Cutting Edge Juvenile Diabetes Adult Stem Cell Research

Interrupting our discussion on State force and conscience, but this news is just too cool to postpone:

Regenetech, the company that has the license agreement with NASA for the "Intrafuge" that processes cord blood cells and bone marrow cells for the production of embryonic-like and select stem cell treatments, has announced a two year agreement for research with Johns Hopkins, on Type 1, insulin-dependent or Juvenile Diabetes:

Regenetech®, Inc. announces that it has signed a Sponsored Research Agreement (SRA) with Johns Hopkins University in order to work toward a treatment for type 1 diabetes. This is in addition to the research agreements which the Company currently has in place with Texas A&M University and the University of Texas Medical Branch at Galveston. Regenetech is pioneering the development and commercialization of technology which the company believes will enable regenerative therapy with adult stem cells for widespread use.

Regenetech’s agreement with Johns Hopkins University will span over two years, and involves significant funding from the Company. The goal of the research project is to develop a treatment for type 1 diabetes using a patient’s own adult stem cells expanded in Regenetech’s IntrifugeTM Bioreactor. Dr. Mehboob Hussain, Assistant Professor of Pediatrics and Medicine at Johns Hopkins University, has considerable experience in the treatment of diabetes with stem cells, and is overseeing the research which will use Regenetech’s technology.

University of Texas Medical Branch at Galveston (UTMB) supplies blood and cord blood stem cells to Regenetech’s laboratories and uses them for their own research purposes as well. In addition, the Company has signed a sub-license agreement with UTMB to use Regenetech’s NASA licensed IntrifugeTM Bioreactor system to expand the stem cells found in the blood. The ultimate goal is to provide low cost, safe doses of adult stem cells for a broad range of diseases and known therapies. The principal investigator from UTMB is Professor Larry A. Denner, who has significant expertise in the identification, expansion and differentiation of primitive cord blood stem cells for pre-clinical studies.

Regenetech also has a SRA with Texas A&M University for the treatment of bone fractures in animals. The research is to demonstrate the clinical efficacy of NASA’s patented time-varying electromagnetic field (TVEMF) technology, which is exclusively licensed to Regenetech. This technology holds rapid healing potential for animals, such as high value race horses and pets, which offer highly significant markets for Regenetech. Once the veterinary treatment protocols have been finalized successfully, it is expected that they will lead the way to human clinical trials.

Regenetech also has a good stem cell "primer," as well as more information on their ongoing research and patents. They do make a case for embryonic stem cells, saying that adult stem cells haven't been found for all tissues and organs and that it might take too long in emergency situations to grow the needed tissues, but do not acknowledge that these limitations also exist for embryonic stem cells.

Oh well, no one's perfect.

Give me liberty or give me condoms!

Where are the condom squads who go around making sure that every grocery store, drug store, and 24 hour convenience store stocks latex condoms and the appropriate lubricants, "at all times"? Condoms are a much more basic public health issue than Plan B, which only works (when it works) for about 5 days in the woman's cycle.

Siricou Raven is keeping the conversation alive as to whether or not pharmacists should be forced to stock and dispense all legal medicines. She asks,

What is the difference between a pharmacist refusing to distribute contraception because it offends his own morality, and one refusing to dispense HIV medication because it offends his own morality?

Treating disease has never been controversial. Have you ever heard of a doctor or pharmacist who refuses to treat syphilis, gonorrhea or chlamydia? Have you noticed any that have ceased doing Pap smears since we learned that abnormal Paps are due to a Sexually Transmitted Disease, Human Papilloma Viruses that are only transmitted by sexual contact?

(I do know a pulmonologist - a lung specialist - who will not take on patients who smoke. I could draw all sorts of parallels between sex and smoking, but I'll leave that to you.)

At issue is the very basic question is that of the "unalienable" individual right to liberty, expressed as following the conscience.

As Judge Lawrence wrote in the Injunction, the Washinton State law is very clear on the right to conscience and freedom to practice religion.

There is no reason to carve out contraception and "reproductive health" (a Newspeak term, if I ever heard one) as a special, protected class of medicines, devices and procedures.

For that matter, why on earth would any woman who doesn't want to become pregnant have sex without two or more contraceptives in hand/body before the act itself and/or know her fertile periods? If men didn't have the back up insurance of abortion, I'd bet they would be more careful, too. (Rape is an Emergency Room issue - the ER doc and SANE nurse can dispense and counsel on fertility risk, right along with prophylaxis for STD's).

While I'm ranting:

Ethics lesson 1: Life trumps liberty, since pretty much everything else depends on being alive.

Ethics lesson 2: The only reason the State should force action from a citizen is in cases of life and death. Each law that is enforced puts the citizen's life and liberty at risk, since the enforcement will involve the real and virtual guns of the State. There is a long history of recognizing the relationship between the right to own property and the right to liberty. If the State may take the property or restrict the livelihood of a person, the person is at risk of prison or hunger and is not free.

Ethics lesson 3: People who will do acts that they believe morally wrong for any reason other than to save lives (to stay out of jail, keep their jobs or avoid controversy) are either unethical people or insane. And I'm not too sure about the people who would force them, either.

Some Bloggers shouldn't reproduce

They shouldn't reproduce their thoughts in writing, that is.

Take a look at the comments on "Laws, conscience, medicine and bloggers," for a perfect example of "they just don't get it."

Freedom of conscience is part of the Washington State law. The Governor threatened to replace the members of the State Pharmacy Board if they voted against an invalid law. The pharmacists do not have to dispense over the counter medications.

All sorts of red herrings have been raised to defend the law, including accusations that someone might refuse to prescribe medicines for HIV patients and insulin for diabetics.

This is also a good example of my editorial style. You would be shocked by some of the answers I've typed and erased.

A brief history of cloning

Steve Connor of the The Independent, from Britain, tells us the history of cloning.

But first, the "good news:"

A technical breakthrough has enabled scientists to create for the first time dozens of cloned embryos from adult monkeys, raising the prospect of the same procedure being used to make cloned human embryos.

Attempts to clone human embryos for research have been dogged by technical problems and controversies over fraudulent research and questionable ethics. But the new technique promises to revolutionise the efficiency by which scientists can turn human eggs into cloned embryos.

It is the first time that scientists have been able to create viable cloned embryos from an adult primate – in this case a 10-year-old male rhesus macaque monkey – and they are scheduled to report their findings later this month.

The scientists will also demonstrate that they have been able to extract stem cells from some of the cloned embryos and that they have managed to encourage these embryonic cells to develop in the laboratory into mature heart cells and brain neurons.

Scientists who know of the research said it was the breakthrough that they had all been waiting for because, until now, there was a growing feeling that there might be some insuperable barrier to creating cloned embryos from adult primates – including humans.
*****

The Oregon team, working with a group in China, has so far produced about 100 cloned embryos that have been transferred into around 50 female macaques, but none has resulted in a full-term pregnancy, he said.

"It's possible that we're still just having bad luck. We're producing may be one in 20 or one in 30 cloned blastocysts that are 'normal' and capable of producing a pregnancy and we just haven't got them into the animal recipient at the right time to allow implantation and pregnancy to occur," Professor Wolf said.

"The focus now is going to be on therapeutic cloning and using the non-human primate as a paradigm for therapeutic cloning for what you might be able to do clinically," he said.

"We're the first to do it, although it's a tainted subject because of the fraudulent research that came out of South Korea. One can never be sure but there may be some validity to what the South Koreans did. But this would now be the first documented therapeutic cloning in a primate," he added.

A brief history of cloning

The monkey-cloning technique is the same basic procedure that resulted in Dolly the sheep. The nucleus of a healthy, unfertilised egg is removed and another nucleus from the mature skin cell of an adult animal is placed inside the egg. With careful timing and the use of electrical pulses, an embryo can be created which is a genetic clone of the skin tissue donor. It is possible to implant embryos created in this way into the womb to produce cloned animals. This so-called 'reproductive cloning' of humans is illegal in Britain and many other countries. However it has been applied to a range of animal species, including:

* Cow: Many domestic cattle have been successfully cloned. First attempt to clone an endangered species was Noah, a rare gaur ox, which was cloned in the US in 2001 but died 48 hours after birth

* Mouse: Cumulina was a common brown house mouse, cloned from adult cells at the University of Hawaii in 1997. She survived to adulthood and produced two litters, before dying in May 2000

* Horse: Called Prometea, the first cloned horse, born in Italy in May 2003

* Cat: A kitten called CopyCat was born in 2002 in Texas, and gave birth to three kittens by a natural father in September 2006

* Dog: Snuppy, born in South Korea. Doubts about its authenticity were dispelled by DNA tests. The group has also cloned two wolf cubs, called Snuwolf and Snuwolffy using the same procedure. Cloned Afghan hounds named Bona, Peace and Hope have also been born.

10% decrease in Medicare payments to Doctors

From the TMA comes another reason to distrust Government healthcare, the "negative update:"

Unless Congress pulls its usual trick of averting disaster at the last minute, the Centers for Medicare & Medicaid Services (CMS) will lower physicians' Medicare fees 10.1 percent on Jan. 1. For some services in some parts of the country – including much of Texas – the cut will be even deeper.

Buried in the seventh paragraph of a CMS news release touting its plans to "improve accuracy of Medicare payment and give physicians and health care professionals additional financial incentives to provide higher quality and value in the delivery of care" is this:

"The Medicare law includes a statutory formula requiring CMS to implement a negative 10.1 percent update in payment rates for physician-related services. This formula compares the actual rate of growth in spending to a target rate, which is based on such factors as the growth in the number of Medicare fee-for-service beneficiaries and statutory or regulatory changes in benefits. CMS has no choice but to implement this negative update because it is mandated by a statutory formula."

If it was difficult to find a doctor for Medicare eligible patients this year, it will be much harder next year.

Government Health: Intervention, Restrictions, and Penalties

What do Massachusetts and Great Britain have in common? Mandated health coverage.

Today is the last day that citizens of the State of Massachusetts may buy health insurance or risk penalties on their State income tax.

The BBC News from Britain reports that the Nuffield Council on Bioethics proposes that the government do more to protect the people from themselves and their choices:

The government should intervene more with public health measures Government ministers should shrug off media accusations that they are running a nanny state and introduce tougher public health measures, experts say.

The Nuffield Council on Bioethics said the time had come to consider a whole host of interventions in the UK after the introduction of a smoking ban.

Its proposes raising alcohol prices, restricting pub opening hours and better food labelling to fight obesity.

The government said it was taking steps to protect public health.

The report by the panel of experts, which include scientists, lawyers and philosophers, said there was a balance to be struck between individual freedom and wider public protection.

*****
"But the government has a duty to look after the health of everyone and sometimes that means guiding or restricting our choices." (emphasis mine, BBN)

Of course, the UK doesn't have our Declaration of Independence, with its insistence that each of us is endowed with the inalienable right to life, liberty and pursuit of happiness and that the government receives its power from the consent of the governed. Massachusetts ought to know better.

However, I'm afraid that the bioethicists and bureaucrats go to the same schools.

While I appreciate that the Massachusetts plan calls for each person or family to buy individual health insurance if they don't have it through their employer, and I recognize that people would be healthier if they follow the recommendations of the UK bioethicists, I would prefer a tax deduction for compliance, rather than a penalty. Rewards seem to work better than punishments for behavior that other people decide is "for your own good."

The statement from Lord John Krebs about restrictions for the common good, however, is the most worrisome. Remember that some in the public health community believe that in times of crisis, the community interests must trump those of individuals due to the scarcity of resource and public funding of relief and rescue. (Never mind that the courts are paid for by community funds, also have limited resources and yet, no one would dare suggest suspension of individual rights in criminal cases.)

Laws, conscience, medicine and bloggers

In contrast to the hype that you might read on blogs and in the press, the Federal District Court judge in Washington has upheld the law of that State. The basic right to not be forced into action that one considers unethical or immoral - the right to liberty - was upheld first, by the Washington State Legislature and affirmed by the Court.

According to the Seattle Times article, there will be a trial next year and the "rules were meant as a compromise after long, contentious hearings and intervention by Gov. Christine Gregoire, who threatened to replace members of the Board of Pharmacy who didn't vote to protect women's rights." (Emphasis mine, BBN.)

The judge ruled in favor of State Law and overturned regulations passed by the Washington State Board of Pharmacy which were changed in July of this year to require that "pharmacies must maintain at all times a representative assortment of drugs in order to meet the pharmaceutical needs of its patients." The plaintiffs, two individual pharmacists and a corporate pharmacy were asking to be allowed to follow their previous practices "refuse and refer."

The Court's ruling is posted here at the Seattle Times website, which also has a fairly good review of the case to this point, here. (I've saved copies of each, so let me know if they disappear).

Judge Ronald B. Leighton issued an injunction that delays the force of the regulation, since it appears that the regulation violates laws passed by the Washington State legislature to protect the rights of individuals:

"As a part of the Health Care Access Act, the legislature expressed the recognition “that every individual possesses a fundamental right to exercise their religious beliefs and conscience.” RCW 70.47.160(1). The Legislature further acknowledged that “in developing public policy, conflicting religious and moral beliefs must be respected.” RCW 70.47.160(1). Accordingly, the Legislature provided that “no individual health care provider, religiously sponsored health carrier, or health care facility may be required by law or contract in any circumstances to participate in the provision of or payment for a specific service if they object to so doing for reason of conscience or religion.” RCW 70.47.160(2)(a). No person may be discriminated against in employment or professional privileges because of such objections. RCW 70.47.160(2)(a). The right of conscience, however, is not intended to result in a patient being denied timely access to any service included in the basic health plan. RCW 70.47.160(2)(b).

"An identical right of conscience was included within the Insurance Reform Act adopted by the Legislature in 1995. RCW 48.43.065."

(emphasis in italics are mine, BBN)


The regulation itself was poorly written.

The phrase "at all times" is a big problem. Would that mean that all pharmacies must change their hours so that they are open or on call 24/7? As to the phrase, "representative assortment," that might mean different things to different people. The wording open to the widest interpretation, however, is the phrase, "pharmaceutical needs of its patients." (Let's forget that pharmacies don't have patients, pharmacists do.)

The "pharmaceutical needs" of patients is wide open to interpretation, especially in the case of Plan B. I've covered the evidence (here) that indicates that Plan B only works to prevent ovulation and fertilization the 5 days or so of the month before and the day of ovulation and the lack of evidence that it acts in any way as an abortifacient. Unfortunately, this isn't acknowledged in the court's ruling or by any of the other parties in the case.

I depend on pharmacists to evaluate the prescriptions I write for my patients. They have often helped me by catching and refusing to fill scripts because they knew about drug interactions, allergies, and fraudulent prescriptions when I didn't. I would like for them to notify me if they refuse to fill my scripts, but their professional judgment is the very thing we physicians and patients are depending on, isn't it? If we force them to do what they believe to be wrong, the only pharmacists we'll be left with will be people who will do wrong because they were "only doing their job." (Where have we heard that before?)


There's an especially over-wrought emotional discussion over at the Women's Bioethics Project blog. No posts are published without the permission of the author, who evidently has some pretty strong feelings involved. I added to the intensity of the silliness and self-righteousness with my comments, I'm afraid. (So far, they haven't posted my remarks from 12 hours ago about cigarettes as a legitimate treatment for priapism [an old remedy - no longer advised - that was actually used as late as the '80's], prescribing of wine as a relaxant, and the fact that I make it a policy not to prescribe medications until they are on the market long enough to be proven by lots of other doctors' patients.)


As Mick Jagger sang, "You can't always get what you want. . . but you can try sometimes to get what you need."

(edit - typos fixed at 5:30 PM CST 11/14/07)

Previous review Texas Cancer and stem cell research

Here's a link to a post from last January on HB 14, and House Joint Resolution 90, the Bills which became Proposition 15, the Legislation for $3 billion in cancer research bonds and the Texas Cancer Prevention and Research Institute of Texas.

The original article is no longer available on the Austin American Statesman site, but here's another article on the debate:

From the San Antonio Express-News, November 3, 2007,

Unlike the California initiative, which was enmeshed in controversy — and litigation — over potential conflicts in its governing board, Proposition 15 would create a new entity — the Cancer Prevention and Research Institute of Texas — that would operate with two advisory boards. A scientific group would decide which research ideas merit funding, while a panel of 11 political appointees would provide oversight.

Political appointees would be restricted from decisions about institutions to which they have ties. And they could overrule the scientists on individual grants only with a two-thirds majority vote. The governor, lieutenant governor and speaker of the House each would appoint threepanel members. The other two would be the governor and state comptroller, or their delegates.

Local communities have been moving to put together lists of local candidates in the event the measure passes, believing the panel would make sure the money is distributed fairly across the state, rather than simply handing most of it over to the University of Texas MD Anderson Cancer Center — Texas' 600-pound gorilla of cancer research. The Greater San Antonio Chamber of Commerce's health care and bioscience committee would recommend John Kerr, president of the Southwest Foundation for Biomedical Research; and Phyllis Browning, CEO of Phyllis Browning Co.; as well as a slate of top local cancer experts for the scientific panel, said Ron Tefteller, who chairs the committee.

Local cancer researchers acknowledge that even with all that, they'll be at a competitive disadvantage with their neighbors to the east — as well as other Texas research institutions with a richer pool of benefactors. The law would require that researchers find matching funds equal to half the amount of the grant they're seeking under the program — "skin in the game," Nelson calls it.

Bioethics on the Ballot

Texas approved Billions in bond debt, some $3 Billion of which will fund the new Cancer Prevention and Research Institute of Texas. There is already private funding of embryonic and fetal tissue research in Texas already.(See this report on the Brown Institute in Houston.) While Texas is a leader in ethical stem cell research and public cord blood banking, there are no limits on State tax funds for research that would limit any sort of destructive research on unborn humans, including cloning, embryonic stem cell research and fetal research. As long as none of the subjects are able to hire a lawyer, it's open season in Texas. The prolife community in Texas is hoping - and has already begun the fight - to ensure that the oversight board will be able to control the use of the money for ethical means.

New Jersey, on the other hand, rejected funding for embryonic stem cells! Hooray!

Wesley Smith reviews Physician Assisted "Suicide"

Bioethics.com, the blog of the Center for Bioethics and Human Dignity published Wesley Smith's excellent review of a British report on so-called "Physician Assisted Suicide."

PAS is not medicine in any sense of the word. Medicine, at the very least involves the intention of bringing health to the body and relief from unpleasant symptoms. It can never mean killing. We don't end suffering by ending the patient.

It's worth your time to read the excerpts.

Mind Whiplash

Read the discussion about women's sufferage at Vox Populi and then go read the eulogies at the Women's Bioethics Project blog. Buckle your (mental) seatbelt first. (The mention of "airbags" seemed to risky.)

("Vox Day" and the posters at Vox Populi are not representative of libertarians or Libertarians, by the way.)

I explained my philosophy about who is "people" in two posts last week, here and here.

Statistics and politics

Statistics are easily mistakenly used and manipulated. Rudy Guiliani is under attack due to statistics that he quoted in a political ad running in New Hampshire . He spoke about the odds of surviving prostate cancer, contrasting the medical systems in the United States and in the United Kingdom. I saw a link to an article titled, "Guiliani learns math is hard" (I couldn't get that link to work and had to do a search) when I was linking to the American Journal of Bioethics for yesterdays' post.

The search at the Washington Post led me to Eugene Robinson's opinion column (free registration required), which featured "Related" links to another op-ed by Libby Quaid of the AP and an AP "Fact Check" article that is almost identical to the Quaid piece. Robinson also links to the article that the Mayor's statisticsare said to have from.

Both Quaid's op-ed and the "Fact Check" article state that 15 out of 100,000 "people die from prostate cancer in the UK vs. 12 out of 100,000 in the US, a 20 percent (12 divided by 15) difference. (Or is it that people have a 25% higher chance of dying of prostate cancer in the UK, since 15 divided by 12 is 1.25?). It's odd that the rates are given as "people" who die of prostate cancer, including men and women, since only men have prostates, I would expect to see those rates given in X out of a 100,000 men.

Somehow, Mr. Robinson adds 12 and 15, and comes up with "25 men out of 100,000 die of prostate cancer each year in both countries." He guesses that Mayor Guilani "didn't really care" whether his statistics are correct. Either Mr. Robinson's math is bad, or he "didn't really care" whether his readers to assumed that that's 25 in the US and 25 in the UK.

Since I'm pro-life, I'm concerned about the possibility that Rudy Guiliani may be the next Republican candidate for President. The reason that I tend to vote Republican is because of the Republican Party Platform is pro-life.

However, I am also very concerned about the risk that Government insurance and control of medicine would bring.

While it's true that the NHS doesn't screen nearly as many men as our US docs, that hardly seems an argument for adopting the finance system of the former. Which system do you want: one that gives a 99% survival rate or one that gives 74% ?

Human dignity: What it is

Whether it's a genetic result of evolution or the way we are designed by a Creator, even very young children seem to have a sense that it's important to understand that there are consequences to infringing rights of other people before they can express "That's not fair!."

My attempt a couple of days ago to discuss the foundations of conservative philosophy and human dignity is not nearly so elegant as this one from Professor Francis Beckwith, associate professor of philosophy and church-state studies at Baylor University:

It is the view that human beings have intrinsic dignity by nature that is not a consequence of their size, level of development, environment or dependency.

and

"We don’t become less intrinsically valuable because others think it is in their interest to destroy us.

The Professor's letter addressed the controversy over abortion in Waco, Texas the home of Baylor. It might also give the editors of the American Journal of Bioethics a better understanding the base of the conservative philosophy and human dignity.

Admittedly, the result can be risky for people, individually and in groups. This is where government comes in and why it's vital to educate the public about the nature of rights as endowed to each human individual from the beginning of life until death. The danger comes from other people who discriminate between which human individuals fit into artificial categories smaller than the species category. The re-defining and discrimination - and the distraction by adding adjectives and qualifiers - is the beginning of the infringement of rights, whether the categories are according to physical or political power, race, status, location, development or function.

Thanks, to Jivin' Jehosaphat for the link to the Beckwith editorial in the Waco Tribune-Herald.

Conservative vs. Progressive (no adjectives)

Once again, we're reminded about the great gulf between perception and reality (just look at the repetition of the names of authors whose ethics comments are published in the "mainstream" science and bioethics journals and explore the political and religious viewpoints of those authors and editors), between the idea that all humans are people possessing rights endowed by "their Creator," and the difference between exercising those rights and the restrictions and privileges afforded by government. And we see another example of projection, re-definition to attack pro-life conservatives.

(Go ahead and read the Declaration of Independence (Here's another text version). I believe it's a good primer for understanding conservativism.)

The latest American Journal of Bioethics includes a silly little target article, "Biotechnology and the New Right: Neoconservatism's Red Menace," (the abstract is free, the rest is behind a pay-wall. Let me know if you want to read it) by Jonathan Moreno, Ph.D. and Sam Berger. Both "progressives" are mouth pieces a Senior Fellow and a (former?) Research Assistant at the Progressive Bioethics Initiative. The PBI is an off-shoot of the "Center for American Progress," a far-left think-tank started by John Podesta.

Moreno and Berger look at the fathers of some men that opponents have named "neocons," and build upon the argument that

"Although the neoconservative movement has come to dominate American conservatism, this movement has its origins in the old Marxist Left. . . . By not acknowledging and embracing their intellectual roots, neoconservatives are left with a deeply ambivalent and often confused view of biotechnology and the society that gives rise to it."

The "Open Peer Commentary" pieces are written by volunteers who review and argue the target article. Remember the Womens Bioethics Project and their "God's Bioethics" expose'? (Read more about that here and here.) The Commentary "Responding to Neocon Critiques of Biotechnology: A Progressive Agenda" (sorry, another pay-to-read) by Kathryn M. Hinsch, and Robin N. Fiore, Ph.D., of the Women's Bioethics Project should offend conservatives of all ages and progressives as well.

In order to overcome what they see as impediments to their goal of ". . . attempting to construct a coherent consensus “progressive view” that could be acceptable to the wide range of extant progressive views (plural)," (sic) they suggest that Progressives work on the following problems:

1) Widespread scientific illiteracy permits the substitution of rhetoric about vague but disquieting threats to human nature, engenders distrust of the scientific enterprise and its products, and sanctions relativism with respect to non-scientific and pseudoscientific explanations and justifications for empirical claims. For example, neocons have successfully exploited the public’s lack of understanding with respect to the differences between therapeutic and reproductive cloning in order to pursue a ban on all forms of embryo research.

2) Social arrangements structured by historical gender, race and class inequities continue to appropriate women’s sexuality, their reproductive capacities, and their labor. Progressives as well as conservatives often neglect analyses of (current and potential) distributions of power and privilege. For example, neither conservatives nor progressives address caregiving in ways that acknowledge the increasing dependence on uncompensated care
by women in families and the impact of caregiving burdens on women’s own well-being. The President’s Council on Bioethics issued a lengthy report that finally concludes with a recommendation (sigh) that yet another commission be appointed to study this issue (President’s Council on Bioethics 2005).

3) Progressives are identified as being more concerned with social justice and conservatives as more concerned with human dignity — 45 million uninsured Americans rebut both propositions. On questions of access, disparities in healthcare and medical entrepreneurship,
progressives have failed to distinguish themselves. Conservatives offer a dystopian vision of a future gerontocracy and blame ill health on the personal irresponsibility of the medically least well off. Mainstream bioethicists have offered arguments from“justice” about individuals’ duty to refuse expensive medical interventions
after a “fair” share of normal life expectancy, but have been unable or unwilling to specify a “fair” profit margin for entrepreneurial healthcare systems and insurers.

4) Moreno and Berger (2007) suggest that the neocon attempts to ban whole sectors of biotechnological research and commercialization — particularly those that implicate reproduction — stem from neocon’s understanding of “people” (scare quotes added for emphasis) as too weak, imperfect, and immoral to make certain weighty decisions. This view of moral agency has, of course, been routinely applied to women and other infantilized social actors, particularly with respect to individual decisions regarding sexuality and reproduction. In Gonzalez v. Carhart, the Supreme Court of the United States justified upholding the ban on late-term abortion in part by invoking gender stereotypes and claiming that women needed to be protected from poor decision-making. As Justice Ginsberg pointed out in her dissenting opinion, this decision could have been accomplished by strengthening informed consent rather than depriving women of the right to autonomous choice. Conservatives are now attempting to limit forms of medical progress that have implications for the moral agency of previously privileged social actors. For example, Francis Fukuyama and Leon Kass, both members of the President’s Council on Bioethics, support legislation that would criminalize the prescription or utilization of treatments developed (anywhere in the world) from cloning technology.
A progressive alternative to technology embargoes and diminished moral scope might focus on developing programs to enhance technological information literacy, critical thinking and decision-making skills and supports, as well as broadening opportunities for community participation. Such efforts may nourish solidarity and ground more substantive forms of autonomy.
5) The patenting of drugs, devices and other medical technologies both stimulates innovation and deprives the medically indigent, creating special interest wealth at the expense of life and health. In contrast, Benjamin Franklin refused a patent on his design for an improved wood stove, preferring that all people benefit from it.
Ultimately, progressives must engage the difficult problem of ensuring that the benefits of the new biology and medical advances are distributed as broadly as fairly as possible.

Both the Progressives and the Women would do well to consider what it means to believe that the right to "life, liberty and pursuit of happiness" are endowed on all humans, rather than legislated and regulated. So many of the misconceptions outlined above are answered anew by this simple philosophy. No matter who your father was.

Note: Post was edited 11/2/07, because of an error in Ms. Hinsch's name.

"Bella," the Movie (Review)

My husband and I saw it in Austin, Texas today, with a group from Texas Alliance for Life. It's a good movie, with flash-backs, flash-forwards and a twist at the end that took me by surprise.

Here's a review without spoilers.

I forgot (a note on memory and humanity)

I know that you may not be able to tell, but I'm trying to make my blog posts shorter. So, I left some quotes out of this morning's post on memory. However, this quote from the Time Magazine article, "The Ethics of Erasing a Bad Memory" by Dr. Scott Haig, on human-ness needs to be repeated:

Much of what we read about brain science in the media today would have us believe that we're nothing more, really, than very fancy machines. And surely what we're learning about the physical brain is exciting and powerful — but thinking honestly, it remains so limited. We can trace the brain pathway of a drug "high," we can call it pleasure, but that tells us nothing about what so many people choose instead — deeper things that somehow beat out mere pleasure as the reasons for doing what we do. Those comforts — of ultimate meaning, virtue, peace and joy — have little to do with molecules.

First babies from "Lab Grown Eggs"

Well, the news out of Great Britain that apparently healthy twins were born from a new technique involving maturation of human oocytes - "eggs" - outside of the body will probably be hailed as the solution to the problem of where to get the eggs for embryonic stem cell and cloning research. It won't solve the problem that I asked earlier today as to whether and why it's important or ethical.

It's interesting that the article emphasizes the danger of Ovarian Hyperstimulation Syndrome:

In mild and moderate cases, affecting up to 20% of women undergoing ovary stimulation, this leads to symptoms such as swelling and breathlessness that resolves.

However, in about 1% the symptoms can become so severe that they are deadly. Among women with PCOS [Polycystic Ovarian Syndrome], the rate is nearer 5-10%.

Thanks to Wired Science blog for the tip.

Drugs, Sleep, Memory and Ethics

New information on the science of memory may one day finally tell me why I have a hard time remembering names and even faces, but I'll store a patient's potassium level without even trying. As with all science research, we'll have to decide whether and why the information we discover matters and how to use it.

Last night's post was on the bioethics questions in a television show dealing with a patient who asked for help forgetting a trauma - actually, the emotional memories, not the facts. A wide range of articles on memory research is the subject of yesterday's post at Bioethics.net. There are posts to articles and blog entries on old and new information on drugs that affect memory, and disorders of memory.

That post contains a link to this New York Times article (free registration required) on the significance of sleep and memories. (I love the title, "An Active, Purposeful Machine That Comes Out at Night to Play.") The same session at the American Society of Bioethics and Humanities conference that dealt with blunting the emotional memory of trauma also touched on the ethics of new medications that enable people to sleep less. The question asked was whether avoiding the need for sleep would allow time for more worthy pursuits - the question and answer period focused on what to consider a "worthy" activity. According to the NYT article, the question should be what is lost.

As is too often the case, science gives us some of the answers to our questions (those "power naps" are probably good for dealing with facts and later sleep appears to be useful for detecting patterns) and technology or means (propranolol, propofol, Provigil, etc.) to manipulate ourselves and our behavior, before we come to a consensus on the ethics - or even the ethical principles that apply - of using our knowledge.

The old saying "let's sleep on it" may have some measurable truth - and a lot of wisdom, after all.

Small Town Hospital Collects Cord Blood for Texas Public Banks

I was so happy to hear that my local hospital is now one of the hospitals that collects cord blood for the public banks.

The cells from cord blood are rich in adult stem cells that can be used to replace the bone marrow of children with blood disorders and for treatment of all sorts of diseases. How about that: a small hospital in a small town can join in adult stem cell therapy!

See my grand daughter's story, here.

Television Ethics: "Private Practice"

The TV show, "Private Practice," hasn't impressed me with its medical, social or psychiatric integrity. But, I found myself watching it tonight, October 24th, and was more impressed than usual. Tonight's show touches on a cutting-edge bioethics topic that was also mentioned at last week's American Society of Bioethics and Humanities.

Major Multiple Spoiler Alert!!! Don't read more if you've recorded the show to watch later.


(Let's forget the thread on the women who come in for their pelvic exam by the kid midwife - where the only exam the women are evidently getting is the actual *pelvic* exam. No eyes, ears, throat, lungs, breast or abdominal exam. My Family Physician, head-to-toe, cradle-to-grave soul can't bear it.)

(And we won't even ask the Mama in me how I feel about 13 year olds having sex. You might be surprised that I don't freak or judge, though, and pretty much treat the girls the same way that the lead doc does. The difference is that I go out of my way to explain to families when they first come to the office that I consider their child my patient in his or her own right and ask permission to treat without notifying - and, of course, without billing - them if the teen requests that I keep silent. I've always been able to convince the young person to turn to their parents for help, but manage to keep privileged information privileged as long as possible. As far as I know, I've only had one family leave my practice after I explained my policy.)

Okay, back to the cutting edge bioethics topic.

One of the guest characters asked the internal medicine doc for a medicine that helps patients forget.

Actually, the medicine, propanolol, will not help her forget. However, it can help some patients stop feeling the panic and other horrifying emotions that come after a near-death or traumatic event like a rape that causes "Post Traumatic Stress Disorder."

MSNBC had a review, here, about the treatment last year.


The technique can be used to blunt the emotional memory -- not the actual memory or physical damage -- of the traumatic event. Adrenaline or epinephrine is the "fight or flight" hormone or drug that is released when there is stress. It's what causes what I call "the near-car-wreck" feeling that we feel, well, when we nearly have a car wreck.

Epinephrine gives you a boost of energy, pumping sugar, cortisone and other hormones into the body, to allow that fight or flight response. Do you need to take off and escape or stand and battle with whatever it is that is threatening you? Epinephrine is also involved in stimulating the bone marrow to make blood and other organs to heal faster, too.

Unfortunately, sometimes the body makes epinephrine inappropriately, when there's no real danger or when the danger is not severe enough. When that happens, we call it a panic attack or an anxiety attack as people experience the physical and emotional symptoms that are associated with real danger. Their bodies are telling them that they are in danger, but there's no actual threat to confront. When it gets in the way of your life, it's a disorder. Long term panic and anxiety that can be related to a past trauma, and that sometimes causing a person to feel as though he's reliving the trauma, is called Post Traumatic Stress Disorder.

Propanolol is a "beta blocker" that blocks epinephrine and which we often use to treat hypertension and even panic attacks. If used during the time after a traumatic event in which the long-term memories are set in the brain and/or in conjunction with behavioral therapy, it appears that the memory is disconnected, "disassociated," from the emotions that the patient experienced during the trauma and during the flashbacks when the memory makes the patient feel as though he's reliving the event, later. The treatment of PTSD that seems to work best is behavioral therapy, teaching the patient to control his own body's reaction.

Some ethicists are concerned that we may blunt a necessary healing function of epinephrine and the other body and mind effects of the stress reaction. However, I think of the treatment of stress disorders in the same way that I think of treatment of pain. Pain may help us prevent injury and warn us of a threat to our health. But we treat pain that is out of proportion or that is not useful to protect us.

Political news in Nature Reports

Rather than science news, Nature Reports focuses on the political (I believe this is available without subscription, but let me know if you need a copy and can't access it):

News Feature

Nature Reports Stem Cells
Published online: 17 October 2007
Scientific definition by political request

(by) Monya Baker

The NIH must set criteria for pluripotency in human cells

Within a month, the US National Institutes of Health (NIH) hopes to start adding to the registry that lists the human embryonic stem cell (ES cell) lines eligible for US federal research funding. The registry currently contains only the human ES cell lines already in existence in August 2001, when President George W. Bush declared that no federal funds could be used for subsequently created lines. But of the dozens of human ES cell lines established since then, none will be added to the registry (with the possible exception of a few created by an unconventional technique that removes individual cells from embryos without destroying them). Instead, the word 'pluripotent' will replace the word 'embryonic' in the name of the NIH Human Embryonic Stem Cell Registry, and the list will begin to include cell lines derived from non-embryonic sources.

The impetus for the change comes from the White House in the form of a executive order that touts the potential of non-embryonic stem cells, and accompanied Bush's veto of popular legislation to lift restrictions on federal funding for research on human ES cells1. Researchers who derive and assess potentially qualifying lines will be given higher priority for new NIH grants and will be eligible for supplemental funds for existing grants. Before that happens, however, the NIH Stem Cell Task Force must set criteria for pluripotency in human cells. Politics has, essentially, mandated that an answer be found to a fundamental scientific question.

Asked about registering lines already clearly eligible for federal funding, scientists interviewed for this article generally reacted with a mixture of confusion, annoyance and indifference. One called the plan a "distraction that won't open any doors", and then asked not to be identified discussing politics. Some worried that political pressure on the NIH would hamper its ability to set a compelling definition. "I look forward to the day when the [registry] website is simply shut down, as its mere existence is a constant reminder of a public policy that does not serve the public good," says stem-cell pioneer James Thomson at the University of Wisconsin-Madison. Of the two dozen or so human ES cell lines eligible for US federal funding, his are the most widely used.

"The term pluripotent has been used for every type of stem cell," says Anthony Atala at Wake Forest University Baptist Medical Center, who recently identified stem cells in amniotic fluid that can differentiate into cell types representing bone, endothelial, fat, liver, muscle, and neuronal lineages. Originally, 'pluripotent' meant a cell could give rise to cells representing the three germ layers found in early embryos. To assess this property, scientists can inject mouse or human cells under the skin of an immune-compromised mouse and see whether they form a benign tumour known as a teratoma. But as the field advanced, says Atala, more requirements were added to the term.

(snipped)

The registry will help scientists to coordinate their research and share cells and information. Including the cells that demonstrate embryo-like markers and growth patterns will fill in a gap that currently exists with the current embryonic stem cell registry at the NIH. And it seems to be desired by some researchers:

"Being on the registry seems to be important to a lot of people," Landis says, even when no one doubts the cells are eligible for federal funding. For example, representatives of groups that store umbilical cord blood have made enquiries, although their materials do not qualify as cell lines. Landis declines to speculate on their motivation, but researchers naturally want to boost the prestige and commercial value of their cell lines, and getting listed on the NIH registry would be one way to do that.

Watson un - reasonable

Dr. James Watson, the man who is credited with discovering the structure of DNA, along with Francis Crick and Rosalin Franklin, has lost his laboratory and much of his status as a respected science icon after allegedly making racist remarks.

From the Times Online (London, UK):

In his interview Watson had said that he was “gloomy about the prospects for Africa” because “all our social policies are based on the fact that their intelligence is the same as ours — whereas all the testing says not really”.

He also said he opposed discrimination and that he hoped all races could be equal, but added: “People who have to deal with black employees find this not true.”

Last month, Dr. Watson spoke at the opening to the "Medical Ethics and the Holocaust: How Healing Becomes Killing: Eugenics, Euthanasia and Extermination" series of lectures co-sponsored by the University of Houston and the Houston Holocaust Museum. (Earlier posts on the series here

At that event, Dr. Watson was one of three Nobel laureates (along with Eric Kandel, MD and Feric Murad, MD, PhD) who spoke on the history and - at least in my opinion - of eugenics, including the sad history of eugenics studies in the early part of the 20th century at Cold Spring Harbor Laboratory.

Dr. Watson opened by telling us that he does not believe that the traits and abilities of people are completely genetic. He believes that his values for life were taught to him by his parents, who taught him to make his decisions based on reason, with "nothing from revelation. They also taught him the value of honesty, kindness, and involvement.

The doctor appeared to fall asleep a couple of times during the Houston presentation. He went out of his way to note that he came before us with "No religious feeling whatsoever." (I believe that he had an assumption that the people in the audience were interested in religion.) He also said that if you are better than than others, you'd better be perceived as helping others, and implied that the Jews killed by the Nazi's in Germany were marked and hated because they were more intelligent and successful than other Germans.

We learned that he had declined information about his genome that would tell us whether or not he carried the genes for a familial type of dementia. He stated that he believed that the study of the genome would improve psychiatry, which he said is still at the level that it was in Nazi Germany.

One of the most truthful statements he made is that "Since I won the Nobel Peace Prize I am heard."

The Politics of Embryonic Stem Cells: Gearhart "pressures" Atala

I was able to attend the "Understanding Stem Cells: Science and Policy" lecture at the Koshland Science Museum, the museum of the National Academies of Sciences, in Washington, DC last week where I heard Jonathan Moreno, PhD, - the ethicist who works for and advances the American Center for Progress and Dr. John Gearhart, Director of Stem Cell Biology at Johns Hopkins University.

The focus of the talk was the need for US tax money for embryonic stem cell research and the downfall of the Bush policy - with just enough mocking of the President himself to make everyone feel at home with the two men.

While Dr. Gearhart takes some of the responsibility for the publishing of the papers on cloning written by the veterinarian from South Korea, Hwang Wu Suk, he was very disparaging of his colleague, Dr. Anthony Atala.

He told the audience that Atala's work on amniotic fluid cells was published in a "Secondary journal." that he couldn't recall. That journal was Nature Biotechnology, last January, 2007. Read Nature Biotechnology's press release on the article, here. The abstract is here. (the article itself is behind a pay wall.)

He also questioned the "rigor" with which the research was done, saying that the technique was poor and that no one could tell where those cells had originated from.

Gearhart and Moreno were vocal about the timing of the publication, since it coincided with the last vote on embryonic stem cells and cloning in the US Congress. Nevermind that the lead time on published articles is months.

However, Gearhart's most worrisome comment came in front of a small group, when he was answering questions after the talk. In order to support his contention that the publication of the article on "embryo-like" cells lacked "rigor," Gearhart said, "We put pressure on him to write Pelosi," to say that all stem cell research needs to be followed.

We heard rumors that this had happened, but this is the first time I've heard or read one of the major players in the politics of destructive embryonic stem cell research confirm his part.

Between two cultures

There's been a lapse in my blogging this week as I've been in Washington DC for the American Society of Bioethics and Humanities annual conference, with a few forays into the Washington Briefing, "Value Voters" forum.

The ASBH is full of conferences like the Panel Session entitled "Collaborated Death: An Exploration of the Swiss Model of Assisted Suicide for its potential to Enhance Oversight and Dmedicalize the Dying Process."

Yesterday, I heard an intensive care doctor denounce those of us who know that it's wrong to kill children in the womb and then declare that anyone who smokes in the home with a child should be put in jail! Balance, people!!!

Between the VV meeting, the TExas Alliance for Life annual banquet early this month, and the Texas Straw Poll last month I've been able to hear all of the Republican Candidates except Governor Huckabee. Good job, men!

More later, after recharging (both my laptop battery and myself).

Texas has funds for SCHIP without Federal increase

Threats to the contrary, the Houston Chronicle has picked up on the fact that Texas has enough Federal funds to continue CHIP in our State for "at least a year," even with the expansions and improvements passed by the 80th Legislature earlier this year.

And in spite of the President's veto.


This news was also posted at the Texas Health and Human Services CHIP website earlier this week:

The state is closely watching federal action on CHIP, but no immediate changes are expected in the Texas program. The state has sufficient federal funding available to maintain the Texas program, including the recent changes authorized by the 80th Texas Legislature.

New President of California Stem Cell Institute

Alan Trounson, PhD, the researcher responsible for the first in vitro (IVF) birth in Australia, who once had to apologize for misleading the Australian Parliament after showing them a video that he claimed showed a mouse that walked after human embryonic stem cell treatment for spinal cord injury (in fact, they were fetal cells from aborted babies), and the man who was recently hired as President of the California Institute of Regenerative Medicine is not under investigation . But the people at his last project are, for discrepancies in reporting at his old lung regeneration project.

The $1 Million (Australian) grant required reports on progress each 3 months. It seems that there were questions not only about the lack of results in the project, but doubts about whether someone falsified one of the reports.

The Herald Sun, "Australia's largest newspaper," reported on October 13th that

World-renowned Melbourne scientist Alan Trounson's $1m stem cell research project is under investigation after it was scrapped for delivering highly doubtful results.

Monash University is examining anomalies in interim findings from the lung regeneration research conducted in its labs with public money.

Prof Trounson -- a doctor of philosophy who was headhunted to run the world's richest stem cell outfit in the US next year -- was the project's principal investigator.

The research was done by a team of about 13 scientists, including postgraduate students, to see how stem cells might help slow lung disease in cystic fibrosis sufferers.

It was stopped in February when the Australian Stem Cell Centre cut funding after a three-week investigation found inconsistencies in multiple progress reports.

The Herald Sun has learned the reports were signed by Prof Trounson and a senior researcher.

Another investigator in the lab is the main focus of the investigation, however. (Warning to all Ph.D. candidates - and you thought it was dangerous enough when choosing your sponsor.)

As of 10 PM CDT, there's no reports in US news sources.

AMA editorial on Partial Birth Abortion Ban

I would like to respond to the Commentary by Lawrence O. Gostin, JD, “Abortion Politics: Clinical Freedom, Trust in the Judiciary, and the Autonomy of Women.” in the Journal of the American Medical Association, October 3, 2007.(behind a pay wall)

Declaring that the Supreme Court's consideration of the “respect for the dignity of human life” in their ruling on the Partial Birth Abortion Ban Act (Gonzales vs. Carhart, 2007) is “Congress’ overtly political discourse,” he neatly sums up his position in this sentence from his last paragraph:

“Morality alone is an insufficient justification for the government to intrude on the private lives of women and the clinical freedom of physicians.”

On the contrary: morality, especially the laws concerning the killing of one human being by another is the basis for all law:

“What makes killing morally wrong, then, when it is wrong, is that a human life, the one killed, is treated as a life that has little or no worth rather than as a life of incalculable worth and as one having a right to be treated accordingly. If laws were permitted to embody the idea that in some circumstances life loses its worth, or that some people lack sufficient worth to have their lives protected, individuals would no longer enjoy equal protection of the law so far as their lives are concerned. Furthermore, some principled basis for protecting human life other than its sanctity would have to be provided to justify what would constitute violations of the unquestioned worth of every individual human life.” Arthur J. Dyck When Killing is Wrong (Cleveland, Ohio: Pilgrim Press, 2001), p. 77. Emphasis mine)

However, the Court did not review the "right to abortion" in Gonzales vs. Carhart. It only ruled on the Constitutionality of the regulation of medical practice in one narrow procedure, which Gostin admits "does not save a single fetus because physicians could instead use a standard D&E method."

Gostin objects to the Supreme Court of the United States over-ruling lower Federal courts and to State governments who dare to regulate medical practice as though he Founding Fathers wrote the Constitution so that only the Federal Judiciary decides the really, really important issues and the representatives of the People are only allowed to decide the inconsequential. He forgets or ignores that Blackburn’s 1973 Court intervened between State legislators and their rightful power to regulate the practice of medicine in Roe vs. Wade, and invented State’s rights that gradually phase in based on trimesters.

Moreover, he seems unaware of the precedent set and precedents reviewed in Washington vs Glucksberg (1997), or Vacco vs. Quill, (1997) when that Court ruled in favor of laws from Washington and New York that served to criminalize “physician assisted suicide.”

Concerning the 1993 Planned Parenthood vs. Casey ruling to which Mr. Gostin frequently refers,

"At the heart of liberty is the right to define one's own concept of existence, of meaning, of the universe, and of the mystery of human life. Beliefs about these matters could not define the attributes of personhood were they formed under compulsion of the State." (Casey, 505 U. S., at 851.)

the Court has stated,

“[A]lthough Casey recognized that many of the rights and liberties protected by the Due Process Clause sound in personal autonomy, 505 U. S., at 852, it does not follow that any and all important, intimate, and personal decisions are so protected” (Washington vs. Glucksberg, 1997)

I suggest that it’s important to share at least some perceptions about reality within the Universe. Otherwise we would not be able to discern the difference between sanity and insanity, much less between ethical and unethical medical practice.

Abortion restrictions can be healthy

The last couple of weeks I've been getting ready for the American Academy of Family Physicians' Annual Scientific Assembly and the hearing of several controversial resolutions at our Academy's Congress of Delegates, held last week in Chicago, Illinois.

One of the resolutions called for the protection of "physician-patient confidentiality" by restricting the information that insurance companies could send to the homes of minor children. It seems that some doctors object to parents being involved in their children's health care, if it means that the parents will find out about "reproductive health services." In other words, parents should pay for, but not know that they are paying for, their child's birth control, treatment for STD's and, I suppose, abortion.

Another resolution called for "the repeal of the Hyde amendment," the rider that Congress has passed each year since 1976 to restrict federal funds from being used to pay for abortions except in cases of rape, incest and life of the mother. In other words, a few family docs are convinced that taxpayers should pay for elective abortions - those that are actually birth control.

Fortunately neither of these resolutions was passed and neither will become part of the position statements of the AAFP. However, during the testimony in front of the Reference Committees, there we heard the usual red herring arguments of increased teen Sexually Transmitted Diseases and the threat of increased illegal abortions.

Several of us were able to stand to tell the truth about abortion and abortion restrictions, as well as parental involvement laws and their effects on the abortion rates and health of minors.

Last month, LifeEthics posted a brief review of an article in the Journal of Law, Economics, and Organization Advance Access published online by Jonathan Klick and Thomas Stratmann on September 4, 2007 entitled, "Abortion Access and Risky Sex Among Teens: Parental Involvement Laws and Sexually Transmitted Diseases."

The statistics show that state parental notification laws result in lower STD rates for teens in those states. The article also reviews some of what we know about laws that restrict abortion and their effects on health, pregnancy rates and abortion rates.

However, it is possible that passage of parental involvement laws will affect the incentives teenagers face, inducing them to engage in less risky sex which would decrease the demand for abortion without increasing the incidence of teen motherhood. That is, if teens implicitly view abortion as a form of birth control, increasing the psychic costs of obtaining an abortion through parental involvement laws may induce teens to substitute toward other forms of birth control such as condoms, birth control pills, or abstaining from sex altogether. For this substitution effect to occur, however, teens must be forward looking in their decision-making process regarding their sexual activities, and parental involvement must represent a nontrivial increase in the total cost faced by a teen when obtaining an abortion.
We examine the effect of parental involvement laws on the decision to engage in risky sex using Centers for Disease Control (CDC) data on the incidence of gonorrhea among teenage girls. Using gonorrhea rates among adult women to control for contemporaneous variation in unobservable characteristics of the state population, we find that parental involvement laws reduce teen gonorrhea rates by 20% for Hispanics and 12% for white teens. The effects are smaller and not statistically significant for young black women.
The results are robust to a wide range of empirical specifications. These results suggest that parental involvement laws reduce risky sexual behavior among teens as predicted by a model in which teens consider costs and benefits when deciding to engage in sexual activities.

When abortion was legal in a few states, those states had higher STD rates than the national average. When Roe v Wade made abortion legal in all states, the STD rates went up all over, to match those found earlier in the states with legal abortion on demand:

Klick and Stratmann (2003) attempt to avoid the data problem illegal abortions represent in examining pregnancy rates by focusing on the incidence of sexually transmitted diseases (STDs) as a proxy for the incidence of risky sex (Klick 2004). That is, since more sex in the aggregate and the substitution toward sex without a condom will both lead to an increase in STDs, increasing abortion access will lead to an increase in STD incidence if individuals are forward looking in their decision to engage in risky sex. Klick and Stratmann (2003)examine the ‘‘double experiment’’ provided by US abortion policy to examine this link. They find that when Alaska, California, Hawaii, New York, and Washington legalized abortion on demand in the period 1969–1970, the gonorrhea and syphilis rates in those states rose significantlycompared to the rest of the country. When the Supreme Court legalized abortion on demand nationwide in 1973, the STD gap between the early legalizers and other states disappeared.

We also know that parental notification laws decrease not only abortion rates for minors, but pregnancy rates as well.

Interestingly, in a more recent article examining the experience of Texas whose parental notification law went into effect in 2000, Joyce et al.(2006) find a significant effect on the abortion rates of those women covered by the law relative to 18-year-old women.

There's also evidence that restricting funding for legal abortion does not increase illegal abortions. When the Hyde Amendment was first passed in 1976 to forbid federal funding of abortion, abortion rates went down but there were no increased rates of illegal abortion. The results of State restrictions on abortion funding were reviewed in the CDC's Mortality and Morbidity Weekly in June, 1980 (no link available):

The present study in Texas found more than one-third of the legal abortions expected among Medicaid-eligible women were not obtained in the postfunding restriction period. The data cited from the present study are consistent with those from a previous investigation in Texas, which found approximately 40% of the expected number of subsidized abortions were not being obtained in the interval after the funding restriction . .. In Texas, pregnant, low-income women who do not have federal or state funds for abortions do not appear to be resorting to illegal abortions to terminate unwanted pregnancies . . . These findings are consistent with those from a national monitoring system, which also could not document that the restriction of public funds for abortion caused
a large percentage of Medicaid-eligible women to choose elf-induced or non-physician-induced abortions.

It's important for each of us to become aware and involved in the making of public policy as much as we are able. We can save the lives of our children of tomorrow and improve the health of our children, today.

Privacy, politics, and medical records

The editors and pseudoeditors of the American Journal of Bioethics blog are talking about all the people who accessed the hospital records of George Clooney after his motorcycle accident.

Somehow, according to the author of the post, it's all President Bush's fault.

In light of the news and comments on the latest iteration of SCHIP and Hillary Clinton's health care plan, I've been doing a little research. We ought to learn and remember the history of the privacy laws, the push for electronic records. But we certainly can't claim that the problem began in January 2001.

HIPAA began the whole electronic record push and originated in 1996. It's about anything but "privacy." See the records available on line, here.

The Privacy Rule, a later part of the Act (the Summary is 25 pages), specifically mandates full disclosure to the Secretary of Health and Human Services, or any agent of the Secretary, of all information in any facility that participates in any way (or ever hopes to do so) with Medicare. It also allowed those entities to make copies to take out of the office and to write their own subpoenas that need to be vetted by a judge after the fact. Attorney General Janet Reno advocated the use of the technology to track down Medicare fraud and abuse back in 2000.

The first big influences toward electronic medical records (EMR) and digital imaging are even older. Back in the late '80's, when I was in medical school, the Veterans Administration pioneered the EMR. (I used to practice diagnosing patients from their list of medications and procedures, the first elements of the record, before our notes could be entered.)In the early '90's, radiologists discovered the benefit of taking call from home while being able to read emergency head CT's and other images.

The electronic medical record and digital storage of images is a good thing - but like all tools needs to be used properly.

The whole coding and reporting of medical care has grown into the usual government "leviathan" (to use Ira Magaziner's defense to the lawsuit against him and Hillary Clinton for the unknown status of the consultants on their 1993 Health Care Task Force).

We still hope that the EMR will help us do better than we have in the past. Although I believe that most clinicians will disagree with the the "quality" markers used, see today's NEJM article about child health care.

However, I don't think that the incident involving Mr. Clooney's records proved anything about electronic records other than the hospital had the ability to monitor who accessed the records - and that human beings are curious about celebrities.

In the meantime, Texas seems to be volunteering to be a lab for privacy issues with the correlation of drivers, insurance, and cars as well as photographing and surveying the people who use US IH 35. Car 54 can run your license plate at a red light or while you're driving down the highway and then cite you if you're uninsured. My taxes should definitely go down if these tactics can be used to generate revenue.

Review: What we know about stem cells

The Journal, Stem Cells, has published a free open access article about those cells that become the different blood cells, including red blood cells, white blood cells and platelets, entitled "Concise Review: Hematopoietic Stem Cells and Tissue Stem Cells: Current Concepts and Unanswered Questions" by Donald Metcalf, MD, of Australia.

An interesting point from this article is the current controversy about the definition of "stem cells." Dr. Metcalf gives his definition and notes that some cells now called stem cells are actually better described as "self proliferative" progenitor cells, which have been committed to only fewer lines of cells.

Which will be important to understand the controversy that surrounds another type of stem cell, which is described in another, newer article published this week online in advance, entitled, "Concise Review: Mesenchymal Stem/Multi-Potent Stromal Cells (MSCs): The State of Transdifferentiation and Modes of Tissue Repair - Current Views" by Donald G. Phinney and Darwin J. Prockop of the Center for Gene Therapy, Tulane University Health Sciences Center, New Orleans, LA.

These adult stem cells are found in most organs and tissues in the body including umbilical cord blood, skeletal, muscle, fat, joint fluid, blood and the cells surrounding the blood vessels, the pulp in teeth, and amniotic fluid. (They have also been harvested from aborted infants.) In the body, they are known to become bone cells, fat cells, and cartilage. When they are grown in the lab, they form a wide variety of tissues depending on the conditions in which they are grown. They can be induced to form cells that function as nerve, lung tissue, retinal pigment cells, blood vessel cells, and repair kidneys and hearts.

However, you may read that these cells are not as "plastic" as embryonic stem cells, that it's hard to study them and cause them to form the exact cells that are desired. While it's true that they do not form "all the cells in the body," they can be induced to form a wide range of cells and tissues and it's no harder to control the development of these cells than it is to control embryonic stem cells. They may in fact be different types of progenitor cells, depending on the source, but there are an awful lot of sources. And they don't require the destruction of a human life.

SCHIP goes on, in spite of veto

Let's get this straight: SCHIP will not cease to be because of the President's veto.

Last month, we read that Congress had passed a 16 week extension of SCHIP and that the President would veto the SCHIP bill if Congress went ahead with their planned expansion to nearly double the funding.

The SCHIP bill that was passed was an ideological stunt that included re-definition of prenatal pregnancy care (to medical treatment of the pregnant woman - which would include abortion in some states, possibly all) and which increased the funding way beyond that needed to continue coverage for the 6.5 million children currently eligible.

Beyond raising the funding level without a clear cut plan for raising funds (possible increased cigarette taxes while counting the lapse of tax cuts of a few years ago), the Bill would have forced States such as Texas, where the cost of living is lower, to subsidize States such as New Jersey and New York, where proponents say that a family of 4 can't live on $80,000+ a year. As it is, Texas does not spend all of our allocated SCHIP and Medicaid money - that money is used to reward the big spender States. (Do we know how much of that reward is responsible for the high cost of living in those States?)

The President and Congress will now come up with a more reasonable plan, probably somewhere between the $5 Billion dollar over 5 years that the President proposed and the $35 Billion dollar expansion that Congress passed.

Late note:
The Democrats are postponing the vote to overturn the veto for 2 more weeks:

But the Democratic-led Congress put off an override vote for about two weeks, to give them more time to put pressure on GOP lawmakers who they think are politically vulnerable. A union-led organization said it would spend more than $3 million trying to influence the outcome.

"It's going to be a hard vote for Republicans," said House Speaker Nancy Pelosi, D-Calif.

The Senate passed the five-year expansion of the program last week on a vote of 67-29, just above the two-thirds margin needed to override a veto, but the House tally of 265-159 was 25 votes short of that mark.

Bush advisers said they remain convinced that they can secure an extension of the 10-year-old program with a less expensive price tag, saying they hope to soon open negotiations. But if the veto stands, Democrats said, they will reapprove the measure without significant changes and send it back to the White House, forcing the GOP to go on record again as opposing expansion of the program.

Speaking of "Expelled," a Scientist is Censored

The news mimics art.

Baylor University, a formerly Southern Baptist owned university in Texas, is being accused in the University's own newspaper, of censoring one of the faculty, in a letter to the editor from Walt Ruloff, an Executive producer of Premise Media:

This is a legitimate question in light of the university's heavy-handed actions in shutting down the research Web site of Dr. Robert Marks.

As many of you have heard, Marks, a distinguished professor of electrical and computer engineering, has been conducting research that ultimately may challenge the foundation of Darwinian theory. In layman's terms, Marks is using highly sophisticated mathematical and computational techniques to determine if there are limits to what natural selection can do.

At Baylor, a Christian institution, this should be pretty unremarkable stuff. I'm assuming most of the faculty, students and alumni believe in God, so wouldn't it also be safe to assume you have no problem with a professor trying to scientifically quantify the limits of a blind, undirected cause of the origin and subsequent history of life?

It would seem this kind of research would be praised and encouraged at Baylor.

But the dirty little secret is university administrators are much more fearful of the Darwinian Machine than they are of you.

I've spent the last two years of my life researching the widely accepted Neo-Darwinian theory and the theory of Intelligent Design.

My team and I (including lawyer, economist, actor, game show host and social commentator Ben Stein) have interviewed dozens of the world's top experts in biology, astronomy, physics and philosophy.

What we have uncovered in our documentary film, Expelled: No Intelligence Allowed, is an attack on freedom of speech and scientific inquiry that is as frightening as it is appalling. And it's happening right here at Baylor.

Last month Dr. Ben Kelley, dean of engineering and computer science, shut down Marks' Web site. He apparently had the blessing of President John Lilley. Why? The university put forth a bunch of phony-baloney procedural explanations that don't stand up to scrutiny.

The truth however, can be found in an e-mail sent to Marks by Ben Kelley in which he told Marks, "I have received several concerned messages..." about his Web site. These complaints have been kept anonymous. How convenient.

Here's what's going on: Somebody within the scientific community let Kelley know that Marks was running a Web site that was friendly to Intelligent Design.

Such a thing is completely unacceptable in today's university system -- even at a Christian institution. Kelley was probably told to have the site shut down immediately or suffer the consequences.

What are those consequences? The ultimate penalty is to have Baylor marginalized by being designated as not a "legitimate institution of higher learning." So designated merely for the "crime" of allowing Neo-Darwinism to be questioned, since conventional elitist wisdom holds it's no longer a theory but an inviolable truth.

Do you think this is some kind of fanciful conspiracy theory? Google the names of Richard Sternberg, Caroline Crocker, Guillermo Gonzalez, Dean Kenyon and Bill Dembski and see what you find. These distinguished scientists have suffered severe consequences for questioning Darwinian theory and there are hundreds, if not thousands, more.

Expelled, the movie (It's about censorship)

Many of the scientists who were interviewed for the soon-to-be-released movie, Expelled, are claiming that the film is an argument for Intelligent Design and against evolution. It appears that the working title for the movie was "Crossroads: the intersection of religion and science." Some of the people interviewed are claiming that they would have said something different if they had known the true name and subject.

However, I don't think any of them have seen the movie yet, and the website blog and trailers seem to focus on the treatment of "rebels" with in the science community, especially those who question "Darwinism."

According to the producers:

“People will be stunned to actually find out what elitist scientists proclaim, which is that a large majority of Americans are simpletons who believe in a fairy tale,” said Walt Ruloff, co-executive producer and co-founder of Premise Media, which is producing the film.

He continued to say that his company agreed to take up the film’s production because they “believe the greatest asset of humanity is our freedom to explore and discover truth.”

The film’s original title was Crossroads: The Intersection of Science and Religion, according to U.K.-based The Guardian. The film company said the movie's title was changed, on the advice of marketing experts.

Here's what the interviewees are saying:

Richard Dawkins

PJ Myers on his blog, Pharyngula
The New York Times


Then, there's this and this from Bioethics.net, the blog of the editors and pseudoeditors of the American Journal of Bioethics.

Two sex ed reviews, still no conclusions

We're finding that nothing changes the rates of pregnancies and STD's in teens except parental and peer pressure and concerns ("costs") of pregnancy.

I'm afraid that two published reviews of the literature on studies on sex education for adolescents and teens done by Kristen Underhill, Don Operario, and Paul Montgomery at the Centre for Evidence-Based Intervention at the University of Oxford ( here)and (here ) don't tell us much more than we knew before.

Although the authors report that there are few if any reports that give biological data or actual pregnancy and STD (including HIV) infection rates, the first study found no significance in behavior in "abstinence only" sex education compared with "usual care" in the community. (We're not sure what the "usual care" at those schools is, however.)

In the second study, authors did a review focusing on reports on sex education in "high income" societies, comparing "abstinence only" (which are defined as not promoting condom use) and "abstinence plus" (those which emphasize abstinence but promote condom use if you're going to have sex). report that there is a significant difference in decrease of "HIV risk behavior," but no evidence that teens have sex later, actually contract STD's less often, or have fewer pregnancies.

Neither of these studies tell us that abstinence based sex education does not work. I'm afraid that the only thing they do tell us is that there are factors we are not measuring and that our young people are engaging in risky behavior.

Hat Tip to "Pure Pedantry."

Democrats for Life (yes, they exist - barely)

Joe Carter at the blog, Evangelical Outpost, reviews a new book (Democrats for Life: Pro-Life Politics and the Silenced Majority by Kristen Day)about the Democrats for Life, which covers how the Democrats became the Party of the Abortion Rights Movement.

The true difference between Republicans and Democrats is best demonstrated by taking a look at the Democrats for Life of America website. Take a look at the "90/10" initiative (pdf brochure, here) which focuses on government spending plans to decrease abortion and the Position Statements, which emphasize the "secular" nature of the US government, as well as feminism and humanism.