Canadian Medicare is failing

More on healthcare funding and rationing, today.

It's important to remember that the Canadian government health system began rationing by limiting services years ago. The doctor in this article in the NYT is correct that it is easier to get desired and even necessary care for dogs than it is for humans.

More than ten years ago, there were complaints that the MRI's and CAT scans were limited to a certain number of tests and hours for use by human, State patients, but the machines would be available for veterinarians after hours. Entrepeneurs who were willing to risk censur by the State took a risk to offer needed care to human patients:

Dr. Day's hospital here opened in 1996 with 30 doctors and three operating rooms, treating mostly police officers, members of the military and worker's compensation clients, who are still allowed to seek treatment outside the public insurance system. It took several years to turn a profit.

Today the center is twice its original size and has yearly revenue of more than $8 million, mostly from perfectly legal procedures.

Over the last 18 months, the hospital has been under contract by overburdened local hospitals to perform knee, spine and gynecological operations on more than 1,000 patients. Since the Supreme Court ruling in June, it began treating patients unwilling to wait on waiting lists and willing to pay their own money.

To understand how this happened, here's information from a 1991 News article:

Greg Moulton of Guelph, Ontario, was in a three-month wait to get a CT scan "to learn the cause of his 'excruciating' headaches." Since York Central Hospital's radiology department was only open to the public at specified hours, the hospital decided to allow pet owners to bring in their animals in need of a CT scan after hours—for $300 a scan. "For dogs, a scan can be arranged within 24 hours," according to the Canadian Press ("Humans Wait in Pain, Dogs Don't," June 14, 1991).

Ecologically sound healthcare

A post by Art Caplan who is a pseudoeditor but not an editor at blog.bioethics.net alerted me to Alternet, a website that is rich with blogger material. We could begin by contrasting the article complaining of the environmental toxin of the production of chicken for food with the one in support of abortion and abortionists. (Of course, those of us who are pro-life know that abortion is not "healthcare.")

But, in the spirit of "Crunchy-cons," let's start with the ecosystem.

I'm always complaining that we seem to have forgotten the '70's. But, Alternet reminds me that some of the politics are still alive and Stan Cox seems to want to turn what I agree is a lack of sufficient environmental awareness and stewardship into a matter of class warfare and denying healthcare.

We could decrease the packaging and layers of packaging - both in the grocery store and the hospital and clinic. We could stop decorating and scenting everything - start with the single-use items. I shop on-line, search out items with less packaging and less waste, reuse, recycle, repair and "make it do" when I can. I hate waste and enjoy doing it myself. (another article on the site is suspicious of that aspect, too. I think we're all supposed to be reading Alternet and following their script for organizing around their causes and in their way.)
But, the author is convinced that we should all do less, expect less and give up more - and that the rich must give up more than the poor. (If I were going to be sarcastic - and of course I won't do that - I'd note that only the rich can afford recycling centers and the space for them in their kitchens.I've noticed that the expensive organic veggies come with less packaging in the supermarket. And I have room for my salad and herb garden in my yard. I haven't had trouble with leaking oil since I traded in the 20 year old used car for a newer used car, when I could afford it, after residency.)

But in the rationing of healthcare, environmental concerns don't seem to be as urgent in the media and "bioethics" activism as first dollar coverage, on government payer plans (did I mention how unefficient those are with money and resources filtered on the way to the captital and all the way back?), even for self-induced disease. And even for William Buffet and every other Medicare eligible billionaire.

More leftist fussin' about Robert P. George

The Nation's Max Blumenthal (also available free online here)has decided that Princeton's Robert P. George (graduate of Harvard, Oxford and recipient of many other honors and degrees) is tainting the entire institution, by causing a "lean to the right."

I agree with a statement Professor George has made: he's a balance for Princeton's other notorious ethicist: Peter Singer (Graduate of Melbourne and Oxford, etc.)

How human is human-enough?

A group of very well respected scientists, philosophers and ethicists (all involved in bioethics and stem cell research) have joined together to discuss and draft what they call a "consensus" on stem cell research, both destructive embryonic stem cell research and non-destructive, ethical non-embryonic stem cell research. The document can be accessed at the Berman Bioethics Institute at Johns Hopkins.

This a very low-key, dry document and on first glance appears very reasonable.

Unfortunately, they follow the Blackmun, Belmont, and Warnock traditions of "we won't address the nature and status of the embryo or where life begins, but let's just go ahead and do what we want."

Here is the justification for the work and the first two points of consensus:

While we strive for consensus on a fundamental ethical framework for stem cell research, we acknowledge the reality of cultural diversity and moral disagreement about some elements of stem cell research. Inconsistent and conflicting laws prevent some scientists from engaging in this research and hinder global collaboration. Societies have the authority to regulate science, and scientists have a responsibility to obey the law. However, policy makers should refrain from interfering with the freedom of citizens unless good and sufficient justification can be produced for so doing. As scientists, philosophers, bioethicists, lawyers, clinicians, journal editors and regulators involved in this field, we have reached consensus that if humankind is to have the very best chance of realizing the benefits of stem cell research in an ethically acceptable manner, the following principles should govern the ethical and legal regulation and oversight of stem cell and related research and its clinical applications. This is by no means a comprehensive list of principles, but rather a declaration of those discussed and agreed upon by our group:

1. Stem cell research should seek to minimize harm, and any risk of harm should be commensurate with expected overall benefit. Scientists and clinicians should conduct research according to ethically acceptable norms. For example, research should be conducted so as to protect the well-being, liberty and rights of cell and tissue donors as well as research participants. Research participants and donors of human materials must provide valid informed consent, and conflicts of interest should be appropriately addressed.

2. The law carries great power to facilitate or restrict scientific exploration in the area of stem cell research. Law makers should be circumspect when regulating science. When enacted, laws or regulations governing science nationally and internationally ought to be flexible, so as to accommodate rapid scientific advance.

Since the philosophers are supposedly discussing adult stem cells and embryonic stem cells, it is easy to focus on those human embryos which are necessarily destroyed in the research. We could devote much time to this subject. (As a matter of fact this blog is evidence that we do.) However,there are other problems within the document.

First, the people who wrote this article do admit to having a vested interest in continuing the research. That is not necessarily bad. However, the rest of the document contains errors of assumption.

For one thing, there is no discussion of possible future generations and the effect of research on them. Are these people, our descendents, to be considered "research participants" and when does their citizenship provide protection for their rights and freedom?

Another problem is the subtle scolding of governments and law-makers for presuming to regulate science (or limit funding?), although the "consensus" acknowledges the legitimacy of such regulation.

The most problematic aspect of the consensus is the complete lack of discussion of the basic function of government and the single "freedom" on which all others depend: the freedom not to be killed.
The wording in this document is too vague, and does not address many humans potentially endangered by a lack of defining "freedoms of citizens" and the "well-being, liberty and rights" of those currently living and those who are not yet alive.

As is often the case in bioethics "consensus" statements, I'm left with serious questions:

What is the status of humans both intra- and extra-corporeal artificially and naturally developed living organisms with human DNA (again, regardless of the source) who may not qualify as "citizens"?

Where is the protection for 400,000 American embryos or 1000 Chinese criminals who could be sacrificed for cures for "citizens"? Will a human descendent who begins life in an artificial womb or whose intelligence has been hampered be a protected "citizen"?

NYT edits article after letter

Okay, it's not as big a deal as actually getting a "Letter to the Editor" published in Scientific American, but Mr. Leonhardt responded to my letter to the NYT. (An expanded version is here.) They've changed "virus" to "infection" on the website. ("Bacteria" would have been better, in my opinion. But, let's face it: I'm not getting paid to write, am I?)

No comment on the "When Doctors Get It Wrong" angle.

Small steps. I know someone read my concerns about P4P, the attitude that docs are only out for the money and that misdiagnosis and "unnecessary tests" are due to a lack of pain on our part. (The "doctors don't go down with the ship" comment.)

More on blog.bioethics.net disappearing posts

I do believe that there is a very real bias in the "mainstream" bioethics, especially in the academic world. Just as with much of the formal sciences and medicine, the belief that all humans at all stages of life are deserving of special protection from harm - the "prolife" viewpoint - is not welcome.

To me, those who claim to be representative of American Bioethics who should, of all people, be held to a higher level.

Is it censoring or is it just poor editorship?
The silly announcement the editors and pseudoeditors at blog.bioethics.net decided to monitor each comment followed last week's lost comments and website glitch. Those missing comments are still missing and the website's posts as well as the comments have slowed down. And the website's comment feature no longer "remembers" my name and information.

Meanwhile, the UPenn Bioethics Symposium has managed to get a Baptist leader, Dr. William J. Shaw , to join the Zen Ph.D. in speaking to religious perspectives on end of life decisions.

Reporters often get it wrong, too

Nancy Valko forwarded a New York Times article, that irritated me as a doctor, on several levels.
First, there's no such thing as a "flesh eating virus." Most likely Isabel's secondary infection was a bacteria: Group A Streptococcus.

The fact that 20% are found to be "misdiagnosed" at autopsy does not mean that a correct diagnose is possible without the autopsy.
I would like to note that the doctors made the correct diagnosis in each of Mr. Leonhardt's pediatric cases. One child was cured while the other, tragically, was not.

I can assure you that doctors are self-driven to care for patients and to excel at what we do. If it weren't for our internal drive, I don't think any doctor would take Medicare or Medicaid. But articles like this remind me that no one wants to work for less than the cost of office overhead to see the patient and no respect or appreciation. In my opinion, much of "burnout" in medicine (and probably in most other occupations) is the combination of working for low pay and low respect.
(As a family doctor, I could handle never being as well paid as superspecialists [or the mythical "rich doctor" so many still believe in], but I can't handle the assumption of "fraudandabuse." I want to be the good girl, if not the hero.)

We doctors are fallible because we deal with living patients and what sometimes seems to be an endless variety of expression of disease. Thank goodness for new tools like the database from Isabel. We all buy new books, subscribe to horribly expensive journals and earn continuing medical education credits. We cannot autopsy our patients and we cannot see the future. We certainly don't know the results before we order those tests so they may turn out to be unnecessary. We may diagnose leukemia without immediately recognizing the particular unusual form which is not susceptible to chemotherapy. As in the case of Isabel, the early symptoms of a secondary bacterial infection may be masked by the symptoms of chicken pox just as the child's immune system is unable to resist certain types of bacterial infection. The viral or bacterial count may be too low to culture or "mixed."


Pay for Performance (P4P or "Pay for Play," as some of us call it) as it has been designed up to this time is not specific for improvement in the health of patients or even to reward or discern better doctors. While guidelines help doctors know what scale we will be measured by and give us a goal, all that's being measured so far are systems changes, not physician improvement. The goal of the P4P initiatives is "management," or to save money. The Center for Medicare and Medicaid pilot projects are aimed at hospitals and large group practices of greater than 200 doctors and rewards "efficiency" in lowering patient's glucose or cholesterol levels. Which will put doctors under pressure to "fire" patients who do no keep appointments or exercise hard enough. (Good bye smokers!)It will not reward listening to patients, holding hands, professionalism or bedside manner. Large practices with the ability to cash in on economy of scale will benefit for doing what they already do. Nothing that I've read about P4P leads me to believe that Medicare plans to pay better doctors more money.

What is a Crunchy Con?

Here's the straight stuff, from National Review Online.

Now, I'm not a Luddite, either. I think of myself as an "early adopter." But I pick and choose. I hope with reasoning behind it.

Like I said, I'm part-Crunchy.

I'm part "Crunchy Con!"

There's a great controversy building about atypical (at least to some non-conservatives) conservatives. There's a great discussion about it over at National Review OnLine.

What does this have to do with Bioethics?

Well, if you think of yourself as conservative while at the same time, you see the protection of the environment as part of your life, if you believe "you are what you eat," if you nursed your babies and/or insisted on natural childbirth, if you don't buy everything the American Medical Association tells you and are just a little skeptical about vaccinations and medications, you may be a "Crunchy Con."

Guilty! As a former member of La Leche League, 2-natural-births-1-homebirth-mom, breast-feed'em-till-they-can-reason, long-time-reader and pick-and-chooser from Organic Gardener and Prevention Magazines, I
am a "Crunchy Con," at least some of the time. I do own Birkenstock clogs. Two pair (one for the garden, one for when I go out in public).


It is consistent to me to protect human life at all stages and to avoid using poisons against animal life (when it doesn't put people at danger) or to recycle in order to keep my world a better place for the people who come after me. And "use original container" as well as "nature knows best" worked for feeding and nuturing my family. I read real-time stories on the hazards of interfering with the diversity of microenviroments and wiping out entire genomes by big agriculture in the '70's and '80's. Although much of what I read about DDT was wrong, the '70's information about Folate and neural tube defects - which I first read in Prevention magazine - prooved true.


And I keep these lessons in mind when counseling my patients and evaluating the scientific, bioethic, and medicine literature.



Hey, Progressives - we're not stereotypical! People rarely are.

I'm sure we're just not "their kind" of "Crunchy."

Great comments on George/Meilander/Gazzaniga/AJOB ethics

Be sure and look at the comments from two of the readers of this blog about personhood and bioethicists on my last post.

The grown-ups speak for the smallest humans

Two of the most brilliant ethicists in the United States have answered one of the most partisan.

Robert P. George and Gilbert Meilander, in the National Review On Line, have answered Michael Gazzaniga's New York Times discussion on embryonic stem cell research.

You'll remember that Gazzaniga's editorial, published in the NYT last week, called for more embryos to disassemble for stem cells and gave us a synopsis of his criteria for human personhood. That criteria would exclude protection for many adolescents, much less toddlers and children who are already given such protection by law.

Gazzaniga, after declaring " It is the journey that makes a human, not the car," belittles most of us with his further comments on personhood:

In his State of the Union speech, President Bush went on to observe that "human life is a gift from our creator — and that gift should never be discarded, devalued or put up for sale." Putting aside the belief in a "creator," the vast majority of the world's population takes a similar stance on valuing human life. What is at issue, rather, is how we are to define "human life." Look around you. Look at your loved ones. Do you see a hunk of cells or do you see something else?

Most humans practice a kind of dualism, seeing a distinction between mind and body. We all automatically confer a higher order to a developed biological entity like a human brain. We do not see cells, simple or complex — we see people, human life. That thing in a petri dish is something else. It doesn't yet have the memories and loves and hopes that accumulate over the years.

On the other hand, George and Meilander do not belittle, there's no diminishing of the worth or intelligence of those who disagree with them or who would make 7 out of 17 in a vote some sort of mandate. They give a reasoned and philosophical answer:

As a people we Americans are committed to the equal worth and dignity of every human being — and, hence, every member of our community. When we ask whose good counts in the common good, we seek to answer that question in ways which include the weak, the incapacitated, and the vulnerable — not in ways that narrow and constrict the number of those to whom we are obligated and for whom we should care.

If that is the political commitment of this country, several things follow. We will not casually suggest that becoming a human being depends on development of various capacities over time without attempting with rigor and seriousness to define and describe the point at which this actually happens — the point at which we have among us another one of us whose good should count in the common good. It will not do simply to opine blithely that "it is the journey that makes a human" without offering any serious description of when that journey begins or ends.

It will not do to opine that a living human embryo of the sort all of us once were (which Gazzaniga prefers to characterize as "that thing in a petri dish") cannot be a member of our community, entitled to the same protections as the rest of us, unless and until it has acquired "the memories and loves and hopes that accumulate over the years" without offering any serious discussion of what this means for newborns, for those afflicted by retardation, and for those suffering from dementia.

It will not do to opine that the distinction between body and brain is decisive for determining whose life should be protected without even considering whether the living and developing human body ought not elicit from us a kind of reverence and respect that would keep us from simply using it in the service of our goals, even praiseworthy goals.

Against this call for reason and consideration, there is a near-out-of-control rant on blog.bioethics.net. But forget "comments" on that site - it's a waste of time due to the censureship and slow "moderation" that the editors and pseudoeditors of the "American Journal of Bioethics" have imposed on their (emotionally incontinent, as in this post) blog.

AMA:Abortion, yes! Euthanasia: umm. Death Penalty: No!

The American Medical Association is reaping some of what the membership has sown in the case of assistance by anesthesia prior to placing an IV to affect the execution of a man on California's death row for the rape and murder of a 17 year old girl, Terri Winchell, in 1981.

Zimbabwe: truth of ABC vs. HIV

According to GlobalEnvision.com and the UNAIDS, Zimbabwe has used ABC ("Abstinence, Be Faithful, and Condoms") as well as "W" for "empowering women" (to demand ABC?) to lower their national HIV/AIDS rates from 25% to 20%. 1 in 5 is still a devastating number, but it's not 1 in 4.

Early analysis suggests that behavioral changes, including young people waiting longer before becoming sexually active, fewer casual sex partners and increased use of condoms, are parts of the explanation. But Mr. Dangor also pointed out that Zimbabwe's strong education system, its emphasis on district and community management of AIDS programmes and improvements in the status of women since independence in 1980 could also be factors.

The nation of Zimbabwe has had one of the highest rates of HIV/AIDs in the world, with as many as one in 4 pregnant women and young people diagnosed with the virus. The country also receives less international AIDS aide, $4 per year per infected person, compared to neighboring Zambia, where the aide is $184 per year per infected person.

As in Uganda, the tools that have made the difference are low cost and available with in each person. Education about the way that HIV is spread is essential, with behavioral changes encouraged in light of that knowledge. Men and women are taught to be abstinent outside of a monogamous relationship, to delay age of first sexual initiation, to limit the number of their partners to one and to be faithful to that one partner. For those who can't manage A or B, condom use is encouraged. And women are empowered to expect ABC.

There are scoffers who assert that the decrease in these high incidence nations is due more to the death rate of AIDS patients, but that skeptism is answered by the death rate of Zimbabwe. According to the article, the death rate would have had to be 4 times as high as it was in order to explain the new, lower rate of diagnosis of HIV.

I can't believe I missed this Conference

An Adult Stem Cell, Bone Marrow and Umbilical Cord Stem Cell Conference in Honolulu this weekend. Well, maybe next year.

Once more women are not protected by the courts

The story of the Dayton, Ohio late term abortion facility of Martin Haskell continues.

The US 6th Circuit Court of Appeals gave a sort of mixed ruling (this is a pdf file) on Friday in the case.

The Court found that the Permanent Restraining Order against the Ohio Department of Health in their capacity to enforce State law on the licensing of Ambulatory Surgical Facilities is not valid. But, the State may not order the Facility closed until a hearing is held.

Haskell refuses to comply with the law which requires ASF's to identify an agreement with a local hospital for transfer of patients to that hospital in the case of complications. Haskell (wh performs abortions at the Dayton facility and two others) admits to 3000 abortions a year at the facility, and he is the only "provider" who does late term abortions (after 18 to 19 weeks through 24 weeks) in Southern Ohio. Haskell had convinced a judge to give him a Temporary Restraining Order and an appeals court had awarded him a Permanent Injunction against the State's requirements for licensing or closing, and had awarded him lawyer's fees that are about $150,000.

Haskell has a written agreement with a hospital out of his immediate area, because none of the local hospitals would contract with him. That agreement was later rescinded. Haskel claims to have an agreement with a private group practice of 5 OB/Gyns who have admitting privileges at a local hospital, but he refuses to disclose who the other doctors are.

The 6th Circuit Court finds that there is no "undue burden" since the law is neutral (covers all ASF's) and Haskell should at least identify his 5 doctor's names. But, the Courts said that the State should have had a hearing so that Haskell could refuse to identify the docs again. And, the 6th says he won enough of his case to win the attorney's fees.
One of the Justices on the 6th Court panel dissented on the hearing. He said that the necessity for a hearing, since Haskell had 3 years to make his case, the law doesn't really require a hearing, and nothing new will come out of the hearing.
To me, it looks as though Haskell is hoping to stall, and maybe start the legal process all over again. (Or maybe the Powers That Be were waiting for the current US Supreme Court to be established.)
From the majority:

In sum, we reverse the district court’s decision with respect to its conclusions that the application of the transfer agreement requirement (and license requirement) to the Dayton clinic constituted an undue burden under Casey and that the Dayton-area hospitals had an unconstitutional third-party veto over the Dayton clinic’s license. We affirm the district court’s conclusion that Director Baird violated the plaintiffs’ procedural due process rights when he ordered the clinic closed before a hearing could be held on the proposed denial of the license application. We also affirm the award of attorneys’ fees and expenses.

Speaking of Stem Cell Research Oversite

The National Academy of Sciences has announced their intention to create a privately funded oversite committee to regulate human embryonic stem cell research.

The good news is that no researchers currently utilizing human embryonic stem cells (hESC) will be included in the committee. The bad news is that the privately funded oversite will give legitimacy the research might not otherwise have. And won't be responsible to - or even possibly responsive to - the public or any elected official.

Again, possibly because I'm naive, I prefer to believe that the scientists mean well. It's unfortunate that they don't believe that the best guideline for the destructive hESC is regulated by the very lack of funding.


Thanks to Nancy Valko for the lead.

Triage or palliative care vs. euthanasia in New Orleans

I may be too certain of the integrity of my fellow doctors, but I don't believe the headlines on blog.bioethics.net or the insinuations on NPR. I believe that there is a legitimate, ethical explanation as to what happened on the 7th floor of the New Orleans Memorial Medical Center.

If the generators were off, the ventilators would not work and many of the monitors and other machines couldn't be used, either. Even Judge Greer, who denied Terri Schiavo oral fluids and nutrition after her feeding tube was pulled, is reported to have allowed IV morphine to attenuate the visible symptoms that you and I associate with suffering. And some doctor prescribed, and several nurses administered, the drug.

It is only right and proper to give sedating medications if life-sustaining technology is suddenly and unavoidably not available.

I don't have any more information than what is available on the internet - I certainly don't have access to "secret" documents - but I'd imagine that the patients on this ward would be accustomed to large amounts of morphine and other sedatives. If so, they'd require larger than normal amounts to help them be symptom free when the doctors and nurses could no longer keep them alive by technological means.

From what I'm reading, we will most likely never know the motives behind the administration of the drugs in New Orleans. I am making a choice to believe that nurses and doctors who had cared for these patients for days continued to care. They treated symptoms as the patients died from their diseases,rather than intentionally ending their patients' lives prematurely.

No honor: Korean researcher accuses Schatten

An associate of Wu Suk Hwang has accused the University of Pittsburgh's Schatten of coming up with the original idea to fake results of the clone/kill/harvest "patient specific" embryonic stem cells.

If you can't trust a colleague, who can you trust?

SEOUL, South Korea

An American collaborator of disgraced stem cell scientist Hwang Woo-suk suggested they fake some data for a 2005 paper, a news report said Thursday.

A senior researcher on Hwang's team has told prosecutors that he heard Dr. Gerald Schatten make the suggestion after learning that some patient-specific stem cell lines had died in January last year, Yonhap news agency reported.

It is not yet known if Hwang followed through on Schatten's suggestion. However, all his stem cell lines were later found to be fake.

Schatten, of the University of Pittsburgh, suggested Hwang write the paper as if the dead cell lines existed, said Yonhap, citing unidentified sources at the prosecutor's office investigating the scandal.

Schatten, a co-author of the since discredited article, made the suggestion when he met Hwang at a seminar, right after the stem cell lines died, Professor Kang Sung-keun of Seoul National University was quoted as telling investigators.

Can scientists be... trusted to regulate themselves?

This is the question posed by pro-cloning ethicists as reported by the USNews in "Stem Cell Potential Said To Be Undimmed." (Also available from the Miami Herald or CBS, here.)

Laurie Zoloth, a bioethicist at Northwestern University, said the "tragic lies and fraud" connected with the South Korean scandal begged greater regulation - oversight that would ensure future research is done in view of the public.
"Can scientists ever again be trusted to regulate themselves?" asked Zoloth, who visited Hwang's lab before the scandal broke. "I don't know. I think the jury is still out on that one."

But, remember all the objections we've heard through the years about any regulation of cloning and human embryonic stem cell research. Francis Fukuyama has been criticized because of his efforts championing regulation. Alta Charo and Laurie Zoloth have been advocates of scientists' regulation of themselves, with their support of the National Academy of Sciences' guidelines, published last year.

Besides, what is President Bush's funding with restrictions, other than regulation? And, at least it's regulation that is accountable to the voters. The NAS is not accountable at all to anyone other than members.

On the other hand, it could be that Korea's government had too much interest in the Hwang cloning work and helped to create the environment that led to the scientist's and the country's scandal.

More on the hazards of abortion

Dr. Throckmorton also has a piece in the Washington Times concerning the Fergusson data and the American Psychological Association. Please take a moment to read it, if you can.

A Little More Notice of Abortion Hazards Evidence

A very little: A new Google News search turns up all of 27 reports on "Fergusson and abortion."

There is a good "Guest Opinion" piece at "Scoop.nz." (New Zealand) which includes information on both the recent Norwegian report on psychological sequelae of abortion, as well as Fergusson's data out of New Zealand.

Recent research from Norway and New Zealand has reported an association between abortion and subsequent mental health problems. Although the two reports are not the first to suggest such a relationship, they are well-designed studies suggesting that abortion may be linked to negative mental health reactions for some women.

The Norwegian study, published online by the journal BMC Medicine, compared the experiences of women who had miscarriages with those who had abortions. Six months after pregnancy termination, women who had a miscarriage were more distressed than women who had abortions. However, after 5 years, women who had abortions were more likely to suffer anxiety and intrusive thoughts of the event than women who miscarried.

The New Zealand study, published by the Journal of Child Psychology and Psychiatry, found that mental health problems, including depression, anxiety, substance abuse and suicidal thoughts, were more likely to occur among women who had an abortion than women who had never been pregnant or pregnant women who did not terminate the pregnancy. The study concluded, "Abortion in young women may be associated with increased risks of mental health problems."

The psychologist who writes, Warren Throckmorton, PhD, calls for a revision of the American Psychological Association and Planned Parenthood policies on informed consent for abortion. Unfortunately, he is a "conservative,," who writes about his faith. He will most likely be marginalized.

Terri Schiavo topic of UPenn Bioethics Symposium

This is a tale of two scandals: bias and possible censureship.

The University of Pennsylvania Center for Bioethics plans to celebrate its 10th Anniversary with a Symposium entitled "The Legacy of Terri Schiavo: Why is it so hard to die in America?" Invited plenary speakers include the advocates for Mrs. Shiavo's intentional death by dehydration (the removal of the tube with simultaneous legal prohibition of oral fluids and nutrition): Michael Schiavo, Judge George Greer, and Dr. Ronald Cranford.
Mr. Schiavo will be the Lead Speaker in the "Personal Stories" session. There is an addition just today of Hospice representatives and a member of National Right to Life, Dave Andrusko. The only "religious prospectives" speaker as of this moment is a specialist in Buddhist and Japanese religions.


However, yesterday the panel was missing advocates for Mrs. Schiavo, "religious perspective" panel members and any sort of advocate for the rights of the disabled or dying.

Interesting incident.
A whole set of comments from the post announcing the University of Pennsylvania Center for Bioethics 10th Anniversary Symposium have been deleted at blog.bioethics.net.

Several of us were discussing the lack of balance on the panel. All those critical, civil and pertinent comments are now gone.

The website for the Symposium was down for a while, so I worried that the server was out. I considered the possibility that the website was being updated. But, the website is up again, and the only comments missing are those critical of the Symposium and the makeup of the panel.

Trying a "trackback" link to the site. I've never been able to get them to work, but I think this deserves another try.

Singer continues political focus

Food for thought. I'm a wimp, but I do believe that blackmailers and kidnappers should never be rewarded and that there should never be negotiation or deals made with them. The encouragement given to future terrorists of this kind places far too many people in harm's way.

I know who I do not want arguing my case for me:

Peter Singer, founder of PETA and consistent utilitarian (even if the greater good includes infanticide and beastiality and the conclusion that it is perfectly all right to utilize new-born infants, any way the parents see fit), has been an outspoken political opponent of the Bush Administration. He wrote a book (if, then reasoning with all the "ifs" being chosen arbitrarily by the author in order to reach his own conclusions) released before the last election, calling Bush the The President of Good and Evil.

Singer's column in today's LA Times (free registration required) concerns the unfortunate terrorist kidnapping of Jill Carroll, the reporter for the Christian Science Monitor. While Singer states that,

It certainly seems likely that things would've been better if, right from the start of the wave of Colombian kidnappings, no one had paid a ransom; the kidnappers would have realized there was nothing to be gained.

he goes on to suggest that the trade should be made, after commenting on what the President might think, if his own daughters were kidnapped.

The kidnapper's demands, if indeed they are limited to the release of the five female prisoners being held by the military in Iraq, seem relatively modest, a small price to pay for saving the life of a young woman.

As far as we know, none of these female prisoners is a significant insurgent leader or someone whose release would pose a major threat. What's more, the U.S. released five other women on Jan. 26 (although it was careful to say that the release had nothing to do with the kidnappers' demands).

A spokesperson said the U.S. military and the Iraqi government had "processed the women's cases according to normal procedures and determined they did not need to be held any longer." Perhaps if the proceedings on the remaining five cases were accelerated, it might turn out that they do not need to be held any longer either. It would be a terrible irony if that conclusion were reached after Carroll had been executed.

It is not obvious to me that it would be wrong to release the female prisoners. It may well be the right thing to do, quite independently of the pressing moral requirement that we do everything possible to save Carroll's life.

Eye opening or self-mutilation?

At bioethics.com, there's a little piece noting that the latest fad in China is plastic surgery resulting in an extra fold that makes the eye look bigger. A google news search yields the information that the fad goes so far as look-alike nose jobs for lovers and $3 Billion dollars a year. Reuters compares the fad to the former mutilation of girls' feet by binding them to make them small (and crippled).

There are a few pictures out there, here and here.

It's true that each of us has the "right" to use our bodies as we will, and that it's not the purpose of government to protect us from ourselves. We get to do dumb things once we're adults, as long as we don't put anyone else in danger or cause another harm.

And this is a nation notorious for forced abortions and harvesting the organs of people on death row, as documented by this detailed Village Voice article. (Talk about a trade deficit!)

but . . .

My big concern is that age will affect the scars resulting from these surgeries in ways no one can predict - will the "double eyelid" droop and obscure the vision, requiring even more surgery later on? - and nothing, especially recreational surgery is 100% safe.

CBS claims human embryos "surplus"

So it must be true, right? (Be sure and see this link for a review of the timeline of embryonic stemcell research.)
CBS's 60 Minutes TV show ran a biased piece last night on "A Surplus of Embryos." The written news article doesn't show the hostility of Leslie Stahl toward Robert P. George (who has a doctorate of philosophy of law from Oxford, his law degree from Harvard,is a professor of constitutional law and jurisprudence at Princeton, as well as a member of the President's Bioethics Council).

Be sure and click here for a portion of the video or the link to the right of the text.

Although there is additional footage of Stahl talking about the segment, for some reason, the whole report is not available, so we are unable to hear her squeals of delight that the tiny heart cells were shown to be beating on the microscope stage. The embyronic stem cells were among the first produced, by James Thomson, a veterinarian and primate pathologist at Wisconsin-Madison's School of Medicine.

From Stahl's interview with one of the IVF technician/doctors, Richard Scott, MD:

It’s been suggested that fertility clinics should stop making so many embryos that go unused.

"You’re really limiting, then, the number of eggs that you can inseminate," Scott says. "Then you’re actively intervening to harm that couple and reduce their chances of ever having a baby. I have a very big ethical problem with that."

No, Sir. We are not "intervening to harm." We are monitoring and controlling a procedure which should be regulated under both Federal and State laws. Regulated doctors, pharmaceuticals and medical equipment are used in protocols that not only affect currently living women and children, but will have unknow effects on all our future children.
There is no monitoring, counting or follow-up on the children who are being born from IVF. There is and never has been any Federal funding for the procedure until the money that was recently made available for adoption of the embryos of families who do not plan to continue the lives of the children in storage the same way they have the ones in their arms.

The hostility was not visible when Stahl interviewed either Dr. Scott or Arthur Caplan, PhD (his PhD is in the history and philosophy of science) from the University of Pittsburgh Center for Bioethics. Stahl mentioned that Caplan has done a survey on the fate of embryos at fertility clinics, but did not challenge him on his statement that there are 400,000 embryos available for research. In fact, not all fertility clinics and parents are in agreement with using the embryos for research, and embryos frozen as long as 13 years can and have been born and and found to be healthy.

From the CBS text version:

"Well, when President Bush says he opposes using embryos for stem-cell research because that would be destroying an embryo, what does it mean that embryos are already being destroyed?" Stahl asks Caplan.

"To me, it means that the president's policy is hypocritical and deceptive," he replies. "And I say that deliberately because it is not a secret that embryos are destroyed at infertility clinics."

"So we have a policy that says, 'Can't destroy them for research. I, as president, cannot abide it.' Every day a clinic somewhere, destroys one — no one says anything," Caplan adds.

This statement is disingenuous. The President's policy only deals with Federal funds. Federal funds are not available to destroy embryos and never have been. The cells for which funding is now available are not part of embryos. I'm sure that Caplan remembers that it was the prior administration that promised to allow funding for research on cells after the embryos were destroyed, but not for the destruction itself. A thorough review is available at Nature Biology.

Ethics of cloning across international borders

You may have heard of Gerald Schatten, PhD, now of Pittsburgh, because of his prior collaboration with the University of California at Irvine fertility specialists who were accused of selling and misplacing - even using them in other women - the embryos of couples who came to them for treatment of infertility. Dr. Schatten needed embryos for research and some of those embryos came from this facility and these doctors.

Schatten had acted as the US liaison/interpreter/publicity agent for Hwang in the Korean veterinarian's fraudulent human cloning scam. Dr. Schatten's withdrawal from the project and public announcement that he suspected impropriety in the procurement of the oocytes used was the first good kick that lead to the down fall and exposure of the Korean national cloning construct.

Dr. William Hurlbut, bioethicist and instructor at Stanford University and one of the members of the President's Bioethics Council, is speaking out about the problems and "pitfalls" of "Cross-Border" research collaboration in an article by Byron Spice in the Pittsburgh Post-Gazette.

Mississippi House bans embryonic stem cell research

Thanks to bioethics.com for alerting me to this story.

(Of course, it's only the House - let's see whether it gets through the Missippi Senate and is signed by the Governor. Hope so.)

The story is common to all who work for laws, especially those which restrict funding for the "experts." One of the legislators is quoted:

Rep. John Mayo tried to amend the bill to allow the House to allow partial embryonic stem cell research to continue.

"Folks, we don't know squat," Mayo said. "We shouldn't be dabbling in this. Let the researchers do it."

If we learn anything from the history of scientific research, including recent history from South Korea, it is that when "we don't know anything," we should slow down, work on the animal models first, and prove the technique is beneficial before we allow human experiments.

I'm sure that embryonic stem cell research was sold as for the "cures" and the promises were that only "spare embryos that were going to be thrown away, anyway."

First, there are no "spare" human embryos, just poor ethics in the production of embryonic children on the behalf of parents who are desperate and longing.

Second, these "spare" embryos can only take the place of animal models. In order to actually match the patient's needs, won't treatments require "patient-specific" embryonic stem cells. (Also known as cloned human embryonic stem cells.)

85% Type 2 diabetics treated with ethical stem cells

http://www.medicalnewstoday.com/medicalnews.php?newsid=37226

Here's an article (from a reliable medical site, despite the typos and obviously poor translation from the original) on bone marrow cells taken from the patient and used to treat diabetes by injecting the appropriate stem cells into the pancreas. 85% of 16 - that sounds like 14 of the 16 began making their own insulin, C-peptide, etc. --- in other words, their beta islet cells were improved somehow.

From animal models, we have reason to believe that the patient's existing beta cells in the islet of the pancreas were supported and encouraged to divide, rather than the stem cells from the bone marrow differentiating to become islet cells. But, the jury's still out.

The article says this is the most significant advance since the discovery of insulin in 1929.

A side issue ---

The paper concerning this research was presented in December to the American Society for Cell Biology. The Press Book can be accessed here.

Every day, I read of stories such as this one, concerning treatments reported at legitimate medical meetings, without a peep in the mainstream media. There's definitely not the same level of hoopla that Hwang and the puppy-cloning team got.

Over 80% of Type 2 diabetics? and no major media blitz??

Edit, December 6, 2006
As noted in the comments, below, there is no follow up on this article, and no corroborating evidence on line or on a Pub Med search. The American Society of Cell Biology "Press Books" have a new url, here. There is no mention of the presentation in the Press Book. Please see the post from today (December 6, 2006) with some relevant links to research in animal models.

Life, intelligence, and feelings

I received an email from one of the readers. (Evidently, my spam program diverted it.) I make it my usual policy to only respond to reader's comments on the blog, but I won't post his name, since he chose not to post it here.

Here's the body of his message, and my reply:

Dear Beverly Nuckols,
life n. pl. lives (lvz) The property or quality that distinguishes living organisms from dead organisms and inanimate matter, manifested in functions such as metabolism, growth, reproduction, and response to stimuli or adaptation to the environment originating from within the organism.
homo sapiens n : the only surviving hominid; species to which modern man belongs; bipedal primate having language and ability to make and use complex tools; brain 1400 cc

Life begins with consciousness. If the cells are not conscious, how can we call them Homo sapiens? After all,humans have this innate intelligence, which is how we intelligently define ourselves. Single cells lack the neural capacity to be conscious and cannot define themselves. Therefore how can you say that single cells are alive, feeling, thinking Homo sapiens? Women should have the right to birth control, and whether or not that baby is born. The line, I feel, should be drawn at the point at which the baby can survive on its own, not as an embryo. I look forward to your intelligent response.
(M.T., California)

Mr T.,
The disciplines of taxonomy, embryology, comparative anatomy and embryology, and common experience affirm that that whatever you are now began as an embryo of the species, Homo sapiens, and that at no time were you other. You were never not-Homo sapiens and you were never not-alive.

I will agree that some living members of our species do not think, feel, act consciously or with intelligence. However, that does not make them of another species, it does not make them not-alive. Not every member of a species will display all of the traits of the species, most certainly not all the time. And, of course, we are not all intelligent or conscious throughout our lives.

The definition of "Homo sapiens" which you give is not only not based on taxonomy, it defies common experience. Even a three year old cannot "define himself." Most adolescents would have trouble meeting this definition of "human."

As you said, the capacity for intelligence is innate in human beings. As you imply, the innate intelligence and consciousness of human beings is what separates us from those beings which will receive less protection from the governments and societies of human beings. (Although we don't encourage the abuse and exploitation of non-human beings without responsibility for suffering. We teach our small children not to hurt animals, for instance.)

We should not allow our feelings to make policy that will result in the creation and killing of members of our species. Since we are apparently the only ones having this conversation, we should welcome all who might join in, whose parents, brothers and sisters are "like us." If nothing else, using the lowest common denominator for inclusion - a living organism whose parents were members of the species - will ensure that none of "us" are harmed and provide the most protection derived from our collective individual human rights.

The dangers of utilizing your criteria are (at the least):
1. Who gets to decide how intelligent is intelligent enough to be protected?
2. How will intelligence and consciousness be measured?
3. Will "human-enough" be determined by democratic means as it was in the Slave States of the US?
4. What happens when the power to protect falls into the hands of those with whom we disagree if the power to define intelligence determines who will be protected?

Will we repeat the history of Stalin's government, where those who dissented were not given the protection of human rights?

Or - again as in Stalin's USSR and repeated in South Korea in the last two years - will we allow nationalistic pride and political power to allow the redefinition of human for current faddish science that can't be replicated in any other labs?

Answers to cloning lies and redefinitions

We had a perfect example of the "I want" (thanks, Stephen King) school of science and medicine in my own home town, last night. Our local State Representative raised the common lies and redefinitions about destructive embryonic stem cell research.

"Just some cells,"
Cells that behave in an organized manner - just like a human organism should at that stage of life.

"Somatic cell nuclear transfer,"
Razzle-dazzle with the term for one technical process does not change the product or the outcome.

"There's no sperm, so there's no embryo,"
There's no sperm present at the moment that an embryo twins, either. Which of the twins is not human?


"Your own DNA is taken from your cells in the lab and put into an emptied egg,"
Sounds like an intentional high-tech method, doesn't it? So, there is a definite responsibility for the outcome. If the outcome is a human organism, historic ethics have always maintained that there is a very high responsibility to protect the life of the human. "First, do no harm."

And we really should talk about the 2300 "eggs" from hundreds of women that were wasted in the absolute, total failed attempt at this process by the Korean veterinarian, Hwang Woo Suk. How many Texas women are we going to exploit?

"No baby is ever made,"
Not if the nascent life is created in harm's way and destined for planned destruction.

"It's never implanted,"
He or she is never implanted. See the last comment.

"For a cure,"
In fact, there have been and most likely will never be any cures using human embryonic - and most certainly those from "somatic cell nuclear transfer," or cloned, embryos. On the other hand, there are currently in use over 70 treatments for deadly and disabling diseases from adult stem cells and umbilical cord stem cells. Heart disease and nerve damage have been treated and there are formal human trials for further treatments ongoing as I type.
Texas has an early and substantial history of this ethical research. Cook's Children's Hospital in Fort Worth has been doing umbilical cord stem cell "bone marrow" transplants for at least 4 years. Dr. Willerson, the President of the University of Texas Health Science Center at Houston Medical School has conducted research on bone marrow stem cells for heart repair in Brazil and his research is being repeated all over the world. Dr. Baumgartner,a pediatric neurosurgeon, also of Houston, has begun recruiting children for bone marrow stem cell treatment of brain trauma.

"For Life!"
It's not for life if it depends on ending life. We do not trade one life for another, as humans are not interchangeable units. Even if not unique (as in the case of those twins) and no matter how small, no matter how hard we had to work with our highest, most cutting edge (and patentable and profitable) technology.

Killing is not "medicine"

One does not treat suffering by killing the sufferer. Treating pain control and the prescriptions intended to cause death as one issue is a red herring. Absolutely we must turn around the unjust abuse of power. But, killing is not pain control and the proper treatment of pain should not be a partisan issue.
I support those who feel intimidated by surveilance of their prescribing habits (although I feel that my documentation should be sufficient to protect me from prosecution, I have watched the abuse of power unfold over the last ten years. Look at the Association of American Physicians and Surgeons website for more accurate information and much wider coverage of the abuses.
Still circulating out there is John Tierney's NYT column on the Supreme Court's ruling against the Justice Department's challenge to Oregon's "Assisted Suicide" law.


Tierney's got to be kidding. Even hyperbole can't justify going this far.
Tierney insists on bluring the line between pain management and the intentional prescription of drugs - completely different drugs, btw - for the explicit and sole purpose of ending a life.
The move by the Justice Department had nothing to do with medical treatment of pain. It was a test of the States' ability to override the Controlled Substances Act. The "jury" is still out on appropriate monitoring of physician's practices and even on "Assisted Suicide."
The Clinton administration Justice Department, along with their guns, prisons and fines took harassment and prosecution of physicians and hospitals to its highest level, making "fraudandabuse" one word, holding rallies in football stadiums (with an appearance by the FBI director) and turning medical treatment a potential criminal offense. Remember the armed raids on doctor's offices and hospital records departments? That administration is responsible for the absolute lack of privacy in the Health Insurance Privacy and Portability Act and for enforcement of the Social Security Act provision that anyone who says they come from the Secretary of Health's office or its subordinates may examine and copy anything in any office that accepts Medicare funds, at pain of "exclusion" from all Federal funds.


I've lived the pain/treatment story this last year, due to my mother's paraneoplastic syndrome after successful "cure" of her thymic (yep) carcinoma. Unfortunately, her response to the tumor is antibodies that not only attack her voluntary (striated) muscles, but it also causes inappropriate pain, smooth muscle and sympathetic nervous system disfunction. The result is unexpected loss of blood pressure, delirium, and pain that doesn't follow any systemic pattern. Several times we have had to make the choice between "curing" Moma's pain and her life. Fortunately, we chose to keep her alive and she is now in a remission. She's stronger each day and very much a "person."



The column is behind the NYT's pay for view wall, now. But, since it's being recirculated on the websites (you can view the pdf version on one site, here), lists and blogs, I will post it here, waste of bandwith that it is:

New York Times
Party Of Pain
By JOHN TIERNEY (NYT) 787 words
Published: January 21, 2006

As the baby boomers age, more and more Americans will either be enduring chronic pain or taking care of someone in pain. The Republican Party has been reaching out to them with a two-step plan:

1. Do not give patients medicine to ease their pain.

2. If they are in great pain and near death, do not let them put an end to their misery.

The Republicans have been so determined to become the Pain Party that they've brushed aside their traditional belief in states' rights. The Bush administration wants lawyers in Washington and federal prosecutors with no medical training to tell doctors how to treat patients.

As attorney general, John Ashcroft decided that Oregon's law allowing physician-assisted suicide violated the federal Controlled Substances Act because he didn't consider this use of drugs to be a ''legitimate medical purpose.'' Karen Tandy, the head of the Drug Enforcement Administration, has been using this same legal theory to decree how doctors should medicate patients with pain, and those who disagree with her medical judgment can be sent to prison.

You know Republicans have lost their bearings when they need a lesson in states' rights from Janet Reno, who considered the Oregon law when she was attorney general. For the federal government to decide what constituted legitimate medicine, she wrote, would wrongly ''displace the states as the primary regulators of the medical profession.''

The Supreme Court agreed with her this week in upholding the Oregon law. In the majority opinion, Justice Anthony Kennedy said the federal drug law did not empower the attorney general ''to define general standards of medical practice.'' It merely ''bars doctors from using their prescription-writing powers as a means to engage in illicit drug dealing and trafficking as conventionally understood.''

That's news to the D.E.A. and the federal prosecutors, who have gone way beyond any ''conventionally understood'' idea of drug trafficking. They've been prosecuting doctors for prescribing painkillers like OxyContin, even where there's no evidence of any of the drugs being resold on the streets. It doesn't matter that the doctor genuinely believed that the patient needed the drugs and was not abusing them. It doesn't matter that the patient was in pain.

No, doctors are now going to prison merely for prescribing more pain pills than the D.E.A. and prosecutors deem a ''legitimate medical purpose.'' These drug warriors are not troubled by the enormous range in the level of pain medication that different patients need.

They don't even seem to worry much about the potency of the pills, just the number. They want enough pills of any dosage to make a good photo at a press conference. In some cases, doctors have been too careless or gullible, but those are offenses to be disciplined by state medical authorities, not criminal courts.

Tandy claims that only a few corrupt doctors have anything to fear from the D.E.A. She responded to a column of mine last year by saying that her agency had investigated only 0.1 percent of the 600,000 doctors in the U.S. But she was far too modest. Most doctors, after all, write few if any prescriptions for opioid painkillers.

The doctors who matter are the small number of specialists in pain treatment who prescribe opioids. Ronald Libby, a professor of political science at the University of North Florida, estimates that 17 percent of those doctors were investigated during one year by the D.E.A., and an even greater number of others were investigated by local and state authorities, typically in concert with the drug agency. That means a pain specialist might have a one-in-three chance of being investigated for prescribing opioids.

Faced with those odds, doctors are understandably afraid. As noted in The New England Journal of Medicine this month, the D.E.A. has made doctors reluctant to give opioids to desperately ill patients, even when these drugs are the most effective pain treatment. The article warned that a victory for the Bush administration in the Oregon case, besides affecting terminally ill patients in Oregon, could cause doctors across the country to ''abandon patients and their families in their moment of greatest need.''

The Supreme Court's decision is a victory for patients and their doctors -- including, I hope, some of the ones in prison for violating the federal legal theory that has now been rejected by the court. The doctors should go free, and Republicans in the White House and Congress should restrain the drug warriors who locked them up. When this year's budget is drawn up, it's the D.E.A.'s turn to feel pain.

(Korean) Oocyte Donors Sue Government

Ova Donors to File Compensation Suit

Women's groups (and Lawyers for a Democratic Society) in South Korea are suing their government for failure to inform them - or to have in place regulation to require doctors and labs to inform them - of the health risks involved with egg donation.
Hwang was deceiving the entire scientific community and his own government, so no surprise that he would not give information for full, informed consent to the women he exploited.

Hwang "misspent" funds

A wise Man once said, "One who is faithful in a very little is also faithful in much, and one who is dishonest in a very little is also dishonest in much." (Jesus, quoted in Luke 16)

Well, it turns out that the veterinarian, Hwang Woo Suk, could not be trusted with the smallest of things, human embryos, and he mispent at least $2 million of the $31 million the South Korean government gave him.

From Forbes:

Through last year, Hwang received $31.8 million in government funds for his research as well as $6.2 million from private donations, the board said. It was unable to account for $2.6 million of those funds.

Separately, Hwang was also found to have personally received an additional $3.5 million in unaccounted for private donations, the auditor said.

"The government and companies provided professor Hwang Woo-suk with a lot of research funds," the board said in a statement. "But professor Hwang didn't follow appropriate accounting procedures."

Dangerous analogy: safer "cutting"

I spent part of the weekend encouraging doctors to teach teens and adolescents that abstinence is the best and only way to avoid pregnancy and Sexually Transmitted Diseases. Unfortunately, most of the doctors who are involved in making medical policy consider this a "right wing religious" idea and prefer to teach children how to use condoms and contraceptives and to supply them with what they "need."

Thank you, Nancy Valko, for forwarding the link to this article from World Net Daily telling about nurses in the UK who support giving clean blades and bandages for those teens who cut themselves.

Here's an excerpt from another article, this one from the (London) Times Online.

NURSES want patients who are intent on harming themselves to be provided with clean blades so that they can cut themselves more safely.

They say people determined to harm themselves should be helped to minimise the risk of infection from dirty blades, in the same way as drug addicts are issued with clean needles.

This could include giving the “self-harm” patients sterile blades and clean packets of bandages or ensuring that they keep their own blades clean. Nurses would also give patients advice about which parts of the body it is safer to cut.

The proposal for “safe” self-harm — which is to be debated at the Royal College of Nursing (RCN) Congress in April — is likely to provoke controversy.

At present nurses are expected to stop anyone doing physical harm to themselves and to confiscate any sharp objects ranging from razor blades to broken glass and tin cans.

However, Ian Hulatt, mental health adviser for the RCN, said: “There is a clear comparison with giving clean needles to reduce HIV. We will be debating introducing a similar harm-reduction approach. This may well include the provision of clean dressing packs and it may mean providing clean ‘sharps’.

“Nurses who encounter individuals who self-harm on a regular basis face a dilemma. Do they go for prohibition? Or do we allow this to occur in a way that minimises harm?”

We should tell them that it is harmful, and that they are our children, we love them, and we will do our best to protect them from hurting themselves. Unfortunately, the message is often "unbiased" in the way this article from the American Family Physician is (admittedly the best one I've seen).

Never, never again

On the 100th Birthday of Dietrich Bonhoeffer, one of the Christians who gave their lives to fight the Nazi horrors, the Nebraska State Paper gives us this story from David Hahn:

Walking slowly, I listened to the story of a young woman who lived in the village next to Dachau but who did not, at first, know of the horrors that occurred there.

She explained that the German military, and many SS, announced that it was a training and military camp, needed to protect the German homeland. When trains loaded with civilians began to arrive, villagers were told it was a work camp.

When she, her friends and family, eventually realized it was a ‘death camp,” she said, her life was ruled by fear.


Children of Dachau.
The now-infamous words Arbeit Macht Frei (Work Makes Freedom) were atop the black, steel gates that led to the camp. We stopped. She did not say she could not continue, but I knew she could go no further. The dog sat passively. I looked down into the woman’s face, her eyes now glassy wet with the tears of pain and the hope of grace.

She said only to me "Never again, never again. Please, you must make sure, never again."

. . .

There is no preparation for being in a place where, thirty-five years before, people tossed bodies into carts, so that the bodies could be burned in furnaces. Where people performed chemical experiments on other people. Where life was absent. Where death won.

Now, they tell us it's to save lives and improve health. We gradually learn that it's to be younger, stronger, and to make money and increase power. And the embryos are so hard to see, so hard to identify as "people."

Edit - I fixed an error I made in typing Dietrich Bonhoeffer's name.

Is Korea considering a ban on cloning?

Is this a case of "It's never too late," or "closing the barn door after the horse is out?"

The South Korean National Bioethics Council is debating whether to allow the creation of embryos and the donation of oocytes (eggs).

From the JoongAng Daily

Ethics group rethinks egg questions
February 03, 2006 ㅡ The National Bioethics Committee tried yesterday to agree on the details of ethical guidelines for creating stem cells by combining the nucleus of a somatic cell with the shell of an ovum. The technique was described by Dr. Hwang Woo-suk in his now-discredited paper on patient-specific stem-cell cloning. The committee postponed any decision, though, doubtful of whether the technique should be allowed at all.
"Since Dr. Hwang's article on somatic cell transplants was proven to be fabricated, questions were raised about whether it would be realistic to write detailed clauses on a research technique that di

d not exist," said Cho Han-ik, the vice chairman of the committee.
The committee had planned to debate the details of standards for egg donations, but dropped plans to do so. "Thousands of eggs were used in the research. If we allowed the technique, researchers having trouble getting eggs in other countries might start coming to Korea, which could create problems for the protection of Korean women," he added. "We decided to discuss the fundamental question of whether to allow the research at all."
Separately, the committed voted to forbid DNA tests for Alzheimer's disease and obesity in most cases. It said those tests were not scientifically proven to be of value. Genetic tests for obesity would be banned completely, but those for Alzheimer's would be allowed for adults at a physician's request. It also added new standards for institutional scientific review boards.

The paper is also reporting that University of Pittsburg's Gerald Schatten, PhD has been summoned for questioning.

Of course, (cloning) stem cell fraud couldn't last!

Blog.bioethics.net has a guest posting by the University of Texas'self-identified "stem cell enthusiast (read that: "destructive stem cell research") John Roberts (a lawyer, not a veterinarian) that is nothing but a demonstration worthy of the Great Oz: "Don't bother to look behind the curtain! It's not necessary, because we'll find out, eventually, what's back there! Trust us we're scientists and bioethicists!"

Hey, Hwang only managed to maintain the fiction with 2 articles in Science Magazine. Which was once one of the top science journals. And he managed to do it for a year and a half. And to waste somewhere between 2000-3000 oocytes from about over a hundred women. (No one knows the exact numbers, yet. No one ever will, thanks to fabrication, poor record keeping and a purposefully wiped hard drive. The numbers and accusations change from week to week.)

And, please notice that Lawyer Roberts can barely bring himself to acknowledge what everyone else has: Hwang lied about "cloning" for embryonic stem cells. Roberts still needs to call the hypothetical process "nuclear transfer," to blur embryonic/nuclear transfer cloning/stem cells and to push for the creation of embryos for destruction and the harvest of ever more oocytes ("eggs") from more women in order to further the dream.

And, of course, it was all a dream.

I don't understand the need for this argument - or the need for more and more exploitation of women. ESC's won't ever be useful in human medicine. Cloning most certainly will never be necessary. We have "patient specific" stem cells in the patient's own body.

Perhaps, important lessons can be learned about markers, stimulating and recruiting factors from the current crude form of embyo disassembling and shotgun form of plate 'em on everything everyway we can think of. But,it would be better and more responsible to utilize animal models and focus on both adult stem cells and the local in vivo environment when and where they are found.

A Medline search yields several references to possible progenitors of beta cells in the adult or post-natal pancreas. This month, Labortatory Investigation describes mesenchymal stem cells derived from human pancreatic ductal cells. But I think the consensus is that the best hope is discovery of the factors that induce proliferation of beta cells, themselves.

Unfortunately, treating insulin-dependent diabetes will also have to deal with the patient's autoimmune response to insulin, as well as the need for increased numbers of productive beta cell islet

Feminist: cures haven’t come, but eugenic(s)...expanded.

Now we have a clear description of the truth about genetic diagnosis, prenatal screening, and abortion. It's far too likely to be the story of the near future of genetics, "regenerative medicine," and all those up and coming forms of unethical, destructive research to "improve" the human genome.

Thanks to the email list of Dianne N. Irving, Ph.D. (a human embryologist and ethicist), here's an interview at the Center for Bioethics and Culture (watch out for the virtual hostess - or could she be "docent")), between the founder of the CBC, Jennifer Lahl, and M.L. Tina Stevens and Diane Beeson.


From Beeson:

When I was younger I believed the confident predictions of the geneticists that selective abortion was merely a temporary solution; within a few years we would have cures for all these conditions and we would not be practicing prenatal eugenics. The fact is the cures haven’t come, but the eugenic functions of reproductive genetics have expanded. For example, I learned years ago that we could eliminate most neural tube defects by addressing folic acid (a B vitamin) deficiencies in women. We chose instead to put our resources into massive prenatal screening programs throughout the country.

Thank you, Ms. Beeson.

Once more, destructive embryo research disappoints

Thanks to a post at FreeRepublic.com, I was alerted to this article in Scientific American on the attempt to produce keratinized skin cells from embryos.

Howard Green--who created the technique for culturing sheets of skin in vitro for transplant--and his colleagues at Harvard University set out to turn embryonic stem cells into keratinocytes and then isolate them. Unfortunately, it proved difficult to coax the stem cells to become skin cells in the first place. And those that did convert, Green says, grew poorly compared to donor skin cells.
In fact, the stem cells proved so deficient that the doctors had to introduce genetic material from the human papillomavirus (the virus responsible for cervical cancer) to induce enough keratinocyte growth. With that extra genetic material, the stem cell-derived skin cells proliferated; one line even produced the kind of connected sheet of cells familiar from Green's earlier work with skin grafts according to the findings published in the current online edition of the Proceedings of the National Academies of Science.
Although the stem cell-derived keratinocytes showed all the markings of such skin cells, such as the various proteins typically found in such cells (see image), they did not behave exactly like normal skin cells. Among other things, the stem-cell derived skin cells refused to differentiate in the same way as normal skin cells, Green explains. "It is commonly assumed that the cell types that people seek from stem cells are identical with what they're familiar with from studies of [adult] material," he says. "This is not the case for keratinocytes and may not be the case for other types."
This--plus the fact that the keratinocytes could only be cultured with a viral gene that could pose risks--means that such stem cell-derived skin cells are unlikely to be used anytime soon for skin grafts. And fulfilling the promise of embryonic stem cells may face even more challenges than heretofore imagined. "[Stem cells] are extremely interesting and powerful," Green adds. "We just have to keep working to see what will be the best applications." --David Biello

Hint: Use original container.

According to John Gearhart, director of research for Johns Hopkins University’s Department of Gynecology and Obstetrics.
. . . “We are going to use the information we get out of this research to get the patient’s own cells and work with them to get them to do what we want.” (Washington Fax, Novermber 19, 2002 - from Dr. Prentice's website presentation on stem cells, www.Stemcellresearch.org)

I would go so far as to predict that embryonic stem cells will not be used for treatment in humans. They are not subject to normal immunity and can't be controlled enough to pass any reasonable standard for use in human beings (other than the ones they started in, of course).

Stem cells, after their first flush of growth in the embryo, are slow growing to dormant. Ever so often they make "forays" out of the bone marrow or are awakened by local conditions. They make copies of themselves - some of which are identical and some of which are farther along the developmental line and some move about looking for areas to repair - becoming part of that area. Then the excess either return to dormancy or die of old age.

Besides,in "real life," the stem cell "stimulating factors" (the best influences, catalysts, or determinants of stem cells) are found - often easily and reliably found - in the local site where they are needed.

Last month, we learned that the sympathetic nervous system helps regulate the stimulation of bone marrow stem cells. In other words, stress leads to the release of epinephrine (adrenaline), which stimulates healing. (Paul Frenette, et.al., "Signals from the Sympathetic Nervous System Regulate Hematopoietic Stem Cell Egress from Bone Marrow." Cell, Vol 124, 407-421, 27 January 2006)

Animal models should be (and are in reality, despite the media's hype) the focus of laboratory research and the media's attention. So, cloning and the production of stem cell lines from embryos produced by IVF and parthenogenesis (or whatever) are just very crude, very destructive methods of research.