Friday, March 29, 2019

Quizzes Apr 2, 4

Add your questions etc.

Apr 2, Beyond 37-39

1. How do global and local inequalities relate to reproductive tourism?

2. What intentional act contributes to making surrogacy especially controversial?

3. Name an equality concern arising from reproductive tourism.

4. What's problematic about the goal of racial family matching "in a commercial context"?

5. Oprah portrayed surrogacy as what?

6. What was PlanetHospital's rationale for only accepting surrogates who already have children of their own?

7. An Indian makes how many multiples of her annual salary by being a surrogate?

8. Why does PH say all surrogate births must be by cesarean delivery?

9. Why didn't most donor-conceived children ever ask questions?

10. Parents who disclosed their children's donor status regarded what as essential to the child-parent relationship?

DQ

  • Is there an analogy, in terms of ethical involvement, between reproductive tourism and prostitution? (That is, are the patrons and solicitors in each instance equally culpable? Are suppliers and demanders equally involved?)
  • Is the separation of biological and social maternity inherently problematic? Is there any parallel to the separation of mothers from their children for geopolitical reasons (as in the recent border-crossing detentions at the U.S./Mexico border)?
  • What, if any, ethically-relevant similarities are there between medical and reproductive tourism?
  • Is the threat and reality of exploitation in reproductive tourism grounds for regulation?
  • Is it misleading to say that women who provide eggs and bear children for others are "free agents" in the marketplace? 345
  • What in general is ethically problematic about the goal of racial family matching?
  • What's "uncomfortable" about the idea of women's bodies becoming "part of a formal economy"?
  • Is the PlanetHospital model of accelerated results ethically problematic?
  • COMMENT on the policy of cesarean delivery for all surrogates.
  • When would you reveal your child's status as donor-conceived to him/her?




Apr 4, Beyond 40-42

1. Prenatal testing and embryo selection, as currently practiced, cannot coexist with what?

2. What are the two new alternatives to the "medical model" of disability?

3. What kinds of opportunities do most Americans say are indispensable to a good life?

4. Brief acquaintance with disabled people should demonstrate what?

5. Adrienne Asch cannot ___.

6. The ADA of 1990 has not markedly altered what?

7. Many genetic counselors do not practice in a way that what?

8. What analogy does Asch see between flying the Confederate flag and enumerating testable genetic diseases?

9. How do we become a welcoming society for all, including the disabled?

DQ

  • Should "the parental experience" be parents' guiding concern, when contemplating and planning a family?
  • In general: is it better not to have a disability?
  • How much of the difficulty posed by disability is socially constructed? 
  • Does the status of social construction undermine itself? Can social constructions be defended as an improvement on "nature"?
  • Do you agree that an absence of capacity is not necessarily a negative or a "dis-value"? 368
  • "Should society make a list of 'serious' and 'trivial' characteristics" for prenatal assessment?

Thursday, March 28, 2019

Bans Against the Unvaccinated


DQs:
1. Is it ethical to ban unvaccinated individuals from public places?
2. What is the best way to respect individual rights but honor the value of freedom and choice?
3. Is the government responding to the outbreak in the right way? Is there a better way?
4. Often time, we shy away from imposing on cultural beliefs and values? How is the issue of vaccinations any different? (devil's advocate question)

Rockland County's State of Emergency and Ban Article

Topic Change

I am planning to switch topics to Applied Behavior Analysis using the book Applied Behavior Analysis for Children with Neurogenetic Disorders by Elizabeth Will, Chapter 6. I am curious to see if anyone else has pivoted topics, so feel free to update your topic below if you feel so inclined.

I also feel the need to explain myself.

The reason why I researched the deaf community was I had a basis and I could learn more. Listening to everyone's topics made me realize I had stepped away from the topic that I knew the most about.

After all, I had been burned presenting about it before.

 For my sophomore speech class, wrote a speech about autism and read it to a bunch of adults in the military. If they had any contact with autism, it was not likely that it was visible or one of their peers. My audience had no questions for me or about my presentation. It was very quiet.

In this class, however, the goals have changed, everyone here is going to meet another person on the Autism Spectrum more than likely. I advocate for myself but information is the only currency that can bridge the gap from the present to the future for social change.

If you have any preceding questions, this would be a good place for those as well.




Philip Defranco Double Feature(+Korea's Baby Box)

I was watching one of my normal news programs and two notes of interest came up, this morning I watched about 22 minutes of statistics telling us that the United States has one of the lowest survival rates for birth.

Second, yesterday, there was the announcement of the state of emergency around the Mesles outbreak in New York.
(It starts about 3 minutes in if the link did not work correctly)
Finally, a special on a Korean priest showed up in my feed and I felt we all needed a bit of good in our day.



Tuesday, March 26, 2019

Get Ready for Controvercy

With all of the searching I do, my search suggestions become interesting overtime. Imagine my surprise when an article from NPR pops up with a topic everyone in our class can be interested in. Dr. Grossman and other colleges of his reported that they had a reversal for chemical abortion.

The article explains first how chemical abortions work, the use of two drugs taken one after the other. The first blocks the creation of progesterone, the hormone that tells a woman's body to not produce an ovum because she is pregnant. According to Grossman, if progesterone is administered after the hour that it takes to digest and absorb the first drug that the pregnancy can continue as usual.

As fascinating as that is, this potentially has huge risks for the infant. Signal chains that are keeping the cells in proper working order are being halted and then restarted. Since the study happened in 2012, there has not been enough time to research the patients he has already tested. Just because the pregnancy came to term does not mean that the individual will live a life free of issues, some of which related to the procedure.

Additionally, a review of the very same study saw some discrepancies with in the science and statistics. There was no control group because of the nature of the reversal procedure. I can understand that people can change their mind but using these people as test subjects at all feels unfair. The statistical analysis also did not stand up to scrutiny as correlation calculations showed no linkage between the use of the reversal and the child coming to term.

With all of this backlash and conflict, it would be expected that the law would be causes about adopting new policies. Unfortunately, many states have so many restrictions that individuals might feel pressured not to go through with the process or become fearful of consequences. With Grossman's support and promotion through organizations, laws about the reversal procedure are being written even though FDA researchers have not approved the procedure. I know this topic has a lot of emotions ridding on it but I hope this can lead to a civil discussion.

Chris Julsgard's Midterm Report Essay/questions

          Medicine is a practice, but also an art. Practicing medicine requires you to be clinical, to shut off your feelings and save a life. However, medicine contains an overwhelming number of unique circumstances where compassion and understanding make all the difference. In my reading of "Being Mortal: Medicine and What Matters in the End" by Atul Gawande, (chapter 7) I encountered many points that are relevant for this course, and stuck out to me as an aspiring physician. This balance between education and understanding was a major underlying theme in this chapter. Atul Gawande describes three different types of mindset a doctor typically uses when discussing care options with a patient.
          This first type of approach a doctor might favor is called the "paternalistic" doctor. This doctor assesses the patient's symptoms and selects the treatment option based upon those. There are likely other treatment options available, but this doctor assumes control and guides this patient down the path he or she deems best. This approach has lost popularity in recent years, but used to be the go-to  for physicians. I suspect the reason for this decline is usage is because of the likewise decline in the "doctors know best" mentality of the masses.
          The second type of approach Atul Gawande describes is the "informative" approach of a doctor. This approach is characterized by a doctor that explains multiple options of treatment, and takes a very "hands off" approach. They work with the patient and discuss what treatments would be most viable. This mindset is most prevalent in doctors today. This likely has to do as well with the surge in medical information available to the public. As education increased, the mystique/ grandeur of the physician faded, and people demanded an interaction with doctors to be on more equal terms.
          The "interpretive" physician is the third approach, and is certainly the most difficult for a physician to establish. This approach involves a doctor helping the patient determine what they actually want. Questions are asked like "What worries you", or "What is most important to you", and find which treatment matches your priorities. This doctor is focused solely on quality of life preservation. This is tricky because the approach requires a physician to think on a far larger scope of just the challenges a disease presents. The doctor must work with the patient to understand not just their priorities but also the root of these priorities and help select a plan that may not necessarily involve direct treatment to achieve the best quality of life.
           During my reading, (and also during Josiah's report) I found myself challenged to define what I think a physician should be. The closest I came to putting words to it ended with this result: I see a doctor as a person at a crossroads. This person is here to educate the passerby as to which paths lead where, and to illuminate paths that are unknown to the traveler. I suppose I most identify with the informative doctor, but specifically for end of life care, I can see the value in the interpretive approach as well.

Questions to be answered during presentation:
1: What chapter does this presentation cover?
2: What are the three types of approaches doctors utilize according to Atul Gawande
3: Which approach sees a decline as the "doctors know best" mindset has faded
4: By 2030, 1/2 or 2/3 of people worldwide will be essentially ______
5: ____ of people today die in their home, or in the assisted living center that has become their home






         

The Truth is…I’m not Iron Man

 Your patient is a 35-year-old male. He seems well put together, tailored clothes and perfectly ordered hair with just a shade of tiredness under his eyes. His chief complaints are chronic fatigue, sleeplessness, irritability, heart palpitations, and occasional suicidal thoughts. Or, they would be his chief complaints, if he ever reported them. He says he’s fine, loves his job, and has an excellent work life balance.

He lies.

But about what? Doctors are said to be the worst patients, and that’s frequently true. Physicians don’t like going to other physicians for a diagnosis on themselves. Sometimes it’s just stubbornness, but there are other, legitimate reasons that a doctor might not go to another for assistance with personal health. Fear of losing his job or medical license is a good one.

In his book Hot Lights, Cold Steel, Dr. Michael Collins recounts his days as a resident at the Mayo Clinic and the ways he dealt with a lot of difficult cases. The Mayo Clinic is one of the best in the country, and it’s often the go-to destination for the strange and severe. Throughout the memoir, Collins tends to critically ill patients with his supervising doctors and struggles with how he himself is supposed to cope with the trauma. The cases are varied and extreme. A young boy fractured his femur and shattered the lower portion of the same leg comes under Collins’s ministrations, as does a young woman with bone cancer in her leg, requiring a hemipelvectomy, the amputation of the entire limb and half her hip. More experienced surgeons at the Mayo Clinic advise Collins, though it’s never stated explicitly, to distance himself somewhat and, in essence, repress the feelings of sympathy that might impair his ability to do his job properly. Collins himself expresses multiple times that he isn’t sure if this is the right approach, but ultimately doesn’t have any better solutions.

For some doctors, this can work, but it isn’t healthy for them, and it’s not the best way to relate and communicate with patients on a human level. Being a physician means having to care about people and put such emotion on a consistent basis. What about the physicians who can’t do this, who can’t repress and just go on? They are out there in the profession, and they are more numerous than most people think.

According to an NPR report from 2018, roughly 300 to 400 doctors kill themselves every year, and, depending on which study is consulted, physicians have a higher suicide rate than any other profession, that of 28-40 per 100,000. Women physicians, in particular, are more likely to commit suicide than their male counterparts, though research and studies have yet to come up with an accepted reason as to why. Actual numbers for physicians suffering from depression, suicidal thoughts, or sheer burnout syndrome are unknown, much less any other mental health condition. These things have to be reported, and for a lot of doctors, having such visits to mental health professionals on their records can disqualify them from positions. For one doctor featured in an article by the Washington Post, a note of mental health problems would eliminate him from contention for his license to practice medicine.

In some subspecialties, such discrimination is necessary. Trauma surgery is a good example. When a patient’s life can be measured in minutes, hospitals have to play it safe and hire the surgeon who’s more robot than human, who can compartmentalize and deal with the horror, because that’s his job to do so. However, few doctors live and work in such adrenaline-junkie environments, and the selectiveness is less understandable for many other sectors of the medical field. Society seems to try very hard to insist that the stigma surrounding mental health is antiquated and must be done away with, yet that supposedly outdated standard is still applied to the medical community. Thankfully, some medical boards are beginning to move away from the question of past mental illness and are more focused on current impairment.

It is an uncomfortable truth to admit that the doctors who take care of us, who try their best to end a patient’s suffering and make them well again, are only human. Patients want a hero. They want iron men (or women) who have the answers and provide order to chaos. To be the best physician, though, a practitioner needs empathy. They can comprehend their patient’s pain, and they can be affected by the stresses of the job, just like anyone else. The question that plagues the medical community is how best to end the stigma around mental health for physicians and provide the help and support that a lot of them so desperately need.

Quiz Questions:
1.     Where did Dr. Collins do his residency?
2.     What is a hemipelvectomy?
3.     What unspoken advice did the senior surgeons give Dr. Collins to deal with the job?
4.     What is the suicide rate for physicians?
5.     Which subspecialty can you make an argument for not wanting physicians with serious mental health concerns and why?
6.     Name the one quality that separates good doctors from the very best.

DQ: What are some ways that the medical community can aid doctors in dealing with mental health concerns, whether they come from the job or from other areas of their lives?

Links:
https://www.youtube.com/watch?v=3lda4KyXbLE

Monday, March 25, 2019

"Disability and DIsadvantage" editor speaks at Vanderbilt Apr 12

The co-editor of Disability and Disadvantage will deliver Vanderbilt's Berry Lecture on April 12...

"This book offers a much-needed investigation of moral and political issues concerning disability, and explores how the experiences of people with disabilities can lead to reconsideration of prominent positions on normative issues. Thirteen new essays examine such topics as the concept of disability, the conditions of justice, the nature of autonomy, healthcare distribution, and reproductive choices..."

Sunday, March 24, 2019

Madam Secretary tackles vaccination

Tonight's episode of Madam Secretary, season 5/episode 17 - "The Common Defense" - all about the Phillipines measles epidemic, anti-vaxxers in the U.S., herd immunity and its vulnerability, and fictional President Dalton's decision to withhold passports from non-vaccinated travelers. Good show! View here...

Anita Silvers, an Authority on Disability Rights, Dies at 78

A philosophy professor at San Francisco State University, she argued that disability rights should be viewed the same as other civil rights and not as an accommodation.
Anita Silvers, a philosophy professor who was a leading voice in the interpretation of the Americans With Disabilities Act, arguing that disability rights should be viewed the same as other civil rights and not as an accommodation or as a social safety net issue, died on March 14 in San Francisco. She was 78.

San Francisco State University, where Dr. Silvers taught for half a century, said the cause was pneumonia.

Dr. Silvers was already a well-regarded scholar with an expertise in aesthetics in the 1990s when she started to focus on disability law and definitions related to it. She knew about disabilities firsthand: She had polio as a child, and the disease left her with limited mobility. The Americans With Disabilities Act had been passed in 1990, and Dr. Silvers began to examine how it was being interpreted, whether philosophically, in the courts or on her own campus.

“A critical thing for her was to understand the A.D.A. as a civil rights statute,” said Leslie P. Francis, a professor of law and philosophy at the University of Utah who wrote papers and edited a book with Dr. Silvers. “Not as an approach to giving people special privileges, but as a way of giving people the rights that everyone else has.”

Dr. Silvers wrote or co-wrote numerous papers on the subject, arguing that a fundamental flaw in many interpretations of the act was measuring people with disabilities against an idea of “normal.”

“Progress depends on constructing a neutral conception of disability, one that neither devalues disability nor implies that persons with disabilities are inadequate,” she wrote in a 2003 paper published in the journal Theoretical Medicine and Bioethics. An earlier paper, published in 1994, was subtitled “Equality, Difference and the Tyranny of the Normal.”

She and Dr. Francis edited a 2000 book, “Americans With Disabilities: Exploring Implications of the Law for Individuals and Institutions,” for the 10th anniversary of the passage of the Americans With Disabilities Act. She was concerned about the way the act was being interpreted in legal rulings, and although most of her writing was as a scholar and not as someone affected by polio, she would play that card to make a point.

“As I search through decisions,” she wrote in a 2002 article in Newsday excoriating the Supreme Court for what she viewed as its unhelpful rulings on disabilities in the workplace, “the terrors of past suffering shadow my future. To cloak my polio-crippled gait, will I have to arrive at work before dawn and leave long after other workers, as I used to do? Will I have to crawl upstairs again because colleagues take offices on the first floor?”

“Judges’ own privileges safeguard them against discrimination,” she concluded, “while they dodge their duty to give less fortunate Americans equitable opportunity to work.”

Dr. Silvers in 2010 in her office at San Francisco State, where she taught for half a century. “She never lost sight of the implications of her views and practices for people with disabilities,” the chairman of the university’s philosophy department said.

Anita Silvers was born on Nov. 1, 1940, in Brooklyn to Seymour and Sarah (Rashall) Silvers.

“She went to Girl Scout camp in 1949 and returned with a severe case of polio,” her brother, David N. Silvers, said, “which required her to spend over a year in an iron lung,” the respiration device.

The disease left her with partial quadriplegia. She was angry about her limited mobility, her brother said, but also determined not to be constrained by the condition. He illustrated that determination with a story about a cross-country trip.

After receiving a bachelor’s degree at Sarah Lawrence College in 1962, she earned a Ph.D. in philosophy at Johns Hopkins University in Baltimore in 1967 and was hired to teach philosophy at San Francisco State. She needed a car to drive to her new job.

“If you’re profoundly disabled and you go cross-country in a car,” David Silvers said in a telephone interview, “the logical thing to do is to get a Ford or a Chevrolet, because if you break down you can get parts.”

Instead, he said, she bought a British car, a Rover.

“That to me is a microcosm of what she was all about,” he said. “If she wanted a Rover she would get a Rover, regardless of whether it made sense in terms of her disability.”

David Silvers is her only immediate survivor.

Dr. Silvers’s expertise in aesthetics led President Jimmy Carter to appoint her to the National Council on the Humanities in 1980. In 1989 she and three co-authors, Margaret P. Battin, John Fisher and Ronald Moore, published “Puzzles About Art: An Aesthetics Casebook.”

At a recent symposium honoring the legacy of Jacobus tenBroek, founder of the National Federation of the Blind, Dr. Silvers recalled one of the things that had led her to turn her attention to disability rights. She said two blind students, having heard that there was a professor on campus with a disability, sought her help in getting into a math class whose professor had turned them away. Dr. Silvers, who used a motorized scooter to get around campus, went to see him.

“He explained to me that they just could not let these two students into a math class because they didn’t know how to teach them, because when you’re teaching math you write on the blackboard,” she related. “ ‘In fact,’ he said, ‘when you’re teaching anything you write on the blackboard.’ Now, as it happens, I don’t write on the blackboard because I can’t reach the blackboard.”

In addition to aesthetics and the rights of people with disabilities, Dr. Silvers wrote about assisted suicide, feminist issues, medical ethics, the evolving field of discrimination based on genetics, and more.

“She had a voracious mind and many philosophical and political interests,” Justin Tiwald, chairman of San Francisco State University’s philosophy department, said by email, “but she never lost sight of the implications of her views and practices for people with disabilities.

“Her popular course on medical ethics,” he added, “was both an introduction to that subject and an opportunity for her to get students thinking more deeply and sensitively about ways in which our implicit moral concepts and frameworks stack the deck against people with disabilities right from the start.” nyt
==
Also NOTE:
Kimberley Brownlee, co-editor of Disability and Disadvantage ,will deliver Vanderbilt's Berry Lecture on April 12...

"This book offers a much-needed investigation of moral and political issues concerning disability, and explores how the experiences of people with disabilities can lead to reconsideration of prominent positions on normative issues. Thirteen new essays examine such topics as the concept of disability, the conditions of justice, the nature of autonomy, healthcare distribution, and reproductive choices..."

Friday, March 22, 2019

Quizzes Mar 26, 28

Add your questions, comments, etc.

T 26 - Beyond 32-34

1. How did James Rockwell and his subject cohorts sabotage their drug study?

2. Why is speed critical in getting drugs approved and on the shelves as early as possible?

3. What motivated homeless alcoholics to participate in trials for Eli Lilly, according to its director of clinical pharmacology?

4. Guinea pigs rely mainly on what to insure their safety?

5. The target audience for the jobzine Guinea Pig Zero was who?

6. DARPA projects include research on drugsto keep soldiers awake and fed for how long?

7. Radiation exposure from nuclear testing on American soil in the '50s was comparable to what?

8. Fear of chemical weapons during the Gulf War led to the administration of what vaccine prior to FDA approval?

9. Gulf War vets and their children have been diagnosed with what?

10. What percentage of DARPA projects fail?

11. How did New York city law enforcement officials help researchers in the mid '90s?

DQ

  • Should "guineau-pigging" be a job?
  • For how long should drug patents be issued?
  • Have you participated in any drug trials? Do you want to?
  • "What happens when both parties involved in a trial see the enterprise primarily as a way of making money?" 292
  • Are for-profit IRBs inherently compromised?
  • COMMENT on the Susan Endersbe case. 295
  • How should test subjects be procured? Should there be a cap on how much doctors can earn for procuring them?
  • How would you fix our "patchwork regulatory system"? 300
  • Should medical research aimed at enhancing soldiers' competence, stamina, and endurance be held to different ethical standards?  Is all really fair in (love and) war?
  • Is there an ethically-defensible military rationale for "race-based" or "man-break" tests? 302
  • What's your response to any of the questions at the top of p.302?
  • Should all soldiers be required to sign waivers allowing the administration of any drugs deemed necessary or appropriate? Does military service tacitly allow drug experimentation in the interests of "national security"?

Health news... Weekly health quiz


And speaking of DARPA...


Th 28 - Beyond 35-36 [no class today]

1. "Gen IVF women" like Miriam Zoll began thinking what, in the 70s and 80s, about their prospects for motherhood?

2. Women who experience failed fertility treatments often exhibit symptoms of what?

3. The ART failure rate for American women over 40 in 2012 was what?

4. How much does surrogacy typically cost in the U.S.?

5. Zoll and her husband were "aghast" at what, during their search for an egg donor?

6. What has become a cultural expectation for many LGBT people?

7. What's the Internet's role in fashioning "queer intimacies"?

8. Who fills the need of outsourced surrogacy?

9. Artificial gametes and cloning would not help who, but would negatively impact who?

10. New reproductive technologies provoke a rethinking of kinship markers while raising what questions?



DQ
  • Why do so many couples have an "obsession to procreate"? Would they be well-advised to try and re-direct that obsession to parenting (and perhaps adopting)?
  • COMMENT on any of the "ten things I wish someone had told me..." (323 f.)
  • COMMENT on the "new grounding assumption..." (329)
  • COMMENT on any of the questions at the bottom of p.334.


Kentucky Governor Says He Let His 9 Children Get the Virus

Remember Chickenpox Parties? 
Amid a renewed national conversation about childhood vaccinations, Gov. Matt Bevin of Kentucky said this week that he and his wife made sure all nine of their children got chickenpox.

“Every single one of my kids had the chickenpox,” Mr. Bevin said in an interview on Tuesday with a radio station in Bowling Green, Ky. “They got the chickenpox on purpose because we found a neighbor that had it and I went and made sure every one of my kids was exposed to it, and they got it. They had it as children. They were miserable for a few days, and they all turned out fine.”

Experts said that the practice Mr. Bevin described was antiquated, a holdover from the days before 1995, when a vaccine for chickenpox became publicly available. Back then, so-called chickenpox parties were set up to spread the disease from one child to the next, under the belief that contracting chickenpox as a young child was safer than as an adult.

Doctors said the method can lead to dangerous complications or death. Still, Tara C. Smith, a professor of epidemiology at Kent State University in Ohio who studies infectious diseases, said that despite warnings from medical experts and the availability of vaccines, the practice of deliberately exposing children to disease continues...
==
And,

Mississippi Bans Abortions if Heartbeat Can Be Heard. Expect a Legal Fight...

Thursday, March 21, 2019

Organ Crescendo

I have lots of interests, it helps me not burn out on one topic. I read comics, books, articles and fan fiction. I watch news, shows and when I have the time, I go to the theater. Musicals have shifted in and out of the mainstream over the years but with the advent of YouTube, off Broadway previews are a click away. Now I don't expect people to go digging through the archives to find cult classics or learn about theater houses that write for themselves. No, today all I want is a little break from reality.

In 2006, an age of grunge meets the drama, a musical was made for screen that had a dark outlook of the future of medicine. The name of this musical was Repo! The Genetic Opera. The movie revision was rated R for the reference of gore, sex, and drugs of a dark future of medicine. A cult classic at best today, I feel it can be an interesting retrospective on the pessimism of the time and (sadly so) the predictions that are coming forth in our markets.

The world of the play is one where organ failure is on the rise and those with the money can replace them. If payments stop, a person comes to repossess the organ, no matter the state of the individual after the fact. As we have talked about in class, the government controls the legal organ trade. Arguments for the market approach are reasonable in theory. An intensive for donator and to more tightly control and close the black market for good. This is not exactly the same as the play but the exchange of funds for organs inserts an ethical dilemma. Those in desperate need of funding will be more motivated to become a part of the system or even give organs and tissues that still allow an individual to function. Using this population as a resource forgoes their human rights. The right approach is difficult to determine because of  the risks for the currently ill, but the constant delays and discussion only gives black market workers more time to commit crimes, here and overseas.

Another issue brought forth is this same fictional company that provides the organs, Geneco in the musical, also makes the drug Zydrate. Based on the side effects listed in one of the songs("Zydrate Anatomy"), it is very similar sounding to an opiate or something that acts like a sedative or local anesthetic. The company opens a support system for addicts, and sees no problem with providing it or it's source. Almost in a scary mirror of this play, the Sackler family is currently in hot water about the opioid crisis. The family, in charge of the company's Purdue Pharma and Rhodes Pharma are currently being sued for negligence when it came to the promotion of Oxycontin and production of treatments for opioids. The company is not the only one to blame as the Washington Post states that the CDC's thresholds for how much should be provided does not reflect the research and effects of the drugs.

Musicals and other media can be a window into the option and views of the society at the time. Sometimes fiction can become a predictor of the future unwittingly. Any media that you have seen recently or not that has a similar effect?

"Beyond Bioethics" XIII: The Genome as Commons

As genetic research and our overall understanding of the human genome progresses, fanatics are heralding the days as the dawn of the post-human, suggesting that we are on the threshold of a drastic change in our species as we know it. Based off of gene editing methods such as TALENs, ZFNs, and most recently CRISPR, some people are convinced that we are about to transcend the era of disease and enter into a time where cancer, malaria, and multiple sclerosis are things of the past, and genetic imperfections in bloodlines are resolved for good. However, it is far less common knowledge that the technology is nowhere close to reaching the ability to live up to its recent expectations. Genetic research and its potential is without a doubt being overhyped by the media and general population, and needs to be approached with an attitude of caution as opposed to eagerness.

There are a number of factors that have led to the sensationalization of genetic science. The first of these is simple curiosity. It's in our nature. The same little voice in our brain that asked our ancestors "What's out there?" when they gazed at the stars a thousand years ago is once again prodding us about what's behind that next genetic door. However, while simple instinct is pushing the interest of some, that of others is fueled by the almighty dollar. Biotechnology was the second highest funded sector in the United States economy in 2015, followed only by software companies. Businesses are willing to do the research, and if they have someone whose money they are relying on, then it is in their best interest to push their findings as much as possible, particularly in the favor of the investors' interests. In addition, bioengineering appeals to the common crowd through scientists' promises of a healthier future. The idea of removal of diseases and improving lifespan is going to sound good to anybody who hears about it. Although the technology for us to do so is very primitive, people still set staggeringly high expectations for gene editing technology to reach before the end of the week. Finally, biomedical technologies generally have a reckless exemption to caution of the industry. To the public, the potential benefits outweigh the alternative outcomes and possible side effects, no matter what they be.

Approaching genetics with this sort of wide-eyed childish interest is not the right way to go into things. Extensive research must be completed in order for gene editing technology to be regularly used on the general public, if at all. No matter what publishers and journals may lead you to believe, genetic editing is still nowhere close to perfect. The process can cause damage to the edited cells, causing them to replicate damaged genes or even become cancerous. The people's tendency to avoid due consideration of new, powerful technologies have had less than ideal results in the past, such as meltdowns from previously cleared nuclear reactors, and plane crashes due to unforeseen circumstances. Genetic editing has the potential to become yet another statistic in that trend. Also, we need to approach the day in age where the human genome can be exploited for economic benefit very slowly. If this type of technology is privatized, capitalism takes over, and it drives a stake further in the ground between the upper and lower class. Those that can afford to could have their genomes tailored to their desires, while the poor remain with their inferior genetics. This type of divide is not something to be taken lightly, and any catalyst for such a scenario should be approached with caution.

The future of genetic engineering and biotechnology is bright. It really is. There have been mosquitoes designed to no longer carry malaria, plants engineered to produce more full crops, and livestock tailored to produce larger calves, and thus more meat and resources. Genetic editing certainly has its appeal, and has the potential for countless applications. However, with the future of genetically engineered humans far in the distance, it only seems reasonable for the crazed genetic advocates to dial back a bit, and instead focus their efforts on whether or not we should actually be doing what we are doing. Progress is progress, but not all progress yields overall beneficial results. For that reason, it is necessary for us to approach advancements in the field of genetics with a hesitant attitude and a sense of caution.

Questions:

What does James Watson describe as the actual desire of the public?

What do Athanasiou and Darnovsky say that the techno-eugenic vision urges us to forget about?

In what kind of cells did Eric Olson find CRISPR to be safer to use?

How much money was invested into biotechnology in 2015?

What tools were used to do gene editing before CRISPR was developed?

What are some things in the movie clip that the doctor mentioned being able to manipulate?

What similarity is drawn between the development of genetic science and nuclear energy?

What does Silver describe as “the ultimate legacy of unfettered global capitalism?”

What mutations have scientists already applied to animals/humans that make people believe that others will be possible?


What are some reasons genetic science is overhyped?

Wednesday, March 20, 2019

Can't handle the truth

Is Pain a Sensation or an Emotion? and Medical Materialism etc.

The essay on the psychology of pain I mentioned in class yesterday:
We could learn a thing or two from the ancient Greeks’ understanding of suffering.
The United States uses a third of the world’s opioids but a fifth of Americans still say they suffer from chronic pain. The only demonstrable effect of two decades of widespread prescription of opioids has been catastrophic harm. With more than 47,000 Americans dying of opioid overdoses in 2017 and hundreds of thousands more addicted to them, it was recently reported that, for the first time, Americans were more likely to die of opioids than of car accidents.

This has forced many to take a step back and ponder the very nature of pain, to understand how best to alleviate it.

The ancient Greeks considered pain a passion — an emotion rather than a sensation like touch or smell. During the Dark Ages in Europe, pain was seen as a punishment for sins, a spiritual and emotional experience alleviated through prayers rather than prescriptions.

In the 19th century, the secularization of Western society led to the secularization of pain. It was no longer a passion to be endured but a sensation to be quashed... (continues)
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A fascinating podcast conversation about the ethics of addiction with Sally Satel and Sam Harris. Sally Satel, M.D., is a practicing psychiatrist and lecturer at Yale, author of PC, M.D.: How Political Correctness Is Corrupting MedicineWhen Altruism Isn’t Enough: The Case for Compensating Organ DonorsOne Nation Under Therapy; and Brainwashed: The Seductive Appeal of Mindless Neuroscience...
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And, William James on "medical materialism":

We are surely all familiar in a general way with this method of discrediting states of mind for which we have an antipathy. We all use it to some degree in criticising persons whose states of mind we regard as overstrained. But when other people criticise our own more exalted soul-flights by calling them “nothing but” expressions of our organic disposition, we feel outraged and hurt, for we know that, whatever be our organism's peculiarities, our mental states have their substantive value as revelations of the living truth; and we wish that all this medical materialism could be made to hold its tongue.

Medical materialism seems indeed a good appellation for the too simple-minded system of thought which we are considering. Medical materialism finishes up Saint Paul by calling his vision on the road to Damascus a discharging lesion of the occipital cortex, he being an epileptic. It snuffs out Saint Teresa as an hysteric, Saint Francis of Assisi as an hereditary degenerate. George Fox's discontent with the shams of his age, and his pining for spiritual veracity, it treats as a symptom of a disordered colon. Carlyle's organ-tones of misery it accounts for by a gastro-duodenal catarrh. All such mental over-tensions, it says, are, when you come to the bottom of the matter, mere affairs of diathesis (auto-intoxications most probably), due to the perverted action of various glands which physiology will yet discover.

And medical materialism then thinks that the spiritual authority of all such personages is successfully undermined.2

Let us ourselves look at the matter in the largest possible way. Modern psychology, finding definite psycho-physical connections to hold good, assumes as a convenient hypothesis that the dependence of mental states upon bodily conditions must be thorough-going and complete. If we adopt the assumption, then of course what medical materialism insists on must be true in a general way, if not in every detail: Saint Paul certainly had once an epileptoid, if not an epileptic seizure; George Fox was an hereditary degenerate; Carlyle was undoubtedly auto-intoxicated by some organ or other, no matter which,—and [pg 014]the rest. But now, I ask you, how can such an existential account of facts of mental history decide in one way or another upon their spiritual significance? According to the general postulate of psychology just referred to, there is not a single one of our states of mind, high or low, healthy or morbid, that has not some organic process as its condition. Scientific theories are organically conditioned just as much as religious emotions are; and if we only knew the facts intimately enough, we should doubtless see “the liver” determining the dicta of the sturdy atheist as decisively as it does those of the Methodist under conviction anxious about his soul. When it alters in one way the blood that percolates it, we get the methodist, when in another way, we get the atheist form of mind. So of all our raptures and our drynesses, our longings and pantings, our questions and beliefs. They are equally organically founded, be they of religious or of non-religious content.

To plead the organic causation of a religious state of mind, then, in refutation of its claim to possess superior spiritual value, is quite illogical and arbitrary, unless one have already worked out in advance some psycho-physical theory connecting spiritual values in general with determinate sorts of physiological change. Otherwise none of our thoughts and feelings, not even our scientific doctrines, not even our dis-beliefs, could retain any value as revelations of the truth, for every one of them without exception flows from the state of their possessor's body at the time.

It is needless to say that medical materialism draws in point of fact no such sweeping skeptical conclusion. It is sure, just as every simple man is sure, that some states of mind are inwardly superior to others, and reveal to us more truth, and in this it simply makes use of an ordinary spiritual judgment. It has no physiological theory of the production of these its favorite states, by which it may accredit them; and its attempt to discredit the states which it dislikes, by vaguely associating them with nerves and liver, and connecting them with names connoting bodily affliction, is altogether illogical and inconsistent. VRE



Josiah's text:



The obligation of physicians to relieve human suffering stretches back into antiquity. But what exactly is suffering? One patient with metastatic cancer of the stomach, from which he knew he would shortly die, said he was not suffering.Another, someone who had been operated on for a minor problem--in little pain and not seemingly distressed--said that even coming into the hospital had been a source of suffering. With such varied responses to the problem of suffering, inevitable questions arise. Is it the doctor's responsibility to treat the disease or the patient? And what is the relationship between suffering and the goals of medicine?

According to Dr. Eric Cassell, these are crucial questions, but unfortunately, have remained only queries void of adequate solutions. It is time for the sick person, Cassell believes, to be not merely an important concern for physicians but the central focus of medicine. With this in mind, Cassell argues for an understanding of what changes should be made in order to successfully treat the sick while alleviating suffering, and how to actually go about making these changes with methods and training techniques firmly rooted in the doctor's relationship with the patient. He uses many stories and anecdotes to demonstrate that there can be no diagnosis, search for the cause of the person's disease, prognostication, or treatment without consideration of the individual sick person. Cassell goes on to explain what needs to be known about a person, as well as the importance of recognizing the dual standing of doctors both as physician and person.

Making an eloquent case for seeing the symptoms within the context of the patient's whole life and person, Cassell injects a critical element of humanism into what has become a largely technical discipline.
  g'r
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Broken-heart syndrome. Poets and politicians have long known that hearts and minds are linked. Now neuroscientists and cardiologists have shown again, in a study published this month in The European Heart Journal, that the connection is more than metaphorical. It turns out that those afflicted by a rare, serious condition known as “broken-heart syndrome” have brains that work differently from those of healthy people, suggesting that what happens in the head can hurt the heart...

Weekly health news quiz...

Tuesday, March 19, 2019

Tests and the Elderly

So I found a nice, almost sterile source of bioethics articles and this one popped out to my attention. I have two living grandparents and one no longer with us. I have conflicting emotions when it comes to each of them but like anyone else, I would want them to be informed and helped when it comes to mental health. My maternal Grandfather has even mentioned when I explained autism that some of those traits mildly applied to him. So, when I saw an NPR (not sure if I am supposed to capitalize it if they don't in their logo but that is beyond the point) talking about the neglection of doctors to test for Alzheimer's, I was shocked.

According to the definition of wellness checkups on Medicare's website, that service is expected with the benefits. The further surveys of the patients done by researchers discovered no increase in anxiety or depression but that feels like a bias on behalf of the medical professional. Asking someone if they are depressed alone inserts bias that can lead the subject to become defensive, especially those of previous generations with stricter gender roles that can lead them to not be open about feelings. I would prefer to have seen the survey but that isn't always possible in some studies. Additionally, the researchers explained that they would know mental deficiency when they saw it. Confidence can be helpful if you know the person and they are truthful with you. However, some individuals in the military don't reach out because of shame or fear according to the NFV. If people who are supposedly strong and have access to mandatory health care are getting missed, how can we know our professionals are as skilled as they are confident?