Pro-life Governor tapped for GOP VP

And she happens to be a woman who hunts and wants to drill for oil.

Governor Sarah Palin is a member of Feminists for Life who lives her values. A year after her election as Alaska's governor, the 44 year old Mrs. Palin, already the mother of 4 children, discovered she was pregnant. Prenatal testing showed that the little boy had Down's syndrome, which results from getting an extra copy of Chromosome 21 from either the mother or the father. The baby is nearly 4 months old now. He is cared for by both his mother and father, Todd Palin.

The Stem Cell Debate Heats Up

Here's a great review about those new "induced pleuripotent stem cells" (iPS) we've been hearing about. iPS's are truly "patient specific stem cells" since they come from the patient himself or herself. The cells are manipulated in the lab, using viral particles and specific environments to make the able to become many different types of cells.

It would be very difficult, in my opinion, to make these cells become embryos, with all the structures that would allow them to function as individual organisms. From what I understand, the cells return to a state that allows them to become tissues with several different types of cells and cell groups, but they are never organized.

In my opinion (again), the induction process can't be more of a problem than the risk of immune rejection and the manipulations that embryos derived from In Vitro fertilization go through or the changes that are bound to be inherent with cloned cells derived through Somatic Cell Nuclear Transfer. On the other hand, volunteers and tissue samples for IPC experiments ought to be abundant.

And no one has to die for it.

"Trained" (medical professionals) should shut up and perform

"Trained" medical professionals should just shut up and perform, according to the President of the National Family planning and Reproductive Health Association.

As mentioned in the last few posts, the right not to be forced to act against the conscience has been under attack by the American College of Obstetricians and Gynecologists. The Washington Post article mentioned in my last post linked to the blog of Health and Human Services Secretary, Mike Leavitt.

Today, the Secretary wrote that he's not used to having nearly a thousand comments and many more "hits" on his blog. Take a deep breath and read the comments on each page.

Take a look, also, at this quote, in today's post:

One thing I did find helpful was the clear explanation of the ideological basis of opposition to physician conscience. Mary Jane Gallagher, President of the National Family planning and Reproductive Health Association, was quoted in Congressional Quarterly’s HealthBeat saying,

“Family planning providers work to provide family planning services. So it’s really not acceptable to the people I represent that this administration is considering allowing doctors and nurses and pharmacists that have received their education to provide services to now be able to not provide those services if they don’t want to.”

“Who’s going to provide access to contraceptives services if the administration provides this large loophole to deny services?"

CQ reported Ms. Gallagher continued: “Providers are ‘given an oath—now they get to pick and choose what they want to do' if a regulation is issued, she said.”

The Secretary answers Ms. Gallagher better than I could. However, don't you wonder that the conversation has moved from "choice" and patients' rights ("If you don't believe in abortion, don't have/do one.") to threats that we who oppose abortion should give up our practices, to the declaration that we trained and obtained a license only to be forced to do what someone elsed demands of us?

Washington Post Addresses Our "Birth Control Fears"

As well as our fear of death and homophobia, in today's article, "Birth Control fears addressed."

Health and Human Services Secretary Mike Leavitt has denied that a controversial draft regulation would redefine common birth control methods as abortion and protect the rights of doctors and other health-care workers who refuse to provide them.

In a statement posted on his blog on Thursday, Leavitt appeared to try to allay fears that the proposed regulation would create sweeping new obstacles to women seeking a variety of commonly used contraceptives, such as birth control pills and the Plan B emergency contraceptive.

"An early draft of the regulation found its way into public circulation before it had reached my review," Leavitt said. "It contained words that lead some to conclude my intent is to deal with the subject of contraceptives, somehow defining them as abortion. Not true."

Leavitt's statement, however, failed to alleviate concerns among members of Congress, family planning advocates, women's health activists and others.

At issue is the American College of Obstetricians and Gynecologists' Ethics Statement "Opinion #385, Limits of Conscientious Refusal in Reproductive Medicine," which states that

Providers with moral or religious objection should either practice in proximity to individuals who do not share their view or ensure that referral processes are in place. In an emergency in which referral is not possible or might negatively have an impact on a patient's physical or mental health, providers have an obligation to provide medically indicated and requested care."

It goes on to declare abortion “standard reproductive care” 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).

After publication of the Opinion, the President of ACOG then wrote letters asking Congress to pass laws to force these limits on our consciences: to force doctors who object to abortion to either change their practice so that they don't take care of women and girls of reproductive ages, or move close to a willing abortionist.

Somehow, the pro-abortion crowd has turned this into an "physician assisted suicide" and "gay, lesbian, bisexual, transgendered, transexual" issue as well as one of hyper-support for abortion and one more opportunity to bash the Bush administration.

Kathryn Tucker, director of legal affairs for Compassion & Choices, which advocates for physician-assisted suicide, said she remains concerned that the regulation could apply to health-care workers who refuse to participate in a variety of end-of-life care, including the withdrawal of unwanted feeding tubes and ventilators.

. . . and . . .

"Until the regulation removes the re-definition of abortion and it clearly states that it deals solely with abortion (and not with any other procedure, nor with any refusals based on the nature of the patient, such as single or gay), I would not be satisfied," R. Alta Charo, a lawyer and bioethicist at the University of Wisconsin wrote in an e-mail. "There is no reason to extend any benefit of the doubt to this administration when it comes to reproductive rights or the civil rights of gay people."

You want to talk about "alarmed"? If an ethicist like Charo can't distinguish between negative rights and positive rights, then the state of "ethics" is worse than I thought. (See "Ethicist for hire")

Remedial ethics 101: you have the right to expect someone not to act, but only in very rare cases can you force them to act when they don't want to. You have the right to liberty, meaning society will protect you from someone who wants to turn you into a slave. But you can't make others to do your will, either. You have the right to swing your arm if you want, but your right to swing your fist ends at the other guy's nose.

In case you're wondering, the Post took their only prolife quote from the Secretary's blog.didn't quote a single pro-life advocate. How hard would it have been to get a quote from the Christian Medical and Dental Association?

I would have never guessed that the attack on physician's conscience rights would somehow become a gay/lesbian/bisexual/transgendered/transexual/pea-green-with-lavender-stripes issue, although I predicted the involvement of "Compassionate Choices" and other pushers of intentional physician killing.

In Oregon, I have the right to a prescription of barbiturates if I want to die. The State limits that right and tells me when my right kicks in, of course. According to lawyers Charo and Tucker, I can go up to any MD or DO and demand that he or she write the prescription.

I ask again: "How far do you trust doctors who will violate our consciences?? How much practice will it take until we do what the State tells us to, rather than what our patients ask - without regard to silly notions of "right" and "wrong?""

Forcing Pro-life Doctors Out of Baby Business?

Two writers from the Heritage Foundation have published an editorial on the Fox News Site that discusses the risks of the new ethics statement of the American College of Obstetricians and Gynecologists (ACOG). Daniel Patrick Moloney and Peter Reed appreciate that limiting obstetrics and gynecology only to those doctors who will do abortions or arrange in advance to refer patients to doctors who will abort, limits women who themselves believe that their children's lives begin at conception and who do not want anything to do with abortionists.

Should pro-life doctors and pharmacists be free to practice their profession according to the dictates of their consciences? Should a woman have the freedom to choose an obstetrician or gynecologist she trusts to provide care consistent with her beliefs?

Current federal law says yes. But many women may have that choice greatly restricted, and their doctors driven out of business, if a medical association is able to require that all doctors either perform abortions or make referrals for abortions.

In November 2007, the American College of Obstetrics and Gynecology (ACOG) announced that the ethical standards of the profession had changed. Its ethics committee stated that an ob/gyn who is unwilling to perform an abortion has an ethical duty to refer the patient to someone who will perform it. If the physician is unable to refer the patient in a timely manner, he would be required to perform the abortion himself.

This decision threatens the livelihood of pro-life doctors. Every ob/gyn who works in a hospital or clinic needs not only a license, but also certification that his skills are up to date and that he is aware of recent developments in the field. To be certified, he must follow the ethical standards of the profession, so under the new ethics policy a pro-life doctor risks losing his certification if his pro-life convictions don't allow him to perform or cooperate in an abortion. And if he loses his certification, a hospital or clinic won't let him deliver babies there.

The American Association of Pro-Life Obstetricians and Gynecologists has labeled the decision “a raw power play to cripple, and ultimately eliminate from practice, those doctors who hold a conscience conviction on the sanctity of human life.” Besides forcing current ob/gyns out of the profession, the policy would make any bright young pro-life student think twice about going to medical school for obstetrics or gynecology.

(More here.)

Besides limiting a woman's choice to have a doctor who shares her pro-life views, restricting all prolife doctors from obstetrics will adversely affect her access to health care in general. Few doctors are doing OB, now. The number can only decrease if the traditional, conservative, prolife man or woman is threatened by ACOG's insistence that conscience is merely a personal feeling and that we doctors can only practice if we promise to go out of our way to violate that conscience.

These ethical statements affect all doctors who care for women and girls through their reproductive ages. In fact, Family Physicians who deliver babies are also held to the same ACOG standards that the OB/Gyns must meet. (If anything, we had better be more careful, since any breech of protocol or "standard of care" may be thought of as due to our training.)

In many rural and underserved areas, the only docs around are the Family Physicians, who care for babies, kids, the elderly, and expectant mothers. In fact, I was the first FP in my small town ( just 20 miles from San Antonio but considered "medically underserved" as it had a large number of Medicaid, Medicare and indigent patients) who did not do "surgical OB," or do Cesarean sections and sterilizations. (I'm a wimp, not a cutter. Although I love to sew up and put back together, I even refuse to make the traditional, courtesy, "first cut" at appendectomies and other non-OB surgeries when the surgeon offers. I finally quit doing circumcisions on new born boys because it made me physically ill to cut perfectly healthy tissue.)

Okay, how far will you trust someone who trains herself to forget that she believes the Creator of the universe - the One who knows every thought and can send her to hell - hates what she's doing? Or even without a religious underpinning, a doc who believes he is killing a person at abortion, but does it anyway?

30 years: In Vitro Fertilization,Bioethics and Public Health

My own first child is a little older than Louise Brown, the first child born from in vitro fertilization (IVF). This incidental pioneer celebrates her 30th birthday this month, calling for reviews and editorials on what her birth has meant to culture and to individuals, such as this one from the UK's Telegraph.

It's good to hear that Ms. Brown has a child of her own, "naturally conceived" with her husband. Full circle.

Human-pig embryo approved in UK

The "cybrid" or hybrid human-animal embryos are created in the laboratory by Somatic Cell Nuclear Transplantation, using emptied eggs from animals and the nuclear and cellular DNA from humans.. We know that there are currently experiments on-going with the human embryos made using emptied cow eggs (more on the "ease" of making these embryos, here), and now the British have authorized the development of pig-human embryos.

The experimenters admit that the problem will be achieving embryos and embryonic stem cells that do not contain DNA left from the egg. Proving the purity and "human-ness" of the stem cells will be a complication that I do not believe they will be able to overcome, at least for transplantation into humans, except possibly in the case of severe, last-hope disease and trauma.

The ethical debates about xeno-transplants and treatments using living organs, cells and tissues from animals carry the risks of transmitting animal diseases that humans have no immunity for and the development of new strains of disease that cross species lines. Ethicists have predicted that at least the early patients will have to live their lives in isolation at the worst, and have life-long surveillance at the best. (more on the debate, here and here.)

However, the researchers will probably be able to develop other uses, such as the early warning chemical weapon detection systems that are being developed by our own military, using human embryonic stem cells.

Rather than humanitarian and medical hope, I believe that time will show us that the research is the result of pure greed, with each lab hoping to come up with a product that can be patented and sold. I'm disappointed that the courts and "ethics" bodies in the US and UK have allowed these patents of human organisms. The drive to "create" new human cells and artifacts using human DNA is the logical outcome.

Medicare, IRS kill doctors by alphabet soup

There's this number called the "NPI." The CMS (Center for Medicare and Medicaid or Can't Manage S(tuff))mandated that any one and any corporation that bills them (for services already done, mind you) needed to add this number, the "National Provider Identifier," by May 23 of this year. (Need I report that quite a few doctors haven't been getting paid properly since? ) Well, out of the blue, the PTB (Powers that Be) sent down a little notice that the names associated with the NPI must now be identical to the ones that the IRS (Infernal Internal Revenue Service) has on file.

The NPI is in addition to the "UPIN" (Unique Provider Identifier Number) the DEA (Drug Enforcement Agency) number, a whole caboodle of state and insurance "identifiers," and that pesky identifier that your mother, father, and husband gave you: your name.

The NPI also had to be acquired for any and each partnership or practice. Some people had one for themselves and one for their practice. Some did not receive their number for months. And, some were unable to get paid even with all the right numbers in the right place.

Now, many will have to start the application process all over if there's a period after the "M" in "M.D." or a space between the letters in their IRS files.

Here's more from "Health IT News:"

Healthcare IT News
By Diana Manos, Senior Editor

06/17/08

WASHINGTON - Just when doctors thought things couldn't get much worse, experts say, the Centers for Medicare & Medicaid Services has thrown another wrench into the already difficult transition to using National Provider Identifiers.

According to a June 11 CMS announcement, doctors will have to reconcile their NPI data with their IRS legal name data in order to get paid.

According to billing experts, this is a disaster waiting to happen. Every aspect of the data must match, including the exact spelling of names, the use of initials and even blank spaces in the data. The slightest discrepancy could send Medicare claims back to the drawing board. Don't go getting married!

After a year-long contingency period, the use of NPIs was required by CMS as of May 23. Both before and since that deadline, doctors have had difficulty getting paid due to a host of complications with CMS and clearinghouse systems, experts say.

Cyndee Weston, executive director of the American Medical Billing Association, said the IRS matching requirement "has blindsided the whole industry."

Weston, who works with small billing companies that submit claims for doctors, said many doctors who began using their NPI identifiers before the deadline have still not received Medicare reimbursements.

"This is going to affect all the doctors we work for. It's going to kill their practices," Weston said.

"I think we haven't seen the worst of this yet. I think we're going to see a big uprising if this continues. No way around it."

Martin Jensen, chief operating officer and chief analyst at the Healthcare IT Transition Group, a consulting group specializing in helping doctors get paid, said physicians aren't getting consistent answers from the CMS or its intermediaries as to what's blocking the claims. The added stress of matching NPI to IRS data is going to compound their troubles.

"This IRS thing is very immediate and one we didn't anticipate," Jensen said. "It's definitely going to set off a cascade of mismatches to data."

The answer most physicians are getting from CMS is to start over with a new NPI enrollment. This could take months, Jensen said. Even doctors who have successfully had their claims paid under NPI could be forced to start over if their IRS data doesn't match, he added.

Are you a provider experiencing difficulty getting paid under NPI? Share your experiences with Senior Editor Diana Manos at diana.manos@medtechpublishing.com.

I don't believe that doctors will actually quit work. Who can, unless our spouse has a good income or we were independently wealthy to begin. What's going to happen is that many more docs will "opt out," or quit accepting Medicare or Medicaid. With the threatened 15%- 20% cut looming over our heads, the extra work and uncertain payment, along with the threat of legal consequences and now no payment) if one comma, period, or space is out of place, I'm not sure I would trust a doc stupid enough to try to play the game.

FDA goes after fraudulent cancer cures

We were just talking about this.

The Washington Post reports

Neil Baker, a retired maker of truck canopies in Helena, Mont., fills about two orders a month for E-Mune through his company, Herbal Remission. It is made from bloodroot, a plant that contains sanguinarine, which has been studied for possible anti-tumor activity. He says one customer's melanoma was cured.

"I really don't know a whole lot about it. All I know is it works," said Baker, 63. "As far as I'm concerned, humanity should have it. But if the FDA doesn't like it, that's okay with me, too."

The FDA's list of "fake cancer cures" is at http://www.fda.gov/bbs/topics/factsheets/fakecancercures.html.

New Bioedge edition available

The weekly newsletter, Bioedge, from the land down under is one of the better bioethics/biotechnology on-line newsletters.

Readers who consider the pro-life movement mainly as a US political matter, may be surprised by the existence of Bioedge, since it is pro-life. The publishers' aim is to:

* to promote evidence-based ethics in medicine
* to promote compassion in medical care
* to highlight the fact that medical excellence is not possible without ethical principles
* to provide high-quality up-to-date information and commentary on bioethics
* to facilitate the participation of health professionals in policy debates on bioethics

This week's headlines include

"Stem cell scientists seek to shed snake oil image"

"California euthanasia lobby scores victory"

"Nature attacks ‘human dignity’"

"Surprise on operating table"

"US Catholic bishops reject embryonic stem cell research"

Coffee drinkers live longer

If true, I may live forever.

According to the Washington Post,

The researchers found that women who drank two or three cups of caffeinated coffee daily had a 25 percent lower risk of death from heart disease during the follow-up (from 1980 to 2004) than non-drinkers. Women also had an 18 percent lower death risk from a cause other than cancer or heart disease compared with non-coffee drinkers.

For men, drinking two to three cups of caffeinated coffee daily was a "wash" -- not associated with either an increased or a decreased risk of death during the follow up, from 1986 to 2004.

The lower death rate was mainly due to a lower risk for heart disease deaths, the researchers found, while no link was discovered for coffee drinking and cancer deaths. The relationship did not seem to be directly related to caffeine, according to the researchers, since those who drank decaf also had a lower death rate than those who didn't drink either kind of coffee.

Election year pro-abortion push

If you don't want your child to suffer, you don't choose Partial Birth Abortion (Intact Dilation and Extraction or "D&X") and you certainly shouldn't complain about State laws concerning prevention of fetal pain during the abortion.

msnbc.com and Self Magazine have teamed up to discuss "When there is no good choice."

In the story, we read about abortions - one at 22 weeks and and one at 30 weeks pregnancy, after two mothers learn that their babies have severe birth defects. While the story spends a lot of space trying to explain that the mothers are having the abortions because they don't want their babies to suffer, the story condemns laws requiring anesthesia, informing the mothers that their children may feel pain during the procedure, or mandating lethal injections to kill the child before dismembering him or her. Of course, we are told how wrong it is to call "D&X" "partial birth abortion," or to ban the procedure itself.

This is a story about the politics of an election year, written to tug on our heart strings rather than inform.

Obviously, I am pro-life, and so, I must be one of those the article calls "anti-abortion." The story claims that I "demonize" the mothers who have abortions at 28 weeks, and mentions that because of George Bush, the Republicans, and "red staters," these women have troubles and the doctors claim that they worry about being charged with breaking the law. However, each woman does abort her child.

The author doesn't seem to notice the irony that she is practicing demonization, herself.

The good news is that the article reports on perinatal hospice, now available across the country:

Today some 60 U.S. hospitals, hospices and crisis pregnancy clinics offer perinatal hospice services; in Minnesota, women seeking to abort fetuses with fatal anomalies are required by law to be informed about hospice as an alternative. “Women appreciate the grieving process and being able to spend time with their babies,” says Dr. Calhoun, vice chair of obstetrics and gynecology at West Virginia University School of Medicine in Charleston. “Perinatal hospice gives women an alternative that is a better choice than abortion.”

Everyone else does it

The American Medical Association and the American Medical Student Association are both up in arms about contact between drug companies and other vendors and doctors and medical students. And yet, no one complains when a New York Times story about the fuss contains advertising. (Free registration required -- is "free" anything undue influence?)

I've said it before, perhaps I can be bought, but not for a pen, some samples or lunch.

Meningitis damage repaired with adult stem cells

A 20 year old young man from Bedford, Texas was about to lose his arms and legs due to the clotting of blood in his vessels caused by meningitis but no longer.

The treatment involved doctors and technicians at Parkland Hospital in Dallas, Florida, Israel and the Dominican Republic, and one aunt with a computer search.

(While it's wonderful that this young man was rescued, I can't help but wonder how many other experiments are going on in other countries, led by US doctors. Remember that Dr. Wilkerson of Houston did his first experiments using adult stem cells in Brazil.)

From the Fort Worth Star Telegram (Free subscription required):

Lampkin's medical odyssey has taken him from his home in Bedford to a hospital in an island country for a treatment the U.S. Food and Drug Administration has not approved.

Sudden onset
It began when Lampkin, a freshman attending Cisco Junior College on an athletic scholarship, returned home for spring break.

That Friday he was fine. But on Saturday while visiting friends, he complained of having a headache and went to bed early, said Michelle Gideon, Lampkin's godmother.

The next morning -- Easter Sunday -- she found him lying on a bedroom floor.

"One side of his face looked totally normal, but the other side was swollen and looked like he had chickenpox," she recalled.

Lampkin was rushed to Harris Methodist H.E.B. Hospital, where he was treated for bacterial meningitis. Those chickenpoxlike spots were signs of clots cutting off blood flow.

Antibiotics helped stabilize Lampkin, who was transferred to Parkland Memorial Hospital in Dallas.

There doctors planned to amputate his legs at the knees and his arms at the elbows.

But an aunt searched the Internet for other treatments and found Grekos, who was using adult stem cells to stimulate tissue regrowth, improve circulation and reduce diabetic amputation rates. Grekos, director of cardiology and vascular disease at Regenocyte Therapeutic in Florida, flew to Dallas to escort Lampkin and his mother to the facility.

"If there was any hope of helping this young man we wanted to offer it," he said.

Once Lampkin was in Florida, his blood was drawn and sent to a lab in Israel.

Although it was Passover and the lab staffers were on vacation, they agreed to process the blood, Grekos said. The cells were then replicated into millions of super cells that Grekos' company has branded "Renocytes." The cells can become almost any type of new cell or tissue, he said.

I'm quoted in Texas Monthly

Over the weekend, at the annual convention of the Texas Medical Association, a friend said that she'd read my quote in "Texas Monthly." I assumed she meant an old article in Texas Medicine, the journal of the Texas Medical Association. I was wrong. (And, maybe now I know why I can't get appointed to any of the TMA Councils or Committees!)

In an article titled, "Faith, Hope and Chastity," in the very liberal Texas Monthly the author (without contacting me at all, by the way) used a statement that I made at a 2004 Texas School Board hearing on the content of high school textbooks on sex education.

The board met to consider these textbooks in July and September of 2004. More than one hundred people testified or submitted written testimony. Those who testified in person were given three minutes each to make their case. According to Gordon Crofoot, a specialist in HIV and STD treatment and research, many of the board members appeared totally uninterested in his testimony. Crofoot cares for about one thousand patients in his practice in Houston and is currently seeing more young patients with HIV than he has in his 31 years of practice.

“These textbooks do not meet the criteria and are factually and scientifically incorrect in what they say,” he told the board, “but their major fault is in what they don’t say and the resulting consequences. . . . If we do nothing [about STDs], the direct cost over the next ten years would be $10.6 billion. Comprehensive sex education programs might reduce this cost by fifty percent. Can Texas afford this cost?”

Crofoot was cut off when his three minutes were up. He offered to answer any questions. The board had none. Later in the day, he watched as Beverly Nuckols, a family doctor in New Braunfels opposed to comprehensive sex ed, was asked about the implications of human papillomavirus for men. She answered that HPV affected women differently than men before stating her position that condom instruction, in her experience as a family doctor, would do little good. “Yesterday I saw a boy who had had three partners in the last month,” she said. “He’s had twenty-two partners. He’s eighteen. He uses condoms every time. Unfortunately, a lot of the times he’s drunk and so they break or they don’t work. I mean, condoms are not a solution for teenagers outside of monogamous relationships. They don’t use them right even if we teach them.”

I'm not quite sure why I was chosen as the representative of those who "opposed comprehensive sex ed." I can't quite remember telling the story, but I probably did -- however, I don't think I would say, "I mean . . ." In order to read it in the journal, you'd have to turn to the "continued on page 200-something." However, I believe that the story was to refute testimony that high school boys and girls should be taught that condoms are the answer to all risk from the consequences of sex. My more common story is to note that condoms are more likely to be used correctly by couples in a monogamous relationship, that couples get better as time goes on, and that if a hundred couples use condoms to prevent pregnancy, 11 of them will get pregnant within a year.

The part that I remember addressing was a comment from a nurse practitioner who stated that there was no risk of contracting the Human Papilloma Virus for a girl, if the male wore a condom. The concern, according to her, is the infection of the girl's cervix. This was about the time that the public was becoming aware that cervical cancer is caused by HPV 99% of the time. According to the nurse, the tip of the penis when covered by the condom wouldn't actually touch the cervix. I felt compelled to delicately explain that the most common human sexual activity involves ins and outs, and that there is much more contact and potential for spread of the virus to all of the male and female genitalia -- except for the parts actually covered by the condom.

Let me correct one thing: I'm not against comprehensive sex education. I disagree with some people about the definition of "comprehensive," and believe that anything beyond the basics of very boring biology - the medical and legal responsibilities of human sexual activity - ought to be vetted by the parents in the local school districts. The school is not the place to teach methods and techniques and condoms are not the panacea they're far too often made out to be.

I do believe that the State (schools) should encourage sex within monogamous marriage, since that is the healthiest for individuals, families and their children, and for the taxpayer. While some people do very well in different arrangements, it takes a lot more work and the risks are far greater.

Add portable hearts to end of life care dilemma

From the Washington Post:

Surgeons at more than 60 centers in the United States are now implanting at least 1,000 LVADs each year. Smaller, more durable and more easily implanted versions are being developed, including one that was approved just this week. With at least 5 million Americans suffering from heart failure, 550,000 new cases being diagnosed each year, only about 2,000 hearts available for transplant each year, and Medicare willing to pay for LVADs (at a typical cost of $200,000), experts predict the number will soar.

"We are at the cusp of a rapid expansion of this type of therapy," said Park, who estimates that within the next five years, 10,000 Americans annually may get the pumps.

Add one more decision to the mix -- I'm afraid that in practical terms, the decision will be whether to even give the patient a trial of LVAD or not.

I disagree with the bioethicist (there's a link to the Hastings Center article in pdf, here) who says that the pump becomes a part of the patient's body. It's still a piece of artificially introduced technology and medical treatment that requires maintenance and battery charges -- would we replace it if we had a biological heart? There's also the very fact that we're able to discuss "powering down" the motor, which makes it different from a "part of the patient's body."


I know of a patient who, for about a month, has worn a "Life Vest," a portable defibrillator while waiting for the implantation of a demand defibrillator/pacemaker. Even the interventional cardiologists hadn't seen one before and came to check it out. I've had patients ask to have an implanted demand defibrillator turned off because it was firing so often - it was like a kick in the chest each time their heart stopped beating.

The Texas Medical Association has a resolution sent forward by one of the County Medical Associations concerning end of life care. It asks for a study to determine reliable scales or ratings for health status based on objective criteria such as labs, age, history. The goal would be ending Federal and State insurance (Medicare, Tricare, Medicaid) funding for any care other than Palliative once a patient meets certain criteria. The resolution wouldn't restrict private funding -- but so far, Medicare has put pressure on docs who charge patients outside their payment limits.

3 times over the past week, I've heard colleagues comment on the expenses related to current standards of health care - and some abuses, such as sending the patient from the nursing home to the doctor's office by ambulance. Each mentioned that the expenses of these patients will bankrupt "the system."

Frankly, I don't want the State to mandate that I can't treat anymore than I like telling me that I have to treat, if the number crunching and check boxes don't fit with my medical judgment.

(But I did realize how much of an aversion I have to wearing a vest that can give me an electrical jolt, and that I have to keep adjusted. I would probably be a little compulsive about adjusting it, and have to check out whether it [still] works, getting an extra shock each time.

Oklahoma abortion Bill survives Governor's veto

The Oklahoma State Legislature has overturned Governor Henry's veto of an "omnibus" bill containing abortion regulations. (The veto is explained at the United Kingdom site of Medical News Today. Besides gives the best definition of human embryo that I've seen in legislation:

“Human embryo” means a human organism that is derived by fertilization, parthenogenesis, cloning, or any other means from one or more human gametes or human diploid cells.

Pro-abortion groups are concerned that the bill requires the facility doctor to perform an ultrasound before every abortion, that the girl or woman be allowed to see it, and that the results be explained to her. Not only is there a requirement to post a notice in the facility informing the women and girls that it is "against the law for anyone, regardless of his or her relationship to you, to force you to have an abortion" and the abortionist evidently must actually speak the words out loud before each abortion!

Called the "Freedom of Conscience Act," (The text is here, in a Word document) the bill offers protection to any medical professional who refuses to act in a way that goes against his or her conscience.


The best news article that I've found is here, at the "Daily Women's Health Policy Report" of the National Partnership for Women and Families, a group I'd never heard of before. It appears that the main focus has been legislation to protect women in the workplace.
Robert Cole, an Oklahoma native, writing for Associated Content, has explained the bill in this article. Here's an article from The Feminist Majority, with good links.

Ironically, Democratic Presidential Candidate, Barack Obama, used the objection to abortion by the Senator from Oklahoma, Senator and Obstetrician Tom Coburn, to justify his relationship with the Weatherman bomb-building conspirator and now-college professor, William Ayers. (Ayers is the man who was quoted in the New York Times on September 11, 2001 as regretting that he did not do enough bombing and fighting the US government in the early '70's.)

Stem cell video collection

Here's a video featuring Scotland's Dr. Colin McGuckin, who has been doing research on cord blood stem cells. Dr. McGuckin has worked with the University of Texas Medical Branch at Galveston and NASA to produce embryonic-like stem cells from umbilical cord blood cells. His lab has gone on to stimulate those embryonic-like stem cells - that no one had to die for - into functional liver cells, masses of liver cells and pancreatic cells that produce insulin and the other hormones vital to the regulation of diabetes.

The video is part of a collection on YouTube, by "Stem cells that work." Visit the YouTube page with great collection of videos about stem cells, including the excellent 50 minute "Google" video, "Everything you wanted to know about stem cells."

Skeptical view on Expelled, the Movie

Michael Shermer, the Skeptic, has seen the movie, Expelled, in advance of its release Friday, April 18th, and posted a review on his blog at Scientific American.

Shermer is a spin doctor who, while purporting to follow reason, is actually better understood by the title he often sports, "skeptic." His near-"single-issue" is atheism vs. religion, specifically Christianity and Christians. He says in one of his books that he joined the Church of Christ (the conservative, no instruments) to impress a girl and never felt the conversion that should have gone with his baptism, but that he tried to justify his choice. He even went so far as to attend Pepperdine University, which is owned and run by the Churches of Christ. Rather than throwing out the bad and keeping or developing a faith in Jesus as he understands the Bible, he set about to prove to the world that religion is just one of the "weird things" that people believe. He loves to debate questions like "Is Religion a Force for Good or Evil?"

Shermer doesn't tell us that the agency that investigated Richard Sternberg's case against the Smithsonian agreed that he had been the subject of discrimination and a behind-the-scenes coordinated move to get him out of the Smithsonian. The case was dropped because he didn't belong to a protected group and he simply had no standing to sue within that agency, since he was not an employee. He did, however lose his lab space - going from a private office to a shared space and the privileges of unlimited access and his own key that he had enjoyed up to that time.

Also, Shermer claims that Sternberg went against policy in the peer review of the article by acting as editor and choosing the reviewers himself. Sternberg tells his side of the story and answers the charges against him at his own website, here, and here.


There's more on the web, including this review from 2006 Dispatches from The Cultural Wars , which details - and is an example of - the political nature of academia, research and the theme of Expelled.

Both sides spin to make a point. But, Sternberg's case appears to be a classic example of academia's - or any closed group with limited power to make change in the open - whisper campaigns and peer pressure to "expel" any doubters, gad-flies on the edge of scientific "consensus." Ironically, I've read that the reason that people don't understand the mutation that brings about changes in the gametes of individuals and eventually species, is that we don't understand really large numbers. Ironically, Intelligent Design began with the discussion about the mathematics involved in the evolution of species.

Nature nurtures debate on namesake

Josh Carter, over at the Bioethics.com blog, comments on the editorial in the April 10th issue of Nature, (subscription only. Joe quoted some but let me know if you need the full text) which uses news of a transgendered (but not transexual) pregnant and bearded woman to ask the age-old question, what is "natural" and whether "natural" is better than "un-natural."

What do you want to bet that the author prefers "natural" fibers for his clothes and "organic," when it comes to groceries? We know that the editorial board has opinions on the good and bad, since the cover of the April 3 issue in front of me has the headline, "Carbon emissions: it's worse than you thought."

Even though the question couldn't have been asked quite this way in the past, Nature asks one of the oldest philosophical questions. Unfortunately, they ask in a juvenile manner. In fact, they beg the question by stating that the approved purpose is to "enhance the human condition."

(As I commented on the Bioethics.com blog) The “natural” uses of medicine and science seek to discover and use our discoveries to encourage, enhance, and/or return to optimal what Aristotle called the “telos,” the “what it is meant to be.” For instance, a splint reduces pain and holds the limb in physiological position as it heals. Hip replacements, glasses and hearing aids aren't normally intended to give you the ability to jump higher or stronger, see with the sight of an eagle or hear a pin drop in the next county -- they are used in an attempt to return your functioning to "normal."

The most active debates in science today are actually discussions about the “nature” of the thing we are studying or manipulating. Is global climate change causing the Earth to heat up more than is “natural,” is it man-made (due to those carbon emissions), or cyclical, etc. Should there be regulation on abortions to for sex-selection or to choose for deafness? Who gets the resources to be the Six MillionTrillion Dollar Woman and why not allow men and women to demand that their limbs be cut off or that their faces be botoxed and surgeried into a human caricature that scares children?

Again, we see the problem with setting up the ethics hierarchy so that "autonomy" trumps "non-maleficence." "I want" ethics over "First, do no harm."

Is there good in the telos, or is there any standard for dividing funding and power in science and medicine? If there aren’t good and bad uses of science and medicine, then “Anything goes,” if you can get the financing, the power, or the ability to do it.