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Bioethics – Page 10 – Life as an Extreme Sport
Life as an Extreme Sport

Lies, Damned Lies, and Mehdi Hasan on Abortion

I got really annoyed this morning. I woke up, and basically the first thing I saw on Twitter was numerous retweets and comments about a HuffPo UK article on abortion and social progressives attempting to argue that one could be socially progressive and still advocate for an anti-choice position.

I disagree, rather vehemently. To the tune of almost 3000 words, give or take, as I basically deconstructed the author’s entire argument in an attempt to show not only why it was wrong, but obnoxiously so. With thanks to Nicholas G. Evans, Catherine Flick, and Laura Northrup, all of whom provided feedback and helped to focus my irritation into coherence.

Without furtherOkay, with slightly further ado: yes, this piece was picked up and published, in edited form, on Comment is Free in The Guardian.

Now, really, without further ado,…

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15 Miles: Firearms Violence in America

Police are investigating a double shooting that left one person dead in the Northern Liberties section of Philadelphia.

“It seems to be a very violent crime that took place in there which led to this double shooting homicide,” Philadelphia Police Chief Inspector Scott Small said.

Just another morning in Philly. Wake up, make note of the body count, get your coffee, go about your morning.

No shooting victims were reported in Philadelphia Friday night but at least 14 people were shot throughout the rest of the weekend, including two homicides and one police-involved shooting. At least four of the victims were women.With thanks to Jim MacMillan and Tara Murtha for the link to guncrisis.org.

But you won’t see an uproar about this, not from the media, not from concerned citizens outside of those few shouting to the roofs about the gun crisis in this country. You won’t hear calls for increased gun restrictions, background checks, 2nd Amendment arguments, or anything except maybe a blip on the nightly news about how sad it is, such violence, don’t these people know better? The well-manicured and coifed anchors will shake their heads sadly, and after the break, perkily bring us to some happier topic.

Because it’s not the Empire State Building. It’s not unexplained white shooters. It’s not people who have everything. It’s not mass casualty where the casualties are people this sort of thing isn’t supposed to happen to. This?

Is expected.

My sister was rotating through one of the northern Philadelphia hospitals last year, and told me about what an odd experience it was — where you note the number of bullet holes on the patient’s bodies, making sure that the number in the chart matches the number on the body. Often, they didn’t; there were more that hadn’t been treated, had healed on their own. Battle wounds and pride. Move 15 miles west, into the suburbs where I live, and the emergency room doctors would be shocked and horrified to have that sort of counting done on the bodies of their patients; it would make the news, rather than be an accepted part of life. Because that’s as far as it takes to move from an area of institutional breakdown, racism, and failed inner-city policies to gentrified and genteel areas where the social expectations are light years difference. You don’t shoot people on the Main Line. Our yards are too well-maintained for that.

I am an anomaly among my very liberal friends: I don’t automatically argue that we need more gun control when violence happens. This is undoubtedly in part because I was raised by a father who hunts, whose family lived in Alaska, because I’ve come face-to-face with a moose before and would very much like to not do that again without being armed and able to defend myself, and yes with a semi-automatic because moose? Are big. Oh, people will excuse hunters and people who live in areas like the wilds of Alaska or even middle of nowhere America, places where it’s still considered acceptable to have a gun, certain sorts of approved and accepted weapons. But that really misses the point, doesn’t it? Because the people who are breaking the law are clearly not motivated by following the law.

And most of the time, those folks who are breaking the law and getting subsequent media coverage? The spree shooters, revenge shooters, the ones who are white and well-mannered and aren’t supposed to be like that? They’re the ones who already own their weapons legitimately, and if they do and have, then all the proposed laws in the world, save an outright ban which has already been negated by the acceptance of subsistence hunters and wilderness safety, won’t help. And no one wants to talk about the illegal guns, the ones that are part of the 14 homicides in two days in Philadelphia. Because those aren’t situations that can be bandage-approached with an appeal to laws and bans. Those are situations that bring us into decaying inner cities and hopelessness and social changes that need to happen beyond a law or two.

It’s not hard to notice that the world that judges the United States for it’s firearms violence tends to be a world that has a more communitarian notion of social health and care. Thus, many times when the world that judges decides to speak up, it comes from an uninformed point of view that assumes that if the United States were to simply do as they do, ban guns, have buybacks, follow the lead of these more progressive societies, then all the firearms violence will simply fade away like a bad memory of a less enlightened time.

This attitude, however, doesn’t consider the very deep social differences between our societies — not differences based on autonomy or amendments, but differences based on the very nature and idea of how we interact with members of our society. In other words, it is not that what is “painfully self-evident to Canadians and citizens of other nations with discernible social democratic traditions needs to be bolstered by sustained reasoning and argumentation in the more atomistic (rights-oriented) U.S. milieu;”Turner L. “Bioethics, Public Health, and Firearm-Related Violence: Missing Links Between Bioethics and Public Health.” Journal of Law, Medicine & Ethics 1997;25:42-48 this is the argument that occurs whenever there are mass shootings that make the news for their stepping outside of what we consider accepted realms of violence. Because those rights are only invoked when the dialog blows out beyond the inner city. Public good and personal autonomy are polite concepts that come up when the violence invades the middle class neighborhoods; it’s not part of the debate that happens when 14 people are killed in two days in Philadelphia, when 19 people are wounded overnight in Chicago. It’s not part of the debate that happens when two are killed and three wounded in Camden, because there isn’t a debate.

It is simply accepted.And to be perfectly fair to Dr. Turner, whom I quoted earlier, this is largely the point his paper is making: that bioethicists have a responsibility to social bioethics, and that these problems of social justice, public health, and so forth need to be the central focus of the field, rather than the “lure of lucre.” I admit to slightly misreading the quote for my own purpose, in that quite a few of my Canadian and Australian friends do say things like that, which does tend to leave me wanting to pitch them through the nearest window.

In order to have an honest discussion about firearms violence in America, we need to realize that the discussion to be had is not one of regulation first, but of greater social issues. It’s a dialog that needs to be based in equality, access, healthcare, education, and removing the constraints that cause such a dramatic difference in medical, hospital, and social response in 15 short miles.

Novel Therapies Should Be Tortoises, Not Hares

I knew there were going to be a lot of hard things about losing Mom to cancer: holidays and birthdays and events like my sister graduating from medical school. This was almost a given, in those panicked moments after hearing the diagnosis and knowing what it meant, that it was a matter of when and not if. I didn’t realize quite how pervasive it was going to be, though, or that it would create such a strange position to be in every time I read about a new treatment for lung cancer, or I read through clinicaltrials.gov for work and see something being tested, or hear about new drug approvals. Each time, I have that brief flash: this existed five years ago. This may have saved Mom.

Early on in treatment, a couple of colleagues pulled me aside and I got one of those lectures. The one that offered whatever help was possible, but – because they were bioethicists – the one that said we should go with established treatment protocols and avoid the clinical trials, especially if it would mean moving Mom out of her home and to somewhere strange. Comfort and palliation were a huge focus, and it’s something I still appreciate, because it did give me a bit of an external rock to lean on when we started getting the “helpful” suggestions. You know, the ones that ranged from legit clinical trials in another state to peach pit essence therapy in Mexico.

And when your mother is dying, you want hope. You will claw desperately for hope, even if it’s in a coffee bean or weed.

So I understand. I understand better than a lot of people when there are complaints about how slowly regulatory agencies move, and that requirements of animal testing slows things down. And I have the education to know that just because a drug works in one animal model doesn’t mean it will be successful in humans. But those regulations are also put in place to protect people, and hearing that researchers in Canada are complaining about stem cell trial regulations does not generate a patient response. In fact, I think my exact words were “you would assume someone who had made it through medical school and become a trial PI would have more patience than a toddler.”

But what really stood out to me was this:

It probably would have delayed the field by another 10 years,said the neurosurgeon. When you think about a condition as serious and life-threatening and damaging as spinal cord injury, is that a reasonable bar, or is that setting the bar at a level that is not appropriate?

Well, personally? I want that bar set high. I want to know that every possible precaution has been taken to make sure that what is being given to the public is safe. Yes, my mother died in part because the bar is set so high on testing novel drug therapies, and she didn’t have access to drugs that are certainly out there and potentially could have saved her life. But I also know that she died from cancer, and not from greed.

And I think that appeal to emotion made by that neurosurgeon is really what irritates me.1 Because that’s getting dangerously close to what the fraud-y stem cell clinics do, and the alternatural therapies – they offer hope and appeal to that emotional “let us skip all the things necessary to prove this is both safe and effective, and instead just jump right to miracles!” When someone advocates stepping outside an established scientific process, it needs to be for a reason that is stronger than “I don’t want to wait.”


Pain Management & Pharma: Yeah, It’s Personal

It’s possible that you’ve heard about the Senate Investigation into pain treatment/control advocacy groups and the makers of narcotic medications; just the announcement of the investigation has had significant effect: The American Pain Foundation immediately dissolved, and the American Journal of Bioethics suddenly realized they had an awful lot of conflicts-of-interest that they had ‘accidentally’ not disclosed. (For a closer look at that, check out William Heisel’s coverage, here and here.)

Today, Deborah Blum posted a link to a 14-years later follow-up of the patients who served as testimonial voices for Perdue Pharma in a video promoting OxyContin (and, according to a doctor who was a paid specialist for Purdue Pharma at the time, to prescribe more opioids period). Of the seven patients, two were addicted to and abusing opioids when they died, a third became addicted, three maintain everything is fine, and the final refused to comment. Not a fantastic track record, especially given what we now know about Perdue Pharma lying about the addictive nature of OxyContin. The company was hit with large fines for their creative promotions and “misbranding” of OxyContin in 2007, but as the above links regarding the extensive financial support of pain management advocacy groups, doctors, and ethicists show, combined with the ProPublic exposé that started the ball rolling, the fines didn’t amount to much discouragement.

The thing is, I realize that a lot of people are outraged about this on the sheer principle of it: the people who are supposed to take care of the patient are making decisions based on money and incentives rather than what’s best for the patient. I share that principled outrage, of course, but for me, it’s also terribly personal.
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It’s a Jolly Holiday Wiv’ Stem Cells

Oh, it’s a jolly ‘oliday wiv stem cells
Stem cells make your ‘eart so right!
When the day is gray and ordinary
Stem cells makes the sun shine bright!
Oh, ‘money’s raining down’ all around ’em
The doctors are smilin’ at the bills
When the doc injects those cells you feel so grand
Your ‘eart’ll start beatin’ like a big brass band
It’s a jolly ‘oliday wiv stem cells
No wonder that it’s stem cells that we love!

Tip of the hat – or blame – to Carl Elliott and the brother he steals his genius from, as well as Leigh Turner.