Tuesday, February 28, 2006

Last words on Brown bioethics

As the undergraduate bioethics program at Brown lurches towards oblivion, it's nice to know that we're at least getting some free press over it.

The Brown Daily Herald has published a news article on the demise of the concentration.   And if you thought that wasn't enough, they've also managed to print an opinion piece (read: partisan propaganda) written by a few of us challenging the university's apathy towards bioethics.

For more reading, check out last year's entry in the AJOB editors' blog bidding farewell to Brown bioethics.

Monday, February 27, 2006

HHS to NIH: Limited Funding for Participation in International AIDS Conference

The NIH had hoped to send 77 of its staffers to the upcoming International AIDS Conference to be held in Toronto. However, if the Department of Health and Human Services has its way, only 25 will be permitted to attend. The Bush Administration is again endorsing limits on the number of federal employees that may attend international conferences. (While these limits were defined by Congress, they have been waved in the past).

If we accept that the open exchange of scientific hypotheses, theories, and findings is integral for progress, and if we agree that the global AIDS pandemic is a topic of scientific inquiry for which progress ought to be made, then this policy does more harm than good. In an age when science is becoming more industry-driven (and therefore less publicly accessible and less objective), we ought to be concerned with strengthening our government-endorsed research programs. Limiting the NIH to one third of the positions it requires will simply hinder opportunities for progress for US and foreign researchers. Is placing a quota on idea exchange really the best way to save money?

The only way around the policy seems to be a move to hold an international AIDS conference on domestic soil. However, this has not been done since 1990 due to a 1993 immigration and naturalization policy that severely restricts the ability for individuals living with HIV to legally enter the US.

The international community has boycotted the US in opposition to this policy, opposing it on ideological and practical grounds. On one hand, the policy clearly discriminates against individuals based upon their health status (with no rational justification for this discrimination). On the other hand, it places a technical hurdle in the way of AIDS conferences, where participants are sometimes HIV positive.

United States policy has therefore boxed us into a corner: we restrict the entry of individuals living with HIV onto our soil, effectively precluding the possibility of a US hosted International AIDS Conference. At the same time, we tell the NIH that they must slash their list of conference attendees to 1/3 their intended amount, simply because the conference is held on foreign soil.

Nowadays, Canada really does seem to be a world away.

Flu Wiki

To read about pandemic flu preparedness, you might check the websites of the CDC, WHO, even the Department of Health & Human Services. But a wiki?

Flu Wiki, to be exact -- the self-described "most complete" internet source on pandemic flu.

Its anonymous contributors, according to the site's creator, include some of the U.S.'s foremost experts on pandemic flu. But why the anonymity? Because they fear reprisals from the Bush Administration for contradicting avowed policy.

With "massive" bird flu looming in China, it's likely a matter of time before A5N1 hits domestic shores. So it's particularly troubling that government-funded scientists are being pressured, explicitly or not, into keeping their mouths shut on flu policy.

If and when the pandemic hits, only an informed public that trusts its government will be equipped to handle the consequences. And for that, we'll need inoculation of a different kind -- a dose of transparency from the Bush Administration.

Saturday, February 25, 2006

Sheldon Krimsky @ Brown

Thanks to everyone who made Professor Sheldon Krimsky's lecture here at Brown a success.
(You know who you are.)

Here's a link to the Brown Daily Herald's coverage of the event.

Wednesday, February 22, 2006

Plan B fallout at the CMAJ

The Canadian Medical Association has dismissed the top two editors of the Canadian Medical Association Journal over a dispute concerning the journal's coverage of privacy violations Canadian women experienced when obtaining Plan B.

The article, which was published late last year, reported that Canadian women seeking Plan B at pharmacies across Canada were routinely asked for personal information, sometimes including sexual history, before being given the over-the-counter pill. This information was entered into computer databases.

The publishers of the journal, CMA Media, headed by Graham Morris, demanded that substantial portions of the article be cut -- including the description of the experiences of the women. Its rationale? That the account of the women's experiences did not constitute reporting but that it amounted to scientific research and hence required peer review prior to publication.

Of course, there's no reason to believe that any of this has to do with information reporting standards and peer review. Rather, CMA's action is a blatant instance of top-down political bias compromising the editorial independence -- and hence, the integrity -- of the CMAJ.

When heads start rolling at Canada's self-described leading medical journal over semantics, you can bet it's political.

Sunday, February 19, 2006

Global warming: fact or (best-selling) fiction?

Michael Crichton, author of State of Fear, a best-selling work of fiction challenging the existence of global warning, has won a journalism award from the American Association of Petroleum Geologists.

In a review posted on the AAPG's web site, State of Fear is termed a "wake-up call" for geologists who have fallen prey to environmentalists' "perverted science." Crichton's scientific analysis is given credence on two accounts: first, because "much of what passes for science is actually fiction"; second, because he has "real scientific credentials": namely, an undergraduate anthropology degree and an M.D. from Harvard.

While intersubjective criticism is vital for ensuring scientific objectivity, Crichton is no geologist or climatologist. He is a fiction writer. Furthermore, it is fatuous to impugn the objectivity of science in order to justify putting science fiction and scientific practice on equal epistemological footing.

Stanford climatologist Stephen Schneider, on the other hand, terms the book "demonstrably garbage." It appeals to petroleum geologists, he says, only because "they are ideologically connected to their product."

Crichton's politically savvy pseudoscience hasn't escaped willing ears: namely, those of President Bush, who invited the novelist to the White House last year for an hourlong chat which left both men in "near-total agreement" about global warming.

Crichton has also testified before the Senate challenging the methodological rigor of climate science. In his testimony, he attests that it is "the proper function of government to set standards for the integrity of information it uses to make policy."

Guess the AAPG didn't get that memo.

Saturday, February 18, 2006

Healthcare Concerns for LGB United States Military Personnel

A recent article in Professional Psychology: Research and Practice discusses the difficulties faced by military psychologists serving lesbian, gay and bisexual (LGB) military personnel. It provides a very interesting discussion of medical practice in circumstances where standards of medical ethics conflict with institutional requirements (e.g. military rules).

Official military rules allow for confidentiality (within certain limits) for military psychologists. However, these rules lack teeth in a military system that values military oversight of service-members’ lives. For example, military psychologists’ records may be viewed by non-medical staff members of the military, particularly when staff members suspect that an individual’s performance may be linked to a psychological state. Thus, although psychologists needn’t openly disclose information, the military has devised a mechanism of bypassing the psychologist altogether.

As a result, some scholars advise psychologists to avoid documenting references to homosexual activities during therapy sessions. This recommendation, if followed, may lead to records being left dangerously incomplete. If a service member’s suicidal tendencies are linked to homosexual feelings, a medical record that omits references to the patient’s homosexual feelings may harm a patient more than help him. If the service member changes psychologists, for example, the new psychologist may be left unaware of the causes of the patient’s suicidal tendencies. As a result, the quality of therapy may be decreased. When choosing how to document a patient's condition, a psychologist may be forced choose between the lesser of two evils.

Furthermore, the regular rotation of individuals through military posts means that a service-member who is a psychologist today may be asked to abruptly change positions tomorrow. It is unclear how a military psychologist who counsels an openly gay service-member will handle information of the member’s homosexuality when he becomes a military administrator who is charged with imposing “Don’t Ask; Don’t tell.” Should he simply pretend that he was not told?

We have no reason to believe that only academics ponder these questions. Service members considering whether to seek counseling for feelings of depression or anger associated with their sexuality may be hesitant to trust psychologists enmeshed in the military machine. As a result, these individuals may turn to the only “counselors” in military settings for whom confidentiality is guaranteed: chaplains. Chaplains are often individuals who lack medical training and who have been known, in the past, to suggest “reparative treatment” for homosexuality. Needless to say, reparative remedies lack scientific support just as chaplains lack the medical credentials needed to counsel individuals coping with homosexual feelings.

Our first priority ought to be repairing a military environment that exacerbates the already difficult task of coping with homosexual feelings. The very fact that service-members avoid counseling for fear of being removed from the military is startling to say the least. However, changes in the ‘Don’t Ask; Don’t Tell” policy must await a more rational period in American politics. In the meantime, the military ought to seriously consider importing civilian psychologists onto military bases and making these experts available for service-members. These civilians ought to be guaranteed uncompromised client-patient confidentiality.

Questionable University Funding Criteria for Genetically Modified Food Research

I recommend Andrew Pollack's recent New York Times article for those looking for a concise explanation of the considerable hurdles precluding research in genetically engineered foods.

Interestingly, it appears that university research into genetically engineered crops (e.g. tomatoes rich in lycopene, a caretenoid believed to have cancer-fighting properties) is facing a lack of funding. This development is significant, as genetically engineered foods are hailed by many members of the scientific community as a potential solution to the developing world’s disease burden. Some suggest that university funding cuts are fueled largely by the fact that genetically modified foods are not often brought to market due to the social stigmas attached to the crops.

We ought to be worried if, indeed, it is true that market predictions and social stigmas are dictating university research funding. If market predictions are influencing the decisions of funding committees, then this represents yet another instance of economic interests moving science away from the objective principles we expect of a public institution. Decisions influenced by social stigmas, conversely, may appear acceptable, as they involve consideration of public interests (after all, science ought to be a public institution). However, it is dangerous to allow for public fears regarding the potential harms of genetically engineered foods to preclude objective scientific research aimed at producing safe crops. To do so would be to allow for the current shortcomings of our technologies to preclude any efforts at improving these technologies.

Universities should continue to fund research into new methods of engineering safe and effective foods, with the understanding that the end result of research may not be perfect. However, the information gained through such research may be useful for the future production of safe, effective foods. Assuming that genetic engineering research itself can be conducted in a safe manner (and there is little reason to suggest that safe, contained experiments cannot be conducted), the research ought to be pursued.

The University serves as one of the final arenas for the pursuit of truly public science. In the case of genetically engineered food research, this is precisely the brand of science we need most. Indeed, we may find that university research will serve as the main avenue through which social stigmas regarding genetically engineered foods are refuted.

Thursday, February 16, 2006

New Rotavirus Vaccine an Expensive Ethical Fix

Recently, Merck secured FDA approval for its new rotavirus vaccine, Rotateq. The new vaccine has been viewed as an alternative to Rotashield, Wyeth's ill-fated rotavirus vaccine that was found to lead to an increased rate of intussusception, a potentially fatal intestinal complication.

In 1999, Rotashield was pulled from the US market. However, continued vaccine studies were considered in the developing world, where pediatric rotavirus mortality rates are greater than morality rates from Rotashield-induced intussusception. Many argued that support for these studies would presuppose that lower standards for pediatric vaccine safety in the developing world were ethically permissible. In the end, developing countries refused to use a vaccine that had been deemed too dangerous for US children.

Now, eight years after Wyeth's development of Rotashield, Merck has developed Rotateq, a vaccine that solves the intussusception problem. For some, this new vaccine marks the end of a bitter debate regarding the use of Rotashield in the developing world.

However, this shiny solution comes with a shiny price tag. Merck will charge $187.50 for the three required doses of Rotateq, making Rotateq one of the most expensive vaccines on the market. Merck predicts that, by 2009, the vaccine will bring in as much as $500 million in annual revenue. Rotashield, meanwhile, had a significantly cheaper $114 price tag.

It is good to know that Merck’s $500 million dollar profit will come largely from the developed world, where rotavirus is more of a nuisance than a killer. Indeed, the vast majority of rotavirus deaths– 82% of them – occur in the poorest countries.

Rotateq’s price tag brings it far out of reach of the countries that most desperately need a rotavirus vaccine. Thus, although we may have succeeded in developing a rotavirus vaccine that addresses an important side-effect issue, we have not succeeded in producing a vaccine for the developing world. For the poorest nations, where rotavirus mortality is the highest, the choice may still be between a cheaper, more dangerous vaccine or no vaccine at all.

Wednesday, February 15, 2006

Genentech's 800 lb. gorilla

Genentech is planning to charge double for Avastin's use in breast and lung cancer.

Avastin is already approved as a last-ditch colon cancer therapy (for which Genentech charges $50,000 for a year's supply). So why the additional cost? Doctors must use double the dose of Avastin for breast and lung cancer. At least, that's the only dose that was used in the clinical trials for breast and lung cancer, leaving doctors in the dark about the efficacy of the lower dose.

Genentech plans to stick by its price-per-milligram scheme, despite the fact that the additional cost of production is minimal. (If Avastin's new price holds, the drug's yearly revenue will rise from $1.1 billion to approximately $7 billion by 2009.)

Because they can't claim they're recouping R&D expenses, Genentech is using a novel justification: the inherent (read: market) value of life-sustaining therapies. A member of Genentech's board, William Burns, sums it up quite nicely: "As we look at Avastin and Herceptin pricing, right now the health economics hold up, and therefore I don't see any reason to be touching them. The pressure on society to use strong and good products is there."

It's interesting how overt the commodification of health has become in the discourse of drug company execs. It's one thing to charge an arm and a leg for "lifestyle" drugs like Viagra, but quite another to let desperate competition between cancer sufferers optimize your asking price.

Go... Genentech!

Tuesday, February 14, 2006

Clay Pots and Evolution

While checking my e-mail, I ran across a Google-targeted ad for an article pitting evolution against common sense. Lo and behold, I found the "mousetrap" argument from irreducible complexity refashioned, using religious discourse, into an appealing argument about clay pots. (For the old-school fans of intelligent design, there's an allusion to Paley's Watch in there too -- David Hume be damned.)

While the philosophical rigor of this Christian fundamentalist website isn't impressive (for other interesting reading, see "Did God Make Me Gay?" and "God is an Elephant?"), it's worth noting that irreducible mousetraps, apparently, come in many forms.

That which we call a rose...

Monday, February 13, 2006

Birth

Greetings all,

Welcome to the Bioethics Society blog. Here's hoping we can use it to share bioethics-related articles, post original commentary on bioethics issues, and keep track of bioethics lectures and events across campus (there are so many of them). Who's with me?

Happy posting,
FF

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