Doctors' Values Are More Important Than Those of Their Patients

I have been warning anyone who will listen about the coming huge policy fight over medical futility--what I call Futile Care Theory--that allows a doctor to refuse wanted life sustaining treatment when the doctor doesn't believe that the quality of the patient's life is worth sustaining (or spending money on). This isn't about asking for treatment that won't work, but withholding treatment that will or may work. Usually futile care protocols--where they have been promulgated--allow an ethics committee to make this decision after a quasi-judicial hearing. Texas has been a big center of futilitarian advances.

There is a futile care case right now in the courts of Winnipeg. In this regard, it is worth noting--and being very alarmed about--the futile care protocol adopted by The College of Physicians and Surgeons of Manitoba, which permits the doctor to make the call, after consultation with a second physician, without even having to pass it by an ethics committee. And this is in cases in which the minimal goal of the patient is likely to be met! From the protocol:

WHERE THE PHYSICIAN CONCLUDES THAT THE MINIMUM GOAL IS REALISTICALLY ACHIEVABLE BUT THAT TREATMENT SHOULD BE WITHHELD OR WITHDRAWN, that physician must consult with another physician...
2. Where the consultation supports the conclusion that treatment should be withheld or withdrawn:

a. The physician who sought the consultation must advise the
patient/proxy/representative that the consultation supports the initial assessment that treatment should be withheld or withdrawn .

b. If there is still a demand or request for treatment, the physician must attempt to address the reasons directly and with a view to reaching consensus...

c. If consensus cannot be reached, the physician must give the patient/proxy/representative a reasonable opportunity to identify another physician who is willing to assume care of the patient and must facilitate the transfer of care and...

d. Where, despite all reasonable efforts, consensus cannot be reached the physician may withhold or withdraw life-sustaining treatment, but: i) in the case of a patient/proxy who is still not in agreement with the decision to withhold or withdraw treatment, the physician must provide at least 96 hours advance notice to the patient or proxy as described below.

There you have it: Doctors think that their values should rule over those of their patients.

This is the beginning of the institution of a duty to die that we ignore at our peril. It also threatens the trust of people in medicine. My prediction: A lot of fireworks ahead!

HT: Alex Schadenberg

Rescind That Knighthood!

Ian Wilmut's old cloning team is furious, apparently, that he is receiving a knighthood for his "service to science." Their point is that Wilmut did not actually clone Dolly or do anything other than administer the lab in which the groundbreaking cloning experiment took place. From the story:

The admission by Sir Ian Wilmut in 2006 that he did not personally create Dolly the sheep set tongues wagging across the world of science. His name had been synonymous with the breakthrough that led to the first clone from an adult mammal, but he made clear that his role was a supervisory one.

So when Sir Ian was knighted at New Year for "services to science", controversy was to be expected.

The latest rumblings have come in the form of a petition to the Queen requesting that his knighthood be revoked. It is signed by four former employees of the Roslin Institute, where Dolly was created in 1997. "Wilmut's knighthood is seen as the crowning insult to honest endeavour," they write, adding that their sentiment is shared by others who signed severance deals with Roslin. "Roslin, the University of Edinburgh and Scotland are all tarnished with this grant. We beg
reconsideration."

Meow!

Stem Cell Ethics? We Don't Need No Stinkin' Stem Cell Ethics!

Ignoring that New Jersey voters recently rejected a $450 boondoggle bond issue to pay for embryonic stem cell research, New York State is funding the research to the tune of $600 million without even giving the people a chance to vote on the issue. And those behind the effort have no intention of letting nonsense like ethics get in the way. From a column by members of the New York Task Force on Life and the Law:

In April, with little discussion and no public input, New York passed Public Health Law Article 2, Title 5-A, creating the Empire State Stem Cell Board to oversee the funding of a $600 million, 10-year stem cell research initiative. Several other states have had major public ethical debates about stem cell research funding. New York's statute does not delineate ethical limits on stem cell research except to prohibit attempts to bring a cloned human being to birth. Instead, the ESSCB comprises a funding committee and an ethics committee, with the ethics committee legislatively charged to make "recommendations to the funding committee regarding scientific, medical, and ethical standards."

Even this minimum level of checks and balances is apparently too tough for the funding committee:

The ethics committee is extremely diverse in its views about these substantive issues. Nonetheless, we unanimously recommended to the funding committee that while this first RFA could permit research on existing human embryonic stem cell lines under current national or international guidelines, funding should not cover the creation of new embryonic stem cell lines or undertake the controversial activities listed above until the ethics committee had the opportunity to deliberate and make solid recommendations. The ethics committee made clear that this brief moratorium did not represent its considered substantive judgment, and that it would make definitive recommendations within six months. What mattered to the ethics committee was that ethics mattered.

On Dec. 13, the funding committee rejected the ethics committee's call for a temporary moratorium, arguing that it would "send the wrong message to scientists." On Jan. 7, Gov. Eliot Spitzer announced that the first round of funding had been awarded.

So the blank check mentality continues among the powers that be without risking direct approval by the people or even taking time to consider appropriate ethical checks and balances. After all, we mustn't give "the scientists" the wrong idea that ethics matter.

PCRM Continues To Attack Scientific Research

I don't know why the media is surprised when animal rights group are never satisfied. Physicians Committee for Responsible Medicine--which is a creature of PETA with only about 4% of its members being doctors--wants to stop medical schools from using animals in their teaching. From the story:

Although the Medical College of Wisconsin has stopped using dogs as live teaching tools, an animal rights group has now called upon the school to stop using pigs.

The Physicians Committee for Responsible Medicine called in a letter to the U.S. Department of Agriculture for the Medical College to get live animals out of the teaching curriculum. The group, which says the use of live animals is unnecessary and cruel, has also put up a billboard on U.S. 45 that calling upon the school to stop...The American Physiological Society, the governing body for physiology education nationwide, endorses the use of animals in medical education, he said...

"The definition of 'physiology' is 'the study of living systems,'" Allen Cowley, a Medical College professor and chairman of physiology there, said in an internal school memo. "The Medical College's cardiovascular laboratory provides students with an exceptional learning experience." Cowley said it was the "only opportunity that students will have in their medical education to experience the cardiovascular function of a large animal with similar responses as humans before they begin clinical work with patients."

To which liberationists will say, "So what." Proper welfare standards to them are as evil as Auschwitz. But don't you want future doctors to learn on animals before beginning to practice on people? I sure do. And pigs are excellent for that purpose because their organs are very much like ours. Indeed, according to the story some other medical schools have done away with the use of live animals. But can simulators really expose students to the grit of dealing with actual living beings?

Media Members: I know that reporters use this blog as a research tool. I deeply appreciate that and indeed, serving as a resource is one of its primary purposes. But please: In your reporting you must understand that "animal rights" isn't about being nicer to animals and improving animal welfare standards. It is about eradicating the status of animals as property and preventing us from using animals for any purpose no matter how beneficial to human thriving. That isn't to say that sometimes the liberationists aren't right when they expose inappropriate practices. But most see each and every act of animal husbandry, no matter how benign, as definitional abuse. Any analysis of these controversies must start from that truth.

Pacificare HMO Hit with Big Fine

More of this please. California regulators have hit Pacificare with a huge fine. From the story:

After an unprecedented eight-month joint state probe triggered by hundreds of complaints, state health insurance regulators Tuesday slapped the PacifiCare unit of UnitedHealthcare with a record $3.5 million fine.

Regulators also will ask an administrative law judge to uphold its allegations that the company mishandled claims and levy additional penalties of up to $1.3 billion. The state accused PacifiCare of 133,000 violations from 2005 to 2007...

UnitedHealthcare officials are still in discussion with the state about the amount of the fine and contend that most problems didn't directly affect consumers. Regulators and the physician groups disagreed, citing these problems:

- A Sacramento-area surgeon couldn't schedule surgeries for more than six months because the insurer was slow to enter his contract in its computer system.

- More than 200 of Watson's patients incorrectly received letters indicating that he was no longer in the insurer's network of physicians. Watson lost about 25 percent of these patients but continued to see others without getting paid for about eight months.

- A consumer spent 11 months trying to get claims paid for his family, including an autistic child. His wife postponed EKG stress tests, fearing the family could be forced to pay for the procedures. Regulators contend PacifiCare never specified what information was needed to reconsider the denied claims.

So far, regulators have helped doctors and patients collect more than $1 million in payments from PacifiCare's preferred provider organization and health maintenance organization plans.

HMOs are problematic because they earn profits by cutting costs, which can mean cutting levels of care. Tough regulation, along with resort to private civil litigation, are necessary checks and balances to the potential for abuse of power by bean counting executives.

Mike Wallace Had Triple Bypass Surgery

Newsman Mike Wallace is recovering from a triple bypass surgery. Why is this a matter of interest to SHS other than to wish him well? Because under age-dictated health care rationing of the kind practiced in the UK and urged upon us by some very notable bioethicists here in America, Wallace would not have been eligible for the surgery. (Forget for a moment that elites like him would almost surely not be limited by rationing protocols.) Instead, the decision to provide the treatment was based on his individual circumstances. That's the way it should be.

Medical Journal Exposes Bigotry of "Deliberate Termination of Life of Newborns with Spina Bifida"

In the Netherlands, doctors sometimes euthanize babies born with spina bifida. There (and here), doctors sometimes refuse to treat them so that they will die. But now, a new journal article calls expose these lethal actions and non actions as the bigotry (my term) that they are. Writing in Childs Nervous System (2008; 24:13-28), T. H. Rob de Jong A Dutch pediatric neurosurgeon writes:

There is no evidence that newborns with MMC and hydrocephalus do either 'suffer' unbearably or hopelessly and certainly not without the prospect to relieve this suffering by standard care. 'Suffering' itself is a nonconclusive,and in newborns, inapplicable denominator that should not be used anymore in this debate. Although they will in their future life be confronted with handicaps,sometimes very severe, their future prospects and their actual experienced quality of life cannot be predicted with such certainty at birth that their lives can be regarded as hopeless or meaningless ('quality of life judgments' as such being unacceptable in this decision making). Possible discomfort in these newborns can easily be treated in a straightforward way by active treatment (closure of the defect and shunting the hydrocephalus) and, when necessary,by the use of a professional pain/symptom protocol.

The decision not to treat such a newborn, when based on expected handicaps, possibly violates the 'non-discrimination' principle (Dorscheidt, 2006).When not being treated, they are not terminally ill because of the MMC and/or hydrocephalus per se; they are 'terminally ill' because of this nontreatment decision. Not being terminally ill, it is not 'humane' or 'merciful' to terminate their life, this also being not in accordance with international legislation and international medical
recommendations...

Such a child can and should be cared for in a respectful and dignified way, providing all its actual needs (which apparently is not death itself). This being the case, there is no indication whatsoever for the deliberate termination of the life of children born with MMC.

But that takes true compassion, which means to suffer with. Too often, in our utilitarian times, it is deemed better to just do away with the problem by doing a way with the patient--a false compassion.

But at last: A learned and ethical answer to the benighted drive in the Netherlands to permit infanticide against babies with spina bifida. Hooray.

The High Price of Biological Colonialism

India is searching for a monster who convinced the destitute to sell their kidneys at bargain basement prices and sold them for a huge profit. But the real empowerers of this atrocity are the foreigners who wanted new kidneys and didn't care who got hurt in the process. From the story:

India has launched an international hunt for a doctor accused of running an illegal clinic that duped between 500 and 600 poor labourers into selling their kidneys and then peddled them to foreign clients...

Police alleged that Dr Kumar used middlemen to entice poor labourers with the promise of jobs worth 150 rupees (about £2) a day, plus food and accommodation, and then offer them money for their kidneys. Those who refused were often drugged and had their kidneys removed without their permission, according to several former "donors"...

India banned the trade in human organs in 1994 but non-governmental organisations estimate that 2,000 human kidneys are still sold in India every year.

If organs can be bought and sold, the rich will buy and the destitute will sell. It's that simple. And there will be horrible people to take advantage of their need. We are entering an era of biological colonialism and it must be stopped.

The only way to effectively stop this is to stifle demand. The time has come to make such purchases illegal and punishable internationally. Desperation over one's own illness does not justify such exploitive depredations. Stop the demand and the supply issue will resolve itself.

The Need for Uniform Criteria to Declare Death by Neurological Criteria

I have written several posts about the need to develop uniform standards of declaring death by neurological criteria--popularly known as "brain death." Now, there's some more information out about that problem. From the story:

Guidelines for determining brain death differ substantially between major U.S. hospitals, a national survey shows, and few stick to parameters established by the American Academy of Neurology.

"There are substantial differences in practice that may have consequences for the determination of death and initiation of transplant procedures," Dr. David M. Greer, at Massachusetts General Hospital in Boston, and colleagues report in the medical journal Neurology.

Greer's team requested guidelines from hospitals named as having the top 50 neurology programs in the nation in 2006 by US News and World Report. Only 42 percent of the hospitals required that a neurologist or neurosurgeon perform the examination for brain death, results showed. Among the 71 percent that stipulated multiple examinations, the time required between examinations varied from 1 to 24 hours. Furthermore, the authors point out, "It was surprising to find that the cause of brain death was not stipulated in a large number (37 percent) of guidelines."

This is a very serious matter. The trust of the American people depends on getting this most fundamental matter right.

Supprting the Murderer of a Disabled Girl

The most robust opponents of assisted suicide--and the most effective in my view--are disability rights advocates. They understand well that legalizing assisted suicide is a gun aimed at their hearts. An opinion column by one Ian Mulgrew of the Vancouver Sun underscores the threat. He urges that the child murderer Robert Latimer be freed. Latimer killed his daughter Traci, because she had cerebral palsy. From the column:

Born with a severe form of cerebral palsy, his daughter Tracy was a 12-year-old who weighed barely 40 pounds, had no mobility, suffered unrelenting pain and endured five to six epileptic seizures a day. She had little more than a newborn's consciousness. Doctors at the time of her death were preparing to install a permanent feeding tube in her stomach and to remove her thigh-bone to relieve the pressure on her hip, dislocated because of the metal rods already implanted in her spine to correct the damage done by her bedridden condition...

It was in the face of such circumstances that while his wife and other children went to church, Latimer carried Tracy to a pickup truck and ran a hose from the exhaust pipe into the cab. She died from carbon monoxide poisoning.

Latimer was charged with first-degree murder and convicted of second-degree murder... In 1997, a second jury again convicted Latimer, but it recommended he be eligible for parole after a year. Juries at both of his trials were conflicted over what had happened and racked because of the empathy they felt for this man.

But our system got in the way of their humanism.

So, winking at the murder of a helpless disabled girl is "humanism?" (By the way, Traci's condition was not as depicted here, but I don't want to get into that debate because it might imply that disability is a legitimate reason to kill a child. For those interested in a more accurate description of Traci's condition, read Mark Pickup's blog entry here, in which he notes:

Monday-Friday Tracey traveled to school on a regular school bus and returned home at the end of each school day on the same bus as her siblings and other children -- right up to the Friday before she was killed.)

What is amazing to me as I read columns like this and stories that are sympathetic to killing disabled children and/or support eugenic infanticide, is that we once understood such acts of murder to be an unequivocal evil. Doctors were hanged after Nuremberg for killing disabled infants, children, and adults.

Some comfort themselves with the false notion that the earlier slaughter was evil because it was Nazism, while the new support for killing people with serious disabilities is rooted in compassion. Wrong. Nazis did not force doctors into killing. Indeed, it was considered a compassionate "healing treatment."

Some then say, well the parents didn't consent to those killings, and that made it wrong. But since when do parents have the right to consent to the murder of their children? Besides, Baby Knauer, the first official infanticide sanctioned by Hitler in 1939, was killed precisely because his father requested the killing. And in the Netherlands, where studies in the Netherlands show that 8% of all infants who die each year in that country are killed by doctors--and of those, more than 20% of parents had not consented.

We are moving into an era of a new eugenics where it is considered humanism to murder helpless disabled children. Mulgrew may think he's a compassionate and liberal. But it is a denial of the equal worth of all people and a profound violation of human rights--which is the antithesis of "humanism" properly understood.

Doctors Urge NHS Not to Treat the Promiscuous

In a stunning development, doctors responding to a questionnaire have urged that promiscuous people be denied certain treatments based on their unhealthy lifestyles. From the story:

Doctors are calling for NHS treatment to be withheld from patients who lead irresponsible and unhealthy sexual lives. Those who have sex with too many people should be barred from receiving some operations, according to doctors, with most saying the health service cannot afford to provide free care to everyone.

I agree, it is absolutely outrageous. But to get your attention, I lied about the proposed targets. It isn't the promiscuous who doctors in the survey want to punish--whose behaviour is at least as dangerous as that of smokers, at least in the short term--but others with unhealthy lifestyles or too many years under their belts. Here is how the story actually reads:

Smokers, heavy drinkers, the obese and the elderly should be barred from receiving some operations, according to doctors, with most saying the health service cannot afford to provide ding free care to everyone.

If we are to punish lifestyles in health care, we should not just pick on those without political power such as smokers and the obese, or people who are deemed "style crimes," a wonderfully evocative term that I stole from Secondhand Smokette. But my real message is: Doctors should not be mutated into some kind of lifestyle police force. Their jobs are to treat patients as they find them, not judge why they are sick nor withhold proper care if they don't approve.

Q and A Interview With Yours Truly

Focus on the Family's on-line magazine did an interview with me for a feature on "pro life heroes." I am certainly no hero. All I do is write and speak, emitting hot air and particulate matter as I go, hence the name of this blog. And as for being pro life, my thesis is human exceptionalism and the equal moral worth of human life--and it still stuns me that is deemed controversial.

The text, linked here, abridged from a much longer interview, is edited fairly, both as to substance and context. Here is how it concludes:

Q: Given embryonic stem-cell research, human cloning and genetic engineering, is science working against the pro-life movement?

A: An unfortunate hubris has seeped into the leadership of science and bioethics--an attitude that sees science as the be-all and end-all. But naked science, unmediated by morality, can become monstrous. I'm not saying these scientists are monstrous, but that biotechnology has developed astonishing powers to the point that we possess the ability to manipulate the very building blocks of life. It seems to me that kind of sheer power calls for a little humility. After all, we are the species that created the unsinkable Titanic.

In our society, we create proper parameters and checks and balances through democratic processes. We don’t allow certain things to be done in human research, not because science says don’t do it, (but) because our ethics and our values say don’t do that to human beings. Science, as every human enterprise, needs ethical boundaries beyond which it should not go, and we have a right to decide what those proper parameters are.

Hardly heroic, but I hope there is some wisdom to be found.

(Last week Rita Marker, my mentor in working against assisted suicide and the head of the International Task Force on Euthanasia and Assisted Suicide was the featured interviewee. Here is the link to what she had to say. If you are interested in the assisted suicide issue, you won't want to miss it.)

Adult Stem Cells Found in Pancreas in Mice

This could be great news aways down the road for diabetics. From the story:

An international team of researchers has finally managed to locate stem cells in the pancreas--in mice, at least.

If the findings are confirmed in humans, they could pave the way for dramatic new therapies for diabetes, namely the regeneration of beta cells so the body could once again produce its own insulin. Until now, scientists had all but abandoned hopes that the pancreas made its own stem cells because they had failed to find evidence to support the theory. But any clinical advances from the new research are still a long way off, experts cautioned.

Adult stem cells are ubiquitous. I am not a scientist, but from what I am reading, it may turn out that pluripotency will not be so important after all for clinical uses because ASCs exist in so many tissues.

SHS Funnies

Dusty's inner carnivore is getting out of hand.


Rat's book is as good as a published scientific study.



Lio finds a proper human use for an animal product.

For "The Scientists" It is Never Enough

Anyone who believes that Bush funding embryonic stem cell research with leftover IVF embryos would satisfy "the scientists" just aren't paying attention to the constant whining by Brave New Britain's scientists who have what amounts to a virtual blank check. Regulators there permit human cloning, permit the creation of human/animal hybrids, permit scientists to pay women for their eggs by reducing the price of IVF treatments, and still they whine that the regulations are too restrictive and that the government is delaying CURES! CURES! CURES! From the story:

Life-saving medical research will be held back by draconian new consent laws planned for embryonic stem-cell experiments, a group of leading scientists tell the Government in a letter to The Times today. The Government’s Human Fertilisation and Embryology Bill will delay vital research by requiring all tissue used to create cloned embryonic stem cells to have the explicit consent of its donor, the experts say.

Good grief! Shouldn't people have to at least consent before their tissues are used in cloning experiments, which after all, results in a near identical genetic twin? And my critics wonder why I claim that "the scientists'" theme song should be Anything Goes.

Ah, the Peace Loving Advocacy of Animal Rights Extremists

The animal rights movement claims to be peaceable--despite the terrorists in its midst. But how peaceable can it be when so many advocates use vividly violent imagery in their advocacy. From an editorial, Animal Rights & Ethical Veganism," by one Gary Yourofsky, published in the University of Southern Indiana newspaper, The Shield. He writes:

So, while my lifestyle and lectures are based on compassion, those who refuse to stop harming animals force me to support 'eye for an eye' and 'by any means necessary' philosophies...

Institutionalized violence doesn't simply vanish with a peaceful protest, a dose of logic and whole lotta love. If people continually deny animals their inherent right to be free, radical tactics are necessary and justified...

Deep down, I truly hope that oppression, torture and murder return to each uncaring human tenfold! I hope that fathers accidentally shoot their sons on hunting excursions, while carnivores suffer heart attacks that kill them slowly.

Every woman ensconced in fur should endure a rape so vicious that it scars them forever. While every man entrenched in fur should suffer an anal raping so horrific that they become disemboweled. Every rodeo cowboy and matador should be gored to death, while circus abusers are trampled by elephants and mauled by tigers. And, lastly, may irony shine its esoteric head in the form of animal researchers catching debilitating diseases and painfully withering away because research dollars that could have been used to treat them was wasted on the barbaric, unscientific practice vivisection."

This reads like the rantings of a very disturbed mind. But note: Yourofsky is apparently no fringe rider if this identifier is true:

Gary Yourofsky is one of the nation's most outspoken and spirited activists. He has given 1,403 lectures in 27 states at 134 institutions to more than 35,000 students.

Animal rights advocates like to compare themselves to the Civil Rights Movement. Would Martin Luther King have ever written and spoken like this? Moreover, would any advocate for another movement who came so close to advocating violence ever be fought for by professors and students to be invited to speak on college campuses?

I am old enough to recall how the violent language and/or actions of groups like the Black Panthers and H. Rap Brown-types severely undercut the Civil Rights Movement that had made so much progress through nonviolent protest and love of enemies. The same thing will happen to animal rights if Yourofsky comes to epitomize the movement.

Organ Transplant Breakthrough Again Proves Need for Animal Research

The wonderful adult stem cell advance that has liberated some organ transplant patients from anti-rejection drugs--which I posted about here--is yet another illustration of the ongoing need to use animals in medical research. From the story:

[Dr. David] Sachs first tried this approach successfully on mice, pigs, then monkeys. In 1998, he won approval to try his treatment on a select group of Mass. General patients with severe kidney failure, all of whom were offered matching kidneys from close relatives. When these six patients did well, Sachs moved on to the most ambitious test of his method, trying it out on patients with mismatched donors.

Consider what this means: mice, pigs, and monkeys had healthy organs removed and received organs from other animals euthanized for the purpose. As unpleasant as this is to contemplate, these preparations for human trials were absolutely necessary to test the concept and perfect techniques before attempting it on humans. The only other options would either be to use profoundly disabled people or not develop the treatment at all.

Animal rights advocates like Gary Francione would say, "Then don't develop the technique," based on an ethical belief that humans don't have the right to treat other sentient beings in such an instrumental manner. I disagree, but at least that is an honest argument. However, dishonest animal rights activists continue to claim that animal research offers no human benefit. This experimental success demonstrates that assertion to be unadulterated bull manure.

Adult Stem Cells Helps Free Organ Transplant Patients from Immune Suppressing Drugs

A wonderful breakthrough in transplant medicine is also another testimony to the apparent healing power of adult stem cells. Bone marrow transplanted from the organ donor to the organ recipient at the time of the transplant apparently can eventually result in the recipient being liberated from anti-rejection drugs. From the story:

The treatment involved weakening the patient's immune system, then giving the recipient bone marrow from the person who donated the organ. In one experiment, four of five kidney recipients were off immune-suppressing medicines up to five years later...

[Dr. David]Sachs' treatment involved weakening each kidney patient's immune system with intravenous drugs several days before the transplant. After the transplant, the patient got an infusion of marrow from the donor to create a new immune system.

The stem cells from the marrow reprogram the body by allowing new immune cells to grow that don't try to attack the donated organ. The patients took anti-rejection drugs but were weaned several months later. Four of the five patients developed a hybrid immune system--where recipient and donor cells live together in the body--for a short time. They were able to stop taking anti-rejection drugs and had healthy kidney function two to five years later.

Great news and a wonderful advance for non-controversial biotechnology.

Secondhand Smoke on the Air

I did an interview with a Catholic radio show last Friday that focused pretty hard on assisted suicide, futile care, eugenics, hospice, and bioethics. It was a call-in show and a couple of hospice nurses called offering some interesting comments. If you want to hear me spout hot air and emit particulate matter like I do in writing here, tune in to this rebroadcast.

UK NHS Continues Its Meltdown as BMA Backs Doctor Walkout

You know it's really getting ugly when the British Medical Association, not exactly known for radical agitation, may urge its member doctors to walk out of the UK's National Health Service. From the story:

A mass exodus of GPs from the NHS is being considered by the British Medical Association as it steps up its campaign against the government's plan to impose extended surgery opening hours in England, internal documents have revealed.

The move, which could result in patients paying up to £25 for a short consultation, was among options drawn up by leading GPs who object to being made to offer evening and weekend appointments. The health secretary, Alan Johnson, has threatened to cut the income of practices refusing to provide the extended hours. The BMA is preparing to ballot GPs next month on how to fight back...

A mass resignation of GPs from the NHS--similar to the exodus of dentists who moved into private practice in the 1990s--would be a potent threat "because the government does not yet have sufficient manpower to replace GPs, were they to resign en masse," the [BMA]document suggested.

What a mess the NHS has become. Pinched money, dirty hospitals, and dominated by utilitarian bioethics--hardly conducive to patient health.

Turning Gold Into Lead: Time to Cancel Proposition 71 Borrowing

As a California resident, I am painfully aware that my state is sinking in a red sea of debt. Yet, the borrowing to support human cloning research continues. Last week, Investor's Business Daily noticed and in "The Bullet Missed," argues that the time has come for a little fiscal sanity and stop the bleeding caused by a program that "is more about politics than science." From the editorial:

It's the morning after the night before in the Golden State. Home prices are plummeting, and unemployment has jumped to 6.1%, well above the national average. The economy already may be in a recession. State government suddenly is looking at a $14.5 billion budget shortfall. Gov. Arnold Schwarzenegger's new budget proposes closing 48 state parks and releasing 22,000 prison inmates early. School funding would be cut by several hundred dollars per student.

But the good times keep rolling on in one area. Through a bond measure passed by the voters in 2004, the state is authorized to spend $3 billion on stem cell research, mainly of the ethically problematic type that uses cells from human embryos.

The state is now the world's largest funder of stem cell research, and spending is expected to accelerate this year, despite the state's fiscal woes. More than $225 million is expected for just grants for new labs...And what are Californians getting for this $6 billion commitment? That's a question even backers of Proposition 71 would have a hard time answering now. The agency set up to administer the bonds says in its strategic plan that it does not expect stem cell therapy to be ready for routine clinical use for at least 10 years. And it's possible that a different scientific track will be a shorter route to cures such as Parkinson's and Alzheimer's...

For Californians, the good news is that only a small part of the $3 billion in Proposition 71 bonds has been issued. So they still could save themselves a good deal of money by winding the program down.

And the editorial didn't even get into the many leadership deficiencies and conflicts of interest that have plagued this boondoggle since its inception. Yes, the time is ripe. Shut Proposition 71 down. We have more urgent financial priorities to keep the Golden State from alchemizing backwards into the Lead State.

Another Adult Stem Cell Human Trial to Start

This time in the UK, using a patient's own bone marrow to attempt to treat heart attack damage. From the story:

British scientists have been given the go-ahead to begin potentially ground-breaking experiments using injections of stem cells to repair patients' damaged hearts. The team hopes to repair the organs of people who have suffered the most severe heart attacks...

The trial will involve patients with the worst prognosis, those who have scarring on at least half of the left ventricular wall. "It's the worst heart attack you can have. Most patients just die," said Ascione.

The team will extract bone marrow from all 60 patients and separate out a class of stem cells that makes up 1% of the tissue. Previous studies have suggested that this cell type is able to regenerate heart muscle cells and blood vessels. By using the patient's own cells there will be no problems with tissue rejection...In his patients the team will examine the size of the scarred tissue in the heart six months after the operation using an imaging technique called heart MRI. That will give an accurate measure of improvement.

A human trial does not a cure make, but this is another example of how quickly adult stem cell therapies are moving from the theoretical into practical training. Let's all keep our fingers crossed.

Germans Overwhelmingly Oppose Human ESCR

We continually hear from the brave new world crowd that only religion would cause one to oppose ESCR and human cloning. That isn't true, of course., One need not be religious to have serious reservations about using nascent human life as a mere natural resource.

Here's some evidence demonstrating this point: German is a very secular country, and certainly isn't dominated by theocrats. And yet, a newly published German poll (no link in English, but here is the German.) is finds overwhelming opposition to human ESCR and embryo-destructive research. Here are the results:

The German January 2008 Opinion Poll on Stem Cell Research.

The poll found that in 2008, 61% supported using only adult/or iPS cells. In 2007, this figure was 56.3%

Only 26.9% also support ESCR, down from 32.9% last
year.

Support for Embryo Protection Act - ban of destructive embryo research:

A whopping 65.2% support the existing ban on destructive embryo
research, and 27.8% oppose, very close to last year's figures.

Interestingly, support for ESCR seems to be dropping. Perhaps this is because the advances in adult stem cell research are becoming more evident.

SHS Funnies: Dusty Finds His Inner Carnivore

Dusty should be careful of what he asks for. I went off Atkins precisely because I felt as if meat was coming out of my ears.

Allow Meat to be Labeled "Clone Free"

The FDA has determined that meat and milk from cloned animals are safe to consume. But some people would rather not consume cloned products, thank you very much. A proper answer to such consumer desires is labeling: Meat, milk, cheese etc. can be labeled clone free. From the story:

Although the FDA said last week that it will not require special labels on foods from clones, legislation already introduced in the Senate could force the agency's hand. Short of that, many consumers are demanding that the agency allow food from conventional animals to be labeled "clone-free"--a marketing move that could dash industry hopes of getting beyond the public debate over clones.

Permission to so label should not require permission.

Of course, the industry doesn't like such approaches. In our book No Contest: Corporate Lawyers and the Perversion of Justice in America, Ralph Nader and I recount how Monsanto, the producer of bovine growth hormone, sued dairies that labeled their milk BGH free on the basis of unfair competition! It was an egregious example of corporate bullying, that thankfully didn't work.

Don't be surprised if the same tactic is tried with cloned products. Too often, large corporations don't want people to truly exercise consumer choice.

Female Circumcision: A Denial of Intrinsic Human Dignity

There is a brutally honest essay in the New York Times Magazine about the dismaying number of young girls in Indonesia whose parents force them to undergo the genital mutilation that goes by the euphemistic term, "female circumcision." It is an awful story of the worst kind of misogyny, and in my view, amounts to slavery. From the story:

When a girl is taken--usually by her mother--to a free circumcision event held each spring in Bandung, Indonesia, she is handed over to a small group of women who, swiftly and yet with apparent affection, cut off a small piece of her genitals. Sponsored by the Assalaam Foundation, an Islamic educational and social-services organization, circumcisions take place in a prayer center or an emptied-out elementary-school classroom where desks are pushed together and covered with sheets and a pillow to serve as makeshift beds. The procedure takes several minutes. There is little blood involved. Afterward, the girl's genital area is swabbed with the antiseptic Betadine. She is then helped back into her underwear and returned to a waiting area, where she's given a small, celebratory gift-- some fruit or a donated piece of clothing--and offered a cup of milk for refreshment. She has now joined a quiet majority in Indonesia, where, according to a 2003 study by the Population Council, an international research group, 96 percent of families surveyed reported that their daughters had undergone some form of circumcision by the time they reached 14.

Don't let a squeamish stomach deter you. Look at what is done to these poor girls squarely and without flinching:

Female circumcision in Indonesia is reported to be less extreme than the kind practiced in other parts of the globe--Africa, particularly. Worldwide, female genital cutting affects up to 140 million women and girls in varying degrees of severity, according to estimates from the World Health Organization. The most common form of female genital cutting, representing about 80 percent of cases around the world, includes the excision of the clitoris and the labia minora. A more extreme version of the practice, known as Pharaonic circumcision or infibulation, accounts for 15 percent of cases globally and involves the removal of all external genitalia and a stitching up of the vaginal opening.

This isn't about not respecting cultural differences. This is about condemning the treatment of female human beings as if they were somehow defective for having normal sexual feelings--which is what mutilating genitalia is all about. The entire world should condemn the practice unequivocally and put pressure on Indonesia and other countries where it occurs to put an end to it.

Some, however, prefer a kinder, gentler approach to opposing the mutilation of girls:

Nonetheless, as Western awareness of female genital cutting has grown, anthropologists, policy makers and health officials have warned against blindly judging those who practice it, saying that progress is best made by working with local leaders and opinion-makers to gradually shift the public discussion of female circumcision from what it'[s believed to bestow upon a girl toward what it takes away. "These mothers believe they are doing something good for their children," Guarenti, a native of Italy, told me. "For our culture that is not easily understandable. To judge them harshly is to isolate them. You cannot make change that way."

Imagine if they'd said that about Apartheid; Mandella would still be in jail. Sometimes terrible injustice has to be confronted squarely. Can anyone say boycott?

Intel Chairman Wants Blank Check for Science

Oh, cry my a river: Craig Barnett, chairman of Intel, boo-hoos about the supposed lack of science funding by the Feds in a whining column in today's San Francisco Chronicle. He writes:

The recent budget deal between Republicans and Democrats effectively flat-funds or cuts funding for key science agencies. Excluding "earmarks," the Department of Energy funding for fiscal year 2008 is up only 2.6 percent, thus losing ground to inflation. The National Science Foundation is up 2.5 percent, with the same result. The National Institute of Standards and Technology is up 11 percent, however the labs where research happens only get 2.3 percent, again losing ground to inflation.

Barrett doesn't use actual numbers in his piece, only percentages, raising my lawyer's radar that the magnitude of the actual dollars being spent on science--in other words, context--might undercut his argument. So, I did a little digging. The DOE's budget is huge, for example in FY 2008 over $24 billion, with nearly$3.5 billion earmarked for "science" and more than $5.5 billion for "environmental management." That ain't hay. Add in who knows how much in earmarks--which Barnett conveniently excluded--and we are talking very real money.

Similarly, National Science Foundation's budget is more than $5 billion, with $390 million to be invested in nanotechnology. From the NSF's press release:

Working with other agencies as part of the National Nanotechnology Initiative, the National Science Foundation's (NSF) nanotechnology research will continue to advance fundamental understanding of materials at the subatomic, atomic, and molecular levels and will enable the development of capabilities to design, manipulate, and construct revolutionary devices and materials with unprecedented properties. The Budget provides $390 million in 2008 for NSF's nanotechnology research investments, an increase of 4.5 percent from the level proposed in 2007, including funding for a new NSF center to address environmental, health, and safety research needs for nanomaterials.

I believe in generous government funding for science--although I wish that when the money helps private companies strike gold that they would be required to share with the taxpayers who helped make it possible. But science isn't the be all and end all. There are many other pressing needs and our economy is slowing down.

Sometimes the sense of entitlement within the science sector is breathtaking.

New Staph Strain Demonstrates Futility of Immortality Movement

There is an alarming story in today's San Francisco Chronicle, byline Sabin Russell, that illustrates how life evolves to ensure that no matter how far we advance scientifically, death will always remain part of the experience of living. A terrible antibiotic-resistant strain of staph bacteria is spreading that could threaten us all. From the story:

Dr. Jeff Brooks has been director of the UCSF lab for 29 years, and has watched with a mixture of fascination and dread how bacteria once tamed by antibiotics evolve rapidly into forms that practically no drug can treat."These organisms are very small," he said, "but they are still smarter than we are."

Among the most alarming of these is MRSA, or methicillin-resistant Staphylococcus aureus, a bug that used to be confined to vulnerable hospital patients, but now is infecting otherwise healthy people in schools, gymnasiums and the home. As MRSA continues its natural evolution, even more drug-resistant strains are emerging. The most aggressive of these is one called USA300.

Last week, doctors at San Francisco General Hospital reported that a variant of that strain, resistant to six important antibiotics normally used to treat staph, may be transmitted by sexual contact and is spreading among gay men in San Francisco, Boston, New York and Los Angeles. Yet the problem goes far beyond one bug and a handful of drugs. Entire classes of mainstay antibiotics are being threatened with obsolescence, and bugs far more dangerous than staph are evolving in ominous ways. "We are on the verge of losing control of the situation, particularly in the hospitals," said Dr. Chip Chambers, chief of infectious disease at San Francisco General Hospital.

Of course, I am not saying that we shouldn't try to help people live longer and healthier lives. And we certainly need to pounce on this problem by developing more stringent cleanliness protocols, for example, and by working hard to develop new antibiotics. But what we don't need, in my view, is to chase a Utopian dream of immortality and put precious resources into that hopeless crusade.

Life is precious, but even more so because it is short. The transhumanist singularity is not going to save us. We need to live with the sobering understanding that we won't last much longer even if we live to be 100. Accepting that reality, I think, can help us get the most out of the time we are here and to focus on the matters of life, philosophy, and faith that are really important.

Adult Stem Cells Build a New Heart

I reported on this story previously from a different angle, e.g. the need for using animals in basic medical research. But this picture is so amazing, that I thought the breakthrough was worth revisiting to discuss the biotechnological implications.

To recap: scientists created a new beating heart using cells from newborn mice and and hearts from dead rats. From the story:

[Doris] Taylor's team started with a heart removed from an adult rat. The researchers soaked it in chemicals to remove the living cells, leaving behind a "skeleton" composed of the heart's nonliving structural tissues, which are made of proteins and other molecules. Onto this scaffolding the researchers placed heart cells from a newborn rat, which are not stem cells but can give rise to multiple types of tissue. The cells took to their new home and after 8 days had assembled into a functioning heart that beat and pumped fluid, the researchers reported online 13 January in Nature Medicine. The new organ had only 2% of the pumping force of an adult heart, but Taylor says that she and her colleagues have since repeated the procedure with about 40 hearts and found that they can produce a stronger organ by adding more cells and giving them more time to grow.

Have no fear, newborns would not be used in people:

To apply this method to people, the heart scaffolding could come from either human cadavers or pigs, Taylor says. Adult stem cells, such as those found in bone marrow, could be taken from patients awaiting transplants and used to grow the new heart.

If this worked in people, it would permit heart patients to receive custom made, immunologically compatible hearts for transplantation without the need for human cloning and fetal farming. Obviously, there is a long way to go still, but this sure seems pretty nifty.