One more thing on errors

That letter mentioned above actually noted nine, not seven, treatments.

Here's the opening paragraphs from the letter (Sorry, subscription only) (Note the uses of "treat," "cure" and "phases"),

Originally published in Science Express on 13 July 2006
Science 28 July 2006:
Vol. 313. no. 5786, p. 439
DOI: 10.1126/science.1129987

Letters
Adult Stem Cell Treatments for Diseases?
Opponents of research with embryonic stem (ES) cells often claim that adult stem cells provide treatments for 65 human illnesses. The apparent origin of those claims is a list created by David A. Prentice, an employee of the Family Research Council who advises U.S. Senator Sam Brownback (R-KS) and other opponents of ES cell research (1).

Prentice has said, "Adult stem cells have now helped patients with at least 65 different human diseases. It's real help for real patients" (2). On 4 May, Senator Brownback stated, "I ask unanimous consent to have printed in the Record the listing of 69 different human illnesses being treated by adult and cord blood stem cells" (3).

In fact, adult stem cell treatments fully tested in all required phases of clinical trials and approved by the U.S. Food and Drug Administration are available to treat only nine of the conditions on the Prentice list, not 65 [or 72 (4)]. In particular, allogeneic stem cell therapy has proven useful in treating hematological malignancies and in ameliorating the side effects of chemotherapy and radiation. Contrary to what Prentice implies, however, most of his cited treatments remain unproven and await clinical validation. Other claims, such as those for Parkinson's or spinal cord injury, are simply untenable.

And here's the references that are noted,
1. Posted at the Web site of DoNoHarm, The Coalition of Americans for Research Ethics (accessed 8 May 2006 at www.stemcellresearch.org/facts/treatments.htm).
2. D. Prentice, Christianity Today 49 (no. 10), 71 (17 Oct. 2005) (accessed 8 May 2006 at www.christianitytoday.com/ct/2005/010/24.71.html).
3. S. Brownback, "Stem cells," Congressional Record, 4 May 2006 (Senate) (page S4005-S4006) (accessed 8 May 2006 at http://frwebgate6.access.gpo.gov/cgi-bin/wais-gate.cgi?WAISdocID=122359256098+2+2+0&WAISaction=retrieve).
4. According the latest version of the list, accessed 12 July 2006.

False information propagated by stem cell news reports

What's new, right?

In an article spread by the Associated Press, "Public misinformed about stem cell issue," (found in the Houston Chronicle, USA Today, and others, there is a blatant factual error.

A July 2006 article in the journal Science refuted claims that there were 65 treatments that utilize adult stem cells. In truth, the article stated, there are seven.

The Science "article" was actually a letter, and opened with the statement concerning treatments that were "fully tested in all required phases of clinical trials and approved by the U.S. Food and Drug Administration."

This letter led columnist Michael Fumento to dub the Journal, "PseudoScience."

For more information, see the editorial by Robert P. George and Eric Cohen at Ethics and Public Policy, "Science gets duped again," Or see my blurbs here and here.

In fact, there are more than 70 diseases in which stem cells are "utilized," many in FDA approved and NIH funded studies.

Human Reproduction: Definition of Human Embryo

Y'all didn't seriously think a little thing like my husband's left hip surgery would stop me, did you?

Human Reproduction, a peer-reviewed, high impact journal of research and opinion concerning "the scientific and medical aspects of reproductive physiology and pathology, endocrinology, andrology, gonad function, gametogenesis, fertilization, embryo development, implantation, pregnancy, genetics, genetic diagnosis, oncology, infectious disease, surgery, contraception, infertility treatment, psychology, ethics and social issues" (free, full text online in advance of pulishing) has published the following definition of a human embryo:

The following biological definition of ‘human embryo’ is proposed.

A human embryo is a discrete entity that has arisen from either:
(i) the first mitotic division when fertilization of a human oocyte by a human sperm is complete or
(ii) any other process that initiates organized development of a biological entity with a human nuclear genome or
altered human nuclear genome that has the potential to develop up to, or beyond, the stage at which the primitive
streak appears,
and has not yet reached 8 weeks of development since the first mitotic division.

There is "insufficient information whether the entities derived by parthenogenesis, gametogenesis using pronuclear DNA from two parents, and several SCNT and Chimera scenarios which - prior to their creation - have had the ability to implant removed from the genome. However, the entity would be covered by the definition if the manipulation can be said to have "the potential to develop up to, or beyond, the stage at which the primitive streak appears."

I would think that this definition would cover most of the most troublesome aspects involving regenerative medicine or destructive human embryo technique. The uncertain cases would need to be proven to not be human embryos, through animal models, or for the more unethical, actual experiments using human DNA.

Let's hear no more about "early" stem cells, or "there's no sperm(!)" or "there's no potential to form a human baby/person/be implanted in a uterus," etc.

Thank you Human Reproduction, for making this article available free. The tables, showing the need for human oocytes and the sources of DNA and cytoplasmic (oocyte) material necessary for the production of each class, are invaluable.

A new left hip!

My husband had a hip replacement today after years of worsening hip due to aseptic necrosis. I may not be a busy blogger until he's home.

Same story, new spin

It's (she's) an embryo. What part of "I'm all for stem cell research, but don't kill a human embryo" don't they get?

Harvard's George Q. Daley is in the news again. This time his research group has produced parthenogenetic mouse embryos, that were used to harvest stem cells. The original article has been published online (Free abstract) before going to print, in Science Express, a feature of the journal, Science. Another well-written review from a slightly different is available online at "ThisisLondon.com," a feature of the UK's Evening Standard. Here's another from Scientific American. Frequent mention of "virgin birth" in the articles is telling.

The method used chemical treatments to prompt the egg to develop into an embryo, a process known as parthenogenesis, and then extracted stem cells from it.

The embryo could not have otherwise developed into a baby mouse, so, even in humans, the strategy is unlikely to raise as serious ethical objections as other methods that destroy a viable human embryo.

I don't think so. The only reason that the "embryo could not have otherwise developed into a baby mouse" is because the researchers intended to destroy it in order to harvest those stem cells. If the embryo had been human, the creation of an embryo in such a situation (that carries a high level of risk for the embryo) can not be ethical.

Parthenogenetic mouse embryos have been developed before, as the Boston Globe artical notes. In 2004, an article in Nature (free abstract online) reported that one of these embryos was implanted and grew to birth, grew to adulthood, became pregnant herself and gave birth to normal mouse babies. This was one of 10 who survived nearly to birth of 23 embryos that were implanted.

Why shouldn't we assume that if the hurdles of parthenogenesis in humans is overcome that the problem with implantation and gestation to whatever stage of developement will seem useful to researchers?

At least, this Boston Globe article doesn't use the term "virgin birth" and it is more honest than some mass media stories on cloning and destructive embryonic stem cell production. The author, Cary Goldberg calls the embryos "embryos" and mentions the worries about tumor formation and other abnormalities of stem cells derived from embryomnic stem cells, as well as the risk of tumor production:

The immediate benefit of the technique is for researchers; it still has many hurdles to overcome before it will be clear whether it is safe for use in humans, said George Q. Daley of Children's Hospital Boston, senior author of the paper published online in the journal Science. There is concern, for example, that such cells could become cancerous.

But, he said, the technique may be closer to working in humans than somatic cell nuclear transfer, the conventional approach in animals for generating customized embryonic stem cells.

In that method, a nucleus from a regular cell such as a skin cell is inserted into an egg and induced to develop.

Also known as therapeutic cloning, it is highly inefficient in animals and has yet to be mastered in humans, though two Harvard teams, including Daley's, are trying.

"This is a much more workable approach to generating patient-specific and tissue-matched embryonic stem cells," Daley said. "But the trade-off is that these cells may not prove to be normal and functional."

If the egg technique works in humans, women would be their own immediate beneficiaries, but the effects could be wider, Daley said. It could also lead to the broader production of stem cells that have only half the usual set of immune system genes -- perhaps even whole banks of such cells -- and that therefore would be compatible with many patients who need to grow new tissue.

Professor Daley needs to Google umbilical cord blood cells.

Texas in Front on Ethical Stem Cells, Again

Here's evidence of private funds backing adult stem cell therapy.

Dr. James Willerson will lead a team investigating a special technique to isolate a special population of bone marrow stem cells. The stem cells will be used to attempt to increase the circulation in the legs of patients with "Critical Limb Ischemia," or very low blood flow to the legs.

DURHAM, N.C., Dec. 15 /PRNewswire/ -- Aldagen, Inc. today announced that the Texas Heart Institute at St. Luke's Episcopal Hospital in Houston, Texas will be the first site for its clinical trial using Aldagen's ALDESORT(R) product to isolate a unique stem cell population as therapy for critical limb ischemia (CLI) patients. The co-lead investigators at Texas Heart Institute on the study will be Dr. Emerson Perin and Dr. James Willerson.
"We are very excited to begin this study as it represents the first clinical study in the United States to use purified stem cells for the treatment of critical limb ischemia. We believe that these cells have the potential to offer CLI patients a new therapeutic option," said Drs. Willerson and Perin. Dr. James Willerson is president-elect and medical director of the Texas Heart Institute at St. Luke's and President of The University of Texas Health Sciences Center at Houston. Dr. Perin is director of New Cardiovascular Interventional Technology and director of the Stem Cell Center at the Texas Heart Institute at St. Luke's.

About the Study

Aldagen's clinical trial will involve 20 patients, all of which will have bone marrow extracted. Ten patients will receive multiple injections of the bone marrow directly into muscle in the ischemic leg and ten patients will receive multiple injections of stem cells isolated from the bone marrow using Aldagen's ALDESORT product. The patients will be monitored for up to six months with a primary endpoint at three months. Endpoints will include safety and the ability of therapy to reduce rest pain, increase skin surface oxygen pressure and improve ulcer healing.

ALDESORT isolates a highly potent population of stem cells taken from the patient's own bone marrow. These stem cells have the potential to build new blood vessels (angiogenesis) in ischemic legs which could ultimately lead to improved functionality for CLI patients.

For more information on the study, call the Texas Heart Institute's Stem Cell Center at 832-355-9404, visit online at http://www.texasheart.org/stemcell or e-mail directly to plea@heart.thi.tmc.edu.

About Critical Limb Ischemia

Critical limb ischemia is a severe form of peripheral vascular disease (PVD). It is estimated that between eight to 12 million Americans suffer from PVD, which is a disease of the blood vessels characterized by narrowing and hardening of the arteries that supply the legs and feet. This causes a decrease in blood flow that can injure nerves and other tissues. CLI can lead to gangrene or tissue death, often necessitating amputation of the affected limb. Currently, there are no suitable alternatives to either percutaneous or surgical revascularization in patients with CLI. Despite some success of limb salvage with leg bypass, the condition remains associated with a substantial rate of morbidity and mortality and the need for subsequent surgery and hospitalization for wound complications is as high as 50%. There is a pressing need for the development of techniques to improve the vascular supply to ischemic leg by less invasive means.

Reports on kidney repair by (ethical) stem cells (and more!)

You may not have read it in the New York Times, but there's exciting news supporting the hope that ethical - non-embryonic - stem cells may be used to treat not only diabetes, but to repair kidney damage.

The most significant article is from The Procedings of the National Academies of Science, which, although largely ignored by the mainstream press, was summarized in a November report in the National Geographic online:

In a study published in November in the journal Proceedings of the National Academy of Sciences, researchers reported that stem cells derived from human bone marrow and transplanted into diabetic mice stimulated the animals' pancreases to produce insulin, repairing damage caused by diabetes.

"This fits with a large body of evidence that these cells have this remarkable ability to go to injured tissues and repair them," said the study's lead author, Darwin Prockop, the director of the Center for Gene Therapy at the Tulane University Health Sciences Center in New Orleans, Louisiana.

In the future, Prockop said, "the therapeutic idea would be to take small amounts of marrow from patients, then grow a large number of these cells, and give them back to the same patient to heal tissue."

From The Procedings of the National Academies of Science article:

The observations here do not rigorously rule out the possibility that the improvements in the glomeruli were secondary to the lower blood glucose levels in the treated diabetic mice. However, it was striking that the human cells were found exclusively in the glomeruli and that some the cells apparently differentiated into endothelial cells. Therefore, the simplest interpretation of the data are that the engrafted hMSCs either prevented the pathological changes in the glomeruli or enhanced their regeneration.

Support for the belief that treatment for kidney damage and disease will come from ethical sources is reinforced by a report from this week's 48th Annual Meeting of the American Society of Hematology (ASH(TM)). Hematologists are the specialists in treating blood disorders, but their field overlaps with Oncologists in the treatment of cancers and, because of the work with bone marrow stem cell transplants, many are also involved in stem cell research.

Three of the papers presented at the ASH conference were on ethical stem cells, including one that dealt with damage from Graft vs. Host Disease in transplant patients using bone marrow stem cells, treatment for one type of "SCID" (popularly known as "bubble boy syndrome," a genetic defect that causes an almost total lack of ability to fight off infection) and the one dealing with stem cell treatment for kidney failure.

As if these two sources were not enough evidence there's a research article in The Journal of the American Society of Nephrology (free abstract) that reports on the isolation of stem cells from the kidneys, themselves.


These reports are exciting news - and should have received much more media coverage - due to the shear numbers of patients who experience acute and chronic renal or kidney failure and disease due to infections, drug reactions, high blood pressure, heart disease and diabetes.

Fetal vs. umbilical cord neural stem cells

The news about "Stem Cells, Inc.'s" phase I trials of fetal neural stem cells in the treatment of Batten disease reports improvement in the condition of the first patient.

I'm a little shocked at how matter-of-fact the article treats the use of brain cells from aborted infants.

Why is there not more questioning about the process and methods involved in harvesting these cells? Where is the open scientific communication?

And why, in the reports about this trial, are there no discussion about - seemingly no consideration of - ethical stem cells from umbilical cords and adult tissues?

Of course, there have never been any human trials using embryonic stem cells. The tissues transplanted into Daniel Kerner's brain are fetal stem cells - the babies killed in the abortions before their brains were collected and then processed for the transplant were at least 8 weeks along, and probably a bit more. However, there's not much info on the "purification" process that resulted in the volume of "purified neural stem cells."

There is quite a bit of research showing that neural stem cells are available from the cells harvested from umbilical cords and even adult sources, such as bone marrow and neural tissue in the mature body.

Wharton's jelly cells have been "easily" ( Free abstract online) induced to transform into neural stem cells and to proliferate in the lab - at least 80 doublings. In animal models, the cells are being evaluated for use in treating Parkinson's and other neurological disease.

There are also reports of development of stem cell lines from bone marrow cells, brain, and even skin cells.


Perhaps, now that "Stem Cells, Inc." researchers believe that they know the specific markers that are to be found on the cells they believe to be useful, they can turn their efforts to more ethical research. And more accessible stem cell sources, especially umbilical cord cells. Even with 1 out of 3 babies aborted in this country, most are aborted at the embryonic stage (1st trimester), and so there are many, many more opportunities to harvest ethical stem cells from umbilical cords.

Hypothetical end of life dilemma

Suppose there was a patient, Mr. B., with adenocarcinoma, a fast growing malignancy that begins in the liver, the pancreas, or another intestinal organ. Although the patient has lived twice the predicted 3 month life expectancy, the cancer has finally spread throughout the body - to the liver, the lungs, the intestines, and, now, the brain.

Mr. B. is a 50 year old engineer, divorced and has no children. When he found out about his cancer, he spent some time "getting his affairs in order." This month, he moved back to the town he grew up in, to live with his older sister, Mrs. S. Unfortunately, he has not seen a doctor in town, since he had planned to continue seeing the oncologist 50 miles away. The day after he arrived, Mrs. S. found him passed out on the floor of his room and called the ambulance.

On admission to the Emergency Room, Mr. B. is not conscious, can't swallow, and his liver and colon are not functional. The CT scan of the head shows a small mass, but the doctors explain that the problem is probably the loss of liver and kidney function.

The liver has completely shut down, causing the loss of the blood plasma protein normally made by the liver. The fluid from his blood moves from the veins and arteries into the body tissues by osmosis. The liver can't clean toxins from the body, so he is yellow, his blood vessels are losing the ability to hold blood pressure, and his kidneys are shutting down.

Mrs. S. refuses to hear of transferring Mr. B. to the big hospital 50 miles away where his oncologist practices. She insists that Mr. B. is a fighter and has already fooled the doctors by living so much longer than they predicted, and demands that he be given "everything possible" to prolong his life.

The family doctor who is assigned as Mr. B's new Dr. by the ER "on call list" has asked both of the kidney specialist groups in town to evaluate the patient for dialysis and each has separately advised him that the dialysis is not appropriate and declined the consult. For one thing, the veins in his arms and legs are not big enough to handle the amount of fluids necessary for dialysis, and he would need a surgical procedure to place a larger central IV line than the one that was placed in the ER.

The sister, Mrs. S, who is acting as the patient's surrogate for making medical decisions, is furious with the new doctor. Although by th day after admission, Mr. B.'s legs are swollen to the point that the skin has begun cracking and draining, she is certain that the patient is thirsty and hungry. Convinced that the doctor is "killing" and "starving" her brother, she calls a lawyer who takes the family doctor to court. The judge grants an emergency hearing and then orders the doctor to begin dialysis and provide adequate artificial nutrition and hydration.

The family doctor, who is board certified in Family Medicine, which requires continuing medical education and repeat certification each 7 years - in fact, he just passed his boards for the 3rd time - has never written the orders for dialysis, hasn't written orders for "total parenteral nutrition" (TPN) since he was in medical school, and hasn't placed a central line since residency 21 years ago. Besides, his hospital privileges don't include supervising dialysis. He's already explained all of this to the judge.

The doc, just looks at the judge and says, "Tell me, your honor, will you assist me in placing the central line and then dictate the exact orders you want me to write? What rate of filtration and how much pressure should I use in the dialysis? How much fluid can I safely remove, and how fast?"

Medicare fees tied to reporting

"Pay for Performance" (P4P, sometimes called "Pay for Play" by some of us who aren't fond of the scheme) just got a huge boost from Congress. Expect to see more docs carrying computers equiped to run an "electronic medical record" (EMR) around the office.

And don't be surprised to see more solo and small group practices withdraw from participation with Medicare and insurance companies, merge with ever-bigger groups or close down completely as the docs find other ways to make a living.

The current lines of EMR cost $50,000 per doc or "provider" to start, and can cost $8000 or so each year for up keep. (I have no idea why, but that's what I hear.) And EMR's will be necessary in order to charge for the work that the doc does in the near future.

Initially, the scheme will measure the doc's ability to report data, more than any health benefits. From today's Wall Street Journal, subscription only:

This is clearest in Medicare, the federal health program that covers more than 40 million elderly and disabled people. Congress agreed to erase a scheduled reduction in payments to physicians, but it made a 1.5% bonus payment available only to physicians who report to Medicare how they perform on certain specified barometers of health-care quality. Initially, the payments will be based on whether the physician reports the data, but the system lays the groundwork for higher payments to better-performing physicians.

Among the information Medicare officials will collect: whether doctors provide aspirin and beta blockers to patients having heart attacks, and whether elderly patients are screened for their risk of falls. These practices are considered indicators of good patient care.

More on End of Life - Family Dilemmas

Increased medical technology creates a burden on family decision makers and loved ones as well as doctors, nurses and pharmacists. Listen to the (free) National Public Radio interview with journalist Stephen Kiernan on medical care at the end of life, from December 4, 2006.

It’s not surprising that there would be misunderstandings between doctors and patients and families during high stress crises. The end of life is, of course, potentially one of the worst times in life of the individual who is dying and all the loved ones around him. The doctors are speaking their own language. The patient and family members not only have to learn new skills and evaluate technology and weigh risks versus benefits. They are each bringing their own perspective, emotions and world views to the bedside. The experiences of everyone will even differ by the time of day and the “baggage” that they bring to each meeting.

And each time we add a new "routine" or "experimental" therapy or protocol - whether it's the ventilator, a new thousand-dollar-per treatment drug, or deciding on dialysis or feeding tubes, the questions become harder.

I’m concerned that end of life care too often becomes care of the families’ fears and pain, rather than being focused on the actual last days of life of the patient herself. We stop treating Moma or Daddy in his or her own best interest and begin to intervene in an attempt to ease our own psychological and spiritual pain. I’m reminded of the natural childbirth literature of the ‘70’s, that accused us of ignoring and adding to the baby’s pain and shock because we are all holding our breath, waiting for his first breath. Labor and delivery is hurried with chemicals and surgery, the lights are overly bright, and we suction, rub and – in the past – slap the baby’s behind for our benefit, not his. It’s as though we can’t breathe until we are reassured that he is alive, even if he is screaming in pain.

Mr. Kiernan reviews the dilemmas that he and his family endured during the illnesses and deaths of his parents. His mother and siblings didn’t realize until after the fact that have a tracheostomy performed on his father was not “progress.”

Mr. Kiernan also speaks of what he calls the “tradeoffs” that go along with hospice coverage. If I understand it properly, however, Medicare does not require a patient to give up dialysis or other treatments. What happens is the hospice contracts with Medicare for a given fee per patient. If a patient needs dialysis, there’s no extra money. On the other hand, Medicare will pay all the costs for outpatient dialysis, but the patient will not have access to the specialized care and services available through hospice.

I thought my “Advance Directive” covered everything. But Mr. Kienan adds a point that I hadn’t considered: he wouldn’t mind being kept alive “by any means necessary” for up to 48 hours in order for his family to gather and say good bye. Then, he wants all the life support stopped and to be placed in the sun.

(Mine was amended after Terry Schiavo’s death. Essentially, I’ve always said, “don’t wake me up to ask me!” There’s a new note that asks for ice chips and for someone to place chocolate on my lips.)

Agreement: no euthanasia for children

Art Caplan, the pseudoeditor at blog.bioethics.net, head of the Center for Bioethics at Pennsylvania University, and a columnist for MSNBC, has posted a note at the bioethics.net blog that calls for an end of the suggestion that sick babies should be killed by their doctors.

Good going, Art!

Human enough to think about

Watching the changing definitions and necessary and sufficient conditions for any of us to be deemed human enough to be afforded the protection against infringement of the right not to be killed , an observant being would just about have to assume we're dealing with a fairly significant group of entities.

The Supreme Court went so far as to allowing an infinite number of meanings of the universe, in order to justify affirming abortion in the Planned Parenthood vs. Casey decision.

And now, people are increasingly willing to make life with the express intent to take it. (Nigel Cameron HT)

It might be that all of us who have this conversation, and all the members of our species are "human enough" just because we're one of us.

At the very least, as I say at the top of the page, we're the only ones having this conversation.

On stem cells and media bias

I report frequently on the media and its bias against reporting successes in adult stem cell research. Sometimes, what appears to bias is just early results and sometimes I'm wrong - there is no bias. JivinJehosaphat mentioned my blog from yesterday comparing the reports on non-embryonic stem cells and embryonic stem cells in Parkinson's, and noted that the numbers of articles were more even, a little later in the day. Monsters and Critics and the UPI even reported on the breakthrough from Georgia researchers who transplanted non-embryonic (adult) human neural stem cells into animal models to study their effects as treatment for Parkinson's disease. As of this morning (about 5 AM CST), the count on Google news is 11:11. (I am glad to be wrong in this case.)

In another example where I might have been wrong about bias, back in February of this year, I posted about a report on bone marrow cells used to treat humans with Diabetes type II. As an anonymous poster has pointed out in the comments, there's not much evidence of this research protocol other than news articles, whether in a Google or Pub Med search. Formal publication in peer-reviewed journals takes a long time, and that sort of delay may explain the lack of corroboration of human stem cell transplants for diabetes. However, 10 months should be long enough to find other, reliable reports of what the original article called "the most important step in Diabetes research since 1929."

The good news, though, is that animal models are demonstrating that the report from Argentina's Dr Fernadez Vina may become a prediction that comes true.

One of the most exciting reports comes from the Procedings of the National Academies of Science, "Multipotent stromal cells from human marrow home to and promote repair of pancreatic islets and renal glomeruli in diabetic NOD/scid mice." The article, available free online, describes the surprising effects of bone marrow stromal cells on not only the pancreas, but the kidneys.

It also has a number of links to research along the same line - many available free online, also. For instance, there's this article from Stem Cells, "Human Cord Blood–Derived Cells Generate Insulin-Producing Cells In Vivo." Which led me to this review of the literature on umbilical cord stem cells in the treatment of diabetes.

Embronic stem cells: twice the coverage

Google News search on new Parkinson's stem cell research.

Reseach on adult stem cells used to treat Parkinsons: 5 citations - none of the big names. Embryonic stem cells used to treat Parkinsons: 10 news articles, including UPI, Science Daily and Monsters and Critics.

Can you study medical ethics?

I'm still working on my article on age at marriage and sexual initiation changes. I'm trying to learn to post the graphics that I think are useful. Preview, tweak, delete.

In the meantime, what about all the docs and student docs who are learning how to treat patients ethically?

Deleting their mistakes is not an option. They can't preview the results of their actions, except in a theoretical way, based on experience and guidelines built on the experience of others. The tweaking can look worse than some of my HTML mistakes.

The BBC has a fairly well written article on teaching medical ethics that I recommend.

We don't always get it right. In my experience, "medical ethics" conferences teach how to get along with Medicare and Medicaid, to avoid charges of fraud, and how not to get sued. We ought to be teaching and reviewing - and perhaps, sharing - how to deal with the truly hard questions. (See the discussions here and here.)

Be sure and take a look at LifeEthics.org and the news commentary at the blog, Lifeethics.org Blog.

Contraception and abstinence in the news

The news today reports on a study by the Alan Guttmacher Institute that abstinence doesn't make as much difference in the overall teen pregnancy rates in the US as increased contraceptive use.

I'm still looking at the data in the report and trying to understand their methods and statistics. (Free Abstract here).


Comparing data from the National Survey of Family Growth, 1995 and 2002, the researchers found,

Our data suggest that declining adolescent pregnancy rates in the United States between 1995 and 2002 were primarily attributable to improved contraceptive use. The decline in pregnancy risk among 18- and 19-year-olds was entirely attributable to increased contraceptive use. Decreased sexual activity was responsible for about one quarter (23%) of the decline among 15- to 17-year-olds, and increased contraceptive use was responsible for
the remainder (77%). Improved contraceptive use included increases in the use of many individual methods, increases in the use of
multiple methods, and substantial declines in nonuse.

On the other hand, some of the blogs and pro-life news sites have been talking about a new study that shows strong evidence that there is protection in abstinence based sex ed.

John Jemmott, PhD of the University of Pennsylvania Annenberg School, reported in Toronto in August, 2006 that his team had compared abstinence-only education with

The PowerPoint slides showing efficacy of the abstinence only approach, from the presentation in Toronto are here.

And here's a review of the discussion in the media, at the time:

A study of 662 African-American Grade 6 and 7 students from inner-city middle schools in Philadelphia found those taught an abstinence-only approach to sex were less likely to have had sexual intercourse at 24 months' follow-up compared to those put through a "safer sex" intervention that emphasized condom use but made no mention of abstinence.

And while Bill Clinton, the former U.S. president, told delegates to the International AIDS Conference in Toronto yesterday that abstinence programs delay sexual activity but make teens less likely to use condoms when they do start having sex, the study found the opposite to be true.

"It did not reduce intentions to use condoms, it did not reduce beliefs about the efficacy of condoms, it did not decrease consistent condom use and it did not decrease condom use at last sexual [encounter]," lead author John Jemmott, of the University of Pennsylvania, said.

The youngsters in the study ranged in age from 10 to 15; half were girls. Twenty-three per cent said they had had sexual intercourse at least once before the study began.

"There aren't any studies that show that children are less likely to use condoms as a result of an abstinence intervention. I've looked in the literature, there are no studies that show that," Mr. Jemmott said in an interview.