Up@dawn 2.0

Thursday, February 26, 2015

Grey's Anatomy

Interesting episode: "Staring at the End"... Dr. Herman (Geena Davis) is usually the coldly paternalistic know-it-all doc, but now she's on the other side of the doctor-patient relation and the surgical knife- vulnerable, fearful, and in need of a caring physician.

Head Transplants!


Genetic Engineering 26 Feb 2015

My contribution is towards researching the benefits of genetic engineering and why genetic engineering is not immoral. Genetic engineering is a hotly debated topic because it is claimed to be (A) “playing God” or (B) relationship-ruining between parent and child. It is also thought that (C) trying to make the “perfect” person is no different than Hitler wanting to make the “perfect” race. Genetic engineering is controversial for these reasons and the following research will try to refute these claims. My research is to find how genetic engineering is not immoral and, in fact, should be a moral obligation.
(A)   There are people who believe that wanting to biologically enhance oneself is wanting to play God. It implies that humans want to be creators, and that we have the knowledge and the wisdom to use that knowledge. Some people think that humans really do not know what to do and that how someone is born should be left to fate and random chance. However, plenty of people are in favor of breeding certain animals together to get the right dog (Savulescu). For example, dog-owners will breed a fast dog for a dog show. There is also breeding of the food we eat. For example, farms and manufacturers will breed the yellowest and the sweetest corn.
Basically, humans have already done genetic engineering to other objects and animals that doing it to themselves should be no different. Also, people already try to enhance themselves emotionally, mentally, and physically by taking drugs, plastic surgery, etc…
(B)   There are people who believe that a parent should not turn their child into what he or she wants the baby to be. It takes away the child’s autonomy and that the child should be free to pursue whatever the he or she desires by chance. A quote from Merriman perfectly replies to this: “How is it suddenly unethical to want an attractive, smart baby when it is perfectly ethical to desire an attractive, smart mate who will consequently provide that attractive, smart baby ultimately desired?” There is also the argument that the parent should not make the decision because it should be the baby’s decision to be enhanced. However, many males were circumcised as babies and there was definitely no consent given at that time. The circumcision was still done anyways (Merriman).
(C)   There are people who believe that genetic engineering to create the “perfect” person mimics Hitler’s attempt for the “perfect” race. However, like Merriman thought, heterosexual people will choose mates that will pass the desired genes to their children. They are already wanting a healthy baby and there should not be a reason that virtually fool-proofing a baby’s genes to be that way could be wrong. Furthermore, psychology has come far enough to study the genes involved with personality. If cancer genes can be removed, the problematic behavior genes can also be removed. More specifically, behavior that involves harming others and themselves can be altered and hopefully removed – resulting in  “ethically better children” (Alleyne, Savulescu).

Alleyne, Richard. “Genetically engineering ‘ethical’ babies is a moral obligation, says Oxford professor.” The Telegraph, 26 Feb. 2015. Web. 16 Aug 2012. <http://www.telegraph.co.uk/news/science/science-news/9480372/Genetically-engineering-ethical-babies-is-a-moral-obligation-says-Oxford-professor.html>.
Merriman, David. “The Genetic Enhancement of Children Should Be Tolerated.” Technology and Society. Ed. David Haugen and Susan Musser. Detroit: Greenhaven Press, 2007. 148-156. Print.
Savulescu, Julian. “Genetic Interventions and the Ethics of Enhancement of Human Beings.” The Oxford Handbook of Bioethics. Ed. Bonnie Steinbock. New York: Oxford University Press, 2007. Print.

Genetic Engineering: What Lies Ahead?

My contribution to our group presentation of the advantages and disadvantages of genetic engineering in humans is to highlight the disadvantages. Genetic engineering does have many advantages by possibly curing hereditary diseases, eliminating genetic disorders, preventing children being born with disabilities, etc. But as the field develops further, many disadvantages can arise for the population as a whole. As with every field concentration, genetic engineering and biotechnology will develop innovations and grow to offer changes to even more areas of genetics. For this discussion I will highlight on two disadvantages of genetic engineering in terms of genetic enhancements.

A disadvantage that will arise very close to when genetic enhancement first becomes available at the consumer’s choice is further separation between social classes. Stratification amongst social classes is a well-known fact of contemporary society. Genetic enhancements threaten society’s equality even more by providing another form of stratification between social classes by limiting a resource from the lower classes. Genetic enhancements give higher classes even more room for improvement of themselves and allow decedents more ability to succeed even higher than the lower classes than these classes did previously. Genetic enhancements challenge the question of whether innovation should be beneficial to society as a whole or can be available to a minor fraction of the population and solely benefit the individual.

Speaking long term, genetic enhancement threatens the evolution of humans and greatly decreases genetic variety amongst populations. If the majority of the population's genomes were to become similar due to the same desired mutations being put in place by genetic enhancements then there would be less genetic diversity, including in immunity. The majority of the population would suffer from pathogens successfully intercepting their immune systems. It would make it very difficult for populations to prevent the spread of viruses and other pathogens since a much lower percentage of people would have the immunity needed to fight off these pathogens.


Project Summary-James Hayes

Speciesism in Biological Research

I have had trouble choosing a topic for this project. I am still a bit unsure how I will approach the topic, so this post will mostly be a “stream of consciousness” of my thoughts on the issue.
I am going at this project solo and, as I currently am conduct biological research myself, I often find myself wondering what sort of pain and/or suffering I am causing on my research subjects. This statement may be misleading, as I do not use animals, mice, or even embryos for my research. In fact, the only “organisms” I use are murine (mouse) macrophages, which are a form of phagocytic white blood cell, and Cryptococcus neoformans, a ubiquitous fungus that can act as an opportunistic pathogen. I often jokingly apologize to my macrophages, as my experiments commonly involve infecting them with C. neoformans. But there is a bit of truth in every joke, right?

While it may seem a bit oversensitive or silly to care about how my experiments are affecting the “lives” of organisms I study, let me take you through my thoughts as they come through my head. When we look back from our current place in time, our history is seemingly to us littered with immoral practices, whether they be “barbaric” entertainment such as gladiators, public hangings, slavery, etc. 

It seems to me that we constantly live in a paradoxical scenario wherein as our knowledge of the world grows, so too does the awareness of our ignorance. Now, as a society, we have risen above old traditions and live in a “modern world,” where we try to remain empathetic to the rights of other individuals, and minimize pain, hunger, and suffering.  

Now, as the 21st century sun rises with countless promising scientific advances on the horizon, we find our moral calibration has gone haywire as science advances at a lightning-quick pace. As we seem to become more and more aware of our past immoralities, I often wonder what current commonplace, everyday practices will be seen as barbaric by future generations. Immediately, the meat industry comes to mind, as well as some other activities that are perhaps better left unsaid. One of these things is biological research, and more specifically, the use of animals in biological research.
I have done extensive reading on the subject, and am having trouble formulating an opinion on what I consider ethical and unethical. I’ll simplify the discussion to the use of mice.

As many studies have shown (I can provide links if needed), mice (as well as many other animals of “lower order”) are capable of experiencing pain just as humans do. The primary difference in suffering of animals versus human suffering is the current belief that animals lack “awareness of their impending doom,” which decreases the psychological aspect of their suffering. There are many ethical issues in play, many of which we have discussed in class, such as utilitarianism, which may argue that the use of animals in research may ultimately result in the end of human suffering.
My project will be to examine the different philosophical approaches to this question, and focus primarily on speciesism, whether it comes into play here, and whether it is justified.

When the system fails

From "The End," a series about end-of-life issues.
I PURCHASED a purple “My Little Pony” at Walmart. I told myself it was to bring a brief smile to a sad little girl’s face. In reality, it was for me. In the overwhelming apparatus that medicine has become, sometimes the patient gets lost. So does the doctor. As the major safety net hospital in our region, my own hospital is arguably better equipped than most to effectively handle the human side of medical care. But even the most experienced institutions face an increasingly uphill battle against the systemic shortfalls of American medicine.
The patient, whom I’ll call Mohammed, was an American citizen, fully employed with health insurance, although with limited English language skills and health literacy. I had been his primary care doctor for seven years, and he came to me about two years ago with a lesion on his scalp after hitting his head on the door. I didn’t know exactly what it was, although my best guess was some sort of post-traumatic injury. I sent him to surgery for another opinion. The surgeon concurred with my diagnosis, but scheduled a biopsy. What I didn’t know was that Mohammed didn’t return for the planned procedure. He was struggling as a new single parent to his two young children who had just arrived from a war-torn African country, while his wife was left behind, her visa delayed by bureaucratic obstacles. He had deferred the biopsy because of his life circumstances without understanding the significance, and without catching anyone’s attention. The ball was dropped, and he fell through the cracks in the mighty apparatus.
Fast-forward eight months to the next time I saw Mohammed...

Athletic Enhancement Mid-Term Presentation

Athletic enhancement presentation. 
(Greg, Rory, and Ramsey) 

For our groups presentation I looked at how we can ethically draw a line of what is reasonable to consider unfair enhancement and what is just a highlight to sports and athleticism such as running shoes. My goal was to figure out a way to distinguish each example used in the book and those drawn from real life and figure out a way to decide on each. I looked at how small things like running shoes don’t really make you a better runner but enable you to avoid things that would hinder you such as a sharp pebble something that has nothing to do with your personal traits and has a lot more to do with the environment with which you a running in. In realizing this I had to look at EPO’s being used by endurance athletes to decide if there was for one a fundamental difference between living in an environment that helps your body create them or to inject them directly. This was interesting for me as the injection version is banned but some athletes train in specially acclimatized houses that allow the natural production and they are not under any ban. As I stated earlier y focus was almost purely focused on trying to find an ethical benchmark with which I might be able to view and breakdown each of the dilemmas brought forth in Sandal’s chapter on Athletic Enhancement. 
Athletic enhancement presentation. 
(Greg, Rory, and Ramsey) 

Greg's contribution. 

Health Effects of Athletic Enhancements

Apart form the obvious negative bioethical associations, drugs used to enhance athletic performance have got and are associated with extreme health consequences which in turn present a whole new aspect of bioethics not associated with sports, but with health issues and burdens on society at large.
Steroidal use in Athletes is associated with:

In Men:
Reduced sperm production
Testicular atrophy
Male-pattern baldness

In women:
Masculinization/defeminization of the female body and genitalia

Additional effects are:
Cardio vascular disease
Premature growth plate closure
Liver tumors
Prostate Cancer

Given the high prevalence of some of these conditions in steroid abusing individuals, should it be allowed knowing full well the possible health consequences? Where can we/do we draw a line with these substances? Should we as a community be expected to pay for the medical costs incurred later on in life? Are the potential harms of these substances really worth the athletic enhancement? At what cost are we prepared to accept the entertainment value of enhancement? Is there any meaning full payback for society associated with Steroid abuse?

These are just some of the questions that are raised as a result of steroid abuse. Most people have the opinion that “its their body, who are we to stand in their way”. But what happens when these drugs have an ultimate cost to society. In a world where there are so many real issues, is this something we should be encouraging and tolerating? Our freedoms and actions are always limited by the extent to which they harm others. We should not loose track of our interconnectedness. 

Wednesday, February 25, 2015

Genetic Enhancement and the Bigger More Positive Picture

Chant, Tim, and Eleanor Nelsen. "Genetically Engineering Almost Anything."NovaNext. PBS, 17 July 2014. Web. 18 Feb. 2015.

My contribution to my groups topic on Genetic Enhancements is to cover the positive attributes towards the science. I’m highlighting the reasons why genetic enhancement, and particularly gene insertion and deletion, should be viewed as a blessing to society rather than simply parents creating children tailored towards specific needs or wants in their lives, or people merely floating their ways to the top instead of using the hard work ethic America is so found of.

Genetic enhancement has gotten a bad reputation throughout the years, most famously people claim that scientists are trying to play God and shouldn’t mess with the natural order of things. But what exactly defines genetic enhancements? Should we view the vaccines our children, and we ourselves, have received over the years as a genetic enhancement,  considering they are unnatural in their own right, being made in a laboratory and injected into our bodies? Do steroids constitute as a genetic enhancement since they promote the rapid growth of muscles that would not naturally be found in the person taking them? At what point do we decide which enhancements are good or bad? Perhaps wrinkle creams and tanning lotions should be turned aside as well. The fact these creams and lotions alter the bodies genes to prevent wrinkles or cause the skin to turn shades darker at a rapid pace, when in fact it is not natural for these things to occur naturally in the body. We wrinkle, some of us are pasty throughout life, but when do we choose what is too far for science and what is just enough to satisfy every soccer moms craving of being a sun kissed cocoa dream?

One such way to look at genetic enhancement is to think of it as an improvement of self. If you could have increased memory capabilities, a better metabolism, be stronger physically, would you not see these things as desirable? If the technology is able, why should one go through the blood, sweat, and tears, so to speak, simply to lift a few extra pounds? Is it really worth subscribing to lumosity to attempt to remember those last few items on your shopping list? Wouldn't you want the best for your child? Not having to struggle through memorizing their multiplication tables with a simple insertion of a gene before birth? Potentially having the upper hand at baseball or basketball, not having to worry about the fragility of breaking a bone while at practice, or pulling a muscle and missing the big game. Maybe even having a simple boost with their physical strength could help them achieve their dreams of climbing Mount Everest. Say you were always terrible at learning to play an instrument, nothing ever stuck in your mind about what hand goes where and what note to strike when, so you request to have your child's musical ability heightened. With a genetic enhancement, they can flourish. They find a group where they seem to fit in so naturally, people who understand them and can help them reach the best of their potential, a group that understands the same things they're going through when learning to play new pieces or learn a new instrument. Could you honestly think this is such a bad thing to want for a child? Genetic enhancements can help the world, and the people in it, find out how to be the very best them they can be!

Plucked from the twitter-stream

Bioethics (@BioethicsRR)
Lying, Bullshitting, and Atul Gawande rightrelevance.com/tw/bioethicsrr…
The Conversation US (@US_conversation)
Medical tourism isn't always a fair deal for developing countries: theconversation.com/medical-touris…

Tuesday, February 24, 2015

Link to Atul Gawande's page.

Link to his page if you interested to know more.


American roots of Nazi Eugenics

Interesting read on Eugenics.

Is modern eugenics wrong?
The case against perfection ch. 4
Fact questions

1. Who called for eugenics to be " introduced into the national conscience, like a new religion " (p. 63)

2. Who opened the Eugenics Records Office in Cold Spring Harbor, Long Island? ( p. 64)

3. In Germany, America's eugenics Legislation found an admirer in __________, who later carried eugenics beyond sterilization to mass murder and genocide. (p.66-67)

4. Describe the free-market eugenics policy of Singapore's prime minister, Lee Juan Yew. (p.69)

5. Jurgan Habermas's case against liberal eugenics is especially intriguing because he believes it rest wholly on _____________ and need not invoke spiritual or theological notions. (p.79)

Discussion questions

1. Is genetic engineering  another form of eugenics?

2 . Do you believe that there will be state-imposed genetic engineering later in the future?

3. Does genetic engineering go against the "notion of giftedness"?

Healthcare programs within USA

                My part of the project in my group is to talk about one of the largest healthcare benefits organizations in the American healthcare system and how it has changed over time, TennCare. My family used to participate in this program at some point in time and I thought it was perfect to look up the history of what I once was a part of. Tenncare has an overall goal of giving people healthcare benefits and insurance to the people who need it most. The one thing that has changed over time is the ideal situation and people that they could do something about. Over time, it has created 18 programs to help those in need. Just to give an idea of the history of Tenncare and changes in eligibility and benefits over time, here’s a summary I made of the changes that have occurred. One thing that I did not know before was that Tenncare, a major health care organization, is made up of multiple health organizations. So while looking into the history, you will find out some organizations left, some disappeared forever and new ones and came in over time to help out. Also, the history further reveals the importance of a role of being a health care provider. Your words in the future may honestly bring stability to state or national funding programs for health care. Your opinion WILL play a major role in shaping society in some form in the future.

Tenncare was implemented in 1994 and at first covered three programs: Group 1(Medical Eligibles), Group 2(Uninsured people who lacked access to insurance of a prior date-March 1993- and still continued to lack access) and Group 3(Uninsurable people who were turned down for health insurance due to certain medical conditions).In December 1994 Tenncare almost reached its capacity for the uninsured category and couldn’t accept anyone else, but if you were on Medicaid at the time and were about to lose and fit the uninsured category, you were allowed to continue the program. This was when TennCare possibly realized that they need to be more specific about benefits to make sure the ideal capacity is reached. Tenncare expanded to have services for substance abuse and mental health in 1996. An agreed order known as Grier had helped people in appealing denials they had gotten from the program and in April 1997 uninsured children under the age of 18 could get Tenncare. There wasn’t any income limit for anyone in this category, but if you were over poverty level, cost sharing was required. In May 1997, enrollment was opened to dislocated workers, who were defined as people who lost work through a bonafide plant closing. By January 1998, uninsured children’s category was extended to 19 years of age with same rules applying as before. Also if parents had insurance, had a family income 200% below poverty level, and the children did NOT have insurance, they could get insurance. If income was above that level, cost sharing was need in family. Xantus, one of third largest medical care organizations, was placed in receivership under Tenncare by March 31, 1999. Prudential, a small medical care organization, gave notice in June 1999 that it would be leaving Tenncare. It only served people in the Shelby County area. By November 1999, Xantus was struggling to pay health care providers for participants in its programs so the state of Tennessee gave it $26 million as a loan to pay providers. By December 1999, Blue Cross Blue Shield, one of TennCare’s largest Medical care organization gave notice it was leaving but it withdrew its termination. By January 2000, the governor, Sundquist arranged a 17 member commission on the future of Tenncare to figure out what to do when Tenncare waiver expired in 2001. By March 2000, Sundquist hosted a  summit on the future of Tenncare to gather ideas from hospital executives, doctors, managed care executives and tennessee lawmakers to get ideas for the program in the near future. A man named John Tighe proposed the idea of Tenncare II. It outlined a business model that called for more accountability in the program in May 2000. Also during this time, Tenncare had been approved for children heald under state custody(foster care; children removed from homes). By July 2000, pharmacy benefits for dual eligibles were taken out of the MCO program. This meant that if you were trying to  use benefits in two different Tenncare related programs, you couldn’t use two at the same time to get certain medicines. By September 2000, multiple MCO’s denied the implementation of Grier to be appealed. By November 2000, Commission on the Future of Tenncare presented its ideas to the governor. By July 2001, Tenncare acquired two operational MCOs: Better Health Plans and Universal Care. By July 2002, Tenncare was altered in the following matter:
 “TennCare was revamped with the intention of dividing it into three programs: one for Medicaid eligibles (TennCare Medicaid), one for demonstration eligibles (TennCare Standard), and one for low income persons who needed help in purchasing available insurance (TennCare Assist). Each of the programs was to have a separate benefit structure.
TennCare Assist has not yet been funded, and the TennCare Standard benefit package has not been implemented due to a settlement agreement reached in Federal Court. All persons enrolled in TennCare currently have the same package of benefits.
Eligibility changes in the new program included the following:
A new Medicaid eligibility category was added. This category covered uninsured women under the age of 65 who had been determined by a Centers for Disease Control (CDC) site to be in need of treatment for breast or cervical cancer. There was no income limit on this category for Medicaid, although CDC required that women receiving screenings at a CDC site have incomes below 250% poverty. Medicaid eligibles have no cost-sharing requirements.
The category of "Uninsurables" was replaced by a category called "Medically Eligibles." New persons can enroll in this category if they do not have insurance, they meet "ME" criteria, and their incomes are below the poverty level. Medical eligibility must be proven through a medical underwriting process, rather than being proven simply by a "turn-down" letter from an insurance company.
The definition of "Uninsureds" was tightened by providing a more restrictive definition of the term "insurance." Certain groups of uninsured people who were already on TennCare were "grandfathered" into the new program.
Persons losing Medicaid eligibility or already enrolled in TennCare in some other category on July 1, 2002, were allowed to remain on the program if they were uninsured AND their incomes did not exceed 100% poverty for adults and 200% poverty for children OR if they were determined to be "medically eligible" at any income level.
New enrollment in the Uninsured category was closed. Provisions were made for an annual open enrollment period for low-income people in this category, depending upon the availability of legislative appropriations.
A process called "reverification" was begun whereby all persons in the demonstration population were asked to make appointments at the Department of Human Services so that DHS could determine whether these individuals were eligible for Medicaid, eligible for TennCare under the new criteria, or no longer eligible for TennCare under the new criteria.”(Citation: tn.gov)
                                              Figure 1: Example of some of TennCare's programs

By October 2002, Tenncare had acquired dental care benefits. All Pharmacy services had been moved to one Pharmacy benefits manager by July 2003. By 2004, more regulations were placed over pharmaceuticals and adults in the uninsured category. Children who were uninsured got to keep same benefits while restrictions were made more tightly around adults, especially eligibility into the uninsured category. Another reform called TennCare Transformation was proposed in 2004, but unless certain modifications were made, it was not going to get enacted. The governor did not want to pursue these modifications, so he was planning to drop Tenncare as a whole and just focus on Medicaid, but he did not want to leave children without benefits. In 2005, they closed the non-pregnant adult medically needy category of its programs because of expenses. In 2006, they broughtthis program back by creating an initiative to lower spending. In 2008, home health and nursing services were limited. By May 2009, re-verification forms were set in place so that TennCare can determine on a yearly basis if enrollees are still eligible for program. For those who lost eligibility, they still had benefits through MediCare. In February 2010, Affordable Health care Act was passed, which greatly impacted Tenncare. In the same month, TennCare submits Amendment nine for requests in benefit reductions and elimination of most adults participating in Tenncare. TennCAre choices in Long-Term Care program was available for people in Middle Tennessee by 2010. It provided community and home based services for people in need. The General Assembly had also passed in 2010 a hospital assessment for hospital that will generate revenue for TennCare because of the recession. By May 2010, TennCare had more than enough revenue to survive, so Amendment 9 was no longer necessary. By December 2010, Tenncare implements Public Hospital Supplemental Payment program, which was passed by submitting Amendment 11. By February 2011, Tenncare submits Amendment 12 to limit adults in program to state budget. By July 2011, Tenncare began covering medically approved smoking cessation products. Previously the benefits were only for pregnant women and people under age 21. By November 2011, surveys were done on TennCare. It was discovered that it had 95% participant satisfaction. Over the years TennCare keeps accepting applicants in their Spend Down program for people in need of health insurance.

Some statistics from the Healthcare and Finance Administration FY 2015 Budget presentation(http://www.tn.gov/tenncare/forms/HCFAbudgetFY15.pdf)

Figure 2: TennCare overall use in 2014

Figure 3: Estimate Increase in costs for 2015

Figure 4: Participant Satisfaction 

Links: http://www.tn.gov/tenncare/news-timeline.shtml

Monday, February 23, 2015

Group 3 Vaccinations Project

     My portion of the project will cover what would happen if vaccines didn't exist and also what would happen if everyone stopped getting vaccinated.

     If vaccinations never existed, measles, diphtheria, polio, flu, whooping cough, and a myriad of viruses would be in epidemic proportions in the world.  World travel has only increased since vaccinations were created.  Travel between countries would pose an even bigger threat to public health if vaccines did not exist.  Here is an example of one of the viruses that would be in epidemic proportions now if it were not for vaccines.
     Poliomyelitis, polio, is a crippling infectious disease.  Once the polio virus infects a host, it invades the brain and the spinal cord resulting in paralysis.  72% of people infected with polio do not show the symptoms associated with the disease (sore throat, fever, tiredness, nausea, headache, stomach pain). 1 out of 25 infected people develop meningitis, and 1 in 200 develop paralysis.

     Similar effects would occur if the vaccination process suddenly halted.  In 1974 80% of children in Japan were vaccinated for pertussis (whooping cough).  There were only 393 cases of pertussis in the entire country.  Plus, there wasn't a single death.  Then people became complacent and stopped getting vaccinated.  Only 10% of children were vaccinated which resulted in 13,000 cases of whooping cough and 41 deaths.
     If vaccinations were to suddenly stop, then the world would revert to the state it was in before they were started.  Diseases close to eradication would flare up again, and all the effort put into stopping them would be wasted.  The amount of cases of disease would increase, and a large portion of the world population would perish.