I'm quoted in Texas Monthly

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

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

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

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

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

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

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

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

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

Skeptical view on Expelled, the Movie

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

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

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

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


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

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

Nature nurtures debate on namesake

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

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

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

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

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

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

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

Gynecology and Obstetrics Policy makers respond to doctors on conscience

It appears that the American College of Obstetricians and Gynecologists and ABOG (the American Board of Obstetricians and Gynecologistsmay be about to abort their efforts to change laws concerning conscientious refusal in Washington. It remains to be seen whether they will deliver on their promise to support -- without limits - the Conscientious Refusal to perform or refer for certain procedures. (I'm sorry, I can't resist obvious puns, even on such a serious subject.)

LifeEthics has been covering the controversy over the American College of Obstetrics and Gynecology's "Opinion #385, Limits of Conscientious Refusal in Reproductive Medicine," which states that,

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

First, "medically indicated" should be up to the physician and not dependent on autonomy - the patient's wants and wishes. Remember that Joseph Kennedy, the father of John and Robert, had his daughter lobotomized because she was too wild. At that time, according to Joe, the lobotomy was medically indicated.)

Obviously, this is not a moral obligation - but one that can be enforced by the use of the words "standard practice" and "standard reproductive services." In other words, abort, refer, or face lawsuits and risk your board certification. And the definition of "emergency" varies.

We also reported that the Secretary of Health, Michael O. Leavitt, had written to the Presidents of the American College of Obstetrics and Gynecology, the professional organization that supposedly sets the standard for these professionals, and the American Board of Obstetrics and Gynecology which certifies and tests OB/Gyns Presidents of ACOG and ABOG. He informed them that they were in danger of risking their own funding for training programs and status by any attempt to override the protections for Conscience in Federal funding regulations.


Even NPR noticed and covered the controversy.

The leaders at the Christian Medical and Dental Association have let CMDA members know that the President of ACOG, Kenneth L. Noller, MD, responded to the Fellows (certified OB/Gyns) last week and Norman F. Gant, MD, the President of ABOG, responded to Secretary Leavitt by letter on March 19, 2008.

Dr. Gant doesn't have a clue what the Secretary is talking about:

I am responding to your letter addressed to me asking about the American Board of Obstetrics and Gynecology’s stand with respect or to a physician’s choice to violate their conscience by referring patients for abortions or taking other objectionable action, or risk losing their board certification.” I can only say that I do not know where you came up with any suggestion, much less documentation, that the American Board of Obstetrics and Gynecology has ever asked anyone to violate their own ethical or moral standards.

And Dr. Noller reassures the Fellows that in this case, an Opinion is just an Opinion (and we're supposed to forget the attempts to change the laws):

We want to be clear the Opinion does not compel any Fellow to perform any procedure he or she finds to be in conflict with his or her conscience and affirms the importance of conscience n shaping ethical professional conduct. For example, while this is not a document focused on abortion, ACOG recognizes that support of or opposition to abortion is a matter of profound moral conviction and ACOG respects the need and responsibility of its members to determine their individual position on this issue based on their personal values and beliefs. We want to assure members with a diversity of views on this issue that they have a place in our organization.
Ethics Committee Opinions provide guidance regarding ethical issues. This Committee Opinion is not part of the “Code of Professional Ethics of the American College of Obstetricians and Gynecologists.” This Committee Opinion was not intended to be used as a rule of ethical conduct which could be used to affect an individuals initial or continuing Fellowship in ACOG. Similarly, it is not cited in the American Board of Obstetrics and Gynecology’s “Bulletin for 2008,” and “Bulletin for 2008 Maintanence of Certification” and an obstetrician-gynecologist’s board certification is not determined or jeopardized by his or her adherence to this Opinion.
Conscience has an important role in the ethical practice of medicine. While this Opinion attempted to provide guidance for balancing the critical role of conscience with a woman’s right to access reproductive medicine, the Executive Committee has noted the uncertain and mixed interpretation of this Opinion. Thus, the Executive Committee has instructed the Committee on Ethics to hold a special meeting as soon as possible to reevaluate ACOG Committee Opinion #385.

"Expelled" Producers make silly, ironic mistake

The producers of the movie "Expelled" owe PZ Meyersa lifetime pass to the movie. And they really need to attend and pass a logic class.

Dr. Myers, a scientist who researches cephalopods, and one of the men interviewed for the movie, was escorted by security from a free event that included a preview of the movie. However, the producers allowed Myer's wife, daughter, and her fiance to enter and view the movie, accompanied by Richard Dawkins.

The producers should be ashamed of themselves. They advertised the event, inviting people to register to see the movie. They did not send out notices that "everyone except x, y, and pz, may see the movie."

And to skip over Red-A Atheist-wanna-be Myers for the original, Dawkins, is just plain dumb. Dawkins has posted his review of the movie, here. (I haven't read it yet.)

Here's the real-time "Pharyngula" blog post about the incident - from PZ Myer's blog (he ran over to the Apple computer store to post on his blog) and there's a follow up post, here.

The entire conversation about the movie has left the original topic of academic prejudice against believers or even doubters, the near topic of the truth about Creation and evolution. The little boys are throwing mud pies and calling each other "dummie." I can't help but believe that the move to expel Myers from the showing was just a power play on the part of some would-be producer intern.

The Producers had a chance to frame the publicity from a PJ Myers appearance (along with that other guy) at their movie. ("Look who's coming to see the movie" will now become "Expelled from Expelled" and "Evidence that "Expelled" is not too bright." and "Myers is a saint.")

Here's the LifeEthics blog conversation that's been going on since October, and which also has a notice about the incident with Myers, Dawkins and the Producers and bouncers. Here's the Christianity Today review, and here's the New York Times. I guess that if all the Producers wanted was publicity, their strategy worked.

Brain Death

Wesley Smith is blogging around the Web on the sad death of a 50 year old Atlanta man whose family took the doctors and hospital to court. Wesley rightly notes the poor communication.

The reporter is indeed a very bad communicator. I wonder about the reliability of the whole story because of the reporter's description of the patient: "he was brain dead and being kept alive by life support." While I can believe that the docs used "life support," the reporter goes on to say that the patient "passed away" when the ventilator was stopped and used the phrase, "pull the plug."

"Brain dead" patients are not alive and they're not on "life support." The doctors are using "artificial support." for the organs on a dead patient. (See this British Journal of Medicine article and comments, below.) Just as we support the body while waiting for the arrangements for organ donation (or for the birth of a child of a brain dead mother), it is customary to notify the family and give them a chance to "say goodbye" before discontinuing the ventilator and medications supporting the

Way down at the bottom, the article actually says,

"doctors told the family the stroke caused massive bleeding in Donald's brain. Four different physicians examined Fennell and his brain scans and determined his brain, including the brain stem which controls basic bodily functions like breathing, had ceased to function, according to court and patient records."

However, the problem started with the nurse who called security to have the family removed from the hospital because Mr. Fennell's 3 sons,

21, 20 and 18-year-old college football players— cried loudly and shouted "No!" when told their father was brain dead. After that, she said, security guards were posted at the door whenever they visited."

It's hard to talk to people who are shouting, but it's harder to talk to them when they've been kicked out of the building.

I'm trying to get my head around the medico-legal problem of delaying the declaration of death by the docs, scheduling a time to turn off the ventilator, and the comment about the machines being broken.

However, people don't live by laws alone. We often act from our hearts.

The New England Journal of Medicine published a review article describing the determination of death by neurological criteria in 2001. And here's an excellent (free) article from 2002, from the British Journal of Medicine that actually calls the ventilator and cardiac support "artificial support" and includes the ethical caveat that ""No physician engaged in euthanasia or medically assisted suicide should be responsible for diagnosing brain death.

Not coincidentally, the subject of yesterday's Secondhand Smoke was the case of an Orthodox Jewish man in Canada. The gentleman is on a ventilator and suffering from the effects of heart failure, pulmonary hypertension and renal failure. Three doctors, including one selected by the family have determined that he is dying and, even without the consent of the patient or the family, decided to remove the ventilator. The family has taken the doctors to court to prevent the removal of the ventilator on religious grounds.

One of the family's lawyers actually said that removing the ventilator is the same thing as smothering the patient with a pillow, and that (of the docs and nurses who must maintain the ventilator and adjust its settings):

"To do what they are suggesting would involve a physical act," he said. "You have to touch him, you have to remove the tubes. My reading of the law is that without consent ... they can't do it. I submit that is assault and battery."

(According to newspaper reports, the docs plan to remove the feeding tube, also. But that's not relevant, here, since Mr. Golubchuk will die within minutes if he is unable to breathe on his own off the ventilator. If any of the docs are making a fuss about the feeding tube, they are not very wise, since doctors and nurses aren't needed to maintain or monitor the feedings.)

An article from the Winnipeg newspaper on December 11 says that

"An orthodox rabbi consulted by the family quotes from guidelines on Jewish medical care that say it is imperative for doctors to prolong life, even if the patient is "suffering greatly" and asks for care to stop."

It's my understanding that Orthodox law forbids disconnecting the machine until the heart stops, even though there has been talk of a machine in use in Israel to randomly turn off ventilators so that the people won't have to. But I've never read that the Orthodox go so far as to demand that suffering be ignored.

In fact, withholding care under Orthodox Jewish law is acceptable. See the discussion about flickering candles, here. Here's a very well written review of Orthodox Jewish law on end of life, from the Virtual Mentor, the AMA ethics journal.

Do you suppose the family really believes that they should force other people to cause suffering? The family lawyer does point us to the ethics of intent and consequence of "a physical act." While the family may have the right to continue their father's suffering and to prevent the removal of the ventilator they don't have the right to force any particular doctor, nurse, or tech to act to violate their own conscience by adjusting, cleaning, and monitoring the ventilator.

Surely there's an Orthodox doc in the area who is willing to care for Mr Goubchuk and his family.

Wesley Smith on Toronto Conference on End of Life

Wesley's report is at his blog, Secondhand Smoke.

The medical interventional suicide or "Physician Assisted Suicide" (PAS) offers a false sense of control to people who are actually the healthiest of the patients who know that they are nearing the end of life.

It's false because before legal medical regulations can be used to "help" terminal patients to control the "time and manner of their death," the laws are actually being sold to voters who aren't sick, who are encouraged to think "there but for the grace of God, go I." Instead of giving dignity to patients in pain, talking about the indignity of having others care for our bodies and the horrors of uncontrollable pain increases the revulsion toward physical weakness and dependency.

Mr. Smith says that in Toronto ( as at the Houston Holocaust Museum last month), he focused the bulk of his talk on "Futile Care Theory."

Calling all cases of withdrawal of care "Futile Care Theory" and eugenics is also false. It denies any acknowledgment that doctors act on their conscience. By denying that doctors and medical ethics committees -a group of peers and lay people, clergy, and ethicists - can be acting in good conscience, even when it goes against the wishes of surrogates and families condemns us all. If we can't trust these people, how can we trust a judge or a jury to act in good conscience?

I hope everyone reads what Wesley says about another speaker, Ms. Frazee:

She told the audience that there are two general veins of opposition to assisted suicide; political and spiritual, with people in each camp disagreeing with each other on other issues. She suggested that the best way to work together would be to develop a philosophical approach that would include all and permit people to also pursue other agendas when not working against assisted suicide.

Too often, the only common ground is the hatred of the control that doctors seem to have. Suicide proponents and "futile care" activists declare doctors the bad guys who diagnose and couldn't cure, who bring the bad news of unavoidable death and who won't "do everything."

As I reported after Wesley spoke at the Houston Holocaust Museum, the risk is to squeeze doctors between two extremes.

I suggest that the doctrine of double effect can help us make the distinction. Doctors may not act with the intended result of death, but we know that some of our actions may cause death, unintentionally. In all cases, the intention and the act must be ethical, but sometimes - as when we poison the body with chemotherapy or radiation to fight cancers - only medical knowledge and experience can inform our conscience.

Laws and the legal process are a poor substitute for medical ethics and will result in the death of those same ethics.

The logical result is an end to all laws protecting the conscience of doctors, pharmacists, and nurses, in favor of laws leading to court and cookbook algorithms. The practice of medicine won't be a profession - much less a calling - with peer review, judgment and conscientious men and women. It will be a job done by people capable of following orders, even when it goes against their best medical and moral judgment.

Who will you trust? Lawyers and judges like Blackmun and Greer? Juries who live in a society that forces medical professionals to act in a way they believe is wrong? Legislatures and referendums that give us Oregon's assisted suicide? Or doctors and pharmacists who are prescribing and dispensing the potassium, heart stimulants or blood pressure control in the IV, adjusting the ventilator, dialysis machine and the dosage of pain meds under the watchful eye of nurses and the rest of their community?

Emotional Debate on "Physician Assisted Suicide"

On Tuesday night, November 26th, I drove to Houston to hear Wesley J. Smith, debate Physician Assisted Suicide (PAS) with Kathryn Tucker, the Director of Legal Services for Compassion & Choices, which was once the old Hemlock Society and then Compassion in Dying. Mr. Smith is the author of The Culture of Death and Forced Exit: Euthanasia, Assisted Suicide, and the New Duty to Die. The only biographical data I can find on Ms.Tucker is this pdf.

The Holocaust Museum Houston has teamed up with the University of Texas Health Science Center at Houston to present the Dr. Michael E. DeBakey Medical Ethics Lecture Series, called ""Medical Ethics and the Holocaust: How Healing Becomes Killing--Eugenics, Euthanasia and Extermination."

From the first, opening night, presentation featuring the-soon-to-be-unpopular James Watson and two other Nobel Laureates, it seems that we are being exposed to an ethics lab, rather than a history and theoretical series. The speakers the first night, including a doctor, Eric Kandel, M.D., 2000 Nobel Laureate, Medicine or Physiology, who was a child in Vienna on Krystallnacht before his family escaped to the US, told us not to worry about research on human embryos as long as the parents give "informed consent." Ironically, after descriptions of the build up to the Holocaust, Dr. Kandel reassured us that that we would gradually get accustomed to embryonic stem cell research.

I could tell that Mr. Smith and Ms. Tucker were irritated with each other during the program. In her introduction, Ms. Tucker referred to an earlier debate that had taken place that day when, as Wesley later told us, "it got angry." I got the idea that the moderator, Dr.Sheldon Rubenfeld, was slightly testy, although he did a good job moderating the questions, as always.

Ms. Tucker' s history of redefining, renaming, and litigating did not reassure me.

She was the lawyer in the case of a family suing a doctor for failing to give their loved one enough medicine to control pain at the end of his life and has fought laws against PAS for 10 years. Ms. Tucker misrepresented "terminal sedation," as though it is always intended to lead to death, rather than "deliberately inducing and maintaining deep sleep but not deliberately causing death in very specific circumstances." It was a surprise to hear Ms. Tucker warn against "back alley deaths" although it turns out that it wasn't the first time I'd heard the term. She frequently used the word, "choice," comparing the patient's choice at the end of life with a woman's right to "Reproductive Choice."

The silliest part of the evening - we were discussing death, after all - was when Ms. Tucker chided Mr. Smith for using the wrong terminology, "Physician Assisted Suicide." She showed us the recently revised policy statements of the American Medical Women's Association and the American Public Health Association. Because these two second tier (that's a word I learned from John Gearhart while attending the ASBH conference this year) organizations revised their own terminology to avoid the "emotionally charged" nature of certain words within the last year, Ms. Tucker shamed Mr. Smith for using the American Medical Association's terminology and legal term instead of calling the act "Aid in Dying."

Mr. Smith pointed more clearly to the problem of emotions when he remarked that it is often acknowledged in these debates that "existential pain," or the emotional component of pain, may be worse than physical pain.

No matter what we call it, death is always going to be an emotionally charged subject and is rarely dignified or controlled. For one thing, the body loses control of the bowels and bladder at death, as well as everything else. The questions from the audience were examples of people who approach the subject of end of life care from a strictly emotional viewpoint, rather than thinking it through to its logical consequences. The emotion is getting stronger as technology introduces more and more variables.

However, when we are discussing Medicine and the death of the body as well as of the mind and spirit, we should confine our conversations to the physical consequences. To be trite: When you're dead, you're dead.

There is no legal question as to whether "Assisting" or "Aiding" death is different from withdrawing care. We don't pinch the patient's nose or remove the oxygen from the room when we withhold or withdraw a ventilator. Physician Assisted Death, in contrast, is an irrevocable interventional act against the living processes of the body using State regulated medical knowledge and medicines, and should be treated as the violation of medical ethics that it is. The history of Western medicine, at least between Hippocrates and Roe, has always condemned intentional use of medicine to positively end the life of the body.

Mr. Smith and I have had several discussions about the ethics at the end of life, especially the Texas Advance Directive Act, which he refers to as the "Futile Care Act." We agree that doctors should never intend to cause death but that they may withhold or withdraw intervention at the request of the patient. We disagree, though, about whether a doctor may refuse to intervene because our best medical judgment is that the intervention will cause increasing damage to the body and prolong death.

I found myself, a Family Physician who cares for people at all stages of life, theoretically squeezed between two legal pressures, one law to force me to act with the purpose of killing a patient and another that would force me to act even though my medical judgment is that the intervention caused harm. Several people from the audience also advocated for legal consequences for doctors who failed to follow patients' end of life wishes by prolonging their lives.

To be honest, if I had to "choose" between the two, I would choose against Ms. Tucker's extreme, which would leave me with Mr. Smith's. I could live with that.

However, I hope that society will teach doctors to never take life while expecting the profession to assist one another in determining when medical intervention causes more bodily harm than healing, when a patient's bodily processes are breaking down faster than we can heal or maintain them.

(Edited 11/20/07 for grammar and order - BBN)

Biographic article on Yamanaka

Here's a cute biography of Shinya Yamanaka, lead researcher from the Japanese team that reported reprogramming of adult cells into embryonic-like stem cells.

As an M.D. myself, I find it interesting that, unlike veterinarians James Thomson of Wisconsin and Time Magazine Person of the Year, Hu Suk Hwang, Dr. Yamanaka is a human doctor, trained in orthopedics:

Yamanaka has spent most of his life in western Japan. A native of Osaka, he earned his medical degree at Kobe University and a doctorate in pharmacology at Osaka City University.

After completing his residency in orthopedic surgery, Yamanaka headed to the University of California, San Francisco, to do postdoctoral studies that laid the groundwork for his current research.

He does express concern about the possible uses of his research by unethical researchers:

Yamanaka worries about the road some people might take.

"We need to come up with some sort of rules about what kind of cells can be used and to what ends. Otherwise, someone may put this technology to use in troubling ways,” Yamanaka said.

The research's ethical and social implications are never far from the table in Yamanaka's laboratory, said Kazutoshi Takahashi, a junior professor who participated in the project.

"The potential problems are cut down when you use this method given that we don't have to use embryonic stem cells, and that's a good thing,” Takahashi said.

Since the debate isn't yet over about ethical vs. unethical stem cells and since some people (like embryonic and fetal stem cell researcher and sometimes guest Science editor, John Gearhart, MD) have admitted to putting pressure on researchers to make sure that they follow the official line to pursue "all promising areas" (echoed here by the stem cell industry trade association organization, BIO) kinds of stem cell research, I hesitated to post this link and the quotes. But someone should record the true "debate."

Bioethics is biopolitics

Kathryn Hinsch, founder of the Women's Bioethics Project and the Women's Bioethics Blog recommended the questions and answers from an article by Joshua Perry published in the Journal of Legal Medicine. (It cost $32 to access - perhaps we ought to talk about open access in publishing.)

Perry notes that others have noted that bioethics has always been "biopolitics," it just took a while for the political angle to "arrest the attention of so many commentators."

In the introductory essay to the June 2006 issue of the Journal of Medicine and Philosophy, Jeffrey P. Bishop and Fabrice Jotterand note: “Bioethics has always been a biopolitics and the political dimension is only now coming into relief for bioethicists.” Writing in the May-June 2006 issue of the Hastings Center Report, Jeffrey Kahn echoes this sentiment when he comments: “Bioethics has always been involved in policy issues and the politics surrounding them.” So, despite a history of political intersections, why has bioethics and its entanglement with politics only recently arrested the attention of so many commentators?

The attention shouldn't surprise anyone. Multiple events have worked together to increase public attention on bioethics questions. Along with the evolution of medical technology and expectations in the treatment of patients who once would have died, the backlash against Roe v. Wade juxtaposed with assisted reproductive techniques, the "right to die" movement alongside of the advance directive, there's also the emergence of the internet and instant communication that is both personal and impersonal.

Oh, and there was the creation of Dolly the cloned sheep and Hwang Wu Suk, the "rock star" cloner turned fake.

There's also the insular nature of the community of bioethics, which I believe actually limits the debate. Don't look for a single "anti-abortion" much less "pro-life" viewpoint in the lists of contributors at the Women's Bioethics Blog site or the editors and pseudoeditors who post at the blog of the American Journal Of Bioethics. I'm not sure there's a conservative on the lists, and can identify only 2 or 3 that self-identify as believers. William Saletan's much commented about article this month pointed me to Dan Callahan and other's comments on the politicization of bioethics, including the exclusion of conservatives and religious ethicists, and the notion of "Progressive Bioethics."

CALLAHAN: Just first a comment on John’s thesis. I would say my hardest struggle at the Hastings Center – I ran the place for 27 years; my hardest struggle was getting the secular philosophers to even allow a theologian, liberal or conservative, to even come to our meetings. Again and again I would say, what about so-and-so? No, no theologians. And the thing that was very striking, how many of the secular philosophers, particularly analytically trained, were extraordinarily hostile to religion. And I just fought year after year saying, let’s get some in and they just wouldn’t – I mean, I did it because I ran the place, but they were usually unhappy. (Laughter.)
But I have a question for Eric. This is an interesting political question. As many of you know, one of the sharper criticisms of Leon Kass’s council was that it did not take up questions of health policy and the whole problem of the uninsured. Now, interestingly enough, neither did NBAC take those up, but nobody dumped on them for not taking it up. But I was told that NBAC was told – instructed not to take up those issues, which if true was a gratuitously political command.

Eric Meslin answered that he never received any commands not to take up any issues, but he did relate an incident when he and NBAC Commissioner Jim Childress were told by National Institute of Health officials that the NIH was "concerned" that the NBAC would propose regulations that would slow research.

It wasn’t a threat. It wasn’t – it was, we were invited to dinner – box lunch. (Laughter.) I wasn’t very hungry at the end of it.

Nevertheless, I don't believe that there was much room for dissenters among the members of Clinton's National Bioethics Advisory Commission. Who on the NBAC could be compared to Gazzaniga or Blackburn in the President's Bioethics Council?

And I didn't notice any objection to Alta Charo's politicization of her luncheon talk, using terms like "endarkenment" and personally attacking Wesley Smith, who was in the audience at that July 06 "Bioethics and Politics" conference in Albany.

Ethics, embryos, and e-rants

Kevin T Keith (His often profane blog, Sufficient Scruples, focusing on why it's wrong to be religious, pro-life or pro-abstinence is here) wonders (in 1700+ words) how scientists ever began to speak in terms of "ethical" and "unethical" about sources of stem cells at the Women's Bioethics Blog:

To emphasize that: the search for "ethical" stem cells has no importance whatsoever, other than the fact that it responds to objections raised by a certain segment of the religious right and grounded on their religous (sic)beliefs. There is no need for them otherwise, and they are less desirable therapeutically than the already-available alternative of actual embryonic stem cells. Such lines of research, and the diversion of time and resources they represent, have no point unless that religious objection is demonstrated to be a compelling moral claim.(Italics in the original)

Let's forget that embryos require that oocytes be harvested from women, risking their health or that embryonic stem cells from embryos created by in vitro fertilization can never be "patient-specific" until and if human cloning is perfected. Let's forget growing evidence that the differentiation of stem cells is dependent on local factors and conditions - the 'niche' in which the cells are found. And, along with Kevin, we can forget that there are in fact people who object to the destruction of human embryos without a religious objection.

Let's look at the question of applying the concept of ethics to research.

Kevin obviously has very strong feelings that there is a right side and a wrong in determining whether or not destructive embryonic research is "ethical."

Isn't the act of determining one position right and others find that position wrong making "ethical" or "moral" decisions?

Sam Harris at the Aspen Ideas Festival

Sam Harris, author of the books, The End of Faith: Religion, Terror, and the Future of Reason and Letter to a Christian Nation, was given a forum at the Aspen Ideas Festival. I'm not sure how I ended up finding the video, "Believing the Unbelievable: The Clash Between Faith and Reason in the Modern World," but I believe I was referred by one of the Science Blog forums. I can't remember which one, and, as far as I can tell, only one of these blogs is owned by a believer.

Which is probably how I got lost. There's a bit of a row, right now, concerning the derision of believers by "Pharyngula." (Which is surprising, since that seems to be his purpose in blogging.) I was once again struck by the idea that science and religion are incompatible, chased some links, and ended up watching a video from the Festival.

Mr. Harris spent his time at the Festival blurring the edges between “Christianity, Judaism, and Islam,” with a little Hinduism and Buddha thrown in to strengthen his point. There doesn’t seem to be any difference in his viewpoint, although he does grudgingly admit to a questioner that “moderate” Christians and Jews have been influenced by the belief in human rights and equality by secular, outside influences, while Muslims have remained isolated and so have not “evolved.”

Beyond the fallacy of treating all religions as one, Mr. Harris denies that atheism is a religion, using his second favorite technique, mockery and one liners designed to encourage his listeners to laugh with him. He mocks the Second Commandment: “Is this as good as it gets? . . . How about, ‘don’t deep fry all of your food?’” and mocks the idea that agnostics are a separate from believers and atheists by saying, “I haven’t met too many agnostics about Zeus.”

The biggest logical fallacy in which Harris engages is his statement that religions change from without, due to secular ideas about human rights. In fact, the Judeo-Christian tradition teaches that we are all created in the image of God.

While Christians have cited the fact that very young children naturally display concern for others and seem to understand the concepts of justice and beauty as proof of God, Mr. Harris believes that this actually disproves the “usefulness” of religion. While he admits that 70% of (I presume, U.S.) college graduates believe in the Biblical God, he strongly commends “peer review” in science.

His major point seems to be that “much of the Bible and Koran is life-destroying gibberish.” He dismisses the rest. While he insists that believers who promote their religions or teach their children to follow them are enabling religious fanatics who kill in the name of religion, shouldn’t Harris, who has been called an "Atheist Evangelist" take responsibility for enabling those who kill and enslave to suppress religion, as in China? Or the Western academic powers that be that harass, deny recommendations, employment and funding to those who fall out of favor, such as Richard Sternberg (see the review at Sternberg's site and at National Public Radio)?