No News is Good News?

            This past Thursday, the BBC published an article “Alzheimer’s brain plaques ‘rapidly cleared’ in mice,” describing a possible breakthrough in understanding brain function in mice that could be the key to developing drugs with the potential of treating Alzheimer’s.

            There were four qualifiers in that sentence alone. And the article itself includes many affirmations that these studies are still in their earliest stages, along with several disclaimers: “He warned people not to “try this at home”, as the drug had not been proven to work in Alzheimer’s patients and there was no indication of what any dose should be,” and “We need to be clear, the drug works quite well in mouse models of the disease. Our next objective is to ascertain if it acts similarly in humans.”

            Now, there isn’t anything wrong with this article alone. Many probably appreciate keeping up with scientific findings, and there was nothing sensationalist or misleading about the article. But hundreds of these articles are published weekly—just the day before, the BBC published “Gene therapy ‘gave me sight back’” and the New York Times published “Study Explores Electrical Stimulation as an Aid to Memory” and this Monday CNN published “Overeating may be linked to memory loss.” The sheer number of these types of articles makes it statistically unlikely that the studies in question are all of the same caliber, but it is becoming harder to separate the promising from the pointless. Some may argue the freedom of information in the age of the Internet will galvanize innovation and bring certain privileges to those who might not have otherwise had access to them. Certainly, bringing these discoveries out of the realm of dense academic journals has its benefits, but these journals have established peer review systems. The studies that are published in them receive attention from other researchers based on how credible the work seems, and how the work relates to similar projects in the field. Now, newspapers and online blogs have instant access to these papers, and can report on any one with the potential to increase readership, regardless of how well the paper has been received in the scientific community.

            The results range from a new way to lose weight being pushed every week to a new carcinogen creating new fears and behaviors at about the same pace. Is this acceptable on the part of journalists? Or have they taken their job as disseminators of information to such an extreme that is potentially detrimental? Most would agree that journalists have an ethical obligation to fact check all of their information, but this responsibility can be met in many different degrees. Yes, all of the facts in this BBC article are accurate, and it even links to the original article in Science. Does the obligation end there? Or should the author also take steps to make sure this research is being followed up by the researchers, picked up by new ones, and generally accepted to be truly promising? Should he publish such an article even if the potential innovations are decades away? Does this article give false hope to Alzheimer’s patients, outweighing any benefits of bringing this study to the public eye?

            I believe these obligations do exist, and more care should be taken to make sure health issues aren’t dramatized and excessively propagated, as these studies can easily be misused. While the journalist and other researchers may know to take all findings with a grain of salt, most readers take an article covering a scientific report as fact. While this doesn’t necessarily cause social harm, it often does create either unnecessary paranoia or unfounded hope. On the other end of the spectrum, the constant barrage of scientific breakthroughs makes it hard to take health news that is actually serious seriously. Scientists and journalists have the duty to make sure that their news is actually worth spreading, or make it abundantly clear that scientific findings are always changing and should not be taken as gospel truth.  

BBC article: http://www.bbc.co.uk/news/health-16945466

deaf lesbian couple creates deaf child

“A hearing baby would be a blessing. A deaf baby would be a special blessing.” – Sharon Duchesneau

Yes. You read right. Here’s the story. Sharon Duchesneau and Candy McCullough of North Bethesda, Maryland were both born deaf. Recently, the lesbian couple (who have been together now for eight years) welcomed the arrival of their first-born-son into the world. However, they have received intense criticism for their action. Why? The couple deliberately attempted to ensure that their son was born deaf by seeking out a sperm donor with congenital deafness. After a series of sperm banks turned them down, the couple found a suitable sperm donor by asking a deaf family friend who comes from a family with five generations of deafness...

When asked why, both women responded by saying they want their son to share in their “culture” – viewing deafness as a cultural identity rather than a medical disability. In response to criticism, the women say their choice is no different from parents “trying to have a girl”. They claim that it will be easier to communicate with their son in their own language as he grows up…

Congratulations! Baby boy! Gauvin Hughes McCullough. Recent hearing tests confirm Gauvin (now four months old) is quite deaf. However, his right ear still has some residual hearing. Doctors suggest a hearing aid as soon as possible to give him a head start on spoken English. Indeed, most parents would try for one in hopes that the child can one day hear proficiently … or at least lip-read... However, Gauvin’s parents won’t let him have one.

First, I want to identify two key decisions made by the couple.

1)    They deliberately selected for deafness in Gauvin.

2)    They deliberately won’t allow Gauvin a hearing aid.

I oppose both actions. By making these two decisions, they violate their son’s right to an open future; parents should bring a child into this world with as many open opportunities as possible, maximizing the chances for his own self-fulfillment in the future.

By selecting for deafness, the couple is effectively shutting the door on Gauvin’s full potential – depriving him of a natural faculty. The couple defends by pointing out that deafness should not be viewed as a disability. And it shouldn’t. Indeed, we should consider a deaf person every bit as human as a hearing person … and surely, in a world where deaf and hearing members of society enjoy equal opportunities this would be plausible… However, society currently denies deaf children to enjoy the same rights, opportunities, and quality of life as everyone else. In the society we live in today, the genetic selection of deafness is unethical.

Furthermore, the couple won’t let Gauvin have a hearing aid. Their claim – it will be easier to communicate with him in their own language. By not allowing Gauvin a hearing aid, the couple is further limiting Gauvin’s opportunities. If Gauvin were to receive the hearing aid, it would be possible for him to communicate with his parents via sign language and communicate with the hearing world via spoken English. I believe that by limiting Gauvin to sign language, the couple has made an especially selfish decision. Perhaps in another life, Gauvin could enjoy a life enriched by both the deaf and the hearing worlds. Perhaps Gauvin, in the future, would decide to leverage his special position as an advocate for the deaf community... We will never know – for his parents have made the decision for him.

footnote* – topic introduced to me via my freshman seminar (FRS126)

http://news.bbc.co.uk/2/hi/health/1916462.stm

http://jme.bmj.com/content/28/5/283.full

Animal Human Hybrids

In Discovery News Article "10 Ways Science is Using Human Animal Hybrids" Lauren Effron discusses some of the huge breakthroughs in science that are employing the use of animals as a way to potentially grow human organs, blood or stem cells for research or to specifically use as an aid to sick humans.  It is clear that chimeras, animals that have two or more sets of genetically distinct cells together, are no longer myths and legends but realities.  The emergence of human-animal hybrids is alarming as it calls into question many many ethical issues and brings to mind countless science fiction horrors but, although the idea is unfamiliar and scary the rewards are potentially very great.  There are rabbits in Shanghai that might one day be used as tissue growers for transplantation surgery, pigs in Minnesota with human blood running through their veins that might enable scientists to better understand viral infections and HIV, and mice with human-brain stem cells that might lead to a cure for several neurodegenerative diseases such as Parkinson's and Alzheimer's.  With the stakes so high ethicists may be forced to sacrifice notions of human inalienable rights in order to cure the disease.  If these animals have parts of human in them then how do they fit into preconceived notions about autonomy and human rights but at the same time when reports from PETA claim that roughly 290 animals are killed in slaughterhouses in the United States per second how can we not sacrifice the lives a few (slightly more humanoid) rats to cure devastating human diseases?

http://news.discovery.com/tech/human-animal-hybrid-chimera-splice-slide-show.html

Misconceptions about Mind Altering Drugs

Many of us know or know of students who have taken Ritalin or Adderall for test taking, mainly form our age group SATs. And many more of us know about the student in our second grade class room that was given similar medication or a depressant to treat ADD or ADHD when really in our opinion they were a brat that just needed to grow up. Unfortunately our negative opinions about mind altering drugs stay with us even when they are being used appropriately. I recently had a conversation with a good friend that was openly advising another friend to stop his use of antidepressants, and cease dulling his own life with drugs. The friend on antidepressants who was prescribed this medication by a professional doctor was seriously considering discontinuing his use because of the misinformation given to him and the negative connotations associated with antidepressants. I found this terribly disturbing, and after talking with him realized several misconceptions he had about antidepressants.

The first of these misconceptions was the effects of current antidepressants and how they work compared to antidepressants used up until the 1990s. I will address these misconceptions because I feel it is the primary cause of the negative feeling the general public seems to have about antidepressants.

The oldest antidepressant is opium which is a from of oxycotton. This drug is associated with the loss of feelings or care about anything. It is the source of the opinion that antidepressants cause people to feel better because they become emotionless. This drug was highly addictive and is no longer used as an antidepressant.  This opinion also comes from the use of MAOIs and some other drugs that in the dosages originally prescribed acted as low grade tranquilizers causing people to become emotional zombies so to speak. 

Another common misconception is that the use of Alcohol and a few other common food and drinks can be potentially lethal or cause suicidal thoughts while on antidepressants. This is true with old antidepressants of the MAOI category with respect to Alcohol. These drugs are very rarely used in modern medicine because of a entire parade of negative side effects. Alcohol is not advisable even with current antidepressants, but that is because alcohol is a depressant and being depressed in general makes you more susceptible to the negative effects of alcohol. 

The final misconception I will address is that taking antidepressants causes thoughts of suicide. This is technically true but statistically insignificant especially when taken into account how many people stop feeling suicidal after taking antidepressants.  In both SSRIs and SNRIs, new forms of antidepressants, these effects appear in only several cases per thousand. Although not a necessarily reputable page I advise anyone with questions about the different kinds of antidepressants to go to the wiki page on antidepressants, because it is broken down into the biochemical difference in the medications and the severity of the associated side effects. 

http://www.aafp.org/fpm/2009/0500/p15.html

http://biopsychiatry.com/ssrisnri.html

http://www.mayoclinic.com/health/maois/MH00072

http://www.cbsnews.com/stories/2010/04/22/60minutes/main6422159.shtml

One last try: unused embryos could be discarded

Recently, one of my friends shadowed a doctor in a fertility clinic and encountered the following ethical dilemma: one day, a middle-aged woman who was suffering from difficulties getting pregnant and who had already almost exhausted all the different methods of treatment came into the fertility clinic and told the doctor that she wanted to try the IVF method. She specified that she wanted the doctor to fertilize several of her eggs using her husband’s sperm, choose the healthiest among them after a few days, implant it into her womb, and then throw away the rest of the fertilized eggs. The rationale behind this proposal was that the one-time IVF was the last treatment she wanted to get; if it was not going to work, she was prepared to give up. The doctor refused her proposal and told her that he would only provide IVF for her if she agrees to freeze or donate the rest of the eggs.

In my opinion, though, doctors should allow patients to create multiple fertilized eggs and only implant one while throwing the rest away, as long as the patient is sure that a one-time IVF trial is the last effort she is going to make to become pregnant. For those who believe that life begins at fertilization, there is a common misconception about the frozen, unused embryos. There is always some sort of hope that they would be implanted later, that we are not really killing them if we preserve their lives in a freezer. However, it is very clear that the eggs will remain in the freezer indefinitely, for many years, or possibly forever, since the patient already specified that she does not want to try again if the one-time IVF she is opting for does not work. Furthermore, the shortage of storage space for these extra embryos is a significant problem. According to the American Journal of Bioethics, there were 400,000 total unused embryos stored in freezers in the US in 2003. As IVF’s become more ubiquitous, it becomes less and less sensible to increase spending on logistics simply to place false hope in embryos that are unlikely to ever be implanted.

The other option that the doctor suggested – donating the extra embryos – is not a perfectly sensible solution either. Couples who have trouble having children want their IVF-fertilized embryos to come from their own eggs and sperms. They would not opt for using an already-fertilized, donated egg if it is possible for their baby to be biologically related to them. As for couples who are physically incapable of having children, including heterosexual infertile couples as well as homosexual couples, it is a lot less costly to adopt a child, rather than spending stupendous amounts on an implantation, not to mention finding a suitable surrogate mother. In addition to the practical nature of the adoption choice, the moral obligation to save the lives of existing children should be seen as greater than the obligation to save the embryos, which, in diverse views, may or may not even be considered as alive. According to UNICEF, there are 210 million orphans in the world. Couples who want to have children but are incapable of it would and should opt for adoption instead of using donated embryos to go through a much more tedious and less morally compelling process.

For these reasons, I think a doctor should allow a patient to discard unused embryos in the IVF process, provided she is certain that the single-embryo implantation will be her last attempt to have a child.

http://www.unicef.org/

http://blog.bioethics.net/

Liver Transplants: A Second Chance for Alcoholics

According to the American Liver Foundation, in 2005, 1,848 people died because they were unable to get a new liver in time.  Right now, about 17,000 people are on the national liver transplant list, waiting for new organs that may never come.  Of course, this scarcity of donated livers brings to question which groups of people should be eligible to receive a transplant – one of the most controversial of which is alcoholics. 

In a recent study published in the New England Journal of Science, the researchers state that, “Reluctance to perform transplantation in patients with alcoholism is often based on the view that they are responsible for their illness and are likely to resume alcohol use after transplantation.”  Currently, the policy is that patients with severe alcoholic hepatitis must refrain from drinking for 6 months before they can be put onto the transplant list.  So, should alcoholics be eligible for liver transplants?  Should they be given a second chance after their own actions ruined their liver?  I believe the answer is “Yes”. 

It is understandable why many people are against the idea of using a limited supply of organs to help people who have shown little care for their body in the past, but alcoholism is not just some life choice or addiction – it is a disease, and it should be treated as such.  For instance, a liver disease expert from Columbia University, Dr. Robert S. Brown Jr., asserts, “Alcoholism is a disease, and it should not be used to exclude patients from transplantation”.  Thus, alcoholism should be treated like any other disease, such as cancer, or other mental disorders like schizophrenia when an individual is being considered for the transplant list.  The current policy is that patients with untreated cancer or mental disorders that prevent the individual from taking care of him/herself are ineligible for the transplant list until they have been treated and cleared by a physician.  Following this reasoning, the current policy on alcoholism makes sense – after the patient has been “treated” for alcoholism, and has refrained from drink for 6 months, he/she should be eligible to be on the transplant list.  Some might say that the alcoholics should stay sober for a longer period of time before becoming eligible, but this is quite unreasonable seeing as 70%-80% of the patients who don’t get a new liver die within 2 months. 

Moreover, even if the alcoholic is at fault it is not as if we deny treatment to others just because their habits caused their medical problem; we don’t deny extreme sports enthusiasts treatment when they break their bones, nor do we ignore the numerous medical problems of smokers (which incidentally is not a disease but rather an addiction). 

The second argument against alcoholics is that if they get a new liver, they will eventually relapse and destroy another organ.  However, in the above mentioned study conducted in France and Belgium, researchers found that of the 26 alcoholics who received new livers, 20 of them were still alive 6 months later and in the coming years only 3 of them relapsed.  Admittedly, the sample size is relatively small, but the statistics are about equivalent to the general survival rate of 75%.  Furthermore, the chance of relapse should not preclude alcoholics from getting transplants since patients who had cancer can also “relapse” after the transplant, and sometimes the liver disease returns after the transplant anyways. 

Therefore, because alcoholism is a disease, alcoholics should be allowed a second chance with a liver transplant as long as they demonstrate that they can remain sober for 6 months.  Due to the limited number of organs available, choosing people who “should” receive transplants will always be very controversial, but we should not preclude entire groups and condemn them to death. 

http://articles.latimes.com/2011/nov/10/news/la-heb-alcoholic-liver-transplant-20111110

http://surgery.about.com/od/beforesurgery/a/ListedForTx.htm

http://www.liverfoundation.org/patients/organdonor/about/

Newborn blood samples and consent: why the government needs to shape up

Class action lawsuits are a fairly decent way of finding out what the latest government scandal is. This month, it's related to claims that the government in Texas has been keeping samples of blood from newborns, and then making them available to researchers without the consent of the parents.
Normally, these blood samples are used to check for a variety of serious medical conditions, including cystic fibrosis. According to the Texas Department of Health Services, this program will allow doctors to identify children with these conditions early in life, and allow them to be treated effectively from a younger age.
Normally, these samples would be kept, but not used without explicit permission. However, do to a loophole in the law, the state government has sold the samples to different companies, without asking for permission from the parents. This is clearly unethical behavior, and the class action lawsuit seeks compensation for those parents who had samples of their child's blood used, without their consent.
But this is not enough. The publicity surrounding the case might make the government more likely to refrain from selling these samples in the future, but it is no guarantee. What is really needed is for the government to follow the policies that are standard in research and medicine when it comes to informed consent. We have an established right to privacy, and the use of newborn blood samples in this manner is a clear violation of this right.

http://www.kxan.com/dpp/news/local/class-action-filed-over-newborns-blood
http://www.kxan.com/dpp/health/government-taking-newborn-dna-samples
http://www.dshs.state.tx.us/LAB/newbornscreening.shtm