the impact of the Induced Pluripotent Stem Cell technique:
Now that the debate seems to be over, what can we say about Bush's policy and the long months it took for him to devise it? I think it is fair to look upon it as a model of how to deal with the complicated scientific and ethical dilemmas that will continue to confront political leaders in the age of biotechnology. Bush refused to accept the notion that we must choose between medical research and the principle of the dignity of life at every stage. He sought both to advance biomedical science and at the same time to respect the sanctity of human life. In the end he came to a moderate, balanced decision that drew a prudent and principled line. The decision was both informed and reasoned, based on lengthy study and consultation with people of widely divergent viewpoints. It was consciously not guided by public-opinion polls.
This is a heterodox view, of course, but it worth the read even for those who despise Bush and his policy. And it seems right to me. From my discussions with those who have been literally into the Oval Office about these matters, there is no question in my mind that Bush acted with integrity and courage. And, as I have written previously, while I don't think the stem cell wars are over--believe me "the scientists" are working overtime to create cloned embryos and cloned stem cell lines in part to overcome the political impact of the iPSCs--the president deserves great credit for the way things seem to be turning.


Tuesday, December 25, 2007

Terrorists Must Be Defended Against and Brought to Justice

Animal rights terrorists are again threatening Oxford University in the UK for building a laboratory that will do research with animals. From the story:

Animal rights campaigners are threatening a new wave of attacks on Oxford University as its biomedical laboratory nears completion. Groups such as the Animal Liberation Front have been waging a campaign of arson and vandalism since work on the controversial facility - which will house all of the university's animal testing labs--began in 2004. [In the earlier story an opponent of the lab denied there would be "intimidation" against the university claiming that charge was a false one that is always leveled against liberationists. Not so false it seems!]

The ALF's spokesman Robin Webb warned university staff to expect "home visits". He said: "The ALF does not wave banners or leaflet neighbours. Our type of home visit involves red paint, breaking windows and criminal damage."

They also major in arson.

This level of radical criminality isn't just occurring in the UK, but also in the USA, such as at UCLA.

Needless to say, such tactics have no place in a free society. I suspect that these "liberationists" are just nihilists using animals as their excuse for mayhem. Be that as it may, the only ones with any chance to stop the crazies before somebody gets killed are other animal rights leaders. Alas, with few exceptions, we mostly hear the sound of silence in the face of terrorism that threatens to discredit the entire animal protection cause.


Eugenics is Eugenics in Whatever Direction it is Aimed

We've heard stories like this before: In the UK, deaf parents want the right to ensure having deaf children through embryo selection. From the story:

DEAF parents should be allowed to screen their embryos so they can pick a deaf child over one that has all its senses intact, according to the chief executive of the Royal National Institute for Deaf and Hard of Hearing People (RNID). Jackie Ballard, a former Liberal Democrat MP, says that although the vast majority of deaf parents would want a child who has normal hearing, a small minority of couples would prefer to create a child who is effectively disabled, to fit in better with the family lifestyle.

Ballard's stance is likely to be welcomed by other deaf organisations, including the British Deaf Association (BDA), which is campaigning to amend government legislation to allow the creation of babies with disabilities.

Some might say that the wrong here is producing children intentionally to have a disability. But the real wrong here is that children are becoming mere products ordered out of a catalogue--only worth bringing to birth if they suit parental desires and satisfy parental 'lifestyles." It marks the end of loving our children unconditionally.

Defenders of the proposal seem to be playing tit-for-tat:
A clause in the Human Tissue and Embryos Bill, which is passing through the House of Lords, would make it illegal for parents undergoing embryo screening to choose an embryo with an abnormality if healthy embryos exist. In America a deaf couple deliberately created a baby with hearing difficulties by choosing a sperm donor with generations of deafness in his family. This would be impossible under the bill in its present form in the UK. Disability charities say this makes the proposed legislation discriminatory, because it gives parents the right to create "designer babies" free from genetic conditions while banning couples from deliberately creating a baby with a disability.
Two wrongs do not make a right. Designing children to be deaf is just as morally wrong as selecting embryos out because they will be hearing impaired. The proper course is to block the eugenic provision now in the bill, not add more such pernicious ingredients into an already noxious stew.


Friday, December 21, 2007

Merry Christmas!

To all the friends and adversaries of SHS, please accept my heartfelt best wishes for the best of the Season. Sometimes, it can seem that all is strife and madness. But while in many ways we live in the best of times, it is all too easy to forget that it certainly isn't the worst of times. Here is what Longfellow wrote in 1863, in the midst of the Civil War:

I heard the bells on Christmas day Their old familiar carols play. And mild and sweet the words repeat, Of peace on earth, good will to men.

I thought how as the day had come, The belfries of all Christendom Had roll'd along th' unbroken song Of peace on earth, good will to men.

And in despair I bow'd my head: "There is no peace on earth," I said, "For hate is strong, and mocks the song Of peace on earth, good will to men."

Then pealed the bells more loud and deep: "God is not dead, nor doth He sleep; The wrong shall fail, the right prevail, With peace on earth, good will to men."

'Til ringing, singing on its way, The world revolved from night to day, A voice, a chime, a chant sublime, Of peace on earth, good will to men! .

As for me, I intend to drink a little eggnog, enjoy my family, play Santa Claus on Christmas morning around the tree, and give thanks for the many reasons for joy in my life.


"Pearls Before Swine" Not Vegetarian Friendly

I love the comic strip Pearls Before Swine. Here is the latest strip, which has just enough relevance to what we discuss here at SHS for me to post. Enjoy.


Animal Rights Terrorists Threaten Life of LA Mayor

The alternative newspapers continue to outshine the MSM in providing basic and in depth journalism: In this story in the LA Weekly, reporter Patrick Range McDonald shows how completely unhinged the animal rights terrorists are becoming in Los Angeles:

Antonio Villaraigosa may need to watch his back. On December 4, the North American Animal Liberation Press Office, a leading mouthpiece for animal-rights extremists in the United States, posted on its Web site a "communiqué" from a newly minted outfit called the Cat and Dog Liberation Army. It read: "Villaraigosa deserves to be bumped off like the dogs and cats we witnessed with their eyes wide, terrified before they were bumped off. He got off way to [sic] easy." The unknown writer of the menacing note also bragged about vandalizing the car and home of Deborah Villar, the mayor's sister, in Rowland Heights.
Realize that what these thugs are so upset about is euthanasia at animal shelters. Yet PETA euthanizes animals and even has material against "no kill" shelters. And pet owners face the extremely difficult task of putting their dogs and cats to sleep every day in veterinary clinics throughout the country.

And here is one terrorist apologist justifying going after the mayor's sister:

"It's a brilliant concept," says ]Lindy] Greene unashamedly. "Even though Deborah is not entirely involved, the idea is that she would be very upset and she'll call Antonio and say, 'Why do I have to suffer for something you’re not doing?' There's a hope that she'll apply pressure on him, or he would feel guilty for what's happening to his sister."

This isn't some new and "brilliant concept!" Totalitarians and terrorists do it all the time, threaten family members to force people in office to do what they want.

A couple of things need to happen and happen quickly before someone is murdered: First, the animal rights movement as a whole has to rise up and in one voice say this is absolutely unacceptable and that it sullies the entire movement. Then, they have to enthusiastically cooperate with law enforcement to bring these creeps to justice. Silence or non condemnation (PETA's stance) is immoral and unacceptable. Second, the MSM has to give much greater prominence to this terrorism to raise the public's consciousness to what is going on.

This kind of viciousness must not be accepted in support of any cause. Otherwise, some victims might just begin to fight back with the same tactics against their tormentors. (Would Green think it would be a "brilliant tactic" if someone she loved were terrorized to force her to help the police find the criminals?) And at that point, we would be well on our way to anarchy.
Alas, I fear this may be what some may want. I have noticed a close connection between anarchists and animal rights extremists. These folk are interested in only in tearing down, never building up.


Thursday, December 20, 2007

PETA: Tax Meat!

I cannot stomach PETA's ideology--views symbolized by the disgusting comic book aimed at kids depicted here--but I sit in awe at its leaders' propaganda and advocacy skills. They never miss a chance to get their message out. Now, they urge that meat be taxed to reduce global warming. From its press release:

With our proposal, a typical meat-eating family of four would only pay about $5 per month, and a chunk of that would likely be absorbed by the large meat companies. (And if a family did replace some of their meat consumption with healthy vegetarian foods, they would likely save hundreds or thousands of dollars in medical expenses over time as their health improved.) Revenue from a meat tax could be used to fund educational programs about the health and environmental benefits of reducing meat consumption.
There will never be such a tax. But it gets PETA in the news and its message out. These people are committed!


The Hospitalist Movement is Here to Stay

Once, when patients were hospitalized, their own doctors would follow and coordinate the care provided by whatever specialist was needed. But economics, the desire to reduce the length of hospital stays, and the unique challenges of providing hospitalized care led to the development of the "hospitalist," that is physicians who specialize in treating patients in the hospital.

I have nothing intrinsically against the concept, except that in today's health care system increasingly challenged by utilitarian pressures, I have worried that hospitalists-- being employees or contractors with the hospitals rather than specifically the patient's own physician--could come to unconsciously represent the hospital's bottom line and culture rather than the needs and values of the sickest patients. I am especially concerned about this potential paradigm in futile care theory cases in which hospitalists who want to terminate wanted care could unduly sway ethics committees. And, not being a patient's usual doctor and with no history with the patient or family, I have also been concerned that communication with families in catastrophic situations could be difficult or become hostile. On the other hand, I have seen the work of hospitalists in my local hospital and have, so far, been quite impressed.

My concerns aside, it is pretty clear that the hospitalist movement has succeeded and is moving quickly from the experimental stage to becoming the norm. This is clear from the conclusion of an article in the current New England Journal of Medicine (no link) entitled, "The Hospitalist Movement--Time to Move On," by Laurence F. McMahon, Jr., M.D., M.P.H.. He concludes:

The hospitalist movement has arrived, and it has transformed the care of hospitalized patients. Investigations similar to the early studies of hospitalist practice, which were focused on cost and comparing outcomes with those of other providers, should begin to wane. New investigations should focus on quality improvement, comparative effectiveness, clinical informatics, the safety of patients, and the translation of new medical advances to clinical practice. Academic medical centers must make strategic investments to provide opportunities in research training for hospitalist physicians and to support the research infrastructure. The academic focus and role models in the training environment will enhance the pipeline for hospitalists, but the underlying payment structure for evaluation and management needs to be dramatically enhanced if this field is to be sustained. Hospitalists are now an integral component of our delivery system; we must take advantage of these skilled physicians and take the next steps to enhance the care of hospitalized patients. It is time to move on.
Like it or not, this is clearly the future of medicine.


Wednesday, December 19, 2007

Beware of Stem Cell Quackery

I sometimes hear from people with serious illnesses telling me they are thinking about getting stem cell treatments from non reliable sources. I always urge them not to and be careful. Here is one reason why: A woman is being jailed for falsely promising to cure Lou Gehrig's disease with stem cells. Jail baby!


More Lies from Missouri Coalition for Lifesaving Cures

The human cloners over at Missouri Coalition for Lifesaving Cures are sure a disingenuous lot, for example, claiming in Amendment 2 to have outlawed human cloning when the measure actually created a state constitutional right to clone human life.

Now, a representative has a letter in the St. Louis Post Dispatch claiming falsely that cloning opponents would have prevented the great iPSC breakthrough. From the letter:

If anti-embryonic stem cell research groups had their way, this outstanding science would not have been possible. They would have blocked the very groundwork that led to the reprogramming of ordinary human skin cells into embryonic-like stem cells. If they get their way now, they will block the important research required to bring this new technique to its full lifesaving potential...Those who threaten to repeal Missourians' access to stem cell research should allow scientists to conduct the work necessary to achieve the goals that I hope we all share: to cure disease and improve the lives of patients and families.
What hogwash. First, legislation in Missouri was always aimed at outlawing human cloning, not embryonic stem cell research. Indeed, ESCR would have remained perfectly legal in MO if A. 2 had failed. Second, the potential repeal pending in MO would really outlaw human cloning, and not impede ESCR in the least. Third, cloning had zero to do with the iPSC breakthrough, and indeed the new approach is seen widely as a moral and ethical way to derive pluripotent stem cells without SCNT cloning. Fourth, Bush-approved ES cell lines were and are perfectly suitable for the kind of basic research into pluripotency that scientists say they need to continue to perfect iPSCs. Finally, James Thomson, one of the scientists who demonstrated the viability of the approach, did so with an NIH grant from the dreaded Bush Administration.

The prevarication and bull manure continually shoveled by this organization is a disgrace to public policy advocacy.


The "Kidney Cult:" Should Choice be Everything in Health Care?

Several years ago, the Montana Supreme Court basically ruled that whatever a patient wants to do with a willing medical provider should not be impeded by the government. Not surprisingly, as I mentioned here at SHS, it bred a lawsuit to create a state right to assisted suicide in the Big Sky State. Many bioethicists share this autonomy ubber alles view, which I see as an offshoot of personhood theory and libertarianism, both of which generally hold that persons should be allowed to engage in whatever actions they see fit with regard to their own bodies so long as others are not harmed.

I take a different view, as readers of SHS know. I certainly believe autonomy is important, but not the be all and end all. Society has a right to put reasonable limits on "choice" in order to protect the common good and prevent individuals from harming themselves. This puts autonomy and paternalism into a dynamic tension, that will move one way on a particular issue and then the other on the next.

There is a religious group in Australia that puts these issues into vivid focus. From the Wall Street Journal story:

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

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

So, should his kidney be taken as a matter of honoring his autonomy or denied as a matter of protecting him from possible coercion and protecting his health? And if he can be stopped, what about a friend of mine who gave a kidney to save an unrelated person's life (and had some difficulties recovering)?

I agree with this approach:
Many hospitals aren't interested in donors who don't have an established, personal relationship with the recipient. That is partly because of fears that such donors may be secretly--and illegally--paid. Other concerns: Stranger donors may be psychologically disturbed, unrealistically hopeful that donating a kidney will improve their own lives, or likely to back out.
I think that on this issue, the burden should be on the would-be giver to demonstrate that the decision to give a kidney is freely and voluntarily made for purely altruistic reasons. It seems to me the only way to prevent potentially irreversible harm being done to someone who acted in the heat of the moment or under some form of coercion or undue influence and later get giver's regret.


Tuesday, December 18, 2007

When Cloning Goes Wrong

This is funny stuff--imagined depictions of animal chimeras caused "when cloning goes wrong." There are too many to present here, but here is sampling.

(Hit this link to see the rest.)

HT: Don Nelson

Conscience Clauses: The Flip Side of Medical Futility

"Conscience Clause" laws that would permit pharmacists to refuse to fill birth control pill prescriptions or doctors to perform abortions, are growing in political prominence. By way of push back, some states are passing laws requiring pharmacists to dispense birth control pills, and New York City requires all doctors training in city hospitals in the specialty of Ob/Gyn to perform abortions during their medical training.

Now, a Montana pharmacist, whose state laws are silent about such matters, has decided to quit dispensing birth control pills. From the story:

Pharmacist John Lane believes he has a responsibility to serve humankind through his profession.

Lane, who converted to Catholicism 10 years ago, also believes the "humankind" he pledged to protect includes fertilized eggs that, because of oral contraceptives, are not able to implant in a woman's uterus and grow into a baby. There's more to it than that. But faith is clearly a big reason that, come Jan. 1, Lane will no longer dispense birth-control pills to his customers in Powder River County, Mont.

That decision wouldn't have much effect if Lane worked in Rapid City or surrounding towns, where dozens of other pharmacists and pharmacies are available and willing to fill prescriptions for birth control. But in a town of 450 people, Lane's decision will force customers to either get oral contraceptives by mail order or drive 80 miles to the nearest pharmacy...

There is another reason Lane decided to stop dispensing birth control pills. Three states--California, Illinois and New Jersey--require pharmacists to fill prescriptions for oral contraceptives. Other states, including South Dakota, have "conscience clauses" that protect pharmacists who choose not to fill certain prescriptions.

This issue is the flip side of Futile Care Theory, which would permit doctors to refuse wanted life-sustaining treatments based on their consciences and moral values. Proponents of medical futility should think about this when pushing their agenda--as should proponents of conscience clauses.

That being said, I think that a crucial distinction can be made between refusing to provide medical services based on conscience that are not optional--meaning when life is literally at stake--and refusing desired services the withholding of which would not threaten a patient's life. Thus, I don't believe any doctor should be permitted to refuse to terminate an ectopic pregnancy, even though that is technically an abortion. At the same time, I don't believe that any doctor should be forced to help kill a patient via assisted suicide or euthanasia--nor to participate in the act in any way such as by giving a list of referral sources who would kill a patient. However, if a new doctor asked for the medical records, the refusing doctor would have to comply even if he or she knew that the requesting physician was consulted for purposes of assisted suicide.

This is all very controversial and the anger and acrimony is only likely to increase in coming years. But such are the consequences that befall a society that is atomizing and losing common moral values. As this ongoing loss of commonality continues, expect increasing loss of comity in medicine and science.


Monday, December 17, 2007

Brave New Britain Strikes Again: OK to Test Embryos for Cholesterol Propensity

Brave New Britain is showing us the future of eugenic procreation unless we are very careful, the perceived right to only have children who pass health--and eventually attribute--muster. Where once pre-implatation genetic diagnosis was reserved to prevent babies from being born with terrible genetic conditions that would be immediately terminal, things are now moving toward weeding out those who would have a propensity to illness later in life. The latest "we never say no" UK Human Fertilisation and Embryology Authority (HFEA) rubber stamp is to allow a couple to screen their IVF embryos for a gene that can cause heart disease in teenage or adult years. From the story:

A British couple have won the right to test embryos for a gene that leads to high cholesterol levels and an increased risk of heart attacks, The Times has learnt. The decision by the fertility watchdog will reopen controversy over the ethics of designer babies, as it allows doctors to screen embryos for a condition that is treatable with drugs and can be influenced by lifestyle as well as genes.

While the procedure is designed to detect a rare version of a disease called familial hypercholesterolaemia (FH), which often kills children before puberty, it will also identify a milder form that can be controlled by drugs and diet. Critics argue that the test will allow couples to destroy embryos that would have had a good chance of becoming children with fulfilling and reasonably healthy lives...

Its decision breaks new ground because it permits Mr Serhal to screen out not only the severe form of the condition but also the milder type, which is usually treatable.

The tragically ironic thing about all of this is that we have reached a point where we believe we are entitled to hyper control all aspects of human life. To paraphrase Lincoln: We can control some of life's vicissitudes all of the time, or all of its vicissitudes some of the time, but we can't control all of life's vicissitudes all of the time. Talk about a doomed enterprise.


Animal Rights Criminal Pleads Guilty

Rodney Coronado is one of the more dangerous animal rights thugs in the country who was previously imprisoned for committing arson "for the animals." Well, it looks like he is going to the hoosegow again, having entered into a plea bargain with prosecutors. From the story:

A well-known animal rights activist pleaded guilty yesterday to a charge of showing people at a speech in San Diego four years ago how to make a destructive device with the goal of having someone commit a violent crime.

Outside court, Singleton said Coronado accepted the deal to move on with his life and raise his family. Coronado already spent four years in federal prison for committing arson at animal research labs in Michigan.

"I needed to do what is best for my family," Coronado, 41, said after he entered his guilty plea. He is free on bond until his sentencing in March. The rarely used federal law Coronado pleaded guilty to carries a maximum of 20 years in prison. But Coronado and the government have agreed to ask Judge Jeffrey Miller to impose a sentence of a year plus one day in federal prison, Singleton said.

I'll bet he has been involved in far more than these charges would imply. But this is good news. Hopefully Coronado's love for his family and a second prison term will induce him to cease all criminality and encouragement thereof in the cause of animal liberation.

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Sunday, December 16, 2007

Adult Stem Cells Appear to be Working as Treatment for Heart Disease

As I pointed out in an earlier post, the syndicated columnist Ellen Goodman recently castigated President Bush for "betting on the wrong horse," e.g., adult stem cells, in the stem cell debate. This was ignorant and ridiculous, as even casual readers of SHS know. Adult stem cell research is producing amazing, if early, results. Here's another little story in that continuing stream:

OSAKA--A medical team at Osaka University Hospital has succeeded in restoring function to the heart of a patient with severe cardiac disease using muscle cells taken from one of the patient's thighs, it has been learned.

The male patient in his 50s, who had been waiting for a heart transplant, is now able to walk unaided, and will leave the hospital in Suita, Osaka Prefecture, on Thursday, according to the hospital. It is the first time in the world that a patient waiting for an organ transplant has been successfully treated using their own cells. [Me: I am not sure this is the first.] "The treatment can be a good alternative to heart transplants," said Yoshiki Sawa, director of the Medical Center for Translational Research at the hospital...

The medical team took the myoblast cells [a form of stem cell] from the patient at the end of March this year, and then spent two months creating 25 myoblast sheets. At the end of May, the team attached the sheets to the patient's heart, mainly around the organ's left ventricle, which is key to circulation.

After the treatment, the patient's heart functions, including pulse rate and quantity of blood pumped, all improved rapidly. On Sept. 5, or 98 days after the treatment, it became possible to remove the pacemaker. According to the hospital, the man's heart functions have almost fully recovered, and he is able to lead a normal daily life.

One patient does not a cure make, as I always say. But this is remarkable.


Let Us All Bow Down Before the Great God Science

This is becoming a constant whine among the scientific intelligentsia: Sir Martin Evans, who won the Nobel Prize for his work with embryonic stem cells, is complaining that we don't pay enough attention to science (as if!) when making policy. From the story in the Guardian:

Britain's latest Nobel laureate has criticised the government and civil service for not valuing science highly enough. Sir Martin Evans, who was awarded the Nobel prize for medicine last week, said a lack of understanding of science within the government was hampering policy-making. "Science has not been regarded with the same level of appreciation as things such as politics and economics as a basis of government and government service, and I think it should be equally important," he said.

The attitude to science in Whitehall reflected a wider ignorance in society. "Science should be part of the understanding, the education of any educated man or woman and also of anybody who really is going to make decisions. At the moment unfortunately it isn't," he said.

What I worry about--and Sir Martin seems a case in point--is that science devolving into naked scientism, in which its powers are seen as an end instead of a means, a belief rather than a method, as grounds for ruling rather than a calling to serve.

On the other hand, in a question and answer interview in the New Scientist (no link), Shinya Yamanaka, who first discovered iPSCs, demonstrated what I think is a proper humility and concern for society as well as naked science:
QUESTION: Who do you think should be responsible for deciding what is ethically acceptable?

YAMANAKA: These are very difficult decisions, and I think that society should make them. It should not be scientists. They can find it difficult to think like the person on the street, and instead may see it simply as a good opportunity. We scientists can be involved in the decision-making process, but I think unless society is comfortable with the therapy it should not go ahead.
No Nobel Prize for him! Yamanaka clearly doesn't recognize that science is god!


Too Many of Us Live in Cities

I'm sorry, this is a trivial matter, really, but it just set me off. The below quoted letter to the editor--reacting to a story about a man who shot a cat to keep it from killing an endangered bird-- was published in today's New York Times Magazine:

I read Bruce Barcott's article with interest, but I must dispute his concluding pronouncement that "the war between cats and birds...continues." Do we call it a war when the slaughter is almost exclusively one-sided? The birds are simply trying to survive in the face of formidable odds.
So are the cats. Predation isn't a "slaughter." Nor is it a "war." Cats killing birds are merely engaged in the Darwinian world of tooth-and-claw predation.

Only humans, in our unique empathy, even have qualms about what happens to the members of other species; which that is one of the things that makes us exceptional. Still, get a grip. Visit the wilderness. Watch a National Geographic documentary. With the exception (sometimes) of human society, this is the way things are.

(I should talk: Once, when our late cat Chloe was "playing" with a chick that had fallen out of a nest, she meowed and meowed for me to come watch. Her adrenalin was up and she was throwing the poor thing all over the yard. I couldn't stand to see the bird suffer, so I dispatched it with a sharp blow from my shoe and put it in the trash. Chloe was furious with me for ruining her fun. But neither of us did anything wrong. She was just being a cat doing what cats do--utterly indifferent to the suffering she was causing the poor bird--and I was doing what humans often do by caring very much about the suffering she was causing the poor bird and thus choosing to interfere with the brutal ways of nature in the raw.)


Something is Going Very Wrong in Healthcare

I am regularly contacted by families who believe their loved ones have been terribly mistreated in hospitals. Sometimes, it is clearly a misunderstanding and I try to set their minds at ease. At other times, the story seems to be an egregious abuse but there is little I can do. On those occasions, I try to give my correspondents ideas about how best to proceed toward obtaining redress or preventing similar abuses--or if that seems unlikely to bear fruit--on how to live with burning fire that one feels when they have seen a loved one victimized.

The following letter is typical of the kinds of letters I am talking about, and in fact, is less incendiary then most. It was written in response to this blog entry in which I recounted the case of a hospital that did not adequately communicate with a woman whose husband had been declared dead by neurological criteria.

I asked my correspondent for permission to post it here with all identifiers removed, and she graciously said yes, writing, "The article in the AJC hit so close to home. My heart breaks for families like this and angers me to no end when medical personnel treat family members and caregivers like they are ignorant and stupid. There is such a thing as "the patient bill of rights." Here is her note to me that deals with rudeness and the kind of pressure often put on patient families to dehydrate their cognitively disabled loved ones:

Dear Mr. Smith:
I took my husband, C---, who is in a coma to [X] hospital to have a test performed. He was transported by ambulance from our home however it was not an "emergency" situation. We were instructed prior to the test to route him through the E.R. for registration purposes so as not to clog up the waiting room and also expose him to others who might be have contagious illnesses. After being inside the hallway of the E.R. for about 5 minutes we literally had a physician and nurse push his gurney and tell us "he has to go...we can't have him in here..." The 2 paramedics almost came to fighting blows with the hospital staff because they were so rude and uncaring. A wonderful, loving and beautiful 42 year old man laying helpless on a gurney and all they want to do is clear up floor space. There was no major emergency going on at the time and believe me the waiting room was not full. Nurses and Physicians alike were goofing off and several exams rooms were empty. Not one person asked if they could help.

When C---- was in Intensive Care after his heart attack EVERY physician I came into contact with urged me to take out his feeding tube. Sometimes they would get me alone with 4 or 5 of them in a room at one time and I actually felt like I was being bullied. There was no other family but me to speak for him. I knew what his wishes were even though they weren't written down. I guess our lucky break was that we had health insurance. God provides all the miracles and He gave me one the day He gave C--- the breath of life again.

Hospital like X which is about 2 miles from my home need to teach their physicians how to behave like human beings and above all do unto others as you would have them do unto you.
I have no doubt she was being bullied. I hear from people on an ongoing basis who feel they were bullied. I have been in an ethics committee meeting representing an elderly woman pro bono who was being very badly treated by a doctor because she would not allow her husband with Alzheimer's to be dehydrated--this even though she had agreed to a DNR and no antibiotics. (We stopped the dehydration and changed doctors. He lived for three more years.) The room was hostile, everyone knew each other by first name, it had the feel of an inquisition. It was hard for me--and I am a lawyer. I don't know how she would have managed on her own.

Most doctors and nurses care very deeply about their patients and are committed medical professionals. Indeed, I believe that it is the workers in the trenches who are keeping medicine moral by resisting some of the utilitarian agendas being driven from the intelligentsia. But hospitals face resource shortages, which causes tempers to fray and can lead, indirectly, to viewing the most expensive to care for as unwanted ballast, which the utilitarian view fosters. This can lead to dehumanizing of the sickest patients and resentment of the families who love them and want to keep them alive. If this incipient conflict worsens, people will lose faith in medicine.


Saturday, December 15, 2007

Adult Stem Cell News Blockade Continues to Crumble

A promising new adult stem cell treatment for breast reconstruction of women who have had lump-ectomies to treat breast cancer has been reported in the Washington Post. From the story:

For the first time, doctors have used stem cells from liposuctioned fat to fix breast defects in women who have had cancerous lumps removed. The approach is still experimental, but holds promise for millions of women left with cratered areas and breasts that look very different from each other after cancer surgery. It also might be a way to augment healthy breasts without using artificial implants...

In the Japanese study, doctors liposuctioned fat from 21 breast cancer patients' tummies, hips or thighs. Half was reserved as the main implant material; the rest was processed to extract stem cells and combined with the reserved fat. This was injected in three places around a breast defect.

Eight months after treatment, "about 80 percent of the patients are satisfied" with the results, said the lead researcher, Dr. Keizo Sugimachi of Kyushu University in Fukuoka, Japan. There was a statistically significant improvement in breast tissue thickness at one and six months after treatment.

Doctors with no role in the research say longer study is needed to see if these results last.

Promising results in early human trials with adult stem cells are popping up all over the place. Now that the iPSC breakthrough has sucked much of the anti-Bush venom from the issue, expect the media to report more stories like this. The news blockade is, at last, crumbling.


Thursday, December 13, 2007

Not Futile Care but a Failure to Communicate

I am assuming that the descriptions in this story are accurate for purposes of analysis. According to the Atlanta Journal Constitution:

Alicia Fennell had just one hour to save her husband's life. Doctors at Emory Eastside Medical Center in Snellville said he was brain dead and being kept alive by life support. She and her children doubted the diagnosis, sensing that somehow Donald Fennell was still aware.
This is awful writing that seeds terrible confusion. To be declared brain dead is--assuming accurate diagnosis--dead. It is not to be declared unconscious. It is to be declared dead. Hence, if true, Mrs. Fennell didn't have one hour to save his life because he was already deceased.

This may seem to be a case of futile care theory in action, but it wasn't if Mr. Fennell was truly dead. However, the problem here was not caused by Mrs. Fennell. She wanted her husband to be maintained because the hospital did a terrible job of communicating fully with her--as a consequence of which she brought the case to court:
[Judge] Davis called everyone back into court at 11:30 a.m. the following day. He asked Chief Medical Officer Michael Heisler at Emory Eastside to bring CAT scans and explain the test results to the family in a way they could understand. He also consulted with a chief administrator for the VA hospital in Decatur, who said it was unlikely they would accept someone in Fennell's condition for a transfer.

Alicia Fennell says that until the court hearing, doctors had never fully explained her husband's condition. It was also the first time she'd seen CAT scans. Previously, hospital workers told the family the machine wasn't working, she said.

Good grief! If this is true, it is unconscionable.

Declarations of death by neurological criteria are tricky enough without an arrogance or neglect that treats a grieving woman like an unwanted spectator to what happens to her husband. It also points to the desperate need for uniform procedures both to determine death by neurological criteria and how to help families deal with the diagnosis with regard to ceasing intervention.

Futile care theory is about imposing institutional or physician subjective value judgments on unwilling patients/families. If the patient is dead--which appears to be the case here--the desired treatment is physiologically futile--and it is not wrong to stop treatment that can no longer help the patient. Physiological futility is not part of the Futile Care Theory problem that this way comes. That imposition is known as qualitative futility. It is crucial to understand the difference between the two.

In this case, again assuming the story is reported accurately, the hospital caused needless fear and suffering to a desperate woman--which resulted in bad reporting sowing confusion about both brain death and futile care among the general public.


"Terri's Day" Established

The Terri Schindler Schiavo Foundation and Priests for Life have announced the establishment of "Terri's Day." From the story:

The Terri Schindler Schiavo Foundation and Priests for Life jointly announced that "Terri's Day" will advocate for people in situations similar to what Terri and her family faced.

Fr. Frank Pavone, National Director of Priests for Life stated, "Those of us who were with Terri will never forget her life and her death. For the sake of all the vulnerable, it is critically important that those who never knew Terri likewise remember the lessons that God taught us through her."

"No family should ever have to witness what my family witnessed, watching a loved one slowly dehydrate to death," added Suzanne Vitadamo, Terri's sister. "We want Terri's Day to remind us all that persons with disabilities are never burdens and should be treated with nothing but our unconditional love and compassion."

Futile Care Theory cases like the current one in Canada, dehydrating people who have not asked to have sustenance removed, castigating and denigrating people with profound cognitive disabilities as mere "V-words," as if any human being can be reduced to the status of a turnip, are among the crucial moral issues facing the country that advocacy actions such as Terri's Day seek to address. I honor the Schindlers for their continued commitment to these issues--in the face of some of the most disgusting denigration and vituperation to which they are continually subjected.


Samuel Golubchuk's Futile Care Case a Hard Sell With the Public

The current Futile Care Theory fuss in Canada, in which a hospital wants to remove Samuel Golubchuk's respirator and feeding tube because he is diagnosed as unconscious, seems to be playing out in the polls as favoring the family that wants their father's life-sustaining treatment to continue. From the story in the Toronto Sun:

It appears Canadians side with a Winnipeg Orthodox Jewish family who fought in a Winnipeg courtroom yesterday to keep their father alive, according to a recent poll.

While Samuel Golubchuk's doctors are advocating the 84-year-old be taken off life support because his vegetative condition will never improve, his family argues their religious beliefs don't allow any action that would hasten death.

An Angus Reid poll released this week shows nearly seven in 10 Canadians think family members--not doctors or judges--should decide when to remove a vegetative patient from life support. Only 2% of the more than 1,000 people polled between Dec. 3 and 4 think the courts should decide--as will be the case for Golubchuk eventually--and 15% believe doctors should make the call.

I am not surprised. In a society that cannot agree on many basic issues of right and wrong or the value of human life, "choice" becomes the end all and be all. In Futile Care Theory controversies, "choice" cuts in favor of those who oppose unilateral withdrawal of treatment. Moreover, it reveals the hypocrisy of those who support assisted suicide in the name of autonomy, but then say choice has its limits when people want their lives sustained.

I predict that the fight over futile care theory will be long and hard-fought. It is favored by the elites in bioethics and Establishment policy thinkers as a way to save resources. But it rubs main street the wrong way--meaning the outcome of the coming brouhaha remains uncertain. However, those pushing the quality of life agenda will have a harder time.than they do usually, having sold the "choice" agenda to the public so well.


Wednesday, December 12, 2007

My Predictions for 2008

Each year the Center for Bioethics and Culture asks me to predict what will happen in the next 12 months regarding the major bioethical and biotechnological controversies of the day. So, I put on my Carnac the Magnificent hat and predicted away. It is worth noting that my expectations were affected materially by the great iPSC breakthrough, as this excerpt from my column suggests:

When the CBC asked me to play Nostradamus and prognosticate on how I see bioethical and biotechnological issues playing out next year, I had a good idea about much of what I would say. And most of it wasn't very encouraging. But then something very big happened that made me glad I hadn't written this article last month: Scientists in Japan and the United States “reprogrammed” human skin cells back to a stem cell state. And the world shifted.
That breakthrough materially impacted the political and scientific environments, which in turn, affected my predictions. (For example, I was planning to predict that the Bush stem cell funding policy would be overturned. I now predict it will remain in place throughout the remainder of his term.)

In any event, in a nutshell, here are some of the major events that I see happening in 2008:
Research into human iPSCs will advance toward overcoming the need to use viruses in the cell reprogramming

The first human cloned embryonic stem cell line will be created

Methods will be advanced toward obtaining human eggs without requiring super-ovulation

No laws will be passed to permit egg buying for biotechnological research

The Bush ESCR funding restrictions will not be overturned

There will be no changes in the law about human cloning

Washington State Will Reject Legalizing Assisted Suicide

No State Legislature will Pass Assisted Suicide Legislation

Futile Care Theory Will Remain Stalled
Tune in here next November and we'll see how I did.


Futile Care Case in Canada

When I was in Toronto recently at the international anti-euthanasia conference, I focused my speech on the looming threat of Futile Care Theory as the next big bioethical controversy. And already, I am proved prescient. A Canadian hospital is trying to force an elderly man off of a respirator and feeding tube over the objections of his family. From the story:

A Winnipeg family is going to court today to try to force a local hospital to keep their ailing father on life support, saying the hospital's decision to withdraw such care violates their orthodox Jewish faith. Orthodox Jews believe it is essential to do whatever possible to extend life, and "sacrilegious" in any way to hasten death, the children of Samuel Golubchuk say in court documents. They are also claiming damages for assault from the Grace General Hospital and critical-care doctors, whom they accuse of acting arrogantly and trying to remove the patient from a ventilator and feeding tube on the Jewish sabbath.

The hospital and its doctors, though, say they have gone out of their way to respect the family's wishes but would now be violating ethical guidelines to keep offering care they say would only drag out the 84-year-old's painful death.

First, we should reject the concept of "dragging out the death" which turns the concept of extending life on its head. As I often say, dying isn't dead, it is living. It is a stage of life. Refusing to extend life when the patient wants it is to turn the very purpose of medicine on its head and impose doctors' or hospitals' values onto patients and families where value judgments truly belong.

Here is what the doctors say:
But the patient suffers from a variety of irreversible ailments and trying to prolong his life now would actually contravene rules of the Manitoba College of Physicians and Surgeons that bar futile treatments, Dr. Elizabeth Cowden, the Grace's chief medical officer, says in an affidavit."I do not feel that I can ethically participate in the administration of this treatment any longer," Dr. Bojan Paunovic, head of the hospital's intensive-care unit, says in his own affidavit.
What is wrong here is that the treatment isn't being cut off because it doesn't work--which is a true futile treatment--but because it does! In effect, the patient is being declared to be futile. And just because the hospital created their own rules, that doesn't mean they should be able to dictate who loses the right to live even though they are no doubt acting in the best of faith.

I am glad this is going to court. There are "cusp" cases where it may be so against the best interests of the patient and cause so much suffering that continued treatment can be unconscionable. But that isn't up to doctors to decide unilaterally because they create their own rules. That is what we have courts for with the right to cross examination, a public hearing, and appeal, where the burden of proof should be on the doctors. In short: Due process--the very thing denied by conventional futile care hospital protocols.


Tuesday, December 11, 2007

Strings Attached to MO Life Science Funding: Blame Amendment 2

A column in the KC Star grouses that the state is funding life sciences research into animal and plant experiments, but not human studies. From the column by Jason Gertzen:

The Missouri General Assembly created the trust fund and the grant program a few years ago. It was one of the ways state leaders decided to use the several billion dollars Missouri ultimately is to receive from its portion of the tobacco settlement.

But only earlier this year did lawmakers pump money into the trust fund for the first time. When they did so, the program was restricted to funding plant or animal projects. Some lawmakers expressed concern about state dollars paying for human embryonic stem-cell research...

The rules of the grant program could be changed so that the human health restrictions are not so broad, Duncan said. "There is a lot of human health research that could be done that has nothing to do with embryonic stem-cell research," Duncan said. "To provide those restrictions is a bit stifling."

That may be. But the Stowers Institute Crowd, who bought and paid for their own constitutional amendment known as Amendment 2 , is responsible for these restrictions. You see, the amendment not only created a constitutional right to perform human cloning in Missouri--accurately defined as the creation of human embryos via SCNT--but it created an explicit non discrimination policy that required human embryonic stem cell research to be funded if other forms of human stem cell research receive state money. So, because of this overreaching and arrogance, the opponents of ESCR and human SCNT just didn't fund human research in order to ensure that state money would not have to be paid toward what they consider to be unethical and immoral experiments.

Gertzen should have placed the blame where it belongs--on overreaching by Amendment 2's authors.


More Animal Rights Terrorism: Threats to Poison General Population in UK "For the Animals"

People like this deserve to be jailed and the key thrown away. The continuing rabid attacks against Huntingdon Life Sciences and any business that deals with the company, has now led these fanatics to threaten to poison the general population. This is an anonymous "communique" from a group of criminals calling themselves the Animal Rights Militia:

December 10, 2007 -- A.R.M. Claims Contamination of Glaxo Products
anonymous communique: "In a series of coordinated actions on the 10th December by the ARM 49 bottles of Lucozade Energy have been contaminated with sodium hydroxide and replaced onto shop shelves in the North of England, London, and Northern Ireland. The affected flavours are Original, Orange, Apple, and Lemon of the sizes 500ml and 1l. Jean-Pierre Garnier the choice is yours, either you cut your companies ties with Huntingdon Life Sciences or these actions will continue. We've been watching GlaxoSmithKline closely and we know what you're up to, Novartis paid the price when we hit its products a couple of months ago the question is how higher a price are you willing to pay? As you can rest assured we will be back. This action is dedicated to the 500 animal who die at the hands HLS workers every day.
Of course, nothing need to have been done to the bottles at all for this insidious terrorism to work. When and if these criminals are caught, the justice system should treat them without mercy.

Some might say that I am assisting the terrorists in printing this. But I think it is important for people to see how evil some in the animal rights movement have become. This isn't about being nice to animals. It is about terrorizing people and anarchy.


Lead Into Gold: Moral Value of Embryo Led to Great Breakthrough

In the NRO, I credited President Bush's ESCR funding restrictions for having played a part into the quest to find non-embryonic sources of pluripotent stem cells--cells "the scientists" insisted they needed to fulfill the total promise of regenerative medicine. My thinking is this: Without the Bush plan and its indirect defense of the intrinsic moral value of nascent human life, the ethical issue would have long been swept aside in the stampede to create regenerative medical treatments and by now the fight would have been over federally funding human cloning research in the quest to find the "gold standard" of patient specific, tailor made ES cells.

James Thomson, while not crediting Bush, has admitted that he had qualms about using embryos. And now, Shinya Yamanaka, the Japanese researcher who first discovered the process of creating iPSCs has suggested that the importance of the embryo also played a big role in his work. From the New York Times story:

Dr. Yamanaka was an assistant professor of pharmacology doing research involving embryonic stem cells when he made the social call to the clinic about eight years ago. At the friend's invitation, he looked down the microscope at one of the human embryos stored at the clinic. The glimpse changed his scientific career.

"When I saw the embryo, I suddenly realized there was such a small difference between it and my daughters," said Dr. Yamanaka, 45, a father of two and now a professor at the Institute for Integrated Cell-Material Sciences at Kyoto University. "I thought, we can't keep destroying embryos for our research. There must be another way."

Yamanaka has said that some ES cells will continue to be needed for basic research. But that means the Bush approved lines should be up to the job.

This debate has always been larger than the sum of its parts. Had we just swept aside the moral concern of turning human life into a mere thing to be used like copper from a copper mine, I believe our society would have been changed unalterably. President Bush saw this and kept the focus on the importance of all human life. Thank goodness good scientists like Yamanaka also had moral concerns and found an ethical way to move forward.


Monday, December 10, 2007

Bioethicist Wants to Tax Parenthood

Saving the planet is all the rage these days. Now, an Australian bioethicist wants to charge people a carbon tax for having children. The money would be used to plant trees as an offset to the global warming that the new children would allegedly cause. From the story:

Professor Walters, clinical associate professor of obstetric medicine at the University of Western Australia and the King Edward Memorial Hospital in Perth, called for condoms and "greenhouse-friendly" services such as sterilisation procedures to earn carbon credits.

And he implied the Federal Government should ditch the $4133 baby bonus and consider population controls like those in China and India.

Let's see: China and India have terrible problem with sex selection abortions and China also has an infanticide problem. Moreover, in other contexts we are told by many bioethicists that reproducing is a fundamental right by whatever means desired by whomever might wish to become parents.

Global warming has become a catchall for policies people would be pursuing anyway based on ideology. Or to put it another way: What a crock.


Animal Liberation Front: The True "Sadists"

The ALF has vandalized a researcher's car in Oregon and boast about it. From the story:

Animal-rights saboteurs have claimed responsibility for vandalizing the property of a second Portland-area scientist who uses monkeys in his research. In a message Friday, the Animal Liberation Front acknowledged creeping onto the Portland Heights property of Dr. Miles Novy early Thursday and damaging two of his vehicles with graffiti and paint stripper.

"Novy's reproductive research on primates has resulted in this senseless torture of one of natures most magnificent creatures," ALF's saboteurs wrote in a message released by the North American Animal Liberation Press Office. "This blatant disregard for the earth, animals and its resources shall not go unseen by the ever-watching eyes of the ALF."...

The scientist awoke Thursday to find the words "sadist" and "ALF" spray painted in red on his Audi and Jeep Grand Cherokee. Paint stripper streaked the vehicles white. "It's time to fight back," the ALF wrote in its claim of responsibility. "The only reason why people like Miles Novy sleep at night is because we let them."

ALF members are the true sadists. They impede research and thus make it more difficult to alleviate human suffering. (See my article on the Silver Springs Monkey case in which a PETA activist almost prevented a tremendous rehab technique for stroke disability from being developed.)

ALF terrorists aren't liberators. They just love being destructive and scaring people. It doesn't rise to civil disobedience since they hide who they are. Pathetic, cowardly, and anti-human.


DNR For Disabled Child at SCHOOL?

I had to think about this, but I think the parents' decision to order their profoundly disabled daughter not to receive CPR at school if she has a cardiac arrest is very wrong. From the story:

As the school bus rolled to a stop outside her Lake County home, Beth Jones adjusted the bright yellow document protruding from the pouch of her daughter's wheelchair, making sure it was clearly visible. In bold letters it warned, "Do Not Resuscitate." The DNR order goes everywhere with Katie, including her 2nd-grade classroom at Laremont School in Gages Lake. The school is part of the Special Education District of Lake County, where an emotional two-year discussion ended this summer when officials agreed to honor such directives.

Now, district officials find themselves in the unusual position of having planned the steps its staff will, or won't, take to permit a child to die on school grounds. Although DNR orders are common in hospitals and nursing homes, such life-and-death drama rarely plays out in schools, where officials realize how sensitive and traumatic the situation could be for nurses, teachers and students.
The scare [an earlier episode in which she stopped breathing] strengthened Beth and Dave Jones' resolve to face the death of their daughter on their own terms.
I have great sympathy for the parents and I am certainly not against DNR orders per se. But this isn't just something that would necessarily be "on their own terms." It could also involve other people; the school administration, teachers, and most importantly other students and their parents who would have to deal with the trauma that could be caused by seeing a classmate die in front of their eyes.

The story says that Katie enjoys going to school:
On a recent morning, Beth Jones could readily see how keenly her daughter enjoyed her trips to school. The little girl was beaming up at her from her wheelchair as they waited for the bus. "You're in a really good mood, aren't you?" Beth Jones asked her.
It strikes me that if it is important for Katie to go to school--which it certainly seems to be--then the Jones family should think about the impact allowing Katie to die would have on others. At home, in a hospice, in a hospital, a DNR order could be proper. But I don't think such orders should extend into the realm of the general public. At that point, the presumption for life should prevail.

HT: Vickie McKenna


Sunday, December 09, 2007

UK: Organs from Drug Addicts Used in Transplantation--Excuse for "Presumed Consent"

This isn't good: In the UK some organs have been transplanted from drug addicts and cases of drug overdose because, allegedly, cases were desperate. And the answer to this disturbing bit of news? "Presumed consent" to organ donation. From the story:

Hundreds of below standard hearts, lungs and kidneys have been taken from drug addicts and transplanted into critically-ill patients, The Daily Telegraph has been told. Three per cent of the organs transplanted into patients in the past five years came from donors with a history of drug abuse--some of whom died from an overdose--figures obtained under the Freedom of Information Act have revealed.

One transplant surgeon said doctors were "desperate" for organs and had to use some they would otherwise have rejected.
The findings sparked renewed calls for a change in the law to presumed consent--in which everyone is included on the organ donor register unless they specifically opt out.
Yes, well there is a big problem with informed consent in a utilitarian, ageist, and health rationing milieu like they have in the UK. If you get seriously injured, particularly if you are not expected to regain full cognitive functioning, some doctors might look at you as if you were a mere collection of organs that others could make better use of than a patient with full equal moral worth. And, in the UK, they have futile care theory already in the law, which could profoundly add complications to the issue.

I debated this issue on the BBC a few months ago and the organ physician I was up against really did not want to talk about futile care as it applied to the issue. Time did not permit us to get into it deeply, but before this proposal gets through Parliament, which it will unless something is done, somebody had better bring it up!

Presumed consent might pass muster in the UK where people are less individualistic and there is a greater sense of the collective. But it would never wash here in the USA--at least if it were clearly discussed. Bioethicists and members of the medical intelligentsia know this, of course, and so they are already busily thinking up the euphemisms to use to get us to swallow presumed consent--as in this paper which spends much time urging that the term be changed to "specified refusal" as a tactic to help get presumed consent laws passed:

Having a policy that can potentially increase rates of organ donation is not enough in and of itself. These informants who are involved in the creation of health policy, suggest that semantics and marketing are just as important as efficacy in influencing political feasibility.
Yes. When our betters among the intelligentsia want to sell us their snake oil, they know that telling the clear and candid truth tends to harm chances of their getting what they want. So, they change the terms. After all, the great unwashed are obstacles to be gotten around rather than constituents to be convinced by candid and honest advocacy.


Saturday, December 08, 2007

Bone Marrow Stem Cells Used in Spinal Cord Surgery

Stories like this are finally breaking the back of the CURES! CURES! CURES! ESCR/cloning hype brigade: A patient is being treated with bone marrow stem cells as part of spinal surgery to help in healing. From the story in the Sacramento Bee, no less:

They are not from human embryos, but the stem cells being packed into Perry Anderson's spine may help him heal from a surgery that failed to heal the first time, leaving him hobbled and unable to work for nearly three years.

The same type of cells, derived from bone marrow, one day may help heart attack patients recover, ease the misery of inflammatory bowel disease, and allow diabetics to continue producing insulin.

While the ethical debate rages over the use of stem cells taken from discarded human embryos, bone marrow stem cells, harvested both from cadavers and from live donors, are being developed for use against a range of illnesses.

This was the kind of story that rarely made it through the news blockade until recently. But the progress in this field in human work is so undeniable that the blockade is beginning to crumble.

Of course some die-hards, like Ellen Goodman--as in this bitter column denying Bush any credit for promoting non-embryonic stem cell research--refuse to open their eyes. She writes:
First of all, the Bush administration bet on the wrong horse--adult stem cells.
That's what comes from only listening to one side of the debate. Ignorance, they name is Goodman.


More Trouble in Proposition 71 Land: CIRM Conflict of Interest Cover Up

The San Francisco Chronicle is reporting that 10 grant applications to fund research have been rejected by the CIRM staff due to conflict of interest violations. That's good. But get this: The agency is refusing to divulge which members of its steering committee violated the rules. From the story:

California's stem cell agency on Friday acknowledged that it has turned back 10 grant applications worth millions of dollars because the applications were accompanied by letters of support from members of its own governing board.

But the state-financed California Institute for Regenerative Medicine declined to identify which grants were dinged and which board members potentially violated conflict-of-interest rules by signing the letters meant to bolster the case for grant approval.the

This is unacceptable. Those on the governing board who tried to steer money to their own institutions--even if ignorant of the rules, which would be telling in itself--should be off the governing board. In fact, representatives of institutions or businesses that are going to apply for grants should not be on the governing board at all to avoid "You scratch my back and I'll scratch yours" scams. And it is worth noting that the story is apparently a leak to the Chronicle. It should have been announced by the CIRM in a press release with full disclosure.

There have been so many irregularities now that the head of the CIRM, Robert Klein, should resign. Time to clean house! Better yet, time to close up shop--not that that will happen.


Friday, December 07, 2007

Coverage of My Speech in Toronto

This article is a pretty good summary of the presentation I made at the international anti-euthanasia conference in Toronto last week. (Kudos to Alex Schadenberg, head of the Canada-based Euthanasia Prevention Coalition, for spearheading such a successful and important get together. Many leaders in the movement to maintain ethical medicine internationally, disability rights activists, religious leaders, medical professionals, etc., were in attendance, and more than 300 people turned out to hear the presenters.)

I was asked to speak about "future concerns." My presentation was divided into two parts. First, I pointed out that the promotion of assisted suicide had moved from the "crackpot" approach (suicide machines, focus on methods of "deliverance," etc.) into the elitist "professional mode" in which very well off and very well-tailored advocates pitch their poison to other similarly very well off and very well-tailored leaders in the media, professional organizations, etc., who think like them, act like them, speak like them, etc. Here's how the story described that part of the speech:

Gone are the many cruder elements of the movement such as the antics of Dr Kevorkian or the promotion of "exit bags" that on a number of occasions garnered strong public reactions against pro-euthanasia proposals just prior to key plebiscites or votes by legislators. Instead, the movement has shifted focus away from trying to change public opinion towards that of influencing political leadership in the areas of law, politics and professional medical associations. The key players in the movement today are professional, upper middle class people who are very influential in changing the opinions of important players who in the words of Smith "happen to look, think and act like them." They are particularly adept at modifying the language surrounding physician assisted suicide to make it more palatable and change the framework within which it is debated.
The bulk of my speech was about futile care theory, which I perceive as the first cousin of assisted suicide. Assisted suicide/euthanasia holds that some people's lives are so miserable and undignified that if they want to kill themselves, society should permit doctors (or others) to facilitate suicide. Futile care theory holds that some people's lives are so miserable and undignified that even if they want to have their lives sustained, doctors and ethics committees can say no. This would seem to be paradoxical. It is, if the issue is "choice." But that isn't the real issue, that is the facade. The real agenda is getting certain people dead.

Here is how the story covered that aspect of the speech:
...[H]uman lives are increasingly being measured by a combination of factors such as the quality of life (as determined by others), the costs of treatment and their value to society. This naturally leads to the development of "Futile Care Theory" which moves the argument from the right of people to choose death to that of promoting the death of people who fail to meet the standards of the "Personhood Theory" approach to measuring the quality of life. Smith summarized it with the line, "we want to put other people out of our misery."
On another point: I was impressed with the speech of Canadian disability rights activists Catherine Frazee. She told the audience that there are two general veins of opposition to assisted suicide; political and spiritual, with people in each camp disagreeing with each other on other issues. She suggested that the best way to work together would be to develop a philosophical approach that would include all and permit people to also pursue other agendas when not working against assisted suicide. Well stated, I think.


More Trouble in Proposition 71 Land: A Continuing Series

The potential for conflict of interest is always an issue when billions of dollars are on the line. But it is built into the system of the California Institute of Regenerative Medicine, tasked with distributing $300 million of borrowed money each year for cloning, embryonic, and now iPSC research. This was a consequence of permitting members of the Citizen Advisory Board to include representatives of the institutions seeking the pork.

The structural problem should have received high profile coverage from the media in the campaign to pass Proposition 71, and opponents tried to talk about it. But the media generally avoided the issue, obsessed instead with pointing out that many of those urging a no vote were pro-lifers. Indeed, it wasn't until after the election that several good stories came out disclosing the many structural problems with the CIRM--and then, of course, it was too late.

The latest story in this sad saga finds four grants in jeopardy because of conflict of interest problems, in which members of the advisory board wrote letters in support of their institutions' grant applications. From the story:

California's stem cell agency may toss out grant applications seeking millions of dollars for researchers at UCSF and other prestigious universities because they included letters of support from deans who also sit on the citizens' board that governs the $3 billion program.

Sources close to the grant-making process said that staffers at the California Institute for Regenerative Medicine flagged the applications for conflict-of-interest violations, despite a requirement that each request contain a letter of support "signed by the Dean or Departmental Chair."

Among the institutions that have been notified their grant applications are in jeopardy, according to sources who spoke only on condition that they not be named, are UCSF, UCLA, the University of Southern California and UC San Diego.

In other words, to get a grant, an institutions needs a letter from the dean. But they named some of these same deans to the board creating a built-in conflict of interest. What kind of management does the CIRM have?

Proposition 71 was passed with more than $30 million in propaganda hyping the soon-to-be derived CURES! CURES! CURES! versus a few hundred thousand dollars from opponents. The media refused to play a proper watchdog role. Now, we have a big mess. And some of this comes out of my wallet since all Californians are being stuck for the bill for this debacle.


Thursday, December 06, 2007

Lead Into Gold: Induced Pluripotent Stem Cells Cure Disease in Mice

Research into the new iPS cells is moving forward at a seemingly breathtaking pace. Mouse studies carried out at Harvard demonstrate that they have the capacity to treat sickle-cell anemia. From the story:

Mice with a human sickle-cell anemia disease trait have been treated successfully in a process that begins by directly reprogramming their own cells to an embryonic-stem-cell-like state, without the use of eggs.

This is the first proof-of-principle of therapeutic application in mice of directly reprogrammed "induced pluripotent stem" (IPS) cells, which recently have been derived in mice as well as humans.
The research, reported in Science Express online on December 6, was carried out in the laboratory of Whitehead Member Rudolf Jaenisch. The IPS cells were derived using modifications of the approach originally discovered in 2006 by the Shinya Yamanaka laboratory at Kyoto University.
And get this quote from Jaenisch:
"This demonstrates that IPS cells have the same potential for therapy as embryonic stem cells, without the ethical and practical issues raised in creating embryonic stem cells."
Jaenisch also states that ESCR needs to continue to further understand issues involving pluripotency. If so, why not just use the Bush-approved lines so that full federal funding can apply?

The stem cell wars are not yet over. But science may have found a way around the ethical contentiousness. Let's hope so. It would be nice to all row in the same direction for a change.


Wednesday, December 05, 2007

Robert Latimer, Canadian Murderer of Daughter, Denied Parole

Robert Latimer murdered his 12-year-old-daughter Tracy in 1993 because she was disabled by cerebral palsy. (The picture is of Tracy and her father.) While many Canadians supported Latimer as a loving father who put his daughter out of misery, he was convicted in of second degree murder. His first conviction was overturned on a technicality, and he was convicted again. In 2000 he began a life sentence with no possibility of parole for ten years.

Throughout this time Latimer has remained unrepentant. His defiant attitude seems to have been key in the decision of the Parole Board to deny day parole. From the story:

Robert Latimer, the Saskatchewan farmer who killed his disabled daughter in 1993, was denied day parole from the minimum-security William Heat Institution outside Victoria on Wednesday afternoon.

The three-member parole board told Latimer that they were "struck" that he had failed to develop any insight into his crime during his seven years in prison. "Folks were left the feeling you have not developed the kind of sufficient understanding of your actions," said Kelly-Ann Speck, one of the three members of the National Parole Board panel.

The decision means Latimer will not be able to spend time in the community. According to Evelyn Blair of the National Parole Board, Latimer likely will not have another opportunity at parole for two years.

I am not against mercy, but denying day parole to Latimer is a very good decision. The Latimer case exposed a noxious core of anti-disabled attitudes in Canada, in which many who would have normally considered any parent who killed his child a monster, instead branded him a hero. (If you doubt it, contrast the public attitude toward Susan Smith who murdered her sons around the time of Tracy's murder, with the sympathy extended by many Canadians to Latimer.) Murder is murder. The fact of Tracy's disability did not make her life less worth living--or punishing for its criminal taking. If Robert Latimer had been released it would have sent precisely the wrong message.


Frivolous PETA Complaint Rejected

I reported here a few weeks ago that PETA had filed a complaint with the federal government against the Oregon National Primate Research Center, claiming abuses of the animals. I wrote then that I believed the claim would prove to be unmeritorious, as many (but alas, not all) of PETA's allegations tend to be. Well now the verdict is in and indeed, the Feds cleared the lab. From the story:

Federal regulators have cleared the Oregon National Primate Research Center of complaints that workers routinely mistreated monkeys at the Hillsboro site. The U.S. Department of Agriculture, which regulates animal care at federally funded biomedical research facilities, sent two veterinarians to the center last week. The inspectors issued a three-sentence report, released today, which concluded, "No non-compliant items were identified during the inspection."
PETA's purpose is to shut down all animal research. One tactic is to file unmeritorious claims as a method of harassment. If PETA knew its complaint was frivolous, there should be a price to pay. In any event, next time PETA makes such a claim, remember this non event.


Tuesday, December 04, 2007

Study Reveals Why Men Marry Younger Women!

Did they really need to do a study to answer this? The authors say it is about evolutionary imperatives. Baloney. Men are hound dogs. It's that simple.

Yes indeed, Secondhand Smokette is a much younger woman!


Scientists Should "Start" to Get Involved in Politics

A presentation at a science convention has urged that scientists get involved in politics. From the blog description of the presentation:

This morning, a group of panelists issued a call to action to a standing-room-only crowd at the American Society for Cell Biology's 47th Annual Meeting: Scientists must get involved in policy issues, and they have to start now.
Start? What the heck do the presenters think "the scientists" been doing since 2001, sipping tea at the Waldorf?
The session--which included scientists, a congressional staffer, and other advocates--focused on how scientists can become involved in advocating for federal dollars for embryonic stem cell research. It's an urgent need, the panelists noted: Since the recent discovery of factors that appear to convert adult human cells into pluripotent cells, opponents of ESC work have stepped up their game, saying the new findings make embryonic work unnecessary.
More to make human cloning unnecessary, but consider this: Embryonic stem cell research has been funded to the tune of about $2 billion! How much more money do "the scientists" think they need? Oh yes, I forgot: They want a blank check, both financially and ethically, and they intend to get it through, yes, politics.

The problem with science isn't that it has failed to become sufficiently political, but that it is threatened with descending to the level of a mere special interest due to hyper-politicization. If that happens, "the scientists" can kiss the support of the public goodbye.


Lead Into Gold: California to Fund Alternative Stem Cell Research

The California Institute for Regenerative Medicine, once dedicated to funding human cloning and ESC research, has shifted gears. Now, it is going to also fund alternative research that does not create or destroy human embryos. From the story:

California's stem cell agency plans to spend up to $13 million on research in 2008 to investigate techniques that do not destroy human embryos. It's a shift from the institute's original goal of funding mostly embryonic stem cell research.
Of course, the CIRM spokesperson claims that this was the plan all along:
The institute had been preparing to finance research into promising alternatives to using human embryonic stem cells months before the November breakthrough was announced. Arlene Chiu, who resigned as a chief scientist at the institute in August, was the key figure in developing the institute's plans to find new cell lines. "We want to support the full spectrum of human pluripotent stem cell types and experimental approaches," she said at an Oct. 3 meeting of institute directors in San Diego...

The plan to fund businesses drew a cautionary note from CIRM watchdog John Simpson of the Foundation for Taxpayer and Consumer Rights in Santa Monica. He noted the current controversy over conflicts of interest at the institute, which has prompted the California state controller to order an audit of the entire agency.

But Proposition 71 would seem to prevent this since "priority" was to be given to funding areas the Feds didn't, or in which the NIH imposed "restrictions." Alternatives are fully funded by the Bush policy, and indeed, James Thomson received a grant from the NIH for the work that lead to the American share of the great human iPSC breakthrough. This raises some issues of legality, but don't expect anyone to interfere.

The CIRM also intends to engage in corporate welfare:
The agency is also opening up its grant process for the first time to for-profit businesses.
The question has to be asked whether we still need the CIRM. But, "the scientists" both in the private, for-profit sphere and their business partners in the universities are ready to feed at the trough. Thus, even though California is at least $10 billion in the red for this budget year, politicians are too invested in this spending to stop borrowing money now.


Monday, December 03, 2007

Young Chimps Have Great Memory

Much is being made of the report that a 7-year-old chimp beat college students in quick memory tests of number patterns. This doesn't affect human exceptionalism, in my view. What makes us special goes far deeper than memory capacities.

But it also may be less than meets the eye. As we know human children are also better at certain brain functions--such as learning language--than are adults. It's in the makeup of the brain at different ages. This seems to hold true in the chimps, as well, since the mother of the Brainiac chimp lost to the college students. Plus, the chimp has been playing the game for his entire life. From the story in the Guardian:

Ayumu has had the advantage of playing this game for most of his seven years of life - and receiving a treat each time he did the task. But the researchers do not think training is the only reason he is so good. Three of Matsuzawa's students received six months of training and never approached his abilities.

Ayumu and the other young chimps' abilities are reminiscent of "eidetic imagery", an ability to retain a detailed and accurate image of a complex scene or pattern. This memory ability is present in some children, but declines with age. The experiment compared the chimps with human adults, but not children and the performance of Ayumu's mother, Ai, was not as good as the humans. Ai, now 31, was the first chimp to be taught the meaning of Arabic numerals in counting.
No doubt chimps are very smart animals. But they are not human. And they shouldn't be deemed persons under the law, as is being promoted by the Great Ape Project.


Putting Suffering People Out of OUR Misery

The New York Times Magazine article about assisted suicide, byline Daniel Bergner, continues to amaze because his analysis actually looks behind the curtain of gooey euphemisms and blithe paeans to "choice." The article, which I first referenced this weekend, is about former Governor Booth Gardner's determination to fund and lead a drive to legalize assisted suicide in Washington-State by initiative. Bergner's piece is unusual in that it allows opponents of assisted suicide to have their full say--and exposes the actual thinking of some proponents. As a consequence, the piece is rife with wisdom and insight into the true agenda behind the facade and false premise of "assisted dying" for the "terminally ill" for whom nothing else can be done to eliminate suffering.

For example, one commenter pointed out that what is legal is soon deemed what is normative. And in that would be a profound risk to people with disabilities--whom Gardner explicitly states he would like to have access to assisted suicide once it is legalized for the terminally ill. From Bergner's piece:

She [Susan Wolf, whose father died of cancer] talked, then, as others had, about the threat of Gardner's statute to society's denigrated and dismissed citizens, but her words on law and culture suggested too a different danger. For the realization of Gardner's vision would allow not only the terribly sick but the healthy to escape the horrors of death. Men like Wolf's father might go more swiftly. My father [who has Parkinson's] might die before his uncertain steps give way to immobility. And sons and daughters like me would not have to confront so much decrepitude and mortality, the realities that keep my visits too brief and infrequent. We would have less protracted and harrowing intimacy with degeneration and death. We would be spared, and that would be our loss.

In the world of Gardner's vision, Wolf might not have leaned toward her father's face for so long and stroked his hair so many times. And I would not have to find a new way to be with my father, with the skiing and swimming and walking gone, through all that will come next.

That is precisely the point. But do we care enough and have sufficient strength to heed it? Here is Bergner's conclusion:
Yet what a luxury to think like this. What a luxury for the well to have their profound moments with the tortured. What a luxury, perhaps, even to focus so much on the effect Gardner's law might have on society's vulnerable. How could such ennobling considerations matter, in the end, to the dying, who are lost within the base and brutal truths of their decomposing bodies?

Could they want anything more, at their very weakest, than the power to escape? Was that power worth more than each stroke of a child's fingers through their hair?

I think the article underplays what can be done to alleviate or prevent the "torture," but this does get to the nub: What matters most? What really counts? The supposedly "free" exercise of autonomy regardless of the harm and normative values it instills and the collateral damage it will cause? Or, is our primary purpose as humans and a society to protect and value those who are vulnerable and struggling, even though it means a few of us will suffer longer than we would otherwise have? How we answer this cultural conundrum will profoundly affect the morality of the 21st Century.


Sunday, December 02, 2007

The Federal Government is Undermining Hospice

With a government like this, terminally ill people don't need enemies. Back in the late 1990s, federal bureaucrats began an assault on hospice known ridiculously as "Operation Restore Trust." The idea was this: If a hospice patient on Medicare didn't die within 6 months, the government would presume that the hospice referral was wrong and demand a refund.

I was a hospice volunteer at the time and I saw the profound chilling effect that this had on hospices. Indeed, my last hospice patient, a man with ALS, was kicked out of hospice--not because he was no longer dying, which I also witnessed--but because he didn't die on schedule. It devastated the patient emotionally and I refused to leave him even though he was no longer officially a hospice patient. He died about 3 months later.

Well, apparently the bureaucrats are still at it. From today's New York Times:

Hundreds of hospice providers across the country are facing the catastrophic financial consequence of what would otherwise seem a positive development: their patients are living longer than expected.

Over the last eight years, the refusal of patients to die according to actuarial schedules has led the federal government to demand that hospices exceeding reimbursement limits repay hundreds of millions of dollars to Medicare.

The charges are assessed retrospectively, so in most cases the money has long since been spent on salaries, medicine and supplies. After absorbing huge assessments for several years, often by borrowing at high rates, a number of hospice providers are bracing for a new round that they fear may shut their doors.

Good Grief! We should be encouraging patients and doctors to prescribe hospice, not make it harder for patients to get quality hospice care! Moreover, one failure of American hospice is that people get into it too late, not the other way around!

Everyone opposes Medicare fraud, but the idea that people die-by-the-numbers or that a terminal diagnosis will follow a certain course and time is ludicrous. I have been hearing a lot of complaints about a seeming rush in what I still assume is a vast minority of hospices, to see the patient off to the great beyond sooner rather than later. If this is happening, the government's assault on the caregivers for the most vulnerable among us is at least partially to blame.


Permit Marijuana to be Prescribed

This column in today's San Francisco Chronicle is a bit of a change of pace for me. I urge that marijuana be removed from Schedule I of the Controlled Substances Act--meaning no legitimate use--and changed to Schedule II or III--which would permit doctors to prescribe it. (I didn't have space to get into this, but it wouldn't necessarily be for smoking or eating. I am told that liquid medicines are now being made from the whole plant that can be sprayed under the tongue.)

I wrote the column because, on one hand, I was sick of presidential candidates promising. if elected, to violate their oath of office by not enforcing a valid law and because I think the pot club distribution scheme is chaotic and rife with abuses. On the other hand, the current classification is dead wrong because marijuana is clearly a palliative agent. In any event, here are a few excerpts. I discuss the federal law and note that candidates for president are being asked to stop DEA raids on medical marijuana users and distributors:

But this is both the wrong question and the wrong solution to the controversy. The problem isn't the DEA raids. They are a symptom... Because marijuana is listed under Schedule I, doctors may not legally prescribe it, and the federal government can ignore state medical marijuana laws.

People can debate marijuana's potential for abuse, but it is increasingly clear that cannabis has definite medicinal benefits. Studies and abundant anecdotal evidence demonstrate that marijuana can stimulate the appetites of people with AIDS and cancer, reduce nausea in chemotherapy patients, and help people with such debilitating conditions as multiple sclerosis, diabetes and glaucoma. And the American people know it: Polls show support in the 70 percent range for medical marijuana.

I call for reclassification to permit doctors to prescribe the drug and proper testing to see what it is and is not good for:

This would hardly be a radical move. It would merely allow doctors to prescribe cannabis according to the same rules currently permitted for far stronger and addicting drugs such as morphine, opium and cocaine.
I point out that even though most candidates who have supported calling off the raids are in the Congress, none has introduced reclassification legislation. I also note that opponents are not heartless but worry about drug abuse.

But it is the Schedule I listing that actually forces medical marijuana to be distributed through a semi-anarchic system in which doctors write notes, instead of properly regulated prescriptions, and patients pick up their drug from pot "clubs" instead of pharmacies...

This much is sure: Marijuana's Schedule I status breeds disrespect for government, forces the DEA to waste resources raiding the homes of sick people, leads to chaotic distribution schemes, and prevents reasonable medical testing to see which maladies benefit--and which do not--from marijuana use. Worse, the stigma of federal illegality deters some sick people from seeking a drug that could help them feel better.

I guess I am just sick of the garbage that passes for public policy debate. Let's get to the real issue.


Saturday, December 01, 2007

The Washington State Assisted Suicide Campaign Begins

Booth Gardner, former governor of Washington and a very rich man, intends to buy a law for Washington legalizing assisted suicide. His opening salvo comes in an extended piece in this Sunday's New York Times Magazine. The piece is actually suprisingly fair, so fair in fact, that Gardner may not be amused.

There isn't space in a blog to fully describe the piece. So, let's just focus on two things. First, this is an "I-I," "me-me" agenda of the elites and Establishment-types like Gardner. As he states in the piece:

"Why do this?" he asked, turning from the other tables toward me. "I want to be involved in public life. I was looking for an issue, and this one fell in my lap. One advantage I have in this thing is that people like me. "The other"--his leprechaun eyes lost their glint; his fleshy cheeks seemed to harden, his lips to thin, his face to reshape itself almost into a square--"is that my logic is impeccable. My life, my death, my control."
The potential for--and abuses that are actually happening--from legalized assisted suicide are well documented. But advocates like Gardner willfully ignore that part of the story. Bluntly stated, they want what they want for themselves and don't care who gets hurt.

Second, the "my death, my life, my control" ideological agenda has nothing to do with terminal illness. If that is the cause, why not guarantee anyone with a non transitory desire to kill themselves access to assisted suicide? And indeed, Gardner acknowledges that his initiative is just a way station that would legalize assisted suicide for the terminally ill on the way to a far broader license:
Yet the proposed law in Washington wouldn't go far enough for Gardner. It wouldn't include him. Parkinson's isn't terminal. The disease can leave the body trembling, contorted, rigid; it can rob the memory and muffle the voice; it can leave a person still and silent; but it doesn't offer an end to its torture; it doesn't kill. Gardner wants a law that would permit lethal prescriptions for people whose suffering is unbearable, a standard that can seem no standard at all; a standard that prevails in the Netherlands, the Western nation that has been boldest [most reckless is more like it] about legalizing aid in dying; a standard that elevates subjective experience over objective appraisal and that could engage the government and the medical profession in the administration of widespread suicide. What is unbearable? What level of acute or chronic physical pain would qualify? What degree of disability ? Would physicians be writing suicide prescriptions for the depressed?

Gardner's campaign is a compromise; he sees it as a first step. If he can sway Washington to embrace a restrictive law, then other states will follow. And gradually, he says, the nation's resistance will subside, the culture will shift and laws with more latitude will be passed, though this process, he knows, would almost surely take too long to help him.
Indeed. That is the agenda and good for Gardner for being candid. With assisted suicide it is in for an inch, in for a mile. If we are to debate this as a society, it should be from that truth, not the phony-baloney ideas of "guidelines" that won't actually--and are not intended to--stop abuse or Siren-song false assurances of limitations on assisted suicide to those diagnosed as terminally ill.

Read the whole thing. It will be worth your time.