"Bella," the Movie (Review)

My husband and I saw it in Austin, Texas today, with a group from Texas Alliance for Life. It's a good movie, with flash-backs, flash-forwards and a twist at the end that took me by surprise.

Here's a review without spoilers.

I forgot (a note on memory and humanity)

I know that you may not be able to tell, but I'm trying to make my blog posts shorter. So, I left some quotes out of this morning's post on memory. However, this quote from the Time Magazine article, "The Ethics of Erasing a Bad Memory" by Dr. Scott Haig, on human-ness needs to be repeated:

Much of what we read about brain science in the media today would have us believe that we're nothing more, really, than very fancy machines. And surely what we're learning about the physical brain is exciting and powerful — but thinking honestly, it remains so limited. We can trace the brain pathway of a drug "high," we can call it pleasure, but that tells us nothing about what so many people choose instead — deeper things that somehow beat out mere pleasure as the reasons for doing what we do. Those comforts — of ultimate meaning, virtue, peace and joy — have little to do with molecules.

First babies from "Lab Grown Eggs"

Well, the news out of Great Britain that apparently healthy twins were born from a new technique involving maturation of human oocytes - "eggs" - outside of the body will probably be hailed as the solution to the problem of where to get the eggs for embryonic stem cell and cloning research. It won't solve the problem that I asked earlier today as to whether and why it's important or ethical.

It's interesting that the article emphasizes the danger of Ovarian Hyperstimulation Syndrome:

In mild and moderate cases, affecting up to 20% of women undergoing ovary stimulation, this leads to symptoms such as swelling and breathlessness that resolves.

However, in about 1% the symptoms can become so severe that they are deadly. Among women with PCOS [Polycystic Ovarian Syndrome], the rate is nearer 5-10%.

Thanks to Wired Science blog for the tip.

Drugs, Sleep, Memory and Ethics

New information on the science of memory may one day finally tell me why I have a hard time remembering names and even faces, but I'll store a patient's potassium level without even trying. As with all science research, we'll have to decide whether and why the information we discover matters and how to use it.

Last night's post was on the bioethics questions in a television show dealing with a patient who asked for help forgetting a trauma - actually, the emotional memories, not the facts. A wide range of articles on memory research is the subject of yesterday's post at Bioethics.net. There are posts to articles and blog entries on old and new information on drugs that affect memory, and disorders of memory.

That post contains a link to this New York Times article (free registration required) on the significance of sleep and memories. (I love the title, "An Active, Purposeful Machine That Comes Out at Night to Play.") The same session at the American Society of Bioethics and Humanities conference that dealt with blunting the emotional memory of trauma also touched on the ethics of new medications that enable people to sleep less. The question asked was whether avoiding the need for sleep would allow time for more worthy pursuits - the question and answer period focused on what to consider a "worthy" activity. According to the NYT article, the question should be what is lost.

As is too often the case, science gives us some of the answers to our questions (those "power naps" are probably good for dealing with facts and later sleep appears to be useful for detecting patterns) and technology or means (propranolol, propofol, Provigil, etc.) to manipulate ourselves and our behavior, before we come to a consensus on the ethics - or even the ethical principles that apply - of using our knowledge.

The old saying "let's sleep on it" may have some measurable truth - and a lot of wisdom, after all.

Small Town Hospital Collects Cord Blood for Texas Public Banks

I was so happy to hear that my local hospital is now one of the hospitals that collects cord blood for the public banks.

The cells from cord blood are rich in adult stem cells that can be used to replace the bone marrow of children with blood disorders and for treatment of all sorts of diseases. How about that: a small hospital in a small town can join in adult stem cell therapy!

See my grand daughter's story, here.

Television Ethics: "Private Practice"

The TV show, "Private Practice," hasn't impressed me with its medical, social or psychiatric integrity. But, I found myself watching it tonight, October 24th, and was more impressed than usual. Tonight's show touches on a cutting-edge bioethics topic that was also mentioned at last week's American Society of Bioethics and Humanities.

Major Multiple Spoiler Alert!!! Don't read more if you've recorded the show to watch later.


(Let's forget the thread on the women who come in for their pelvic exam by the kid midwife - where the only exam the women are evidently getting is the actual *pelvic* exam. No eyes, ears, throat, lungs, breast or abdominal exam. My Family Physician, head-to-toe, cradle-to-grave soul can't bear it.)

(And we won't even ask the Mama in me how I feel about 13 year olds having sex. You might be surprised that I don't freak or judge, though, and pretty much treat the girls the same way that the lead doc does. The difference is that I go out of my way to explain to families when they first come to the office that I consider their child my patient in his or her own right and ask permission to treat without notifying - and, of course, without billing - them if the teen requests that I keep silent. I've always been able to convince the young person to turn to their parents for help, but manage to keep privileged information privileged as long as possible. As far as I know, I've only had one family leave my practice after I explained my policy.)

Okay, back to the cutting edge bioethics topic.

One of the guest characters asked the internal medicine doc for a medicine that helps patients forget.

Actually, the medicine, propanolol, will not help her forget. However, it can help some patients stop feeling the panic and other horrifying emotions that come after a near-death or traumatic event like a rape that causes "Post Traumatic Stress Disorder."

MSNBC had a review, here, about the treatment last year.


The technique can be used to blunt the emotional memory -- not the actual memory or physical damage -- of the traumatic event. Adrenaline or epinephrine is the "fight or flight" hormone or drug that is released when there is stress. It's what causes what I call "the near-car-wreck" feeling that we feel, well, when we nearly have a car wreck.

Epinephrine gives you a boost of energy, pumping sugar, cortisone and other hormones into the body, to allow that fight or flight response. Do you need to take off and escape or stand and battle with whatever it is that is threatening you? Epinephrine is also involved in stimulating the bone marrow to make blood and other organs to heal faster, too.

Unfortunately, sometimes the body makes epinephrine inappropriately, when there's no real danger or when the danger is not severe enough. When that happens, we call it a panic attack or an anxiety attack as people experience the physical and emotional symptoms that are associated with real danger. Their bodies are telling them that they are in danger, but there's no actual threat to confront. When it gets in the way of your life, it's a disorder. Long term panic and anxiety that can be related to a past trauma, and that sometimes causing a person to feel as though he's reliving the trauma, is called Post Traumatic Stress Disorder.

Propanolol is a "beta blocker" that blocks epinephrine and which we often use to treat hypertension and even panic attacks. If used during the time after a traumatic event in which the long-term memories are set in the brain and/or in conjunction with behavioral therapy, it appears that the memory is disconnected, "disassociated," from the emotions that the patient experienced during the trauma and during the flashbacks when the memory makes the patient feel as though he's reliving the event, later. The treatment of PTSD that seems to work best is behavioral therapy, teaching the patient to control his own body's reaction.

Some ethicists are concerned that we may blunt a necessary healing function of epinephrine and the other body and mind effects of the stress reaction. However, I think of the treatment of stress disorders in the same way that I think of treatment of pain. Pain may help us prevent injury and warn us of a threat to our health. But we treat pain that is out of proportion or that is not useful to protect us.

Political news in Nature Reports

Rather than science news, Nature Reports focuses on the political (I believe this is available without subscription, but let me know if you need a copy and can't access it):

News Feature

Nature Reports Stem Cells
Published online: 17 October 2007
Scientific definition by political request

(by) Monya Baker

The NIH must set criteria for pluripotency in human cells

Within a month, the US National Institutes of Health (NIH) hopes to start adding to the registry that lists the human embryonic stem cell (ES cell) lines eligible for US federal research funding. The registry currently contains only the human ES cell lines already in existence in August 2001, when President George W. Bush declared that no federal funds could be used for subsequently created lines. But of the dozens of human ES cell lines established since then, none will be added to the registry (with the possible exception of a few created by an unconventional technique that removes individual cells from embryos without destroying them). Instead, the word 'pluripotent' will replace the word 'embryonic' in the name of the NIH Human Embryonic Stem Cell Registry, and the list will begin to include cell lines derived from non-embryonic sources.

The impetus for the change comes from the White House in the form of a executive order that touts the potential of non-embryonic stem cells, and accompanied Bush's veto of popular legislation to lift restrictions on federal funding for research on human ES cells1. Researchers who derive and assess potentially qualifying lines will be given higher priority for new NIH grants and will be eligible for supplemental funds for existing grants. Before that happens, however, the NIH Stem Cell Task Force must set criteria for pluripotency in human cells. Politics has, essentially, mandated that an answer be found to a fundamental scientific question.

Asked about registering lines already clearly eligible for federal funding, scientists interviewed for this article generally reacted with a mixture of confusion, annoyance and indifference. One called the plan a "distraction that won't open any doors", and then asked not to be identified discussing politics. Some worried that political pressure on the NIH would hamper its ability to set a compelling definition. "I look forward to the day when the [registry] website is simply shut down, as its mere existence is a constant reminder of a public policy that does not serve the public good," says stem-cell pioneer James Thomson at the University of Wisconsin-Madison. Of the two dozen or so human ES cell lines eligible for US federal funding, his are the most widely used.

"The term pluripotent has been used for every type of stem cell," says Anthony Atala at Wake Forest University Baptist Medical Center, who recently identified stem cells in amniotic fluid that can differentiate into cell types representing bone, endothelial, fat, liver, muscle, and neuronal lineages. Originally, 'pluripotent' meant a cell could give rise to cells representing the three germ layers found in early embryos. To assess this property, scientists can inject mouse or human cells under the skin of an immune-compromised mouse and see whether they form a benign tumour known as a teratoma. But as the field advanced, says Atala, more requirements were added to the term.

(snipped)

The registry will help scientists to coordinate their research and share cells and information. Including the cells that demonstrate embryo-like markers and growth patterns will fill in a gap that currently exists with the current embryonic stem cell registry at the NIH. And it seems to be desired by some researchers:

"Being on the registry seems to be important to a lot of people," Landis says, even when no one doubts the cells are eligible for federal funding. For example, representatives of groups that store umbilical cord blood have made enquiries, although their materials do not qualify as cell lines. Landis declines to speculate on their motivation, but researchers naturally want to boost the prestige and commercial value of their cell lines, and getting listed on the NIH registry would be one way to do that.

Watson un - reasonable

Dr. James Watson, the man who is credited with discovering the structure of DNA, along with Francis Crick and Rosalin Franklin, has lost his laboratory and much of his status as a respected science icon after allegedly making racist remarks.

From the Times Online (London, UK):

In his interview Watson had said that he was “gloomy about the prospects for Africa” because “all our social policies are based on the fact that their intelligence is the same as ours — whereas all the testing says not really”.

He also said he opposed discrimination and that he hoped all races could be equal, but added: “People who have to deal with black employees find this not true.”

Last month, Dr. Watson spoke at the opening to the "Medical Ethics and the Holocaust: How Healing Becomes Killing: Eugenics, Euthanasia and Extermination" series of lectures co-sponsored by the University of Houston and the Houston Holocaust Museum. (Earlier posts on the series here

At that event, Dr. Watson was one of three Nobel laureates (along with Eric Kandel, MD and Feric Murad, MD, PhD) who spoke on the history and - at least in my opinion - of eugenics, including the sad history of eugenics studies in the early part of the 20th century at Cold Spring Harbor Laboratory.

Dr. Watson opened by telling us that he does not believe that the traits and abilities of people are completely genetic. He believes that his values for life were taught to him by his parents, who taught him to make his decisions based on reason, with "nothing from revelation. They also taught him the value of honesty, kindness, and involvement.

The doctor appeared to fall asleep a couple of times during the Houston presentation. He went out of his way to note that he came before us with "No religious feeling whatsoever." (I believe that he had an assumption that the people in the audience were interested in religion.) He also said that if you are better than than others, you'd better be perceived as helping others, and implied that the Jews killed by the Nazi's in Germany were marked and hated because they were more intelligent and successful than other Germans.

We learned that he had declined information about his genome that would tell us whether or not he carried the genes for a familial type of dementia. He stated that he believed that the study of the genome would improve psychiatry, which he said is still at the level that it was in Nazi Germany.

One of the most truthful statements he made is that "Since I won the Nobel Peace Prize I am heard."

The Politics of Embryonic Stem Cells: Gearhart "pressures" Atala

I was able to attend the "Understanding Stem Cells: Science and Policy" lecture at the Koshland Science Museum, the museum of the National Academies of Sciences, in Washington, DC last week where I heard Jonathan Moreno, PhD, - the ethicist who works for and advances the American Center for Progress and Dr. John Gearhart, Director of Stem Cell Biology at Johns Hopkins University.

The focus of the talk was the need for US tax money for embryonic stem cell research and the downfall of the Bush policy - with just enough mocking of the President himself to make everyone feel at home with the two men.

While Dr. Gearhart takes some of the responsibility for the publishing of the papers on cloning written by the veterinarian from South Korea, Hwang Wu Suk, he was very disparaging of his colleague, Dr. Anthony Atala.

He told the audience that Atala's work on amniotic fluid cells was published in a "Secondary journal." that he couldn't recall. That journal was Nature Biotechnology, last January, 2007. Read Nature Biotechnology's press release on the article, here. The abstract is here. (the article itself is behind a pay wall.)

He also questioned the "rigor" with which the research was done, saying that the technique was poor and that no one could tell where those cells had originated from.

Gearhart and Moreno were vocal about the timing of the publication, since it coincided with the last vote on embryonic stem cells and cloning in the US Congress. Nevermind that the lead time on published articles is months.

However, Gearhart's most worrisome comment came in front of a small group, when he was answering questions after the talk. In order to support his contention that the publication of the article on "embryo-like" cells lacked "rigor," Gearhart said, "We put pressure on him to write Pelosi," to say that all stem cell research needs to be followed.

We heard rumors that this had happened, but this is the first time I've heard or read one of the major players in the politics of destructive embryonic stem cell research confirm his part.

Between two cultures

There's been a lapse in my blogging this week as I've been in Washington DC for the American Society of Bioethics and Humanities annual conference, with a few forays into the Washington Briefing, "Value Voters" forum.

The ASBH is full of conferences like the Panel Session entitled "Collaborated Death: An Exploration of the Swiss Model of Assisted Suicide for its potential to Enhance Oversight and Dmedicalize the Dying Process."

Yesterday, I heard an intensive care doctor denounce those of us who know that it's wrong to kill children in the womb and then declare that anyone who smokes in the home with a child should be put in jail! Balance, people!!!

Between the VV meeting, the TExas Alliance for Life annual banquet early this month, and the Texas Straw Poll last month I've been able to hear all of the Republican Candidates except Governor Huckabee. Good job, men!

More later, after recharging (both my laptop battery and myself).

Texas has funds for SCHIP without Federal increase

Threats to the contrary, the Houston Chronicle has picked up on the fact that Texas has enough Federal funds to continue CHIP in our State for "at least a year," even with the expansions and improvements passed by the 80th Legislature earlier this year.

And in spite of the President's veto.


This news was also posted at the Texas Health and Human Services CHIP website earlier this week:

The state is closely watching federal action on CHIP, but no immediate changes are expected in the Texas program. The state has sufficient federal funding available to maintain the Texas program, including the recent changes authorized by the 80th Texas Legislature.

New President of California Stem Cell Institute

Alan Trounson, PhD, the researcher responsible for the first in vitro (IVF) birth in Australia, who once had to apologize for misleading the Australian Parliament after showing them a video that he claimed showed a mouse that walked after human embryonic stem cell treatment for spinal cord injury (in fact, they were fetal cells from aborted babies), and the man who was recently hired as President of the California Institute of Regenerative Medicine is not under investigation . But the people at his last project are, for discrepancies in reporting at his old lung regeneration project.

The $1 Million (Australian) grant required reports on progress each 3 months. It seems that there were questions not only about the lack of results in the project, but doubts about whether someone falsified one of the reports.

The Herald Sun, "Australia's largest newspaper," reported on October 13th that

World-renowned Melbourne scientist Alan Trounson's $1m stem cell research project is under investigation after it was scrapped for delivering highly doubtful results.

Monash University is examining anomalies in interim findings from the lung regeneration research conducted in its labs with public money.

Prof Trounson -- a doctor of philosophy who was headhunted to run the world's richest stem cell outfit in the US next year -- was the project's principal investigator.

The research was done by a team of about 13 scientists, including postgraduate students, to see how stem cells might help slow lung disease in cystic fibrosis sufferers.

It was stopped in February when the Australian Stem Cell Centre cut funding after a three-week investigation found inconsistencies in multiple progress reports.

The Herald Sun has learned the reports were signed by Prof Trounson and a senior researcher.

Another investigator in the lab is the main focus of the investigation, however. (Warning to all Ph.D. candidates - and you thought it was dangerous enough when choosing your sponsor.)

As of 10 PM CDT, there's no reports in US news sources.

AMA editorial on Partial Birth Abortion Ban

I would like to respond to the Commentary by Lawrence O. Gostin, JD, “Abortion Politics: Clinical Freedom, Trust in the Judiciary, and the Autonomy of Women.” in the Journal of the American Medical Association, October 3, 2007.(behind a pay wall)

Declaring that the Supreme Court's consideration of the “respect for the dignity of human life” in their ruling on the Partial Birth Abortion Ban Act (Gonzales vs. Carhart, 2007) is “Congress’ overtly political discourse,” he neatly sums up his position in this sentence from his last paragraph:

“Morality alone is an insufficient justification for the government to intrude on the private lives of women and the clinical freedom of physicians.”

On the contrary: morality, especially the laws concerning the killing of one human being by another is the basis for all law:

“What makes killing morally wrong, then, when it is wrong, is that a human life, the one killed, is treated as a life that has little or no worth rather than as a life of incalculable worth and as one having a right to be treated accordingly. If laws were permitted to embody the idea that in some circumstances life loses its worth, or that some people lack sufficient worth to have their lives protected, individuals would no longer enjoy equal protection of the law so far as their lives are concerned. Furthermore, some principled basis for protecting human life other than its sanctity would have to be provided to justify what would constitute violations of the unquestioned worth of every individual human life.” Arthur J. Dyck When Killing is Wrong (Cleveland, Ohio: Pilgrim Press, 2001), p. 77. Emphasis mine)

However, the Court did not review the "right to abortion" in Gonzales vs. Carhart. It only ruled on the Constitutionality of the regulation of medical practice in one narrow procedure, which Gostin admits "does not save a single fetus because physicians could instead use a standard D&E method."

Gostin objects to the Supreme Court of the United States over-ruling lower Federal courts and to State governments who dare to regulate medical practice as though he Founding Fathers wrote the Constitution so that only the Federal Judiciary decides the really, really important issues and the representatives of the People are only allowed to decide the inconsequential. He forgets or ignores that Blackburn’s 1973 Court intervened between State legislators and their rightful power to regulate the practice of medicine in Roe vs. Wade, and invented State’s rights that gradually phase in based on trimesters.

Moreover, he seems unaware of the precedent set and precedents reviewed in Washington vs Glucksberg (1997), or Vacco vs. Quill, (1997) when that Court ruled in favor of laws from Washington and New York that served to criminalize “physician assisted suicide.”

Concerning the 1993 Planned Parenthood vs. Casey ruling to which Mr. Gostin frequently refers,

"At the heart of liberty is the right to define one's own concept of existence, of meaning, of the universe, and of the mystery of human life. Beliefs about these matters could not define the attributes of personhood were they formed under compulsion of the State." (Casey, 505 U. S., at 851.)

the Court has stated,

“[A]lthough Casey recognized that many of the rights and liberties protected by the Due Process Clause sound in personal autonomy, 505 U. S., at 852, it does not follow that any and all important, intimate, and personal decisions are so protected” (Washington vs. Glucksberg, 1997)

I suggest that it’s important to share at least some perceptions about reality within the Universe. Otherwise we would not be able to discern the difference between sanity and insanity, much less between ethical and unethical medical practice.

Abortion restrictions can be healthy

The last couple of weeks I've been getting ready for the American Academy of Family Physicians' Annual Scientific Assembly and the hearing of several controversial resolutions at our Academy's Congress of Delegates, held last week in Chicago, Illinois.

One of the resolutions called for the protection of "physician-patient confidentiality" by restricting the information that insurance companies could send to the homes of minor children. It seems that some doctors object to parents being involved in their children's health care, if it means that the parents will find out about "reproductive health services." In other words, parents should pay for, but not know that they are paying for, their child's birth control, treatment for STD's and, I suppose, abortion.

Another resolution called for "the repeal of the Hyde amendment," the rider that Congress has passed each year since 1976 to restrict federal funds from being used to pay for abortions except in cases of rape, incest and life of the mother. In other words, a few family docs are convinced that taxpayers should pay for elective abortions - those that are actually birth control.

Fortunately neither of these resolutions was passed and neither will become part of the position statements of the AAFP. However, during the testimony in front of the Reference Committees, there we heard the usual red herring arguments of increased teen Sexually Transmitted Diseases and the threat of increased illegal abortions.

Several of us were able to stand to tell the truth about abortion and abortion restrictions, as well as parental involvement laws and their effects on the abortion rates and health of minors.

Last month, LifeEthics posted a brief review of an article in the Journal of Law, Economics, and Organization Advance Access published online by Jonathan Klick and Thomas Stratmann on September 4, 2007 entitled, "Abortion Access and Risky Sex Among Teens: Parental Involvement Laws and Sexually Transmitted Diseases."

The statistics show that state parental notification laws result in lower STD rates for teens in those states. The article also reviews some of what we know about laws that restrict abortion and their effects on health, pregnancy rates and abortion rates.

However, it is possible that passage of parental involvement laws will affect the incentives teenagers face, inducing them to engage in less risky sex which would decrease the demand for abortion without increasing the incidence of teen motherhood. That is, if teens implicitly view abortion as a form of birth control, increasing the psychic costs of obtaining an abortion through parental involvement laws may induce teens to substitute toward other forms of birth control such as condoms, birth control pills, or abstaining from sex altogether. For this substitution effect to occur, however, teens must be forward looking in their decision-making process regarding their sexual activities, and parental involvement must represent a nontrivial increase in the total cost faced by a teen when obtaining an abortion.
We examine the effect of parental involvement laws on the decision to engage in risky sex using Centers for Disease Control (CDC) data on the incidence of gonorrhea among teenage girls. Using gonorrhea rates among adult women to control for contemporaneous variation in unobservable characteristics of the state population, we find that parental involvement laws reduce teen gonorrhea rates by 20% for Hispanics and 12% for white teens. The effects are smaller and not statistically significant for young black women.
The results are robust to a wide range of empirical specifications. These results suggest that parental involvement laws reduce risky sexual behavior among teens as predicted by a model in which teens consider costs and benefits when deciding to engage in sexual activities.

When abortion was legal in a few states, those states had higher STD rates than the national average. When Roe v Wade made abortion legal in all states, the STD rates went up all over, to match those found earlier in the states with legal abortion on demand:

Klick and Stratmann (2003) attempt to avoid the data problem illegal abortions represent in examining pregnancy rates by focusing on the incidence of sexually transmitted diseases (STDs) as a proxy for the incidence of risky sex (Klick 2004). That is, since more sex in the aggregate and the substitution toward sex without a condom will both lead to an increase in STDs, increasing abortion access will lead to an increase in STD incidence if individuals are forward looking in their decision to engage in risky sex. Klick and Stratmann (2003)examine the ‘‘double experiment’’ provided by US abortion policy to examine this link. They find that when Alaska, California, Hawaii, New York, and Washington legalized abortion on demand in the period 1969–1970, the gonorrhea and syphilis rates in those states rose significantlycompared to the rest of the country. When the Supreme Court legalized abortion on demand nationwide in 1973, the STD gap between the early legalizers and other states disappeared.

We also know that parental notification laws decrease not only abortion rates for minors, but pregnancy rates as well.

Interestingly, in a more recent article examining the experience of Texas whose parental notification law went into effect in 2000, Joyce et al.(2006) find a significant effect on the abortion rates of those women covered by the law relative to 18-year-old women.

There's also evidence that restricting funding for legal abortion does not increase illegal abortions. When the Hyde Amendment was first passed in 1976 to forbid federal funding of abortion, abortion rates went down but there were no increased rates of illegal abortion. The results of State restrictions on abortion funding were reviewed in the CDC's Mortality and Morbidity Weekly in June, 1980 (no link available):

The present study in Texas found more than one-third of the legal abortions expected among Medicaid-eligible women were not obtained in the postfunding restriction period. The data cited from the present study are consistent with those from a previous investigation in Texas, which found approximately 40% of the expected number of subsidized abortions were not being obtained in the interval after the funding restriction . .. In Texas, pregnant, low-income women who do not have federal or state funds for abortions do not appear to be resorting to illegal abortions to terminate unwanted pregnancies . . . These findings are consistent with those from a national monitoring system, which also could not document that the restriction of public funds for abortion caused
a large percentage of Medicaid-eligible women to choose elf-induced or non-physician-induced abortions.

It's important for each of us to become aware and involved in the making of public policy as much as we are able. We can save the lives of our children of tomorrow and improve the health of our children, today.

Privacy, politics, and medical records

The editors and pseudoeditors of the American Journal of Bioethics blog are talking about all the people who accessed the hospital records of George Clooney after his motorcycle accident.

Somehow, according to the author of the post, it's all President Bush's fault.

In light of the news and comments on the latest iteration of SCHIP and Hillary Clinton's health care plan, I've been doing a little research. We ought to learn and remember the history of the privacy laws, the push for electronic records. But we certainly can't claim that the problem began in January 2001.

HIPAA began the whole electronic record push and originated in 1996. It's about anything but "privacy." See the records available on line, here.

The Privacy Rule, a later part of the Act (the Summary is 25 pages), specifically mandates full disclosure to the Secretary of Health and Human Services, or any agent of the Secretary, of all information in any facility that participates in any way (or ever hopes to do so) with Medicare. It also allowed those entities to make copies to take out of the office and to write their own subpoenas that need to be vetted by a judge after the fact. Attorney General Janet Reno advocated the use of the technology to track down Medicare fraud and abuse back in 2000.

The first big influences toward electronic medical records (EMR) and digital imaging are even older. Back in the late '80's, when I was in medical school, the Veterans Administration pioneered the EMR. (I used to practice diagnosing patients from their list of medications and procedures, the first elements of the record, before our notes could be entered.)In the early '90's, radiologists discovered the benefit of taking call from home while being able to read emergency head CT's and other images.

The electronic medical record and digital storage of images is a good thing - but like all tools needs to be used properly.

The whole coding and reporting of medical care has grown into the usual government "leviathan" (to use Ira Magaziner's defense to the lawsuit against him and Hillary Clinton for the unknown status of the consultants on their 1993 Health Care Task Force).

We still hope that the EMR will help us do better than we have in the past. Although I believe that most clinicians will disagree with the the "quality" markers used, see today's NEJM article about child health care.

However, I don't think that the incident involving Mr. Clooney's records proved anything about electronic records other than the hospital had the ability to monitor who accessed the records - and that human beings are curious about celebrities.

In the meantime, Texas seems to be volunteering to be a lab for privacy issues with the correlation of drivers, insurance, and cars as well as photographing and surveying the people who use US IH 35. Car 54 can run your license plate at a red light or while you're driving down the highway and then cite you if you're uninsured. My taxes should definitely go down if these tactics can be used to generate revenue.

Review: What we know about stem cells

The Journal, Stem Cells, has published a free open access article about those cells that become the different blood cells, including red blood cells, white blood cells and platelets, entitled "Concise Review: Hematopoietic Stem Cells and Tissue Stem Cells: Current Concepts and Unanswered Questions" by Donald Metcalf, MD, of Australia.

An interesting point from this article is the current controversy about the definition of "stem cells." Dr. Metcalf gives his definition and notes that some cells now called stem cells are actually better described as "self proliferative" progenitor cells, which have been committed to only fewer lines of cells.

Which will be important to understand the controversy that surrounds another type of stem cell, which is described in another, newer article published this week online in advance, entitled, "Concise Review: Mesenchymal Stem/Multi-Potent Stromal Cells (MSCs): The State of Transdifferentiation and Modes of Tissue Repair - Current Views" by Donald G. Phinney and Darwin J. Prockop of the Center for Gene Therapy, Tulane University Health Sciences Center, New Orleans, LA.

These adult stem cells are found in most organs and tissues in the body including umbilical cord blood, skeletal, muscle, fat, joint fluid, blood and the cells surrounding the blood vessels, the pulp in teeth, and amniotic fluid. (They have also been harvested from aborted infants.) In the body, they are known to become bone cells, fat cells, and cartilage. When they are grown in the lab, they form a wide variety of tissues depending on the conditions in which they are grown. They can be induced to form cells that function as nerve, lung tissue, retinal pigment cells, blood vessel cells, and repair kidneys and hearts.

However, you may read that these cells are not as "plastic" as embryonic stem cells, that it's hard to study them and cause them to form the exact cells that are desired. While it's true that they do not form "all the cells in the body," they can be induced to form a wide range of cells and tissues and it's no harder to control the development of these cells than it is to control embryonic stem cells. They may in fact be different types of progenitor cells, depending on the source, but there are an awful lot of sources. And they don't require the destruction of a human life.

SCHIP goes on, in spite of veto

Let's get this straight: SCHIP will not cease to be because of the President's veto.

Last month, we read that Congress had passed a 16 week extension of SCHIP and that the President would veto the SCHIP bill if Congress went ahead with their planned expansion to nearly double the funding.

The SCHIP bill that was passed was an ideological stunt that included re-definition of prenatal pregnancy care (to medical treatment of the pregnant woman - which would include abortion in some states, possibly all) and which increased the funding way beyond that needed to continue coverage for the 6.5 million children currently eligible.

Beyond raising the funding level without a clear cut plan for raising funds (possible increased cigarette taxes while counting the lapse of tax cuts of a few years ago), the Bill would have forced States such as Texas, where the cost of living is lower, to subsidize States such as New Jersey and New York, where proponents say that a family of 4 can't live on $80,000+ a year. As it is, Texas does not spend all of our allocated SCHIP and Medicaid money - that money is used to reward the big spender States. (Do we know how much of that reward is responsible for the high cost of living in those States?)

The President and Congress will now come up with a more reasonable plan, probably somewhere between the $5 Billion dollar over 5 years that the President proposed and the $35 Billion dollar expansion that Congress passed.

Late note:
The Democrats are postponing the vote to overturn the veto for 2 more weeks:

But the Democratic-led Congress put off an override vote for about two weeks, to give them more time to put pressure on GOP lawmakers who they think are politically vulnerable. A union-led organization said it would spend more than $3 million trying to influence the outcome.

"It's going to be a hard vote for Republicans," said House Speaker Nancy Pelosi, D-Calif.

The Senate passed the five-year expansion of the program last week on a vote of 67-29, just above the two-thirds margin needed to override a veto, but the House tally of 265-159 was 25 votes short of that mark.

Bush advisers said they remain convinced that they can secure an extension of the 10-year-old program with a less expensive price tag, saying they hope to soon open negotiations. But if the veto stands, Democrats said, they will reapprove the measure without significant changes and send it back to the White House, forcing the GOP to go on record again as opposing expansion of the program.

Speaking of "Expelled," a Scientist is Censored

The news mimics art.

Baylor University, a formerly Southern Baptist owned university in Texas, is being accused in the University's own newspaper, of censoring one of the faculty, in a letter to the editor from Walt Ruloff, an Executive producer of Premise Media:

This is a legitimate question in light of the university's heavy-handed actions in shutting down the research Web site of Dr. Robert Marks.

As many of you have heard, Marks, a distinguished professor of electrical and computer engineering, has been conducting research that ultimately may challenge the foundation of Darwinian theory. In layman's terms, Marks is using highly sophisticated mathematical and computational techniques to determine if there are limits to what natural selection can do.

At Baylor, a Christian institution, this should be pretty unremarkable stuff. I'm assuming most of the faculty, students and alumni believe in God, so wouldn't it also be safe to assume you have no problem with a professor trying to scientifically quantify the limits of a blind, undirected cause of the origin and subsequent history of life?

It would seem this kind of research would be praised and encouraged at Baylor.

But the dirty little secret is university administrators are much more fearful of the Darwinian Machine than they are of you.

I've spent the last two years of my life researching the widely accepted Neo-Darwinian theory and the theory of Intelligent Design.

My team and I (including lawyer, economist, actor, game show host and social commentator Ben Stein) have interviewed dozens of the world's top experts in biology, astronomy, physics and philosophy.

What we have uncovered in our documentary film, Expelled: No Intelligence Allowed, is an attack on freedom of speech and scientific inquiry that is as frightening as it is appalling. And it's happening right here at Baylor.

Last month Dr. Ben Kelley, dean of engineering and computer science, shut down Marks' Web site. He apparently had the blessing of President John Lilley. Why? The university put forth a bunch of phony-baloney procedural explanations that don't stand up to scrutiny.

The truth however, can be found in an e-mail sent to Marks by Ben Kelley in which he told Marks, "I have received several concerned messages..." about his Web site. These complaints have been kept anonymous. How convenient.

Here's what's going on: Somebody within the scientific community let Kelley know that Marks was running a Web site that was friendly to Intelligent Design.

Such a thing is completely unacceptable in today's university system -- even at a Christian institution. Kelley was probably told to have the site shut down immediately or suffer the consequences.

What are those consequences? The ultimate penalty is to have Baylor marginalized by being designated as not a "legitimate institution of higher learning." So designated merely for the "crime" of allowing Neo-Darwinism to be questioned, since conventional elitist wisdom holds it's no longer a theory but an inviolable truth.

Do you think this is some kind of fanciful conspiracy theory? Google the names of Richard Sternberg, Caroline Crocker, Guillermo Gonzalez, Dean Kenyon and Bill Dembski and see what you find. These distinguished scientists have suffered severe consequences for questioning Darwinian theory and there are hundreds, if not thousands, more.

Expelled, the movie (It's about censorship)

Many of the scientists who were interviewed for the soon-to-be-released movie, Expelled, are claiming that the film is an argument for Intelligent Design and against evolution. It appears that the working title for the movie was "Crossroads: the intersection of religion and science." Some of the people interviewed are claiming that they would have said something different if they had known the true name and subject.

However, I don't think any of them have seen the movie yet, and the website blog and trailers seem to focus on the treatment of "rebels" with in the science community, especially those who question "Darwinism."

According to the producers:

“People will be stunned to actually find out what elitist scientists proclaim, which is that a large majority of Americans are simpletons who believe in a fairy tale,” said Walt Ruloff, co-executive producer and co-founder of Premise Media, which is producing the film.

He continued to say that his company agreed to take up the film’s production because they “believe the greatest asset of humanity is our freedom to explore and discover truth.”

The film’s original title was Crossroads: The Intersection of Science and Religion, according to U.K.-based The Guardian. The film company said the movie's title was changed, on the advice of marketing experts.

Here's what the interviewees are saying:

Richard Dawkins

PJ Myers on his blog, Pharyngula
The New York Times


Then, there's this and this from Bioethics.net, the blog of the editors and pseudoeditors of the American Journal of Bioethics.

Two sex ed reviews, still no conclusions

We're finding that nothing changes the rates of pregnancies and STD's in teens except parental and peer pressure and concerns ("costs") of pregnancy.

I'm afraid that two published reviews of the literature on studies on sex education for adolescents and teens done by Kristen Underhill, Don Operario, and Paul Montgomery at the Centre for Evidence-Based Intervention at the University of Oxford ( here)and (here ) don't tell us much more than we knew before.

Although the authors report that there are few if any reports that give biological data or actual pregnancy and STD (including HIV) infection rates, the first study found no significance in behavior in "abstinence only" sex education compared with "usual care" in the community. (We're not sure what the "usual care" at those schools is, however.)

In the second study, authors did a review focusing on reports on sex education in "high income" societies, comparing "abstinence only" (which are defined as not promoting condom use) and "abstinence plus" (those which emphasize abstinence but promote condom use if you're going to have sex). report that there is a significant difference in decrease of "HIV risk behavior," but no evidence that teens have sex later, actually contract STD's less often, or have fewer pregnancies.

Neither of these studies tell us that abstinence based sex education does not work. I'm afraid that the only thing they do tell us is that there are factors we are not measuring and that our young people are engaging in risky behavior.

Hat Tip to "Pure Pedantry."

Democrats for Life (yes, they exist - barely)

Joe Carter at the blog, Evangelical Outpost, reviews a new book (Democrats for Life: Pro-Life Politics and the Silenced Majority by Kristen Day)about the Democrats for Life, which covers how the Democrats became the Party of the Abortion Rights Movement.

The true difference between Republicans and Democrats is best demonstrated by taking a look at the Democrats for Life of America website. Take a look at the "90/10" initiative (pdf brochure, here) which focuses on government spending plans to decrease abortion and the Position Statements, which emphasize the "secular" nature of the US government, as well as feminism and humanism.