D.Vorhaus
From Cyberlaw
April 24, 2006
What I Learned from Terri Schiavo
In listening to the presentations about the Schiavo case, an issue that I've thought about some before, the point that stood out most clearly to me, above and beyond any question about whether the right thing (legally or ethically) was done in Terri’s case, is that end-of-life decisions are something that must be faced before that time comes.
Of course I understand that, in some cases and for some people, to expect advance planning on this topic is unlikely. Unfortunately there are those in life who die young or who have more immediate problems to consider, such as feeding themselves or their families. And, for these reasons, as well as for others, the issues that Terri Schiavo’s case raised to the level of national consciousness are indisputably important ones that must be carefully considered.
But for those of us with the dual luxuries of health and leisure – and I can only assume that most, if not all, members of this course fall into that category - we have the ability, and the responsibility, to avoid situations like Schiavo’s by making end-of-life decisions on our own behalf; and making them well in advance. In so doing we can avoid the uncertainty, and the type of gut-wrenching decisions, that tore apart the Schiavo family.
Tonight, shortly after class, I learned that my grandfather had been admitted to the hospital with pneumonia. My grandfather has been suffering from Alzheimer’s for over a decade and, according to his doctor, in his current deteriorated condition attempting to treat the pneumonia, even if successful, would leave him dependant on life-sustaining technologies of some sort. I'm thankful that, within my family, there is no confusion over what is to be done next. My grandfather and my grandmother discussed this scenario years ago – with each other and with their children. Though I’m saddened, and though I miss my grandfather more acutely today than yesterday, I am happy for him in a way. I am thankful that he made his wishes clearly known and that they will be obeyed. Most of all, I am proud: he lived a full and admirable life, and a long life as well – and his sun is now setting.
We should all of us be so fortunate in our own lives.
[Note: For those seeking information on advance directives and living wills, Caring Connections offers comprehensive information on the subject, along with official forms (available as .pdfs) for all fifty states.]
April 23, 2006
The Stem Cell Wedge Maneuver
Taking a page out of the Discovery Institute's playbook, the Democratic party is angling to make embryonic stem cell research a 2006 campaign issue which will drive a wedge into the Republican party, divide candidates and voters, and reclaim a Congressional majority in the 110th Congress. Will it work? Ask me again in September, after we've invaded Iran and everybody has forgotten about stem cells...
April 16, 2006
The Unknown: Cartagena to Berlin
The unknown.
It is baffling to Rummy and a frightening prospect to many. As such it is no surprise to learn that Food and Drug Administration is planning to take a closer look at nanotechnology at an upcoming meeting this October. This announcement falls on the heels of a recent recall in Germany where a bathroom cleaner using nanoparticles was recalled after being preliminarily linked to respiratory problems.
With regulators taking a closer look at nanotechnology, and some degree of concern that the long-term effects of pursuing nanotechnologies are largely unknown and potentially harmful, it's perhaps instructive to reflect on the Cartagena Protocol, created in 2000 to protect against the unknown dangers of genetically modified organisms. In a piece last week on SciDev.net, Arnoldo Ventura argues that while caution at the time was prudent, the Cartagena Protocol today serves primarily as a barrier to scientific development, and a drain on resources.
Am I arguing that the FDA is doing the wrong thing by taking a closer look at the emerging nanotechnology and nanomaterials industry? Not at all. But it's important to remember that "unknown" is not synonymous with "dangerous". Prudence is desirable, irrational fear of the unknown is not.
In the words of Horace Porter, "Be moderate in everything, including moderation."
New Face, Old News
With far less fanfare (or consternation) as last November's operation in France, a Chinese man received a partial face transplant on Friday after having been mauled by a black bear. Isn't it amazing the relative calm brought about by even the most modest familiarity with a scientific procedure?
- Dan- I was thinking the same thing myself. It's amazing how the whole world was so disturbed by the partial face transplant in Europe this past fall and no one is even blinking an eye this time (especially when the transplanted part of the face apparently is noticeably lighter in color than the patient's own skin, making the fact that he has had a transplant much more apparent). It almost seemed like there were so many negative sentiments in the US surrounding the first procedure (at least from the medical community's perspective) because we hadn't been the ones to do it first, and now that we've gotten past that, no one is even questioning the ethics of the procedure anymore.Julie Baher 12:00, 20 April 2006 (EDT)
- I know. I'm not entirely sure what to ascribe the relative lack of publicity / outcry to. Perhaps it's, as you suggest, something resembling hubris: we got scooped on the first transplant (I know there was a team in Ohio that was attempting to perform the first operation), we questioned the ethics, and then we moved on. Now that the shiny blue ribbon for first place has already been handed out, we're seemingly indifferent. Or, perhaps, it has something to do with our ability to quickly adapt to new technologies - which might indicate to us that our reservations the first time around were grounded, at least to a significant degree, in the mere fact that this was a novel, unknown procedure. Perhaps that it has been done once, seemingly successfully, really does make a big difference from an (arguably) ethical perspective. I'm not sure, but it certainly is interesting....DVorhaus 14:41, 25 April 2006 (EDT)
Spitzer Wants New York to Join the State Stem Cell Movement
And is promising to put $1 billion on the table if he's elected governor. Now, whether or not any of that money would actually get spent is another story entirely...
Diagnostic Testing: The Next Big Expense Thing?'
Julie's journal has a reprint for Thursday's NYT article on "a new wave of sophisticated genetic or protein tests that are starting to remake the diagnostics business." The article is interesting in a number of respects but I'm fascinated, once again, by the high prices that the developers and marketers of the diagnostic tests are charging (routinely in the several thousand dollar range), and the willingness of patients to tolerate these high prices.
The story is the same: companies justify the price of their drug or device, in this case diagnostic tests, based on how much they believe they can charge and, as a result, the price for both patients and insurers becomes entirely unmoored from the development costs, as well as the efficacy, of the test. Patients, for their part, demonstrate little or no price sensitivity, allowing test providers to continue to ratchet up prices. I won't rehash all of my arguments on this topic...they're in this earlier post...but I remain somewhat baffled by it all...
April 8th, 2006
Nanotech Recall in Germany
A bathroom cleaning product, claiming to utilize nanotechnology, was recently recalled in Germany due to reports of respiratory problems.
My first thought is that this is going to result in a hue and cry over the lack of reliable safety and efficacy data for most nanotechnology products. Beyond that, my second thought, was whether or not the nanoparticles are really at fault. The article suggests that the evidence is ambiguous as to whether or not the nanoparticles are to blame and, anecdotally, I'm reminded of the food poisoning outbreak in 1999 that was attributed to a bad batch of Belgian Coke. Malcolm Gladwell uses this example in the final chapter of the Tipping Point to illustrate how anxiety can be contagious. As it turned out, in Belgium, the problem wasn't the Coke; it was that anxiety is tremendously contagious, and anxiety alone can have a very real physical effect upon people.
Is that what happened in Germany? No clue. But it certainly wouldn't shock me to find out that, at the least, rogue nanoparticles do not deserve to shoulder all of the blame. Oh, and the point of all of this is to wonder aloud, again, whether our fear of things that are unknown or uncommon, and the anxiety with which they produce, doesn’t' perhaps make some of them more dangerous in the end.
April 5th, 2006
Maryland Joins the Stem Cell Club
With the passage of the Maryland Stem Cell Act of 2006, Maryland becomes the fourth state (after California, New Jersey, and Connecticut) to provide state funding for embryonic stem cell research. While we debate who should decide the biotechnology/bioethics issues presented by emerging technologies, and the Federal Government sits on its hands, states are starting to take action. Is this federalization of science, particularly stem cell research, a good thing for this country? It appears we're about to find out...
April 4th, 2006
Indian Sex Selection Doctor Jailed
Apropos of our discussion in class yesterday, India has jailed a doctor and two assistants for performing sex-based abortions. Apparently, Professor Nesson is not running things in India after all - using sex as a basis for abortion is (and has been) illegal.
March 18th, 2006
Nanotechnology Delivers
After all the talk about how nanotechnology is going to remake the world it has finally done just that. Well, sort of. Cal Tech scientists have produced a DNA map that resembles the Americas.
"The mini-map measures just a few hundred nanometres (billionths of a metre) across, smaller even than some bacteria - a scale of 1:200 trillion." The lead scientists write in the journal Nature that "their technique could find uses in the emerging field of nanotechnology." Not clear on exactly what those uses might be, but they did also produce an evil Wal-Mart icon a smiley face.
In a possibly more practical development, nanotechnology is being used to return sight to hamsters that were previously blind.
Talk on Tuesday: Embryos and Stem Cell Research
There's an upcoming talk at the Medical Center that I thought might be of interest:
“Killing Embryos for Stem Cell Research” A talk by Jeff McMahan, Professor of Philosophy - Rutgers University
For more details see the calendar page. I can't make it due to class but if anybody does go I'd love to hear about it...
March 15th, 2006
Who Cloned Dolly?
Apparently that's a matter of some debate. While the dispute over who to credit for the much-heralded breakthrough in ovine reproduction continues, the good news is that there is no indication that Hawng Woo Suk was involved in the research the science itself is being called into question.
Science Federalism
In Glenn McGee's newest column in The Scientist he discusses the "State of Science Funding" (excerpt from the column available for free on the AJoB blog, full column requires a login). McGee notes that, increasingly, scientific funding and policy decisions are migrating from Capitol Hill to statehouses nationwide, a process that he terms "science federalism."
As evidence McGee cites budget cuts at the NIH, the Senate's persistent opposition to all forms of stem cell research, and the rise of state programs designed to fund expansive new science initiatives:
So scientists and Congressional constituents are turning to the states. Citizens who kept their states from accepting others' trash in their landfill once chanted, "not in my backyard." In 2004, dissatisfied with national policy about stem cell research, Californians marched on Sacramento to ask the cash-strapped state for $3 billion for stem cell research.
More importantly, some states are debating large programs to fund innovative science in general. For example, New York's more than half-billion dollar investment in nanotechnology transformed the state overnight into a competitor not only with other states but also with the US government itself. Michigan put tens of millions of dollars from the proceeds of tobacco lawsuits into giant glass temples of science that rise above Ann Arbor, like new casinos in Nevada. Even tiny Rhode Island is building a fund to attract and retain scientists from a variety of disciplines.
Is science federalism a fad, or has McGee identified a real trend in the future of science funding and policymaking in this country? The answer will depend in large part on the success of these state-sponsored science initiatives. Procuring funds is, after all, only the first step. Despite a federal funding ban for new embryonic stem cell lines, the federal government provides tens of million of dollars annually for embryonic stem cell research (using ESC lines created before the ban went into effect). California, on the other hand, "has yet to award a dime of its $3 billion stem cell initiative."
Irregardless of the ultimate outcome of these state-sponsored initiatives their very presence makes it clear that, at least in certain parts of this country, citizens are increasingly unwilling to permit the federal government to act as the final arbiter on questions of science funding and policy. Which begs the following question: As emerging scientific technologies infiltrate the lives of individuals in increasingly obvious and intimate ways will we, as individuals, cede control over science funding and policy decisions to national (or even international) political institutions, however they are constituted, or is this becoming a truly local issue?
March 14th, 2006
Intelligent Design to Quantum Mysticism: (or bad biology to bad physics)
"Reality is just a mental construct that we can rearrange and improve, if we are enlightened or determined enough."
That, as Dennis Overbye reports in today's New York Times, is the conclusion presented by two recent films: "What the #$!%* Do We Know!?" and "What the Bleep!?: Down the Rabbit Hole". These cinematic purveyors of what is known as "quantum mysticism" are, it turns out, physics' answer to the bad biology of intelligent design.
Like intelligent design, the quantum mysticism notion that, at some level, our minds control the reality around us is premised on faith and scientific theories that are decades out of date. And both movements have acquired followers for the same basic reason: "We want to know that God loves us, that we are the pinnacle of evolution."
To an outside observer the parallels between quantum mysticism and intelligent design are readily apparent. But this discussion begs a further question: just what does the intelligent design community think of quantum mysticism?
If individual minds control the reality that surround them, does that mean that an intelligent designer created human beings who are, in their own fashion, intelligent designers themselves? Talk about constructing in one's own image. And if the original intelligent designer was, as many intelligent design proponents not-so-secretly speculate, the big G-O-D himself, does that mean that all of us, in the process of manipulating the reality around us, are guilty of "playing god"? Time to focus our mental energy and magic up some bigger britches.
Seriously, somebody needs to answer these questions for me.
- One last thought: if you haven't heard about the indigo children you should take a look at this story. Then, riddle me this: are indigo children simply budding quantum mystics?
The Individual Elephant-Keeper
I wanted to clarify in a sentence or two the question that I was asking at the end of class yesterday: I'd like to think more carefully about the role of the individual in managing information about adverse effects, both for medical devices and for drugs. But by this I mean something more than just "what information should be given to patients or consumers, and who should give them that information?"
As Dr. Lorell suggested, I think there has indeed been a shift by device manufacturers to providing more information, leading to a less paternalistic stance by health care providers and device manufactures with respect to patients. But this is still a one way street. Even if the informational bar is set very low (i.e., companies err substantially on the side of full disclosure), it is still up to the company, and often, secondarily, to the doctor, to determine what information is of significance to the ultimate patient.
I wonder if this is a paradigm that could (should?) be rethought? Rather than having manufacturers and doctors decide what information to release to a large, general group of patients that are using the drug or device in question, why not allow the patients themselves to specify what sort of information they would like to be made aware of. For many this would undoubtedly result in a request to be made aware of "anything that the doctor believes to be medically significant", or something similar to that. But for a not insignificant number of patients it might mean something different: some might want to be privy to all possible information about the drug or device, regardless of whether the manufacturer or doctor conceives it as relevant; and others might want to be given new information only above a certain threshold (e.g., about a device recall, but otherwise nothing).
I think the point here is that different individuals desire different levels of information, and of informed consent. This alternative model goes straight to the heart of an issue we didn't get to yesterday: Is there a right not to know?
See below for more...
March 13th, 2006
The Right Not to Know
Laurie's most recent post asks a question of incredible relevance for today's class:
Should companies that know their devices have potential defects (or the FDA) be required to instruct doctors to advise their patients of those risks when the doctor is outlining the patient's options before surgery, etc? Or are some risks so improbable that it's better, therapeutically, for the patient not to know?
More commonly this dilemma shows up in the bioethics and biotechnology literature in the debate over a patient's right not to know. Whether it's a medical device with a relatively low rate of failure or a genetic test that implicates siblings, the right is one that is invoked with increasing frequency as our predictive powers increase.
Thomas Gray wrote: “Thought would destroy their paradise! / No more; where ignorance is bliss / 'Tis folly to be wise.” Personally, I prefer the Socratic approach: “[I]t is the greatest good for a man to discuss virtue every day and those other things about which you hear me conversing and testing myself and others, for the unexamined life is not worth living for men.”
To put a finer point on it, I prefer to pursue epistemically justified beliefs and reject beliefs held in willful ignorance of the truth. Thus, as a patient, I would like to demand that a doctor outline all the known risks, as well as their expected probability, rather than determining on my behalf which risks are so improbable that my ignorance of them is to my benefit. Nevertheless, I believe this is a matter of preference. It's something we should talk about, but I think that the 'right not to know' is one debate which doesn't require a resolution: it's easy enough, with informed consent forms at every corner, to allow those, like me, who want in on all the minutia of a medical procedure to 'opt-in', and for others to 'opt-out' if they so choose.
Decision-Makers in Bioethics
Returning to our earlier discussion of the first few classes, re: who are the appropriate decisionmakers when it comes to bioethical issues, here's former justice Sandra Day O'Connor attacking Tom Delay for his meddling in the Shiavo case. It would seem that O'Connor, at least, thinks that partisan politics should be kept largely removed from bioethical issues that implicate judicial action.
Note: I stumbled across this story on the AJoB Blog, a website that everyone should check out.
Saying No to (Expensive) Drugs
Thank you Brenda for drawing my attention to a NYT article over the weekend that I missed. The article discusses the sudden price increase of a cancer drug,nitrogen mustard, that has been on the market for decades.
There is, as the article points out, a lack of price regulation for drugs that have few or no competitors:
And once a company sets a price, government agencies, private insurers and patients have little choice but to pay it. The Food & Drug Administration does not regulate prices, and Medicare is banned from considering price in deciding whether to cover treatments.
True enough. Patients have little choice but to pay the price of the drug, despite its high cost. But "little choice" is not equivalent to "no choice". The always available alternative, that of choosing not to take the medicine at all rather than pay an exorbitant fee, is one that the article fails to touch upon.
We - as individuals, consumers, patients - constantly engage in health tradeoffs. We forgo sunscreen because we'd like a tan, even though it increases our risk of skin cancer. We eat french fries even after a second bypass operation because a burger just isn't a burger without them. We drive seven hours to visit relatives for the holidays, rather than fly, because airplane tickets are too expensive. All of these decisions represent common enough instances in which we are willing to trade an increased probability of harm to ourselves for some other good, e.g., an attractive tan, a pleasurable meal, or some extra money in the bank.
So why, when drug prices soar, are we so unwilling to say "enough is enough"? As drug manufacturers "increasingly point to the intrinsic value of their medicines as justification for [high] prices", perhaps its time to reexamine the categorically high intrinsic valuation of medicines.
Keep in mind that there are very few drugs on the market that are 100% efficacious. Taking an AIDS drug is not a cure, indeed it doesn't guarantee any improvement whatsoever. All it can offer is a probability of success, however "success" is defined for that particular drug-disease pairing. And, of course, it offers hope.
And, I have to imagine, it is hope that ultimately does much to explain the individual patient-consumer's tolerance for the spiraling increase of medicines and treatments. Skin cancer? That's in the future. A fatal car accident? A non-specific probability. A disease like AIDS or cutaneous lymphoma (the drug discussed in the Times article) is a present reality, often painful both physically and emotionally, and medicines like Mustargen offer the possibility of a solution.
The elephant in the room - lurking behind complaints about high drug prices, as well as debates over wrongful birth (see below), end of life care, etc. - is whether all lives are intrinsically worth preserving, regardless of the cost.
At least in the abstract there are few of us, if any, that support this position. The value of a statistical life is a common calculation for many an administrative agency, government organization, private employer...even for the individual. Ask whether the FDA is justified in preserving 12 statistical lives at a cost of $300 million and people will haggle over numbers, but they won't haggle over the basic principle that some risk of harm is inevitable in the crowded world in which we live. To attempt to prevent the loss of all lives would bring society to a grinding halt.
And yet, as soon as you put a face to the statistic - as soon as it is you or I who stand a 1 in 1,000 chance of death from a disease, rather than an unnamed, unknown individual who stands a 1 in 1,000 chance of being killed by an exploding radiator - the game changes dramatically. Expenses that would never be countenanced if undertaken for the benefit of a faceless statistical population group are accepted without second thought - after all, when it comes to your health money is no object, right?
I'm not so sure. While I can understand the emotional and personal elements involved, I also think that there is a certain amount of unthinking submission to the idea that our own health, or the health of our loved ones, is not the proper subject of a cost-benefit analysis.
To some extent I believe that attitude is correct. Money is, after all, just bits of green paper (or more accurately these days, bits representing ones and zeros in electronic bank accounts) and you can't take it with you when you go. Then again, very few of us will leave behind nothing more than our bank accounts. There will be friends, family members, and the rest of our society which we have touched in various ways.
Ultimately, like Socrates in the Apology, I find fault with the notion that death should be abhorred and life should be preserved at all costs. If you throw your grandmother in front of the bus to save your own life, will you regret that decision later? Similarly, if you bankrupt your family scooping up long-shot medications that, at best, will extend your life by a few months or years, is that a justifiable decision?
I'm not advocating any sort of strict utilitarianism here - this isn't a kill the old to feed the young proposition of any sort. All I'm suggesting, to go back to the article that started this whole long rant, is that there is always an alternative to over-priced drugs: just saying no.
March 12th, 2006
Why We Abort
Frequently lost in the argument over whether or not to allow abortions is the discussion about what types of pregnancies are appropriately aborted. While this debate may one day be mooted, if other states follow South Dakota's footsteps, and the courts acquiesce, for now it's still one worth having. To that end there's a nice piece in this week's NYT Magazine on the topic of wrongful birth. Read it and see what you think.
Also, there's a brief discussion about the technology and the utilization of PGD, something that we touched on in the first couple of classes...
Rewriting the Rules: Now that's Cheating
Barry Bonds is in the news. I'd post a link to an article discussing the recent SI story, the book, the ongoing allegations...but if you can't locate one yourself you're just not trying (if you're really desperate Brenda posted a link in her journal).
There's so much noise on the subject these days that it's easy to imagine that all athletes have turned into cheaters, they're all guilty as hell, and sports as we know it is at a crisis. In what increasingly reminds me of a witchhunt, fans and writers (especially a certain cadre of writers that seems to relish the opportunity to take athletes down a peg or two) are asking two basic questions, over and over again: 1) How guilty are they? and 2) How many records/medals/titles are we going to strip from them?
But there is another question that is prior both temporaly and logically, that isn't being asked: 1) Were they even cheating?
All the sound and fury surrounding the steroid allegations directed at Bonds misses a key point: steroids weren't a banned substance in the world of professional baseball until last year. A year in which Bonds played only a handful of games. And you know, there are good reasons why we don't approve of ex post facto laws. Fact is, there's a very, very good chance that Bonds, whatever else he may be (liar, poor role model, over-the-hill ballplayer, etc.) is not a "cheater", at least not if we refrain from rewriting the rules to suit our cause.
Oliver Wendell Holmes wrote: "[T]hose who choose ... to sail as close as possible to the wind inevitably run some risk." What Holmes meant, I believe, was that part of pushing the envelope, whether in the realm of law or sport, is knowing that the boundaries between legal and illegal aren't always clear, and even legal courses of action may not be entirely risk-free.
Bonds sailed close to the wind and for that he will be punished with a tarnished reputation, millions lost in endorsements, and, potentially, future physical effects from his steroid use. From where I sit it looks like Bonds has plenty to worry about as it is - there's no need to go back and rewrite the rules just because we don't like the guy. That's just cheating.
February 25th, 2006
Conducting Science in the Country of the Blind
Thus far we’ve talked, frequently, about how we can come to some sort of agreement about the acceptable scope and methods of scientific research. How, for example, do we develop guidelines that prevent the recurrence of Nazi-era torture, disguised as scientific experimentation? Can we come to an agreement on the appropriate role of embryonic stem cell research (ESRC) in contemporary society?
What these questions all seem to take for granted is our conviction that if we can only come to some sort of agreement, some consensus on the appropriate guidelines or course of conduct, that all will be well. But who is there to value our shared assumptions and beliefs, that may in fact be leading all of us, collectively, astray?
What the hell am I talking about? Where is all this nonsense coming from?
Thanks for asking. I was re-reading The Country of the Blind, by H.G. Wells, and stumbled upon this passage:
"Those queer things that are called the eyes, and which exist to make an agreeable depression in the face, are diseased, in the case of Nunez, in such a way as to affect his brain. They are greatly distended, he has eyelashes, and his eyelids move, and consequently his brain is in a state of constant irritation and distraction."
"Yes?" said old Yacob. "Yes?"
"And I think I may say with reasonable certainty that, in order to cure him complete, all that we need to do is a simple and easy surgical operation--namely, to remove these irritant bodies."
"And then he will be sane?"
"Then he will be perfectly sane, and a quite admirable citizen."
"Thank Heaven for science!" said old Yacob, and went forth at once to tell Nunez of his happy hopes.
Among many other questions posed by the story, Wells asks us to imagine what fundamental assumptions we take for granted in our pursuit of science (or medicine, or biotechnology) that might seem, to a disinterested (perhaps non-human? Non-acculturated?) observer to be just a tad bit bizarre. Is it our obsession with the extension of life? Our quixotic quest for improved and enhanced performance in all aspects of our lives? Or are those too obvious? Is it something so deep-seated and ingrained that we lack all capacity to conceptualize it?
Anyhow, I find these interesting questions to ponder while I’m rapidly being snowed in to my apartment for the day…
February 22nd, 2006
Stem Cells by Osmosis
Almost a week ago Michael Gazzaniga, a member of the President’s Council on Bioethics, wrote that all clones are not the same (thanks to, I believe, Brenda for originally pointing this out last week on the Wiki). What Gazzaniga meant, more precisely, was that all forms of cloning are not the same. An important point to make after Bush’s state of the union characterization of all forms of cloning as “the most egregious abuses of medical research.”
But Gazzaniga doesn’t stop there, continuing on to attack the current restrictions on embryonic stem cell research (ESRC), especially the president’s ban on developing new stem cell lines. I wholeheartedly agree with Gazzaniga that the restrictive ESRC climate in the United States is a problem, and I find his critique of pursuing, for reasons of political expediency, alternative technologies at the expense of the best known research avenues particularly persuasive.
But I think that his attempt to redefine “human life” is misguided and, unfortunately, unlikely to be successful. Gazzaniga is right to recognize the clear dualism that causes us to view fully developed human beings – our friends, family members, even our enemies – differently from a cluster of embryonic cells. But, realistically, I believe this is something that most opponents of ESRC are implicitly, if not explicitly, aware of. And, for those that aren't, I don't expect that Gazzaniga's arguments come across as especially compelling: not when your belief about "human life" is rooted in something as intangible as a soul.
The more serious obstacle standing in the way of ESRC is not an uncommon one: an inertial resistance to new technology, a barrier of which Gazzaniga is well aware:
At the most recent meeting of our bioethics council, Patricia Churchland, a distinguished philosopher from the University of California at San Diego, observed that through history, medical innovations — from vaccines to anesthesia — have been initially resisted only to later be widely accepted. It will be the same with stem cells.
And in this prediction I think Gazzaniga is entirely correct. As with so many other technologies I doubt that it will not be the reasoned examination of what constitutes “human life” that ultimately leads to the acceptance of ESRC. Quite frankly, that's just too much work for too many members of the general public, who have other things to worry about at the end of the day.
The much more likely scenario is one that makes use of stem cell's own inertial energy to ultimately legitimize ESRC. The key to unlocking the political chains that gird ESRC is not to reconceptualize “human life” as a term inapplicable to a cluster of cells, but to reconceptualize a cluster of cells as no more extraordinary than being given a vaccine, or believing that the Earth is round.
Like it or not, stem cells are here to stay. We just need to give that fact a little bit more time to sink in.
Teaching Reporting the Controversy
As Brenda pointed out in a recent journal entry, there was an article yesterday in the New York Times discussing the relationship between science and religion. A few more thoughts on that topic...
The Discovery Institute started a petition skeptical of Darwinian evolution in 2001. Since then, according to the Times article by Kenneth Chang, the petition has been signed by 514 scientists and engineers, although "only a quarter of the signers are biologists, whose field is most directly concerned with evolution."
Why, I wonder, is this significant? It's hardly breaking news that the Discovery Institute's intelligent design position is unpopular among scientists generally, and even more so among biologists. Which the Times piece confirms. Also reported: many of the signers "are evangelical Christians, whose doubts about evolution grew out of their religious beliefs." Unless you've been detained at Guantanamo living in a cave recently you already knew this.
It's not at all clear what real news is being reported in this piece. And why do I care? While the Discovery Institute has been thus far largely unsuccessful in carrying out its "teach the controversy" attack on evolution, it has been indisputably successful on a parallel front: "report the controversy."
As the saying goes, "there's no publicity that's bad publicity." I want to note that I agree wholeheartedly with Brenda:
science needs to break out of the ivory tower and into the public discourse to avoid being stifled by religion, esp when Establishment Clause violations may occur.
When the Discovery Institute, or any other group peddling unfounded or downright false reformulations of basic science, enters the public forum and attempts to impose its thinly veiled religious agenda upon public school systems the media, scientists, and concerned citizens (including all of us) share a responsibility to shine a light on the situation and to protest.
But I wonder if at other times, now being one of them, whether it might not be prudent to allow the Discovery Institute and others to languish on the sidelines. The alternative seems to be pieces like this most recent one in the Times: a couple rather thinly veiled swipes at the Discovery Institute (it's not supported by real biologists, and the ones that do support it are evangelicals, etc.) that say nothing new and draw attention to a group that is already reeling from recent setbacks in Ohio and Pennsylvania.
- Interesting...I don't really have a problem with the Times running a piece on the Discovery Institute, particularly if the article gives both sides of the story, i.e. includes the fact that "teach the controversy" is an approach used by evangelicals to discredit evolution despite the vast majority of scientists on the other side. I do see where you're coming from, though, particularly when thinking about how many articles have been run on the Institute (although many of those I think were called for given the Dover litigation). I see the persistence of the issue in the paper as evidence of the continuing battle between science and (some) religious convictions -- which is one that, in my opinion, will keep going indefinitely. - Brenda
February 20th, 2006
Navigating Slippery Slopes
(note: this is a response to Julie's journal entry from 2/18)
It's interesting (and quite probably not a coincidence) that you bring up the matter of slippery slopes in advance of Shedlon Krimsky's visit to our class this week. I know that Krimsky has written about slippery slopes, though I'm not very familiar with his work. He does make the distinction in one place that I'm aware of (Krimsky, Biotechnics & Society: The Rise of Industrial Genetics (New York: Praeger, 1991)) between deterministic and probabilistic slippery slopes. If you accept the premise that a ban on reproductive cloning is absolutely necessary (which, personally, I don't. I believe it's necessary now but for safety reasons, I don't think that is an inherently objectionable or immoral procedure although, like many other technological/scientific inventions, it has the potential for sever misuse) I don't think that it necessarily follows that a ban on therapeutic cloning follows. To argue for such a ban you would need to either believe that the "fall" from therapeutic to reproductive cloning would be induced by a deterministic slippery slope (which I think is pretty clearly untrue) or that it is so highly probable that it could simply not be avoided. This last point is where the real debate lies but it's important to first make clear just what kind of slippery slope it is we're concerned about. I think that there may be a tendency, in some instances, to conflate the two kinds of slippery slopes and convince ourselves of the inevitability (using a deterministic slippery slope model) of reproductive cloning.
Also on the topic of slippery slopes: I think what Professor Robertson brought up, and what Julie is grappling with above, is a version of what Eugene Volokh (in “The Mechanisms of the Slippery Slope”) has termed the “slippery slope inefficiency: decision A might itself be socially beneficial, and many people might agree that it’s beneficial, but some swing voters’ concern that A will lead to B might prevent decision A from being implemented” (Volokh, 1036). I think that, realistically, it is the slippery slope inefficiency with which Julie, Professor Robertson, and the rest of us are struggling with in the context of cloning (as well as a host of other emerging technologies); not the mere presence of a slippery slope itself. After all, there are countless slippery slope scenarios in which a beneficial A leads to a beneficial B without incident, or where an undesirable A would lead via a slippery slope to an undesirable B. These slippery slopes are trivially navigated by society without real incident. It is the inefficient cases which we must resolve, those which “…point clearly to a serious moral hazard and contain some reason for thinking that this hazard will become much more likely if we take the first step” (“Human Cloning and Human Dignity: An Ethical Inquiry.” President’s Council on Bioethics, pp. 296-297) , especially when that first step appears to many to be a desirable one.
The situation with cloning (reproductive vs. therapeutic) offers what seems like a textbook example of slippery slope inefficiencies. There is nearly universal agreement that, at some level, the use of reproductive could potentially offer very real benefits to individuals with a wide range of diseases and disabilities. But move beyond this basic starting point and the consensus starts to fade. It is because of our differing (and often subjective) valuations of the A and B in question (therapeutic and reproductive cloning respectively) that we fail to achieve an easy consensus on how to treat cloning. If we conclude that reproductive cloning is unproblematic (as I suggest it might be appropriate to do provided some other background concerns are addressed) then there is no problem. But assuming, as seems likely now, that a majority of society is fundamentally concerned with reproductive cloning, then Volokh's concern still remains: How can we maximize the benefits of A while minimizing the risks of B, i.e., how do we reduce the inefficiencies created by the slippery slope relationship between A and B. A ban is certainly one alternative, but it is unlikely to be the best one. Whether or not a ban on therapeutic cloning (or therapeutic cloning research) would be unconstitutional, as Professor Robertson speculated about, we owe it to all those who might benefit from therapeutic cloning to at least consider the intermediate alternatives.
DVorhaus 14:23, 20 February 2006 (EST)
February 16th, 2006
The Cost of a Cure
The Times has an interesting article about Avastin, a colon cancer drug for which its maker Genetech plans to charge $100,000 a year. That steep price tag raises a number of questions, most notably a suite of difficult ones suggested by the conundrum of a drug that is potentially both life-saving and bankrupting.
It's not difficult for me to imagine that there are some colon cancer sufferers out there who wish that Avastin, with its astronomical price tag, simply didn't exist. I think there is mentality, especially among certain segments of our society, that while government agencies and insurance companies may place a dollar value on a life, no amount should be too much when it comes to saving the life of a friend or a loved one.
Well that philosophy is certainly being put to the test. How do individuals handle the presence of life-saving drugs that they simply can't (or won't) pay for because to do so would be financially crippling for themselves or for their family? How does a doctor tell a patient that a treatment that might save her life is too expensive? And is anything going to stop the rising cost of some of these drugs? Will it require some form of regulatory intervention?
Finally, an out of left field question for general consideration: Do we feel differently about the cancer patient who refuses a life-saving treatment for economic reasons than we do about the cancer patient who desires euthanasia to avoid being a financial burden on her family? If so, why? DVorhaus 15:01, 16 February 2006 (EST)
February 14th, 2006
Biotech Failing to Deliver?
We spent a lot of time - both in our reading for class and in the class presentation - talking and thinking about the promise of biotechnology. Today's NY Times has an article entitled "Biotech's Sparse Harvest" which wonders what has happened to the promises of genetically engineered crops and foods. I'm not trying to be a wet blanket, I think I'm just articulating a point that Mr. Dagi made repeatedly yesterday: biotechnology is hard. Most companies fail, and so too do most predictions about what and when biotechnology is going to deliver (especially the when part). Doesn't mean it's not worth trying though. DVorhaus 00:04, 15 February 2006 (EST)
(Belated) Happy Birthday Darwin
In honor of the man who may have done more than anybody else to make this course possible: a belated Happy Birthday to Mr. Charles Darwin. The man with the giant white beard turned 197 on Sunday. For anybody who is interested, The Questionable Authority has nicely aggregated many of the blogosphere's posts and pictures commemorating Darwin Day. DVorhaus 00:04, 15 February 2006 (EST)
