Art Caplan on med schools and industry freebies
Over at MSNBC, Art writes that a recent recommendation for medical schools to ban free stuff from industry is on target:
The American Association of Medical Colleges recently released a long-awaited report recommending that pharmaceutical companies and medical device manufacturers knock off their efforts to bribe medical students and faculty. The Association said in no uncertain terms: No more freebies. That means no more doling out free lunches, tickets, trips, pens, binders, flashdrives, bookbags, free samples and other trinkets in classrooms, offices, exam rooms and reception areas of medical schools.
What led the leaders of the schools that train American doctors to pull the plug on the free flow of chachkes, baubles and doughnuts to medical students and their teachers? The report says that the steady marketing of drugs using freebies raises questions about the “objectivity and integrity of academic teaching, learning and practice.” In other words, if you let young, well-coifed drug company representatives run around your school in short skirts or snazzy suits doling out gifts, it conveys a very bad image — that a school is an appropriate place to do marketing.
Worse still, making your medical school a drug company free-fire zone conveys the impression that the faculty believe there is a lot to learn from slanted drug company sales pitches. And worst of all, when the welcome mat is out for drug reps bearing small gifts, this says that the faculty believe the best way to educate the next generation of doctors about drug safety and efficacy is to make sure students remember a drug’s name by having it thrown in their faces 10 times a day on every pen, notepad, vase, clock, key ring, calculator and coffee mug that a pharmaceutical company’s marketing department can have their legions of salespeople lug into the hospital.
I think a ban makes good ethical sense. I am proud to say that my medical school and its teaching hospitals were the first in the country to boot the drug reps and freebie peddlers off campus.
But the policy of banning marketing in medical schools has drawn some predictable criticism.
10 Reasons to Sequence the Platypus Genome
By Ricki Lewis
Move over Craig Venter and James Watson, the latest celebrity to have her genome sequenced is Glennie, a member of Ornithorhynchus anatinus. She hails from New South Wales, Australia.
When the planners of the human genome project set aside funds for sequencing the genomes of others, I was glad that the enigmatic platypus made the list. Occupying a key branchpoint on the evolutionary tree, the platypus is a hodgepodge of parts borrowed from birds and reptiles, and echoed in the vastly more numerous placental mammals. The curious web-footed and furry, egg-laying and lactating beasts diverged from the most recent shared ancestor of all mammals about 166 million years ago, heading in a different direction from its pouched and placental brethren. The reports on the platypus genome are published in Nature and Genome Research.
Why sequence the platypus genome? Let me count the ways.
Are you diseased? Pre-diseased? Potentially diseased?
Today's Science Times included an interesting story about work toward classifying diseases by their genetic underpinnings. There are bunch of interesting angles to this idea, but one in particular stood out for me: as we gain greater insight into the nature of disease, our concept of what it means to be "sick" changes. From Andrew Pollack's piece:
The shift from symptoms to anatomical measurements had big implications for patients, said Dr. Duffin, who is also a hematologist.
“Up until the 18th century, you had to feel sick to be sick,” she said. But now people can be considered sick based on measurements like high blood pressure without feeling ill at all.
Indeed, Dr. Duffin said, people who feel sick nowadays “don’t get to have a disease unless the doctor can find something” and instead might be told that it’s all in their head. Doctors argue, for instance, about whether fibromyalgia or chronic fatigue syndrome, which have no obvious anatomical causes, are really diseases.
Genes might allow the study of diseases at a finer level than even physiological tests. Genes are the instructions for the production of proteins, which interact in complex ways to carry out functions in the body. Disruptions in these molecular pathways can cause disease.
“It gives you a direct connection to what the root causes are,” said Dr. David Altshuler, a professor of medicine and genetics at Harvard and Massachusetts General Hospital, and a researcher at the Broad Institute. “That is different from listening to a stethoscope.”
The 5 (OK, 6) most popular Bioethics News stories from the week of April 28
Here are the most popular Bioethics News items from last week based on average clicks per day:
1. House passes GINA
(NYT) The Genetic Information Nondiscrimination Act passed on a 414-1 vote. President Bush has said he would sign the bill.
2. Praying parents charged
(AP) The parents of a Wisconsin child who prayed while the child died from diabetic complications have been charged with reckless homicide. The parents regarded their daughter's condition as "a test of faith" and a "spiritual attack."
3. Med college group: no more industry gifts
(NYT) The Association of American Medical Colleges has proposed banning free food, gifts, travel and ghost-writing from drug and device makers.
4. More details on McCain's health plan
(NYT) The presidential candidate's plan would try to shift the basis of coverage from employers to individuals. McCain has also called for the federal government to assure that coverage will be available for people who have been turned down.
5. Marrying for health care (tie)
(LA Times) A survey sponsored by the Kaiser Family Foundation reports that seven percent of Americans said they or someone in their household got married for healthcare benefits last year.
5. iPS cells used to create heart cells in mice (tie)
(Reuters) Researchers from UCLA report in the journal Stem Cell Express that they got mouse iPS cells to differentiate into two types of heart cells as well as hematopoietic cells.
The top five stories from two weeks ago.
Surrogacy without drama
When surrogacy comes up in the media, it's usually within the context of a story about celebrities, outsourced wombs, court cases or comedy. But this past weekend, the Washington Post had the story of a surrogacy gone absolutely, positively... normal. From Brigid Schulte's piece:
Fourteen years ago, Kovacic, a married, middle-class mother of three, signed a $15,000 contract with Carol Van Cleef and Doug Thompson, now of McLean, to carry the embryo that their sperm and egg had created in a petri dish. On her 35th birthday, Kovacic gave birth to Jamie. The two families, without a second thought or a hint of awkwardness, have celebrated together every year since.
In technical terms, Kovacic was a "gestational carrier" for Carol and Doug, the "intended parents." Kovacic, 49, short and easygoing with an impish sense of humor, and Van Cleef, 52, a tall, willowy, self-described type-A partner in a major law firm, couldn't be more different. But theirs is an intimate bond of flesh and bone, forged in science and the ancient yearning for a child that society has yet to find the words to describe, much less understand.
Kovacic, who lives in Herndon, brought two of her own daughters to the birthday dinner. The girls gushed about movies and bands and teased Jamie's 17-year-old brother, Peter. Jamie, sitting between Kovacic and Van Cleef, mentioned that she would be singing soprano in her upcoming chorus concert.
Kovacic looked at Van Cleef and raised an eyebrow. "I know she didn't get that from either one of us, did she?"
Kovacic has been Jamie's "special friend" at preschool. She has attended her graduations, school performances and confirmation. She babysat for her as a child. But the one thing she clearly isn't is Jamie's mother.
One interesting fact from this piece: surrogate births account for less than one percent of all births from reproductive technologies.
-Greg Dahlmann
Toward test tube meat
PETA recently announced it would award $1 million to the first person who develops commercially viable in vitro chicken meat during the next four years. They've set the bar pretty high -- the meat has to have "a taste and texture indistinguishable from real chicken flesh to non-meat-eaters and meat-eaters alike."
So, what's the likelihood of that happening? In the near future, not too good, according to Time:
In theory, this seems like an excellent idea, with the potential to ease the burden on the environment from meat production, reduce greenhouse gas emissions and improve human health. In practice, however, the chances of anyone actually winning the prize seem slim. "No one has yet produced [in vitro meat]. No one has succeeded in coming close," says Dr. Stig Omholt, director of Norway's Centre for Integrative Genetics and chair of the In Vitro Meat Consortium, which held its first symposium this month. Still, Omholt says, "it seems possible to develop this technology."
If such a product is created, it would raise some interesting questions.
Bioethics and pop culture watch
Two recent items that probably don't mean a whole lot, but might be interesting in a bioethics-in-pop-culture kind of way:
+ Oprah's interview with the pregnant transsexual man scored big ratings.
+ And Tina Fey's surrogacy comedy Baby Mama easily topped the box office last weekend, delivering (!) more than $18 million.
-Greg Dahlmann
Can you buy changes in health behaviors?
By Stuart Rennie
And the girl behind the counter has a tattooed tear
One for every year he's away she said
Such a crumbling beauty,
Ach there's nothing wrong with her
That a hundred dollars won't fix
Those are lyrics from Tom Waits' song '9th and Hennepin.' They slipped involuntarily into my consciousness when I read about a World Bank study that is being planned in Tanzania. According to the report in the Financial Times, the study involves 'incentivizing' sexual behavior change by means of cold hard cash. Participants, if they do not pick up sexually transmitted infections during the study period, are told that they will receive $45 for their efforts. The study also will have a comparative control arm in which participants will also be tested for STIs, but will not receive any money. One of the researchers from the University of California-San Francisco is reported as saying: “We hope this ‘reverse prostitution’ will make people think hard about the long-term consequences of their short-term behaviour.” An intriguing statement, since it implies that the problem with Tanzanians, in regard to sexually transmitted infections, is that they are just not thinking hard enough. Nothing like 45 dollars to get you to think straight. If the question is -- as the accompanying Editorial puts it -- "Are the funders saying young Tanzanians cannot be trusted to do what is good for them without a bribe?", it looks like the answer is a resounding yes.
The 5 most popular Bioethics News stories from the week of April 21
Here are the most popular Bioethics News items from last week based on average clicks per day:
1. "Untouchable" woman dies after being denied treatment
(AFP) An Indian woman died after giving birth when several doctors refused to touch her or provide treatment because of her caste status.
2. Congress close to passing GINA
(New York Times) A deal in the Senate opened the way for passage of the Genetic Information Nondiscrimination Act. (See the next story.) The bill would make it illegal to deny health coverage to someone on the basis of genetic information. It would also bar employers from hiring or firing on such info.
3. Senate passes GINA
(LA Times) The Genetic Information Nondiscrimination Act passed on a 95-0 vote.
4. Life expectancy declining in some parts of US
(New York Times) A study in PLoS reports that men and women in pockets of the Midwest and South are seeing life expectancy declines. One of the study's authors says this type of decline is unheard of in other developed countries.
5. Employer suspends 39 for lying about smoking
(AP) The suspended workers at a Whirlpool factory had signed insurance forms claiming they didn't use tobacco. Their jobs are now in jeopardy after they were caught smoking or chewing on company property.
The top five stories from two weeks ago.
Art Caplan on living forever
Over at MSNBC, Art writes that concerns over research into life extension are overblown:
Is it right to want to try to live forever? This ethical question is being kicked around quite a bit these days.
As the science of regenerative medicine using stem cells inches forward, as more is understood about how lifestyle influences longevity, as organ and tissue transplants become routine and as geneticists begin to unravel the secrets of why we age, the prospect of living forever — or at least until the Cubs win a pennant — makes the question something more than an exercise in science fiction.
What is particularly interesting is that many of those raising the question of the ethics of immortality do so with an answer already in mind — “No, it’s not right!” Both conservative and liberal writers alike are expressing a lot of moral angst in recent books, articles and opinion pieces about the prospect of people hanging around long, long after the last broadcast of "The Price Is Right" has aired, which could be an eternity.