New England Journal of Medicine plays conscience politics ("Trust me, I will act against my conscience," cont'd)

The New England Journal of Medicine has published a "Commentary" by a lawyer who has worked for Planned Parenthood, concerning the practice of medicine and conscience.

I don't like to publish entire articles from subscription-only sources (especially one written by a lawyer), but this serious breach of ethics on the part of the NEJM should be documented.

The NEJM published this in advance of the dead-tree version because the last day for comments is the same day the paper Journal comes out.

This most definitely should have been in the "Free Content" form, and it is. We should thank the editors for this favor. Physicians and others who do not subscribe (to the tune of several hundred dollars a year) are able to read and answer this lawyer's viewpoint of the practice of medicine.

There is no opposing view offered. Yep, let's talk about "choice" and "consent." but only give their choice and their consent.

The essay contains more of the ridiculous examples that we should be used to by now: the author asks about a doctor who refuses to care for diabetics because his religion counts gluttony as a sin.

She calls abortion - all abortions, without making the distinction between elective abortion and those necessary to save the life of the mother - "standard of care."

More in a bit:


From the online version of the New England Journal of Medicine, published in advance of printing in the April 9, 2009 issue of the Journal:

The regulation, as explained in its text (see the Supplementary Appendix, available with the full text of this article at NEJM.org), aims to raise awareness of and ensure compliance with federal health care conscience protection statutes. Existing laws, which are tied to the receipt of federal funds, address moral or religious objections to sterilization and abortion. They protect physicians, other health care personnel, hospitals, and insurance plans from discrimination for failing to provide, offer training for, fund, participate in, or refer patients for abortions. Among other things, the laws ensure that these persons cannot be required to participate in sterilizations or abortions and that entities cannot be required to make facilities or personnel available for them. And they note that decisions on admissions and accreditation must be divorced from beliefs and behaviors related to abortion. On their face, these laws are quite broad.

But the Bush administration's rule is broader still. It restates existing laws and exploits ambiguities in them. For example, one statute says, "No individual shall be required to perform or assist in the performance of any part of a health service program or research activity funded" by DHHS if it "would be contrary to his religious beliefs or moral convictions."1 Here the rule sidesteps courts, which interpret statutory ambiguities and discern congressional intent, and offers sweeping definitions. It defines "individual" as physicians, other health care providers, hospitals, laboratories, and insurance companies, as well as "employees, volunteers, trainees, contractors, and other persons" who work for an entity that receives DHHS funds. It defines "assist in the performance" as "any activity with a reasonable connection" to a procedure or health service, including counseling and making "other arrangements" for the activity. Although the rule states that patients' ability to obtain health care services is unchanged, its expansive definitions suggest otherwise. Now everyone connected to health care may opt out of a wide range of activities, from discussions about birth control to referrals for vaccinations. As the rule explains, "an employee whose task it is to clean the instruments used in a particular procedure would also be considered to assist in the performance of the particular procedure" and would therefore be protected. Taken to its logical extreme, the rule could cause health care to grind to a halt.

It also raises other concerns. In terms of employment law, Title VII of the Civil Rights Act, which applies to organizations with 15 or more employees, requires balancing reasonable accommodations for employees who have religious, ethical, or moral objections to certain aspects of their jobs with undue hardship for employers. But the new rule suggests that if an employee objects, for example, to being a scrub nurse during operative treatment for an ectopic pregnancy, subsequently reassigning that employee to a different department may constitute unlawful discrimination — a characterization that may be at odds with Title VII jurisprudence.2 As officials of the Equal Employment Opportunity Commission remarked when it was proposed, the rule could "throw this entire body of law into question."3

Furthermore, although the rule purports to address intolerance toward "individual objections to abortion or other individual religious beliefs or moral convictions," it cites no evidence of such intolerance — nor would it directly address such intolerance if it existed. Constitutional concerns about the rule, including violations of state autonomy and rights to contraception, also lurk. And the stated goals of the rule — to foster a "more inclusive, tolerant environment" and promote DHHS's "mission of expanding patient access to necessary health services" — conflict with the reality of extensive objection rights. Protection for the silence of providers who object to care is at odds with the rule's call for "open communication" between patients and physicians. Moreover, there is no emergency exception for patient care. In states that require health care workers to provide rape victims with information about emergency contraception, the rule may allow them to refuse to do so.

Recently, the DHHS, now answering to President Barack Obama, took steps to rescind the rule (see the Supplementary Appendix). March 10 marked the beginning of a 30-day period for public comment on the need for the rule and its potential effects. Analysis of the comments (www.regulations.gov) and subsequent action could take some months. If remnants of the rule remain, litigation will follow. Lawsuits have already been filed in federal court, and Connecticut Attorney General Richard Blumenthal, who led one of the cases, has vowed to continue the fight until the regulation is "finally and safely stopped."4

This state of flux presents an opportunity to reconsider the scope of conscience in health care. When broadly defined, conscience is a poor touchstone; it can result in a rule that knows no bounds. Indeed, it seems that our problem is not insufficient tolerance, but too much. We have created a state of "conscience creep" in which all behavior becomes acceptable — like that of judges who, despite having promised to uphold all laws, recuse themselves from cases in which minors seek a judicial bypass for an abortion in states requiring parental consent.5

The debate is not really about moral or religious freedom writ large. If it were, then the medical profession would allow a broad range of beliefs to hinder patient care. Would we tolerate a surgeon who holds moral objections to transfusions and refuses to order them? An internist who refuses to discuss treatment for diabetes in overweight patients because of moral opposition to gluttony? If the overriding consideration were individual conscience, then these objections should be valid. They are not (although they might well be permitted under the new rule). We allow the current conscience-based exceptions because abortion remains controversial in the United States. As is often the case with laws touching on reproductive freedom, the debate is polarized and shrill. But there comes a point at which tolerance breaches the standard of care.

Medicine needs to embrace a brand of professionalism that demands less self-interest, not more. Conscientious objection makes sense with conscription, but it is worrisome when professionals who freely chose their field parse care and withhold information that patients need. As the gatekeepers to medicine, physicians and other health care providers have an obligation to choose specialties that are not moral minefields for them. Qualms about abortion, sterilization, and birth control? Do not practice women's health. Believe that the human body should be buried intact? Do not become a transplant surgeon. Morally opposed to pain medication because your religious beliefs demand suffering at the end of life? Do not train to be an intensivist. Conscience is a burden that belongs to the individual professional; patients should not have to shoulder it.

Patients need information, referrals, and treatment. They need all legal choices presented to them in a way that is true to the evidence, not the randomness of individual morality. They need predictability. Conscientious objections may vary from person to person, place to place, and procedure to procedure. Patients need assurance that the standard of care is unwavering. They need to know that the decision to consent to care is theirs and that they will not be presented with half-truths and shades of gray when life and health are in the balance.

Patients rely on health care professionals for their expertise; they should be able expect those professionals to be neutral arbiters of medical care. Although some scholars advocate discussing conflicting values before problems arise, realistically, the power dynamics between patients and providers are so skewed, and the time pressure often so great, that there is little opportunity to negotiate. And there is little recourse when care is obstructed — patients have no notice, no process, and no advocate to whom they can turn.

Health care providers already enjoy broad rights — perhaps too broad — to follow their guiding moral or religious tenets when it comes to sterilization and abortion. An expansion of those rights is unwarranted. Instead, patients deserve a law that limits objections and puts their interests first. Physicians should support an ethic that allows for all legal options, even those they would not choose. Federal laws may make room for the rights of conscience, but health care providers — and all those whose jobs affect patient care — should cast off the cloak of conscience when patients' needs demand it. Because the Bush administration's rule moves us in the opposite direction, it should be rescinded.

Dr. Cantor reports representing an affiliate of Planned Parenthood in a legal matter unrelated to conscientious objection. No other potential conflict of interest relevant to this article was reported.


Source Information

Dr. Cantor is an adjunct professor at the UCLA School of Law, Los Angeles.

This article (10.1056/NEJMp0902019) was published at NEJM.org on March 25, 2009. It will appear in the April 9 issue of the Journal.

References

1. 42 U.S.C.A. § 300a-7(d).
2. Shelton v. Univ. of Medicine & Dentistry of New Jersey, 223 F.3d 220 (3d Cir. 2000).
3. Pear R. Protests over a rule to protect health providers. New York Times. November 17, 2008:A14.
4. Press release of the State of Connecticut Attorney General's Office, Hartford, February 27, 2009. (Accessed March 20, 2009, at http://www.ct.gov/ag/cwp/view.asp?A=3673&Q=434882.)
5. Liptak A. On moral grounds, some judges are opting out of abortion cases. New York Times. September 4, 2005.

Texas teens form pro-life club

And, it seems that the kids in Coppell, Texas (near Dallas) are only "anti-abortion" because of the undue influence of their families and churches. From the Dallas Morning News:

Abortion rights advocates say it's even harder for them to organize high school students because of the focus on abstinence.

"We're up against a movement that has federal dollars going into public schools," said Kierra Johnson, director of Choice USA. "You compound that with what they could be learning in church, and it sets us back in terms of outreach to young people under 18."

Of course, the Dallas Morning News calls the club "anti-abortion," not "pro-life." In spite of the fact that the kids call themselves "The Pro-Life Club." The author calls for tolerance on the part of the "anti-abortion crowd but can't even bring herself to use the term the teens would prefer.

I guess the DMN doesn't keep up with the latest research. Otherwise, they'd know that the study on abstinence that was in the news earlier this month informed us that teens - whether they sign a pledge or not - who come from religious, conservative backgrounds are more likely to delay their first intercourse for about 3 years longer than their peers. I nominate the author of the article,Katherine Leal Unruth, her editor, and Ms. Johnson for Twits of the Year and definitely award them my own Yellow Brick Road award. ("Do Not Look Behind the Curtain, Ignore That Little Man." Or small woman.)

Bravo Coppell teens, their parents, and their churches!

The (manufactured) Stem Cell Debate at Dartmouth

I don't believe I've ever seen a report on a presentation that allowed half the space for "debate," after the fact.

The Stem Cell Debate at Dartmouth

Sunday, November 16, 2008

Father Tadeusz Pacholczyk, Ph.D. was recently invited to give a lecture entitled “Stem Cells and Cloning: Understanding the Scientific Issues and the Moral Objections” at Aquinas House, in observance of the Feast of St. Luke, the patron saint of medical professionals. Pacholczyk, or Father Tad as he encourages his audience members to call him, is the Director of Education for the National Catholic Bioethics Center. He arrived at this position after receiving degrees in philosophy, biochemistry, molecular cell biology, and chemistry, a Ph.D. in Neuroscience from Yale University, and years of research in molecular biology, bioethics, and dogmatic theology. In a free public lecture lasting more than two hours, Pacholczyk outlined both the scientific and ethical considerations of human embryonic stem cell research and to a lesser extent cloning, giving justifications for the Catholic Church’s positions on these technologies.

After giving an in depth layman’s version of the science involved in stem cell research and a history of both scientific milestones and relevant policy decisions, Pacholczyk corrected what he believed were some of the most pervasive myths about stem cell research. He believes that individuals and organizations within the media and others who engage in expensive advertising campaigns have deliberately misled the American people in an effort to reframe the debate over the use of human embryos for research.

**************
The Dartmouth Review understands that this is an issue on which reasonable moral people can disagree, and so Michael S. Gazzaniga ‘61, Ph.D., Director of the Sage Center for the Study of Mind at the University of California, Santa Barbara was asked to explain some of the ethical justifications. He indicated that, “The handling of human tissue has always commanded the respect of the biomedical community and always will.” However, Gazzaniga does not consider an embryo to be in possession of the same moral status as an adult human, while acknowledging that the issue has “deep meaning to millions of people.”

The Review has raised several ethics questions regarding the virtual debate they created by interviewing Dr. Gazzaniga after Dr. Pacholczyk's talk.

Will they seek out opposing views in the future or is it only Catholic priests who require such answers? Will they now give Dr. Pacholczyk an opportunity to respond?

In addition, Dr. Gazzaniga finds the determination as to when a human being becomes a human being fairly simplistic:

Asked the basic question underlying this debate and that about abortion, when a human embryo becomes a human being, Gazzaniga called it a “social decision, not unlike the kind a society makes about when to call someone legally blind.”

Does Dr. Gazzaniga's emphasis on contrasting "adult" human beings with embryonic human beings indicate that he finds differing moral values in the lives of infants, children, and "adults," does he extend these differences to the state of function of the brain, and can he justify these variations at least as well as we can our culture's definition of "legally blind?"

CNN objects to conscience

This subject again.

CNN, that bastion of upstanding plants ethics, objects to doctors with morals - or at least the ones who act on them.

The CNN video (not a "news piece") shows interviews with a woman who was refused contraception by one doctor and a second interview with another doctor who is Catholic and who does not believe that contraception is moral and so he does not prescribe it.

The reporter is shocked that 60% of doctors feel that it's okay to tell patients our moral views.

The reporter asked the patient whether she felt "rejected." The woman said that she did and that she felt that the doctor was judging her and imposing his morals on her. She said that any doctor who would not do what his patients wanted should not be in practice.

The woman isn't judging or imposing her morals on every doctor, is it?

Doctors make "judgments" all the time. We are not simply dispensers of products that people want. We must "impose" our judgment on patients who smoke (a perfectly legal drug) and drink (ditto) or who have become overweight from eating legal food and choosing not to exercise enough to burn off calories faster than they take them in. We are responsible for determining whether a patient is becoming addicted to pain medications, asking for a note for missing work when they were never sick, or a handicapped parking sticker when they're not disabled.

Much more often, we make judgments about the cause of a patient's symptoms or disease and how best to treat it. Our job is not to make the patient feel good about themselves, although most doctors I've met prefer to do so. What we do is diagnose and treat in order to help the patient be as healthy as we are able.

While I don't object to non-abortifacient contraception, it is an elective service in most cases. It is very rarely necessary to maintain the health of the body of patients. It is truly a "choice."

As I've said before, it would be simpler for people who feel that contraception is important to arrange to pay doctors who will write and dispense those medications and devices to go around to the areas where they are needed.

The alternative is to find a way to trust a doctor who will act against his conscience - to do what he considers the wrong thing for your pet issue - to do the right thing every other time.


Hat Tip: Blog.bioethics.net

"Exaggerated resistance" (Or how not to report science)

Scientific American gives us several reasons to "resist" the information in its pages this month, the August, 2007 issue. Unfortunately, only the Table of Contents is free, but the problem is in the titles given "news" stories themselves.

Under the title, "Roots of Science Hatred," on page 29 we learn that people learn to trust their own experiences, causing us to have "exaggerated resistance" to scientific reports:

For instance, because objects fall down if not held up, kids may have trouble accepting
the world is round, reasoning that things on the other side should naturally fall off.
Intuitive notions concerning psychology also lead children to see everything as designed for some reason—for example, a cloud’s purpose might be to rain—which can lead to opposition to evolution. In reportingtheir work in the May 18 Science, the researchers also note that when both adults and kids obtain knowledge from others, they judge claims based on how much they trust the source of an assertion. It suggests that science will meet exaggerated resistance in societies where alternative views are championed by trustworthy authorities, such as political or religious figures. —Charles Q. Choi (emphasis is mine)

Yeah, and the exaggeration is all on our part, and due to "hate," "religion," and "politics," right?

Since SA can't be engaging in politics, then only someone inclined to hate science would notice the problem with the following headline on page 32: "SciAm Perspectives: Worse Than Gasoline: Liquid coal would produce roughly twice the global warming emissions of gasoline." Couldn't they have used the more correct and less political term, "green house gasses?"

Yes, I'll admit to being a human-caused-global-climate-change skeptic. I remember the '60's and early '70's, when we humans were told that we were the cause of global cooling. I believe it had something to do with clouds blocking the sun's radiation from warming the earth. I'm watching and waiting, although I've always believed in keeping my little micro-climate as clean as possible..


However, for a review of the current "consensus" on global climate change, those of you with access to SA can read "The Physical Science behind CLIMATE CHANGE" (all caps in the original), beginning on page 64.

Global Warming: No Debate? (Reporting bias)

Just one more example of the effects of reporting bias in the scientific literature - and another warning to be wary, even about "consensus."

The journal, Nature, now reviews its own blogs on a web page titled the "From the blogosphere,"a subheading of the "Author" web page., on the homepage of the journal's website. The "From the blogosphere" heading was on this morning's "headlines" that were chosen by my Google search page. Unfortunately, the blogs are behind a paywall.

One of the blogs, "Peer-to-peer: for peer-reviewers and about peer review" has a discussion about the controversy over a meta-analysis published in Science magazine by the science historian, Naomi Oreskes, based on this opinion piece - that is available for free - at the UK Guardian, by Jonathan Wolfe. I believe that the point of Mr. Wolfe's commentary is that non-experts should "shut" our mouths, because we flat don't know enough.

Neither Mr. Wolfe nor the Nature blogger make any mention that the report by Oreskes was severely flawed and inaccurate. However, as the one comment at "Peer to Peer" reports, "This is very odd. The main critic of Oreskes' work was Benny Peiser, who is not a blogger or a think-tanker, but a member of faculty at John Moores University and a fellow of the Royal Astronomical Society."


I hope Mr. Wolfe or the Nature bloggers will follow up on the Oreskes article and the controversy surrounding it, because there appears to be a secondary theme: bias can lead to error, even in peer reviewed, scientific journals.

Oreske's article, originally published in Science in December, 2004. This review of the scientific literature is often quoted to support the position that there is no disagreement among scientists about whether the earth is warming due to the increase of "greenhouse" gases, and that those greenhouse gases are due to the influence we humans have on our environment. However, the problem appears to be a flaw in both the professor's methodology and her reporting. She mis-reported her search terms, and those terms - the use of the three words, "global climate change," rather than "climate change" - make a huge difference.

Here is the "Erratum" published in January, 2005 by Science:

Essays: “The scientific consensus on climate change” by N. Oreskes (3 Dec.2004, p. 1686). The final sentence of the fifth paragraph should read “That hypothesis was tested by analyzing 928 abstracts, published in refereed scientific journals between 1993 and 2003, and listed in the ISI database with the keywords ‘global climate change’ (9).” The keywords used were “global climate change,” not “climate change.”

The choice of search terms seems to make a huge difference. From a web page entitled, "The Letter Science Magazine refused to publish," by professor of anthropology, Benny Peiser, we learn,

On December 3rd, only days before the start of the 10th Conference of Parties of the United Nations Framework Convention on Climate Change (COP-10), Science Magazine published the results of a study by Naomi Oreskes (1): For the first time, empirical evidence was presented that appeared to show an unanimous, scientific consensus on the anthropogenic causes of recent global warming.

Oreskes claims to have analysed 928 abstracts she found listed on the ISI database using the keywords "climate change". However, a search on the ISI database using the keywords "climate change" for the years 1993 - 2003 reveals that almost 12,000 papers were published during the decade in question (2). What happened to the countless research papers that show that global temperatures were similar or even higher during the Holocene Climate Optimum and the Medieval Warm Period when atmospheric CO2 levels were much lower than today; that solar variability is a key driver of recent climate change, and that climate modeling is highly uncertain?

These objections were put to Oreskes by science writer David Appell. On 15 December 2004, she admitted that there was indeed a serious mistake in her Science essay. According to Oreskes, her study was not based on the keywords "climate change," but on "global climate change" (3).

Her use of three keywords instead of two reduced the list of peer reviewed publications by one order of magnitude (on the UK's ISI databank the keyword search "global climate change" comes up with 1247 documents). Since the results looked questionable, I decided to replicate the Oreskes study.

***

DISCUSSION:
According to Oreskes, 75% of the 928 abstracts she analysed (i.e. 695) fell into these first three categories, "either explicitly or implicitly accepting the consensus view". This claim is incorrect on two counts: My analysis shows that only 424 abstracts (or less than a third of the full data set) fall into these three categories.

It also shows that many abstracts on "evaluation of impact" and "mitigation" do not discuss which drivers are key to global climate change, instead often focusing exclusively on the possible effects of elevated CO2 levels on plant growth and vegetation. Many do not include any implicit endorsement of the 'consensus view' but simply use certain assumptions as a basis for often hypothetical impact assessments or mitigation strategies.

Quite a number of papers emphasise that natural factors play a major if not the key role in recent climate change (4). My analysis also shows that there are almost three times as many abstracts that are sceptical of the notion of anthropogenic climate change than those that explicitly endorse it (5, 6, 7).

I guess our lesson should be to be skeptical of "consensus," just as we are becoming skeptical of "peer reviewed" journals that rush to print on "hot" stories about cloning and stem cells.

The Veto vs. the Big Picture

Yesterday, the President vetoed a Bill that would have "enhanced" some human embryos right out of life, while pledging to save more lives, now.

According to the White House Press Release reporting on President Bush's speech, he was joined by Dr. William Hurlbut and Dr. Don Landry. Both of these men are proponents of alternative means to harvest cells that could be as "plastic" as embyronic stem cells - in fact could be embryonic stem cells - without destroying or harming embryonic humans.

The President got his priorities right as well as his science.

Congress has sent me a bill that would overturn this policy. If this legislation became law, it would compel American taxpayers -- for the first time in our history -- to support the deliberate destruction of human embryos. I made it clear to Congress and to the American people that I will not allow our nation to cross this moral line. Last year, Congress passed a similar bill -- I kept my promise by vetoing it. And today I'm keeping my word again: I am vetoing the bill that Congress has sent. (Applause.)

Destroying human life in the hopes of saving human life is not ethical -- and it is not the only option before us.

First, he states that no matter how "useful" the harvest of human embryos, it is not ethical and he will not support the purposeful destruction of some non-threatening humans for the benefit of others.

We call these humans "innocent,"but this is one of the words that will be attacked when the opposition reports on the story. When you hear or read about someone ridiculing the notion that the President is protecting "innocent" embryos, you could ask them how any embryo ever harmed them enough to deserve to die.

It might also be useful to remember that there was protest in the '70's over the institution of in vitro fertilization and the creation of human embryos out side of the body. We were promised that these youngest members of our family would only be loved, wanted and implanted, never used as experimental fodder.

Well, that promise lasted about as long as the promise to use only "left over" embryos, a promise broken at Universities around the US, at least very remotely supported by our taxes and society.

This week, we've seen an increased push for that Country's regulatory board to allow human-animal hybrid embryos, using human DNA and animal eggs. We've heard about one researcher's cloning of Primates using rhesus monkey skin cells in order to successfully create embryos, and then to destroy and harvest two lines of embryonic stem cells. (Note, everyone's calling it "cloning," although watch the way the topic is quickly moved to "blastocyst" from embryo.) There'll be quite a bit of hype about how this will advance human cloning. There's even a new report that indicates that 60% of IVF parents would donate their embryonic children to research if they knew the embryos would be used to harvest stem cells.

Please watch the language and the route of the discussion. We'll hear about the "waste" of embryos that are left over, but no suggestions that we make fewer embryos. Instead, immediately following, there'll be a plea for funding to create more, specific embryos in order to study disease. Disease which is not seen at the embryonic stage of life, by the way. we'll hear about the "necessity" for "patient specific stem cells," using "SCNT" (yes, it's cloning, see the articles on the cloned rhesus monkeys) to create new blastocysts and new cell lines to match each patient and each disease. You'll probably read the new term, "blastocystic" or "blastocyst" stem cells, being touted by at least one author.

Men have always killed each other and they probably always will. There's just no need to hand them US Federal tax dollars for doing so.

"Flawed" Adult Progenitor Cells Study

Lots in the stem cell news about the report a few years ago that certain populations of adult stem cells can become "any cell in the body."

No one doubts whether Verfaillie found the stem cells that she said she did. The problem is that there were mistakes in the reports about how she actually did it and that other labs have had a hard time duplicating her work. From the New Scientist article on the "flaws":

"In her most recent paper, Verfaillie and Irving Weissman, a stem cell biologist at Stanford University in California, showed that MAPCs can give rise to all the cell types found in blood, but it is still unclear whether MAPCs are as versatile as she claimed in the original Nature paper."

Many researchers are unable even to isolate them. “They’re very testy cells,” observes Amy Wagers of Harvard University, who spent a week in Verfaillie’s lab trying in vain to learn the technique.

The problems with the marker profiles may help explain these difficulties. “If I had been following this recipe since 2002, I’d be extremely angry,” says Jeanne Loring, a stem cell biologist at the Burnham Institute for Medical Research in La Jolla, California.

There's a much more detailed evaluation on the original report in yesterday's The Scientist:

Tim Mulcahy, vice president for research at the University of Minnesota, told The Scientist that the university asked two experts in flow cytometry to review the data, and they found "technical flaws with the paper," but said they didn't have the background to determine if the problems affected the results. The university then contacted three stem cell experts, and two agreed to review the data. One reviewer said the flawed data wouldn't affect the findings, and the other said the flaws might "weaken the conclusions," Mulcahy noted. He said the university decided to release the information to allow the scientific community to debate the impact of the panel's findings. The university is not releasing the names of the stem cell experts who reviewed the data.

Mulcahy added that Verfaillie asked the university to investigate the findings, and has been very helpful. "This was all done with her consensus and her willing cooperation."

The outside experts agreed with Aldhous that the antigenic markers used to define the MAPCs were in question, Verfaillie said -- "as do I," she added. But these concerns don't affect the results, she noted. "As MAPCs were - and still are - not defined on the basis of a phenotype, but based on functional criteria, I believe therefore that the conclusions of the papers are still correct. Obviously that is up to the scientific community to decide."

The current debate is over a "minor point," said Diane Krause, a stem cell researcher at Yale University. The concerns about the Nature paper focus on the "antigenic profile of these cells, and not what they can do," she told The Scientist. "I certainly believe Catherine," Krause added. "I think she's got the highest amount of integrity."

Indeed, researcher Mark Clements, from Westminster University in London, UK, has had some success replicating Verfaillie's results with human cells. "The inaccuracies in Catherine's papers do cast a shadow over her work," he told The Scientist, "but I do believe the underlying premise is valid."

Clements said the errors in the paper raise questions about the definition of MAPCs in terms of cell markers, but agreed that the overall premise of the paper is intact. "Our experience of the human cells tells us that the main problem with them is that they're so fastidious to grow," he said. This would explain why other labs and indeed Catherine's lab have had difficulties replicating this work, Clements said.

Thomas Braun from the Max Planck Institute for Heart and Lung Research in Germany told The Scientist he thinks the explanation for the duplication of the figures was adequate. "Things like that happen although it is always hard to understand why such errors are not recognized at an earlier stage," he said.

A follow up study published in Journal of Experimental Medicine (I don't have link) and reported on in Science,that included doubter Irving Weissman proved multipotency, if not pleuripotency.

"The work has impressed one skeptic, Stanford blood stem cell researcher Irving Weissman, who collaborated on the new work. Weissman calls the result "remarkable." His skepticism, he adds, "makes me a perfect collaborator, because I insisted on very rigorous criteria for the experiments."

He emphasizes, as does Verfaillie, that these cells are clearly not as versatile as ES cells. But despite their limitations, they could prove to be useful therapeutically.

"A lot of people have lost interest in MAP cells by this point," says Weissman. "What our paper will help do is get everybody to look at it again." Others agree. "I'm sure it will revive interest in MAP cells," says stem cell researcher Paul Schiller of the University of Miami, Florida."

Perhaps, now that the "recipe" is corrected, more labs will confirm the original reports.

Different populations and kinds of adult stem cells are indeed very versatile, especially for producing what we really want: stable cells that will only become the exact specialized cells that are needed, where they are needed.

Adult stem cells have yielded more populations of specific progenitor and stem cells than even embryonic stem cells. The only place that embryonic stem cells work to produce "every cell in the body" is in the original container - in the intact embryo. Elsewhere, they produce embryoid bodies or teratomas, or mutate and die out unless first manipulated to become a more specialized stem cell or progenitor cell.

Which sounds like an adult stem cell or progenitor cell, to me.

Part of the problem with all stem cell research is that, as in the press coverage, scientists have also been "shotgunning" with groups of cells as though all samples stem cells are a bunch of homogeneous one size fits all entity. Slowly but surely, we're learning what markers to look for in order to find the most primitive or the exact future lineage we need, the environment, stimulating factors and the epigenetic factors involved.

If we think the progress has been fast before, I don't think it's anything like what will happen in the next 5 years.

(HT to FreeRepublic's neverdem.)

Debate On Ethics

After several days of discussion about a baby that Texas lawyer Jerri Ward asked Wesley Smith to blog about on Secondhand Smoke, I have been asked "How can you be a doctor and not know this about what passes for ethics nowadays?"

Because I have a different understanding "about what passes for ethics nowadays."

I do not agree that euthanasia is practiced in Texas medicine or that utilitarian arguments prevail in medical ethics, especially in Texas. I am a pro-life family doctor who has been studying and practicing medicine, and now, bioethics in Texas. My activism and biggest motivator has been focused on the manipulation and dehumanizing of humans at the beginning of life, because of the advocacy for abortion and destructive embryonic research. I am repeatedly reassured that our Texas physicians do not support euthanasia at the end of life by what I know of them and by what I witness at our medical association meetings and at the meetings where we have been debating the amendment of the Texas Advance Directive Act.

I know what is said in the literature, in the media, in the blogs, and what is said between doctors. I've experienced being the patient, the daughter, wife and mother of a patient, and the doctor in some tough ethical situations.

The elite "ethicists" across the world voice and publish all sorts of utilitarian ideas, including the feminist bioethicists at the American Society of Bioethics and Humanities who discounted conscience as a legitimate guide for physician's actions. I oppose this sort of "ethics" every chance I get.

However, the doctors in Texas do not advocate or encourage such drivel. The very rare doc who is unwise enough to voice the opinion that some lives are not worth living is immediately countered and out-numbered and out-reasoned by his or her professional and compassionate colleagues.

In contrast to my own experiences and education, in the one-sided reports on the blogs and in the media, I hear a story that never quite fits what I know about medical facts, much less about the way I see practical clinical ethics being practiced and taught in Texas. Unlike the other posters at Secondhand Smoke, it is not at all "obvious" to me what happened in this case.

Concerning the bit we know about the case in question, it's not at all "obvious" to me that any pediatrician would have argued to an ethics committee that there are not enough resources to go around or that a child would be better off dead than to have a safe tracheostomy and feeding tube placement in order to continue the current level of technology and in anticipation of transfer to the proper step down care.

On the other hand, if, as I suspected, there had been concerns about imminent death or about a crisis due to the mitochondrial defect flaring after stress of surgery, then it would have been appropriate to object to treatment that could hasten death while causing pain and (surgically) separating the child from her/his mother.

I spent several hours over the last two days watching and listening to the hearings last August 9 on the TADA. I couldn't attend them because my mother was in the hospital - she died August 14. I was reassured by the testimony of the doctors and hospital representatives.

As I said, part of what the lawyer who reported this case experiences is most likely ("obviously") the result of her previously publicized comments in the media that doctors and hospitals kill patients and bury their mistakes.

There's (Still) No "Futile Care Act" in Texas

I keep running across news articles like this one in the Dallas Morning News (free subscription required) which claim that Texas has some sort of "futile care" law. There is no such thing as a "Futile Care Law" in Texas and never has been. (Previous LifeEthics posts include several in April, 2006.)

There is a law called the Texas Advance Directive Act (TADA). (Here at the Texas Statutes website in pdf, and an excerpt with my comments, here.) The law was written by a coalition of doctors, lawyers, patient advocates, disability rights groups, and pro-life groups such as Texas Right to Life, National Right to Life, and Texas Alliance for Life.

In that DMN article above, please note that Dr. Fine was interviewed without knowledge that he would be quoted in an article about a very sad case, one which had not come to the point of being subject to TADA at the time of the interview.

I am concerned that Texas Right to Life is not speaking up about why they found the law acceptible in 1999, but feel that they can condemn it - and all doctors and hospitals - now.

We never stop treating the patient. The TADA has never been invoked in order to withhold food or water from patients or from a patient who only needs artificial food and water. The Texas Advance Directive Act does, however, allow doctors to refuse to use medicine and technology that is not in our patient's best interest, treatment that is harmful or futile.

There are no futile patients, and no "futile care law," there is only futile medicine and technology.

If my patient suffers organ failure after organ failure, some medicines and technology can become harmful -- sometimes by causing side effects and more organ failure, often by prolonging the patient's dying.

In fact the TADA coalition has been trying to come to a consensus on making sure that the Act cannot be invoked if the only intervention needed is food and water. It has also been agreed that the Coalition will support a longer period of notice before the ethics committee meeting is held, that medical records need to be offered in a timely manner and that the family should have two weeks in order to find another doctor or facility.


The cases in Texas which have been cited to criticize the TADA include:

• A woman who had been in the ICU for 4 or 5 months after heart surgery, who had had a stroke and was on a ventilator. Her doctors had suggested to her family that perhaps they should not begin dialysis when her kidneys failed. The family rejected the suggestion and the patient had to have continuous, then intermittent dialysis. She then needed increasing doses of medicines to raise her blood pressure. After a while, the attending doctor again suggested stopping or withholding the addition of new treatments because of the risk of pain and complications that each treatment added on top of the previous complications. Again, the family refused. The doctor decided that he couldn't continue to escalate the interventions and asked for an ethics committee meeting under 166.046. The family members postponed several times, putting off the meeting. Somewhere in this time, the family threatened legal action, picketing, and raising as much bad publicity for the family as they could muster. Finally, the hospital set a meeting for a firm time and refused to budge. The ethics committee members agreed with the doctor and began the process to help the family find a new doctor or a new facility for the patient. The family began protests that became news nation-wide. A new doctor was found and additional treatments and invasive interventions were performed on the patient. Finally, the doctor reported that the patient had had a heart attack, and the ventilator was stopped without verifying brain death.
• In another case, the patient was brain dead, but the family members sued to prevent the doctor - who had been the woman's family doctor for years - from turning off the ventilator. A new doctor came in, did an additional test, and confirmed that the patient was brain dead.
• A third case involved a woman who had a stroke, was unconscious and required a ventilator and dialysis. The patient's daughter was an ER doctor in that hospital. There are no Texas long term facilities that offer dialysis to an unconscious patient on a ventilator. The patient was sent home with home dialysis and ventilator.
• A fourth case involved another woman who had had a stroke, was unconscious and required dialysis. There is still no facility in Texas that offers dialysis for a comatose patient on a ventilator. Her family objected to the hospital's "forcing" them to move her to another facility. Eventually, she was moved to another state, where there is a long term facility that could provide the treatment she needed.

Unfortunately, a repeating theme from some of the lawyers at the meetings is an objection that doctors are protected from malpractice if they follow the Act.

Two identical Bills before the Texas Legislature, SB 439 and HB 1094 not only remove the current protection from risk of malpractice for doctors who follow their consciences and would require doctors to use ever escalationg "life saving treatment" until (as in the case of Andrea Clark) the family decides to remove it or until transfer to another doctor or facility is arranged, without a time limit.


Do we really want to override doctors' consciences? Remember the NEJM article from last week.

Concerning abortion due to failure of contraception and prescribing contraceptives to 14 to 16 year olds when parents object, the Chicago Tribune reports that some believe this is the case:

That approach doesn't even give a patient the option to access other physicians," said R. Alta Charo, a professor of law and bioethics at the University of Wisconsin-Madison who was not involved in the study. "It's a raw imposition of your personal beliefs on all those who come to you for professional services."

Publish (destroy embryos) or perish

Professor James L. Sherley is losing weight on his hunger strike, but Fox News and Reuters are the only mainstream media outlets to take notice. It seems that racial discrimination, storming the Administration building of a university and even extreme measures of weight loss are not newsworthy if you're critical of embryonic stem cell research and cloning.

It doesn't matter that Dr. Sherley reported a break-through on the secret to inducing adult stem cells to divide and how and why these cells can form cancers (here and here). It is of no consequence whatever that he won an award from the NIH, and millions of dollars in research money to go with it. Unfortunately, he also criticized embryonic destruction and cloning in public, with letters to the editors in Science, Nature, and The Boston Globe.


Dr. Sherley has shown rare conscience and integrity by confronting and exposing the bias and prejudice within academia encountered by those who believe that human beings should not be killed in experiments, and most certainly should not be created for the purpose of killing.

He has been a vocal critic - albeit one who is rarely quoted in the media - of embryonic stem cell research, creating embryos for the purpose of killing for research, and of cloning in order to obtain embryos for research and killing in research.

He is using the tools - the legitimate, legal and ethical tools using current law and endangering no one other than himself - that have been provided by the law, the media and his own intellectual and moral adversaries. But, don't expect to see his story in the National news.

In the United States, the law protects those discriminated against because of their race and Dr. Sherley has charged that he is a victim of racial discrimination at the Massachusetts Institute of Technology. According to this article (from a conservative news service begun by Brent Bozell - one of the very few reporting at all on the story) points out that Dr. Sherley is "he first and only black faculty member of MIT's Division of Biological Engineering, and he was awarded a $2.5 million research grant last year from the National Institutes of Health." Colleagues support the conflict of interest demonstrated by the choice of the lead tenure reviewer - who is married to someone who was a prior critic of Dr. Sherley:
From the Boston Globe,

Some MIT professors are circulating a letter that asks for further investigation into the process that denied Sherley tenure. The letter states that a head of Sherley's department is married to a senior faculty member whose relationship with Sherley has been "openly contentious." That division head should have recused himself from deciding Sherley's case, rather than soliciting an internal letter from his wife to include in Sherley's tenure file, the letter said.

"We checked to see whether that influenced the decision, and we are confident that it did not," Clay said.

Of 740 tenured faculty members at MIT, 27 are African-American or Hispanic. Three minority faculty members have earned tenure since Sherley was denied, according to the school.

The mainstream media have not given Dr. Sherley the same publicity that they would if he would just advocate for the killing of a few embryos. Even his hunger strike is not very successful at gaining national attention.

Could it be that no one at UPI, any of the big 3 television networks, Time, Newsweek, or CNN cares about racial discrimination at MIT? There's nothing from any of these as of this morning - not one little note - according to my Google News search at about 7:30 AM CST.


Or could it be that no one cares about the discrimination against a man who has had a letter published in Nature criticizing embryonic stem cell research?

Bad, Bad Doctors (Religious, with Consciences)

The NEJM has a free on line article evaluating the results of a survey of doctors, "Religion, Conscience and Controversial Clinical Practices," which is a perfect example that far too much of the effort of "medical ethics" or "bioethics," goes into deciding who can be killed.

"In recent years, several states have passed laws that shield physicians and other health care providers from adverse consequences for refusing to participate in medical services that would violate their consciences. For example, the Illinois Health Care Right of Conscience Act protects a health care provider from all liability or discrimination that might result as a consequence of "his or her refusal to perform, assist, counsel, suggest, recommend, refer or participate in any way in any particular form of health care service which is contrary to the conscience of such physician or health care personnel." In the wake of recent controversies over emergency contraception, editorials in leading clinical journals have criticized these "conscience clauses" and challenged the idea that physicians may deny legally and medically permitted medical interventions, particularly if their objections are personal and religious. Charo, for example, suggests that the conflict about conscience clauses "represents the latest struggle with regard to religion in America," and she criticizes those medical professionals who would claim "an unfettered right to personal autonomy while holding monopolistic control over a public good." Savulescu takes a stronger stance, arguing that "a doctor's conscience has little place in the delivery of modern medical care" and that "if people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors.""

"If physicians' ideas translate into their practices, then 14% of patients — more than 40 million Americans — may be cared for by physicians who do not believe they are obligated to disclose information about medically available treatments they consider objectionable. In addition, 29% of patients — or nearly 100 million Americans — may be cared for by physicians who do not believe they have an obligation to refer the patient to another provider for such treatments. The proportion of physicians who object to certain treatments is substantial. For example, 52% of the physicians in this study reported objections to abortion for failed contraception, and 42% reported objections to contraception for adolescents without parental consent."

Not surprisingly, these "controversial" "legal" practices are abortion "for failed contraception," giving "birth control to teenagers between the age of 14 and 16 if their parents do not approve," and "sedation to unconsciousness in dying patients." For some reason, the authors do not give results or even discuss the other "Controversial Issues in Medicine": Physician assisted suicide, withdrawal of artificial life support or abortion for congenital anomalies.



First, "elective" abortion is neither mandatory nor beneficial.

Second, I guess that the first discussion must be whether or not "legal" implies that a practice is necessarily "beneficial," moral, or required.

Third, the legality of providing contraceptives to minors under the age of consent, against their parents' wishes, is questionable, except in Federally funded clinics, where it is mandated under Title X funding for Family Planning clinics.

Fourth, it is illegal in most states to participate in "Physician Assisted Suicide."

And fifth, the "monopolistic control" is distraction. Are all professionals who are licensed by the government required to do whatever is demanded of them by whomever can use their services? Let's see: architects, engineers, all those media types?

If so, I'd like to ask Alta Charo - who, after all is a licensed lawyer, working for a State University that receives Federal funds - to give me some good, solid quotes that do not advocate the taking of human life or the defamation of those of us who act on our convictions.





Take a look at the survey and the article. Take the survey.

Do you agree with the "bioethicists" quoted in the introduction?

Texas: First to Mandate STD Vaccine

That'll shock 'em on the coasts, won't it? Not to mention France and England, since the story has gone global.

Governor Rick Perry reportedly (free registration required) has signed an order mandating that teen girls in the State of Texas receive the vaccine against four strains of the Human Papilloma Virus by 12 years old and that the State pay for the vaccines that are not covered by health insurance. Two of these strains cause most cases of cervical cancer, and the other two cause most of the big, ugly genital warts that, while they don't cause cancer, can obstruct the urine or bowels and definitely cause bleeding and pain.

We all hope that our daughters and sons will meet their perfect mate, get married while they are both virgins. Then, we wouldn't have to worry about 99.7% of all cervical cancer. However, as Dr. Gene Rudd of the Christian and Dental Medical Association has said, no matter how well we raise our daughters and sons, their future husbands and wives may not have benefitted from the same background. A virginal wife can catch the virus from her husband on their wedding night(and vice versa - although he has vastly less risk of cancer of the penis in the US).

Another shock will probably come when (what the Houston Chronicle and the Austin American Statesman are calling) "the Governor's base" does not rise up in revolt and rants.

There is a strong lobby in the State against mandated vaccines (largely driven by objection to mercury preservatives, the vaccinations that are grown in human cell cultures and the troubles with the pertussis [whooping cough] vaccine from the '70's and '80's.) However, while good people who probably agree with the Governor's pro-life, pro-family views on other issues, these are not quite large enough to be called the Governor's "base."

In my opinion, the Governor decided that the vaccine is too important to leave to politics - especially in a State still healing from the redistricting fight of 2003, that ended up with first the Democratic Representatives and then the Democratic Senators running away from Austin and leaving the State to stall legislation.

I wish he would go ahead and let both the boys and girls get the shot -- Take a look at this video on "herd immunity." If we're going to do this thing, we might as well eradicate as much of the virus as possible.

I am concerned that no one knows how long the vaccine's effects will last.

On the other hand, this is Texas.

We don't like the government mandating anything. We can be convinced that some things are for the good - at least for other people - if you sell it right(grin).

The Governor must make a huge effort to convince the parents of Texas that this is good for the boys and girls in Texas, and that the money spent on the vaccine ($360 per girl, for 3 shots over 6 months) will save lives and money by preventing cervical cancer, genital warts and even anal cancer in both men and women.

Book Review: Michael Crichton's NEXT

"Stroke Damage May Help Smokers Kick the Habit: The insula, an area of the brain largely ignored by researchers, may hold the key to breaking harmful addictions" (Scientific American Science and Technology News, January 25, 2007)

"Fresh light thrown on tragic drug trial: Animal tests may have missed danger because monkeys 'too clean'." (news@nature.com online, January 25, 2007)

"Preparing cloning for market: Ranchers are getting set, but are consumers ready?" (Boston Globe, January 26, 2007)

"Biomed firm commercializes stem-cell sales" (UPI Business Newstrack)

"New WARF Stem Cell Rules To Benefit Biotech Research" (BioWorld Headlines, AHC Media, LLC, January 25, 2007)

"Crunch time for multiple-gene tests: Sophisticated new genetic tests face an uncertain future — unless they can win clear-cut approval from regulators, insurers and, most importantly, doctors. Virginia Gewin reports." (Nature News, premium access only)

"Stem Cell Debate Rages: Effective Treatements "Decades Away" Prof. McKeown Shocks Audience" (Beaumont College Alumni News, as reported in NEXT, 2006)

Only that last headline is fictional, from Michael Crichton's newest book, NEXT.

I'm just a bit more than half-way through the book, but the fact is that I had to "Google" the fake news report to convince myself that it wasn't a very real article from some past news source. After my sureal experience of researching today's news and having to remind myself that the Google stuff was "real," I was spurred to give y'all a heads up.

Dr. Crichton is the author of The Andromeda Strain, Jurassic Park, and The Terminal Man. His science fiction is heavy on science and he has always seemed to be drawing on tomorrow's news stories - probably (I'd like to believe) because of his medical training.

This book is not very flattering to doctors. Or the media, research scientists, regulatory agencies, public policy makers or politicians. I had nearly decided that the author was stretching reality and coincidence in order to build his story, but then I opened my e-mail this morning and there were the Google News search alerts I've cited above - some of which are more fantastic than anything in the book so far.

In that "fake" news piece above, the reporter quotes a fictional professor of biology as he describes the hype that's surrounded stem cell research, including a thorough history of the human cloning scandals by Korea's Hwang Wu Suk. The "doc" continues,

". . . First, in a media-saturated world, persisitent hype lends unwarranted credulity to the wildest claims. For years the media have touted stem cell research as the coming miracle. So when somebody announced that the miracle had arrived, he was believed. Does that imply there is a danger in media hype? You bet. Because not only does it raise cruel hopes among the ill, it affects scientiest, too. They start to believe the miracle is around the corner - even thought they shourld know better.
"What can we do about media hype? It would stop in a week, if scientific institutions want that. They don't. They love the hype. They know it brings grants. So that won't change. Yale, Stanfor, and Jons Hopkins promote hype just as much as Exxon or Ford. So whenever you hear a scientist claim that his statements have been exaggerated, or taken out of context, just ask him if he has written a letter of protest to the editor. Ninety-nine times out of a hundred, he hasn't."
. . .
"Next lesson: Peer review. All of Hwang's papers in Science were peer-reviewed. If we ever needed evidence that peer review is an empty ritual, this episode provides it. Whang made extraordianry claims. He did not provide extraordinary evidence. many studies have shown that peer review does not improve the quality of scientific papers. Scientists themselves know it doesn't work. Yet the public still regards it as a sign of quality, and says, "This paper was peer-reviewed,' or 'This paper was not peer-reviewed,' as if that meant something. It doesn't.
"Next, the journals themselves. Where was the firm hand of the editor of Science? Remember that the journal Science is a big enterprise - 115 people work on that magazine. Yet gross fraud, including photographs altered with Adobe Photoshop, were not detected. And Photoshop is widely known as a major tool of scientific fraud. Yet the magazine had no way to detect it."
. . .
"The ultimate lesson is that science isn't special - at lest not anymore. Maybe back when Einstein talked to Niels Bohr, and there were only a few dozen important workers in every field. But there are now three million researchers in America. It's no longer a calling, it's a career. Science is as corruptible a human activity as any other. Its practitioners aren't saints, they're human beings, and they do what human beings do - lie, cheat, steal from one another, sue, hide data, fake data, overstate their own importance and denigrate opposing views unfairly. That's human nature. It isn't going to change."

Crichton also slams the patents on human genes and on cells that have been removed from patients in the course of medical treatment - patents that become property and make people near-property of universities and then private corporations.

(He also tweeks people like me, who love to give references in the form of urls or internet addresses in support of their points. One of the characters invents pages of "Google" references in just a few hours in order to hide her own secret. Lesson: Watch your sources, verify and then verify, again.)

Crichton is one of the writers that I recommend for what I call "ethics lessons we don't have to learn the hard way." Science fiction, which long-time Astounding Science Fiction - now Analog Science Fiction and Fact - editor John Campbell called "future fiction," often explores the "why's" and "why not's" of science, medicine and research, and the feelings that characters experience in what are (usually) novel situations that strain everyday ethics. Just as we study classical and contemporary fiction to learn more about the human condition, we can learn from science fiction authors' and their characters' reaction to what is fantastic today (but may not be tomorrow, in a few minutes, or in an "alternate history"), as well as our reaction to their reactions.

I recommend the NEXT to other SF fans and bioethics nuts. I also recently read and recommend Prey and I'm listening to State of Fear on Audiobooks. My favorites are still The Andromeda Strain and The Terminal Man, but Congo is worth reading, too.

The future of stem cells, Texas and politics

The Friday, January 26, 2007 Austin American Statesman editorial, “Stem cell opposition could steer research away from Texas,” flatly states that Governor Rick Perry’s $3 Billion dollar cancer research initiative won't help at all if it doesn't include funding for embryonic stem cell research. The Statesman editors doubt that there will be any scientists to spend the money on.

The editorial is ridiculous – and, as the editors admit, political - in light of daily strides in ethical stem cell research and Texas’ strong research community.

Texas hospitals were among the first in the nation to offer umbilical cord blood transplants. Cooperation between Texas universities, medical schools, NASA and foreign researchers led to technology which allowed the development of embryonic-like stem cells and liver cells from umbilical cord stem cells.

Texas is already enough of a leader in ethical stem cell research to lure the President of the International Society of Stem Cell Researchers, Paul Simmons, Ph.D., away from Australia to the University of Texas Health Sciences Center at Houston.

We also have Diego Castrillon, MD, PhD., who moved from Massachusetts to the University of Texas Southwest Medical Center. Dr. Castrillon is credited with research into the "Fox O's." These are "transcription factors," or local proteins that cause the expression of certain genes. They promote the health of adult stem cells and suppress cancer cells.

This month’s issue of the journal, Cell, will include a report on further research on FoxO’s. From a press release at "Newswise"

The FoxO1, O3, and O4 transcription factors regulate genes in the complicated cell signaling network known as PI3K-AKT, or simply PI3K. Scientists have discovered that PI3K signaling is intimately involved in fundamental cell processes such as metabolism, aging, and protecting the body against cancer. The PI3K circuit has been found to be disrupted in many forms of cancer, making it a hot topic in cancer research labs and drug company boardrooms.

Based on previous work in his laboratory, DePinho, working with Diego Castrillon, MD, PhD, (who is now at the University of Texas Southwest Medical Center), determined that the three FoxOs had redundant, overlapping functions: To uncover those functions, it would be necessary to engineer mice that lacked all three FoxO transcription factors.

To make the task even more difficult, mice lacking FoxO1 die in the womb. DePinho and Castrillon had to engineer mice whose FoxO genes would function normally during development, but would contain a mechanism allowing them to be switched off in adulthood at the scientists’ will. It took DePinho’s team about two years to get the system to work, which Gilliland hailed as a “true tour-de-force of mouse genetics.”

Mutant FoxOs have been implicated in leukemia, and for Gilliland, who studies blood cancers, the triple-knockout mice were an opportunity to dig deeper into the issue. Unexpectedly, however, deletion of FoxO1, 03, and 04 caused blood cell abnormalities but not outright leukemia. A bigger surprise was that the blood stem cells “were really in trouble without those transcription factors,” he said, dividing too rapidly, losing their ability to renew themselves, and dying out. “This means that FoxOs contribute to the longevity of stem cells, and if you take them away, you dramatically shorten stem cells’ lives.”

Looking further, Gilliland and his colleagues found that the damage was being caused by reactive oxygen species, or ROS, a toxic byproduct of cells’ energy production. When the mice were treated with anti-oxidants, the stem cells regained health and longevity. “So, the FoxOs are acting as natural antioxidants,” said Gilliland. Conceivably, he added, drugs could be developed to manipulate the FoxO pathway and extend the lives of stem cells beyond their natural limits, which could aid their use in repairing diseased body tissues.

Texas' limited research funds should be spent on supporting the State's cord blood bank system and continuing research that will give us real cures for Texas' patients.

Note: First paragraph edited for grammar at 10:25 AM CST.

Proof there's no stem cell "ban"

Wesley Smith, at his blog Secondhand Smoke, notes that American Cell Technology has received a grant from the National Institute of Health for research on embryonic stem cells. He also points out what should be obvious: ACT must have received this funding for research on the stem cell lines that are authorized under President Bush's August, 2001 policy.

(In case you can't remember who ACT is, they're the organization that claimed to have cloned human embryos back in 2001, and who claimed to have found a way to produce embryonic stem cells without killing the embryo when in fact they killed every one of those human embryos they used. The company is one of the best examples of the sort of ethics that make people like me think of "ethics for sale." ACT has employed ethicists Art Caplan and Glenn McGee and is very closely associated with Geron, WARF (the research foundation at the University of Wisconsin).

So much for the myth that these cells can't be used or that there is any sort of "ban."

The focus of the research is basic research on how Embryonic Stem Cells divide and differentiate.

From the Washington Business Journal:

The money will support an ongoing collaboration between Alameda-based Advanced Cell (OTCBB: ACTC) and The Burnham Institute of Medical Research in La Jolla.
Researchers are investigating the genetic mechanisms and proteins believed to control how basic embryonic stem cells develop and differentiate. That understanding is essential in harnessing the regenerative powers of stem cells in medical applications, the company says.

This is very basic research, not an actual attempt to produce cells for use in treatments. Hopefully, the added knowledge will point to ethical, non-destructive ways to obtain stem cells for treatment in actual patients.

"Forcing" women to talk to their doctors

This pro-abortion rant from the San Antonio Current is really reaching:

Frank Corte is a pro-life legislator who wants to control Texas’s women and health professionals. With HB 21, he wants to deny women the ability to review abortion warnings privately on video, and instead force them to hear it directly from the doctor; with HB 23, he’d force pharmacists who handle emergency contraception to post “If you believe that life begins at fertilization ...” warnings.

The SA Current is spinning their commentary on the 80th Legislature as though it's a review of TV shows during sweeps week. The Current is a free/throwaway rag, found in lobbies and vestibules of businesses all over town. They advertise themselves as

The Current strives to capture the times in which San Antonians live. We attempt to challenge our readers, by being provocative, irreverent, skeptical, funny, vibrant, and imaginative. We earn our readers' trust by being devoted to fact and dedicated to artful storytelling.

Make that an emphasis on "provocative, irreverent and skeptical."

Texas has a great "Woman's Right to Know Law," designed to fully inform the older - usually surviving - victims of abortion of the nature and consequences of abortion. There's a companion document that lists resources that provide help to pregnant women and young families, which is intended to enable women to chose not to kill their children.

The abortionists hate this booklet and the information that they are required by State law to give the woman, as well as the informed consent process that the State mandates. They've worked out all sorts of ways to avoid the booklet and having the doctor provide the consent, from showing the girls and women the book and telling them they have the option of reading it (or not), to placing stickers on front that state that the information is inacurate. The main tactic is to set up "informed consent" procedures so that the doctor (herself or himself) does not actually have to tell a girl or a woman what he or she is going to do and what will happen.

However, since this "choice" is "between the woman and her doctor," shouldn't the consent process be between the "woman and her doctor?" (Forget for a moment that in real life, the great majority of abortionists never meet their patients before the day of the procedure, unless they do follow the letter of the Texas Womans Right To Know law.)

The irreverence continues in the Current's discription of the legislators who would introduce bills to make the punishment for sexual abuse of children more severe. I hate the death penalty and extremely strict, mandatory prison terms, but recognize that they are sometimes appropriate. (A few years ago, we had a prison break, and the 7 escapees ended up killing a policeman before they were caught.) Child sexual predators are known to be prone to recidivism. This article tells us that these men usually molest 80 to 120 children before they are caught, and tells the stories of Jacob,Jessica, Megan, and Ashley.)

Here's how that Current article views these stories:

Having campaigned successfully for reelection on a kill-all-repeat-child-rapists platform, Dewhurst is now Senate President and determined to pass Jessica’s Law, a Bill O’Reilly-endorsed, sex-offender-punishment proposal that includes a mandatory 25-year sentence for repeat child molesters. Dewhurst can’t introduce legislation on his own, but he’s got a team of senators under his command. They include: “2005 Crimefighter of the Year” Bob Deuell, who’s sponsoring SB 68 to make a second child-rape charge a capital offense; hard-nosed Democrat Rodney Ellis, whose SB 97 would remove the statute of limitations for certain sex offenses; and Florence Shapiro, who ushered through a series of “Ashley’s Law” sex-offender bills in previous sessions.

"Pluripotent" Amniotic/Placental Stem Cells

I've just skimmed the Nature Biotechnology article (free abstract and references with free registration to Nature.com, the article is for subscription or by individual purchase, only)by Atala, De Coppi, et. al, "Isolation of amniotic stem cell lines with potential for therapy" (Nature Biotechnology - 25, 100 - 106 (2007). Published online: 7 January 2007; | doi:10.1038/nbt1274)

The authors claim that the cells are pluripotent. This is not being publicized as much as I would like it to be. Please, when you call your Representative and Senators about the vote that is planned for Thursday, on HR 3, please let them know that these cells may, indeed, be more useful and are much more ethically acceptible than embryonic stem cells from "spare" embryos.

The cells can be obtained from placenta as well as amniotic fluid, so can be harvested without risk to the baby.

The cell lines were evaluated through 120 doublings and appear to be stable. All cell lines were confirmed in mice, using human stem cells implanted into mice that are immune-deficient. There were no teratomas. The human cells repaired damage in the mouse brains, in mice with a disease similar to Krabbe's disease. While the production of dopamine is not documented, the cells also developed along the lines of dopaminergic cells - the cells that are diseased in Parkinson's.

While the use of human nerve cells in the mouse brain could be considered ethically problematic, this is a very significant finding.

The researchers report that they were able to produce several lines of cells, and to prove that some of these cell lines are functional.

"We conclude that the AFS cells are indeed broad-spectrum multipotent (that is, pluripotent) stem cells."

Potential sources of AFS cells in the developing fetus are diverse31.
CD117 (c-Kit), the surface marker used for immunoselection of AFS
cells, plays an important role in gametogenesis, melanogenesis and
hematopoiesis32,33. This receptor protein is present on human ES
cells34, primordial germ cells and many somatic stem cells, including,
but not limited to, those of the neural crest35,36. Despite sharing
expression of c-Kit, AFS cells appear clearly distinct from ES cells, germline stem cells and certain adult stem cell populations, such as hematopoietic stem cells, on the basis of differences both in a variety of cell surface markers and in gene expression patterns assessed by transcriptional profiling37. Thus, the role of AFS cells in ontogeny is not yet clear.
AFS cells can serve as precursors to a broad spectrum of differentiated cell types. We used retroviral marking of AFS cell clones to rigorously assess their multipotent character. Cells from a marked clone were induced to differentiate along six distinct lineages (adipogenic, osteogenic, myogenic, endothelial, neurogenic and hepatic). DNA of the resulting specialized cells contained a unique marker junction fragment between proviral and cellular sequences in the genome. In addition to the markers and cell types documented here, we have demonstrated that human AFS cells of the same clone can be induced to express markers characteristic of cardiac muscle, including cardiac myosin, troponin I and troponin T, and of pancreatic beta-cells, including Pax6, neurogenin D and insulin (data not shown). Human AFS cells can therefore yield differentiated cells corresponding to each of the three embryonic germ layers. The full range of adult somatic cells to which AFS cells can give rise remains to be determined.

. . .

AFS cells are able to differentiate along adipogenic, osteogenic,
myogenic, endothelial, neurogenic and hepatic pathways.We show the
acquisition of lineage-specific functionality by AFS cells differentiated
in vitro toward neurons, osteoblasts and hepatocytes. For some cell
types, acquisition of a full terminally differentiated phenotype is
difficult to achieve in culture. The expression of characteristic functions
may demand multistage protocols, as exemplified here by the
expression of GIRK channels after neurogenic differentiation. Similarly,
we observed urea secretion after hepatogenic differentiation. This
represents a liver-specific function that requires the coordinated
expression of several enzymes and specific mitochondrial amino
acid transporters.

Note - edited for the spelling of De Coppi, and for a correction concerning "Krabbe's Disease." (The disease treated with fetal stem cells was "Batten's Disease."

No Debate, No Amendments on Embryonic Stem Cell Bill

From the Sun Chronicle

Democrats have an agenda for the first 100 hours of the new session that includes ethics reform, a higher minimum wage, more stem cell research and lower student loan costs.

Those bills are being debated under what is called a closed rule, under which no amendments are allowed.

They are being proposed directly from the Democratic leadership, without the benefit of committee hearings.

We must call our Representatives and our Senators about the Castle-DeGette Bill, HR 3 and S 5.

We keep saying, "There is no 'ban.' There's already taxpayer funding for both ethical stem cells and for the few stem cell lines that the President authorized (after the Clinton administration made the commitment to buy them).

We can talk and write and blog all week on the stem cells from amniotic fluid, umbilical cords, the placenta and in the target organs themselves. We can discuss "niches" and local environments, factors and markers.

Very little of this positive talk about ethical stem cell research is being heard.

"It's a matter of taste."

Bioethics.com has posted a YouTube video from the Ali G show with Dr. Edmund Pelligrino (identified as from "Georgetown University, Papal Advisor Medical Ethics"), Richard Fischer ("American Institute of Homeopathy), Dr. John Freeman ("Johns Hopkins Medical School") and Louis Brescht ("Catholic Medical Association"). The segment can also be viewed here, identified as "Ali G - Medical Ethics."

For more information, you may want to read this article at the American Enterprise Institute that explains how one man escaped the same fate.

I'm incredibly impressed with the way the men who find themselves in an obviously ridiculous position behaved. No one was angry, no one was condescending, and they seem to be trying to teach, almost kind.

Now, I have to figure out whether my posting all this information about the circumstances as well as the links makes me as gullible as the men that were fooled by Sacha Baron Cohen. Especially since I have to admit that, although I thought I recognized the interviewer as the same man who plays "Barat," but know I didn't have a clue who "Ali G" was until I googled the name.

Cow-human hybrid ban "would cost patient lives."

The pushing of limits never stops.

First, as far as we know, no one's been able to make an embryo by injecting the nucleus of a human into the emptied cell of a cow oocyte. If they have, they aren't publishing the results and there's definitely no reports about stem cells from the results.

However, the BBC News and USAToday are now telling us that if the UK authorities refuse to license researchers who wish to do this research, then cures for "even Alzheimer's disease" are at jeopardy and threatened. The Telegraph claims that a ban "would cost patient lives."

The Times tells us that these embryos are

. . . are purely for laboratory use and will be used in the valuable search for genetic causes of such deadly afflictions as motor neuron disease. Animal eggs are far easier to harvest than human ones, but once emptied of their DNA can be used to produce an embryo that is more than 99.5 per cent human. They are therefore not technically hybrids or chimeras and there is no question of such embryos being implanted in a womb — which is already illegal.

I'm reassured, aren't you? Especially since the Times goes on to imply that our real problem is that we don't understand what the smart scientists are doing, and an Editorial in Nature (sorry, subscription only) warns of a "quagmire" if scientists allow the public to regulate them.

At least the controversy brings up the fact that harvesting eggs from women is not "practical."

Several stem cell experts submitted applications for a license to create human stem cells using animal eggs. The process involves injecting an empty cow or rabbit egg with human DNA. That would produce an egg with human genetic material inside, with minute traces of animal genetic material.

After a burst of electricity, the egg would be tricked into dividing regularly, becoming a very early embryo from which stem cells could be extracted.

Removing the animal's nucleus ensures that it would not be a chimera, or human-animal hybrid. "When you remove the nucleus with its DNA, you remove the species identity of the egg," said Dr. Stephen Minger, director of the stem cell biology laboratory at King's College. The proportion of animal to human genes would be tiny, with 13 animal genes versus 30 000 human genes.

Minger and colleagues applied for licenses to do this kind of work to better understand degenerative diseases at the cellular level, with the aim of finding targets for new drug treatments. The embryos would not be allowed to develop for more than 14 days.

Using human eggs is not practical because transferring genetic material into a host egg is extremely inefficient. In addition, there are too few human eggs available. Scientists say they would be lucky to get two or three human eggs in one month. In contrast, they could easily get 200 cow eggs in a single day.

All of this makes the research sound like a given. It's anything but.

There was a report out of China that embryos were created using rabbit oocyte cell bodies and human nuclear material. (Articles from 2003: a report from the Washington Post here and the abstract of the original article in Cell Research, here.)The embryonic cells that resulted supposedly manufactured human proteins and appeared to follow human development. Last January, researchers were asking for permission to repeat this experiment in the UK. I haven't been able to find reports that this sort of Somatic Cell Nuclear Transplantation or cloning of hybrid or human-animal embryos has ever been replicated in other labs, or whether the stem cells from this report have been examined by other researchers.

As I wrote yesterday, there is no way to discover how normal or abnormal these cells - if they are ever produced in other labs - is by implanting them in humans.

And, of course, the real ethical question is whether or not the embryos would be "human." If they produce human embryonic stem cells, I would say, "yes." And it is not ethical to destroy even
"potential" human lives in research.