Up@dawn 2.0

Monday, May 18, 2015

Oliver Sacks

Andrew Solomon:

Medicine is dominated by the quants. We learn about human health from facts, and facts are measurable. A disease is present or not present; a reckonable proportion of people respond to a particular drug; the inability to predict gene-­environment interactions reflects only a failure to map facts we will eventually be able to determine; and if the observable phenotype varies for an established genotype, the differences must be caused by calculable issues. In this version of things, the case histories that constituted most of medical literature up to the early 20th century reflect a lack of empirical sophistication. Only if we can’t compute something are we reduced to storytelling, which is inherently subjective and often inaccurate. Science trades in facts, not anecdotes.
No one has done more to shift this arithmetical naïveté than Oliver Sacks, whose career as a clinician and writer has been devoted to charting the unfathomable complexity of human lives. “All sorts of generalizations are made possible by dealing with populations,” he writes in his new memoir “On the Move,” “but one needs the concrete, the particular, the personal too.” The emergent field of narrative medicine, in which a patient’s life story is elicited in order that his immediate health crisis may be addressed, in many ways reflects Sacks’ belief that a patient may know more about his condition than those treating him do, and that doctors’ ability to listen can therefore outrank technical erudition. Common standards of physician neutrality are in Sacks’ view cold and unforgiving — a trespass not merely against a patient’s wish for loving care, but also against efficacy. Sacks has insisted for decades that symptoms are often not what they seem, and that while specialization allows the refinement of expertise, it should never replace the generalism that connects the dots, nor thwart the tenderness that good doctoring requires. A reasonable corollary to the Delphic injunction to “know thyself” is to know thy patient, and few physicians have devoted themselves more unstintingly to such inclusive knowledge than Sacks. Patients want coherence, which can be achieved only when the contradictory essentials of experience are assembled into a fluid account. The doctor must not only listen, but also process what he has heard.

Sacks’ interest, however, is not merely in helping his patients construct their stories, but also in recounting them to the rest of us. The ethics of that undertaking have often been questioned... Continue reading the main story

Related in Opinion - Op-Ed Contributor: Oliver Sacks on Learning He Has Terminal Cancer

Friday, May 15, 2015

Health & gender, mistakes etc.

TED News (@TEDNews)
How Paula Johnson's TED Talk helped create a wider understanding of gender differences in health t.ted.com/57cM6Vy

No Longer Wanting to Die  A therapy technique I had never heard of helped me deal with the depression and anxiety that threatened to end my life.

The New Yorker (@NewYorker)
One of Britain’s foremost neurosurgeons wrote a memoir about the mistakes he has made and the patients he has failed: nyr.kr/1KY2O73

Thursday, May 14, 2015

Edward Jenner

It was on this day in 1796 that the doctor Edward Jenner inoculated an eight-year-old boy with a vaccine for smallpox, the first safe vaccine ever developed.
Jenner was a country doctor and surgeon in the small town of Berkley, England, where he had lived for most of his life. The only time he’d ever been away from Berkley was when he studied for a few years at a hospital in London. It was there that he learned the basics of the scientific method, experimentation and careful observation. The job of a country doctor involved a fairly rudimentary treatment of injuries and illness, but Jenner thought he might be able to put the scientific method to some good use.
The most devastating disease in the world at the time was smallpox, a disease that caused boils to break out all over the body. It killed about one in every four adults who caught it, and one in every three children, and it was so contagious that most human beings in populous areas caught it at some point in their lives. During the 18th century alone, it killed about 60 million people.
In the mid-1700s, British doctors had imported a procedure from Asia in which healthy people were deliberately infected with smallpox through the skin, which brought on a milder form of the disease and then immunity. The procedure was called “inoculation,” after the horticultural term. Inoculation wasn’t practical, because inoculated patients could pass the disease onto others while they were showing symptoms, and some inoculated patients developed the more severe form of the disease and died.
Jenner wanted to develop a smallpox inoculation that wouldn’t harm anyone. He worked in a place with a lot of dairy farmers, and there was a rumor that milkmaids almost never caught smallpox. Jenner realized that the milkmaids had all suffered from disease called cowpox, which they’d caught from the udders of cows. Jenner had a hunch that the infection of cowpox somehow helped the milkmaids develop immunity to smallpox.
Jenner decided to take some of the fluid from a cowpox sore and inject in into a healthy patient. There were no laws governing medical experimentation on human subjects at the time, but Jenner still had some reservations about trying his ideas out on a person. He mulled it over for years, and then finally decided to go ahead. On this day in 1796, he gathered some cowpox material from an infected milkmaid’s hand and injected it into the arm of an eight-year-old boy named James Phipps.
The boy developed a slight headache, and lost his appetite, but that was all. Six weeks later, Jenner inoculated the boy with smallpox, and the boy showed no symptoms. He had developed immunity from the cowpox.
Jenner submitted a paper about his new procedure to the prestigious Royal Society of London, but it was rejected. The president of the Society told Jenner that it was a mistake to risk his reputation by publishing something so controversial.
So Jenner published his ideas at his own expense in a 75-page book, which came out in 1798. The book was a sensation. The novelist Jane Austen noted in one of her letters that she’d been at a dinner party and everyone was talking about the “Jenner pamphlet.” The procedure eventually caught on, and it was called a “vaccine” after the Latin word for cow. It wasn’t perfect at first, because of poor sanitation and dirty needles, but it was the first time anyone had successfully prevented the infection of any contagious disease.
What made it so remarkable was that Jenner accomplished this before the causes of disease were even understood. It would be decades before anyone even knew about the existence of germs.
Writer's Almanac

Oxford Academic (@OUPAcademic)
Edward Jenner: soloist or member of a trio? oxford.ly/1HlUL5z by Anthony R. Rees #medicine

Tuesday, May 12, 2015

Ethics ethics

If you agree with Atul Gawande about "our job in medicine" being the production of well-being, to help people flourish, then bear in mind that there is ethical life after Bioethics - starting in the Fall with PHIL 3160, The Philosophy of Happiness - TTh 4:20 pm, BAS S279. (Sorry, couldn't resist one last commercial.)

"Ethics ethics" (including PHIL of HAP) is all about the quest for well-being, and the good life.

Ethics Ethics

Have a great summer, everybody. Drop me a line, let me know how you're doing. Live long and prosper.

Thursday, May 7, 2015

Standing by

I don't think Nigel's talking about grading here.

Nigel Warburton (@philosophybites)
If things get bad, I'd like a doctor like Freud's standing by with an overdose of morphine.theguardian.com/commentisfree/ #assisteddying

Also of note: 

Company Creates Bioethics Panel on Trial Drugs (celebrity bioethicist Arthur Caplan in the news)

Johnson & Johnson named the bioethicist Arthur L. Caplan to create a panel to decide on patients’ requests for lifesaving medicines before they are approved.
The New Yorker (@NewYorker)
.@Atul_Gawande examines America's epidemic of unnecessary care: nyr.kr/1IH8eEapic.twitter.com/5QKNzneR4j

"The Far Shore of Aging"  w/Jane Gross, founder of nyt "New Old Age" blog - On Being w/Krista Tippett

The Last Day of Her Life When Sandy Bem found out she had Alzheimer’s, she resolved that before the disease stole her mind, she would kill herself. The question was, when?
 30 minutes ago
“I can’t imagine looking back on my life not having given this to her.” Tonight on :

Exclusive: Meet the world’s first baby born with an assist from stem cells

When Doctors Help a Patient Die. The patient was terminally ill. He had decided to end his life under his state’s “death with dignity” law, and his doctor prescribed the medication he would use to do it. But his death was unexpectedly delayed because he drank a large soda before taking the medication — an ordinarily lethal dose — and it apparently interfered with the drug’s absorption. I’ve been told that patients who want to die are now warned not to drink carbonated beverages before or after taking the medication.
In another situation, a physician assisting in a death for the first time prescribed less than the recommended dose of the lethal drug. Although the patient died, it might have been otherwise. And an A.L.S. patient who requested the prescription from his physician met one criterion (having a terminal illness) but not the second (prognosis of six months to live). These are just some of the unexpected wrinkles that have come up in the still-new world of physician-assisted death... (continues)

Steroids (Posted for Ramsey Ferguson)

Blog Post (1 of 3)

I would like to use my final blog posts to reopen the discussion on steroid use/abuse. I know the midterm reports were very long winded and even then I feel like some people may have been tired of one group talking and not gotten possible questions answered.  I’ve read up on it a lot (admittedly on the internet so how reliable is that), but I also heard/know of several personal accounts of people using anabolic steroids. The biggest issue I see with people using steroids, aside from the fact that they are illegal, is the abuse where they do not cycle off properly. Many people use steroids with little or no unwanted side effects when they run a reasonable length cycle, and when they come off of them and stay clean for long enough to let their body get a break from them.  These same people could possibly face complications down the road, but a lot of the big cases you hear about where there are serious side effects come from years of steroid use with very little or no cycling off. Another serious problem with steroid use today is that the correct dosage/cycle length really is not set in stone. This makes me pose the question  ‘If people are going to use steroids (legally or not), and they can be used without people suffering serious side effects, then should research be done and credible resources be available to those to help minimize the risk associated with steroid use?’ This idea would gain a lot of opposition because if you published something informing people of what a bad cycle consists of (dose, length, stack, specific steroid) and warned them against it then some may take that as you promoting the “safe” use of steroids. I do believe, however, that as steroids are gaining popularity among more common people and not just the big bodybuilders that some type of education could be utilized and possibly help us with healthcare costs down the road by lowering associated health risks in this fashion.     Let me know what you think!!

Ramsey Ferguson
Post 2 of 3
This post will focus primarily on the Anabolic Steroid Control Act of 1990.  This is where congress declared anabolic steroids a schedule III controlled substance.  This puts steroids in the same class as Vicodin, LSD precursors, and some veterinary tranquilizers.  There is a specified difference between charges on personal use and intent to distribute, but this can be skewed sometimes because while many drugs are bought and sold in small amounts where it is more easily determined whether there is intent to distribute or not, that is not the case with steroids. Steroids are generally bought per cycle or per couple cycles.  This means that an individual could have massive amounts of steroids for personal use of one or a couple cycles and it would be hard to differentiate between personal use and intent to sell.   Many medical professionals from the FDA, DEA, National Institute on Drug Abuse, and even the American Medical Association were called on to speak at the congressional hearings leading up to the Steroid Control Act of 1990. Their evidence and arguments were disregarded when congress didn’t hear what they wanted to hear. These professionals didn’t agree with anabolic steroids being classified this way based on medical evidence, statistics, and personal accounts, but the scare of steroids was enough to override the evidence presented to them. That doesn’t make much sense, but time and time again throughout the semester we have looked at examples of how what people don’t understand scares them, and often times they are too stubborn to look at the facts that lay before them and see that some claims don’t match reality. The studies done on anabolic steroids seem to point towards the same conclusion that the mental risks are greater than the physical risks when taking steroids.  There have been several cases where a person committed suicide after taking steroids, but that makes me wonder if the underlying depression or causes of suicide where there prior to taking the steroids.  Maybe those psychological issues led to them being unhappy and taking steroids because they believed that an enhanced physique would bring them happiness? That is purely speculation, but does seem viable.
Ramsey Ferguson

Post 3 of 3
For my third blog post I want to supplement the first 2 with some before and after pictures and pictures of some side effects.   What is interesting that some people may not realize is that many people take steroids without the desire of being some huge Arnold-like body builder.  Many people take them to go from small or average, to just well toned and bigger than average.  If you start off as a big, lean muscled up person and then take steroids then you are obviously going to get bigger and maybe leaner, but my point here is that it,s not just bodybuilders taking anabolics there are many average people just like you and me that take them to enhance their appearance and help them achieve that beach body that they’ve always wanted.
    In this picture you can see that this guy started I would think about average for a guy that hits the gym.  After an 8 week cycle you see him on the right much leaner and a lot more muscle mass.  Now if you saw the guy on the right walking around campus you probably wouldn’t jump straight to the conclusion that he has been taking anabolic steroids.  That physique can be achieved naturally, but instead of an 8 week transformation it may take a year or so.
Here are a few more before and after pictures
Люди, поменвшие свой облик. Часть 2. (50 фото)
Люди, поменвшие свой облик. Часть 2. (50 фото)
Люди, поменвшие свой облик. Часть 2. (50 фото)
You can see how not all of the guys look like Arnold Schwarzenegger after taking steroids, some of them have bodies that can be achieved naturally without steroids, it only takes about a quarter of the time and effort.

Wednesday, May 6, 2015

Transhumanism and Personhood (Devin Atkins)

(Posted for Devin Atkins)

Transhumanism and Personhood

            Transhumanism is fundamentally about transforming humanity
into something post-human. To discuss a bit of ethics behind this, we
have to clean up some language. The first is distinguishing a
difference between human and person. The former describes Homo
sapiens. The latter is what we’re more interested in and is much more
important. Now we could go into a very very very long post into the
definition of personhood, but for now let’s try to keep it simple with
some common criteria without going too far into specifics. Virtually
all humans have personhood: we are self-aware, can learn, and have
higher cognitive skills. There are, however, some exceptions, such as
humans in a vegetative state / braindead. There’s no cognitive actions
happening, and no self-awareness, just a body mechanically alive,
pumping blood. What’s less often thought about, however, is the idea
of non-human persons. This could be as simple as intelligent alien
life: think Vulcans from Star Trek. Sure, they aren’t human, but I
doubt anyone would argue Spock isn’t a person.

It gets trickier when we look at artificial intelligence, where we
also hit another word to more clearly define. Artificial literally
means made by a person, however we often think of it in a sense of
fakeness (such as artificial flavors). So artificial intelligence is
not “fake intelligence” but “designed intelligence” (as opposed to
naturally evolved). Going back to how this relates to personhood, we
can again look to Star Trek for a great example of an AI with
personhood: Data. Most would consider him a person, as he can also
learn from mistakes, has higher cognitive skills, and is self-aware.

I use examples like this because we are familiar with them and
comfortable; they are easy to accept if you’ve seen a few episodes of
the show. Even if you haven’t, there are plenty of similar examples
that are easy to draw from. But here the ego starts creeping in: what
does this have to do with humanity? Well we don’t look down on Spock
or Data for not being human. They are people, just in a slightly
different way than us. Then why should we look at our hypothetical
altered selves any differently? So often the criticisms of genetic
engineering, cybernetic implants, and all that jazz are the sense of
something lost. There’s a general thought that by fundamentally
altering humanity, we are lesser in some way for it. But this is a
double standard: doesn’t Spock have different genes from humans?
Doesn’t Data have a synthetic brain rather than an organic one? If we
keep characters like this in mind, it’s easy to see that humanity
changing into something post-human does not mean it has lost out on
personhood or some moral fiber. It’s simply another step towards

I wish I could have gone into more detail, really fleshing out ideas
behind genetic engineering, artificial intelligence, and cybernetic
implants. These posts, however, have already gone well over the usual
range, and we discussed a good bit of one of those topics in class, so
the point of this was to take a step back. We worry so often about
smaller details that are an issue right now, but sometimes it helps to
instead look hundreds of years into the future instead of simply
decades. To say, hypothetically, if we mastered it, is it right? Or is
there something fundamental at the core of transhumanism that is
wrong? And so for these last 3 blog posts I focused on parallels
between it and problems in the past, what’s happening now, and how it
could look in the future. Hopefully you’ve gained some perspective on
current developments in science and see that limbs and heartbeats and
even brains don’t make you a person, just your mind.

Experimental drugs; Elders (Posted for Awad)

Posted for Awad Awad
An adequate approach for FDA to establish a successful pathway for terminal ill patients to have an access to experimental drugs
    FDA should establish a committee containing doctors, lawyers, religious representatives, and family members to assist terminal ill patient in process of forming his/ her decision to use the experimental drug. Each group of the professions in the committee should be able to help the patient know about his status and rights. For example, doctors will help the patient to form a clear view of the risks of using the experimental drug, and the damages that the drug may cause to the patient’s health and quality of life. Furthermore, the lawyers should assist the patient in his legal problems such as if he/ she dies after using the drug or goes into a comma, and the layer should protect what the patient desire if he / she goes into a comma or dies. Religious representatives of the patient’s faith if he has any and a family members have a similar role in aiding the patient emotionally, and also in the process of making important decisions such as after he/ she goes into a comma what they should do for him/ her. Libertarian and utilitarian are the two main ideologies, the FDA needs to ensure that patient can use to make his/her decisions. The patient should always have the important voice in the matter of his/ her life or death decisions, and the type of care he / she should receive. They also should choose if they want to trade off comfort for extension of life or vice versa. The committee goal is to assist the patient to make important decision and never to make them for the patient unless he/ she is unable to decide for himself/herself due to a disease, a disorder or an accident.    

Dependence and independence for Elders

As the book “Being Moral” describes characters in chapter three that each individual has 

a story where he/she favored a place that provided him/ her with a sense of independence and 

allowed them to obtain a life as close to their typical life. For elder patients, a nursing home, 

hospice should not represents to them a place of exile where they must denounce all of the 

activities and habits that bring them joy for the name safety. The society expects the elder to 

abide by rules that takes away their voices in what their life should be like. These creates a 

culture inside nursing home and hospice that ignores the elders’ demands and desires in the name 

of safety and longevity of the elders’ life than the quality of the time they spend inside a hospice 

An easy solution to this issue to start customizing the life an elder wishes to have. For 

example nursing should allow elders to customize their room and their food. Elders should be 

encouraged to explorer life rather than hide behind the wall of nursing home or hospice. They 

should be allow every month to leave nursing home and hospice to visit her family or go on 

picnic with her or mates at the nursing home or hospice. These are small changes to the culture 

of nursing home that would not cost a lot’ however, they will have appositive outcomes on the 

quality of life of the elders inside nursing homes.

Tuesday, May 5, 2015



In the last installment we saw what a breakthrough the use of aminopterin was in battling what was, at the time, a childhood illness with a one-hundred-percent mortality rate – ALL, or acute lymphoblastic leukemia.  This time we look at some of the statistics about the disease and the effect Farber’s treatment had on his patient’s odds of survival.
ALL accounts for twenty five percent of all cancer in people under the age of 15, and affects 1 in 50,000 people in the US.  As mentioned, when Farber first began administering aminopterin, the mortality rate was one hundred percent.  According to the Journal of Clinical Oncology, the survival rate had increased to about ten percent by the 1960s (read the article here: http://bit.ly/1ckrT0p).  This is important to note for two reasons.  First, while ten percent may not seem like much, it is a dramatic improvement over zero.  Imagine the difference between being told that your child had a zero percent chance of survival compared to being told her odds are one in ten.  It may only be a slim hope, but it is hope nonetheless, and the difference between no hope and slim hope cannot be overstated.  Second, it is important to note that aminopterin was not the end of the story – new and improved drugs would soon step in to replace it.  The breakthrough was in Farber showing the medical community that these types of treatments were indeed effective.  Up to this point, it was considered cruel, perhaps even inhumane, to inject these children with substances known to be poisonous.  “Let them die in peace” was the motto of the day.  But these children were not dying in peace – they suffered terribly before their inevitable end.  The extreme suffering of these children is what drove Farber to such a radical treatment, as he felt each loss deeply and personally.

As I said, Aminopterin was not the end of the story.  The same Journal of Clinical Oncology cited above states that, by 1985, the survival rate had increased to seventy seven percent.  By 2005 the survival rate had increased to over ninety percent, and that number has increased steadily up to the present.  It is important to note that these are five to ten year survival rates.  ALL is still a deadly disease that affects many children, and also affects adults, albeit at a much lower rate.  But Sydney Farber paved the way for the increased survival rates that we enjoy today by proving that chemotherapy was effective.  His legacy as the Father of Modern Chemotherapy is well deserved – may his memory be for a blessing.

Cancer: The Emperor of All Maladies documentary: http://bit.ly/1EffZz7