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.

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...

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:
Germany:

Mexico:

Ecuador:

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?

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.

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.

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.

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.

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.

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.

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.

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 do