Literature Search: Smoking exposure and kids

Texas will ban smoking in the homes of foster kids beginning January 1. For some reason, there are not many articles in the News on this subject. (There is this editorial from my hometown.)

I would guess there's not much media attention because the deadline is a month away and because the rationalization is supposed to be a slam dunk. I'm sure any objection won't be popular.

So, I did a Pub Med search or two, on "passive smoking ear infections," "otitis media," and some more I can't remember. Although I found quite a bit of assumptions and mention of increased risk, the data is not as conclusive as I expected, except for "wheezing." (I will have to admit that I wasn't surprised, since I remember some studies from the '80's and '90's that showed conflicting risks of cancer from second hand smoke at home in wives and in children of smokers.)

This article shows a correlation between carriage of Streptococcus pneumoniae in children whose mothers smoke, with a probability of P=0.016. I'm used to seeing numbers that show probability <0.01 or <0.05 - meaning that there's less 1% or 5% chance of being a coincidence.

Then there's this review in Pediatrics (free copy) that does show correlations, but no real data or tables.

On the other hand, I found some significant articles with no correlation or inconsistent correlation with childhood infections.

Free text and tables
"Respiratory Infections" from Norway study on over 3000 10 year olds.
Here's the table showing risk factors for ear infection, tonsilitis, and lower respiratory infections. (sorry, my skills aren't up to posting the table.)

This article shows no correlation with ear infection and passive smoke, although there is a correlation between being exposed before birth and after birth with recurrent ear infections:
Archives of Pediatrics, AMA (Free full text with free registration):

RESULTS: The cumulative incidence of ear infections was 69%. Of all participants, 38% were exposed to passive smoke, 23% were exposed to gestational smoke, and 19% were exposed to combined passive and gestational smoke. The occurrence of any ear infection was not increased by passive smoke exposure (adjusted risk ratio [RR], 1.01; 95% confidence interval [CI], 0.95-1.06), but was slightly increased by gestational (adjusted RR, 1.08; 95% CI, 1.01-1.14) and combined (adjusted RR, 1.07; 95% CI, 1.00-1.14) smoke exposures. The risk of recurrent ear infections (> or = 6 lifetime episodes) was significantly increased with combined smoke exposure (adjusted RR, 1.44; 95% CI, 1.11-1.81). Other risk factors for ear infection identified in multivariable analysis were race/ethnicity, poverty-income ratio of 2.00 or more, attendance in day care, history of asthma, and presence of allergic symptoms. CONCLUSIONS: Passive smoke exposure was not associated with an increased risk of ever developing an ear infection in this study. The increased risk found with gestational and combined smoke exposures has marginal clinical significance. For recurrent ear infections, however, combined smoke exposure had a clinically and statistically significant effect.

For those concerned about smoking risks for children, please consider reading this free article, which has been translated into English, from the Jornal de Pediatra, a fantastic review of the literature on risk factors ("RF") for recurrent and chronic ear infections.

In conclusion, although some authors declared the relation between RAOM and COME with passive smoking as established, others are totally against such affirmation. It may be said that passive smoking does not increase the chance of non-recurrent AOM (level of evidence IV). With regard to recurrent AOM and COME, passive smoking was classified as a probable RF (level of evidence II).

New House and Senate Revive Embryonic Stem Cell Bill

Wasn't there a Bill that promised to increase funding for (ethical) alternatives to embryonic stem cell research - using umbilical cord blood and other cells to produce embryonic-like stem cells? Will the Democratic controlled Senate and House re-examine that Bill?

Senator Harry Reid has promised long days for the first seven weeks in the new Congress. Speaker of the House to be Nancy Pelosi has laid out her priorities for her first 100 hours. Each has promised to bring back the legislation that the President vetoed in September, to use Federal funds on destructive embryonic stem cell research.

There's no mention in the news articles of the other bill, the "Alternative Pluripotent Stem Cell Therapies Enhancement Act" by Arlen Specter and Rick Santorum (current Republican Senators from Pennsylvania).

The Alternative bill, and the House versions such as the Stem Cell Therapeutic and Research Act, authored by Rep. Christopher H. Smith (R-N.J.), who was the chairman of the House Pro-Life Caucus at that time, would have increased funds for research to find new ways to produce stem cells without destroying embryos. It would have been directed to the research on umbilical cord cells conducted at Galveston University of Texas Medical Branch in cooperation with NASA and researchers from the UK to produce embryonic stem cells from cord blood. Similar work has resulted in masses of functional liver tissue the size of pennies and in lung cells that function to produce surfactant. There's also reports about blood vessels and heart valves that have been grown from cells in the amniotic fluid - so that babies who are found to have heart defects could have hope of transplants built from their own cells.

Unfortunately, what we're hearing about in the news and on the blogs, is politics as usual (just as in Texas) - the embryonic stem cell funding bill that would over ride the Dickey Amendment and the President's ruling of August 2001. It would also waste a ton of money, since so much would have to go to the Wisconsin Alumni Research Fund at the University of Wisconsin for the patent and royalty fees.

Ongoing discussion: science vs. religion

CBS' Blogophile, Melissa P. McNamara, has summarized the blogosphere comments on the Beyond Belief seminar, quoting LifeEthics and other wise and level heads (grin) (even if she did misspell my name):

Religion and science are not mutually exclusive, some suggest. "If you ask me ... a rational universe that is subject to measurements and study that yield consistant and ever sharper, more focused results in different labs and at different times does not preclude a Creator," Beverly Nuchols (sic)at LifeEthics writes.

Thanks for the pings, Ms. McNamara!

The conversation about science vs. religion is ongoing (along with the promotion of books) at Jewcy ( 4 day debate between Dennis Prager and Sam Harris on "Why are atheists so angry?" that continues in the comments, at Vox Populi (in several posts around November 27), Richard Dawkin's site (virtually all the posts - actually a good site for reading the op eds and articles around the Web dealing with this subject), BlogCritics and at The Edge (again, virtually all of the site - very high level discourse).

You can watch highlights or the entire conference at TSN, The Science Network.

Planned Parenthood's "Free EC Days" (for men and girls)

Planned Parenthood in Waco, Texas, Memphis, TN and Williston, Vermont, and probably a town or city near you, will host a Free EC (Emergency Contraceptive) day next week. (Waco on Dec. 8, Memphis and Williston Dec. 8. More sites can be found by searching Google or Yahoo for "Free EC Days" - including information from MySpace PP pages, and information on previous "Free EC" days before the med when over the counter.)

The Memphis Regional Planned Parenthood notice states:

We can provide EC to girls and women of any age and to men 18 or older. (emphasis mine)

The Waco Herald-Tribune

The event, billed as Free EC Day, is something Planned Parenthood affiliates are doing across the nation, said Pat Stone, education director for the local affiliate.

In general, it’s meant to raise awareness about emergency contraception.

But more specifically, it’s to remind women that the medication is now available without a prescription for people ages 18 and older.

. . .
That’s where Planned Parenthood’s event comes in, Stone said. The idea is that making the drug available for free might nudge some women into keeping a box on hand, she said. Planned Parenthood normally sells the medication for $25, but it costs up to twice that at stores around town.

Officials also are hoping the event will help remove any of the taboo or intimidation factor surrounding the medication or sexual health in general, Stone said.
Officials also are hoping the event will help remove any of the taboo or intimidation factor surrounding the medication or sexual health in general, Stone said.

For some women, all it takes is an initial visit to a health care provider for them to begin taking control of their sexual health, she said.

That’s why in addition to giving the drug away for free, Planned Parenthood officials also will be giving tours of their facility and handing out a price list for services, Stone said.

She added that men are welcome at the event and that it will be a come-and-go process to accommodate people who may have to stop by before or after work or during their lunch breaks.
(emphasis mine)

I'm very concerned that that Plan B is being given to minor girls, but especially about the promotion to men. This is the first time that hormonal contraceptives intended for women have been available to men without concern or knowledge of the women or girls who will be taking the medicine. How can there possibly be education or informed consent in the giveaways and over-the-counter sales in pharmacies, for the girl or woman who will be taking them. I'm concerned about the potential for abuse. Will men present the pill to the women as a reason to skip the condom? Will the women be faced with being forced to take the pill by their partners? And, since half of the partners of minor girls 15-17 years old who get pregnant are 2 or more years older than the girls, will the pill give license to child abusers?

As I've posted before (here and here), I don't believe EC, used as directed, will cause the loss of any embryos - there's good evidence that it does not block implantation and that it only works, when it works, to hamper ovulation and to interfer with the sperm getting to an oocyte or egg. It only has a contraceptive effect - it only needs to work - during the 5 days or so that a woman or girl is fertile - just before and the day of ovulation.

Unfortunately, JAMA (the article is reproduced on my blog), Contraception, and the British Medical Journal, reports show that even in women and girls who are part of a study and who receive education and follow-up, there is no change in unprotected sex, Sexually Transmitted Infections or pregnancy rates.

UK: Teaching children how to use condoms no help

This month, the British Medical Journal (sorry, subscription only) has published a report on a randomized controlled study on enhanced sex ed that failed to reduce the numbers of pregnancies or abortions in teen girls. Essentially, the "programme" involves education for boys and girls 13 to 15 years old, including teaching them to obtain and "handle" condoms (how to put them on), role playing and games about sexual situations. This is in contrast to "Conventional Education" in the UK, which is described this way in the report:

In the 12 control schools sex education for third and fourth years varied from seven to 12 lessons in total, primarily devoted to provision of information and discussion. Only two control schools routinely demonstrated how to handle condoms, and none systematically developed negotiation skills for sexual encounters. The cost of conventional education varied, with individual packages starting from about £20. Few teachers had more than one day’s training, which would have cost about £180 a day, and some had received none or only a few hours’ training.

Luckily, there are some good reviews online:
"Sex Education Fails to Cut Teenage Pregnancies" from the Guardian.

"Role playing sex classes fail to cut abortions," from the Telegraph.

An enhanced sex education programme for teenagers has proved no better than conventional teaching in cutting unwanted pregnancies or abortions, a detailed research study said yesterday.

The programme was based on an intensive £900 training course for teachers that was then delivered to 15-year-olds over three years.

Five years later, conception rates were measured in 20-year-olds who had been on the programme and compared with those in young people who had not.
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The teaching system, called Share — sexual health and relationships: safe, happy and responsible — included group work, role play and games. The teenagers were shown how to use condoms and access sexual health services and were given leaflets on sexual health.

The programme and research was devised and supported by the Medical Research Council (MRC) and the Education Board for Scotland, now Health Scotland.

Teachers in the schools used for comparison had less instruction or none at all.

"Sex education "only does so much'" from BBC News notes that schools are required to teach sex ed from ages 11-14 in England and Wales, but there has been no such requirement in Scotland.

And from the November 23 "Learning and Teaching Scotland" web site, we learn that the program was introduced throughout that region last week.

The UK press reports that the teen pregnancy rates under 18 are going down, from 44.3 births per 1000 girls ages 15 to 17 to 42.9 since 1998, and declared this a "success."

Edited 12/29/08 for labels.

Physicians to UK TimesOnLine: Abortion and Depression

The letter to the editors of the (UK, London) TimesOnLine one month ago from several physicians concerning the New Zealand report by New Zealand's Fergusson on the increased risk between abortion and depression (that article is online in pdf, here - and that issue is their free sample issue, here) was hard to find. So, once I found it, I thought I'd post it, with the link (I'll review it and the original article, later):

The Times October 27, 2006

Risks of abortion
Sir, Research published in The Journal of Child Psychology and Psychiatry in January has shown that even women without past mental health problems are at risk of psychological ill-effects after abortion. Women who had had abortions had twice the level of mental health problems and three times the risk of major depressive illness as those who had given birth or never been pregnant.

This research has prompted the American Psychological Association to withdraw an official statement denying a link between abortion and psychological harm.

Since women having abortions can no longer be said to have a low risk of suffering from psychiatric conditions such as depression, doctors have a duty to advise about long-term adverse psychological consequences of abortion.

We suggest that the Royal College of Obstetricians and Gynaecologists and the Royal College of Psychiatrists revise their guidance, and that future abortion notifications clearly distinguish between physical and mental health grounds for abortion.

ROBERT BALFOUR
Emeritus Consultant Obstetrician and Gynaecologist, Bridgend

PATRICIA CASEY
Professor of Psychiatry, University College, Dublin

MARJORY FOYLE
Consultant Psychiatrist, London

GREG GARDNER
General Practitioner, West Midlands

LIZ GUINNESS
Consultant Psychiatrist, Surrey

TONY LEWIS
Emeritus Consultant Obstetrician and Gynaecologist, Bridgend

LUKE PARSONS, QC
Barrister, Inner Temple, London

EVELYN SHARPE
Consultant in General Adult Psychiatry

ANDREW SIMS
Past President Royal College of Psychiatrists

PAM SIMS
Consultant Gynaecologist, Hexham

JOAN SMITHIES
Consultant Psychiatrist, Hampshire

TREVOR STAMMERS
General Practitioner, London

GORDON STIRRAT
Emeritus Professor of Obstetrics & Gynaecology, Bristol

ADRIAN TRELOAR
Consultant Psychiatrist, London

HANRI VOGELZANG
General Practitioner, London

Parachutes, Abstinence, Randomized Controlled Studies

There have never been any controlled randomized trials on "Parachute use to prevent death and major trauma related to gravitational challenge," according to this review published in the British Medical Journal in December 2003. And yet, in the nearly 3 years since it was documented in a prestigious peer-reviewed journal that the evidence supporting the use of parachutes by those who jump from planes is anectotal, Federal, State and private entities continue to support the private parachute industry.

The Government Accounting Office released a review (in pdf) on the accuracy and effectiveness of abstinence sex education programs, in response to a request by several members of Congress. Editorials from the Bangor (Maine)Daily News, the Atlanta Journal Constitution and others on the review indicate that abstinence education is "scientifically invalid."

The International Herald Tribune's headline reads, " . . . no-sex-before-marriage programs forgo accuracy, are ineffective."

The GAO report actually covers several ways that an entire alphabet soup of agencies and States fund abstinence-until-marriage programs, how these programs are reviewed for accuracy and efficacy. There are also descriptions of problems that have been found and corrected. There is a mention of studies that are pending that would be equivalent to the "randomized controlled studies" that will supply "scientific validity" to measurements of evidence comparing outcomes in children who participate in abstinence-until-marriage programs to those in abstinence-plus programs and those who receive no structured sex ed according to standardized end points.

None of the sources give any references for "scientifically valid" "abstinence-plus" or "if you do it, use a condom and a back-up method of contraception" sex ed.

If I may, I'd suggest that editors learn to read reports and perhaps take a class in statistics. Or, they could follow the recommendation of Smith and Pell:

A call to (broken) arms

Only two options exist. The first is that we accept that, under exceptional circumstances, common sense might be applied when considering the potential risks and benefits of interventions. The second is that we continue our quest for the holy grail of exclusively evidence based interventions and preclude parachute use outside the context of a properly conducted trial. The dependency we have created in our population may make recruitment of the unenlightened masses to such a trial difficult. If so, we feel assured that those who advocate evidence based medicine and criticise use of interventions that lack an evidence base will not hesitate to demonstrate their commitment by volunteering for a double blind, randomised, placebo controlled, crossover trial.

(Final emphasis, mine)

Beyond Belief: the Institutional Delusion of Scientism

The New York Times reports on "Beyond belief: Science, religion, reason and survival," a symposium sponsored by the Science Network at the Salk Institute for Biological Studies, which

began to resemble the founding convention for a political party built on a single plank: in a world dangerously charged with ideology, science needs to take on an evangelical role, vying with religion as teller of the greatest story ever told.

No one should be shocked that there was a conference of scientists (put on by the self-described "CSPAN for science") who condemned religion while outlining ways to replace religion with an awe for science. After all, these guys want to launch a TV cable network and Richard Dawkins has to sell his book, The God Delusion.

But, wow, when these "Scientism"-ists (see Voegelin quote, below) let go (from the New Scientist, subscription only):

The big challenge, according to Porco, will be dealing with awareness of our own mortality. The God-concept brings a sense of immortality, something science can't offer. Instead, she suggested highlighting the fact that our atoms came from stardust and would return to the cosmos - as mass or energy - after we die. "We should teach people to find comfort in that thought. We can find comfort in knowing that everyone who has ever lived on the Earth will some day adorn the heavens."

Like many of the others at the meeting, Porco was preaching to the choir, and there was no more animated or passionate preacher than Neil deGrasse Tyson, director of the Hayden Planetarium in New York. Tyson spoke with an evangelist's zeal, and he had the heretics in his sights. Referring to a recent poll of US National Academy of Sciences members which showed 85 per cent do not believe in a personal God, he suggested that the remaining 15 per cent were a problem that needs to be addressed. "How come the number isn't zero?" he asked. "That should be the subject of everybody's investigation. That's something that we can't just sweep under the rug."

This single statistic, he said, gave the lie to claims that patiently creating a scientifically literate public would get rid of religion. "How can [the public] do better than the scientists themselves? That's unrealistic." (Emphasis is mine.)

Other examples of public statements by scientists that the belief in God is dangerous include the comments of Robert Buckman, MD, an oncologist who gives talks concerning the correlation between right temporal lesions and “sensitivity” to religious experiences as well as violent and psychotic behavior. He cites surveys which lead him to believe that, “If you believe that there is a god, you are halfway to aggression,” because, of course, if your god told you to kill, you would have to do so. In the fall of 2005, the New York Times (available only for a fee, now - see Note 1) reported about scientist’s attitudes about religion and science, including the explicit statement concerning those working in science who believe in a Creator, by Herbert Hauptman, Ph. D., "this kind of belief is damaging to the well-being of the human race."

The late philosopher Eric Voegelin decried this attitude, describing the loss due to it:

"The transfer of [the pathos of autonomy and self-reliance that animates the advancement of science] from science to existence expresses itself concretely in the growth of the belief that human existence can be oriented in an absolute sense through the truth of science. If this belief is justified, then it becomes unnecessary to cultivate knowledge beyond science. As a consequence of this belief, the preoccupation with science and the possession of scientific knowledge has come to legitimate ignorance with regard to all problems that lie beyond a science of phenomena. The spreading of the belief has had the result that the magnificent advancement of science in Western civilization is paralleled by an unspeakable advancement of mass ignorance with regard to the problems that are existentially the important ones."

What "important" questions?

The Beyond Belief participants mentioned a few of them: aesthetics, the meaning of life, mortality, love, and "being good:"

"The axiom that values come from reason or religion is wrong... There are better ways of ensuring moral motivation than scaring the crap out of people."
Patricia Churchland, philosopher, University of California, San Diego

"What about the hundreds of millions of dollars raised just for Katrina by religions? Religions did way more than the government did, and there were no scientific groups rushing to help the victims of Katrina - that's not what science does."
Michael Shermer, editor-in-chief, Skeptic magazine

"It doesn't take away from love that we understand the biochemical basis of love."
Sam Harris, author of The End of Faith

If you ask me (or read this far in the blog), a rational universe that is subject to measurements and study that yield consistant and ever sharper, more focused results in different labs and at different times does not preclude a Creator.



Note 1. Cornelia Dean, “Scientists Speak Up on Mix of Religion and Science,” New York Times August 23, 2005. http://www.nytimes.com/2005/08/23/national/23believers.html (accessed September 29, 2005).

Heart "master stem cells"

There's news about embryonic "master stem cells" for heart tissue, or embryonic stem cells that give rise to the 3 types of cells in the heart, which were found in mouse embryos.

I wonder how many of the articles will mention non-embryonic human cardiac precursor cells from amniotic cells (this month) and umbilical cord stem cells (reported in 2005, 2005, and this year) that have been used to produce heart valves in the lab?

Or that umbilical cord blood cells and the embryonic cells that are derived from them are less likely to be rejected than we thought in the past?

The animal research will be useful to find the markers or identifying genes of precursor cells in the human. They might lead us to the discovery of factors and conditions that will recruit and stimulate each patient's stem cells in place. But they won't treat anyone. As the article above about the embryonic stem cells explains, the local environment and stimulation are the determining factors that turn precusors in to functional tissues.

(Edited 11-24-06 for grammar.)

Balky Democrats, Selective Travel, Selective Signatures

Three members of the Texas House State Affairs Committee have refused to sign off on the Committee's final report on stem cell technology.

The Houston Chronicle calls them Balky Democrats.

I'm not surprised. None of them bothered to come to the Committee's hearing on the charge held in Houston in September, where I was one of many who testified.

And they were 3 of the Democrats who ran away to Ardmore, Oklahoma in 2003 to prevent the House from having a quorum for deliberation.

Grey Goo Grief Bombs Second Life (A Thanksgiving Lesson)

The virtual fantasy world, Second Life, was attacked for at least the second time this weekend . Self replicating rings bogged down the servers, disrupting players on the site, giving us a short-term virtual model of Eric Drexler's grey goo scenario wherein self-replicating nanotech machines destroy the Earth by using up the surface resources.

There's a bioethics discussion in there, somewhere. At least, we should contemplate how much our lives have changed in the last 10 years due to the Internet and the improvements in the 'Net and our access to it. (And don't get me started on Digital Video Recorders. I keep trying to re-wind the rest of my world when I realize that I missed bits and pieces - or, heaven forbid, what the bits and pieces meant.)

I've never had the patience it takes to build an avatar and personality in one of the virtuals. I did try 'way back in 1996, on e-something or the other. Instead, being a data-junky, I get lost at Google, GoogleNews, and all the blogs that I try to follow (not to mention my mini-fantasy-vacations when I use up bandwith with wishes at Travelocity or Expedia).

However, I can sympathize with the designation of the attacks as "Grief Bombs." I've suffered along with others when attacks in the form of worms, viruses, and overwhelming volumes of email have been able to slow down the Web or shut down servers for specific sites. Recently, I've had from troubles with my on-line and off-line computer activities, thanks to a not-so-helpful Internet Security Suite update from McAfee.

Over the next couple of days, many of us in the US will be traveling, away from our wi-fi access and high-speed connections in general. We will be interfacing in the real world with our families and over-stuffing our tummies, mostly without discussion about the ethics of the production, distribution and consumption. (My family might get into the discussion over at the New Scientist about whether science can replace religion, and when we do, it will make my husband and some of the other inlaws uncomfortable or bored.)(There, I knew I could work the NS' "God Question" in, somehow.)

Y'all will hear/read much more eloquent comments from others about the blessings we enjoy, but I want to remind you to be aware, be good, be safe, and enjoy.

More on "Illegal" 5-Way Kidney Transplant

There is more information about the 5-way kidney transplant swap at Johns Hopkins. (Here's the original Washington Post article I reported on earlier today.)

An Illinois television station called the process "illegal."

Okay, sometimes issues are illegal but not immoral or unethical. Sometimes, good things are done for motives that are both ethical and slightly less than clear. At the same time. In the same person.

It seems that Dr. Montgomery, while doing a good thing in transplanting the kidneys, is using the "domino transplant" to make a point against the long-standing law that prohibits trading organs in exchange for any thing of value, including other organs for someone else.

From the Orlando Sentinel:

Some institutions feel multiple arrangements come uncomfortably close to quid pro quo, Montgomery said. He called for a clarification of the law.

The complicated swap worked this way:

Rothstein donated her kidney to Jantzi. Jantzi was incompatible with the kidney offered by her adoptive mother, Florence Jantzi, a Christian missionary who donated her kidney to George Brooks, 52, a mechanic who was not compatible with the kidney offered by his wife, Sharon Brooks.

Sharon Brooks, 55, a telephone company maintenance administrator, donated her kidney to Gary Persell, 61, a retired film distributor. His wife, Leslie, 61, a retired history teacher, gave her kidney to Gerald Loevner, 77, a real estate developer. Loevner's wife, Sandra, gave a kidney to Sheila Thornton, a retired elementary school teacher.

I'm afraid that the 10 hour, 12 surgeon, 11 anesthesiologists procedure followed by press conferences and petitions to Congress do not lessen the appearance of ensuring that everyone involved follows through with their part of the "bargain."

On the other hand, Sally Satel, M.D., has an article published at the American Enterprise Institute website that gives reassuring answers to some of my concerns about the safety of becoming a kidney donor:

Long-term risks are also low. Typical is a 1997 study from Norway that followed 1,332 kidney donors for an average of 32 years. It found no difference in mortality rates between people who give kidneys and the general population. A 25-year follow-up of seventy donors conducted by the Cleveland Clinic found that the renal function is "well preserved" and that the overall incidence of hypertension was comparable to that of non-donors. The truth is that a normal person can get along perfectly well with one kidney. The risk a donor runs is that his single functioning kidney will become diseased or injured, and he'll need a transplant himself--a highly unlikely event.

Dr. Satel is a recipient of a non-related donor's kidney, herself. She did know her donor before the transplant, however. Unfortunately, she is championing "Organs for Sale."

(Maybe I just don't like complicated questions, but it seems that the more I have to think about the ethics of a practice, the less I like to see it codified in law.)

Ambivalence on Quintuple Kidney Transplant

The news from Johns Hopkins in Baltimore about an historic 5-kidney "marathon" transplant among 4 pairs of relatives and 2 unrelated people troubles me on several different levels. 5 people will (hopefully) have a better life now, and that's wonderful, a miracle. And, that 5th, unrelated recipient is one of the luckiest people on earth!

However, I wonder about the motives of the transplant team and the stringency of the usual transplant ethical scrutiny, especially in light of the publicity.

It seems that there were 4 patients who needed transplants, and they had 4 relatives willing to donate, but none of them matched their own relatives. There was a woman who signed up to donate one of her kidneys to anyone who needed it. And there was a 10th person, the 5th with a need for a kidney.

Someone noticed that if all of the donors were shuffled there was a match for 5 of the patients on the waiting list.

Because of tissue or blood type incompatibility, none of the relatives could donate to her specific family member. But as they traced the possible connections, officials discovered that each turned out to be a fit for someone else in the group, and the five-way match emerged.

I worry that the "marathon" was an elaborate publicity stunt on the part of the Hopkins transplant team,

Surgeon Robert Montgomery, who directs the Comprehensive Transplant Center at Hopkins, has advocated a broader system of such pairings to increase the nation's supply of organs and save more lives of desperately ill children and adults. Although more than 72,500 people are waiting for a kidney transplant in the United States, only 11,653 such operations were performed this year through August, with only about 4,400 involving living donors.

Before I go on, I want to say that I admire all the donors. I hope that I would do what they have done, if need be. In fact, I have felt disapproval for family members who will not donate to their own relatives, while understanding their fears. I lean toward the school of thought that it is not society's job to protect an adult from himself. It is vital, however, that we all discuss the ethics in advance, in order to protect the vulnerable around us from harm caused by others. I also wonder about the duty of healthy young donors to themselves and their children and whoever will care for them if they become ill due to becoming donors. What of the young mother or father who volunteers to become a donor to a stranger?

There have long been questions about the ethics of an adult submitting to the dangers of donating a kidney to a relative who is in need, but there are legitimate questions about the "consent" that is given in these cases. How much does guilt, family and societal pressure play into the decision, and how can we objectively measure consent to a harmful procedure that will not benefit the donor? No one knows the future, and what happens if the donor has kidney failure in the future? Does the donor have the right to endanger his or her health in this way? What happens if the kidney is rejected and the donation ends up being futile?

These questions are multiplied in the case of an unrelated, altruistic donor. In this case, the woman who added the wild card (kidney) that made the 5/10-way transplant possible said that she is doing this in reaction to the loss of a husband and daughter. She is only 48 years old, herself. What of her future health? Will she someday regret an action from grief, rather than simple concern for her fellow human being.

Finally, however, I wonder about the timing. Performing the operations virtually simultaneously seems to be some sort of stunt. Or where the surgeons afraid that some of the donors would back out after their relatives recieved a kidney from someone else?

I can't believe that there are "economies in scale" in kidney transplants or that it was more efficient and safe for the donors and recipients to arrange such a complicated scheme:

The undertaking required 12 surgeons and more than two dozen other doctors and nurses working for 10 hours in half a dozen operating rooms. Twice that many Hopkins staff members, including medical specialists, technicians, social workers, psychologists and pharmacists, took part in the planning and in post-operative care, officials said.

In 2003, the hospital performed what it believed was the world's first triple-swap transplant. Montgomery was in the lead then, too, calling that success "a monumental-type experience." Three years later, it became even more so.

Massachussetts: The Healthcare Finance Lab State

(and now for something completely different)

The Country is watching to see how the new healthcare finance plan works in Massachusetts. The State had only 7%-10% of its population uninsured, unlike the regional average around 15%. (My State, Texas has a 26% uninsured population - half of those families make more than $75,000 a year, so, it seems, have decided not to spend their money on insurance. At up to a $1000 per month per person for individual buyers or small employers, it's hard to blame them.)

The Massachusetts State insurance plan is to increase participation in insurance coverage by requiring all employers to either provide insurance or pay the State $295 per year, per employee.

Unfortunately, it appears that the program is costing more than expected, according to the Washington Times:

Full coverage is the lynchpin of the plan. Yet it's hard to see how the state will get even close to 100 percent participation, the whole point of the expensive exercise. On the subsidized plans, families will be expected to spend up to 7.7 percent of their income on health coverage. If eligible residents say "no thanks" to this new monthly bill, people are supposed to pay penalties under the individual mandate. This could lead to the absurd result of confiscating a person's earned income tax credit -- a government handout -- because one refused to accept a health care subsidy.
Officials haven't even started designing the private plans -- the plans that non-poor individuals must purchase by July of 2007 or face fines.

The theory is that if more of the low risk young and healthy people buy in, even at a low rate, the extra money added to the pool will cut the costs for everyone else and will save the State money in funding for indigent care and Medicaid. And Massachusetts does have a State Income Tax that can be dinged if penalties are needed. However, the insurance plans aren't allowed to charge different fees for different risk groups and ages. And there are a lot of other mandated benefits required by law. Also, the cutoff point for subsidies is 300 percent of the Federal poverty level, the plans will cost $300 per individual and $600 for each family. It's estimated that many of those eligible for subsidies and most likely to use their insurance are already insured at higher rates. (From a subscription only article in the Sept-Oct 2006 Hastings Center Report.)

According to another commentary in Hasting Center Report there are more than the obvious dollar costs (free registration required for this article),

Third, the legislation promises that the Connector will help the uninsured find comprehensive and affordable private health plans, but that’s like promising delicious chocolate chip cookies with no fat, sugar, or calories. While officials have projected that the mandatory policy will cost only $300 per month for an individual plan and $600 for a family, the only way to get private plans that cheap is to strip down the coverage:boost copayments and deductibles and exclude important services from coverage altogether. Such stripped-down coverage may let politicians claim they’ve done something
useful, but it provides neither adequate access to care nor real
financial protection. In the RAND Health Insurance Experiment (the only randomized controlled trial comparing highdeductible plans to comprehensive coverage), high deductibles caused a 17 percent fall in toddler immunizations and swelled the number of children failing to see a doctor in the course of a year from 15 percent to 32 percent among school-aged children and from 5 percent to 18 percent among infants and toddlers.2 While high deductibles reduced children’s use of “rarely effective care” by 33 percent, they also reduced “highly effective care” by 28 percent. Adults in the
RAND Experiment also used less preventive and primary care, and had higher blood pressure and higher risks of dying, when high deductibles were placed on their insurance coverage. Stripped-down plans like those that the Massachusetts uninsured will be forced to buy also do little to protect people against financial catastrophe due to illness. In our own work on medical bankruptcy, 76 percent of those bankrupted by medical problems had insurance at the onset of the illness that bankrupted them; many were ruined by copayments, deductibles, and uncovered expenses such as physical therapy.

Somehow, we've got to convince both the insurers and the insured that preventive care will pay off. It's discouraging to have patients "forget" their wallets so that they can't pay their co-pays (forcing me to bill them or be liable for Federal insurance fraud felonies), and it's very discouraging to have them trade "Primary Care Providers" for a $10 increase in co-pays.

That felony risk for failure to charge the patient a co-pay is not the only problem with copays and deductibles for Medicare docs. Medicare patients who have an HMO that I don't accept or who have a high deductible "Health Savings Account" type of insurance cost docs when we are required to bill Medicare before billing the patient. Not many people realize that the Social Security Act was amended in the late '90's to force any doctor who sees Medicare to treat all Medicare-eligible patients the same, no matter the patient's actual financial status: we must file for the patient, limit our fees to 125% of Medicare, and we must never, ever charge anyone less than Medicare allows. And then, our patient will get a letter telling him that the tetanus shot he received in our office after he stepped on a rusty nail was not "medically necessary."

Confirmation of Chinese Prisoner Organ Harvests

Art Caplan, PhD, a pseudoeditor of the blog at the American Journal of Bioethics, reports on an admission from a Chinese official that confirms the rumor that prisoners are killed for their organs, which are then sold. US residents are among those that pay for these organs.

Speaking at a conference of surgeons in the southern city of Guangzhou, Deputy Health Minister Huang Jiefu called for a strict code of conduct and better record-keeping to stem China's thriving illegal organ trade, state media reported.

"Apart from a small portion of traffic victims, most of the organs from cadavers are from executed prisoners," said Huang, reported the English-language China Daily newspaper Thursday. "The current organ donation shortfall can't meet demand."

(From an article in the Houston Chronicle, originally published in the Los Angeles Times). Both require free subscription.

(Accidentally posted the first paste-and-cut version. )

Anti-Religion "Declaration in Defense of Science and Secularism"

These groups are not simply against religion, of course. They object to what they call "religious fanaticism:"

Unfortunately, not only do too many well-meaning people base their conceptions of the universe on ancient books—such as the Bible and the Koran—rather than scientific inquiry, but politicians of all parties encourage and abet this scientific ignorance.

Their idea of ignorance is to advocate against embryonic stem cell research and for abstinence in order to limit Sexually Transmitted Diseases.

The joint statement of the Center for Inquiry (CFI)and the Council for Secular Humanism (CSH) "Declaration in Defense of Science and Secularism," (as published at the Institute for Ethics and Emerging Technologies) is signed by about 45 people: fellows and staff of the two organizations, (retired) editors, Nobel Laureates, and professors at major universities. You might recognize the Chair of the Department of Medical Ethics at the University of Pennsylvania, Arthur Caplan, PhD, and Peter Singer, the notorious "ethicist" from Princeton. For some reason, it seems especially odd to me that one of the signers is Edward O. Wilson, PhD, of Harvard University.

Mixing information from polls concerning beliefs and scientific knowledge and confusing religion and education, the Declaration opens with

The Center for Inquiry, affiliated with the Council for Secular Humanism, has organized this petition in defense of secular and scientific public policy:

We are deeply concerned about the ability of the United States to confront the many challenges it faces, both at home and abroad. Our concern has been compounded by the failure exhibited by far too many Americans, including influential decision-makers, to understand the nature of scientific inquiry and the integrity of empirical research. This disdain for science is aggravated by the excessive influence of religious doctrine on our public policies.

We are concerned with the resurgence of fundamentalist religions across the nation, and their alliance with political-ideological movements to block science. We are troubled by the persistence of paranormal and occult beliefs, and by the denial of the findings of scientific research. This retreat into mysticism is reinforced by the emergence in universities of “post-modernism,” which undermines the objectivity of science.

The Center for Inquiry dedicates its international resouces to counter any and all expression of religious moral grounding in the public conversation on science and ethics. CFI projects include the Committee for Scientific Examination of Religion and conferences like "Scripture and Skepticism, the Uses of Doubt in Biblical and Qu'aranic Studies" conference.

The Council for Secular Humanism publishes the journal "Free Inquiry" and objects to baptism of children and moral education that includes religious worldviews. They reject authoritarian beliefs(except their own).


The advocacy for "humanist" ethics and a "Cosmic World View" appears every bit as religious as the worldview to which the CFI objects. (I will admit that I am confused by the notion of "humanist ethics" and advocates for human enhancement in partnership with CFI, an organization that supposedly objects to the notion that "that the Earth has been given to the human species as its dominion."


The motto of the Institute for Ethics and Emerging Technologies (where I first found the Declaration which is also published at CFI) is "Promoting ethical technology for expanding human capacities." They "work closely with the World Transhumanist Association," which has the same motto. Both organizations ask why we can't be "better than well" through enhancement with technology. Since it seems that I'm almost attached to my own laptop and smartphone, I could agree with them except for their authoriatarian way of rejecting religion and proselytising in favor of moving beyond being human. At least they do admit that transhumanism might be a substitute for religion, "however, transhumanists seek to make their dreams come true in this world, by relying not on supernatural powers or divine intervention but on rational thinking and empiricism, through continued scientific, technological, economic, and human development."

Adult Stem Cells, Muscular Dystrophy: Old News, Biased Coverage

I am grateful for any mainstream media coverage of adult stem cell therapies. I'm thrilled that the journal, Nature, is giving space to research on treatments that are ethical. I understand that the new research (Abstract is here) not only reports benefits from the injection of specific populations of stem cells that have been isolated and multiplied in the laboratory rather than risky bone marrow stem cell transplants. Cossu and his colleagues in Italy have achieved several breakthroughs.

The Italian-French team not only identified the stem cells called mesangioblasts that move about the body carrying the treatment, but they have managed to correct the genetic defect the function of a gene, "dystrophin"in the cells of dogs with Muscular Dystrophy using gene therapy and a viral vector. The reesarchers then used these repaired (autologous) cells from the diseased dogs by injecting them back into the original donor dogs.

But I don't understand why the news articles on the study in dogs do not report that adult stem cells are already being used to treat patients with several forms of Muscular Dystrophy. Instead, as in this article from the UK Medical News Today website on-line and this one in Scientific American online the treatment is presented as speculative and treatment of humans as "some day."

Or worse:

Professor George Dickson of Royal Holloway, University of London tells the British paper, the Telegraph, that the results are "a very significant advance, perhaps even a breakthrough."

Science Magazine reviewed the early research by this team in 1998. A March of Dimes article from 2002 mentioned that the news that bone marrow transplants could treat muscle disorders was 3 years old, citing Dr. Louis Kunkel and his work in the US. In 2002, there was a report about a little boy who had had a bone marrow stem cell transplant to treat his "bubble boy" immune deficiency or X-linked Severe Combined Immune Disorder and who was later discovered to also have a "Intriguingly" mild form of Duchenne Muscular Dystrophy. Doctors found that his muscle cells contained mesenchymal stem cells from the marrow transplant donor.

At that point Weinberg got in touch with Louis Kunkel, Ph.D., chief of the Division of Genetics at Children's Hospital Boston and professor of pediatrics and genetics at Harvard Medical School. Over the past five years, Kunkel's group has shown that stem cells in bone marrow transplanted into mice with DMD can restore the function of the dystrophin gene in the mice.

It seems that about all I write on anymore is reporting bias. However, when the coverage of a report on a successful retroviral gene therapy, the identification of a specific population of stem cells, and the apparent cures in animal models of a devastating genetic disease using these discoveries downplays or dismisses the importance of the (yes) breakthroughs achieved by the scientists and ignores the history and previous research, I believe that the reporting becomes a story in itself.

Critical Care of Babies Born and Unborn

The Nuffield Bioethics Council has published its report, "Critical care decisions in fetal and neonatal medicine: ethical issues."

I've just skimmed over it, so far. More later.

You can read the entire report in pdf form , my summary (below) at LifeEthics.org, which includes links to other people's summaries, including one from the chair of the Council.

Adult vs. Embryonic Insulin Stem Cells

A friend asked me about the report in Nature Medicine on the development of human embryonic stem cells that produce the hormons found in the pancreas. These cells were grown in cultures (in dishes, not animals and certainly not in humans) and don't appear to be able to respond to the levels of glucose. So they just sit there and make the insulin and other enzymes whether they're needed or not and can't make more when that's needed. The only advance over previous research is that these scientists are convince that the cells are actually making insulin and the other hormones because the cells have more insulin that the surrounding medium. Here's a more detailed review on the report.

The problem, as in all embryonic stem cells is finding a way to control the growth and development of the embryonic stem cells to prevent the formation of tumors and to achieve the cells that are needed.

Another group of scientists believe that they have discovered a way to prevent tumors by wrapping the embryonic stem cells in seaweed. I would think that this will add more than a couple of brand new variables and possible complications and hurdles to overcome before this will be helpful.

On the other hand, adult "mesenchymal stem cells" or "stromal cells" from the bone marrow can stimulate the Type II diabetics' own pancreas to make insulin on demand and also repair kidney damage from diabetes.

While there is not much popular press coverage, The best non-scientific report is at CBC.CA:


Scientific American gives more detail:

Before transplantation, the mice had severe hyperglycemia (high blood sugar) and a loss of function in B and T cells. Lower blood glucose levels were seen in treated mice by day 32 but not in untreated control mice. On days 17 and 32, human DNA sequences were found only in the pancreas and kidneys of treated mice.

Treated animals had an increase in pancreatic islets and beta cells that produced mouse insulin.

"In the (mouse) pancreas, the human cells promoted the regeneration of mouse cells that produce mouse insulin," Prockop told Reuters Health. "In the kidney, the human cells probably helped repair the damage that diabetes does to the kidneys. The cells were there after a month and we think they can probably last much longer."

From a press release at PRWeb.com:

Tulane University Researcher Darwin Prockop said of the tests: "We are not certain whether the kidneys improved because the blood sugar was lower or because the human cells were helping to repair the kidneys. But we suspect the human cells were repairing the kidneys in much the same way they were repairing the insulin-producing cells in the pancreas."

LifeEthics reported on these adult stem cells last February (even if the mainstream press did not), about Argentinean scientists who reported curing 85% of Type II diabetics with their own bone marrow stem cells. The the latest news covers a controlled experiment in mice to discover what the scientists have found since about what is actually happening in the patients.

In fact, Baylor College of Medicine (in Houston, Texas) reported finding insulin-producing stem cells in fat, bone and liver tissue of diabetic mice back in 2004. I imagine that that research is continuing.

Resuscitating and prolonging life

The Nuffield Council on Bioethics' "Working Party on Critical Care Decisions in Fetal and Neonatal Medicine" setting week-by-week guidelines for the treatment and resuscitation of newborns will be released today, November 16, 2006. In the meantime, based on news reports and last week's unethical statement by the Royal College of Obstetricians and Gynaecologists, the blogosphere is full of assumptions, judgements and even quite a bit of reasoned discussion about what is expected to be in the report. I'm not surprised that the comments are similar to the discussions about care for patients at the end of life, in content and divisiveness among prolife advocates.

Here is a "White Paper" summary of the report, published in The Scientist on November 15, and authored by the chair of the Council, Margaret Brazier.

The actual report evidently draws a line for "struggling" premies at 22 weeks gestation, saying that they should not be routinely resuscitated and taken to the Neonatal Intensive Care Unit (NICU), except when enrolled in experimental trials. The British Medical Association has already released a statement emphasizing that doctors should make clinical judgments on a case by case basis, rather than following arbitrary timelines. It's expected that the Report will suggest allowing babies who are not expected to live in spite of intervention to die a natural death. There is never a suggestion in the Report of the Working Party that babies' lives should be deliberately ended, although there is the recognition that some attempts to relieve pain may carry an unintentioned but known risk of speeding death. The report also concludes that there is no ethical difference between withholding and withdrawing treatment that will not preserve life.

Unfortunately, I don't think any US schools use the Hippocratic oath anymore. (Here's a concise article on the newer oaths that focus on relieving suffering rather than honoring the sanctity of life and which include promising to manage "finite resources." I can't count the number of times I hear "finite resources," which just means "taxes.")

However, the original Hippocratic oath says, "Heal when possible, but first do no harm."

We doctors can do so much harm using the tools we have at the medical centers where these babies are cared for. After all, most of the centers are research and teaching schools. We make strides by experimenting and the medical students and residents need to learn. But there must be a point at which we say, "This much and no more," without ever acting to intentionally cause death. In other words, it is acceptible to withdraw or withhold a ventilator or feeding tube, but it's never acceptible to smother the child or inject poison that's intended to cause immediate death.

If we are keeping the babies alive for the sake of proving we can keep them alive by our skills and technology, to avoid malpractice lawsuits or because the family can't let go, and we can see that the treatments are in fact only prolonging death for a child who can only feel pain and never process and understand that pain, we are wrong. We should not keep the child alive for our sakes, but only for his.

An interesting point in light of the RCOG's recommendation that there be more discussion about intentionally killing some children is made in this article in the UK Telegraph.
It seems that abortion is prohibited in most cases from the 24th week in the UK. For a couple of weeks, the babies who would be resuscitated under the guidelines of the Working Party could legally be aborted. The Telegraph editorial suggests that doctors should urge the Members of Parliament to reconsider their recent refusal to lower the limit on abortion on demand to 21 weeks.

Hwang: no technology, no cloned stem cells

Hwang Woo-Suk has admitted that his laboratory did not create any "patient-specific" stem cells through somatic cell nuclear transfer, often abbreviated as "SCNT," "NT," or cloning. He also admits that he does not have the technology to do so.


The reports on the latest statements from the Korean veterinarian and his lawyers are reported by Associated Press and have been picked up by Forbes, the Times Pickayune, the New York Times, the Fort Worth Star Telegram/Dallas Morning News and the Houston Chronicle. Scientific American (link no longer works as of Nov. 15 at 10:15 AM CST) and Reuters have focused on the admission that Hwang cannot prove that he spent millions of dollars attempting to clone extinct mammoths, without specifying the admission that there were never any human embryonic stem cells.


The AP article explains why the lies that Hwang told are important:

Stem cells are the basic cells that can grow into all kinds of tissue, and cloning them could create a way for patients to be treated with cells matching their own DNA - minimizing risk of rejection.

This confession is great news for the prolife side of the debate (if we forget the numbers of human eggs that have been wasted, the fact that some scientists are asking to use animal eggs in further attempts, and the debacle of the passage of Amendment 2 in Missouri last week), and should cause the advocates of embryonic stem cell research to reconsider their push for more tax funds.

No one has been able to produce stem cells from cloned human embryos. In fact, no one has been able to clone human embryos that survive long enough to produce the inner cell mass that contains the embryonic stem cells. Our only source is and will be for the near future, the embryos created by in vitro fertilization.

Add in the news that 1/2 to 1/3 of all revenues from any possible future accomplishments utilizing embryonic stem cells going to Wisconsin and the wonderful advancements using adult and umbilical cord stem cells, as reported here last week.

Isn't it time that we just forget about pushing this waste of tax dollars on the State or Federal level?

A weekend with political docs

I just spent the last 3 days attending the American Academy of Family Physician's (National) State Legislative Conference, where a hundred or so docs and staff members representing the leadership of nearly 30 State Academies (and a few crashers of committee meetings and self-appointed policy-watchers like me) listened to political pundits, consultants, and each other as we contemplated last week's election and next year's legislation outlook.

It was interesting to listen to the slightly bipolar comments on the Democrat's win on the National front and in many of the States. There were probably a few more Democrats than Republicans present, and just a bit of discussion based on voter's expressing their displeasure with the last group of legislators. (BTW, they pretty much got the motivation of the Right wrong.)

However, I'm proud to say that we reflected the purpose of the Conference: how we Family Docs could and should interact with our local, State, and Federal lawmakers to influence policy in order to help our patients and stay in business. Most of the comments were based on whether and how well Medicaid and Medicare funding would be financed, how much farther the "scope of practice" of "practitioners" without medical degrees and with less training would need to be watched and a very rare note that tort reform wouldn't be possible.

It's important to understand, however, that "staying in business" means one thing to the majority of docs and another thing entirely to most academics and State Academy staff members.

I'm sure I've mentioned somewhere that I have noticed that there almost seems to be two populations of doctors at medical meetings: the ones in the Committee meetings and the ones I talk to at lunch who attend for the Continuing Medical Education. The former tend to be from the big city medical centers, left-leaning, "prochoice," and to work for the State and/or in a Medical School, Residency Program setting or very large, multi-specialty group and the latter tend to be from smaller towns or rural areas, right-leaning, pro-life and work in private practice clinics, quite often solo or very small groups.

This observation is a generalization that tends to break down as often as most cliche's, and is not nearly as consistant in Texas Academy of Family Physician meetings as it is in the Texas Medical Association meetings, but it's a good working model.

I'm impressed that we manage to find common ground in funding for medical schools, residency programs, and health care for the indigent and those locked in to Medicare and other Government-paid medical care. We all agree that we need tax funds that our States send to Washington to be returned to our States from Washington, that our States need to manage those funds with our input, that medicine should be practiced by physicians rather than corporations, bean-counters and lesser-trained "practitioners," and we'd like to keep ourselves out of malpractice suits.

One of the "discussions in the House of Medicine" (a polite way of saying there's disagreement between doctors) is whether medicine should be "single payer" or "socialized medicine." Those who use the first term either believe that government-run medical care paid for by taxes is a good thing. Or they've learned to speak in Politically Correct terms to keep those who use the second term (not coincidentally members of the second group, above) happy, while slipping in the occasional "Universal coverage," "Health care for all," and "medical care, while not necessarily a right, is a common good that society should fund."

The fact that our AAFP literature is very good at hiding this "discussion" (and the dichotomy between the Committee members and the general membership) was proven in one of the workshop sessions.

Our presenter gave an informative and instructive step-by-step workshop on "Framing the question," or offering perspective to influence the opinion of others. He just didn't know that we docs don't agree on the issue of government-financed health care and that we've agreed to disagree, in order to take care of our patients and stay in business. I could feel the stillness around me as my fellow Conferees realized his mistake.

(We're too practiced in our bedside manner to actually gasp.)

LifeEthics a New Contributor on ProLife Blogs

I've just cross-posted my first submission (yesterday's LifeEthics post) on ProLife Blogs. My thanks to Tim for inviting me and (in advance) for forgiving me if I did it wrong. In the future, I hope to post more original pieces.

ProLife Blogs has a filtered "aggregator" that I check often. Bloggers can sign up to have their sites linked to ProLife Blogs, and excerpts will be picked up and linked at that site. The "ProLife Aggregator" will show the obvious prolife entries, and is a good way to keep up with who's commenting on what. The worst thing is when I check, post, then find that 10 other bloggers just posted on the same subject.

There's also an unfiltered aggregator on the site.

Most of the bloggers are more political and religious than I try to be on this site. But, if you want to keep up with the news and views, check out the Aggregator.

We need sharing, not eggs or embryos!

From WebMD:

"We don't need any eggs or embryos at all," says Shinya Yamanaka, MD, a professor at the Institute for Frontier Medical Sciences in Kyoto, Japan.

Yamanaka describes his lab's early successes in mice creating stem cells from adult cells. His research involves isolating two dozen chemicals that give embryonic stem cells their ability to grow into nearly any tissue in the body.

How long does it take for news of embryonic-like cells from the patient's own cells and from umbilical cord blood cells to make it to the mainstream media and the daily medical news pages? This article was published election day, although Dr. Yamanaka published his report months ago. Perhaps the stem cell scientists could begin to share their information more openly and much more quickly. Perhaps they could start a new tradition: prestige for rapid and frequent sharing of information that is immediately used and referenced by other scientists. Sort of like the prestige we bloggers aspire to.

The cells that Dr. Yamanaka has developed have the same properties as the cells derived from destroying embryos, they even cause tumors when emplanted in mice:

That property, called "pleuripotency," is what makes scientists think stem cells can be coaxed to form new tissues that could help cure Parkinson's and other diseases.

The Japanese researchers found that four of the chemicals, in the right mixture, transformed connective tissue cells from adult cells into pleuripotent cells Yamanaka says are "indistinguishable" from embryonic stem cells.

Still, significant problems remain.

"I have to point out, the efficiency … is very low," Yamanaka today told the scientific conference hosted by the Institute of Medicine. Only one in 1,000 attempts to transform adult cells into stem cells was successful.

Also, the cells formed tumors when implanted in mouse tissue -- a significant roadblock to using such cells for human treatments.

As a matter of fact, one of the classic tests of "stemness" is the ability of embryonic stem cells to make teratomas, a mass of several different types of cells, when injected into the body of mice. This is what other scientists look for when some lab, somewhere, reports they've derived embryonic stem cells. The next step is to induce these cells to grow "indefinitely" while maintaining this "stemness" and avoiding genetic mutations.


All embryonic stem cells are rare, efficiency is low and the property of making tumors must be overcome. This is the nature of the cells.

However, Dr Nico Forraz and Professor Colin McGuckin, working with scientists from the University of Texas Medical Branch at Galveston and NASA have been able to produce embryonic-like stem cells from umbilical cord cells, have been able to cause the cells to divide to make larger numbers of cells, and induce some of those cells to turn into functional masses of liver cells.

In addition, researchers at the University of Michigan have produced functional type II alveolar lung cells from umbilical cord blood cells. These cells make surfactant, the mixture of lipids and proteins that line the airways of the lungs and allow us to breathe by preventing the alveli (the little pockets that take in oxygen and give off carbon dioxide) from collapsing. This is one of the types of cells that give patients with cystic fibrosis trouble and study of these cells may help us learn to treat the disease.

In their rush to be the next superstar of stem cells, scientists appear inefficient and definitely disorganized to those of us who are watching from the sidelines. From UK scientists who want to make embryos using cow eggs and human nuclear DNA, to scientists who brag that they used mouse embryonic stem cells - rather than Dr. Nicco's human liver cells - to create an artificial liver.

Then, we have confirmation from Glenn McGee, over at blog.bioethics.net, of news shared here in the past that "as much as half of stem cell revenue" from embryonic stem cell scientists who honor the US patent laws will go to the Wisconsin Alumni Research Fund.

It's easy to criticize when you're not sitting at a lab bench 20 hours a day. However, that's what ethicists (and critics and bloggers, etc.) do, I'm afraid. I believe the criticism has a valid point, though: Embryonic stem cell researchers need to realize the rate of change in their field, and utilize modern methods of sharing information and awarding prestige in order to help human patients sooner and more ethically.

Cartoons, Elections, Enhancement and Veils

Today's "Day by Day" Cartoon by Chris Muir is not just an election day political jibe at Nancy Pelosi. It's a commentary on modern attitudes toward plastic surgery and nerve injections in the attempt to enhance one's appearance. See? Just about all the big news stories relate to bioethics.

Seriously, the 70 plus year old Representative, like so many other women in Washington, Hollywood, and a city near you, does not look nearly her age.

However, the enhancement comes at a price. The masked facial expressions must be a problem for people who have to live with these women.

For some reason, I can't help but think of the burqha.

Oh, well, it's a self-imposed burqha, freely chosen with full informed consent and no one died, right?

Any egg in a crisis (Human-Cow Cybrid)

Who knew there was a term for an animal/human hybrid? Actually, "cybrid" is short for "cytoplasmic hybrid."
Wesley Smith has already reported on the story that scientists in the UK - where such things are regulated by the government, unlike in the USA - have requested permission to produce a somatic cell nuclear transfer embryo using the cytoplasm from an enucleated cow egg and human nuclear DNA.

The Telegraph has this FAQ on the proposed procedure.

Will the cells of the hybrids have other benefits?

Yes. Although cybrid stem cells could not be used for treatments and will not be allowed to develop beyond an early stage, they will prove invaluable for studies of how to clone embryonic stem cells more efficiently — so human eggs could eventually be used — and could be used to test drugs on cell lines created from people with Alzheimer's disease, and shed light on the basic disease process.

But that's not all the "Facts."

If you read between the lines and remember your cloning history, you'll see that it's not just that human oocytes come to dear and are too hard to obtain. Remember, no one's been able to clone a human embryo by SCNT (using human oocytes and DNA) long enough to produce embryonic stem cells. However, a Shanghai researcher claims to have been able to do so using a rabbit oocyte and human nuclear DNA.

So, these scientists have given up on human cloning and are just going for the next best thing that they hope is a sure thing.

Another Liver Stem Cell Breakthrough

Researchers in Nebraska and Japan have used a "bioartificial" liver implant filled with mouse embryonic stem cells to prolong the lives of mice with liver failure.

Now, if we can just get these guys together with the UK and Texas scientists who developed the technique allowing them to turn umbilical cord stem cells into liver cell tissues the size of pennies, perhaps sick human patients will be helped sooner than we thought.

We're about to see whether Wesley Smith's prediction comes true:

All they have to do is go back to the lab and do it again--only this time with mouse embryonic stem cells. Then, the New York Times is sure to put their pictures on the front page.

"Intentional killing is not part of medical care."

This can't be repeated enough: "Intentional killing is not part of medical care."

And that's why I started LifeEthics, hoping to motivate other doctors, scientists and citizens to take their place in public conversations and especially in policy making for our professional associations and governments.

From articles in the online versions of the UK's papers such as The Times and The Independent (Edit - Contrary to what I remembered, The Times did cover the derivation of liver tissue from umbilical cord cells), we learn that once again, human life and the notion of rights is endangered. This time, it's the Royal Society of Obstetricians and Gynaecologists of the UK that's calling for the killing of newborn children who have disabilities.

What the news articles do not report is that the RSOG's main argument is against the Bioethics Council's apparent "revisiting" of the rightness of abortion. It appears that once again the discussion about what to do in the face of increased technology ("bioethics") has devolved into a discussion about who we will kill, widening the classes that are not protected.

The college called for “active euthanasia” of newborns to be considered as part of an inquiry into the ethical issues raised by the policy of prolonging life in newborn babies. The inquiry is being carried out by the Nuffield Council on Bioethics.

The college’s submission to the inquiry states: “We would like the working party to think more radically about non-resuscitation, withdrawal of treatment decisions, the best interests test and active euthanasia as they are ways of widening the management options available to the sickest of newborns.”

Initially, the inquiry did not address euthanasia of newborns as this is illegal in Britain. The college has succeeded in having it considered. Although it says it is not formally calling for active euthanasia to be introduced, it wants the mercy killing of newborn babies to be debated by society.

Thankfully, some are willing to stand and declare what I believe is the truth, that only a minority of doctors support euthanasia:

However, John Wyatt, consultant neonatologist at University College London hospital, said: “Intentional killing is not part of medical care.” He added: “The majority of doctors and health professionals believe that once you introduce the possibility of intentional killing into medical practice you change the fundamental nature of medicine. It immediately becomes a subjective decision as to whose life is worthwhile.”

If a doctor can decide whether a life is worth living, “it changes medicine into a form of social engineering where the aim is to maximise the benefit for society and minimise those who are perceived as worthless”.

Simone Aspis of the British Council of Disabled People said: “If we introduced euthanasia for certain conditions it would tell adults with those conditions that they were worth less than other members of society.”

Actually, what it teaches is the view that some humans are not human enough to be protected by society from those who would kill them. As with so much of human history, if those with the physical or political power can decide to kill some of the humans they find inconvenient, too much work, or "disabling," then the very notion of "right to life" is questioned. Out of the right not to be intentionally killed - and the expectation that the people, courts, and guns of government will enforce that right - who has liberty?

If your body can be killed, your mind is already stunted, your property is on loan from whoever has the might to kill you. Because never in history have people been content to stop with deeming one class of people as less than human-enough.

Even this story shows that doctors from the Netherlands - the nation that began with killing patients who were about to die, then moved on to those not dying fast enough and then on to killing "defective" infants in the "Groningen Protocol" - has moved across international borders to advocate the practice:

Dr Pieter Sauer, co-author of the Groningen Protocol, the guidelines governing infant euthanasia in the Netherlands, said British medics already carry out mercy killings and should be allowed to do so in the open. "English neonatologists gave me the indication that this is happening."

Or, one more iteration of the "they're doing it anyway, so it might as well be safe and legal" that we always hear to justify abortion and embryo destruction for research. But, in case this last point was not clear enough:

It says "active euthanasia" should be considered for the overall benefit of families who would otherwise suffer years of emotional and financial suffering.

Deliberate action to end infants' lives may also reduce the number of late abortions, since it would allow women the chance to decide whether their disabled child should live.

"A very disabled child can mean a disabled family. If life-shortening and deliberate interventions to kill infants were available, they might have an impact on obstetric decision-making," the college writes in a submission to the Nuffield Council on Bioethics.

"We would like the working party to think more radically about non-resuscitation, withdrawal of treatment decisions, the best interests test, and active euthanasia, as they are ways of widening the management options available to the sickest of newborns."

Such mercy killings are already allowed in the Netherlands for incurable conditions such as severe spina bifida. John Harris, a member of the official Human Genetics Commission and professor of bioethics at Manchester University, welcomed the college's submission. "We can terminate for serious foetal abnormality up to term, but cannot kill a newborn," he told The Sunday Times. "What do people think has happened in the passage down the birth canal to make it OK to kill the foetus at one end of the birth canal but not the other?"

Possible lead in treating nerve disease

We'll see whether this story gets any coverage.

Science Daily tells us that a group from Massachussetts General Hospital and Harvard have published a report in Nature Neuroscience that the "Insulin-like Growth Factor 1" (IGF-1) stimulates the regrowth of axons (the long appendages or tails of nerves that connect to other nerves) in patients with Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig's disease) and other motor neuron or nerve diseases.

The cell bodies of motor neurons are in the brain. The axons can be up to 3 feet long, however, and extend into the spinal cord, where they meet up with other nerves that connect to the muscles in the body. When the neurons are damaged or die, they aren't generally replaced. Sometimes, the axons will regrow if the nerves aren't actually killed, however, and it appears that IGF-1 stimulates this regrowth.

This discovery leads to hope of causing the repair of nerves in place, without transplants of stem cells, precursors, or nerve cells.