"Objectivity is Bias" (meaning, healing, integrity)

Our recent conversation about conscience and medicine and the ongoing conversation about science and controversies is reflected in the NPR "Speaking of Faith" replay of an interview with, and publication of an essay by, Dr. Rachel Naomi Remen. (The outline and much of the story is available in text, here.)

"An answer is an invitation to stop thinking about something, to stop wondering."

Dr. Remen speaks of the stories that we share, the meaning that we need to find in those stories and acknowledges that objectivity is in itself a bias. Scary thought: that some data is ignored in science, medicine and public policy because it doesn't fall within the parameters that we've already decided is acceptable.

There's a description that most of us who have any medical training at all will recognize: the med student looking at the veins of strangers and judging their suitability for drawing blood or inserting IV's:

On one very rare summer afternoon off I remember traveling home to visit my parents on the subway, realizing only after a while that I had been unconsciously scanning the veins of the bare-armed people around me, wondering whether my skills with a needle were good enough to allow me to successfully draw blood from them. This sort of training changes the way you see things, the way you think. Gradually things that had been central in my previous life became vague and faded into the background and other things more heavily rewarded became overdeveloped. After a time I just forgot many important things.

Actually, what seems a demeaning way of looking at the human body isn't necessarily a proof that medical training leads to depersonalization and instrumentalization of our fellow humans, if we recognize the new viewpoint as an outgrowth of our wish as students and doctors to heal, prevent and relieve pain. Finding the underlying meaning or connecting it to a story that has a "better" meaning can inform our conscience, help to maintain our integrity and prevent some suffering of our own as profession.

About 20 minutes into the interview, there's the story of Dietert, who continued weekly chemotherapy injections as the only way to continue the contact - the touch and communication - with his doctor. In the meantime, the doctor was depressed because the "only thing" he had was failing to cure the patient. I worry about this: how often do we only offer and only validate active intervention, science and the material, rather than the passive, spiritual or psychological valuable - the intangible moral worth - like the listening that Dr. Remen offers so generously?

Early in the interview, Dr. Remen speaks of her mystic, Orthodox Jewish grandfather who described the birthday of the world as an accident, when the vessels containing the light of the world were broken and the striving of each of us to heal the world, to reveal the light around us and especially in our fellow human beings. I recognize her grandfather's conversation with the world, and with God, as I was raised surrounded by the knowledge of the love of God.

Now, I am just as guilty as anyone else of deciding that if you don't at least relate somehow to the same meaning that I do. If you don't seem to even live in the same reality that I do, you must be wrong and may even be insane. You'd benefit from my "fixing" you (her word, not just mine), either by inundating you with facts and references and some arguing or by some medical or technological intervention, like a nice shot of Haldol ("vitamin H") or an antipsychotic medication.

But I think - I hope - my best skill is listening, learning your language and meanings, and trying to translate between our two perceptions (even if I have to admit to myself that I really think of it as my understanding and your misunderstanding).


What too many people don't realize is that it's actually easier to interfere than to refrain. (So we end up with drug resistant bacteria, because it was easier to write the antibiotic than to explain viruses and risk your anger. Or it's easier to hook you up to chemotherapy, a ventilator or dialysis than to explain that I'm probably not going to be able to cure or even heal you. At least it looks - it feels - like I'm doing something!)

The interview and the essay point to the need for meaning in the practice of medicine beyond "objective" science and even healing that we can achieve as doctors - and society. I love the how and when, the molecules and causes. I believe in the germ theory and the disease model of Western medicine. I need and love my tests and measurements. But what drives me (and gets me in trouble) are the why's and what if's, what is right or ethical. It's probably what drives you, too or you wouldn't be reading this blog.

(I think Dr. Remen's Orthodox Jewish grandfather and I would have had a nice conversation during this season of Hanukkah and Christmas, when our two traditions celebrate light and dedication, revelation and reconciliation, watching and listening expectantly and generously.)

Abortion, miscarriage, and risk to later babies

I'm afraid that the report I blogged about a couple of days ago is being misinterpreted by at least one Pro-life source.

The numbers are impressive enough from a public health and pro-life view point, without ignoring the fact that the original data is 40 to 50 years old (without the advantage of our current Neonatal Intensive Care Units and the wonderful advances in our medical abilities) and that there's no way to know whether the mothers in the study had a miscarriage or an intentional, induced abortion. The authors do report on more recent, reliable data showing an increase after abortion, compared to miscarriage, not the 300% to 900% increase seen in the earlier (and less relevant to today's medical realities) report.

As I said before, we can't really control the numbers of miscarriages, but we can control and decrease elective abortion. That would decrease the numbers of premature births and low birth weight babies who are at such risk for early death and chronic problems like cerebral palsy and lung disease.

Abortion and risk to the health of later babies

New analysis of old data published in the January 2008 issue of the Journal of Epidemiological Community Health (free abstract) has confirmed the association between induced abortions and later premature birth and low birth weight babies. Babies born prematurely and/or weighing less that normal are much more likely to die in the first month or have severe health problems like lung disease or brain damage.

However, the focus of the original research is based on self-reported information from over 45,500 moms who gave birth from 1959 to 1966 and the records don't tell us whether the mothers had spontaneous abortions (miscarriages) and induced intentional abortions. The authors do find that increased numbers of miscarriages or abortions increase the risk of low birth weight at full term and of premature birth:

Compared with women with no history of abortion, women who had one, two and three or more previous abortions were 2.8 (95% CI 2.48 to 3.07), 4.6 (95% CI 3.94 to 5.46) and 9.5 (95% CI 7.72 to 11.67)times more likely to have LBW, respectively. The risk for PB was also 1.7 (95% CI 1.52 to 1.83), 2.0 (95% CI 1.73 to 2.37) and 3.0 (95% CI 2.47 to 3.70) times higher for women with a history of one, two and three or more
previous abortions, respectively.

The new information from the JECH is nearly 50 years old and can't distinguish between miscarriages and induced abortions, so it doesn't really tell us much about the risk from today's elective abortions or give proof that induced abortion is risker than miscarriage. I'm afraid that that is the emphasis of media reports like those in Time and Medical News Today. (Although they don't note the surprising result that the study found no association between smoking and premature birth, although there was a significant association between smoking and low birth weight.)

However, the authors review results from other studies which do make distinctions between the mothers who had previous induced abortions and those who had miscarriages. Those studies do show an association between induced intentional abortions and low birth weight, term low birth weight, and premature birth. Instead of the 300 to 900% risk over full term live birth, most found at least a small 1.1 to 1.4 (10% to 40%) increased risk after one intentional induced abortion and up to 3 times the risk after 2. While there is also a risk after miscarriage, miscarriage can't be helped. The variables which can be changed - not those that can't be - are matters for public health policy.

And fewer of our children will have to die for it.

Brain Death

Wesley Smith is blogging around the Web on the sad death of a 50 year old Atlanta man whose family took the doctors and hospital to court. Wesley rightly notes the poor communication.

The reporter is indeed a very bad communicator. I wonder about the reliability of the whole story because of the reporter's description of the patient: "he was brain dead and being kept alive by life support." While I can believe that the docs used "life support," the reporter goes on to say that the patient "passed away" when the ventilator was stopped and used the phrase, "pull the plug."

"Brain dead" patients are not alive and they're not on "life support." The doctors are using "artificial support." for the organs on a dead patient. (See this British Journal of Medicine article and comments, below.) Just as we support the body while waiting for the arrangements for organ donation (or for the birth of a child of a brain dead mother), it is customary to notify the family and give them a chance to "say goodbye" before discontinuing the ventilator and medications supporting the

Way down at the bottom, the article actually says,

"doctors told the family the stroke caused massive bleeding in Donald's brain. Four different physicians examined Fennell and his brain scans and determined his brain, including the brain stem which controls basic bodily functions like breathing, had ceased to function, according to court and patient records."

However, the problem started with the nurse who called security to have the family removed from the hospital because Mr. Fennell's 3 sons,

21, 20 and 18-year-old college football players— cried loudly and shouted "No!" when told their father was brain dead. After that, she said, security guards were posted at the door whenever they visited."

It's hard to talk to people who are shouting, but it's harder to talk to them when they've been kicked out of the building.

I'm trying to get my head around the medico-legal problem of delaying the declaration of death by the docs, scheduling a time to turn off the ventilator, and the comment about the machines being broken.

However, people don't live by laws alone. We often act from our hearts.

The New England Journal of Medicine published a review article describing the determination of death by neurological criteria in 2001. And here's an excellent (free) article from 2002, from the British Journal of Medicine that actually calls the ventilator and cardiac support "artificial support" and includes the ethical caveat that ""No physician engaged in euthanasia or medically assisted suicide should be responsible for diagnosing brain death.

Not coincidentally, the subject of yesterday's Secondhand Smoke was the case of an Orthodox Jewish man in Canada. The gentleman is on a ventilator and suffering from the effects of heart failure, pulmonary hypertension and renal failure. Three doctors, including one selected by the family have determined that he is dying and, even without the consent of the patient or the family, decided to remove the ventilator. The family has taken the doctors to court to prevent the removal of the ventilator on religious grounds.

One of the family's lawyers actually said that removing the ventilator is the same thing as smothering the patient with a pillow, and that (of the docs and nurses who must maintain the ventilator and adjust its settings):

"To do what they are suggesting would involve a physical act," he said. "You have to touch him, you have to remove the tubes. My reading of the law is that without consent ... they can't do it. I submit that is assault and battery."

(According to newspaper reports, the docs plan to remove the feeding tube, also. But that's not relevant, here, since Mr. Golubchuk will die within minutes if he is unable to breathe on his own off the ventilator. If any of the docs are making a fuss about the feeding tube, they are not very wise, since doctors and nurses aren't needed to maintain or monitor the feedings.)

An article from the Winnipeg newspaper on December 11 says that

"An orthodox rabbi consulted by the family quotes from guidelines on Jewish medical care that say it is imperative for doctors to prolong life, even if the patient is "suffering greatly" and asks for care to stop."

It's my understanding that Orthodox law forbids disconnecting the machine until the heart stops, even though there has been talk of a machine in use in Israel to randomly turn off ventilators so that the people won't have to. But I've never read that the Orthodox go so far as to demand that suffering be ignored.

In fact, withholding care under Orthodox Jewish law is acceptable. See the discussion about flickering candles, here. Here's a very well written review of Orthodox Jewish law on end of life, from the Virtual Mentor, the AMA ethics journal.

Do you suppose the family really believes that they should force other people to cause suffering? The family lawyer does point us to the ethics of intent and consequence of "a physical act." While the family may have the right to continue their father's suffering and to prevent the removal of the ventilator they don't have the right to force any particular doctor, nurse, or tech to act to violate their own conscience by adjusting, cleaning, and monitoring the ventilator.

Surely there's an Orthodox doc in the area who is willing to care for Mr Goubchuk and his family.

Red florescent cat cloned

In my day - we just belled them. Poor kitties won't be able to catch mice. The author reminds us about the veterinarian fake cloner, Hwang Wu Suk, before he finishes.

From the Korean Times:

Researchers found a way to clone pet cats five years ago. Now they can play a trick on their genes to change their color.

A Gyeongsang National University team said they have succeeded in cloning cats after modifying a gene to change their skin color. Because of the red fluorescence protein in their skin cells, the three Turkish Angola kittens look reddish under ultraviolet light, the researchers said.

The red cloned cat research is expected to be utilized in dealing with certain genetic diseases in animals and humans. It will also help reproduce rare animals, such as tigers and wildcats, which are on the verge of extinction, the team said.

According to the team led by professor Kong Il-keun, four kittens were born in January and February by caesarian section, but one died during the procedure. They weighed between 110 and 136 grams at birth and now weigh 3.5 kilograms each now, the researchers said.

``We have proved our world-class ability in cloning animals that have modified characteristics,'' said Kong. ``We found that the red fluorescent protein in all the organs of the dead kitten, which means we have established an efficient way of cloning gene-modified cats.''

The first cloned cat, nicknamed Copycat, was born in 2002 at Texas A&M University. Many other animals such as cows, dogs, pigs, bulls and goats have been successfully cloned by a number of researchers in North America, Europe and South Korea.

Kong cloned a cat in 2004 for the first time in the country. He has since worked as director of research at a state-supported project to clone animals for therapeutic research.

To clone the Turkish Angola cats, Kong's team used skin cells of the mother cat. They modified its genes to make them fluorescent by using a virus, which was transplanted into the ova. The ova were then implanted into the womb of the donor cat.

Called reproductive cloning, the method has been mostly used in cloning animals that are genetically identical, until Kong's kittens were born with the tampered genes.

The technique differs from therapeutic cloning, which is to make a ``stem cell'' that can be guided to grow into a specific body part. Former Seoul National University professor Hwang Woo-suk used this method in his human stem cell cloning research, which was later found to have used fabricated data.

Doctors, Abortion and Conscience

The debate on medical ethics has definitely moved from "Our Bodies, Our Choice," to "My Choice, You Don’t Have a Choice." Autonomy, the "I want" ethics, trumps the right to life, the right to liberty and the physician's duty to do no harm. Where once laws were written to punish doctors who harmed patients, doctors are now threatened with lawsuits and the loss of our licenses for refusing medications or procedures demanded by patients and their surrogates.

The American College of Obstetricians and Gynecologists ethics statement, "The Limits of Conscientious Refusal in Reproductive Medicine" is a case in point. Abortion is so important to the ACOG Ethics Committee that they deny the right not to be killed and threaten the right not to be enslaved by calling abortion the “standard reproductive care that patients request” and demands that doctors who “deviate from standard practices” (object to abortion) “practice in proximity to individuals who do not share their views or ensure that referral processes are in place” (with a willing abortionist). The President of ACOG then wrote letters asking Congress for laws to force these limits on our consciences: doctors who object to abortion should either change their practice so that they don't take care of women and girls or move close to a willing abortionist.

The Christian Medical Association and 28 other pro-life, pro-family organizations have written a letter criticizing ACOG’s Statement as “a profound misunderstanding of the nature and exercise of conscience, an underlying bias against persons of faith and an apparent attempt to disenfranchise physicians who oppose ACOG's political activism on abortion.”

GrannyGrump posted several reasons conscientious doctors should consider elective intentional abortion bad for the mother. I agree with her that abortion is wrong because it is bad for women. I also believe that she begins from the same viewpoint that I do: Even if abortion weren't bad for women, it would still be wrong.

Elective intentional abortion is immoral because it takes the life of a human being. If the mother's life is in danger, she has the right to self preservation and it is moral to help her save her life. Even then, the child's life should also be protected if at all possible. The intent can never be to produce a dead child.

State officials have mandated that all medical students learn to perform abortions in New York and that all pharmacies stock and dispense contraceptives in Illinois and Washington. ER doctors are forced to dispense Emergency Contraception in Connecticut, California, Massachusetts, New Jersey, New Mexico, New York, Ohio and Washington. How long before autonomy supersedes the physician's right to conscience at the end of life since the American Medical Association has condoned the use of Oregon's "Physician Assisted Suicide" law (now renamed and redefined as "Aid in Dying")?

Laws against the conscience are a poor substitute for medical ethics and will result in the death of those same ethics. The end result of limiting the physician’s conscience is cook book health care written in court rooms by lawyers and judges. The practice of medicine will no longer be a profession, much less a calling, practiced by men and women of conscience. It will become a job done by people capable of following orders, doing what they believe is wrong.

Lee Silver: iPCs named due to politics

Lee Silver, author of is someone that I've read about on the 'net and about whom Robert George and Patrick Lee said, "He hides his ideology under a veneer of science."


He was the guest on Carl Zimmerman's Bloggingheads.tv November 30, discussing reprogrammed skin cells.

Dr. Lee is convinced that if a couple of more labs reproduce the reprogramming (and others have since, Jaenisch and Yamanaka's lab have already published follow-up results), then reprogramming will probably be the way we get embryonic stem cells, rather than by destruction of embryos.

However, he claims that the naming of the cells "induced Pluripotent Stem cells" or iPC's is a political move to hide either the fact that the opponents of embryo-destructive research are being fooled or being hypocrites.

From the thread following the interview:

Actually, human ES cells (unlike mouse ES cells) are perfectly capable of differentiating into trophoblast (Nature Biotech 20:1261; 2002). Why do you think this isn't common knowledge? (Hint: politics) And mouse ES cells can be turned into whole mice quite efficiently with a technique that does NOT involve blastocyst injection or tetraploid embryos (Nature Biotech 25:91; 2007). Concerning your next post, how do you know what the intent was behind naming these cells iPS cells?

. . .

The question is whether continued research will soon get us to the point where fibroblasts cells can be transformed into cells that are completely indistinguishable from human ES cells, with the potential to form every human cell type (including, eventually, blastomeres which could, in theory, develop into babies without any further "tinkering"). With all of the accomplishments of the last ten years, it is very hard to imagine that this won't be possible. The ONLY reason to doubt it is based on a religious-inspired faith that there is something FUNDAMENTALLY different between blastomeres and ES cells.

So now, it's a religious opinion that there's some difference between blastomeres and ESCs?

Hat Tip to The Daily Transcript at ScienceBlogs.

Yamanaka has a conscience

“When I saw the embryo, I suddenly realized there was such a small difference between it and my daughters,” said Dr. Yamanaka.

The New York Times article on Shinya Yamanaka, "Risk taking is in his genes," (free one time registration necessary) should get the headline-writer in trouble for a sad pun.

Instead, Dr. Yamanaka might be in trouble with the objectors to conscience. (No links, just look at today's posts - or the last two months of posts - the subject keeps popping up.)

People like John Gearhart, MD will want to "put pressure" on Yamanaka to write letters to Nancy Pelossi and the rest of the US legislators making the usual reactionary case for Federal funding for embryonic stem cell research in light of the successes with non-destructive research.

The NYT reporter, Martin Fackler, can't be too popular in the next few days for pointing out that the US laws and funding are not nearly as tight as those in Japan, due to moral objections in that country:

In 1999, his career got a break when he was hired by other universities, including Kyoto University in 2004, that were willing to give him a laboratory and more money. At about the same time, he said, he visited his friend’s fertility clinic. That visit inspired him to find a way around the moral issues that had bogged down stem cell research, not just in the United States but also Japan, where the Education Ministry put tough restrictions on embryo use.

In fact, restrictions are so tight that he says he cannot use human embryos at his laboratories here. Instead, research using human embryos is done at U.C. San Francisco, where he maintains a small two-person laboratory. He said he had never handled actual embryonic cells himself, and the American lab uses them only to verify that the reprogrammed adult cells are behaving as true stem cells.

“There is no way now to get around some use of embryos,” he said. “But my goal is to avoid using them.”

For a look at the science and bioethics slant on these revelations, see Wired Science (see the comments on this one), Blog.bioethics.net, Wesley Smith's Secondhand Smoke, and Jennifer Lahl's blog, "The Human Future."

Text of Letter from CMA to ACOG on Conscience

(The press release is here and the LifeEthics coverage is here.)

December 7, 2007
American College of Obstetricians and Gynecology
Douglas W. Laube, MD, President
PO Box 96920
Washington, D.C. 20090-6920

Dear Dr. Laube:
The undersigned individuals and organizations urge the repudiation and withdrawal of the recently published position statement of The Committee on Ethics of the American College of Obstetricians and Gynecologists (ACOG), "The Limits of Conscientious Refusal in Reproductive Medicine."
The ACOG statement suggests a profound misunderstanding of the nature and exercise of conscience, an underlying bias against persons of faith and an apparent attempt to disenfranchise physicians who oppose ACOG's political activism on abortion.
The paper indicates that ACOG views the exercise of conscience and faith not so much as a cornerstone right in a democracy or as a historic hallmark of medicine, but rather as an inconvenient obstacle to abortion access.
A few excerpts from ACOG's paper illustrate these concerns:

1. "An appeal to conscience would express a sentiment such as 'If I were to do 'x,' I could not live with myself / I would hate myself, I wouldn't be able to sleep at night."

By caricaturing conscience as a pitifully self-centered, subjective feeling, ACOG denigrates the objective sources of conviction. Physicians of faith base decisions of conscience not on personal whims and feelings but
on the objective teachings of Scripture--the same Scriptures that have provided the foundation for the laws of much of civilization. A physician's conscience may also be informed by time-honored ethical standards such as the Hippocratic Oath, which for centuries provided a foundation for medical ethics until abortion advocacy censored its teachings.

2. Physicians may not exercise their right of conscience if that might "constitute an imposition of religious or moral beliefs on patients."

This harshly skewed view of the exercise of conscience would have the practical effect of reducing physicians to pawns of patients, since in ACOG's view, conscientiously declining a prescription or procedure is tantamount to "imposing religious or moral beliefs on patients."

3. "Physicians…have the duty to refer patients in a timely manner to other providers if they do not feel they can in conscience provide the standard reproductive service that patients request."

This assertion contradicts a basic corollary of conscience. The same life-honoring, objective principles—"Thou shalt not kill," and "first, do no harm"--that persuade many conscientious physicians not to perform abortions also persuade them not to recommend someone else to do the deed.

4. "All healthcare providers must provide accurate and unbiased information so that patients can make informed decisions."

Normally no one would question this principle, but in this case, context is everything. Since ACOG has gone to court to fight laws requiring abortion doctors to offer informed consent information to patients on the risks and alternatives to abortion(1), clearly ACOG intends to selectively apply this requirement only to pro-life physicians to force them to offer abortion as an option.

5. "Providers with moral or religious objections should … practice in proximity to individuals who do not share their views…"

It is incredible that ACOG would actually require a pro-life physician to relocate his or her practice to be close to an abortion facility. Besides the fact that this drastic requirement is selectively invoked only against pro-life doctors, it would also have the negative practical impact of removing desperately needed doctors from underserved areas.
ACOG's misguided and uninformed public statement on conscience limits is bound to have the effect, whether unintended or actually intended, of discouraging persons of faith from practicing or choosing obstetrics and gynecology as a profession. At a time when many communities are already suffering the loss of obstetricians and gynecologists forced out of their practices for economic reasons, it seems especially unwise to send such a message of ideological intolerance and religious discrimination.
ACOG's aggressive political advocacy for abortion has significantly impaired its ability to speak for all physicians and to judge matters of medical ethics without bias. We urge ACOG to reconsider and withdraw this statement as a step toward remedying that lamentable loss of respectability and credibility.
Sincerely,

David Stevens, MD
Chief Executive Officer
Christian Medical Association

1 American College of Obstetricians v. Thornburgh, 737 F.2d 283, 297-98 (3d Cir.1984).

Please see the CMDA website for the other signers.

CMDA to ACOG: Stop Attack on Conscience

The Christian Medical and Dental Association has released a statement condemning the American College of Obstetrics and Gynecologists for ACOG's position statement (earlier coverage, here and here) that would require all doctors who object to abortion to either change their practice or make sure that they work next to a willing abortionist:

Physicians call on The American College of Obstetricians and Gynecologists to stop attacking conscience rights

December 11, 2007--The nation's largest faith-based association of physicians, the 15,000-member Christian Medical Association (www.cmda.org), today joined other leading national organizations in challenging The American College of Obstetricians and Gynecologists (ACOG) to stop its attack on the conscience rights of pro-life physicians.

A letter, drafted by CMA and signed by other national organizations, blasted ACOG's Committee on Ethics position statement, "The Limits of Conscientious Refusal in Reproductive Medicine." CMA's letter noted that the statement "suggests a profound misunderstanding of the nature and exercise of conscience, an underlying bias against persons of faith and an apparent attempt to disenfranchise physicians who oppose ACOG's political activism on abortion."

CMA CEO David Stevens, MD said, "ACOG is not only out of touch with conscience-driven physicians, but also with our long-standing American tradition to protect the rights of citizens to not participate in conscience-violating actions—especially when those actions would take a human life. That American tradition rests on constitutional principles of religious freedom and speech."

ACOG's position paper targets pro-life physicians, insisting that abortion-objecting physicians refer patients to get abortions and declaring that physicians who will not participate in conscience-violating procedures and prescriptions must actually move close to doctors who will.

Dr. Stevens added, "Many physicians had been realizing that because of their aggressive abortion lobbying, ACOG officials do not represent the values of most physicians and mainstream medicine. This statement goes a step beyond not representing our life-affirming values to actually advocating policies to prevent us from exercising those values. ACOG's attitude seems to be, 'If you don't toe the ACOG line on abortion, the 'morning-after pill,' and the application of reproductive technology, then you shouldn't be practicing obstetrics--and if you do, we're going to do everything in our power to force you to accommodate our abortion agenda."

CMA Executive Vice President Gene Rudd, MD, an obstetrician and gynecologist, noted, "I have withdrawn my ACOG membership of over 25 years. My conscience can no longer support their lack of conscience. ACOG's strategy seeks to marginalize dissenting opinions. I as an obstetrician have a moral obligation not only to act in my patient's best interest, but also in the best interest of the developing baby, and of society as a whole."

Warnock Answers

Dame Mary Warnock has written an essay which was published in the November 29, 2007 issue of Nature, which appears to be an apologetic for her part in the establishment of the ethics of embryonic research in the United Kingdom. The bloggers at Women's Bioethics Project speculate that she wrote in anticipation of Parliament's review of the Human Fertilization and Embryo Authority.
The full essay is for subscribers only - but there's a 2006 article that describes the wider function of the committee, here.

What Warnock explains (but doesn't acknowledge) is that her committee did exactly what they accused the Catholics of doing: "answering in advance the very question we were asking."

The task was to justify embryo experimentation, posed to the Committee after it was proven that the embryonic Louise Brown was the born Louise Brown. They did the job they believed that they were assigned, and then projected their own act of "answering in advance" upon anyone who drew a connection between the moral worth of the embryonic Louise Brown and the born Louise Brown.

Ironically, Dame Warnock admits to no expertise in morality yet feels justified in rejecting the moral expertise of the Catholic Church simply because it is the Church. All the while complaining about the difficulty of pleading the case that the issue is one of morals.

I wonder whether we could get murder and rape prohibited by this committee.
From the Nature essay (emphasis is mine):

When in 1978 the first baby was born by in vitro fertilization (IVF) it was inevitable that there would be calls for the procedure to be prohibited. That science develops too fast for morality had become the cliché of the twentieth century. Wisely, the UK government decided to set up a committee from which to seek advice before legislating on such a complex and emotive issue.

The Committee of Enquiry into Human Fertilisation and Embryology was founded to examine the social and ethical implications of the new techniques. Therefore the committee could not be made up entirely of physicians and scientists. With some difficulty, 16 people — including me as the chair — were gathered to look at the problem from all angles. Our areas of expertise included social work, law and theology.

We were not a group of 'moral experts', with particular moral authority derived from our expertise. Rather, our entitlement to propose legislation derived from the fact that we had been set up by government and that we had been given the time and resources to do so. The only other requirement was that we should all be capable of formulating and listening to arguments.

The central and most controversial issue before us was whether or not research using live embryos should be permitted. There was little possibility of a moral consensus. If research were prohibited, IVF could not continue. It would have been too risky for patients.

When legislation seemed imminent in Britain, the Catholic Church published an instruction condemning IVF and research using human embryos. The Church stated that its instruction was based on "the criteria of moral judgement as regards the application of scientific research and technology, especially in relation to human life and its beginnings".

The Church claimed a right to regulate science in this area, because of its superior knowledge of morality. In sharp contrast, the committee's entitlement to issue moral advice to ministers derived from its having been set up to do so, and from its having a wide and non-partisan membership.

Prohibition of IVF did not seem to the majority of the committee to be a serious option, given its widespread welcome as an innovative remedy for infertility. We all regarded infertility as a serious malfunction, causing much distress. Instead, we proposed a strict system of licensing, backed up by the criminal law. Regulation was not a mere sop to science-phobia. There was a real danger that women, desperate to conceive, might be exploited, taken in by unrealistic promises and charged extortionate fees for futile or dangerous treatment.
Establishing what limits should be placed on embryonic research entailed a decision by the committee as to the moral and legal status of the live human embryo in vitro. Those who opposed the use of embryos in research could seek to demonstrate that it was morally wrong only by answering in advance the very question we were asking. They deemed that the embryo had the same moral status as any human being.

One of the most difficult tasks the committee faced was to get parliament to understand that the status of the embryo in vitro was a matter not of science but of moral decision. The novelty of the embryo in vitro meant that there could be no appeal to precedent or existing moral convention or to religious laws.

30 years later, the evolution of the HFEA regulations - through one mutation followed by another due to pressure to expand the limits of research - allow preimplantation genetic diagnosis, selection for "savior siblings" and against low risk genes, cloning and (most recently) licensing the use of non-human oocytes and human DNA for cloning experimentation.

Wesley Smith on Toronto Conference on End of Life

Wesley's report is at his blog, Secondhand Smoke.

The medical interventional suicide or "Physician Assisted Suicide" (PAS) offers a false sense of control to people who are actually the healthiest of the patients who know that they are nearing the end of life.

It's false because before legal medical regulations can be used to "help" terminal patients to control the "time and manner of their death," the laws are actually being sold to voters who aren't sick, who are encouraged to think "there but for the grace of God, go I." Instead of giving dignity to patients in pain, talking about the indignity of having others care for our bodies and the horrors of uncontrollable pain increases the revulsion toward physical weakness and dependency.

Mr. Smith says that in Toronto ( as at the Houston Holocaust Museum last month), he focused the bulk of his talk on "Futile Care Theory."

Calling all cases of withdrawal of care "Futile Care Theory" and eugenics is also false. It denies any acknowledgment that doctors act on their conscience. By denying that doctors and medical ethics committees -a group of peers and lay people, clergy, and ethicists - can be acting in good conscience, even when it goes against the wishes of surrogates and families condemns us all. If we can't trust these people, how can we trust a judge or a jury to act in good conscience?

I hope everyone reads what Wesley says about another speaker, Ms. Frazee:

She told the audience that there are two general veins of opposition to assisted suicide; political and spiritual, with people in each camp disagreeing with each other on other issues. She suggested that the best way to work together would be to develop a philosophical approach that would include all and permit people to also pursue other agendas when not working against assisted suicide.

Too often, the only common ground is the hatred of the control that doctors seem to have. Suicide proponents and "futile care" activists declare doctors the bad guys who diagnose and couldn't cure, who bring the bad news of unavoidable death and who won't "do everything."

As I reported after Wesley spoke at the Houston Holocaust Museum, the risk is to squeeze doctors between two extremes.

I suggest that the doctrine of double effect can help us make the distinction. Doctors may not act with the intended result of death, but we know that some of our actions may cause death, unintentionally. In all cases, the intention and the act must be ethical, but sometimes - as when we poison the body with chemotherapy or radiation to fight cancers - only medical knowledge and experience can inform our conscience.

Laws and the legal process are a poor substitute for medical ethics and will result in the death of those same ethics.

The logical result is an end to all laws protecting the conscience of doctors, pharmacists, and nurses, in favor of laws leading to court and cookbook algorithms. The practice of medicine won't be a profession - much less a calling - with peer review, judgment and conscientious men and women. It will be a job done by people capable of following orders, even when it goes against their best medical and moral judgment.

Who will you trust? Lawyers and judges like Blackmun and Greer? Juries who live in a society that forces medical professionals to act in a way they believe is wrong? Legislatures and referendums that give us Oregon's assisted suicide? Or doctors and pharmacists who are prescribing and dispensing the potassium, heart stimulants or blood pressure control in the IV, adjusting the ventilator, dialysis machine and the dosage of pain meds under the watchful eye of nurses and the rest of their community?

Alabama Citizens for Life Link to LifeEthics

There's a link to LifeEthics.org at the website of Alabama Citizens for Life. I'm flattered that their "Stem Cell Primer" quotes this blog on the division of research into destructive and non-destructive.

Colorado's Human Life Amendment

Although Time Magazine, the Denver Post and the blogs insist on calling it the "fertilized egg rights" law, Colorado's State Supreme Court has approved the wording for a proposed "Human Life Amendment." The proponents of the amendment need 76,000 signatures in order to get the initiative on the November, 2008 ballot.

The Chicago Tribune reporter at least understands that after fertilization we are talking about an "embryo." The Trib even found three ethicists who agree that the human embryo is alive. Which puts them in opposition Justice Blackburn’s opinion ( which medical school did he go to, anyway?) in Roe v. Wade that no one knows when life begins.

Unfortunately all three of those ethicists are much more worried about the definition and description of the qualities and abilities of those living humans they deem worthy of “personhood” than whether or not it is acceptable to discriminate between which humans are persons or not. Their main objection seems to be that protection of the inalienable right not to be killed, enslaved or treated as research material “would cause a lot of problems." (I'll bet that they disagree with the Dred Scot opinion, though. Overturning that one sure caused a lot of problems.)

U.S. law, based as it is on “unalienable rights” mentioned in the Declaration of Independence, should absolutely prevent courts, laws and ethicists from infringement of the right not to be killed or enslaved. Ethicists – of all people – shouldn’t need a lawyer to understand that the full exercise of unalienable rights affects infants, children, the mentally disabled and the mentally ill. Parents have special duties to their children and children can't claim the same expression of liberty (drinking, driving, entering into contracts) that their parents do. There are legal precedents for dealing with the “problems” posed by the varying abilities of the mentally ill and disabled as well as for minors – including very young infants who can legally be restrained against their will (in a crib, playpen or car seat).

The “ethicists” in the Tribune article, as well as readers' comments in both papers and in blogs all over the internet, bring out every pro-abortion objection except the coat hanger. They warn us that fertile women will be “monitored,” that women who miscarry or who drink a glass of wine will be prosecuted. They insist that if State law recognizes the human being as a person from fertilization, we’ll have to decide whether to try to save every child at miscarriage and ectopic pregnancy or fail to enforce the law. Elective intentional abortions and manipulation that is intended to end the organization of an embryo - are acts which may be prohibited under law and the State Medical regulations. Spontaneous abortions (miscarriages), and stillbirths, like so many natural deaths, are impossible to prevent and cannot be prohibited.

Since US Supreme Court rulings (Roe v. Wade and Casey, among others) all base the “right” to an abortion on the autonomy of the mother and while affirming the right of the State to protect the child in certain cases, the “extracorporeal” embryo should be protected, somehow, even in current law.

It might be worth noting that the law requires determination of the cause of death of everyone who dies, and that Texas requires a special review of children under 6 and those of any age who die within 24 hours of admission to the hospital. Texas also names a “person” as living human individual from fertilization to natural death through our Penal Code. The 2003 Prenatal Protection Act allows criminal charges when a third party causes the death of an unborn child while exempting the actions of the mother or deaths due to legal medical procedures with the consent of the mother.

In fact, 3 men have been convicted of capital murder under our 2003 Prenatal Protection Act. The convicted men were abusive, the father, and intended to kill the child(ren). One killed twins at 5 months gestation but not the mother, the other two each killed mother and child. One man received the death penalty for killing a teenaged girl he'd gotten pregnant. There are charges pending in at least one more case, a drive-by shooting that caused the death of a pregnant woman.

Last month, the Texas Court of Criminal Appeals ruled in favor of the conviction of a man who killed one of two women he was sleeping with after the first told him she was pregnant. He told his second girlfriend that he would take care of the pregnancy of the first, and shot the first woman 3 times with a shotgun, once in the face.

As for "monitoring the actions of women:" a couple of county District Attorneys in Texas have tried to turn the law into an excuse to lock up mothers for endangering their unborn children. The outcome was similar to the cases in South Carolina a few years ago, when women were arrested after being tested as part of their pregnancy screening, required by that State’s Medicaid regulations. One lawyer made a speech to a group of lawyers that the Act could be coordinated with our State's Consent Laws to charge doctors with capital crimes. Texas State Attorney General has given an official statement on the intent of the Legislature that exempts mothers and doctors.

The handling of an ectopic pregnancy is well established under the doctrine of self-defense. With our current medical technology, the child cannot be saved and he or she is a direct danger to his mother’s life.

While we can’t verify the soul, we can verify which embryos are organisms: techs do it all the time in labs. The embryo, unlike the sperm, egg, and transplanted organs, is an organized organism. It's easy to tell within a day whether the oocyte is fertilized and which are not. It's also easy to tell the difference between embryonic stem cells and an embryo.

Genes Cut Out of Reprogrammed Cells

Lots of people (here, here, and here, etc.) are commenting on the "Proof of Concept" by Jaenisch, et. al., in this week's ScienceExpress (early online publication before print) that showed gene modification to reprogram mouse cells in order to create blood line stem cells that would achieve gene therapy - or even, a cure - for sickle cell anemia.

(BTW, these mice are called "humanized knock in mice," meaning that the genes of the have been modified so that the their bone marrow hematopoietic or blood line stem cells have genes "knocked in" to produce human cells blood cells.)

To reduce the potential risk of tumor formation due to c-Myc transgene expression (13), iPS cells were infected with an adenovirus encoding Cre-recombinase to delete the lentivirus transduced c-Myc copies. One out of 10 iPS subclones (iPS #3.3) had deleted both transduced copies of c-Myc and was used for further experimentation (Fig. 2C).

Trust me, as soon as more labs figure out how to make use of these cells, to remove or repair - or to ensure there's no - damage from the insertion of the needed genes, the push for embryos will slow down. (I think it would even faster if Thomson and the California Institute for Regenerative Medicine could find a way to capitalize on adult stem cell research.)

Flash: Embryonic tissue more difficult to obtain than adult

This could liberate future researchers from relying on embryonic tissue, which can be more difficult to acquire.

"NatureNews," the news alert website for the journal Nature, has a news report (registration required) on a study published in the December 6 issue of the journal by researchers from Bonn, New York, Rhode Island, and Pennsylvania on regenerating heart muscle.

It is known that (in mice and assumed in humans) that embryonic heart stem cells or precursor cells (they're a bit more specialized than most of the "stem cells" we've been hearing about - cardiac myocytes (eCMs) and skeletal myocytes ("SMs") will bind to damaged areas of the heart and promote healing and division. However, the SMs have a much higher risk of irregular heartbeats called "ventricular tachycardia." (The "VTach" that causes most sudden deaths after heart attacks in real life and the dramatic scenes on TV.) Even though some people do have better heart function after treatment with their own SMs (from bone marrow or skeletal muscle), 15% of them die of VTach within 3 years.

The researchers found that the eCM's "coupled physically" to the damaged cells in the heart and exchanged electrical signals with the surrounding heart cells, so that they contracted in the proper rhythm.

The scientists (rather than deciding to pursue only eCM therapy) wanted to know why the SMs didn't do as well as eCM when it came to producing the correct rhythm. They discovered that the eCMs had more Cx43 than skeletal muscle. Mice were developed with gene therapy (using viral vectors to insert genes, a common technique used to create "gene mod" mice for research) so that the SMs of the mice express more Cx43 in skeletal muscle than normal. The mice hearts that received the modified SM's from these mice, when cultured and then injected into damaged hearts of other mice, did as well as the hearts that received eCMs.

The science is fascinating, but the irony of the report coming this week is pretty interesting, too. The author of the NatureNews report is truly unbiased or evidently didn't get the memo from the reactionary scientists this week.

(In case you're wondering, I don't get a memo from anyone other than the reactionaries' own blogs, and statements to the press.)

Wash this reactionary's mouth out with soap!

Bioethics.net compares the Bush administration's happiness about reprogrammed adult stem cells with that man, Mr. Clinton's, "I did not have sex with that woman!" and President Bush's statement "Mission accomplished," after our US troops captured Baghdad.

I'll accept the latter (at some future date, if the evidence supports it), but the first is at least as false as Clinton's wagging finger - and (speaking of Yuk factors) did we really need to be reminded of that?

The author, James W. Fossett (who is anything but "non-partisan") states that Yamanaka, the first to report reprogrammed adult cells in humans and mice is from Japan and wasn't affected by the US Federal funding limitations. He doesn't mention that Yamanaka's research didn't rely on the use of new embryonic cells, at all. Yamanaka took the information gleaned from animal research and the currently funded cells and moved to the front of all other stem cell researchers by pointing the way to the key to the production of stem cells from each patient who needs them - from his or her own cells.

Instead, Fossett is running scared due to the "rhetorical parity" from cell reprogramming and the possibility that the success in reprogramming cells will result in more reprogramming research!

Fossett doesn't mention that James Thomson's research using human Embryonic Stem cells (hESC). then human fetal cells harvested after abortions - and finally in skin cells harvested at circumcision of little boys - was funded by the National Institutes of Health, and that those hESC are the ones that supposedly are of no use.

Fossett also fails to mention of the new report by Yamanaka on the technique using only 3 inserted genes to the prior 4, and that the eliminated gene is the one that had scientists concerned about cancers.

I'm sure that he doesn't recall the "first transplantable lung cells" from hESC's by Texas researchers last year. These cells were developed by viral "transfection," also, and were lauded as "a platform that could potentially be useful in the development of spinal cord cells, heart cells, nerve cells and others.” These were neither the first or transplantable, but they did get much more notice than similar cells developed from umbilical cord blood cells without viral transfection.

That may be the problem: the proponents of hESC research are used to getting many times the publicity from hESC research than that received by the non-hESC researchers. And so, we get the concerns about "rhetoric."

There's those deceitful knee jerk reactionaries practicing their projection, again.

Knee Jerk Deceit (Embryonic Stem Cells)

The Washington Post has published an editorial by Alan I Leshner, Ph.D., and James A. Thomson, Ph.D. The op-ed is evidently in reaction primarily to Charles Krauthammer's November 30, 2007 column and blurs the line between fact and fiction in order to make a political plea to remove restrictions on funding for embryonic stem cell research.

Leshner is a psychologist, the Executive Director of the American Association for the Advancement of Science and the Executive Publisher of the magazine, Science. Science is the journal that published the two completely fabricated and retracted reports by Wu Suk Hwang about cloning, the letter attacking David Prentice, Ph.D., for his list of adult stem cell therapies, a letter by Dr. Prentice rebutting the attack, and yet another set of attacks-counter attacks. It is also the journal that published the article ahead of print by Thomson and Yu, et. al., describing the reprogramming of adult fibroblast skin cells on November 22, 2007, after the basic research was done using embryonic stem cells funded by the National Institutes of Health.

Thomson is the veterinarian and professor of anatomy at the Genome Center of the University of Wisconsin who first reported embryonic stem cells from human embryos and who confirmed that adult cells can be reprogrammed into embryonic stem cells. Thomson's institution oversees the NIH program for distributing the Federally funded embryonic stem cell lines and for training researchers to use those cells.

The editorial published December 3, 2007 is titled "Standing in the way of Stem Cell Research." Notice that there is no distinction made between embryonic stem (ES)cells and adult.

The opening sentence says, "A new way to trick skin cells into acting like embryos changes both everything and nothing at all." These stem cells do not act like embryos; they act like ES cells. According to Thomson in his report: "The human iPS cells described here meet the defining criteria we originally proposed for human ES cells."

Leshner and Thomson make the usual claim that ES cells can make all the cells of the body in order to treat spinal cord injuries, brain, heart and other diseases. They do not note that all these cells only come from embryonic stem cells in functioning intact embryos or with very limited, inefficient and difficult methods. In the lab, the stem cell cultures are not homogeneous clumps that can be be easily directed to the desired cells. Instead, the colonies contain cells at different stages of differentiation. Like adult stem cells and progenitor cells, the few stem cells that are amenable to some of the desired cell types must be selected and grown in special environments and nutrients.

No one has yet been able to guarantee that the cells derived from ES cells can be controlled. The risk of introducing a primitive, undirected cell line that will form tumors is the main reason that no one has yet attempted to use these cells in humans. The risk of uncontrolled - tumor causing cells is accompanied with the problem of immune rejection of transplants in patients. Researchers won't be able to obtain "patient specific" cells unless they are able to clone human embryos or learn to reprogram adult cells.

The letter points out that embryonic stem cells were used to help the researchers know how to grow human ES cells while claiming that funding has limited research, without admitting that research on those ES cells was indeed funded by Federal money. They write about the frozen embryos from IVF that would have been destroyed anyway but do not note that unless the donors of the gametes that join to become the embryo give informed consent prior to fertilization, those embryos are not eligible for ethical research. They don't mention the pleas for the intentional creation of new, disease specific embryos with the intention of harvesting research material to create '''disease specific" cell lines (like those made to "model" Fragile X syndrome and cystic fibrosis.)

The authors complain of restrictive funding that prevents young people from doing ES cell research. Then, they say that other countries don't have the same sort of problems and mention that Yamanaka did his research in Japan. In fact, there are other countries with much more rigid restrictions, and few have spent as much on ES cell research as we have here in the US. (Germany's policy actually forbids destruction of embryos.) Dr. Yamanakas' research would have qualified for Federal funding in the US since he didn't use embryonic stem cells at all in his experiments.

Leshner and Thomson tell us that it "remains to be seen whether reprogrammed skin cells will differ in significant ways from embryonic stem cells." It also remains to be seen whether human ES cells will ever be used in human beings.

Talk about reactionary science!

Edited 12/4/07 for punctuation, grammar - BBN

Texas Employees, Politics, and Science

(Just to be clear about where I'm coming from, I believe in a Creator and also believe that the evidence I've seen supports the evolution of species. When asked about evolution, I say, "It looks like that's how God did it." Now that I've alienated all but a few of my readers . . .)

The New York Times has an article today on the resignation of the Texas Education Agency (TEA) employee, Chris Comer. In my opinion, the NYT and the Austin American-Statesman focus on the wrong theme. The story is more about the politics of being a State employee than about the politics of science.

The blogosphere is full of comments relating her resignation to "creationists" and drawing an analogy to the movie, "Expelled."

However, there's a difference between speech and advocacy on scientific controversies while working in a academic position (even when paid by the State) and the same activity while working for a State Agency. While both should avoid frank political advocacy while on the State's time clock, the former is in the business of discussing and critiquing science. The Agency employee works directly for men and women who are themselves restrained by the voters of the State, who have their own politics.

The implication of the NYT piece is that Ms. Comer was under pressure due politics, the appointment of a new Chairman of the State Board of Education and the hiring of a woman who used to work for the Bush Administration. On further research, I found a possible connection between a statement that Ms. Comer made concerning the lack of "real" leadership at the TEA under an acting Commissioner and the appointment of the same man to the office of Commissioner.

In addition, it might help to know that the Texas Legislature recently mandated that each agency develop ethics policies.

Texas elects our State Board of Education, the Governor appoints (and the State Senate confirms) one of these elected officials to the Chair and he also appoints the Commissioner of the TEA. The TEA is the bureacracy that provides "leadership, guidance, and resources to help schools meet the educational needs of all students."

State employees are forbidden by policy to mix in politics while on the job and with State resources. At the very least, it's not wise to risk bringing pressure down on your appointed or elected bosses. The offense that led to Ms. Comer's resignation was sending an email from her TEA account that announced a talk entitled, "Creationism's Trojan Horse."

Ms. Comer and the author of the NYT article find something notable in the policy at TEA:

But several months ago, in response to an inquiry letter, Ms. Comer said she was instructed to strike her usual statement about the board’s support for teaching evolution and to quote instead the exact language of the high school biology standards as formulated for the Texas Essential Knowledge and Skills test.

“The student knows the theory of biological evolution,” the standards read, and is expected to “identify evidence of change in species using fossils, DNA sequences, anatomical similarities, physiological similarities and embryology,” as well as to “illustrate the results of natural selection in speciation, diversity, phylogeny, adaptation, behavior and extinction.”

I fail to see a problem in a policy requiring the quote. I would think that it would inform and educate any one with questions and protect State employees from political fallout.

Ms. Comer herself makes correlations between certain politically controversial subjects:

“I don’t see how I took a position by F.Y.I.-ing on a lecture like I F.Y.I. on global warming or stem-cell research,” Ms. Comer said.

And she did consider the email risky:

As for the e-mail, Comer said she did pause for a "half second" before sending it, but said she thought that because Forrest was a highly credentialed speaker, it would be OK.

For a step-by-step report about Ms. Comer's troubles at the TEA, see the Austin American-Statesman article and my earlier post.

"embryo uber alles"

Ellen Goodman reminds us that it ain't over yet. As she said in her November 20, 2007 op-ed piece (Free registration at the Boston Globe may be necessary),

Democrats, on the other hand, may breathe a sigh of regret. The stem-cell controversy gave pro-choicers an iconic image of their enemy: someone who put the embryo uber alles. It gave progressives a poster girl in Nancy Reagan - and a poster boy in Michael J. Fox. Stem cells were to the left what partial-birth abortion was to the right, a way to frame a touchy issue and look like the reasonable center.

The next time someone has any questions about the source (or existence) of the divisive politics and agendas in the life issues, just point them to Ms. Goodman's observation.

But first, arm them with the explanation that there's no such thing as a "fertilized egg" (there's either an egg or an embryo) and note that the funding for embryonic stem cell research never existed before the President Bush's policy was set and was never maxed out on the Federal level.

Reactionary Scientists

I wonder how often our friend from Kyoto is planning to publish and what tweaks we'll hear about next week?

I also wonder how many of the comments about "must fund all" come from - or actually are a type of - the application of the sort of pressure that Gearhart told his audience in DC that he and others applied to induce Atala to write Pelosi?

I'm trying to get used to the idea of scientists as reactionaries.

Politics aside, I don't think any of the research could have gone any faster even without the "pressure" from either side. The basic science had to be done, and was.

Politics Bites

Chris Comer, Director of Science Curriculum for the Texas Education Agency (TEA) sent out an email from her State account that was blatantly political in nature and which she knew was a bad idea.

Surprise! So did her bosses.

She made the political move, and got fired for it. Really, advocating a lecture titled, "Inside Creationism's Trojan Horse," by Barbara Forrest, a well-known anti-Creationist. That's worse than "not neutral." The title of the lecture is blatantly political.

If you want to see a video of Forrest's lecture, this page hasa link to the video, "Barbara Forrest's Inside Creationism's Trojan Horse."

The Red-A blogger,Pharyngula, The Austin American Statesman, and Nature blogger, "The Great Beyond," among others are blaming the politics on the Texas Board of Education. "The Austringer" blogger has the text of the original memo that Ms. Comer sent out.

In my experience, Ms. Comer's boss has it right. In her memo to the Agency, she notes that Ms. Comer either violated what she knew is TEA policy against employees of the State advocating for a political cause or she does not have the understanding that she should. (There's a link to the memo from the boss on the Austin American Statesman link above, but theres some sort of glich in it - it tries to add Japanese script updates to my computer.)

(In the video, go to 1:01/1:09:52: "These people are fanatics. . . . They know they have to get hold of the kids." A little earlier, Forrest stated that the believers are guilty of projection. From this side, it looks like a case of "Pot, Kettle." The last thing Forrest speaks on is the need to watch out for which judges are appoint, the need to teach the teachers to tell students that belief in a Creator is bad science and that "We need to stop electing people who put up with this crap!")

Reactionary Scientists (Stem Cells)

I wonder how often our friend from Kyoto is planning to publish and what tweaks we'll hear about next week?

I also wonder how many of the comments about "must fund all" come from - or actually are a type of - the application of the sort of pressure that Gearhart told his audience in DC that he and others applied to induce Atala to write Pelosi?

I'm trying to get used to the idea of scientists as reactionaries.

Politics aside, I don't think any of the research could have gone any faster even without the "pressure" from either side. The basic science had to be done, and was.

Politics Bites (Creation, Evolution and the TEA)

Chris Comer, Director of Science Curriculum for the Texas Education Agency (TEA) sent out an email from her State account that was blatantly political in nature and which she knew was a bad idea.

Surprise! So did her bosses.

She made the political move, and got fired for it. Really, advocating a lecture titled, "Inside Creationism's Trojan Horse," by Barbara Forrest, a well-known anti-Creationist. That's worse than "not neutral." The title of the lecture is blatantly political.

If you want to see a video of Forrest's lecture, this page hasa link to the video, "Barbara Forrest's Inside Creationism's Trojan Horse."

The Red-A blogger,Pharyngula, The Austin American Statesman, and Nature blogger, "The Great Beyond," among others are blaming the politics on the Texas Board of Education. "The Austringer" blogger has the text of the original memo that Ms. Comer sent out.

In my experience, Ms. Comer's boss has it right. In her memo to the Agency, she notes that Ms. Comer either violated what she knew is TEA policy against employees of the State advocating for a political cause or she does not have the understanding that she should. (There's a link to the memo from the boss on the Austin American Statesman link above, but theres some sort of glich in it - it tries to add Japanese script updates to my computer.)

(In the video, go to 1:01/1:09:52: "These people are fanatics. . . . They know they have to get hold of the kids." A little earlier, Forrest stated that the believers are guilty of projection. From this side, it looks like a case of "Pot, Kettle." The last thing Forrest speaks on is the need to watch out for which judges are appoint, the need to teach the teachers to tell students that belief in a Creator is bad science and that "We need to stop electing people who put up with this crap!")

Wait 'Till Next Week! (More iPS good news)

Dr. Yamanaka of Japan, the MD who made history last week by announcing that he had been able to obtain embryo-like stem cells fom adult skin cells called fibrobalsts. On Friday, November 30, has published a new report in Nature Biotechnology telling us how he was able to skip inserting the potential cancer causing gene, c-Myc.

At this rate, who knows what we'll have next week?

From The Scientist (online here):

In the current study, the researchers showed that pluripotent cells can be made from both mouse and human adult cells without introducing the c-Myc gene, by transducing just the other three. It's not that Myc isn't needed in the process, the authors noted in the paper; rather, they suggest that the other three genes may be spurring endogenous Myc activity. None of the 26 chimeras made from cells generated without c-Myc developed tumors within 100 days, compared to six out of 36 chimeras made from cells using all four genes.
*************
So far, too, efficiency with this triple-gene method is much lower than with the original four genes; half of the experiments without c-Myc did not produce pluripotent cells at all, while experiments using the four genes almost always yielded pluripotent colonies. "Does this mean that it now only works with a rare cell type?" Lovell-Badge wrote. "As always, many more questions are posed than answered."

The question is whether all fibroblasts are alike, or whether there is a smaller group of fibroblasts that are easier to induce to become "induced Pluripotent Stem" Cells.

If there are specialized cells in the skin that are easier to manipulate than others, this is good news for researchers and the patients who are looking toward stem cell research for treatments and cures.

Ethics, Conscience and Cheating

Is there a difference between matters of conscience and things you shouldn't do? If there is something that would just get you in trouble but you don't believe it's wrong, how do you decide what to do?

The blog, Adventures in Science and Ethics, is one of the ScienceBlogs that I follow. (I love her "Friday Sprog Blogging" about her kids and the discussions about being a woman and having a family in Academia.)

There's a conversation on morality and cheating:

A reasonable ethical decision is one that you can defend -- to others, not just to yourself. You can give reasons why, of the choices available, this was the right way to go.

A course of action that you are taking pains to hide -- one which you would not want to have to defend to others -- is a red flag, ethically speaking.

Being able to justify a course of action to others is a more stringent requirement than being able to justify it to yourself. Folks who see themselves as living up to a high moral standard ought to keep that in mind and make sure their deeds can meet this requirement.

I was raised on the Bible, being taught to respect the authorities and to understand that a sin is a sin is a sin. However, I have a sense of "that's not fair" when I think of putting highway speed limits on the same plane as hurting someone else or even cheating on a test.

Old Dog, New Tricks

I've been working on my LifeEthics.org website and got most of the boxes lined up and the links all work! But the cool thing is that I've made a window for "Bioethics Headlines" as part of the main page.

Not bad for an old lady who learned to type at 40, if I do say so myself. BTW, Microsoft Publisher makes a decent web page composer.

Translation of Yamanaka, Yu "induced Pluripotent Stem Cells" (Revised)

Scientists who report their findings are expected to discuss the problems as well as the outcome of their research. This is usually found in the "Discussion," "Conclusions" or "Results" section of the paper. This is the best place to figure out what the researches intended, what they did and what the report means. (Then you go back and check to see if they proved what they "discussed." And then, you wait for other labs to confirm it.)

The actual (Takahashi et al., "Induction of Pluripotent Stem Cells from Adult Human Fibroblasts by Defined Factors," Cell (2007).) Cell article on reprogrammed adult fibroblast skin cells, the "induced Pluripotent Stem Cells) or "iPS," is available for free, here. The Science Magazine report about similar work by James Thomson from Wisconsin (the researcher who reported the production of human embryonic stem cells in the first place) is supposed to be published November 22, 2007. (Editorial note 11/30/07 – Science published the Thompson and Yu report the same day that Tamanaka's report was published, two days ahead of schedule. See my “translation,” here.)

To the best of my understanding, here's a translation into layman's terms about what the Takahashi/Yamaka report means:

While it took a lot of cells and more time than the researchers first expected because the human iPS grew much slower than the mouse iPS,

1. The cells that grew looked and functioned like human embryonic stem cells with a few minor differences,
2. They believe they proved that their technique is responsible for all the new pluripotent cells that were found in their cultures(there weren't any cells from another culture introduced accidentally or on purpose and which would make them look more successful than they were),
3. The cells could be directed to develop nerve cells and heart cells,
4. They were able to use several types of adult specialized cells to achieve iPS, and
5. The researchers suggest several possible ways to overcome the drawbacks of the process.

The authors believe that the inefficiency or the need to begin with lots of adult cells and wait a little longer for a substantial amount of human iPS should not be a "practical" problem because the adult cells are easy to obtain and labs all over the world should be able to reproduce their results. Since the technique should be well-funded (it qualifies for US Federal funding and is ethical, since no human beings have to die), the authors believe it will be possible for lots of researchers to work on them.

If I were to predict the future, I would anticipate banks of iPS - or even specialized or intermediate forms of cells that are produced from iPS - being stored for each of us, just in case. In the very long term, we will learn more about stimulating our on bodies' stem cells from research on these cells, so that we can repair or prevent damage without transplants or waiting for cultures to grow in the lab.

The major hurdle is that the cells were produced by the Recombinant DNA technique, using retroviruses in plasmids.

The retroviruses are a class of viruses that actually insert themselves into the DNA strands of animal or plant cells to become a part of that cell’s DNA and are copied when the cell reproduces. They are manufactured in the lab in the form of plasmids in order to carry genes into the experimental cells.

Plasmids are little bits of DNA, a mini-virus in a circle. Think of a chain with pairs of magnets or interlocking puzzle pieces that connect the ends and make a loop. When open, the plasmid becomes a strand of DNA which has ends that are "sticky.” When placed in a culture with mouse or human cells, the plasmids infect the cells and then move into the nuclei of the cells. The retroviral DNA is inserted or inserts itself into the DNA of the host cell because the sticky ends of the plasmid strand match or mate to certain areas of the host DNA.

Plasmids can be manufactured to carry copies of genes that researchers want to insert into the DNA of experimental cells. The technique is common in commercial and experimental labs for at least the last 30 years. In fact, "Recombinant DNA" is used to induce strains of bacteria and yeast cells in cultures to manufacture vaccines like the flu and Hepatitis B vaccine and the insulin used by diabetics these days. The particular retroviruses used by Tamanaka are said to be "strongly silenced in humans." In other words, they don't normally get reproduced as viruses when the cell divides. Once they are taken up in the cell DNA, the viruses used in research don't break out to become infectious viruses, again. However, some of them can induce the cells to form tumors or cancers if injected in an animal or human.


One of the possible problems that the article notes is that the new iPS cells each had several copies of the retrovirus included in their DNA. There is a concern that these bits may be responsible for the tumors that were seen in the mice used in the experiments. Before iPS can be used in humans, it will be necessary to learn to remove all the viral particles or to learn to make the cells without viruses that can cause tumors. Otherwise, there is a risk of causing cancer in patients.

The researchers note that another group of scientists have already reported that it is possible to insert one of the genes without using retroviruses and that the hope is to either find a way to insert the other three genes or to remove all traces of the virus.

There's also a suggestion that what they are actually inducing to grow is a sub-set of fibroblasts with the tendency to become embryonic-like stem cells.

CNN objects to conscience

This subject again.

CNN, that bastion of upstanding plants ethics, objects to doctors with morals - or at least the ones who act on them.

The CNN video (not a "news piece") shows interviews with a woman who was refused contraception by one doctor and a second interview with another doctor who is Catholic and who does not believe that contraception is moral and so he does not prescribe it.

The reporter is shocked that 60% of doctors feel that it's okay to tell patients our moral views.

The reporter asked the patient whether she felt "rejected." The woman said that she did and that she felt that the doctor was judging her and imposing his morals on her. She said that any doctor who would not do what his patients wanted should not be in practice.

The woman isn't judging or imposing her morals on every doctor, is it?

Doctors make "judgments" all the time. We are not simply dispensers of products that people want. We must "impose" our judgment on patients who smoke (a perfectly legal drug) and drink (ditto) or who have become overweight from eating legal food and choosing not to exercise enough to burn off calories faster than they take them in. We are responsible for determining whether a patient is becoming addicted to pain medications, asking for a note for missing work when they were never sick, or a handicapped parking sticker when they're not disabled.

Much more often, we make judgments about the cause of a patient's symptoms or disease and how best to treat it. Our job is not to make the patient feel good about themselves, although most doctors I've met prefer to do so. What we do is diagnose and treat in order to help the patient be as healthy as we are able.

While I don't object to non-abortifacient contraception, it is an elective service in most cases. It is very rarely necessary to maintain the health of the body of patients. It is truly a "choice."

As I've said before, it would be simpler for people who feel that contraception is important to arrange to pay doctors who will write and dispense those medications and devices to go around to the areas where they are needed.

The alternative is to find a way to trust a doctor who will act against his conscience - to do what he considers the wrong thing for your pet issue - to do the right thing every other time.


Hat Tip: Blog.bioethics.net

Emotional Debate on "Physician Assisted Suicide"

On Tuesday night, November 26th, I drove to Houston to hear Wesley J. Smith, debate Physician Assisted Suicide (PAS) with Kathryn Tucker, the Director of Legal Services for Compassion & Choices, which was once the old Hemlock Society and then Compassion in Dying. Mr. Smith is the author of The Culture of Death and Forced Exit: Euthanasia, Assisted Suicide, and the New Duty to Die. The only biographical data I can find on Ms.Tucker is this pdf.

The Holocaust Museum Houston has teamed up with the University of Texas Health Science Center at Houston to present the Dr. Michael E. DeBakey Medical Ethics Lecture Series, called ""Medical Ethics and the Holocaust: How Healing Becomes Killing--Eugenics, Euthanasia and Extermination."

From the first, opening night, presentation featuring the-soon-to-be-unpopular James Watson and two other Nobel Laureates, it seems that we are being exposed to an ethics lab, rather than a history and theoretical series. The speakers the first night, including a doctor, Eric Kandel, M.D., 2000 Nobel Laureate, Medicine or Physiology, who was a child in Vienna on Krystallnacht before his family escaped to the US, told us not to worry about research on human embryos as long as the parents give "informed consent." Ironically, after descriptions of the build up to the Holocaust, Dr. Kandel reassured us that that we would gradually get accustomed to embryonic stem cell research.

I could tell that Mr. Smith and Ms. Tucker were irritated with each other during the program. In her introduction, Ms. Tucker referred to an earlier debate that had taken place that day when, as Wesley later told us, "it got angry." I got the idea that the moderator, Dr.Sheldon Rubenfeld, was slightly testy, although he did a good job moderating the questions, as always.

Ms. Tucker' s history of redefining, renaming, and litigating did not reassure me.

She was the lawyer in the case of a family suing a doctor for failing to give their loved one enough medicine to control pain at the end of his life and has fought laws against PAS for 10 years. Ms. Tucker misrepresented "terminal sedation," as though it is always intended to lead to death, rather than "deliberately inducing and maintaining deep sleep but not deliberately causing death in very specific circumstances." It was a surprise to hear Ms. Tucker warn against "back alley deaths" although it turns out that it wasn't the first time I'd heard the term. She frequently used the word, "choice," comparing the patient's choice at the end of life with a woman's right to "Reproductive Choice."

The silliest part of the evening - we were discussing death, after all - was when Ms. Tucker chided Mr. Smith for using the wrong terminology, "Physician Assisted Suicide." She showed us the recently revised policy statements of the American Medical Women's Association and the American Public Health Association. Because these two second tier (that's a word I learned from John Gearhart while attending the ASBH conference this year) organizations revised their own terminology to avoid the "emotionally charged" nature of certain words within the last year, Ms. Tucker shamed Mr. Smith for using the American Medical Association's terminology and legal term instead of calling the act "Aid in Dying."

Mr. Smith pointed more clearly to the problem of emotions when he remarked that it is often acknowledged in these debates that "existential pain," or the emotional component of pain, may be worse than physical pain.

No matter what we call it, death is always going to be an emotionally charged subject and is rarely dignified or controlled. For one thing, the body loses control of the bowels and bladder at death, as well as everything else. The questions from the audience were examples of people who approach the subject of end of life care from a strictly emotional viewpoint, rather than thinking it through to its logical consequences. The emotion is getting stronger as technology introduces more and more variables.

However, when we are discussing Medicine and the death of the body as well as of the mind and spirit, we should confine our conversations to the physical consequences. To be trite: When you're dead, you're dead.

There is no legal question as to whether "Assisting" or "Aiding" death is different from withdrawing care. We don't pinch the patient's nose or remove the oxygen from the room when we withhold or withdraw a ventilator. Physician Assisted Death, in contrast, is an irrevocable interventional act against the living processes of the body using State regulated medical knowledge and medicines, and should be treated as the violation of medical ethics that it is. The history of Western medicine, at least between Hippocrates and Roe, has always condemned intentional use of medicine to positively end the life of the body.

Mr. Smith and I have had several discussions about the ethics at the end of life, especially the Texas Advance Directive Act, which he refers to as the "Futile Care Act." We agree that doctors should never intend to cause death but that they may withhold or withdraw intervention at the request of the patient. We disagree, though, about whether a doctor may refuse to intervene because our best medical judgment is that the intervention will cause increasing damage to the body and prolong death.

I found myself, a Family Physician who cares for people at all stages of life, theoretically squeezed between two legal pressures, one law to force me to act with the purpose of killing a patient and another that would force me to act even though my medical judgment is that the intervention caused harm. Several people from the audience also advocated for legal consequences for doctors who failed to follow patients' end of life wishes by prolonging their lives.

To be honest, if I had to "choose" between the two, I would choose against Ms. Tucker's extreme, which would leave me with Mr. Smith's. I could live with that.

However, I hope that society will teach doctors to never take life while expecting the profession to assist one another in determining when medical intervention causes more bodily harm than healing, when a patient's bodily processes are breaking down faster than we can heal or maintain them.

(Edited 11/20/07 for grammar and order - BBN)