Bloomberg's "Eat Your Veggies" Mandate

Anemona Hartocollis reports that Mayor Bloomberg recently requested federal permission to bar New York City’s 1.7 million current food stamp recipients from using them to purchase sugary beverages like soda. The question is: is this ethical?

Well, the answer depends on how we are defining government. So, let’s examine two commonly utilized definitions: limited government and paternal government. Limited government, whether defined by Ibn Khaldun or Locke, is characterized by minimal governmental intervention in the liberties of the individual. Using this definition Mayor Bloomberg’s request is unethical because the welfare of the state as a whole does not depend on the health of the minorities affected by obesity or diabetes, seeing as how neither directly affects the participation of said minorities in the political unit. On the other hand, the purpose of a paternal government, according to Hegel, is to look after its constituents as parents would look after their children and promote their wellbeing. With this definition Mayor Bloomberg’s actions are well within reason because he is attempting to maintain the health of his people.

In terms of bioethics, however, this is clearly unethical. The parental government argument assumes that the people of a state are best represented by the political system. This ignores the fact that many of the people who constitute the political body are perfectly capable of informed consent. Not to mention, “the mayor requested a ban for two years to study whether it would have a positive impact on health and whether a permanent ban would be merited.” If this is approved, 1.7 million people will take part of a massive study without being consulted first, which is a clear violation of those people’s rights. Sure, approving the ban would allow food stamp recipients to purchase more nutritionally rich foods, but there is more to health than just sugar-intake. Therefore, Mayor Bloomberg’s request should not be approved.

New York Asks to Bar Use of Food Stamps to Buy Sodas

When an Apology Isn’t Enough

When we are young, our parents and teachers teach us time and time again that a meaningful apology can fix anything, but at some point it becomes necessary to ask ourselves—does sorry really suffice?

On Friday, October 1, Secretary of State, Hilary Rodham Clinton and the Health and Human Services Secretary, Kathleen Sebeluis, publicly apologized to the Guatemalan government for unethical medical crimes done against their people over sixty years ago. In a case like this, sorry is not enough.

Beginning in the 1940s, the United States Public Health Service began to do research testing if penicillin could prevent early syphilis infection, the possibilities of more efficient blood tests for this disease, the proper dosage of penicillin to cure infection, and how re-infection happened upon initial clearance. Because of their inability to grow syphilis in a laboratory and the failures of animal testing, American doctors thought it to be necessary to test penicillin on human subjects. After a brief attempt to inject prisoners at the Terre Haute Federal Penitentiary in Indiana with gonorrhea from a lab, the US government gained clearance from Guatemala to conduct their studies there.

So between the years 1946 and 1948, American public health doctors, led by Dr. John C. Cutler—a primary doctor in the Tuskegee experiments—purposely infected almost seven-hundred Guatemalans with diseases in an attempt to learn more about penicillin. Though cleared by the Guatemalan government, their subjects were left completely unaware of the experiments. Doctors specifically targeted prisoners, mental patients, and soldiers and primarily used infected prostitutes as a way infect the test subjects. And when that didn’t work, they often poured the bacteria into scrapes on their penises, faces, or arms. Other times, spinal punctures transferred the diseases to the patients. Though the test subjects were given antibiotics upon infection, it is unclear about how many of them were actually cured.

Despite the fact that these unethical medical practices happened over sixty years ago, it was only in May of last year that Wellesley College medical historian, Susan Reverby made this discovery. She found this information hidden among some of the works of Dr. Cultler at the University of Pennsylvania and immediately decided to do further research on the subject.

This new discovery brings to light many issues in the field of medical ethics. Most importantly though, it highlights the importance of constantly re-evaluating our guidelines of human experimentation. Even though we have made great advances since this “dark chapter in the history of medicine”, as termed by the National Institute of Health’s director, Dr. Francis S. Collins, more information is being uncovered about similar medical scandals. For example, in the 1960s, researchers infected mentally retarded children of the Willowbrook State School on Staten Island with hepatitis, and around the same time, elderly patients from the Brooklyn Jewish Chronic Disease Center were injected with live cancer cells. It is important that we go beyond an apology and take it as further incentive to continue to improve the conditions we abide by in medicine. We must not repeat this, and use history as a way to continue our quest towards finding the best solutions for medical advancement.

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Sources:

http://www.nytimes.com/2010/10/02/health/research/02infect.html?_r=1&hp

http://www.startribune.com/lifestyle/health/104158238.html?page=3&c=y

http://www.startribune.com/politics/104165213.html?elr=KArksUUUoDEy3LGDiO7aiU

http://www.wellesley.edu/WomenSt/fac_reverby.html

ADHD - Fact or Fake?

When I read this article on CNN, I was interested by the possibilities it raised. A new article published in Lancet shows a correlation between a particular type of genetic variation and ADHD. It was the comment section that was really interesting, however. After reading all three hundred and fifty something comments, I found that virtually all of them fell into one of two camps. One has people who have been diagnosed with ADHD, or who are very close to those who have been diagnosed, and who believe in the reality of the disorder. The other is composed of individuals who consider ADHD to be an excuse to give special treatment and medication to children who are misbehaved, undisciplined, lazy, slackers, or just plain old bad. As for me? I know ADHD is real – I have it.

Many of those who commented on the article in question are skeptical of any claims that ADHD is a real disorder. As far as they are concerned, the children who have been diagnosed with ADHD are the product of households where they are not disciplined and act out to gain attention and special treatment. If only these children would sharpen up, pay attention, and put more effort into their work, the symptoms would go away, and everyone would see that there is no such thing as ADHD after all. From personal experience, I know that this is not the case. I have certainly tried to pay more attention in school and at work, to put more effort into what I do, to sit still and listen up. Unfortunately, my symptoms haven’t disappeared, no matter what I have done. It’s pretty clear to me, and to the psychologists who tested me for this disorder, that I do have ADHD, and I am not just goofing off.

If we can assume that this disorder does, in fact, exist, the other big question is why some people have it in the first place. This new study is evidence for a genetic cause. The other major piece of evidence that supports this theory is the fact that ADHD runs in families. I know that my father has ADHD, and some of my siblings have the traits – but not all of them. Other theories as to what causes the disorder include environmental factors, like chemicals in the drinking water or food, brain damage, or some sort of social influence. We don’t know exactly what the cause of ADHD is, but our best guess is that it is a combination of genetic predispositions and environmental factors.

The really cool thing about the possibility of a genetic cause is that scientists might be able to work out why some medications and treatments work better for different people. If treatment could be tailored to the specific needs of an individual, it would definitely help people with ADHD to function better. Tests that could identify those who are more likely to have ADHD would help parents, doctors, and teachers to identify and appropriately treat this disorder earlier. Overall, this study is good news for those of us who have ADHD, or live with someone who does.

For more information, try following these links:

The Lancet article (warning - this article is not open access yet, you may not be able to read the full article)

The National Institute of Medical Health web page on ADHD

The Attention Deficit Disorder Association ADHD fact sheet

In-Vitro Fertilization; worth it?

On Monday, October 4, 2010, Professor Robert Edwards of the University of Cambridge won the Nobel prize in medicine for his ground-breaking work involving in-vitro fertilization, a project he has been working on in collaboration with the now deceased surgeon, Patrick Steptoe since the 1950s. In-vitro fertilization is a method “in which eggs are removed from a woman, fertilized outside her body and then implanted into the womb.” For many couples whom have unfortunately been determined infertile, this treatment has been especially monumental and integral in allowing them to reproduce. Infertility affects 10% of couples worldwide, so clearly a decent amount of people are affected by this treatment, not to mention the large percentage of people that are indirectly affected by this treatment.

In-vitro fertilization is still a relatively untrustworthy method; however, it is the only method that is available to couples that desperately want to have a child that shares both their DNA when the couple is not naturally able to due to infertility. There are some risks associated with in-vitro fertilization such as a higher chance of the child acquiring cerebral palsy, a disease that affects the cerebrum in the brain and results in limiting motor control, communication skills, cognition and sometimes even triggers epilepsy. In 1993, 13% of in-vitro fertilization procedures were successful. Since then, the rate has increased—but even so, it continues to be an unreliable source and is still in need of further research.

Personally, I think that this is an extraordinary and almost inhuman discovery in medicine. I’d imagine it to be a heartbreaking realization when a couple finds out that they’re incapable of reproducing. And thus, this brings hope to them. Although I’m awed by this treatment, I similarly believe that there is a reason that some couples are infertile and that the option of adoption should be considered first. Perhaps I would need to be put in that situation to make true judgment, but it just seems to me that with the existing population of the world and the number of children who are in need of a family, couples should consider adopting if they’re unable to conceive on their own.

Additionally, this issue becomes increasingly controversial when religion is brought into play because this method is unnatural and thus violates many beliefs on that front.

http://www.latimes.com/health/la-fgw-nobel-medicine-20101005,0,2977962,full.story

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WF2-501570S-1&_user=1082852&_coverDate=05%2F06%2F2010&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1484902588&_rerunOrigin=scholar.google&_acct=C000051401&_version=1&_urlVersion=0&_userid=1082852&md5=b15b2658e83f9c39dd52bec5beb7efc2&searchtype=a

http://www.jstor.org/stable/2885620?&Search=yes&term=reaction&term=fertilization&term=in-vitro&list=hide&searchUri=%2Faction%2FdoBasicSearch%3FQuery%3Dreaction%2Bto%2Bin-vitro%2Bfertilization%26wc%3Don%26acc%3Don&item=15&ttl=3748&returnArticleService=showFullText

Choosing Our Ends

Assisted suicide has been a point of contention for decades. It has been a major issue in the world of bioethics and constitutional law alike, and has garnered serious media attention – most notably in recent years because of Dr. Jack Kevorkian. Mr. Kevorkian was let out of prison June 1, 2007 after having served eight years in prison for assisting an estimated 130 suicides.

By current law, assisting suicide is outlawed in every state except Washington and Oregon. The United States Supreme Court has heard two major cases relating to the issue, and both of these cases have led to a ruling against the legalization of assisted suicide. In 2009, however, The Montana Supreme Court ruled in favor of its legalization in Baxter v. Montana , with a few restrictions of course.

My question is – why are Washington and Oregon the only states to have this option available to patients in extreme amounts of pain?

Life, liberty, and the pursuit of happiness were the ideals that America was founded on. All people deserve to live their lives with the freedom to do that which will give them a better quality of life, as long as this path keeps them within the confines of the law. And currently, yes, assisted suicide is against the law, but why? Because of religious opposition? Statistics have shown that being religious is incredibly likely to influence your view on euthanasia, as the act is generally associated with “playing God.” (Lancet, 5). By “playing God,” physicians are “unnaturally” ending the lives of other human beings, which, in other words, is to say that they are controlling their time here on Earth. But, surely, a large majority of the religious opposition would not be opposed to all forms of antibiotics and surgeries, right? Any surgery or antibiotic used is meant to prolong human life and do things for the body that it could not do by itself. Is this not also controlling our time on Earth?

Assisted suicide has gotten a bad rep over the years – Jack Kevorkian was not branded “Dr. Death” by his avid supporters, after all. However, ethically, it seems sound to me. If someone is in an extreme amount of pain and doesn’t want to bear it anymore, then they should have the right to tell their doctors to ease their suffering. Those who live every day in extreme agony and have no hope of getting better would be extremely grateful to find peace and die with dignity.

We’re only here for so long, and each of us chooses how we want to spend our time…so if what someone wants is to turn out the lights when the pain is too great, then let the lights be extinguished so they can find their dignified and painless rest.

Articles:

http://www.msnbc.msn.com/id/18974940/

http://www.nytimes.com/2010/01/01/us/01suicide.html

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-4B8JMMB-245&_user=1082852&_coverDate=06%2F29%2F1996&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1484908142&_rerunOrigin=scholar.google&_acct=C000051401&_version=1&_urlVersion=0&_userid=1082852&md5=288420c83245354ad20c54b2e5072803&searchtype=a

How a Speck of Skin Could Change the World: Induced Pluripotent Stem Cells

What if we could put an end to the stem cell debate once and for all?

Stem cells have an almost god-like power: the ability to transform into any type of cell in the human body. As such, they can be used to cure diseases, regenerate organs, and generally improve the lives of millions of sick people. Up until a few years ago, however, the only viable way to obtain stem cells was to destroy a human embryo. This unfortunate predicament led to countless debates on the proper balance between protecting the rights of the unborn and offering potentially life-saving treatment to those in need.

But in 2007, scientists developed a technique by which regular human skin cells can be genetically modified and transformed into stem cells. These stem cells, called induced pluripotent stem cells (iPS cells), can differentiate into any type of cell in the same way that embryonic stem cells can, while completely sidestepping the ethical debate surrounding the destruction of fertilized eggs.

When I first heard about this discovery about a year ago, I was elated, thinking that the debate was over and that the process of further research, discovery, and development of treatments could finally proceed unhindered. But, as a recent article in Scientific American explains, a whole host of other issues surrounding induced pluripotent stem cells have arisen and taken hold of the bioethical community. If they can be used to create new organs, how about using them to create new gametes? This gives people of any age the opportunity to have children, but is that ethical? What about creating gametes from dead people? And cloning? The list goes on and on.

The Scientific American article focuses most of its energy on fretting about all the ways in which iPS cells could potentially be used for nefarious and questionably ethical purposes, while failing to stress the crucial point that iPS cells completely resolve the ethical debate over the destruction of human embryos. Many other things in life, including medicine, knives, and water, can cause terrible consequences if misused, but this does not mean that, for example, we should buy so much into the hype about the dangers of overdosing that we decide never to take Tylenol again. As with anything potentially dangerous, we should protect ourselves from and restrict its misuses, while not denying ourselves the benefits it provides when used properly.

As for induced pluripotent stem cells, the fact that they can be used toward questionable ends should not cloud our assessment of their promise and should not stop us in any way from using them to cure diseases and regenerate organs. We have resolved the major ethical debate surrounding stem cells; let us not get sucked into another one and forget what we are trying to accomplish in the first place.

http://www.scientificamerican.com/article.cfm?id=undifferentiatied-ethics

http://video.google.com/videoplay?docid=8370692532177471184&hl=en#

Genetic Testing on College Students: Innovative and Hands On, or Just Plain Reckless?

            Before they start their freshman year, most students are sent a large yet predictable envelope full of forms to fill out – medical information, housing requests, and other routine documents. However, this year if you were an incoming freshman at UC Berkeley, there was one extra package mailed to you over the summer: a saliva sample kit and a request to submit your DNA for genetic analysis. The intention was to use the results of the DNA tests for a new orientation program on the topic of personalized medicine, in the hopes that students would learn best by studying their own DNA and thus gain valuable insight into the customization of medical treatment.

Both UC Berkeley and Stanford, which has implemented a similar program for its graduate and medical students, have received mixed feedback regarding these programs. On the one hand, they are praised for innovation and for making cutting edge technology available to students that they might never otherwise experience. On the other hand, many ethical dilemmas have arisen from these programs which have been criticized for being implemented too quickly and without enough thought put into their planning. There are three main issues that concern critics in the bioethics community: the manner in which universities ask students to give them genetic data, what happens to the information, and how the students themselves will interpret and react to the results.

Some argue that by offering the genetic testing at an incredibly low cost, they are encouraging students to participate without fully thinking through the risks. This is also potentially a form of coercion, as is the “peer pressure” associated with the program. One student may feel that by not taking part in the test, they will be missing out on a valuable part of the program and thus be alienated from the community.

Surprisingly, the issue of what happens to the students’ genetic information is not as clearly defined as one would expect from universities who are expert in carrying out scientific research projects. The physical DNA samples are destroyed within a year, but the results of the allele testing are kept on file, with very little indication of how they are to be preserved or used in the future. The informed consent forms that students were required to fill in were also worded very much like a research study, leading to further confusion and ambiguity as to what would happen with the results. Defendants of the programs argue that the risk of violation of students’ privacy is not a concern. They say that the test results could never be used for future research because of the manner in which they were gathered, and that the genes tested (which included genes related to how the body metabolizes alcohol, certain vitamins and lactose) were specific and unimportant in the scheme of the field of genetic research. However, perhaps student should be concerned that they are unwittingly donating their genetic information for testing later on?

Finally, one of the main risks of these programs is that the students who decide to participate may not fully understand the results of the testing, and may in turn make poor, uninformed decisions based on their newly revealed genetics. For example, a student may find out that they have a certain gene that metabolizes alcohol efficiently, and thus make a rash decision to drink more in future without fully understanding the implications. Students will most likely have never had any genetic testing done before, and so are inexperienced in integrating information about their genomes into their day-to-day lives. While the programs offer information to students via lectures, this does not guarantee that every student is truly making an informed decision.

Overall, the programs are innovative and definitely have merit, as they are taking a step in the right direction of engaging the next generation with new technology and incorporating it into their education to make medical and genetic issues seem more personal and relevant. Most of the ethical issues raised by critics are directly related to the fact that the programs were not planned or thought through as thoroughly as they could have been. By better defining the scope of the studies, and by being more specific about what was going to happen to the results in the long term, the universities could have avoided questions about the privacy of student’s genetic data. Furthermore, they could have consulted ethics experts who would have predicted many of these accusations of “recklessness” and other ethical criticisms. Using this feedback the universities could have duly avoided such criticisms by, for example, ensuring that each student was fully informed and unlikely to make rash decisions based upon a poor interpretation of the results. 

Source: http://www.scientificamerican.com/article.cfm?id=exposing-the-student-body