"Expelled" Producers make silly, ironic mistake

The producers of the movie "Expelled" owe PZ Meyersa lifetime pass to the movie. And they really need to attend and pass a logic class.

Dr. Myers, a scientist who researches cephalopods, and one of the men interviewed for the movie, was escorted by security from a free event that included a preview of the movie. However, the producers allowed Myer's wife, daughter, and her fiance to enter and view the movie, accompanied by Richard Dawkins.

The producers should be ashamed of themselves. They advertised the event, inviting people to register to see the movie. They did not send out notices that "everyone except x, y, and pz, may see the movie."

And to skip over Red-A Atheist-wanna-be Myers for the original, Dawkins, is just plain dumb. Dawkins has posted his review of the movie, here. (I haven't read it yet.)

Here's the real-time "Pharyngula" blog post about the incident - from PZ Myer's blog (he ran over to the Apple computer store to post on his blog) and there's a follow up post, here.

The entire conversation about the movie has left the original topic of academic prejudice against believers or even doubters, the near topic of the truth about Creation and evolution. The little boys are throwing mud pies and calling each other "dummie." I can't help but believe that the move to expel Myers from the showing was just a power play on the part of some would-be producer intern.

The Producers had a chance to frame the publicity from a PJ Myers appearance (along with that other guy) at their movie. ("Look who's coming to see the movie" will now become "Expelled from Expelled" and "Evidence that "Expelled" is not too bright." and "Myers is a saint.")

Here's the LifeEthics blog conversation that's been going on since October, and which also has a notice about the incident with Myers, Dawkins and the Producers and bouncers. Here's the Christianity Today review, and here's the New York Times. I guess that if all the Producers wanted was publicity, their strategy worked.

UK Psychiatrists urge informed consent for abortion

The United Kingdom's Royal College of Psychiatrists have released a statement on the correlation of mental health status and subsequent mental illness after elective, intentional abortion. London's Times and Daily Mail are cover the story.

While acknowledging that women can experience mental illness after normal full term birth, the doctors rightly note that if a woman has mental illness, she may not be competent to give informed consent.

Secretary of Health Supports Conscience

Secretary of Health Michael O. Leavitt has stepped up to protect the right of conscience and conscientious refusal, specifically in the right not to be forced to commit or be complicit in abortion and other forms of killing. The Secretary has sent a letter to the President of the American College of Obstetrics and Gynecology warning about a possible conflict with Federal anti-discrimination rulings secondary to ACOG's Ethics Statement #385. (that's a pdf)

See the LifeEthics post explaining the origin of the conflict, here.

The American Association of Pro-Life Obstetrics and Gynecology, alerted us to the Press Release sent out by the HHS, most likely due to the fact that the ACOG Ethics Committee is meeting Monday and Tuesday, March 17 and 18.

Here's the news item:

FOR IMMEDIATE RELEASE Contact: HHS Press Office
Friday, March 14, 2008 (202) 690-6343

HHS SECRETARY CALLS ON CERTIFICATION GROUP TO PROTECT CONSCIENCE RIGHTS

Unless changes are made, physicians could be forced to refer patients for abortions even if it violates their conscience

Health and Human Services Secretary Mike Leavitt today expressed disappointment in a new policy put forth by the American College of Obstetricians and Gynecologists (ACOG).He also called on the American Board of Obstetrics and Gynecology (ABOG) to reject this policy and protect the conscience rights of physicians.

In a letter sent to ABOG Executive Director Dr. Norman Grant today asking for clarification, Secretary Leavitt notes, "It appears that the interaction of the [ABOG Bulletin for 2008 Maintenance of Certification] with the ACOG ethics report would force physicians to violate their conscience by referring patients for abortions or taking other objectionable actions, or risk losing their board certification."

In particular, the Secretary expressed concern that enforcement of this ACOG policy by certain federally-funded entities would violate federal laws against discrimination.

Secretary Leavitt continues, "As you know, Congress has protected the rights of physicians and other health care professionals by passing two non-discrimination laws and annually renewing an appropriations rider that protect the rights, including conscience rights, of health care professionals in programs or facilities conducted or supported by federal funds."

The full text of Secretary Leavitt's letter appears below:

Norman F. Gant, M.D.,
Executive Director
The American Board of Obstetrics and Gynecology
2915 Vine Street
Dallas, TX 75204

Dear Dr. Gant:

I am writing to express my strong concern over recent actions that undermine the conscience and other individual rights of health care providers. Specifically, I bring to your attention the potential interaction of the American Board of Obstetrics and Gynecology's (ABOG) Bulletin for 2008 Maintenance of Certification (Bulletin with a recent report (Opinion Number 385) issued by the American College of Obstetricians and Gynecologists (ACOG) Ethics Committee on November 7, 2007 entitled "The Limits of Conscience Refusal in Reproductive Medicine".

The ACOG Ethics Committee report recommends that in the context of providing abortions, "Physicians and other health care professionals have the duty to refer patients in a timely manner to other providers if they do not feel that they can in conscience provide the standard reproductive service that patients request." It appears that the interaction of the ABOG Bulletin with the ACOG ethics report would force physicians to violate their conscience by referring patients for abortions or taking other objectionable actions, or risk losing their board certification.

As you know, Congress has protected the rights of physicians and other health care professionals by passing two non-discrimination laws and annually renewing an appropriations rider that protect the rights, including conscience rights, of health care professionals in programs or facilities conducted or supported by federal funds. (See 42 U.S.C. § 238n, 42 U.S.C. § 300a-7, and the Consolidated Appropriations Act, 2008, Pub. L. No. 110-161, 121 Stat. 1844, § 508). Additionally, threats to withhold or revoke board certification can cause serious economic harm to good practitioners.

I am concerned that the actions taken by ACOG and ABOG could result in the denial or revocation of Board certification of a physician who -- but for his or her refusal, for example, to refer a patient for an abortion -- would be certified. These actions, in turn, could result in certain HHS-funded State and local governments, institutions, or other entities that require Board certification taking action against the physician based just on the Board's denial or revocation of certification. In particular, I am concerned that such actions by these entities would violate federal laws against discrimination.

In the hope that compliance of entities with the obligations that accompany certain federal funds will not be jeopardized, it would be helpful if you could clarify that ABOG will not rely on the ACOG Ethics Committee Report, "The Limits of Conscience Refusal in Reproductive Medicine" when making determinations of whether to grant or revoke board certifications.

Thank you very much for your assistance in this matter.

Sincerely,

Michael O. Leavitt
cc:
Kenneth Noller, M.D.

The American College of Obstetricians and Gynecologists

"Expelled, The Movie" Conversation Continues

The many Anonymice are still discussing world views on a post from last October.

(In case you wondered where I've been:

We've had our primary, with one hotly contested local Republican race ending in a cliff-hanger. The same seat was decided by 54 votes out of about 20,000 in 2006. This time, it looks like the winner may be decided by about 38 votes out of 30,000, before the mail in ballots are counted. We're expecting a recount.

It turns out that the consequences of politics and policy became personal this last 2 months. We've spent the last year - over 14 months, now - working out a plan to remodel our 65 year old house only to find out that the city adopted the new provisional FEMA flood plain map, and we can't remodel - we have to fill in the basement, tear down the old house, and build 2-3 feet higher. I'll admit that I haven't reacted very well. But, still, the City's bureaucrat literally lost the plan for 6 weeks before telling us that the concrete-poured-in-place house and basement that's still plumb, smooth and level after more than 60 years might float up and turn on its side.)

Nature Reviews Stem Cell Heart Treatments

The journal, Nature, has published a review article, "Stem-cell therapy for cardiac disease,"
about treatment of heart disease with stem cells, focusing on the many types of cells that are being used in research, including bone marrow derived stem cells and progenitors and "resident" cardiomyocyte stem cells. The latter are actually found in the heart and can be harvested from the patient who needs them and used to repair damaged heart disease.

The abstract promises more than I ever thought I'd read in a "First tier" journal.

Heart failure is the leading cause of death worldwide, and current therapies only delay progression of the disease. Laboratory experiments and recent clinical trials suggest that cell-based therapies can improve cardiac function, and the implications of this for cardiac regeneration are causing great excitement. Bone-marrow-derived progenitor cells and other progenitor cells can differentiate into vascular cell types, restoring blood flow. More recently, resident cardiac stem cells have been shown to differentiate into multiple cell types present in the heart, including cardiac muscle cells, indicating that the heart is not terminally differentiated. These new findings have stimulated optimism that the progression of heart failure can be prevented or even reversed with cell-based therapy.

Tulane Stem Cell Scientist Coming to Texas

From the Temple, Texas news, we hear that the "brain drain" is gaining Texas another adult stem cell pioneer.

Read about Dr. Darwin Prockop's move to Texas and his research in adult stem cells, here.

He will serve as inaugural holder of the Stearman Chair in Genomic Medicine, professor of molecular and cellular medicine in the Texas A&M Health Science Center College of Medicine and director of the Institute for Regenerative Medicine at Scott & White.

Everyone has stem cells, which are “generic” cells that can make exact copies of themselves indefinitely. In addition, a stem cell has the ability to produce specialized cells for various tissues in the body - such as heart muscle, brain tissue.

“There are still some mysteries about stem cells, but many people are now using the cells to treat almost any disease you can name - arthritis, heart disease, diabetes, stokes, kidney diseases,” Prockop said.

Why stems cells do what they do is a puzzle, he said.

“Our ideas have changed,” Prockop said. “It seems as though we are tapping into cells that are there to repair any tissue in the body.”

Time flies

Someone pointed out to me that it has been a while since I've posted anything. It turns out that I'm not as good and multi-multi-tasking as I used to be. Nowadays, it seems that I can only handle 3 or 4 really big things at time.

Work, family and politics are eating up my days and nights, so I'm not keeping up with my blogging.

There's still occasional comments on old posts on the movie, "Expelled," (here) , on how Plan B works (here), and even one from August, 2006 on stem cells from breast milk (here).

That anonymous is very busy.

New York Times article on cloned humans

The New York Times (free one time registration required) has a news piece on the Stemagen cloned human embryos, with reference to "making copies of people" and implantation of cloned embryos for reproduction.

One of the men who donated the fibroblast skin cells is also the owner of Stemagen.

The NYT has more on the story behind the cloned human embryos:

The Stemagen scientists, led by Andrew French, an animal cloner recruited from Australia, used skin cells from Dr. Wood and another Stemagen employee as the DNA source. They used 29 eggs donated by young women at the fertility clinic that Dr. Wood manages.

Five blastocysts were developed. One was shown to be a clone by genetic testing, the scientists reported, and two others also showed good evidence of being clones.

Dr. Wood said the key to success might have been choosing egg donors who were known to be fertile and healthy because they had previously been successful donors at his fertility clinic.

The women were also donating at the same time to couples wanting babies. Some eggs went to the couples and the others to the research, with the consent of both the donors and the couples. The donors were paid for the eggs that went to the in vitro fertilization but not to the research, Dr. Wood said.

Therapeutic cloning has been hampered by lack of access to healthy eggs, in part because it is often considered unethical to pay women for such donations. Dr. Daley of Harvard said Stemagen’s “egg sharing” approach appeared to be a reasonable way to obtain eggs.

The media will have fun with this story.

Human embryos cloned in California

Scientists at Stemgen, a La Jolla, California laboratory have published a report on the successful cloning of human embryos in the journal, Stem Cells. (The article is available free, due to the open access policy of the journal.)

The authors are very clear: these are human embryos produced by somatic cell nuclear transfer or cloning. The embryos were clones of the men who donated the fibroblast skin cells.

This study demonstrates, for the first time, that SCNT can be utilized to generate cloned human blastocysts using differentiated adult donor
nuclei remodeled and reprogrammed by human oocytes. Evidence of successful SCNT was shown with DNA fingerprinting analyses of three SCNT cloned blastocysts where embryo genomic DNA was that of the donor fibroblast cell line and were not fragmented oocytes or of parthenogenetic origin.

. . .DNA fingerprints from three SCNT blastocysts were consistent with those of the somatic cell donor employed with no evidence of contamination from the egg donors, indicating that embryonic development was being controlled by the donor cell genome.

The cloned human embryos were produced using donated oocytes less than 2 hours old and the DNA from the skin cells of men. (The eggs were donated by women for the use of other couples, see below.) The use of male donor DNA allows for easier distinction from any possible parthenogenetically produced embryos, which would be female. Any embryos that are male serve to prove the success of the experiment.

In this case, the cloned embryos were actually compared to parthenogenetically produced embryos created by stimulating oocytes to become embryos. These embryos only contain the DNA of the women who donated the eggs. Parthenotes are not clones, because of the rearrangement of genes that happens when the eggs are produced with half of the normal chromosomes which would be matched by the haploid sperm if fertilization took place.

It appears that the group had a very high success rate, with approximately 2/3 or 16 of 25 of the enucleated oocytes producing very early embryonic organisms, which (who) demonstrated cell development and division similar to embryos produced by in vitro fertilization. 10 of the embryos developed to day 3 and 5 of those went to day 5, with the formation of blastocysts. Blastocysts are embryos that have developed enough cells to form a layer of cells around a hollow center, and eventually the inner cell mass, the differentiated grouping of embryonic stem cells at one spot within the sphere. All 5 of the blastocysts formed inner cell masses. The authors do not report any stem cell lines from these embryonic stem cells, but note that they are trying to do so - either from these embryos or from additional cloning.

The Discussion includes speculation that the success rate was so high because the oocyte donors were young women who were able to produce so many eggs through stimulation of their ovaries that there were more than enough for the use by the parents (couples?) to whom they were donating for the production of embryos for implantation and pregnancy. Although the article states that all 3 of the parents were able to get pregnant from the eggs that went to them, that could not have been known at the time the eggs were taken to the experimental lab. Some went to the in vitro lab and some went to the experimenters within less than 2 hours. It takes at least a few hours after in vitro fertilization to determine whether any embryos were formed.

If embryonic stem cell lines are developed from this technique, perhaps some group will compare them to embryonic-like stem cells developed by reprogramming.

Myths on Myths about stem cells

There's a new Public Broadcasting System (your tax dollars at work) television show on "stem cells," "Mapping Stem Cell Research: Terra Incognita."

You don't have to go any farther than the top of the home page, with its picture of a girl in a wheelchair and this quote,

"Some people consider stem cell biology to be the Holy Grail of Regenerative Medicine, while others view embryonic stem cell use as morally wrong."

to see that it's propaganda for embryonic stem cell research and cloning for embryonic stem cells. The authors immediately begin the pattern of using the term "stem cells" for both of the two basic kinds of stem cells: those that require the destruction of a human life and those that don't.

Here are the first three points from the "Myths and Realities" page, with my comments in Bold after each.

MYTH
Stem cell research uses aborted fetuses.
REALITY
Stem cells can be totipotent (a fertilized egg with the “total potential” to give rise to all different types of cells in the body), multipotent (stem cells that can give rise to a small number of different cell types), or pluripotent (stem cells that can give rise to any type of cells in the body except those that are needed to develop a fetus). While pluripotent stem cells could be developed from fetal tissue or even adults, they are best derived from early-stage embryos, a mass of cells that is only a few days old—not aborted fetuses.

The authors skip over the significance of the fact that embryronic stem cells come from destroyed human embryos in the lab, it is true that most stem cell research does not use tissues obtained from abortions. Nowadays, however, the term "fetus" is too often used by the media (and even researchers who ought to know better) for all pre-born human beings. The proper definition of human embryo is the organism from fertilization or the beginning of the first cell division to 7-8 weeks of age. The term "fetus" in humans is properly used from 8 weeks until birth.

More on the claims about what is the "best" source of stem cells and about "embryonic-like stem cells," below.

MYTH
Somatic cell nuclear transfer using human cells involves the use of fertilized eggs.
REALITY
Somatic cell nuclear transfer, the process in which the nucleus from an adult cell is removed and then transferred to an egg whose nucleus has been removed, is the first step in cloning and can be used to create an embryonic stem cell line. However, an egg cell does not need to be fertilized to be used in this procedure—an unfertilized egg cell can be used.

Here, the authors avoid using "embryo" and throw around the terms "unfertilized egg" and "fertilized egg." An embryo is not a "fertilized egg" - once an egg is fertilized, it becomes an embryo. In Somatic Cell Nuclear Transfer (cloning), the embryo is produced artificially by inserting the DNA of a donor cell and stimulating division and organized development that occurs with natural reproduction. When human DNA is used to produce human embryonic cells in an organized embryo, there can be no doubt that what we are talking about is a human embryo. No matter how he or she is created - or produced - or how severely handicapped by the intentions and actions of the producers, a human embryo is a very young human being.

MYTH
Researchers can use adult stem cells instead of embryonic stem cells. Other treatments using adult stem cells are available to treat conditions such as Parkinson's disease and spinal cord injuries.
REALITY
Adult stem cells lack the versatility and flexibility of embryonic stem cells, making them less likely to lead to medical breakthroughs. Embryonic stem cells have a far greater developmental potential and are more likely to be pluripotent, while adult stem cells are thought to be merely multipotent, or restricted to only certain cell types.

In November 2007, Japanese and American research teams reported new ways to obtain stem cells that behaved like embryonic stem cells from human skin cells—without having to use human embryos. This breakthrough holds great promise in solving the ethical dilemmas of stem cell research, but scientists currently still face technical hurdles and the challenge of finding ways to use these stem cells successfully in medical treatments and therapies.

The biggest lie of all is that embryonic stem cells are more useful in treatments for human beings. Just ask the 20,000 plus in the US alone who have been treated with adult and umbilical cord stem cells or go looking for even one human who has been treated with embryonic stem cells.

While it is true that most ethical, adult stem cells are not "pluripotent," there are many kinds of "multipotent" stem cells and precursor cells in the body. In fact, these are the cells that we probably will use in the future, because they are the cells the body uses to repair itself and because they are less likely to grow out of control or cause tumors.

We are also learning that the desired development of stem cells and precursor cells is influenced by the environment and all sorts of "factors," or chemical and physical signals present in the part of the body where they grow into cells, tissues and organs. The key to future treatment for most disease will probably come from learning to stimulate these conditions and factors.

Besides the ethical dilemma of destroying early human life, embryonic stem cell research has every problem or hurdle that could be cited for adult stem cells: they are difficult to grow, found in small numbers, the cultures may be contaminated with different, undesirable cell lines, and are difficult to control to produce for the exact stem cell line that is needed.

Moreover, no one wants to transplant embryonic stem cells into people. What we want is to produce adult stem cells for treatments.

The last paragraph mentions embryonic-like stem cells. There are several ways to produce stem cells that behave in every way that the unethical stem cells do.

These cells are being used in research to replace the unethical cells produced by destruction of embryos.

The goal of all stem cell research is to have a source of "patient-specific" stem cells from the patient or to find ways to stimulate stem cell production in the body of the patient, when and where they are needed.

The producers of this program are advocating for outdated research methods.While researchers have learned a lot from human embryo research in the past, most of what we use has been developed from research in animal models. The production of new embryonic stem cell lines from human embryos and from cloning is no longer necessary to carry out this research.


(Thanks to Janet, of the Bedford County Citizens Concerned for Human Life, for sending me the link to the website on the show.)

Surfing the web, leaving a trail

It might surprise many Internet surfers and commenters how much a slightly curious website owner knows about them.

I've always believed that I shouldn't post any thing I didn't want published in my hometown newspaper. However, I forget how much information about me is available on the Internet - whether or not I actually post.

There are several for-fee and free sites that allow me to track which pages are viewed and when, how many visitors I get, the viewer's location and the links that referred them to my website. The reports also tell me the type of browser, the length of time and divides the reports by unique visits and pages viewed. There are all sorts of reports that I don't use - or understand why I would want them.

It is cool to see that what I write has been seen - possibly read - by someone from Czechoslavakia this morning.

The images above are pictures of one report that I check most often. It shows the numbers of "hits" or visits to my blog during the last week. The top image is from this morning, the bottom is from January 8th. This website that produces the reports, Sitemeter, filters out most of the newsreader "hits." Another program shows those, inflating the numbers two or three times.

By studying the numbers and who, when and how, I keep trying to figure out how to get more readers.

I haven't found many patterns, by the way, except the "hits" seem to go up about the time midterm and end of the semester school papers might be due.

I am surprised to discover that one of the most read pages on this blog are those which deal with the subject of evolution and public policy. I post on these stories as a way of discussing the intersection of public policy and what I perceive as a bias in the science community. Few people seem to care about "Ethicists for hire," but there is a lot of interest in evolution and public policy.

One of the most frequent searches that links to LifeEthics are those on the movie, "Expelled." LifeEthics has been viewed about 12 times over the last day because someone used Google or another web search engine with the search words, "Expelled, the movie." This morning, my post from last October, "LifeEthics.org: Expelled, the movie (It's about censorship)" is the third link in a search on the US Google. One of those visits was by someone from somewhere in the United Kingdom who used the AOL and Google.uk search engines to view my page for a little over a minute, each time. They clicked on a link on my post to view the Guardian.uk article on Richard Dawkin's reaction to the movie.

There were comments yesterday on "Expelled: movie to explore politics of science" from a reader who objects to my critique of the case of one of the scientists mentioned in the press releases about the movie. This post was from August 23, 2007. That commenter and I are still having a conversation on a story about a Texas Education Agency employee who sent out an email alerting people she knew about a talk on "Creationism's Trojan Horse." Those posts were written in early December,2007 and titled, "Politics Bites," and "Texas Employees, Politics, Science."

Happy New Year! (a little late)

Okay, it's January 9th, and I'm just getting back to the blog after a couple of weeks obsessed with politics, house design, and moving. (We are about to remodel our 60 year old house.)

I do my best to keep raw partisan politics out of this blog. However, this is a Presidential election year here in the US, and so much of our Bioethics is really just Politics.

So, I'm activating a sister blog, "Bioethics and Politics." Don't be surprised if that one gets as much or more attention as LifeEthics.

Women do not want pro-abortion President

The New York Times has weighed in on the secret to Hillary Clinton's win in New Hampshire: women voters.

I am convinced that Senator Clinton’s campaign is very aware of the importance of the women's vote. (I believe that the "crying" incident of January 6th was aimed at reminding women that Hillary is a woman, and that this is their chance to have a woman President. But that's just my opinion.)

Pro-life voters who do not want a pro-abortion President must begin to emphasize and educate one another about the voting record of the candidates. Our belief that every human life has value (not the personalities of the candidates, inevitabilities, and religious identification) is something that we have in common with members of both the major parties.

There is no question that Hillary and Obama fought the Partial Birth Abortion ban (Hillary as First Lady and then as NY Senator and Obama while still in the Illinois legislature). Polls like this one (comments here and the poll in .pdf, here) from the Susan B. Anthony List, from last August, show that even among women who want to vote for a woman to get a woman President, a large number will not vote for the advocates of Partial Birth Abortion. These are the voters we need to alert/inform.

The reality is that politics will play a part in our goal of protecting human rights in medicine and science policy in the US. The next President will, like this one, be in a position to name several Supreme Court Justices.

Women do not want a pro-abortion President

The New York Times has weighed in on the secret to Hillary Clinton's win in New Hampshire: women voters.

I am convinced that Senator Clinton’s campaign is very aware of the importance of the women's vote. (I believe that the "crying" incident of January 6th was aimed at reminding women that Hillary is a woman, and that this is their chance to have a woman President. But that's just my opinion.)

Pro-life voters who do not want a pro-abortion President must begin to emphasize and educate one another about the voting record of the candidates. Our belief that every human life has value (not the personalities of the candidates, inevitabilities, and religious identification) is something that we have in common with members of both the major parties.

There is no question that Hillary and Obama fought the Partial Birth Abortion ban (Hillary as First Lady and then as NY Senator and Obama while still in the Illinois legislature). Polls like this one (comments here and the poll in .pdf, here) from the Susan B. Anthony List, from last August, show that even among women who want to vote for a woman to get a woman President, a large number will not vote for the advocates of Partial Birth Abortion. These are the voters we need to alert/inform.

The reality is that politics will play a part in our goal of protecting human rights in medicine and science policy in the US. The next President will, like this one, be in a position to name several Supreme Court Justices.

"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.