or: How I Learned to Stop Worrying and Love Biopolis.

We are used to doing it to China, India, and any other nation with citizens hungry for the Land of Milk and Honey. We entice them with our posters of freedom, of democracy, of intellectual pursuit. Yet, we now face our very own brain drain of our leading stem cell biologists to a place called Biopolis.

Biopolis may not advertise the sort of political ideology or market economy we sport on our fronts, but what the Singaporean research center does offer is a whole-hearted backing of the intellectual curiosity of these scientists. It has become a haven for top US researchers who are simply fed up with the stem cell-stifling policies of the Bush Administration. Among them are two of the nation's top cancer researchers who were 'napped' by Philip Yeo, a headhunter of sorts. He and others of his mission have taken advantage of the US political climate and converted it into a fueling energy towards the research. The center receives continued backing by the Singaporean government and even international institutions such as Cambridge University which set aside $45 million in 2006 to fund the Singapore Stem Cell Consortium. 

The analysis of Biopolis' role may be simple on the surface: it is analogous to a child sneaking dessert after being told not to, analogous to Al Capone's speakeasies during the Prohibition era. By regulating the activity of such research in the US (the only place where our US policies take effect), we have simply encouraged the sprouting up of such international centers and concentrated the world's brightest minds in the field together on one campus.

Taken deeper however, we may be able to gain valuable experience regarding our views and implementation of such views. For those who directly oppose stem cell research--whether theologically, ethically, morally, economically, politically-- has the Bush administration been successful in blocking the advance of the field? Have we forgotten that other countries can 'nap' the same top minds that we 'napped' when we advertised freedom of curiosity and scientific pursuit? 

It may seem counterintuitive, but the best (only) policy for slowing the pursuit of stem cell research and experimentation may well be to allow it. If that does not work, perhaps there is no real way to control human curiosity. Personally, I find that a very good thing.

http://www.nytimes.com/2006/08/17/business/worldbusiness/17stem.html?_r=1

The $100 Genome

In 2003, the Human Genome Project was completed for approximately $300 million. Now, an entire human genome can be sequenced fraction of the cost and time at only $100,000. However, this cost is still far out of everyday reach. What if, however, a $100 sequence were possible?

Yesterday, two articles revealing new methods of gene sequencing were published within hours of each other, each mentioning the clear goal of affordable personal gene sequencing. First, an American company named BioNanomatrix has developed a new technique that allows far larger segments of DNA to be sequenced. They believe that within only 5 years, a $100 8-hour personalized sequence is possible. The second article reveals another technique, developed by Oxford Nanopore Technologies, that further improves on current technology. The Oxford-based company is quite a bit less ambitious, hoping to develop a $1000 by 2014 with the help of significant government funding.

The prospects are numerous. Imagine if you – and everyone else – knew their complete DNA sequence. Although such technologies are underdeveloped at the moment, personalized medicine would become a real possibility. Furthermore, family planning would become far more insightful. After all, the genome of embryos could be sequenced as well – revealing gender, hair color, eye color, and birth defects. If enough came to be known about analyzing the human genome, it may even be possible to predict height and other attributes.

How much would such knowledge be worth to you?

These articles were found through CNN and Google News.

http://sify.com/finance/fullstory.php?id=14861845
http://www.physorg.com/news154786034.html

Here come the Superhumans

In 1972 Paul Berg developed the first technique to clone DNA. He inserted lamda phage DNA into the DNA of SV40, a Simian virus. Shortly after successfully managing to form a recombinant DNA, his experiments had to be halted for safety reasons. What were the implications of what Berg had achieved. Implanting a gene into the Simian virus could transform it into a virus capable of infecting humans, which could have catastrophic consequences. Berg’s experiments were deemed safe and he was allowed to continue. However, what is our guarantee that all other cloning experiments will be safe. Our knowledge of cloning has increased dramatically since Berg’s experiment, and this knowledge is readily available on the Internet for anyone to read up on. How are we to regulate who is able to clone, and what they are able to clone. Is it not possible for an individual to insert the wrong gene in the wrong virus creating a lethal strain in a makeshift laboratory in their backyard?

Cloning of more complex genes and entire genomes has become possible to the extent that in 1996 researchers were able to clone a sheep, dolly. As cloning in humans becomes more and more realistic, we are flooded by an entourage of ethical questions. Cloning in humans would bring about many positive aspects such as elimination of genetic diseases and allowing infertile couple to have children who are biologically related to them. But where do we set our limits? Imagine a situation where prospective parents choose specific genes, tall genes, smart genes, athletic genes etc, for their child from a catalogue. These genes are then cloned and inserted into the DNA of a blastocyst, which is then placed in the mother’s uterus, and nine months later, presto, you have a beautiful baby that will grow to be tall, smart and athletic. Who is to draw the line between cloning that is ethical and that which is not? If we are not careful cloning could bring about a new species of superhumans.

Soucres: Mol214 Lecture, Professor Shenk

"Designer Babies" - How Far Along Are We?

With all the advances in understanding the human genome and manipulating DNA an important question has risen: Can people design babies with no genetic flaws, any eye or hair color or even different appearance. Is it just a matter of time before parents can pay for their child to be born a great musician or a scientist? The idea of having a perfect child might indeed sound appealing to future parents at first, but its consequences on society are unpredictable to say the least. Will people have to save money their whole life in order to afford the “latest gene mutation” that will make their child smarter than the “older models” or will this be widely available to every parent, who will just have to browse through available profiles and pick the one he likes best? Whatever the answer is, it will shake the foundations of our current moral system and establish a society based on how “good your genes are”.

This is why germline gene experimentation is at this time strictly monitored and regulated. Although limited number of experiments are being done on modifying embryos’ genetic material, such specimens have to be destroyed within a couple of weeks after their creation. Why are then so many news articles claiming that “designer babies” are being born? This misconception comes from the fact that even though parents can chose the sex of their child as well as eye and hair color using IVF, no genetic modifications are actually being made to the future child’s DNA. Doctors are simply scanning the DNA of numerous possible samples and they choose the one with the preferred characteristics. In this way even certain genes that cause terminal diseases can be “filtered out” by choosing the “right baby”, which has become a common practice for IVF procedures. How different is that from actually modifying your child’s DNA? People are merely choosing a child from all the possible ones they can have, instead of introducing new mutations. The difference is indeed significant, but it seems a small step between choosing to creating. One can only speculate on how long it will be before this happens but it seems that this life changing event might not be so far away.

Sources:
http://www.scienceprogress.org/2008/05/designer-babies/
http://www.foxnews.com/story/0,2933,478406,00.html

An Unintended Experiment

Ever since the first IVF baby was born on July 25, 1978, in vitro fertilization has helped millions attain their most treasured dream: parenthood. Yet new research is beginning to show that there may be serious problems with the technique. IVF may lead to abnormal patterns of gene expression, which in turn appear to be linked to an increase in the incidence of rare genetic disorders among IVF babies. Additionally, the risk of premature birth and low birth weight for gestational age appears to be higher among babies born with the aid of IVF.

Although this discovery in itself is disturbing enough, the ethical implications are even more problematic. This is the worst type of research: the type that is done too late, and as a result uses human subjects who thought that they were getting a safe treatment. There was no informed consent here, no approval by bioethics boards to run a study using human subjects. Instead, a medical product was released into the real world and the clinical trial was conducted there. 

This case illustrates the need for proper, regulated human experimentation. Without it, research on the effects of medicine is conducted only when many people have already been hurt, and the result is a form of research more harmful than even the worst-designed clinical trial.

http://www.nytimes.com/2009/02/17/health/17ivf.html?pagewanted=1&ref=science

Memories over...Mind?

According to a recent study conducted on 60 people, Dutch investigators believe that beta-blocker drugs could help people who suffer from emotional after-effects of traumatic experiences. These drugs are commonly used as heart medicine, but could potentially be used to alter how memories are recalled. The tests conducted were done so by artificially creating a fearful memory by associating pictures of spiders with a mild electric shock delivered to the patients. After being split into two groups, one given the beta blocker propranolol and the other a placebo, according to a “startle response” test, results showed that those given the beta blocker showed less fear of the images of the spiders. So, memories are still intact, yet the emotional intensity of the memories is dampened.

However, alongside the potential memory-banishing use of this drug, there is the ethical issue of tampering with the mind. Each individual’s personal experiences, and subsequent memories of these experiences, play a major role in shaping that person’s personality and decision-making skills. For instance, I am sure that many adults can attest to the fact that they have at least one childhood or adolescent memory of a bad decision that they made, and have used this particular memory as a learning tool for future decisions. So, as Dr. Daniel Sokol, lecturer at Medical Ethics at St. George’s University of London points out, “Memories are important, for people to learn from their mistakes.”

Though the doctors cited in the article point out that their goal is to use this drug for complex conditions such as post traumatic stress disorder, tampering with memories could potentially have a disastrous effect on the mind as a whole. The results of the trials suggest that the use of this drug eliminates or dampens the effect on the brain of traumatic memories. Yet, there is still the possibility and the danger that this procedure can also eliminate good memories in the mind. In this case, which Medical ethics expert Dr. Daniel Sokol argues, there is the risk of a type of “accelerated Alzheimer’s” effect. So, using this drug to attempt to eliminate bad memories may be successful, but may also have the same affect on good memories, and ultimately completely alter the mind of an individual.

Though at first glance this procedure seems to be the next possible solution for curing the traumatic memories that lead to depression, anxiety, and even suicide, we have to be very cautious when dealing with altering the most unique and valuable part of a human being; the mind.

http://news.bbc.co.uk/2/hi/health/7892272.stm

Cash or Test?

A recent study conducted by Times magazine has revealed that number of genetic tests performed on newborns have increased dramatically since the start of the decade. With a simple needle prick on the heel of the infant, doctors can now screen for a variety of diseases that are rare but severely debilitating. The ease of the procedures have sparked action throughout the nation; all fifty states now require tests for at least twenty-one diseases out of a recommended list of twenty-nine. Twenty-four states require all twenty-nine tests outright. The laws have come largely in response to a 2005 survey by the March of Dimes organization that found only 38% of the babies were being screened for the minimum twenty-one diseases. Nowadays, that percentage is closer to one hundred percent.

The new laws, while well intended, have placed additional responsibility and burden on the healthcare structure. The states have had to pay for the tests, which cost about $100, if the patient’s health plan does not cover it. This has created a drain of state funds that becomes increasingly difficult to fill. With the gloom of the bad economy looming over every financial decision, the question that comes to mind is whether these genetic tests are a responsible use of state funds.

The only justifiable answer to this question for society is yes. Despite the increased burden the law has on a state budget, it seems to me to be a crucial test for infants. Many of these diseases are treated and manageable if caught early; if diagnosis were to be delayed, it could cause irreparable damage. In the end, it comes down to the long-run; according to Dr. Jennifer Howse, president of the March of Dimes: “It’s much less expensive to treat these conditions than it is to manage the catastrophic illness that can occur if they are not detected.” So it makes both prudent and financial sense to make these screenings, despite the initial hit on the state’s wallets. One can only hope the states legislators understand this logic and continue the programs.

http://www.time.com/time/health/article/0,8599,1880704,00.html

"Pharm" Animals

We have chickens for eggs, cows for milk, but goats for...drugs?

On February 6th, the F.D.A. approved of the use of a drug derived from genetically-engineered goat milk, marking the first of its kind. A company called GTC Biotherapeutics engineered goats by inserting a gene into their genomes that produces antithrombin, a blood thinner protein. The breed of 200 closely monitored goats (which also was approved by the F.D.A) have been bred for this sole reason, to create this protein. Conventional methods of getting antithrombin include plasma donations or from vats of engineered cells, but neither has the efficicacy of this new method, especially due to the shortage of plasma and the outrageous costs of cell methods. The breed can also be expanded to fulfill need.

Deriving drug components from animals is not new, but creating "pharm" animals as they're dubbed soley for that purpose is unexplored. Animal rights activitsts are predictably up in arms over this new development, citing the exploitation of the animals as merely tools. There are also concerns about these goats or their milk inadvertently entering the food supply, or reproducing with the wildlife; the company assures that this won't happen, but they're safe to eat anyway.

I feel this is a great step forward in pharmaceuticals that shouldn't be hampered by weak ethical misgivings. We already "exploit" animals in the sense that we breed them to eat them or their animal products, and I find this no different; cows are bred to make milk for us to drink, and these goats are bred to make milk for us to make drugs out of. The human race has been doing this since the beginning of time, now we're just altering the product. In fact, I feel like animals such as research mice, which are doomed to have crippling genetic disorders or be cut up, have it worse than these goats; the quality of the product is dependent on the well being of the animal, so I'm sure they'll be treated well. Genetic engineering by itself isn't anything new either and is a generally accepted facet of biomedical research, so there's really no reason why this shouldn't be OK. I expect to see more developments in the future derived from this new method.

http://www.nytimes.com/2009/02/07/business/07goatdrug.html?ref=research

Shocking story

This article has nothing to do with human experimentation or anything we are discussing in class right now but it is still pretty shocking.

http://www.thesun.co.uk/sol/homepage/news/article2233878.ece

Playing two roles: Parent and Scientist

The New York Times recently published a story about a “new breed” of researchers who are using their children as subjects in various experiments. Dr. Pawan Sinha, a neuroscience professor at MIT was excited for his baby’s birth because “[he] really wanted to study [his baby] and do experiments with him”. Dr. Sinha then went on to install a camera on his baby Darius’s head to study what the baby was looking at. 

However, as the article goes on to describe, such experiments have been happening for a long time now. Those who study language acquisition and child development have been using their own children as subjects for many years.

Even though most of the studies performed on these children are harmless and even provide valuable scientific data, bioethicist have raised questions about the “conflict of interest” between playing the role of a parent and or a researcher. It is very easy to agree with these ethicists because as a reader it is alarming to see how children are used as scientific experiments. It is impossible to play both roles side-by-side as one side will always take over the other; either the parent will take over the researcher or the researcher will gain precedent over the parent.

Looking from another perspective, however, I feel that most children are subjected to experiments led by their parents in their childhood. Whenever I had a sore throat my mother would force me to drink hot milk mixed with turmeric as she was convinced that it was the best medicine. My best friend’s dad, on the other hand, also did several reading exercises (which he created) when he noticed that my friend stammered while speaking. Neither my mother nor my friend’s dad is a scientist. And this is what leads me to believe that is impossible to separate the “scientist” from the “parent”. Parenting on its own involves a lot of experimenting – what is the best way to train your child to use the toilet, or what is the best way to help your child start reading? In this sense the research is less formal but it still involves a similar scientific process which scientists like Dr. Sinha used.

 I can understand concerns about bias and about the welfare of the child. On the other hand, is the concept of growing up in a parent’s lab any different from growing up in your own home?

Got high blood pressure and PTSD? Then this is for you.

Your brakes fire like a machine gun as the ABS tries to give you back control of your car. The ice is merciless as it carries your car downhill. The frame of your car crumples, as it violently and abruptly embraces the telephone pole, the metal frame awkwardly wrapping itself around the wood, while you’re still trapped inside. Your heart’s pounding as fast as your breaks were a moment ago and blood’s running into your eyes.
Following this traumatic episode you can no longer get behind the wheel without your hands shaking and your palms sweating. What if there was one simple drug you could take to bring your life back to normal, block your fearful memory, and go back to taking for granted the ability to drive with confidence – take one pill and no longer feel that fatality is approaching in your rearview mirror. Or for that matter what if you’re the victim of a violent crime, or returning from war? Wouldn’t you too like to not necessarily forget, but at least no longer fear those memories? Well according to Dutch scientist at the University of Amsterdam this fear suppressing wonder drug may already be, or soon be, sitting in our medicine cabinet.
The scientist conducted a study using a drug called propranolol. This drug, which is classified as a “beta-blocker” is already used to reduce blood pressure. In the study the 60 undergraduate student who participated where shown a picture of a spider and then given a shock on the wrist. This was done so as to create a conditioned fear response; the undergraduates would associate seeing a spider with a shock so when they saw spider, regardless of being a shocked, they would still elicit a fearful response. Half the undergrads were then given propranolol and the other half was given a placebo. In subsequent testing the group that received propranolol no longer suffered the conditioned fear response, while students in the placebo group still did. This effect of propranolol has been shown to have the same effect in animal studies as well.
Although how propranolol produces this effect of diminishing fearful associations it is understood that beta-blockers, like propranolol, do have an influence on the chemical processes in the amygdala, the brain’s fear center. So propranolol might actually block the pathway by which the amygdala associates a fearful response with a certain memory.
But of course propranolol’s prospects raises concerns: "Removing bad memories is not like removing a wart or a mole," Daniel Sokol, lecturer in medical ethics at St George’s, University of London, says in a statement. "It will change our personal identity since who we are is linked to our memories. It may perhaps be beneficial in some cases, but before eradicating memories, we must reflect on the knock-on effects that this will have on individuals, society, and our sense of humanity." It has been proposed by others that some of these effects maybe the altering of other positive memories as well. In addition it can be imagined that a drug like this could easily be abused, like by someone just trying to forget a particularly embarrassing day at the office.
Whatever the ramifications, this drug may turn out to be very exciting and influential.


Sources:
-http://www.sciam.com/blog/60-second-science/post.cfm?id=could-a-blood-pressure-drug-dim-bad-2009-02-16
-http://www.webmd.com/mental-health/news/20090216/beta-blocker-may-erase-fearful-memories
-http://www.theregister.co.uk/2009/02/16/spotless_mind/

23AndMe Shows You What You're Made Of

In Your Cart:____________Price:_______Qty:

Your Genome Decoded_____$399.00___ _ _1

Once upon a time, we had hypothetical conversations about a time when everyday people would have access to their genetic information, to use as they pleased. We knew it would happen eventually. We just never thought it would be so soon.

Today, for $400 a company called 23AndMe will provide a detailed genetic analysis of a small sample of your saliva. Test results currently include around 90 conditions and traits, and more are added every month. Even more striking is the sharp decrease in the cost of this service: just a year ago, it cost $1000. With constantly expanding capabilities and a steadily decreasing price, it seems almost inevitable that 23AndMe’s popularity will skyrocket.

As fascinating as this is, one must consider the possible ramifications should this new trend go mainstream. I can imagine that there will be quite a bit of confusion between genes that predispose a person towards a certain condition and genes that actually cause a condition. Having interned in an oncology center for two summers, I have met a number of patients who, upon finding out that they had tested positive for BRCA1 or BRCA2 mutations (two types of mutations that are strongly associated with an increased risk of cancers of the breast and female reproductive system), immediately burst into tears because they mistook this as a diagnosis of cancer. In a clinical setting, these test results are carefully explained to the patient by a physician or a genetic counselor, so these misconceptions can be immediately corrected. However, depending on how much information this company provides, there is a possibility that people will misinterpret the 23AndMe analysis. This brings to mind a chaotic scenario, in which doctor’s offices are flooded with panicked patients seeking treatments for diseases that they don’t even have.

If used appropriately, I think that widely accessible genetic testing will be a huge help to those who choose to take advantage of it. If we know what diseases we are at risk of developing, we can make important lifestyle choices to try to avoid them. Increased vigilance will facilitate early detection, and therefore improve the chances of a more favorable prognosis. This could very well be the first step towards a healthier and better informed population.

P.S. Even if you don’t respond to my post, you should check out this article. (Or talk to Professor Rosenberg.)
http://www.wired.com/medtech/genetics/magazine/15-12/ff_genomics

Also, here is the website for 23AndMe: https://www.23andme.com/

Uh Oh.

The arguably most honest thing my high school research mentor has ever said to me, coincidentally, had to do with honesty. “There are these moments,” he said “these ’uh oh’ moments in research when there is evidence against what you have believed all your life staring you straight back in the face. It is what you do with this ‘uh oh’ evidence that defines the kind of scientist you are.”

A vast number of scientists will have a chance to prove themselves as a result of recent studies on the moral perceptive abilities of monkeys reviewed in the London Times. The studies reflected the animals’ innate sense of right and wrong, fairness, and altruism through experimental conditions using reward-and-punishment systems. The research teams applied their results to the evolutionary theory of morality and the human conscience, suggesting that evidence of such features in chimpanzees and other precursors to man correspond to proof that man is not defined by having a conscience at all, but rather a deeper sense of conscience.

These new findings also raise an important question in the minds of bioethicists around the world: an ‘uh oh’ moment for many, if you will. For the vast portion of the history of medical science, we have tested our most far-fetched theories, our most commonly held beliefs on animals. We have considered them worthy enough to serve as parallels to our own bodies and yet manipulate their bodies in ways we could never allow on fellow men. We once clearly distinguished men from animals based on our mental aptitude to recognize beyond base emotions and needs, based on our awareness of our own ‘knowing.’ Part of this distinction lies in our consideration of transcendent laws such as those governing morality and religion.

Uh oh. We have begun to investigate the possibility that animals may possess these metacognitive abilities as well. What does that mean in the realm of animal experimentation? Can we still test on animals the way we have before, given that we now understand their internal standards of right and wrong? Can we still utilize them as ‘lower beings’ if we are no longer sure what truly distinguishes man from mammal?


It may make us more dishonest as scientists, more selfish as occupants of this Earth, but also better to our fellow man. We may possess the nobler judgments of kind treatment to other species, but this special metacognition cannot uproot our base instincts of survival. We are human and as such are morally obligated to defend our fellow man and posterity. We may consider it immoral to harm other species in order to better understand our illnesses, but is it not more immoral to harm our own kind through inaction?

Read the article. It’s interesting. http://www.timesonline.co.uk/tol/news/environment/article5733638.ece

You Want a Full-face or a Partial-face Procedure?

Transplanting organs have become a common method of treatment in the United States, a last-resort method that has yielded many beneficial results. But how about transplanting an entirely new face? Back in December, the Cleveland Clinic announced that it has successfully “replaced 80 percent of a disfigured woman’s face with that of a decreased female donor”. The head surgeon was Maria Siemionow. The living patient is reported doing well, but the surgery has sparked enormous controversy within the medical field.

Facial reconstruction is a fairly common treatment for burn victims. Skin from various other parts of the patient’s body is grafted onto the burn surface. However, this creates a discolored pattern on the face in many cases. The way to get around this, argues Dr. Siemionow, is to transplant an entire new face onto the area. The controversy behind this conclusion is that the new treatment is not absolutely necessary for survival; it is merely a cosmetic improvement. Also, it would completely change the appearance of a person. A trait that was unique by birth can now be changed at will.

This opens up a host of problems. No matter how sophisticated face detecting software becomes, it is unable to detect a face that has been transplanted entirely. This opens up a host of problems regarding law-enforcement and privacy issues. How can cops be expected to catch a hardened criminal if the criminal looks nothing like the picture in their hands, and how can identity theft be stopped if the faces look exactly alike? The simple answer is that it would be impossible. Furthermore, psychology can confirm that facial features are a huge part of personal identity. There would be huge psychological consequences to a person if the image looking back at him in the mirror were unrecognizable.

The bottom line is that the issue of full-face transplants must be handled carefully. It must not become a mainstream phenomenon before its full effect on the psyche is known. Patients treated with such a procedure are often times doomed to a life of constant immunosuppressants. The pills must be taken or else they face rejection of their entire faces by their immune systems. Is this really a necessary and credible treatment? The old method of skin transplant may be outdated and leave splotches on the face, but at least it retains the original appearance without fear of an immune response. It seems that full-face transplants is a step backwards in terms of treatment and benefits. Unless a patient’s face is injured beyond irreparable repair, it should not be used.

http://www.washingtonpost.com/wp-dyn/content/article/2008/12/16/AR2008121600838.html

http://blog.wired.com/wiredscience/2009/02/facetransplant.html

Preventing Regrets More Painful than Colonoscopies

While the medical field is working hard at opening more opportunities for patients with cutting edge research, Medicare has recently taken a step in the opposite direction. An article in the New York Times informed that Medicare, the governmental insurance program, made a decision, although not final, to no longer pay for virtual or CT colonoscopies. In contrast to the traditional colonoscopy, the virtual colonoscopy is not only noninvasive, but also more affordable. “Dr. Perry J. Pickhard, …professor of radiology at the University of Wisconsin,…said the virtual colonoscopy was ‘better, safer, faster, cheaper’ than conventional colonoscopy.” So what could have prompted Medicare’s decision?

Medicare believes that these virtual colonoscopies may not “improve outcomes in Medicare beneficiaries.” It is reported that people who undergo virtual colonoscopies fall under an age group that is more prone to developing polyps. Because of the weak effectiveness of virtual colonoscopies in detecting small polyps, the larger polyps detected would warrant another traditional colonoscopy for radiation treatment. As argued by Dr. John Petrini, president of the American Society for Gastrointestinal Endoscopy, “Why do a test that will pretty much require another test to be done?”

But is it ethical to limit patients to the traditional colonoscopy as a result of this decision? Virtual colonoscopy is viewed as “a more tolerable alternative to conventional colonoscopy in screening for colon cancer.” Minimizing the choices can hinder individuals from performing colonoscopies, especially for those who do not want to go through the uncomfortable process of the traditional colonoscopy, “in which a probe with a camera on its ends is snaked through the rectum and colon.” This notion can negatively influence the welfare of the Medicare beneficiaries by limiting their sources. It is also particularly interesting to note the emphasis Medicare placed upon how “less cost-effective” the procedure is in making its decision. As less effective at detecting smaller polyps as it is, opening up opportunities for polyp detection, which is the key to successful prevention and treatment of colon cancer, should be the priority. We certainly should prevent regrets such as an increase in colon cancer cases among the Medicare beneficiaries that could be more painful than the conventional colonoscopies.

Sources:
http://www.nytimes.com/2009/02/13/health/policy/13colon.html?ref=health

Locked Up & Locked Out: Healthcare in our Nation's Prisons

In an article from U.S. News & World Report, Amanda Gardner discusses the issue of U.S. prisons lacking good healthcare. According to multiple studies, compared to non-incarcerated citizens, inmates in state jails were 31% more likely to have asthma, 55% more prone to diabetes, and 90% more likely to have suffered a heart attack. Additionally, there is an estimate 42.8% of inmates in state prisons who have a chronic medical condition. Even though many inmates suffer from chronic conditions, and estimated 20% of those being held in state jails have not seen a health care provider since their incarceration. In general, Gardner reports that the individuals being held in local, state, and federal prisons have difficulty accessing care both inside and outside of the correctional system.
These statistics are extremely surprising, especially since these people, although they are locked up for various amounts of time, are still citizens of the United States. According the 8th Amendment, which prohibits cruel and unusual punishment, these prisoners should be receiving proper and regular health care. If the country makes a vow to protect all its citizens with the rights instituted in the Constitution, these rights must be properly extended to those who are looked down on in society. Ethically, there should be no distinction in health care between someone who has saved lives, and someone who has possibly taken multiple lives away. But, how can we realistically ignore the wrongdoings of these criminals and treat them the same as other, normal citizens.
The real issue with this subject is that most people, whether based on their religion or basic morals, view those who have sinned or done wrong as lower than others who strive to do right. But, should these religious and moral views get in the way of extending proper healthcare to those locked up in jail cells? For instance, if a member of the Salvation Army and a murderer both suffer a heart attack, who gets treated first? Clearly, one of them has strived to help others while the other has taken away a human life. But, is it in the doctor’s or health official’s power to decide who is the better person?
I feel that most tax-paying citizens would not want their money going towards health care for the most dangerous members of society. But, on the other hand, it is not ethical to mark these individuals as subordinate in our healthcare system. This is the same type of medical discrimination that may occur towards women, minorities, and poor people. So, we must make an effort to eliminate yet another disparity in our health care system; the phenomenon of untreated chronic disease and limited access to healthcare in our nation’s prisons. But, how we go about doing just this is just the beginning of the solution to the problem.
Article from: http://health.usnews.com/articles/health/healthday/2009/01/16/many-in-us-prisons-lack-good-health-care.html

The Economic Future of Guinea Pigging

The idea for this posts stems from a conversation with my father during intersession. Just briefly, our discussion landed on the topic of economics – and how many fast food companies were doing well in spite of the recession. Guinea pigging is considered an easier, less demanding alternative to minimum wage jobs. Given this parallel, I wondered how contract research organizations (CROs) were faring in our current economic situation. Did the lack of jobs create a larger pool of willing low-wage test subjects, allowing for easier and cheaper testing? Or did the economic decline affect CROs as dramatically as other companies?

To get a general sense, I examined stock prices over the past two years for the CROs mentioned in the NYT article “Guinea Pigging” (Covance, Parexel, PPD), as well as a few other well-known companies (Charles River, MDS Pharma). The trends observed were almost identical: steady growth over the past two years with a steep decline starting late 2008. Most companies’ stocks dropped to well under half their early-2008 prices. It is clear that CROs have not benefitted from the recession.

The impact this will have on the future of Guinea Pigging is uncertain; however, it is unlikely to be a favorable change. Given the financial situation of CROs, conditions during testing are likely to deteriorate. Furthermore, wages are likely to decrease as well, leading to greater activity, and thus risk, among professional guinea-pigs. Furthermore, with jobs continuing to be lost, more and more people may rely on guinea pigging for supplemental wages. The dangers of Guinea Pigging seem even greater than before.

Stock prices taken from http://finance.yahoo.com/

Do you own your own kidney?

Ever since the time when the first organ transplant was made the supply of organs for sick patients has been a major problem of healthcare throughout the world. There are numerous ethical concerns with using organs from already deceased people but the donation of organs by living people poses even more interesting and debatable concerns. The donation of an organ is considered a purely altruistic act of helping someone and is therefore not associated with any benefits for the donators, who need to do it “out of the pure goodness of their hearths”. More and more economists however are starting to look at organ donations as a viable and prospective market that could benefit society as a whole. As outrageous as that might sound there is actually a system based on that idea that seems to be working surprisingly well – since 1988 Iran has adopted a compensated government regulated organ transplant program.

The Iranian government kidney procurement program can indeed be characterized as a “market” in the sense that a person is free to sell one of his kidneys, for which he receives a fixed amount of money from the government and an additional amount either from the patient to whom he is donating the organ, or in the case when the patient is financially incapable of providing the money, from charitable organizations. The results of this “social experiment” speak for themselves, by 1999 Iran had virtually no transplant waiting list – everybody who needed a kidney got one. Why are then all the other countries in the world prohibiting people to sell their organs? Aren’t our own organs our most personal possessions, thus giving us full rights to do with them whatever we desire?

A lot of ethical and moral issues arise if organ donation is turned into a “business”. Wouldn’t it be just another way for the rich to take advantage of the poor? Similarly to how guinea-pigging has become a “profession” for the financially disadvantaged, circumstances might force people to unwillingly donate organs for the sake of money. The need for organs however keeps increasing and smaller and smaller fraction of the people on transplant waiting lists actually get one. Even though the means for saving thousands of lives exist altruistic motives of society are not enough to supply the necessary product. A parallel can be made to human experimentation – if no money was offered to participate in experiments medical research would be in serious trouble, ultimately leading to a worse outcome for society since far more people would die. Organ donation doesn’t seem to be very far from this example – the introduction to regulated compensated organ transplant program might serve society a greater good that the voluntary principle that governs it now. The provided example really makes one think – can the idea of people selling their organs actually lead to a better outcome for a society.

Sources:

http://cjasn.asnjournals.org/cgi/content/abstract/1/6/1136

http://freakonomics.blogs.nytimes.com/2008/04/29/human-organs-for-sale-legally-in-which-country/

Welcome

And it seems I am late in welcoming everyone to the best writing seminar that Princeton has to offer. Well here it is: congratulations on signing up to WRI167, a writing seminar unique in several ways, one of which is that you'll actually be able to tell your jealous friends that you actually enjoyed your writing seminar. Though I have not been at Princeton much longer than you all have, I can safely say that this is a class that will remain among my favorites (even despite the fact that it met at 8:30 every time - I hope you all aren't currently going through that).

This class has much to offer, and immerses you in a topic that is extremely engaging, very informative, and highly relevant. I'm sure you all know this already, of course - but I would like to add that whatever effort is invested in this class will be well worth it. It can be time consuming at times, but taking full advantage of the quality of the class' topic, discussion, and professor will not be time wasted.

Have fun! Wishing you the best!
Alex

Relevant Website to My Post

http://sportsillustrated.cnn.com/2009/baseball/mlb/02/07/alex-rodriguez-steroids/index.html

http://sportsillustrated.cnn.com/2009/baseball/mlb/02/09/arod.admits/index.html?eref=T1

A-Rod is a Fraud?

The recent news that Alex Rodriguez of the New York Yankees tested positive for steroids back in 2003 has once again touched off a fiery controversy that has threatened to consume baseball for quite sometime. As the heir apparent of the home-run record with 553, a clean, 33-year-old A-Rod was seen by many as the eraser to Barry Bond’s current steroid-injected, asterisk-tipped record of 762. With this hope now fading away, Major League Baseball must handle cautiously the ongoing defamation of its best player, or else risk the loss of more credibility, something that it has very little in reserve.

No other sport has been rocked by the steroid controversy more so than America’s pastime. When other sports associations cracked down hard on the use of artificial hormone derivatives, it fell in a relatively gray area for baseball. By the time realization dawned on the league that steroid use was inflating statistics, it was too late; records were being shattered at an unprecedented rate. Because of its long and rich history, no other sport places as much emphasis on records as baseball. Joe DiMaggio’s 56-game hitting streak. Cy Young’s 511 wins. Nolan Ryan’s 5,714 career strikeouts. These numbers stand out in the mind of baseball fans like a lightning rod. The use of steroid put these numbers at risk, and inflamed the passions of fans who want things done right.

Despite not being a passionate follower of baseball, I believe that there is something to be admired about achievement the good old-fashioned way. Humanity’s greatest strength is its ability for improvement. Players today are competing at a level far higher than their predecessors, and advances in workout regimens and diet plans are shaping more physically gifted athletes than ever before. However, a spirit of fairness is far more important than any championship. For a substance that affects every player differently, whose advantages do not come from hard work and sweat but needle pricks, and that causes drastic long-term damages for a few short-term benefits, it is clear that regulation must be handed down swiftly by the authorities of baseball.

Harsher penalties for steroid use were finally issued in 2005, but the larger issue concerns the records that were broken or are in danger of being broken in this era of steroids. These achievements, great as they are, must be recognized with asterisks of sorts, a reminder that they were accomplished under the auspices of a powerful and advantageous artificial enhancer. As for Rodriguez, it would be best for him to come clean with his mistakes. Sports fans may be passionate, but they are a fickle crowd. There is no doubt in my mind that this whole mess will just wash over soon enough.

Deception in Human Experimentation

In many types of experiments involving human subjects, especially psychological ones, there is a need to deceive the research subject in order to ensure that the experiment is relevant. The deception is generally more blatant in psychological studies; research subjects are often deprived of important information about the experiment, such as its purpose, because knowledge can distort the results of the experiment. For the same reason, pharmaceutical studies tend to deceive subjects regarding the treatment that they are being given, since they need a control group that is unaware of the fact that it is receiving a placebo rather than an actual experimental drug.

Is this deception ethical? In "Dying Children and Medical Research," Oberman and Frader claim that since "American society values altruism and autonomy over communitarian or altruistic values," human experimentation that may harm the patient is only ethical if there is some possible benefit to the actual research subject, and not only to society as a whole. (305-306) Does this mean that depriving a patient of a drug that may help them without letting them know is unethical? Perhaps more importantly, is it unethical to risk psychological harm to a person in conducting a psychological experiment that has very little chance of helping the subject in any way? Practically, such a standard seems difficult to uphold while conducting any significant research; but in an abstract ethical sense, is this a problem?

Just sign on the dotted line

Consent in the context of human experimentation refers to the agreement of a volunteer to participate in an experiment with full knowledge of both the benefits and the risks of doing so. Therefore, if the researcher obtains a signed consent form, there are no questions of ethics that need be addressed. The nature of the experiment is of no consequence. Whether it is just a simple questionnaire or something outrageous that the average person would find unconscionable. In both cases the experiment would be completely viable due to the fact that someone has volunteered on their own accord. After all we live in a free world and are all at liberty to do what we want with our bodies and minds.

A perfect example of this need for consent and nothing more can be seen in the Jesse Gelsinger case. Despite the shock of his son’s death, Paul Gelsinger did not inculpate the doctors for it. However, after further investigations, information surfaced showing that the researchers had not fully disclosed all that they had known. There had been sufficient evidence suggesting that the researchers should not carry out the experiment due to the advertent risks but they chose to ignore these blatant stop signs. In light of this new information, Paul Gelsinger sued the researchers on account of the fact that the risks affiliated with the experiment were downplayed in the consent form. If all the risks had been disclosed from the very start, Paul Gelsinger would not have sued the researchers. This shows the ethical issue raised by the Gelsinger case is not that he died as a result of the gene therapy but that he was not fully informed of the risks.


Articles:
http://query.nytimes.com/gst/fullpage.html?res=9C03E4DE1F3CF93BA15752C1A96F958260
http://www.ncbi.nlm.nih.gov/pubmed/11660806

An Introduction to our Blog

Dean’s Date Assignment (Due 5/11)

Every week for weeks 2-11 each of you will post either an entry or a response to an entry for this class blog. Posts should be at least 200 words, but may be longer. They MUST address a contemporary issue/controversy in human experimentation. You may address the structure of the issue, or choose a side in the controversy and argue for your position. For inspiration, try reading some of the bioethics blogs linked from ours. Include links to any sources you refer to or cite.

Please remember that everything you post will be available to the public, and it’s entirely possible that people from outside Princeton will find this blog and comment on what you write. (It happened last year.) Think about what you are writing and how your writing makes you look.

Group 1 will post entries and Group 2 will post responses beginning in week 2.

Blog entries must be posted by midnight on Monday, and comments by midnight on Friday.

At the end of the semester, you should revise your blog entries. As a group, your five best blog entries or comments will become the Dean’s Date Assignment, and will be graded for argument, structure, clarity, etc.

Some Advice:

You can find an infinite number of pages offering advice on what makes a good blog post. I’ve taken the main points from http://www.findableblogs.com/what-makes-a-good-blog-post/ and edited those suggestions for this assignment. (Feel free to read that post in its entirety.)

• Good blog posts are laser-focused

• Good blog posts have original content

• Good blog posts have links to their sources and other relevant information

• Good blog posts are readable

• Good blog posts have accurate intriguing titles

Look at posts from last year, especially those of Adam Rosenthal and Alex Hwang.