Category ►►► Future of Medicine
July 27, 2009
Another Immodest Proposal: Housecalls R Us
Some discussion in the comments of a previous post here center around the problem of poor people, seniors, and illegal aliens (with some obvious overlap) using emergency rooms and trauma centers as doctor's offices. That is, these patients cannot or will not, for various reasons, visit ordinary doctors' offices for their non-emergency conditions; so they clog up ERs with relatively minor injuries, illness, and conditions. Over and above the health-insurance debate, this causes problems of overcrowded ERs and real emergencies going untreated; and it can lead (along with unwarranted lawsuits and over-the-top judgments) to such centers for emergency care actually being shut down, due to the financial drain on the associated hospital.
So what can be done?
The illegal-alien component in this problem is considerable: They often can't get insurance, can't afford regular checkups -- and they're afraid to go to doctors and give a history, because they might be deported. Of course, the real solution to this component of the ER problem is to resolve the problem of illegal immigration itself. Long-time readers of Big Lizards know that I strongly support a comprehensive, four-part policy:
- Reforming the legal immigration system to make it more rational, predictable, and just, so that we admit those most easily assimilated, rather than favored ethnicities or nationalities;
- Building a wall to keep out those who don't qualify for legal immigration under the new standards;
- Immunizing legal residents who are not yet citizens from the raft of minimum-wage laws -- so we get our low-wage workers not from temporaries, with no loyalty to the U.S., but from those who are in the process of becoming citizens;
- And offering a plea-bargain (not "amnesty") to those currently here illegally, wherein they (a) pay a fine, (b) pay any back taxes they may owe, and (c) then and only then receive legal residency -- so long as (d) they have otherwise behaved themselves while living here illegally. (I also support deportation of illegals convicted of crimes here, as soon as they finish their sentences.) Naturally, we need a more technologically sophisticated "green card" with biometrics, and an upgraded and updated database of citizens, residents, and tourists.
But that's not likely to happen anytime soon. Under the Obama-Pelosi-Reid administration, we may instead very well get a "solution" that even I would call amnesty... but that hasn't even been seriously proposed yet (thank goodness). So what can we do in the meanwhile? And what can we do about American citizens and legal residents who also use the ER as a doctor's office for their children's colds or their own arthiritis?
I have a suggestion... but I don't know how much it would really help or whether there are serious impediments that would make it impractical. Thus, I throw it open to the massmind of the Big Lizards readership, many of whom have far more experience than I:
Housecalls R Us
Proposed: The federal government should encourage more young doctors to join Mobile Care Units that make housecalls and neighborhood calls. The incentive should be partial or even complete forgiveness of federally guaranteed med-school loans, along with grants to states to offer similar forgiveness of state-guaranteed loans, for doctors (especially those who speak a useful foreign language) who agree to serve their residencies in such MCUs... sort of like the program to encourage newly minted doctors to move to rural areas for their residencies.
MCUs would be focused in urban areas where urgent-care centers are overused for non-urgent situations; the idea would be to make regular medical visits to residents who would otherwise use ERs; the doctors would perform regular checkups, non-emergency treatment, and could call for emergency transport for any actual urgent medical problems they discover. The doctors would not be allowed to report suspected illegal aliens. (I believe all police should be required to report any criminal suspect here illegally to U.S. Citizenship and Immigration Services; but doctors aren't cops. Without the prohibition against MCU doctors reporting, illegals might just run and hide when the MCUs come to their neighborhood, negating the whole point.)
Each unit would be assigned to a particular neighborhood or group of neighborhoods, depending on the population of impoverished or otherwise "disadvantaged" patients (perhaps using the proxy measurement of non-emergency ER visits); some very dense neighborhoods would get multiple MCUs. This would in particular include new-immigrant-heavy neighborhoods, poor and high-crime neighborhoods, ethnic enclaves, and so forth.
The doctors would be accompanied by registered nurses (same sort of debt-forgiveness deal), and by social-service bureaucrats who could work out payment plans for patients, including signing them up for whatever subsidized insurance programs or other benefits are already available for residents (legal or illegal). Patients would be required to pay something, that "something" being determined by actual need. MCUs would also include trained and armed security guards, for obvious reasons.
Finally, the program would include some tort reform for those doctors and nurses participating in the program, raising the standard of proof required for liability and limiting judgments to some reasonable level, along with the feds offering medical malpractice insurance to the participants; this to allay fears that some junkie or wino given perfectly proper treatment will nevertheless die, and his heirs will see the death as their ticket to lifelong wealth.
As to cost, if we made 50,000 Mobile positions available per year, and if the average medical resident was able to get the feds to pay off $50,000 of his debt, that would cost $2.5 billion directly -- plus administrative, logistical, and insurance costs; call it $7.5 to $10 billion. Some of that would be direct payoffs, the rest would be block grants to states.
Does anybody here think that would help relieve the ERs, trauma-care centers, and urgent-care centers? Would it encourage more of the so-called "underclass" to get regular, non-ER medical checkups and other care? Would it save taxpayer money in the long run? Would it cause more problems than it solved? Could it even be done legally? And is it already being done on a national level, and I've just never heard about it?
I'm definitely groping for a solution here, so your input is urgently needed to solve this emergency without too much mental trauma.
July 16, 2009
Who's an Embryo? Plan B...
Caroming off our previous post on the appointment of Dr. Francis Collins, M.D., Ph.D., as the director of the National Institutes of Health -- in which we argued that extreme pro-lifers were wrong to try to derail the appointment because of a miniscule doctrinal difference that actually made no difference in the real world -- conservative columnist Cal Thomas (who also supports Collins) now weighs in: He reports that extreme pro-choicers are also unhappy with Collins... because they're worried he might introduce a note of conscience into medicine. Can't have that!
(Alas, Thomas' argument is diminished, as he slips in an instance of Godwin's Law that may overshadow the main point.)
The recent New York Times story announcing the president's selection of Dr. Collins ("who led the government's successful effort to sequence the human genome") reflects what would be considered bigotry or sexism if applied to someone because of his or her race or gender. Reporter Gardiner Harris writes that one of the objections to Dr. Collins (he names no objectors, which is the pattern of a smear) "is his very public embrace of religion. He wrote a book called 'The Language of God' and he has given many talks and interviews in which he described his conversion to Christianity as a 27-year-old medical student."
I don't know exactly what story he references, so I can't read it and see if Thomas' charge is fair; nor am I going to spend any time looking it up: I have other irons to fry.
But I have certainly seen that same ad-hominem attack on Collins coming from ultra-secular materialist liberals, Socialists, and self-described atheists I personally know, when I recommended his book, the Language of God... so I have no difficulty believing that the attack is once again raised in response to the Collins appointment: He can't be a real scientist, because belief in God is fundamentally irrational and demonstrates a disordered mind.
Normally I despise the facile "argument" that if so-and-so draws fire from both the extreme Right and extreme Left, he must, as in the Goldilocks story, be ju-u-u-ust right; it's juvenile and generally a cross between a crocodile and an abalone... that is, a crocabalone. But in this very particular case, I think two ends attacking the middle does tell us something good and fine about Collins (and again, a rare rave to President Barack H. Obama for making the appointment).
Collins draws fire precisely because he sees no conflict between faith and science, and in particular, between evangelical Christianity and modern evolutionary theory; his own success in the scientific field is a living refutation of the warped pronunciamentos of those secularists (e.g., Richard Dawkins, Chris Hitchens, Philip Pullman) who say that studying evolution necessarily makes one an atheist... as well as the religious who refuse, for reasons of faith, to accept evolution -- including Ben Stein, Michael Medved, Ann Coulter, and indeed everyone at the Discovery Institute, from Michael Behe up and down the line.
In this case, the fact that both extremes of the debate turn their rhetorical guns on Collins -- generally without troubling to read what he writes or listen to what he says -- does indeed show that he represents the Kirkian mean between the Spockian and Bonesian poles, to which scientists and the religious should all aspire.
I find it interesting that the very same atheists I personally know -- literally, the exact same individuals -- also dismiss any story from the Washington Times because it's "a Moonie newspaper!" -- as if the paper itself being owned by the Unification Church "proves" that Wesley Pruden, John F. Solomon, John McCaslin, Greg Pierce, Cal Thomas, Mark Steyn, Jeffrey Birnbaum, Bill Gertz, Frank Gaffney, David Brooks, Bill Sammon, Tony Blankley, Tony Snow, and every other writer or editor who has ever worked for the newspaper must himself be -- a Moonie! -- and therefore incapable of reporting without inserting Unification Church propaganda and evangelism into every story, column, or editorial decision.
This type of rhetorical attack -- Argument by Religious Repulsion -- appears to be a habit, possibly an addiction, with some.
July 13, 2009
Who's an Embryo? St. Francis of Genomia at the NIH
Those who follow Big Lizards religiously (have you all put on your phylacteries before reading?) know that we're big on Dr. Francis Collins, M.D., Ph.D., the evangelical Christian who headed up the Human Genome Project -- and especially on his book the Language of God: A Scientist Presents Evidence for Belief. In fact, we've spoken in favor of his ideas (and highly recommended his book) in the following Lizardian posts, from the oldest (August 28th, 2006) to today:
- Jury Nullification Or Nullifying the Jury?
- I appear to have become a Nazi...
- Expelled: No Intelligence Offered - part 1 (Win Ben Stein's Monkey Trial!)
- Expelled: No Intelligence Offered - part 2 (Ben in the Dock)
- The Nuclear Winter of Conservative Discontent
- The Membrane Connecting Science, Morality, and Aesthetics - More Thoughts
- Who's an Embryo? St. Francis of Genomia at the NIH
But who is Francis Collins? This post is going to be long, so I'll tuck the rest away behind the Slither on...
Collins' main thrust in his first book (he is secretive about the subject of his second, but he had to resign from his government position at the National Institutes of Health -- NIH -- to write it) is that there is no essential conflict between Christian faith and evolution by natural selection (hence, "evolutionary biology"). Collins uses the term "BioLogos" for the particular branch of theistic evolution he supports, the "wind up the universe and let it run" thesis: God created the universe and all its physical laws and constants, set the initial conditions, and then allowed it to evolve naturally.
Being omniscient and omnipotent, God deliberately set everything up so that moral human beings (and perhaps other sentient, moral creatures elsewhere) would eventually evolve; so in that sense, you could call it a version of creationism. But it's quite distinct from the Biblical creationism that ruled the creationist roost until a series of legal setbacks in the 1980s, and also from "Intelligent Design," the current method of back-dooring creationism into the public schools by not using certain words -- e.g., "God," "Lord," "Creator" -- and using code words instead ("Designer"): BioLogos requires no direct intervention or manipulation, no "fine tuning," to run its course; in Collins' view, God got it right at the first time and doesn't need mid-course corrections.
So it likely comes as no surprise that we soundly applaud, and even jump up and cheer a bit (in a dignified way, you understand), President Barack H. Obama's announcement last Wednesday appointing Collins to head up the NIH, subject to Senate confirmation. This will put Collins in control (along with the Advisory Committee to the Director) of all federal funding for medical, biomedical, and health-care research, both direct -- "intramural research" at the NIH's main campus in Bethesda, MD -- and indirect, by funding "extramural research" conducted by private universities, hospitals, and other medical research facilities outside government.
I myself am also unsurprised that some more absolutist members of the evangelical community are upset by the appointment; they fret that he will not be as -- all right, I'll say it -- not as doctrinaire as they themselves would be, particularly regarding stem-cell research:
President Obama's nomination of Francis Collins to be director of the National Institutes of Health has resulted in pro-life advocates expressing concerns about the views regarding unborn life held by the world-renowned scientist and evangelical Christian....
In announcing his intention to nominate Collins, the president described him as "one of the top scientists in the world," adding "his groundbreaking work has changed the very ways we consider our health and examine disease...."
Since Obama announced Collins' nomination July 8, some evangelical and pro-life spokesmen have taken issue with the nominee's comments about embryonic stem cell research and cloning.
A Southern Baptist philosophy professor at Union University said Collins needs to make his views clear before he takes over as director of the National Institutes of Health (NIH), which oversees federal funding of embryonic stem cell research (ESCR). Extraction of stem cells from an embryo requires the destruction of a tiny human being less than a week old.
Whoa, stop right there; that is not, strictly speaking, true, as we have discussed here. There is already a procedure for extracting stem cells from human embryos non-destructively, utilizing the same procedure used in preimplantation genetic diagnosis (PGD) to extract cells from living embryos to test for various genetic diseases... extractions that leave the embryo intact and still growing normally.
Besides non-destructive ESCR, there are also other types of stem cells, of course; they can be found in somatic (bodily) cells of various types: uterine cells, placental cells, amneotic fluid cells, testicular cells, dental cells, mammary cells, and so forth. Many of these latter have already been used extensively in medical therapies; embryonic stem cells have barely been used so far, but they still show tremendous promise.
President George W. Bush had issued an executive order (EO 13435) on June 20, 2007 that specifically funded:
[R]esearch on the isolation, derivation, production, and testing of stem cells that are capable of producing all or almost all of the cell types of the developing body and may result in improved understanding of or treatments for diseases and other adverse health conditions, but are derived without creating a human embryo for research purposes or destroying, discarding, or subjecting to harm a human embryo or fetus.
We posted on that, too... in a post noting that one of Obama's earliest EOs (March 9th) after assuming office was to revoke EO 12435, killing the requirement to fund non-destructive stem-cell research, even as he lifted the federal-funding ban on destructive ESCR. (Anything you need to know, you can learn from Big Lizards.) The natural conclusion most drew was that Obama supported destructive ESCR and was uninterested in or even hostile to non-destructive stem-cell research, either embryonic or somatic... both of which positions comport with his ultra-liberal base.
Federal stem-cell research funding policy is still governed by President Obama's EO 13505, according to the NIH website; I doubt that NIH's "final regulations," issued last Monday, July 6th, 2009, differ from this, since federal agencies are bound by relevant executive orders.
But it's important to note that Obama did not order a ban on future funding of non-destructive stem-cell research; he just revoked Bush's EO that ordered NIH to actively seek out opportunities to fund such research. Bush asked NIH to conduct research in non-destructive stem-cell therapies; but it seems Obama would not particularly care if all that research withered on the vine.
(There is also a federal law, the Dickey-Wicker Amendment, preventing NIH or any other federal agency from directly funding the killing of embryos to create new lines. But once such lines are created privately, under Obama's EO 13505, they are fair game for federal funding.)
Still and all, the technique for non-destructive ESCR, somatic cell nucleus transfer, exists; it simply is not necessarily federally funded, now that the Obamacle presides. So the statement in the Townhall.com article above is at a mimum misleading, and might even be called fraudulent -- unless it "stems" from simple ignorance, which itself is not very reassuring. But we continue with the attack on Collins:
Collins was mistaken or misleading in comments about Obama's position on federally funded embryonic stem cell research, said Justin Barnard, associate professor of philosophy and director of the Carl F.H. Henry Institute for Intellectual Discipleship at Union University in Jackson, Tenn.
At Obama's direction, NIH issued final regulations July 6 governing federal funding of stem cell research. In a May interview Collins said Obama's position "is not very radical" because Obama basically said "what Bush said in August of 2001" when the former president announced his policy. But that is not the case, Barnard says. The new NIH guidelines allow research not only on lines that were in existence when Obama made his announcement but new stem cell lines, Barnard wrote in a July 13 commentary for Public Discourse. Obama's position in fact is a "dramatic shift" from Bush's, Barnard said.
In these and other comments, Collins "is less than clear" regarding "the metaphysics and moral value of human life," Barnard wrote.
Perry Mason for the defense...
"Less than clear" is a term that can be equally applied to Barnard's attack: Is he saying that Collins supports the creation of new stem-cell lines from existing human embryos, or from other kinds of stem cells? And even if the former, does he mean embryos created for the purpose of research -- or embryos that were already created for reproductive purposes (in vitrio fertilization), remain unused, and are already slated to be destroyed? Barnard's deliberately vague wording leaves his accusation a complete muddle.
He does make one charge very explicitly in his Public Discourse article. First, a little background from Collins himself, quoted by Barnard:
Basically, what the president’s executive order said and what the NIH in its draft guidelines has now made more clear is that federal funds will be allowable, assuming these draft guidelines get finalized, for stem cell lines that were developed from leftover embryos from in vitro fertilization clinics. And in a way, this is not very radical because that’s what Bush said in August of 2001 when he became the first president to authorize federal funds for embryonic stem cell research. Remember, it wasn’t allowed at all before his statement. But he said only lines that were developed before 9 p.m. on Aug. 9, 2001, could be used, which obviously seems like a bit of an arbitrary deadline.
Now Obama is saying, what about the 700 lines that have been developed since then, which are actually scientifically more useful? The early lines had problems. These new lines will now be allowed as well. Remember, though, that just means the funds will be allowed for the study of those lines, not for creating new ones. That is prevented by the Dickey-Wicker amendment, which people expect will probably remain there unless Congress decides to take it away. My bet is that they probably won’t, and I’m not sure that it’s necessary for them to do so in terms of supporting research. The use of private funds to develop new lines might be sufficient.
Barnard then pounces, flattening a very difficult, complex question into an easy soundbite of utter moral certitude, an "eternal verity":
Collins’s comments here are remarkable on several different levels. To begin, it is unclear whether Collins has any moral qualms about the wanton destruction of innocent human life given his apparent optimism about the sufficiency of private funds for the doing the federal government’s dirty work. [There's that weasel-word "unclear" again! -- the Mgt.] But even if one supposes that he’s not happy about it, his analysis of the difference between the Bush administration policy and the new Obama guidelines is mistaken at best, misleading at worst. For the August 9, 2001 deadline under the Bush administration was imposed precisely to take away the incentive for private entities to engage in more embryo destruction. Of course, as Collins’s remarks make clear, this did not prevent private entities from doing so. And apparently, they did so at least 700 times. (Of course, who knows how many embryos it actually took to get the 700 lines to which Collins refers!) And if the Obama guidelines were written so as to allow funding for these 700 lines and only these 700 lines, they would, in that respect, be similar to the Bush guidelines. But the new Obama guidelines do not limit the use of NIH funds exclusively to these existing, additional 700 lines.
Knowing this, Collins chose his words carefully when he said, “Remember, though, that just means the funds will be allowed for the study of those lines, not for creating new ones.” By the letter of the law, what Collins here claims is true. The new NIH guidelines do not permit the use of federal funds for creating new human embryonic stem cell lines. This is because, as Collins points out, such activity is prohibited by the Dickey amendment. Moreover, the guidelines do allow for the study of those 700 lines that have been produced since August 9, 2001. What Collins does not say, however, is that the new NIH guidelines also allow for federal funds to be used in studying new human embryonic stem cell lines that are created (by private entities, of course) beyond the 700 currently in existence. This represents a dramatic shift in policy from the previous Bush administration regulations. And Collins is doing nothing more than engaging in rhetorical subterfuge to suggest otherwise.
Collins in the dock...
This really boils down to one philosophical question: Do we admit the reality that:
- In vitrio fertilization will continue
- Excess embryos (beyond those that are implanted in a womb) will continue to be created, and
- Those excess embryos will either be destroyed outright or frozen in suspended animation for eternity (or until someone pulls the plug)?
If so, then neither Obama's EO or the new NIH policy provides an "incentive" to create embryos for purposes of research; the incentive already exists (via fertility therapy) to create far more embryos than could ever safely be implanted, and far more than could ever be used in research anyway -- a point that Barnard himself glosses over. (Just as he imputes pejorative motives and moral beliefs to Collins that Barnard could not possibly know unless he's a telepath.) The embryos are there and will continue to be there, with or without federal funding.
If we accept that such lines will be created willy nilly, entirely privately -- as Barnard himself admits -- then the only question is whether we allow federal funding to research those new lines... or only to research the old, degraded lines created the exact same way, but prior to 9 PM, August 8th, 2001.
This is certainly not the black-and-white issue that Barnard pretends; it's both more nuanced and more profound. But Barnard demands utter conformity to the most restrictive possible moral interpretation, or he launches a crusade against the heretic.
He has chosen his target well. Barnard knows that such high-level, future funding decisions are generally made by the Director of the NIH in conjunction with his Advisory Council; and he knows that director is going to be Francis Collins; there is no serious senatorial opposition to the appointment.
So what are Collins' thoughts on ESCR -- destructive and non-destructive -- and other kinds of stem-cell research? Fortunately, we have the answer to that question in his own words, from a series of interviews he gave, excerpts of which have been collated by a Christian blog.
First, on the precise moral question above, from an interview in Salon (the interviewer's questions are in blue):
Geneticists are sometimes accused of "playing God," especially when it comes to genetic engineering. And there are various thorny bioethical issues. What's your position on stem cell research?
Stem cells have been discussed for 10 years, and yet I fear that much of that discussion has been more heat than light. First of all, I believe that the product of a sperm and an egg, which is the first cell that goes on to develop a human being, deserves considerable moral consequences. This is an entity that ultimately becomes a human. So I would be opposed to the idea of creating embryos by mixing sperm and eggs together and then experimenting on the outcome of that, purely to understand research questions. On the other hand, there are hundreds of thousands of such embryos in freezers at in vitro fertilization clinics. In the process of in vitro fertilization, you almost invariably end up with more embryos than you can reimplant safely. The plausibility of those ever being reimplanted in the future -- more than a few of them -- is extremely low. Is it more ethical to leave them in those freezers forever or throw them away? Or is it more ethical to come up with some sort of use for those embryos that could help people? I think that's not been widely discussed.
So your position is that they should be used for research if they already exist and they're never going to be used to create a human life?
I think that's the more ethical stance. And I say this as a private citizen and not as a representative of the U.S. government, even though I'm employed by the federal government at the National Institutes of Health. Now let me say, there's another aspect of this topic that I think is even more confusing -- a different approach which is more promising medically. It's this thing called somatic cell nuclear transfer, which is where you take a cell from a living person -- a skin cell, for instance. You take out its nucleus, which is where the DNA is, and you insert that nucleus into the environment of an egg cell, which has lost its nucleus. Now think about this. We have a skin cell, and we have an egg cell with no nucleus. Neither of those would be things that anybody would argue has moral status. Then you give a zap of electricity and you wait a couple of days. And that environment convinces that skin cell that it can go back in time and it can become anything it wants to be. That is an enormously powerful opportunity because the cell would then be received by that same person who happened to need, say, neurons for their Parkinson's disease or pancreas cells for their diabetes without a transplant rejection.
Isn't this the process that is otherwise known as cloning?
Yeah, it's called cloning, which is a very unfortunate term because it conjures up the idea that you're trying to create a copy of that human being. And at this point, you're doing nothing of the sort. You're trying to create a cell line that could be used to substitute for something that a person desperately needs. It would only become a cloned person if you then intentionally decided to take those cells and reimplant them in the uterus of a recipient woman. And that, obviously, is something that we should not and must not and probably should legislate against. But until you get to that point, it's not clear to me that you're dealing with something that deserves to be called an embryo or deserves to be given moral status.
Let an urgent point not be forgot...
This is a much more sophisticated response than Barnard's; Barnard wants to anwers this... but the only way he can do so is to deny there is any moral distinction between the union of a human egg and human sperm -- and the union of a denucleated human egg and a human skin-cell nucleus.
His thesis appears to be that anything that could conceivably grow into a human being -- even if that would require future intervention by doctors, and even if it has never been demonstrated in the lab yet -- is a human being. But of course, once egg and skin-cell nucleus are combined but before electricity is added, I can still say it "could conceivably grow into a human being"... assuming "future intervention by doctors," including the spark. Does that mean such a union is already a human being?
In fact, I can still say the same after two cells have been extracted but before they are combined. This oddball definition not only entirely removes the necessity of sperm, its structure disturbingly reminds me of Roe v. Wade's test of whether a foetus can survive outside the womb: In both cases, the test of human personhood depends upon the state of medical technology du jour:
Nobody ever has cloned a human being; we don't even know if it would ever be possible to grow such a "cloned" embryo into a human.
- So if we're not actually able to clone human beings in 2009, then a cell created by somatic cell nucleus transfer is not a human person by Barnard's thesis.
- But if ten years later, we are able to clone humans, then those same, exact cells from 2009 magically transmaugrify into human beings by 2019 -- even though they are utterly identical in every respect to what they were ten years ago, having been kept on ice all that time.
(If an old growth spotted owl leaves its old-growth tree, flies a few feet away, and nests in a young tree, it becomes a member of a whole new species!)
I'm with Collins on this: I consider such a definition preposterous and unscientific. We must have a definition of "human person" that doesn't change with every advance in medical science, one that seeks a deeper element of humanity than superficial morphological characteristics -- what I refer to as a "movable verity," rather than an "eternal verity," because it's robust enough to remain consistent even as technology changes around it.
When, for example, does the soul enter a human body?
- If you believe that occurs sometime after conception, then is the developing embryo still a human being even before being ensouled?
- And even if you believe that occurs "precisely" at conception, then when "precisely" do you define conception itself to have taken place? (a) When the soon-to-be successful sperm starts to penetrate the egg's cellular wall? (b) When it works its way fully inside the egg? (c) When it contacts the egg nucleus? (d) When it combines chemically? Or (e) when it first divides into a blastocyst? Conception is a continuum, like everything else in biology -- conception, gestation, birth, and even death.
- Finally, no matter how one defines conception in the normal circumstance -- does the soul also enter into a cloned cell at the moment of transfering the nucelus of a non-sperm cell into the egg, even though no combining of DNA occurs?
- Does it occur after the electrical charge is applied?
- Or does it not occur at all, since there is no bisexual reproduction taking place in any event?
Is a human body a person, absent a soul?
These are not easy questions; but without answering them, we cannot decide "who's an embryo" -- and what isn't.
Shouldn't we then, just for safety's sake, accept the Barnard thesis that anything that could conceivably grow into a human is therefore automatically a human person from the moment of its creation, no matter how? Shouldn't that be the default presumption?
Not necessarily... because such a presumption is not cost-free in the realm of human life. Making that presumption will inevitably kill people -- people already living, breathing, thinking, and feeling.
Collins understands, as Barnard gives no evidence of understanding, that ESCR comprises more than just the rights of human embryos; it also includes the rights of those already born and suffering, even dying, from potentially curable diseases. As often happens in law, the two rights must be weighed against each other in individual cases and a just decision reached. From part 2 of an interview of Collins for a PBS television show titled Think Tank:
So I think one thing we ought to do is, sort of, tone down the rhetoric and try to get our scientific facts straight. So stem cells-- there's lots of different kinds of stem cells. The kind that I think many people are most concerned about are the ones that are derived from a human embryo which is produced by a sperm and an egg coming together. The way you and I got here.
There are hundreds of thousands of those embryos currently frozen away in in vitro fertilization clinics. And it is absolutely unrealistic to imagine that anything will happen to those other than they're eventually getting discarded. So as much as I think human embryos deserve moral status, it is hard to see why it's more ethical to throw them away than to take some that are destined for discarding and do something that might help somebody.
Reality and the limits of dogma...
Morality is never a lightswitch; it's never either all-the-way on or all-the-way off. Morality always exists on a continuum, because human life and the human condition exist on a continuum (recall my example of conception above). That's why each case must be judged individually -- under general guidelines.
(It's a terrible and dangerous error to try to write too much specificity into a guideline; that's how you end up with "zero tolerance" drug laws that expel a girl from high school for taking Mydol for her menstrual cramps.)
Even if one believes that a human zygote (fertilized egg) is a human being, not even the most ardent pro-lifer argues that a zygote can feel the pain of its own destruction; that capacity clearly comes much later in ontogeny. But a person suffering from Cystic Fibrosis certainly does feel the pain as that disease destroys him by inches until he finally dies an agonizing, suffocating death. Is it black-and-white that each zygote is morally equal, on a one-to-one basis, to every already-born person?
I see a whopping huge moral distinction between killing a zygote to save a teenager -- and killing a newborn baby to save that same teenager. Perhaps it's just sentimentality; but sentiment is as much a part of humanity as rigorous logic. Sentimentally, I attach far more value to a newborn, or even to a seven month old foetus, than to a human zygote... let alone to a cell produced by somatic cell nucleus transfer, a.k.a. "therapeutic cloning."
Professor Justin Barnard sees no moral distinction whatsoever. Early in his Public Discourse article, he refers to the destruction of human embryos as "the wanton destruction of innocent human life;" then towards the end, he adds the following tendentious codicil:
[T]he embryo produced by cloning enjoys the same moral status, whatever one judges that to be, as the embryo produced the old-fashioned way.
Since we know what Barnard "judges that to be," he must see no moral distinction at all between a skin-cell nucleus stuck into a denucleated egg cell and given a spark of electricity -- and a teenager dying of CF.
I consider that position vile and thuggish if he holds it merely for political purposes, and monstrous if he holds it honestly. (A lack of hypocrisy doesn't necessarily ameliorate a grotesque idea; I'm sure that many advocates of eugenics were quite sincere in wanting to eliminate inferior humans.)
But why can't we just use the stem-cell lines for which even George W. Bush approved federal funding, those generated before 9 PM, August 9th, 2001? Simple: Because they are old, degraded, and no longer work very well. In the interview linked above, Ben Wattenberg asks whether Collins agrees with the Bush decision to restrict federal funding for ESCR to those lines that already existed. Collins responds:
But as a scientist -- I would say we are currently not making as much progress as we could if we had access to more of these stem cell lines. The ones that are currently available for federal funding is a very limited set and they clearly have flaws that make them hard to use. But you know what? I think that kind of stem cell research is actually not the part that's going to be most interesting.
The part that's really showing the most promise is to take a skin cell from you or me and convince that cell, which has the complete genome, to go back in time and become capable of making a liver cell or a brain cell or a blood -- cell if you need it to. That reprogramming. That's called somatic cell nuclear transfer in the current mode. And yet people still refer to those products as an embryo. Well, there's no sperm and egg involved here.
And that's where I think we've really gotten muddled. That the distinction between these various types of biology has been all murkified. And people are beginning to argue in very irrational ways based on a lack of understanding what the science says. If we could back off from all of the, sort of, hard edged rhetoric and really say, okay, what is science teaching us, I suspect that the moral dilemmas are not nearly as rough as people think they are.
Finally, I think this response in a third interview for Christianity Today sums up and clarifies Collins' beliefs (which Barnard claims are "less than clear"), not only as to ESCR but human cloning as well (see p. 5):
[E]ven if the safety issues were solved, would human reproductive cloning be an acceptable practice? It wouldn't be for me. I believe that human beings have come into this world by having a mother and a father. To undertake a different pathway of creating a human being is a profound departure from the normal state of things. I have yet to hear a compelling argument for why we need to do that.
It is a classic example of a collision between two very important principles. One is the sanctity of human life and the other is our strong mandate as human beings to alleviate suffering and to treat terrible diseases like diabetes, Parkinson's, and spinal-cord injury. The very promising embryonic stem-cell research might potentially provide remarkable cures for those disorders. We don't know that, but it might. And at the same time, many people feel, I think justifiably, this type of research is taking liberties with the notion of the sanctity of human life, by manipulating cells derived from a human embryo.
It's rare that we get a presidential nominee to an important scientific (or legal) position who has thought as deeply and consistently about the great moral dilemmas as Francis Collins has. It's even rarer that after such thought, he remains so close to what I would call the best conservative principles of individualism, respect for human life and dignity, and ethical scientific inquiry. (And it's especially dumbfounding that a president who would call himself "the One We Have Been Waiting For" would make such an appointment. One would think that the One would be more apt to attempt to use somatic cell nucleus transfer to appoint an exact clone of himself to head up NIH.)
But for heaven's sake, let's grab this one while we can. Let's not make a big stink just because Francis Collins' evangelical Christian position on stem cells is an angstrom apart from that of the most dogmatic true believer, such as Professor Barnard. For God's sake, Obama could have named Peter Singer!
Collins is an amazingly good choice for NIH Director. He will be sensitive to human-life issues, a strong advocate for scientific inquiry, and not only not hostile to, but actually embracing of issues of faith, religion, and morals in federal funding of biomedical and health-care research.
Cross-posted in Hot Air's rogues' gallery...
December 10, 2008
I found an article on improving brain function biochemically, instead of by, say, higher education, sexual abstinence, and ideological purity of essence -- three proven failures. "Smart pills," that is to say.
Some earthbound IQs on both left and right are wringing their hands at the very idea of boosting intelligence or concentration via psychopharmacology; but as an old student of Timothy Leary and Robert Anton Wilson (I took multiple multi-day seminars from each over a number of years), it's old home week for me.
The ethical questions such intervention raises are interesting; but ultimately, I don't think the neophobes (a.k.a., Luddites) have an argument to stand on: There is nothing inherently unethical about making people smarter, though I agree that smartening up alone will not solve our most pressing problems.
It would certainly help, though; I consider intelligence increase to be a necessary but not sufficient component of evolving the human race into something more advanced. (For the killer arguments on this issue, I call your attention to Poul Anderson's early novel, Brain Wave, 1954.)
Here is the somewhat shallow and ham-fisted way the Associated Press "analyzed" the questions:
Healthy people should have the right to boost their brains with pills, like those prescribed for hyperactive kids or memory-impaired older folks, several scientists contend in a provocative commentary.
College students are already illegally taking prescription stimulants like Ritalin to help them study, and demand for such drugs is likely to grow elsewhere, they say.
"We should welcome new methods of improving our brain function," and doing it with pills is no more morally objectionable than eating right or getting a good night's sleep, these experts wrote in an opinion piece published online Sunday by the journal Nature.
Needless to say, in this dark age of science, the idea of better thinking through chemistry has stirred up a hornet storm:
Some health experts agreed that the issue deserves attention. But the commentary didn't impress Leigh Turner of the University of Minnesota Center for Bioethics.
"It's a nice puff piece for selling medications for people who don't have an illness of any kind," Turner said.
Note the implication: If you don't have what Ms. Turner would call an "illness," you have no business altering yourself chemically. How liberating!
I personally consider stupidity a disease caused by a malfunctioning brain, leading to a lack of intelligence that society would be well advised to eradicate, if it can. But the same holds true for sociopathy -- which I envision as a lack of empathy leading to amoral, criminal, or unethical behavior.
In reality, civilization would be immensely benefitted by increasing both intelligence (chemically or otherwise) and traditional morality, which must go hand in hand, or catastrophe ensues:
- Increasing intelligence without increasing morality leads to a world of Adolf Eichmanns and A.Q. Khans;
- But increasing morality without increasing intelligence leads to a world of Prince Charleses and PETA-people, well-intentioned dimwits who do just as much damage as the mad scientists; how? By successfully palming off their own follies and foibles onto the nation as a whole.
I say hurrah for increasing intelligence! Or to put it in a Learyesque context, hurrah for Space Migration, Intelligence Increase, and Life Extension (SMI²LE), by any means necessary. So long as we simultaneously work just as hard to increase traditional moral understanding -- also necessary but not sufficient, and upon which our entire civilization of freedom, liberty, Capitalism, and individualism is built.
April 11, 2007
I stand foresquare for scientific progress, particularly in the field of medicine (I want to live forever)... and most particularly for the hot field of stem-cell research. I have no moral qualms about even embryonic stem-cell research, especially when the stem cells are extracted without destroying the embryo that contains them; and I have argued the point rather forcefully.
But it's bloody awful and a bloody shame that the Times of London has just been caught with its knickers down, defending embryonic stem-cell research by pointing to a new miracle cure... brought about by adult stem-cell research.
They've got some bloody cheek!
I refer to this passage in the story:
Diabetics using stem-cell therapy have been able to stop taking insulin injections for the first time, after their bodies started to produce the hormone naturally again....
Previous studies have suggested that stem-cell therapies offer huge potential to treat a variety of diseases such as Alzheimer’s, Parkinson’s and motor neuron disease. A study by British scientists in November also reported that stem-cell injections could repair organ damage in heart attack victims.
But research using the most versatile kind of stem cells -- those acquired from human embryos -- is currently opposed by powerful critics, including President Bush.
Darn that theocratic Bush! This is one of the most stunning breakthroughs of stem-cell therapy, and he wants to throw it all away, just because his "religion" doesn't agree with science. Science, man! Does Bush think he's God?
Why is the Bush administration trying to stop such a wonderful medical advances from embryonic stem-cell research as a cure for diebetes?
Of course, the elipses above indicates something was cut out. Here is the next paragraph after the first above:
Diabetics using stem-cell therapy have been able to stop taking insulin injections for the first time, after their bodies started to produce the hormone naturally again.
In a breakthrough trial, 15 young patients with newly diagnosed type 1 diabetes were given drugs to suppress their immune systems followed by transfusions of stem cells drawn from their own blood.
Needless to say, the diabetic subjects were not embryos, or they couldn't have signed the consent forms.
The chutzpah of the Times aside, I don't want to minimize the medical breakthrough reported here. More and more, we're starting to realize that stem cells may be the "magic bullet" that offers us a splendid panoply of cures for a laundry list of disease and dangerous and crippling conditions -- not just alleviate their symptoms:
They enrolled Brazilian diabetics aged between 14 and 31 who had been diagnosed within the previous six weeks. After stem cells had been harvested from their blood, they then underwent a mild form of chemotherapy to eliminate the white blood cells causing damage to the pancreas. They were then given transfusions of their own stem cells to help rebuild their immune systems.
Richard Burt, a co-author of the study from Northwestern University’s Feinberg School of Medicine in Chicago, said that 14 of the 15 patients were insulin-free for some time following the treatment. Eleven of those were able to dispense with supplemental insulin immediately following the infusion of stem cells and have not had recourse to synthetic insulin since then, he said.
“Two other patients needed some supplemental insulin for 12 and 20 months after the procedure, but eventually both were able to wean themselves from taking daily shots,” he added. One patient went 12 months without shots, but relapsed a year after treatment after suffering a viral infection, and resumed daily insulin injections. Another volunteer was eliminated from the study because of complications. The therapy, known as autologous hematopoietic stem cell transplantation, has already shown benefits to individuals with a range of auto-immune diseases such as rheumatoid arthritis, Crohn’s disease and lupus.
I am steadfast in my support not only for proven therapies using adult stem cells but also for even greater potential therapies from placental, uterine, and embryonic stem cells.
Anent the last, I understand that a great many people see deliberately killing an embryo as a form of abortion, thus infanticide. However, as we discussed here back in August (linked above), researchers have already developed a very promising technique for extracting embryonic stem cells without harming the embryo, which continues to live and reproduce normally.
But my cause is not helped by elite media idiots who try, for political purposes -- and with all good intentions, I can only assume -- to shoehorn embryonic stem-cell research into a story that is entirely about adult stem-cell research, with the clear implication that Bush's policy would prevent future advances... such as a cure for diabetes.
You cannot raft into truth through a cataract of lies. It is a lie that embryonic stem-cell research shows no promise at all; but it's just as much a lie to say that embryonic stem-cell research has a track record of proven cures. It is at the same stage now as gene therapy was in the 1980s, prior to its first successful use in 1990.
Given time and continued research, stem-cell advances will likely be more significant to future medical care than anything since the description of DNA by James D. Watson and Francis Crick in 1953. We're already seeing extraordinary cures by the use of stem cells; and there is every reason to pour resources into all forms of stem-cell research, including embryonic -- with proper safeguards to avoid killing embryos.
But please, folks on both sides of the debate... stick to the truth: The web is tangled enough as is.
January 8, 2007
For years, I have wondered why we assume that two persons -- call them Pat and Mike -- who eat the same portion of the same food necessarily absorb the same number of calories. I mean that it's inherently implausible: the calories you absorb depend upon the precise mechanism of digestion; since everything else in our bodies works with varying degrees of efficiency, why shouldn't the stomach, small intestine, and large intestine as well?
We've all seen people who eat, eat, eat, yet cannot gain a single pound; and others who eat no more than everyone else at table, exercise as much or more -- yet pack on the leaf-lard, year after year, regardless.
I'm in the latter camp; my agent is the in former... when Ashley described to me how he ate his way across Italy some years ago -- at least 3,000 calories per day (by the traditional measurement) -- I could only seethe with envy. The answer seemed pretty obvious to me: that "3,000 calories" for Ashley was really only about 1,500 per day; but had I eaten all that pasta and pizza, cheese-stuffed portabellas and cream sauce... it would have been about 4,500 calories per diem!
But the proof (of the pudding?) has been lacking -- until now. Last month, AP reported a stunning breakthrough in our understanding of how food calories become body calories... which will eventually allow us to perfectly manage weight, from morbidly obese, to obese, to overweight, to underweight, to skeletal:
The size of your gut may be partly shaped by which microbes call it home, according to new research linking obesity to types of digestive bacteria.
Both obese mice - and people - had more of one type of bacteria and less of another kind, according to two studies published Thursday in the journal Nature.
As it happens, humans cannot naturally digest the food we eat. This isn't unusual; termites cannot naturally digest wood, either. All we can do is break the food down to itty bitty pieces: the final work of turning fats, carbohydrates, and protein to lean body tissue, blood, bone, body fat, and biochemical energy is done by bacteria that live in our digestive tract. (This is the scientific field of "infectobesity.")
There are two main types of bacteria that can do the job of actually digesting food: Bacteroidetes and Firmicutes; the latter are much more effective than the former. Firmicutes extract more body calories per food calorie than do Bacteroidetes... and the exact mix of these bacteria in Pat's and Mike's digestive system determines, to a large degree, how much weight they pack on:
In one study, Gordon and colleagues looked at what happened in mice with changes in bacteria level. When lean mice with no germs in their guts had larger ratios of Firmicutes transplanted, they got "twice as fat" and took in more calories from the same amount of food than mice with the more normal bacteria ratio, said Washington University microbiology instructor Ruth Ley, a study co-author.
It was as if one group got far more calories from the same bowl of Cheerios than the other, Gordon said.
In a study of dozen dieting people, the results also were dramatic.
Before dieting, about 3 percent of the gut bacteria in the obese participants was Bacteroidetes. But after dieting, the now normal-sized people had much higher levels of Bacteroidetes - close to 15 percent, Gordon said.
From an evolutionary standpoint, I would guess that people whose ancestors (on the mother's side) were poor and often on the brink of starvation probably have higher levels of Firmicutes in their guts; we get our necessary bacterial "infection" from our first food -- usually breast milk -- and in starvation situations, females with higher levels of Firmicutes would be much more likely to survive and breed, being able to extract more calories from the meagre amounts of available food.
Either way, this holds out the promise of finally being able to help people lose weight (or gain it) by techniques more effective than the crude "eat less and exercise more" -- which sounds great but actually works for only a fraction of the population. To lose weight, replace a portion of the patient's Fermicutes with Bacteroidetes. Similarly, by reversing that process, impoverished people in countries prone to famine could be more fully nourished by the smaller amounts of food available to them.
Millions of Americans have been waiting for just such a breakthrough... now we just have to wait until the doctors decide to do some large-scale longitudinal studies. (Pssst... I volunteer!)
That is, if the Center for Science in the Public Interest -- the folks who breathlessly informed us all that Mexican food, Chinese food, pizza, and popcorn were fattening -- will allow infectobesity research to continue... or whether they will launch a jihad against it, as they did against the synthetic fat substitute olestra.
See, the CSPI believes that suffering and hardship builds character; and by golly, they're out to make sure we get it, good and hard. What it really boils down to is this: who do you want to control your caloric intake... you and your doctor? Or a bunch of sallow, pasty-faced vegans giddy from self-induced malnutrition?
Hand me that bucket of Bacteroidetes, Mabel, and down the hatch!
Look out gums,
Look out Fermicutes,
Here it comes!
January 7, 2007
A little while ago (August 23rd, 2006), we posted on the discovery that human embryonic stem cells could be extracted non-destructively, leaving the embryo intact; then on November 9th, we noted how President Bush could make use of this stunning breakthrough, offering to fully fund federal stem-cell research with two conditions:
- That the funding be available not only for embryonic but also adult and placental stem-cell research;
- That funding for embryonic stem-cell research only be made available to researchers that used the new, non-destructive extraction technique.
And now there's this:
Scientists reported Sunday they had found a plentiful source of stem cells in the fluid that cushions babies in the womb and produced a variety of tissue types from these cells - sidestepping the controversy over destroying embryos for research.
Researchers at Wake Forest University and Harvard University reported the stem cells they drew from amniotic fluid donated by pregnant women hold much the same promise as embryonic stem cells. They reported they were able to extract the stem cells without harm to mother or fetus and turn their discovery into several different tissue cell types, including brain, liver and bone.
I believe it's now more crucial than ever that Bush and the GOP in Congress get out front of this issue by themselves proposing a huge increase in funding, including funding for amniotic-fluid stem-cell research, along with adult, placental, and even embryonic (when extracted non-destructively).
This would flummox the Democrats and take the wind out of their soles; it's particularly effective in countering the meme of "anti-science, fundamentalist Republicans" that the Democrats have so successfully wielded to turn Independents away from GOP nominees.
This is the issue; this is the time to move. There is no longer any moral case that can be made against stem-cell research... so while the Democrats are floundering around with minimum wage proposals (that the Republicans should also immediately adopt and support, bad as they are, just to get them off the table), we can come roaring forth with a proposal to help everybody live to be 150 years old.
Well, that's how we should sell it, at any rate. For a change, let's make the Democrats look like tired, old men, the "establishment," perpetually trapped fighting for yesterday's leftism. It shouldn't be hard... but we actually have to do it.
There's an old story that seems apropos:
Moishe was an exceptionally assiduous follower of every jot and tittle of Jewish law and ritual; he never failed to attend synogogue every shabbat and every holy day, he kept rigidly kosher, and he prayed constantly.
Moishe wanted to move to Israel, but he was too poor. So he began praying to God for money: "Lord, make me win the lottery, make me win the lottery. You know I'll do nothing but good works with the money -- so make me win the lottery!"
Day and night he prayed -- "make me win the lottery, make me win the lottery!" -- until the third day, on the 10,001st repetition of the prayer, the Lord God of Israel actually answered.
A burning bush appeared in Moishe's living room, and a booming voice fillled every corner: "Moishe, Moishe," said the Voice, "meet me half-way... for God's sake, buy a lottery ticket!"
Come on, folks; there is every scientific reason why we, not the technophobic New Left, should become the champions of stem-cell research and no moral argument why not: it's an issue that truly resonates with Independents, young voters, and libertarian-conservatives... and it's darned good public policy, too.
The odds on this bet are much, much better than the odds of winning a money-type lottery. So let's buy that ticket and get out ahead of the Democrats on this important issue!
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