Defining "political bias" bias

Bioethics.net blog, by the editors and pseudoeditors of the American Journal of Bioethics, has another hit piece aimed at the current administration, referencing that stellar peer-reviewed medical and scientific journal, Glamour Magazine.

It seems that the author of the Glamour article) (Brian Alexander, who writes sometimes politically biased sci-tech articles for Wired magazine and has written a book called, Rapture, How Biotech became the new Religion)has discovered that “Doctors just don’t trust the government anymore.” Mr. Alexander relies heavily on one doctor, whom he describes as unbiased and “mainstream.” In fact, Ruth Shaber, M.D., just happens to be a member of - and spokeswoman for - Physicians for Reproductive Choice and Health. To evaluate the possible bias of Dr. Shaber for yourself, look at this page, about halfway down, at “Reactions," where the doctor is applauding the 2002 California move to force hospitals to offer emergency contraception. PRCH Board of Directors includes infamous abortionists Leroy Carhart and George R. Tiller as well as a former Administration’s Surgeon General, Jocelyn Elders.


Note, please, that this protest against the politicization of bioethics in the US is on the same page as examples of blatant political biases of their own. There’s another glowing commendation of Jonathan Moreno and his Center for American Progress bioethics institute and its conference on the conservative attacks on bioethics.


There’s another post on the pro-life protests against the fact that the University of Pennsylvania invited to Michael Schiavo and Judge Greer to speak at their Center for Bioethics 10th Anniversary Symposium. The editors and pseudo-editors still “just don’t get it” why the Schindlers still don’t get it.

Anyone who reads the Kaiser Network Daily reports(see the example above) - or for that matter has been following Glamour magazine - knows that there is a definite pro-abortion-rights slant to both. The same “Daily Women's Health Policy Report” that references Dr. Shaber as a spokesperson for PRCH is a perfect example of the way in which Kaiser reproductive health and women's health reports frequently have protests about limits and even comments on this administration's policies, in particular. Glamour featured the “November Gang” abortion facilities in their September, 2003 issue, encouraging women to feel good about their abortions and to write love letters to the children they had aborted on pink paper hearts. The article in question is actually a commentary on State laws as well as Federal medical information, formatted with headings such as, “YOU MAY BE DENIED . . . (fill in the blank).” Glamour objects to any legal or regulatory limits on dispensing emergency contraception, parental notification or consent before minor girls may obtain an abortion, and government information on the connection between abortion and breast cancer.

Let's not forget that other administrations have promoted the idea that not all sex is sex, that teens should practice some of these non-sex acts (such as Jocelyn Elders’ advocacy of teen mutual masturbation), and that they should be taught to use condoms on models of the male genitalia in order to avoid pregnancy. Clinton’s denial that oral sex is sex led to the famous and questionably timed Journal of the American Medical Association article on teen’s attitudes toward oral sex.

For those of you, who (like me) can recall 30 years ago, remember when breast cancer was called "the nun's disease"?

And does anyone else have an explanation for the increase in Sexually Transmitted Disease that is better than the increase in numbers of sexual partners, the acceptance that oral sex and some other types of sex aren't "sex," and decrease of the age of first sexual encounter?


"Bias" is definitely in the eye of the beholder. The same people who define pro-abortion Republicans as "moderate" and who deny the agenda of very active advocates of abortion and call them "mainstream" as well as those who institute bioethics centers which they name "Progressive," "Feminine" and "Humanistic") where the viewpoints of people of faith are dismissed as "rightwing" and "conservative" should not call "bias" and "politics" when they are opposed. The nature of discussion will reveal disaggreement as well as common ground and consensus.

After all, "tolerance," by definition assumes disagreement.

Less than animals, still?

SR answers "Humans less than animals?" by arguing for his own personally held view (or even a "consensus" of personally held views) with minds such as Peter Singer and H. Tristan Englehardt. The latter's qualifications for person hood moves well into childhood.

If you move away from what we know of embryology, comparative anatomy, and the fact of our own knowledge that these are the children of the only species having this conversation (not all, and not all the time - but why is that relevant when none of the animals will ever mature or develop the ability to do so?) then you turn the definition into a personally held viewpoint or opinion. From there comes definition by raw, brute power or the threat of same.

Robert P. George has answered all your questions,:

George pounces on the person/body dualism implicit in this remark and forces the class to confront the implications of affirming it: “If ‘I’ was not an embryo or fetus, neither was ‘I’ once an infant,” he says. “To have destroyed the fetus or infant that later became ‘me’ would not have been to destroy me. So at what point then do we say ‘I’ began to exist? At what point do we draw the line on killing?”

George then drops a cerebral smart bomb: “If dualism is true, the answer won’t be ‘birth,’” he notes. Will it be six months after birth? A year? Two years? Three? After all, when does a child achieve thoughts, beliefs, and desires?

Pro-choice students must now confront an uncomfortable fact: The logical implications of their position entail believing that killing three-year-old children is morally acceptable.

more than once:

But the potentiality of the human embryo, like that of the human infant, is precisely the potentiality to mature as the kind of being it already is — a human being.

and yet once again:

As Sandel himself implicitly concedes, we value human beings precisely because of the kind of entities they are. (That is why he has staked his entire argument on the proposition that human embryos are different in kind from human beings.) Indeed, that is why we consider all human beings to be equal in basic dignity and human rights. By contrast, we value oak trees because of certain accidental attributes they have, such as their magnificence, their special beauty, or a certain grandeur that has taken perhaps seventy-five or a hundred years to achieve. If oak trees were valuable in virtue of the kind of entity they are, then it would follow that it is just as unfortunate to lose an acorn as an oak tree (though our emotional reaction to the two different kinds of loss might, for a variety of possible reasons, nevertheless differ). Sandel’s purported analogy works only if he disregards the key proposition asserted by opponents of embryo-killing: that all human beings, irrespective of age, size, stage of development, or condition of dependency, possess equal and intrinsic dignity by virtue of what (i.e., the kind of entity) they are, not in virtue of any accidental characteristics, which can come and go, and which are present in human beings in varying degrees. Oak trees and acorns are not equally valuable, because the basis for their value is not what they are but precisely those accidental characteristics by which oak trees differ from acorns. We value the ugly, decaying oak tree less than the magnificent, still flourishing one; and we value the mature, magnificent oak more than the small, still growing one. But we would never say the same about human beings.

and one more:

George finds fault with such scenarios for many reasons, including the fact that the little girl "would experience terror and horrifying pain, while the embryos would not." For the same reason, he says, "one might rescue the little girl rather than several terminally ill adults in deep comas without denying that the adult patients are human beings who ought not to be killed and dismembered for their body parts."

You missed the implication that it's just as significant that our children can cause us to love as it is that they be able to love.

I might identify and feel more concern for someone that I do know than for a stranger across the world. But that is not relevant to the right not to be killed or enslaved. It does not mean that I do not see the two as deserving equal legal and societal protection. That is part of the nature that is human. The woman in my local battered women's shelter is just as deserving as my daughter, and the woman in Iran is just as deserving as either.

Texas Advance Directive Act - in its own words

§ 166.046. PROCEDURE IF NOT EFFECTUATING A DIRECTIVE OR TREATMENT DECISION.

My comments are interspersed and at the bottom.

(a) If an attending physician refuses to honor a patient's advance directive or a health care or treatment decision made by or on behalf of a patient, the physician's refusal shall be reviewed by an ethics or medical committee. The attending physician may not be a member of that committee. The patient shall be given life-sustaining treatment during the review.

Please note that the decision is the doctors' to make. The committee may affirm or not.

(b) The patient or the person responsible for the health care decisions of the individual who has made the decision regarding the directive or treatment decision:
(1) may be given a written description of the ethics or medical committee review process and any other policies and procedures related to this section adopted by the health care facility;
(2) shall be informed of the committee review process not less than 48 hours before the meeting called to discuss the patient's directive, unless the time period is waived by mutual agreement;
(3) at the time of being so informed, shall be provided:
(A) a copy of the appropriate statement set forth in Section 166.052; and
(B) a copy of the registry list of health care providers and referral groups that have volunteered their readiness to consider accepting transfer or to assist in locating a provider willing to accept transfer that is posted on the website maintained by the Texas Health Care Information Council under Section 166.053;
and
(4) is entitled to:
(A) attend the meeting; and
(B) receive a written explanation of the decision reached during the review process.

(c) The written explanation required by Subsection (b)(2)(B) must be included in the patient's medical record.

(d) If the attending physician, the patient, or the person responsible for the health care decisions of the individual does not agree with the decision reached during the review process under Subsection (b), the physician shall make a reasonable effort to transfer the patient to a physician who is willing to comply with the directive. If the patient is a patient in a health care facility, the facility's personnel shall assist the physician in arranging the patient's transfer to:
(1) another physician;
(2) an alternative care setting within that facility; or
(3) another facility.


Either the doctor or the patient or the person making decisions for her may object to the ethics committee conclusion.

The doctor who has decided that the treatment is inappropriate may transfer to another doctor in the hospital or another place in that hospital or another hospital.

(e) If the patient or the person responsible for the health care decisions of the patient is requesting life-sustaining treatment that the attending physician has decided and the review process has affirmed is inappropriate treatment, the patient shall be given available life-sustaining treatment pending transfer under Subsection (d). The patient is responsible for any costs incurred in transferring the patient to another facility. The physician and the health care facility are not obligated to provide life-sustaining treatment after the 10th day after the written decision required under Subsection (b) is provided to the patient
or the person responsible for the health care decisions of the patient unless ordered to do so under Subsection (g).

(e-1) If during a previous admission to a facility a patient's attending physician and the review process under Subsection (b) have determined that life-sustaining treatment is inappropriate, and the patient is readmitted to the same facility within six months from the date of the decision reached during the review process conducted upon the previous admission, Subsections (b) through (e) need not be followed if the patient's attending physician and a consulting physician who is a member of the ethics or medical committee of the facility document on the patient's readmission that the patient's condition either has not improved or has deteriorated since the review process was conducted.

(f) Life-sustaining treatment under this section may not be entered in the patient's medical record as medically unnecessary treatment until the time period provided under Subsection (e) has expired.

There is a distinction here between "inappropriate" treatment and "medically unnecessary" treatment.

(g) At the request of the patient or the person responsible for the health care decisions of the patient, the appropriate district or county court shall extend the time period provided under Subsection (e) only if the court finds, by a preponderance of the evidence, that there is a reasonable expectation that a physician or health care facility that will honor the patient's directive will be found if the time extension is granted.

(h) This section may not be construed to impose an obligation on a facility or a home and community support services agency licensed under Chapter 142 or similar organization that is
beyond the scope of the services or resources of the facility or agency. This section does not apply to hospice services provided by a home and community support services agency licensed under Chapter 142.


First, I probably would not remove the ventilator against the patient's or the patient's family's wishes. But I would cease hooking Mrs. Clark up to the dialysis and stop the tests and as many of the other invasive procedures as possible if I were convinced that I was hurting her more than I was helping her. As organ system after organ system failed, each added treatment requires more and more complicated coordination and has less and less chance of actually helping.

Unfortunately, I'm not sure that the TADA allows for refusal of some of the intensive treatment, while maintaining the rest.

There are still comments about what the hospital or the ethics committee is doing. While I suspect that there is some hostility between the family and some of the hospital personnel, the hospital cannot practice medicine.

I'm surprised that any facility that is capable of both ventilation and kidney dialysis cannot give any sort of medications that a patient would need. The hard part would be finding someplace that can monitor both the ventiliation and the dialysis. The only guess I have is the need for constant supervision of pressors - medicines that make the blood vessels tighten up so that the blood pressure can be maintained high enough. These medicines are very dependent on nurses and protocols, unless the doctor can stay at the bedside and turn the dials himself.

I'm surprised about the way people are talking and writing about the doctors, the ICU nurses and the hospital personnel in general. In your experience, are ICU nurses likely to be in on the conspiracy that is alleged?


On the contrary, the nurses are probably struggling to suppress their grief at the torture they are forced to inflict on Mrs. Clark.


For that matter, I haven't seen many conspiracies hold up as well as the rumored "aggreement" between the Houston hospitals that are said (by Wesley Smith and others) to refuse to accept Andrea because St. Luke's has declared her treatment futile.

More than likely the truth is that other doctors and hospitals understand the medical situation and agree that the care is prolonging death and actually adding complications that may lead to death.


As to pain and sedation:
75% of patients on dialysis have itching. I've had to practically knock them out with antihistamines and tranquilizers.


Now then, I've seen criticism about the doctor going on vacation this week. In most large facilities, the vacation times are planned a year in advance. And I know that I have to buy airplane tickets and make reservations in advance to save money. And I can't imagine telling my kids they can't go on vacation. They were used to the phone ringing in the night, but they expected me to be home on my vacations and other times I'd arranged for another doctor to cover for me. If doctors only went on vacation when none of their patients were sick, they'd never get to go.


It's likely that the doctor thought the family would be swayed by the ethics committee and/or their decision and that this would all be over before he left.

Steril cord blood collection

Just a bit of nerdiness. (Did I mention that I love gadgets?)

I hadn't thought of this, but there's been a problem collecting cord blood from babies born by Ceasarian section. The blood has to be collected in a sterile surgical field.

Medical News Today has an announcement by ViaCellabout their new device developed to address this dilemma.

Newborns less than animals?

SR and Michael have been commenting on Wednesday's post, "What are human embryos?" Neither one of them are impressed enough with my argument that the protection of all humans is justifiable, simply because the human has human parents. Actually, one of the best markers of what is "human" is that we, alone of all the animals, have this concept.

And the conversation continues. . .

They cant be measured or defined easily, and they fail one vital test - they dont apply to newborns, whose thinking abilities are extremally limited. Below those of many animals, I would estimate. The moral consequences of this problem are clear, and unacceptable. Yet so is an arbitary boundry. No, I think that is the wrong path...

Michael might be on the right track though. It does make an intuitative sense - if you wish to provide a way to measure a continuium, you use a continuous scale.

The continuum? A scale?

Now, this is where I say that the "moral consequences of this problem are clear, and unacceptable."

Talk about "Who will certify the weights on that scale? Who gets to decide which criteria they'd have any of us meet before we are human enough for them? For how long? And how will the protection be enforced, since it's negotiable in the first place? All that would leave is the far too prevalentcircumstance in which at one instant a human embryo is not a "human" and the next it is, or the protection appears and disappears when crossing national borders.

The continuum is just one way of saying there is no right not to be killed, putting human ethics back to the personal preference of the powerful.

Of course, no one is measuring any of these criteria in the embryos we are discussing. And none of us get to choose who will be protected and who will not under the current laws, even in the US. Roe v. Wade, Casey, and all the other abortion laws trump consensus and our representative legislatures in the various States. (We may find out that even the Federal Legislature is helpless to affect that definition when the Supreme Court rules on the partial birth abortion ban.)

As I've pointed out, that definition of "human" and "person" varies according to the weights on the scale. In Saudi Arabia, I could not be a person no matter what my functional abilities, since I'm a woman. In our own history, persons people who had too much pigment in their skin or with too low an IQ (Carrie Buck, who was sterilized because the judges deemed her an "imbecile") were deemed non-persons. When we get down to the definitions of "person" written by ethicists of the last century, we move into functions of higher thought that 3 year olds wouldn't meet, and many that we now consider protected (even in the US) would no longer have the right not to be killed.

We may not be able to measure art, truth, beauty, justice or love, but we - and as far as we know only we - are the only species that even looks for these. We consider them our highest goals. We understand that every one of our children have the capacity for either demonstrating genius in one or more of these qualities, or bringing them out in others.

Take love, for instance. No one would be happy with love that is given if we meet certain measurable criteria. We want to be loved "just for ourselves." The traditional (Western) marriage vows even say, "for richer, for poorer, in sickness and in health." Our society looks down on marriages of convenience or when the assumption is that one person marries for the other's money.

Who could deny the value - and genius - of a couple that is genuinely in love, or the way that a mother is able to love her child?

In fact, the three of us are demonstrating our own search for truth and justice by this conversation. Who have we killed by destructive research, abortion, and prejudice that leads to murder and genocide? We may have killed as many Ghandis and Mother Teresas as we have killed Machiavelli's and Ted Bundy's. Or it could be the other way around. But destruction according to any criteria other than the fact of human origin cannot be the answer to the question of who is human.

Arbitrary? Unilateral?

Take a look at this conversation, at "The Cheerful Oncologist".

I have often wished that my patients' bodies had read the books and articles that I have. In anthropomorphic fits, I am certain that if their bodies knew better, I wouldn't even have a job.

At the very least, I wish that decision-makers - both families and patients - could know all that I know about medical care and its consequences.

Unfortunately that's not how bodies, patients or families work. I'll admit that some of the confusion may be due to the fact that so many doctors can't or don't learn to explain medical terms and care to patients and families. Interpretation between the two languages is difficult to learn and teach.

Just one of the reasons we still call medicine an "art." At least occasionally.

Besides, we keep changing the "rules" about what we expect bodies to do.

Once upon a time, people who could not breathe for themselves were considered to have a "natural death." The redefinition of renal failure is even more recent. As a matter of fact, in my memory, the dilemmas of resources and medical decision-making at the end of life have been pressured as much by the advent of dialysis as by the ventilator.

Early ethical and practical discussions about dialysis treated it as a semi-chronic treatment to be used with the expectation of a kidney transplant or to give the patient a chance to heal. The reality of life and bodies led to restrictions on who qualified for dialysis during the early years, and doctors still make referral determinations based on age and other health factors. (See this article for more on treatment of ESRD and this one on the symptoms and side-effects of dialysis. Remember that these numbers concern outpatient and ambulatory patients, not patients in the ICU with so many other complications.)

Wesley Smith, the author of The Culture of Death, is discussing the ethics of the care of Andrea Clark on his blog, Secondhand Smoke. He and the lawyer for Mrs. Clark's family are complaining of the lack of "due process" in medicine.

However, they reject the process in place. Perhaps there are not enough lawyer-guided steps? Should judges practice medicine? Are all doctors potential slaves who must suspend their own judgment and consciences? How far will we take this - remember, some (lawyers, doctors, activists) believe that I am abandoning patients when I refuse to refer for abortion.

Doctors don't practice medicine by "due process." We use evidence and experience. While some of us love our algorhythms, "cookbook medicine" doesn't always serve at the extremes of disease and life. We must, however, plan and anticipate for the consequences of each decision. And our experience will influence each step and choice.

There is no conspiracy, here. There is common education, experiences and evidence.

Whether Mrs. Clark has been in the hospital since November or January (the accounts I've read vary), there has been a long trial of intensive technological intervention in order to give her heart a chance to heal, her brain a chance to resume its drive to spontaneous breathing, her kidneys a chance to begin filtering the blood and again make urine.

I hope the family is prepared for the coming decisions when Mrs. Clark's heart fails, when her hepatic congestion makes her liver fail, when a stress ulcer begins bleeding, etc.

Perhaps one change needed is a process for the doctor to determine that no new treatments will be added, while continuing the current intensity of treatments. While it's true that there is no ethical difference between one life saving treatment and another, the burdens of treatment add up, with the numbers and the length of time the treatments are used. From what I've seen and heard, though, the law isn't very clear on this option, and the lawyers and family would be - and perhaps have been - just as hostile to the idea of limits as they are to stopping the dialysis.

Wasn't St. Luke's the hospital that led the way in heart transplants . . . that led to kidney transplants, etc.? What are the limits?

Edited for spelling "algorhythms" - 11-03-06

Make any cell into a stem cell

At last, a scientist confirms what I've believed for quite some time: the future of stem cell therapy will involve using the patient's own cells.

MonstersandCritics.com, a website that often deals in cutting edge bioethics and scientific and medical research, gives an early report on an upcoming article covering the work of Stephen Davies, a professor of neurology at Baylor University in Houston, Texas. Dr. Davies is using rats in his research, not humans. He has developed a treatment using embryonic stem cells that make astrocytes to greatly decrease scarring in the rats when they are given a spinal cord injury.

Dr. Wise Young, a neuroscientist whose specialty is treating spinal cord injury and who is currently investigating umbilical cord stem cells, discusses the problems with the ethics of using embryonic cells.

Even so, this could be a short-term dilemma: Young said he is confident that it won`t be long before scientists can make any cell into a stem cell.

'A stem cell is just a cell expressing certain genes, and there`s nothing more mysterious than that. We just have to know what the genes are,' he said.

What are human embryos?

Once again, a poster, SR, confronts us with the question of the nature of human embryos. Because they don't look right. Because they can't do enough.

There's no question that the embryos involved are human embryos. They were created purposefully and intentionally. Human gametes were used, without question. If human cloning is ever successful, then human nuclear material will be used. They are no more "use" to the researchers than the animal embryos that SR mentions, if we don't know whether they are human or not!

If not at fertilization (or generation, in the case of asexual reproduction), then when?

There is no other clear moment when we can say that this organism, this human being did not exist before, but there is this human being here, now.

The embryo is organized. He or she is an organism. His or her parents are human. He or she is a human. And he or she deserves the same protection from intentional, institutional killing orenslavement that the rest of us cherish and depend upon in order to have the time, technology and knowledge to carry out the very science that we are discussing.

More on Texas Advance Directive Law

I’m sure that I’m not the only one who has spent some quiet time thinking about Mrs. Clark and her family. And, I hope that those of us of faith have been praying.

I keep reading that the ethics committee has the “final say” on whether or not the life saving treatment can be stopped. That is not true, since only a doctor can practice medicine in Texas, the doctor actually has the final say, unless a new doctor willing to take over care can be found.

Please take a look at the law, especially 166.046, about one third of the way down.

The doctor has refused to continue what he or she says is inappropriate medical intervention that is not in the best interest of the patient. Treatment is usually considered inappropriate if it causes undue burden to the patient that outweighs the benefits or if it is not really treating her: if it is not allowing her lungs, heart, brain and kidneys or her skin time to heal or if it is not helping her heal at all, but is only prolonging her dying while other complications build up.

The ethics committee does not actually make any treatment decisions. The committee is charged with evaluating whether the treatment is medically appropriate or inappropriate, and in this case the committee has agreed with the doctor.

Again, maybe it would help if people think of the provision in the law as a “conscience clause.” Don’t forget that the doctor may be refusing to withdraw or withhold treatment – not just refusing to continue treatment. Before this law, doctors had to act on our own, risking lawsuits even when we did follow the Advance Directive. Sometimes, we made these decisions ourselves if no one else would or could, and we got another doctor to sign that he or she agreed with us.

However, if the doctor disagrees with the committee, he still has the option to transfer the patient to another doctor’s care.

The patient, or the person making the decisions for the patient, has the same option.

Finally, there is subsection (g), which allows the patient or the patient’s decision maker to petition the court to force the doctor to continue life saving care if the court thinks that there is a reasonable chance that another doctor or facility can be found that will accept the patient in transfer.

Most importantly, though, the doctor is not going to kill the patient. He is not going to stop artificial nutrition or hydration while refusing natural food and water. He is not going to smother her or give her poison. Unless her heart gets stronger, her brain causes her to begin breathing on her own again and/or her kidneys begin filtering her blood again, her disease will kill her and she will die a natural death.

The doctor is refusing to continue to write the orders and to monitor the intensive, life saving treatment that he or she believes is prolonging the patient’s death. If it is true that her heart is failing and that her kidneys will never function again and she will never breathe on her own again, then Mrs. Clark will never leave the ICU and she will most likely die within a few weeks, probably of a heart attack, lung damage that can’t be overcome with the ventilator, a severe, overwhelming infection, or a massive intestinal ulcer that causes her to bleed to death.

Remember, Mrs. Clark has been getting worse for about 6 months.
Warning: the following hurts to write, so it may be too graphic and painful for some readers.

I don’t know all the details in this case, but I can imagine what is going on from experience and the parts I do know about from reading the DU post, Right Wing News and Winds of Change and the original blog at the Chronicle.

Mrs. Clark has been in the hospital since November, 2005. Her heart is failing, she is on a ventilator because her brain does not stimulate her to breathe, and she has kidney failure that requires that she undergo 4 hours or so of hemodialysis at least 2 times week. She can’t go to the dialysis clinic while on the ventilator, so the machine must be brought to the ICU. She also has the underlying heart disease that caused her to need the surgery last November, and it sounds as though the infection aggravated her heart failure.

Between dialysis treatments, the fluid in the patient’s body increases and builds up, making treatment of her heart condition and the maintenance of her blood pressure and ventilation more difficult. She will need constant adjustment of her IV medications to control her blood pressure. The medicines will affect the blood flow in her fingers and toes.

Her ventilator settings will need adjustment, and the nurses will continue to suction the tubing and the patient’s upper airway to keep it clear.

Ventilation tubes and IV’s, as well as any feeding tubes or urinary catheters will have to be changed out periodically. There will be frequent blood tests to check on the kidneys and liver, blood count, look for infection, etc. Dialysis also removes some nutrients that must be replaced. Mrs. Clark’s fluids will be closely followed and severely limited so that the fluid doesn’t build up too fast.

People with kidney failure also have problems with anemia, since the kidney produces erythropoietin to stimulate the bone marrow. The lungs and kidneys each affect the blood pressure by hormones and blood vessel changes. The artificial feedings, the medicines to maintain the blood pressure, and the fluid build up as well as the backing up of blood from a poorly functioning heart can cause the liver to stop making the proteins that are required to stop bleeding. Decisions will have to be made about blood transfusions and clotting factors. Eventually, if Mrs. Clark’s heart doesn’t give out as the doctor believes, she will develop an overwhelming infection or she will start bleeding somewhere – usually in the gastrointestinal tract - and that will be the point where not all the medicines and technology that we have will be able to save her.

Hard decisions at end of life

There's a woman named Andrea Clark whose family is fighting the decision by her doctor to stop life saving care at St. Luke's Hospital in Houston, Texas. The story has been reported on World Net Daily and several blogs, including this one at the Houston Chronicle. (Warning, there are links to the Democratic Underground threads by one of the sisters - DU posts, and even the titles of the posts, are full of coarse language.)

This is definitely one of the "hard cases."


I think I would agree with her doctor, although I believe I'd go much more slowly and talk with the family until they agree that I'm at least trying to give care in the best interest of Mrs. Clark. I'd be against continuing dialysis in this case, on top of the ventilator, her heart disease, and the loss of mental capacities. The actual mental status the major point of dispute, evidently, and finding evidence that the family believes and trusts would be my first priority. (As a matter of fact, I'd almost bet that the doc thought the ethics committee process would lead to that end and show the family that he is right. Instead, they don't trust the committee, either.)


There are no facilities for chronic care of patients on ventilators who need hemodialysis for kidney failure. And the dialysis facilities can't handle a patient that comes in to the clinic two or three times a week on a ventilator. So Andrea Clark will have to stay in the ICU bed.

From what patients have told me, dialysis can be physically uncomfortable even when the patient knows why we're doing it to them. The kidney failure, even with the dialysis, adds to the lack of healing and to the bad circulation that aggravates the bed sores she's reported to have. And the ventilator limits the turning and repositioning the nurses would do to prevent the bedsores in a patient who can't move for herself.

The Texas Advance Directives Act has a portion, .046, which concerns the doctor who refuses to follow the request of the patient or his surrogate.

Every time I read the part of the law that is in dispute, I come away thinking of it as a "conscience clause" with an appeal process for anyone with a different conclusion, due to their conscience.

That portion of the law and its history has been described and explained very well by Katherine Jean Lopez in the National Review Online blog, "The Corner," back when Terri Schiavo was being refused oral as well as artificial nutrition and hydration:

But according to a source familiar with what went down in Texas, the then-governor signed into law the best bill he could get at the time, improving an already bad situation. Here’s some background explained:
In August 1996 the Journal of the American Medical Association published an article describing procedures then in effect in Houston hospitals. Under these procedures, if a doctor wished to deny a patient lifesaving medical treatment and the patient or the patient's surrogate instead steadfastly expressed a desire for life, the doctor would submit the case to the hospital ethics committee. The patient or surrogate would be given 72 hours notice of the committee meeting would be allowed to plead for the patient's life at it. During that short 72 hour period, the patient or surrogate, while preparing to argue for life, could also try to find another health care provider willing to give the lifesaving treatment, food or fluids.
If the ethics committee decided for death, under these procedures there was no appeal. There was no provision that the food, fluids, or lifesaving treatment be provided after the decision while the patient or family tried to find another hospital willing to keep the patient alive.
So under these procedures, the hospitals in Houston were denying life-saving treatment, food and fluids against the wishes of patients and their families, when the hospital ethics committees said their quality of life was too poor. Patients and families were being given only 72 hours after being notified of the proposed denial to find another health care provider.
In 1997 there was an advance directives bill going through the Texas legislature that would have given specific legal sanction to such involuntary denial of life-saving treatment. An effort in the Texas legislature to amend the bill to require treatment pending transfer to a health care provider willing to provide the life-saving treatment had been defeated. When that bill reached Governor George Bush’s desk, he vetoed it, and said he was vetoing it precisely because it authorized hospitals to deny lifesaving medical treatment, food, and fluids against the will of the patients.
But even without that bill, these procedures were still going on. So there was an effort in the next sitting of the legislature, in 1999, to pass protective legislation. Unfortunately, the votes just weren’t there to require lifesaving treatment, food, or fluids be provided by unwilling hospitals. So there were negotiations that resulted in a bill that gave partial protection. That 1999 bill:
first, formalized more protections for in-hospital review
second, gave patients 10 days of treatment while seeking transfer, and third, authorized court proceedings to extend the 10 days for reasonable additional periods to accomplish transfer.
Now this was not what patient advocates wanted and it wasn’t what Governor Bush wanted. However, it was an important advance over the existing situation of no legal requirement of treatment pending transfer, for any period of time. The votes were not there in the Texas legislature to accomplish a more protective bill. So Governor Bush signed it because it was an improvement over the existing law.

They just don't get it

A few new examples that some people just don't understand the meaning of "pro-life":

Yesterday, my State Representative refused to introduce me on the floor of the Texas House of Representatives because I was an "instrumental" "idealogue" for giving presentations about her support of a clone-and-kill bill for her opponent during the primary campaign. Then she talked to the Austin American Statesman reporter to tell him why, and he called me. I did get to explain that in politics, we always have to choose between the candidates and that "I'm all for stem cell research, I just wouldn't kill anyone for it." We were a blog item.

Then today I got a comment on a post from April 14th about the Texas Cord Blood Bank. The comment reminds me that I shouldn't "close the possibility" of using embryonic stem cells. As I pointed out in that post (and this one), we can't consider the creation and destruction of embryonic humans for the purpose of research or for therapy of another human. We can't "kill anyone for it."

Each and everyone of us was an embryo at one time. If we had been killed or harvested at that time, we wouldn't be, now.


That's the point that Michael Gazzaniga doesn't seem to get, any more than he did in the past. He spoke to York (Pennsylvania) College students earlier this month, saying,

During his talk, he presented different arguments people have used to debate the issue, one being that doing the research endangers a potential life.

"Everybody in this room values human life," Gazzaniga told the students. "Look around you. Look at your loved ones. Do you see a hunk of cells or do you see something else?"

A group of cells in a petri dish have no brain, no memories, he said. But some people against the research believe the cells are equal to an adult because they have the potential to turn into a life, given the right circumstances, such as being placed in a woman.

Gazzaniga used an analogy.

Think of The Home Depot, Gazzaniga said. Perhaps, in one Home Depot there are enough tools and people to build 30 houses. If Home Depot burns down, the news headline would read "Home Depot burns," not "30 homes lost."

No, my friend who is sitting next to me is not a blob of cells. But then, he's wasn't a blob of cells with the potential to become a human being, even when he was an embryo. He was an organized organism. That organism has continued to this day, without the purposeful action of another, intentional in the case of the destruction necessary to embryonic stem cell research.

As others have pointed out, it's natural for us to feel more emotional attachment to the people that we know and love and who are easily identifiable as "persons." But, just because I don't recognize a given human being as a "person" does not make him any less a human being or any less human-enough to deserve protection from intentional acts to kill him. After all, as a woman (and a talkative physician), I wouldn't be considered a "person" in much of the world.

Who owns you? by LifeEthics.org

And how much information is owed to you if someone can make a buck off your body parts?

The New York Times recently discovered informed consent. Rebecca Sklook has written a fantastically informative article, "Taking the Least of You," (free subscription required) for the magazine, published April 16, 2006.

The article explains more about patents on human tissues, which was touched on last week, in my post on the patents on human (and all primate) embryonic stem cells.

It is more than worth your time to read the article, for the history of a few key patients and legal rulings. Hopefully, Ms. Skloop will also stimulate more discussion in public venues of the commercialization of much of scientific research and about the duties of universities, our doctors and even a thought or two about judges who rule that patients' tissues are abandoned when they are left with our doctors. There is much to consider in the very brief discussion about the work-around in the selling and buying of human tissues. (An interesting observation: Ms. Skloot does not mention the HeLa cells, the history of which is the subject of her new book.)

"The truth," he [Catalona, one of the doctors who lost control of samples to the university he worked for] told me, "is that the interests of patients and science often conflict with the interests of the university. And sometimes universities protect their interests to the detriment of the patients."

What it all comes down to is that you do not own the parts of you, if there is a utilitarian purpose that unscrupulous doctors, universities, and lawyers and judges can perceive or conceive of for those parts. (Money talks and no one wants to die - I guess these age old motives still rule.)
I doubt than many of us consider what happens to our blood at the laboratory or to that skin tag the doc cut off and sent to the lab.

Today most Americans have their tissue on file somewhere. In 1999 the RAND Corporation published a report (the first and, so far, the last of its kind) with what it called a "conservative estimate" that more than 307 million tissue samples from more than 178 million people were stored in the United States. This number, the report said, was increasing by more than 20 million samples each year. These samples come from routine medical tests, operations, clinical trials and research donations. They sit in lab freezers, on shelves or in industrial vats of liquid nitrogen. They're stored at military facilities, the F.B.I. and the National Institutes of Health. They're in biotech companies and most hospitals. Biobanks store everything from appendixes, ovaries and skin to sphincters, testicles and fat. Not to mention blood samples taken from most children born in the United States since the late 60's, when states started mandating screening newborns for genetic diseases.

and

Editors' Note

An article on Page 38 of The Times Magazine today about human tissue includes an outdated reference to a lawsuit between Washington University and Dr. William J. Catalona over ownership of samples that he collected while employed there. On Friday, after the magazine had gone to press, the presiding judge ruled that the university “owns all biological materials, including but not limited to blood, tissue and DNA samples” that it stores.

Texas begins cord blood banking

Texas has one of the 20 national cord blood banks and is now beginning to recruit donations from mothers, according to this article in the Brownsville Herald.

A statewide blood bank soon will begin collecting umbilical cord blood, which has the potential to save the lives of leukemia and lymphoma patients, in the Rio Grande Valley.

The Texas Cord Blood Bank, a division of South Texas Blood & Tissue Center in San Antonio, will start collecting cord blood in May from consenting families at Valley Baptist Medical Center in Harlingen and Brownsville, Carmen Davila, spokeswoman for the center, said.

“We wanted to expand to the Valley because of its diversity,” Davila said. “That’s something that is key and can improve the chances of a (donor-recipient) match.”

Cord blood, which is extracted from the umbilical cord and placenta after birth, often is rich in stem cells, or cells that have not yet differentiated. These cells can produce many other types of blood cells, and therefore can be used to treat leukemia, lymphoma and blood disorders.

More and more doctors are using cord-blood stem cells instead of bone marrow stem cells to treat patients with leukemia, Brownsville oncologist and hematologist Dr. Balesh Sharma said.

With cord blood, “there’s a low risk of complications after the transplant,” Sharma said.

Some bone marrow transplant recipients are at risk of “graft versus host disease,” a possibly fatal complication in which the donated cells attack the recipient’s tissues, Sharma said. Cord blood transplant recipients are at a lower risk of this complication.

Unfortunately, the reporter ended the article with a comment that embryonic stem cells would be even better than the umbilical cords stem cells.

Well,she might be right if the embryonic cells didn't require oocyte donation, the generation of a human embryo and then much more work and time to expand the number of cells and as-yet unknown techniques to ensure that the cells become exactly the sort of cells we need. Or, if anyone had actually ever been successfully treated with embryonic stem cells.

European Union restricting embryo destruction

Be sure and read this week's "Lifematters", the bioethics column in Christianity Today which is written by Nigel Cameron, Ph.D. This week, the topic begins with an overview of the goals of transhumanists and then links to the various news articles on successful adult stem cell research and moving on to the controversy surrounding destructive embryonic stem cell research in the European Union.

Dr. Cameron points out that, while focusing on embryonic stem cells, the US media ignores the greater issue of changing humans through biotechnology and the facts that not only are there current treatments and great promise resulting from adult stem cells, there have been no benefits from embryonic stem cells.

The "mainstream media" also ignores that other nations have policies even more restrictive than that in the US. They ignore the fact that nations such as Germany, Austria and even France and Canada have criminalized what our government refuses to fund, but has not outlawed.

From the article in The Scientist::

"Germany, Austria and other nations opposed to EU funding of human embryonic stem cell research proposed an EU funding ban this month in Brussels at a meeting of the EU's 25 national science ministers, raising concerns that the minority group could force nations to remove this funding from the newest budget, even for scientists in countries where the research is legal.

"The six nations -- including also Italy, Poland, Malta and Slovakia -- failed to win additional backing at the meeting for a funding ban, but do hold enough combined voting power in the Council of science ministers to form a so-called "blocking minority." This means they could halt enactment of the EU's next science funding program for 2007-13, known as Framework Programme 7 (FP7), unless wording is added to the final FP7 document that would ban EU funding of human embryonic stem cell research.

"Under Framework Programme 6 (FP6) guidelines, the EU gives funding priority to human adult stem cell research and will not fund any research on embryonic stem cells conducted in member states that forbid the research. Under FP6, eight projects involving human embryonic stem cell research have been funded and nearly 100 involving human adult stem cells have received funding approval, said Antonia Mochan, spokeswoman for EU Research Commissioner Janez Potocnik.

"Mochan told The Scientist that Potocnik has recommended that current guidelines pertaining to funding of human embryonic stem cell research in FP6 be retained in FP7. Although the six nations oppose this proposal, 15 nations agree, and four are neutral. Before any FP7 money for research can start flowing, a final plan must be approved by a qualified majority of the Council's 25 science ministers and also by the European Parliament.

"Daniel Pipeleers, professor at Brussels Free University-VUB and director of the JDRF Center for Beta Cell Therapy in Diabetes, which will receive about €1 million from the EU in direct support of human embryonic stem cell research from 2005-10 under FP6 guidelines, told The Scientist that he is concerned. (According to Mochan, already-approved FP6 money would not be affected by changes in FP7.)

"Pipeleers added that a small group of nations should not impose a minority opinion on the EU. "I don't think they can decide for the whole EU," he said, adding that successful research in human embryonic stem cells requires collaboration among scientists across the EU, involving also teams working on adult stem cells, as well as ethicists. "Trying to block EU incentives and support for such European scientific collaboration goes too far."

"This is a familiar situation to EU scientists -- opponents of human embryonic stem cell research actively sought an EU funding ban in FP6, Pipeleers said, but eventually accepted the current guidelines. They might not give up as easily this time, he added.

"In an interview with The Scientist, Florian Frank, a spokesman for Germany's new Minister of Education and Research, Annette Schavan, who strongly opposes human embryonic stem cell research, said that Germany's position is that EU funding should not be used for research projects that are not legal in Germany, even if those projects take place in other countries. If EU money is being used to support research not legal in Germany, "then we have something to say about it," he said.

"Frank added that Germany would continue trying to convince other nations to accept this position. "This is politics. You try to convince the others." However, he declined to say if Germany would form a blocking minority if the FP7 does not ban EU funding for human embryonic stem cell research."

As would be expected, the representatives of Germany will not support money from their country's taxes going to research that would be illegal if carried out in that country. For some reason, this is considered a minority's blocking the goals of the majority.

As the EU is a "Union," and has a set of rules in place for determining the collection and dispersal of funds, why shouldn't the members follow those rules?

Follow the money

Yet another government-employed scientist resigns, supposedly due to the Administration's life-affirming policies. But, the resignation announcement is - once again - actually the announcement about a new job in the private sector. And the criticisms are - coincidentally, I'm sure - as much in favor of the new employer and that employer's (wishful) claims on federal funds as they are criticisms about the Administration's refusal to hand over those funds.

Wired News has a 3 page on-line interview with Mahendra Rao, the leader of the National Institute of Health's stem cell unit. Rao has a new job at Invitrogen in Carlsbad California. I'm sure he has no hopes of new and lucrative patents and business success. Especially in light of the fact that California has pledged $3 Billion dollars to what is essentially start up money for a bunch of private firms.

All of the men and women who complain about the Administration's policy on funding for stem cells act as though the rules have changed on them. In fact, if they've changed, it is in order to become looser. No other Administration has ever given money to research that depends on the (in this case, the past) destruction of human embryos. The Clinton administration set up the deal for the production of the now-funded cell lines, but didn't appropriate any money for the research. (Or for the required destruction of the embryos.) All such funding is limited by Congress and the Hyde Amendment.

The rules have always been that no human research subjects are subjected to experiments that do not have a reasonable expectation of benefit to that human, unless that human can give full informed consent. Even then, the research could not have the expectation that the human would die as part of the intention of the research protocol. The more recent rules, necessary after some scientists decided they didn't have to follow the above rule if they simply redefined "human," is that no federal funds are used to support such research.

In this case, the embryonic stem cells that are available were created without federal funding. There was the specter of more such lines being created - as we have all too well seen- and so the President decided that the compromise to allow some pilot research would hopefully spare human lives while allowing time for some of the preliminary research to go on.


The only thing we need to change is the definition of human being, which is now variable, depending on the utility it has to whomever. And, so, the definition varies from use to use. One person may feel that it's after the entire body is delivered. Or, it's after implantation. Or, it's after developing the ability to feel pain - which changes according to the purposes for defining "pain."


This constant redefining of human being ignores embryology, taxonomy, and common sense. But it's absolutely necessary to continue to utilize the technologies coming out of destructive embryonic research. Because 5 years of research has confirmed that none of the frozen IVF embryos will work in living current or future human beings without further processing. As in gestation in a natural or artificial uterus. Or possibly - if anyone ever gets it to work - through somatic cell nuclear transplant - which will also require gestation in a natural or artificial uterus.


In the meantime, there are ongoing trials and ongoing recruitment of humans for treatments with non-destructive stem cells and all sorts of factors to recruit and stimulate reproduction of their own stem cells and the cell lines and organs supposedly sought by Hwang and Rao, with their red herring trials.

Take a look at these, on diabetes, both Type 1 (juvenile) and Type 2 (adult onset):
http://www.clinicaltrials.gov/ct/show/NCT00239148?order=46
http://www.clinicaltrials.gov/ct/show/NCT00239187?order=47

Miracles - Can Nature explain the Supernatural?

It's Palm Sunday. So, in a rare departure from my usual, there's a bit of religion in today's post. I'm leaving the physical and moving more definitely into the metaphysical for today.

There's been a big ballyhoo over a prayer experiment on heart patients and even a recent article speculating about how and whether Jesus Christ walked on water.

(No, I'm not kidding - really: "imagine an ice bridge in the middle of the lake that Peter (and the rest of the occupants of the boat) couldn't see . . . ??? Give me a break.)

(While we're at it: I don't believe that one of the most important variables was covered in the prayer experiment: did the ones who were prayed for *believe*? Belief is one of the elements - although not absolutely necessary - of the placebo effect - that can yeild results from 30%-70% of the subjects.)

An article by George Johnson in todays' New York Times, attempts to cover the debate, which it titles, "Science and Religion, Still Worlds Apart."

Actually, couldn't they be Cosmoses apart?

In the end, it comes down to "In the beginning. . . ."


The whole subject seems to boil down to the age old question of "Where did I come from?" And which sometimes seems like an age old war. As a matter of fact, "war" among the supernatural is one of the "supernatural" explanations for why everthing is the way it is.


Anyway, the question has two main, competing factions, these days: 1. Everything just is, there is no Creator,and reality, including the existence of the humans who are speculating on reality, can be explained as the current outcome of natural progress of natural phenomena, and 2. There is a Creator of our Cosmos, and therefore, ultimately, a Creator of us.

(Just in case you didn't know: No one's ever been able to answer the "in the beginning" question satisfactorily to me, without the Creator similar to the one of the Judeo-Christian Bible.Before I answer "And who created God, I just think they should answer how natural phenomena came from no-natural phenomena.)


Logically, a Creator of the "natural" would have to be outside of the natural dimensions of what He created - He would be "supernatural." So miracles would be phenomena that are consistent with the "supernatural" outside of our reality, but we can't measure them or understand them.

Notice I said "consistent with the 'supernatural.'" I meant more than "explainable by the existence of dimensions and reality outside of ours." In order for me understand (what I don't understand), I have decided that there is order Out There. This Cosmos that I know is a subset of that one, and that while the other does not have to obey all of the "natural laws" of this one, it does have natural laws of its own, which are, in fact natural laws of ours.

As in the cliche'd two dimensional "Flatworld" vs. the 3 dimensional world we live in. Or even Plato's cave dwellers who live in shadow and can't turn around. (pdf format)

You and I can comprehend our nature, but, by definition, we can't understand the "super-natural."

Which doesn't prove that there is, a "super-natural," of course.


But, it would go a long way to explain why what we believe are miracles one day can be explained as natural phenomena the next.

Well, that and we develop better measuring and recording tools all the time.


The NYT piece does end well, though:

"In the 1902 book "The Varieties of Religious Experience," William James gave what he considered the broadest and most general definition of religion: "The belief that there is an unseen order, and that our supreme good lies in harmoniously adjusting ourselves thereto." For all the advances science has made in the century since — relativity, quantum mechanics, computational theory — it has not found a way to measure the immeasurable, or prove that it cannot exist.

Another viewpoint on medical news

The Christian Medical and Dental Association has a weekly newsletter that can be read without subscription on line. The content changes each week.

This week there are two of the three topics that I'd like to point out.

The first is the article on conscience in medicine and CMDA's policy on the actions of our members (I'm a member.)

Although we ask each member to affirm their belief in, we don't tell them how to be a Christian, or make them promise or swear that they'll follow a set of do's and don'ts. However, there are those who would smother the conscience in all of us, since they believe that (and their beliefs are so much more compelling),

The door to "value-driven medicine" is a door to a Pandora's box of idiosyncratic, bigoted, discriminatory medicine.

Hey! I was just doing my job!


The second is a comment on "Designer Babies," by fellow Texan and Chair of the Texas Physicians Resource Council, Linda Flower, MD.

Nanotechnology's first recall

It's not grey goo, and no one is sure what's going on, but we have our first recall of a commercialized nanotech product.

Wonder what the ethics board will say?


From the Washington Post:

At least 77 people reported severe respiratory problems over a one-week period at the end of March -- including six who were hospitalized with pulmonary edema, or fluid in the lungs -- after using a "Magic Nano" bathroom cleansing product, according to the Federal Institute for Risk Assessment in Berlin.

Symptoms generally cleared up within 18 hours, though some had persistent breathing problems for days.
The spray is meant to be used on glass and ceramic surfaces to make them dirt- and water-repellant. "The distributors have launched a recall and advised against using the sprays," according to a statement from the institute, which is conducting tests on the product.

Nanotechnology is an emerging field of materials science involving substances smaller than one-ten-thousandth the width of a human hair. The tiny specks have chemical properties that make them potentially useful in engineering and medicine. But some can clog airways or trigger immune responses.

Pro-lizard, pro-science, anti-human

The Austin American Statesman has an article in Wednesday's paper on the unwise words of the herpetologist at the University of Texas (Austin), which included suggesting the specific virus needed to eliminate 9 out of 10 humans on earth.

As a sort of defense (equally unwise, in my opinion) one of the lizard man's UTAustin colleagues defends the herpetologist with,

"There's a strong anti-science sentiment in the country right now," Hillis said."

Oh, good grief!

The only identification that is necessary for those of us who object is the identification with the humans around us. We have a concern for our own species that seems understandable to me.

After all, we are the only species that provides Pianka with enough calories, the means to travel around the world, and the various protections that allow him to sit safely in Austin in his old age, playing with lizards all day.

It's funny that the professor doesn't seem to be bothered by the lengthened life span that has accompanied our population growth. That could be because he is 67 years old.

Humans, besides adapting the environment to our needs and a concern for the well-being for even the lives of those (human and non-human) who cannot help us and our own offspring, are also different from all other animals because we learn, record and share what we learn, and are able to learn from those records.

That's how the professors make their living, so I would think they could see a pattern: Intelligence means that lessons and other messages can be shared without resorting to fear and implied or real violence.

Too bad they're not smart enough to see that.

The Joke's On Us (healthcare finance)

From a fellow family physician, more reasons to avoid expanding centralized, government insurance:

The Joke's On Us as ALWAYS!
Remember that 4.4% Fee Schedule Reduction we had to start the year from Medicare?
Remember we were given that back through all the efforts of the AMA and AAFP?
Forget about the fact that the fee reductions are going to come over the next few years - from anywhere from 12% to 27%.

Here's the bigger farce:

Many of the insurance companies that were secondary carriers for Medicare, still have not resumed the correct schedule, so your 4.4% reduction sticks and the $$ you were supposed to get back from the beginning of the year you are still not getting back.

But here is the real JOKE.
Having seen what my billing has to accomplish in terms of extra time, extra effort and the complexity of the accounting I was dumbfounded!
First we were getting dribs and drabs of $2+/- checks.
Now we have received this past week (and we expect many more to come) 4-5 checks from Medicare varying in size from $250 - $500 (rounding off). HOWEVER, these checks are hundreds and hundreds of individual accounts on patients we were paid the Medicare Fee Schedule less 4.4% .... each of these individual patient account items varies between $ 0.94 (that's right NINETY FOUR CENTS) and $ 9.02 with an average about $2-$3.
Can you imagine being a Billing person who has to post all these and the hourly costs and wages that goes into posting checks with so numerous payments of such small amounts!
Absolutely hysterical!
Sure you can create ONE big dump and cash the checks, but that will make the accounting of individual patient accounts incorrect and will make continued monitoring of reimbursements a near impossibility. So each little $ 0.94 and $2.70 and $3.30 needs to be adjusted out of each account and then reapplied to correct the account and account for these checks coming in.

I once received a $0.02 check from Medicare.

The doc figures that one of the larger checks will cost 10 hours of a biller's salary --- he will lose $40 in the book-keeping mix up on one $500 check, on top of the money he lost waiting for months to get paid for the work he did in giving medical treatment to a couple of hundred patients. He already had to pay his employees, rent, suppliers, etc.

This was in the midst of a conversation about the costs of billing patients. The consensus is that it costs about $5 to $6 to send a bill, so many do not bill for smaller amounts. Instead, we try to collect from the patient at the next appointment, in order to avoid "fraudandabuse".

Massachusetts is about to go bankrupt

And run off all the business left in the State.

More on that insurance scam plan from Massachusetts, this time from the USAToday coverage:

The plan hinges in part on two key sections: the $295-per-employee business assessment and a so-called "individual mandate," requiring every citizen who can afford it to obtain health insurance or face increasing tax penalties.

Liberals typically support employer mandates, while conservatives generally back individual responsibility.

"The novelty of what's happened in this building is that instead of saying, 'Let's do neither,' leaders are saying, 'Let's do both,'" said John McDonough of Health Care for All. "This will have a ripple effect across the country."

The state's poorest — single adults making $9,500 or less a year — will have access to health coverage with no premiums or deductibles.

Those living at up to 300% of the federal poverty level, or about $48,000 for a family of three, will be able to get health coverage on a sliding scale, also with no deductibles.

Free equals fraud

I wish I could applaud the Massachussetts initiative to require everyone to have health insurance. I haven't seen much to recommend the government as a responsible regulator of insurance or healthcare. Healthcare too easily becomes an entitlement that can be used in the way that circuses and bread were in old Rome: If you play along or they want your vote, you get State-issued bread and a general seating ticket to the circus. If you can be marginalized or demonized, you will be sacrificial fodder for the lions. The coordinated Medicare crowd will always want to be treated seperately from the rest of the insured, and it will always be useful to blame the greedy doctors for high costs, while ignoring the $125 Million yearly salary of insurance Execs.

Here's part of an op-ed on healthcare by Donald Devine, from the Washington Times. There is one possible mistake: if the doctor does not charge for a visit at all, then he is more than like safe. However, there is dispute about that belief and it's never been tested. Most advisors tell us to forget about professional courtesy, for example, since it might look like "fraudandabuse."

"God help us if we inadvertently write off charges or perform services that Medicare doesn't see medically necessary and bill the patient without an advance beneficiary notice (ABN) signed. The average citizen does not understand basic health insurance let alone all the rules and regulations surrounding it. So for them it is hard to understand why we cannot just write off their balance. They think physicians are money hungry. There are so many rules and regulations that are constantly changing there is really no way to keep up. Once you think you have it down something somewhere changes or is in the process of changing. I fear government in these instances. If I were to ever be audited and missed something my physicians would be at risk of huge fines and even jail. I then would be out of a job no questions asked. I do not believe that we have much control over our government as we are sometimes led to believe."
When one reads about doctors being hauled off to jail for fraud, odds are this is the cause: guilty not of fraud but of charity. If a health provider bills for either government program, it is subject to a federal audit. Every patient's record, whether Medicaid or Medicare or not, is scrutinized to assure that no non-government patient pays less than the government. A physician can fill out paperwork for an exception but who will take the time or the risk? If the health provider gives anyone an undocumented break this is "fraud" and it is off to jail for the foolish Mother Theresa.
The decline in charity by physicians documented in the study is guaranteed to get worse. It shows that most charity is performed by doctors working in small practices. Large practices already hire people like the student to assure they commit no charity. As the smaller practices become aware of how the government operates, they will perform fewer charitable acts.
The unique American attribute of private and local charity that has so amazed the world since the French observer Alexis de Tocqueville described it so vividly in the early 19th century will soon be regulated away, leaving a world for our children and grandchildren where it will be impossible to give free medical assistance for fear of being accused of fraud.

Bozell sheds some light on media - again (and again . . .)

Brent Bozell has long been a critic of the old mainstream media, with his Media Research Center.

Today, he has a column on Townhall.com in which he examines the bias of the Washington Post when it comes to coverage of the personalities on either side of the abortion debate. I recommend both a daily check on the news at the MRC website and reading today's Townhall column, in particular.

Science confirms true pain in 25 week premies

It has long been possible to observe very premature babies pull away from painful stimuli and react physically as though they were in pain by crying, showing faster pulses and breathing rates and even changes in their blood hormone levels that mimic pain response in older human beings. But that pain has been dismissed as mere "animal reflex," most recently by the Journal of the American Medical Association. (Never mind that we do not encourage anyone to cause pain in animals or that the authors of that last article are connected to the actual practice of elective abortion and could have motives other than the study of pure science. Such as justifying the procedure itself.)

However, there is now evidence by means of functional scans that show that the structures of the brain that are known to process pain are involved as young as 24 weeks. The on-line news service, Medical News Today, discusses the methods for measuring the pain response of premature babies in the nursery, as they undergo a heel stick for a blood test:

Brain scans taken while babies were having blood tests registered a surge of blood and oxygen in the sensory area in babies' brains, which indicates that the pain was processed in the higher levels of the brain. The somatosensory cortex is involved in processing sensations from the body surface and is known to be linked to pain sensation in adults.

The results were found using near-infrared spectroscopy, which - like fMRI scans - works by measuring blood levels and oxygenation in the brain. During clinical care work, essential for ensuring a premature baby's stability, eighteen babies aged between 25 and 45 weeks from conception were studied. Scientists registered the brain activity in the babies at the moments before, during and after nurses performed routine blood tests using a heel lance.

Professor Fitzgerald added: “The importance of this is clear. The UK has the highest rate of low birth-weight babies in Western Europe; 12% all babies born need some level of special care at birth (~ 80,000 per annum) and 2.5% need neonatal intensive care (~ 17,000 per annum). Estimates show that in intensive care each baby is subjected to an average of 14 procedures per day, many of which are considered by clinical staff to be painful, such as heel lancing for blood tests and inserting chest tubes. Furthermore there is evidence that these repeated painful procedures are a significant stressor and lead to increased sensitivity to other non-painful procedure. Since pain information is transmitted to the preterm infant cortex from 25 weeks there is the potential for pain experience to influence brain development from a very early age as the brain is highly malleable at this stage of development.”

The fatherhood question

Kevin T. Kevin questions my post concerning the rights of fathers to choose to be fathers or not to be fathers.


Irony was the point, Kevin.
There definitely is no child for hours to days after ejaculation. There's not even an embryo or fetus.

Where is the logic in determining the "personhood" based on one other person's arbitrary decision to kill or not kill? Surely the choice to not be responsible in the way that fathers are held responsible by the courts is much more private than the choice requiring licensed and regulated medical personnel, equipment and medication.

Ancient law holds that anyone who digs a hole is responsible for harm if anyone falls in that hole, even much later than the act of digging. It's a good law, calling for responsibility on the part of everyone who digs.

Genocidal elitist honored by the Texas Academy of Science

Recently, this blog mentioned the advocacy of "death with dignity" for all humans who desire the help of physicians and modern medicine in their quest for self-induced death. But, there's a worse ethical position, one I thought had died out (excuse the pun).

Eric Pianka, Ph.D, a tenured professor in the Integrative Biology department of the University of Texas (Austin) has advocated - and described in far too much detail - the deliberate and intentional killing of at least 9 out of 10 of the humans alive today. The report comes from a reliable witness, Forrest M. Mims III. Mr. Mims is Chairman of the Environmental Science Section of the Texas Academy of Science, and the editor of The Citizen Scientist.

This is another case of what I called in that earlier post, "elitists who don't follow their own advice. Possibly because they really do not believe that anything is better, after suicide or any other kind of death."

In this case, if the "scientist" followed his own advice - or induces one of his impressionable followers to do so - however, he would set off a random killing of billions of our fellow human beings. For the leadership of the Texas Academy of Science to follow through with their award to this man on the day of his irresponsible speech does not impress me with either the intelligence, competence or responsibility of that organization.

Humans are the only species which discuss or act on moral ideas. We are the only protection men like Pianka - or our children of tomorrow - have. Does anyone believe that the remnant of humans who survived a world wide holocaust such as the one Pianka proposes would govern by democracy or representative democracy? Would they preserve the right to life and liberty, much less free speech?

Sorry for the interruption

No technical difficulties, just attendance at Trinity International University's Master of Arts in Bioethics. This week marked the last of my classes. The program can be taken as an "executive" course, similar to many of the Master's of Business Administration courses which are attended in a couple of blocks of a few days at a time each semester. Last semester (Fall 2005) was the most intensive - 9 semester hours, with 4 days of class, usually from 9:00 am to 10:00 pm. This time, it was only 3 days, 6hours, 10 hours, and then 7 hours, for 4 semester hours.

The tough class this time was "Clinical Ethics." We had the privilege to learn under the guidance of one of the most experienced and qualified clinical ethicists, Dr. Robert Orr.

Wouldn't you hate to have me for a student? Or, if you're a fellow student, just imagine that the entire class is full of very bright men and women, who make you hope the teacher doesn't grade on a curve. To make matters worse, half are as young as my children, and they make me feel as though I'm every bit of my 50 years and then some.

As I type, a postmenopausal osteoporosis ad is on TV. I can't be that old, can I? But then, if I'm not that old, why did I pay attention to the Netscape ad for (replacement) "Knees designed for a woman," yesterday?


Anyway, back to class for the last few days:
It turns out that I know all the words for "withdrawal of care," but don't really believe in the concept, except in the case of truly futile care: the actual, certain cases where we're causing more pain than we're relieving or "prolonging death." On the other hand, at a gut level, I fully support a patient's refusal of treatment and even food and water. Providing I'm allowed to wheedle, nag and beg while presenting tempting food, water and nutrition as often as I want. Along with the pharmaceuticals to prevent nausea.

I can't find the "Mom's Ethics: the Gut Factor" guidebook.