By STEPHANIE SAUL
Published: December 12, 2009
Unable to have a baby of her own, Amy Kehoe became her own general contractor to manufacture one. For Ms. Kehoe and her husband, Scott, the idea seemed like their best hope after years of infertility.
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Working mostly over the Internet, Ms. Kehoe handpicked the egg donor, a pre-med student at the University of Michigan. From the Web site of California Cryobank, she chose the anonymous sperm donor, an athletic man with a 4.0 high school grade-point average.
On another Web site, surromomsonline.com, Ms. Kehoe found a gestational carrier who would deliver her baby.
Finally, she hired the fertility clinic, IVF Michigan, which put together her creation last December.
“We paid for the egg, the sperm, the in vitro fertilization,” Ms. Kehoe said as she showed off baby pictures at her home near Grand Rapids, Mich. “They wouldn’t be here if it weren’t for us.”
On July 28, the Kehoes announced the arrival of twins, Ethan and Bridget, at University Hospital in Ann Arbor. Overjoyed, they took the babies home on Aug. 3 and prepared for a welcoming by their large extended family.
A month later, a police officer supervised as the Kehoes relinquished the swaddled infants in the driveway.
Bridget and Ethan are now in the custody of the surrogate who gave birth to them, Laschell Baker of Ypsilanti, Mich. Ms. Baker had obtained a court order to retrieve them after learning that Ms. Kehoe was being treated for mental illness.
“I couldn’t see living the rest of my life worrying and wondering what had happened, or what if she hadn’t taken her medicine, or what if she relapsed,” said Ms. Baker, who has four children of her own.
Now, she and her husband, Paul, plan to raise the twins.
The creation of Ethan and Bridget tested the boundaries of the field known as third-party reproduction, in which more than two people collaborate to have a baby. Five parties were involved: the egg donor, the sperm donor, Ms. Baker and the Kehoes. And two separate middlemen bro-kered the egg and sperm.
About 750 babies are born each year in this country through gestational surrogacy, and twice that many surrogacies are attempted. Most are less complicated than the arrangement that resulted in the birth of Ethan and Bridget.
But as the dispute over the Michigan twins reveals, surrogacy arrangements that go badly can have profound implications, particularly for the children. Surrogacy is largely without regulation, with no authority deciding who may obtain babies through surrogacy or who may serve as a surrogate, according to interviews and court records.
Instead, surrogacy is controlled mainly by fertility doctors, who determine which arrangements are carried out and also earn money by performing the procedures. And while some agencies that coordinate surrogacies and some clinics that carry them out strictly adhere to guidelines, others do not, the interviews and records show.
The lax atmosphere means that it is now essentially possible to order up a baby, creating an emerging commercial market for surrogate babies that raises vexing ethical questions.
In some cases, parents must go through adoption proceedings to gain legal custody of the children. But even in those situations, the normal adoption review process is upended. In surrogacy, prospective parents with no genetic link often create their own baby first, then ask for legal approval, potentially leaving judges with little alternative. Some states allow prebirth orders that place the parents’ names on the birth certificates without any screening.
When disputes arise after the babies are born, the outcome can vary from state to state. In California, considered a friendly state for surrogacy, courts have upheld the validity of surrogacy contracts, meaning that the people who hire surrogates are very likely to keep the babies if a dispute arises.
But a statute in Michigan, where Ethan and Bridget were born, holds that surrogacy is contrary to public policy and that surrogacy agreements are unenforceable, giving the woman who gives birth a strong case if she decides to keep the babies.
A handful of other states have similar laws, according to an analysis by the Center for American Progress, a liberal research group.
About 10 states have laws that allow for surrogacy but impose restrictions; several of those states require at least one parent to have a genetic relationship to the baby. But the majority of states are silent on surrogacy, according to the analysis. Legal uncertainty in some states means that babies are sometimes left in limbo, their parentage left up to courts.
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“When they go bad, it’s so sad,” said Mitzi Heineman, the Michigan broker who supplied Ms. Kehoe’s donor eggs. “You feel sorry for the baby. Who are the baby’s parents?”
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Four-year-old twin girls in Union City, N.J., have lived under such uncertainty. Their short lives have included two tours in the foster care system.
New Jersey child welfare officials alleged earlier this year that the girls were neglected by Stephen Melinger, 62, who arranged their birth almost five years ago. In July, a New Jersey judge exonerated Mr. Melinger of those accusations. But the Supreme Court in Indiana, where the girls were born, recently ruled that his adoption of the twins was improperly executed and must be redone.
Fewer problems arise when the prospective parents have a genetic link to the offspring, lawyers who have handled such cases say. Gestational surrogacy frequently involves couples who can produce their own eggs and sperm, but in which the female partner cannot carry a baby.
Doctors say that when surrogacy arrangements go smoothly, they are very rewarding.
“It’s been unbelievably satisfying seeing these families grow that otherwise wouldn’t have,” said Dr. James Goldfarb, director of fertility services at the Cleveland Clinic and president of the Society for Assisted Reproductive Technology. Dr. Goldfarb was involved in one of the world’s first gestational surrogacies in 1986. Today, the Cleveland Clinic takes part in 8 to 10 such arrangements a year, he said.
But even less complex arrangements can lead to legal challenges. In another case in New Jersey, a woman agreed to be a surrogate for her brother and his male partner, who donated sperm. But the three are now playing tug of war over 3-year-old twin girls. The woman is seeking custody and a declaration that she is the mother, even though she did not supply the eggs. Lawyers in both New Jersey cases asked that the children’s names be withheld for reasons of privacy.
The New Jersey physician who performed the procedure, Dr. Susan Treiser, did not require psychological screening and waived what is commonly a prerequisite for being a surrogate — that she must have given birth to her own child.
Ms. Baker, the surrogate in Michigan, says the fertility clinic where she was impregnated failed to perform psychological screening of the Kehoes, which is recommended by professional societies. Such screening, she believes, might have prevented her from going through with the pregnancy.
Partly in hopes of standardizing the disparate laws governing surrogacy, the American Bar Association has developed a model act for state legislatures. Judges across the country have said they need guidance to sort out complex legal issues posed by reproductive technology. One section of the proposal says that when prospective parents have no genetic link to the babies, surrogacies would require preapproval by a court in a process that would include a home study.
Lawyers who handle surrogacy arrangements say those cases represent only 5 percent of surrogacy cases, but they are the riskiest.
George J. Annas, a bioethicist who is chairman of the health law program at Boston University, said, “This is the main problem with commercialization, seeing children as a consumer product.”
“This is especially true when there is no genetic connection with the child,” he said. “It really does treat children like commodities. Like pets.”
Brokers and Fees
It was a pet — a pet bird — that transformed the birth of the Melinger twins from a private transaction into a public controversy.
Employees at Methodist Hospital in Indianapolis became alarmed when the man who had commissioned their creation, Stephen Melinger, took his pet bird to the neonatal intensive care unit where they were hospitalized. It was among several things that raised concerns about Mr. Melinger’s ability to care for the two girls, according to court documents.
When Mr. Melinger, a single man who taught elementary school in Union City, decided he wanted a child, he enlisted the help of an agency called Surrogate Mothers in Monrovia, Ind.
The American College of Obstetricians and Gynecologists has adopted a set of guidelines for surrogacy arrangements. Among its recommendations are that surrogacy be handled by nonprofit agencies. Currently it is largely for-profit and can be very lucrative.
Between brokers, legal and medical expenses and surrogate fees, a successful surrogacy can cost prospective parents $80,000 to $120,000. About an estimated 100 agencies advertise themselves as surrogacy brokers.
“People can get into this business easily,” said Charles P. Kindregan Jr., a professor at Suffolk University Law School who was co-chairman of the American Bar Association committee that drafted the model legislation.
Surrogate Mothers, one of the older agencies, advertises on its Web site that it can arrange surrogacies for under $50,000.
On April 8, 2005, the twins intended for Mr. Melinger were born in Indianapolis to a surrogate mother from South Carolina. The girls were 9 weeks premature and weighed only 3 pounds each.
Steve Litz, a lawyer who runs Surrogate Mothers, filed a petition on behalf of Mr. Melinger seeking to adopt the twins, identified in court papers as the “infants H.” According to court documents, the petition identified Mr. Melinger as an Indiana resident, born in Indiana and employed as a teacher.
The woman who carried the children was giving up her rights to them. She had listed Mr. Melinger as “father” on the birth certificate.
The private adoption was on track to be granted, almost as a perfunctory matter. But hospital employees became concerned by Mr. Melinger’s eccentric behavior. On one day, he arrived at the intensive care unit carrying his pet bird, which posed a risk of infection. Mr. Melinger testified that his bird was not near the babies because he had stayed in the office area. Yet on a separate visit, hospital workers said he had gone into the intensive care unit with bird feces on his clothing.
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The hospital staff was also worried about what they considered Mr. Melinger’s unrealistic plan for taking the babies home. He hoped to make the 12-hour drive from Indianapolis to Union City in his car, alone, with the two premature infants strapped in car seats.
Hospital workers asked Indiana’s child welfare agency to investigate.
After learning of the investigation and the possibilities that there would be difficulties in getting Mr. Melinger’s adoption approved, Mr. Litz filed another motion on his client’s behalf, calling the children “hard to place” because their mother was African-American, he said, making the girls biracial.
It is easier for out-of-state residents, like Mr. Melinger, to adopt “hard to place” children. But it was not true that the girls were biracial. The surrogate mother was African-American, but the babies she had carried grew from eggs from a white donor. The twins were white.
It was merely one of the assertions in papers filed on Mr. Melinger’s behalf by Mr. Litz that turned out to be false, according to the Indiana Supreme Court.
“An earlier representation that Mr. Melinger was a sperm donor likewise turned out not to be true,” the court said, so the children were not his biological offspring.
In addition, Mr. Melinger was not born in Indiana, but New York. The Indiana residence he claimed was a hotel room.
A lower court had criticized the submissions for “lack of candor.”
In an e-mail message, Mr. Litz denied that he had misled the courts. “I have never knowingly made a misrepresentation to a judge in my life,” he said. Mr. Melinger declined to be interviewed.
As the case moved forward amid a swirl of Indiana news reports, the girls were placed in foster care. Mr. Melinger continued his fight to adopt the girls, finally prevailing in 2006. Mr. Melinger returned to New Jersey with the girls, but the Indiana Department of Child Services appealed the adoption to the Indiana Supreme Court.
The appeal was still pending in January when the girls had another encounter with the child welfare system, according to records disclosed by Mr. Melinger’s lawyer, Anthony Carbone of Jersey City.
It began as a simple family outing to a park in January.
A woman who saw Mr. Melinger with his children complained to the police that the girls were dirty and inappropriately dressed for cold weather, the records show.
One was wearing a pink coat, a skirt, ankle socks and black shoes. The other was wearing pajamas, a yellow coat and sneakers with no socks. Mr. Melinger later said that it had been a particularly warm winter day and that he had taken extra clothes for the girls.
The complaint prompted a review by the New Jersey Department of Youth and Family Services, which sent a worker the next day to Mr. Melinger’s apartment in Union City.
When a caseworker arrived “she noticed a strong smell of urine in the apartment,” according to a court document. Mr. Melinger later said that the girls were not completely toilet trained and had accidents, and that he tried to clean up after them as best he could.
The home was “particularly dirty,” the caseworker said, with inadequate clean clothes for the twins. Department workers also said the children’s pediatrician, Dr. Pearl Cenon, had concerns about their care and had considered contacting the agency. The girls were removed from Mr. Melinger’s custody.
But in a hearing last summer, a parade of witnesses came to Mr. Melinger’s defense. They included Dr. Cenon, who denied being concerned about the girls and testified that Mr. Melinger was an excellent father.
In July, Judge Bernadette N. DeCastro of New Jersey Superior Court ruled that the Department of Youth and Family Services had failed to prove its claim against Mr. Melinger. The girls had already been returned to his custody in April.
Meanwhile, the Indiana Supreme Court had also ruled.
Uncertain Laws on Surrogates Leave Custody at Issue
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Published: December 12, 2009
(Page 4 of 5)
In a decision issued in April and reaffirmed in October, the court said the adoption of the 4-year-old twins must be repeated. Among missing elements in the original adoption, the Supreme Court said, was a letter from New Jersey authorities stating that the placement was in the twins’ best interest.
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The Indiana court said that as the case continued, the girls would be allowed to remain with Mr. Melinger. Frances Watson, a professor at the Indiana University School of Law in Indianapolis who briefly served as the appointed legal representative of the children, said the case provided a stark example of what the state’s adoption laws attempted to prevent.
“You should not be able to come from out of state on some contract and order up some babies and then go about your business,” Ms. Watson said.
Barriers to Adoption
On July 11, 2004, Donald W. Robinson, a Manhattan accountant, boarded the Norwegian Dawn cruise ship with his partner, Sean Hollingsworth.
The departure from New York was the maiden voyage of the “Rosie” cruises, named after the entertainer Rosie O’Donnell, which cater to gay men and lesbians and their families.
The cruise was also the genesis of a major surrogacy dispute.
As the 1,600 passengers sailed from New York to Florida and the Bahamas, one of the speakers was Dr. Treiser, the fertility specialist.
The weeklong cruise was an excellent way to promote her clinic, IVF New Jersey, to an important surrogacy niche market: gay partners who might want to become parents.
The shift from traditional surrogacy, in which women carry their own biological children after artificial insemination, to gestational surrogacy, as well as the wide availability of donor eggs, has opened the possibility of parenthood to a variety of people who cannot have children of their own.
In Manhattan, the Lesbian, Gay Bisexual & Transgender Community Centersponsors monthly seminars on having families through surrogacy. The well-attended sessions often feature speakers with children born through surrogacy arrangements.
In many of those cases, one of the male partners donates sperm that is used, along with a donor egg, to impregnate a surrogate.
Many of the people who have children through surrogates would have had difficulty adopting because of sexual orientation, marital status or age. Some foreign countries place upper age limits on adoptive parents. And birth mothers giving up their children in the United States often hand-pick the adoptive parents of their children.
“The default position for young birth moms tends to be a mother and a father in a stable relationship and a white picket fence around the yard,” said David C. Cole, a Dallas lawyer with Little Flower Adoptions, which also handles surrogacy arrangements.
After Dr. Treiser’s speech, Mr. Robinson and Mr. Hollingsworth approached her to discuss their plans for having a child through surrogacy.
As Dr. Treiser remembered during a deposition, they wanted to use Mr. Hollingsworth’s sperm and an egg from Mr. Robinson’s sister, Angelia Gail Robinson, a resident of Texas. That way, both Mr. Robinson and Mr. Hollingsworth would have genetic ties to the child.
But testing later revealed that Ms. Robinson, already in her 40s, could not produce viable eggs. Instead, the couple decided to use another egg donor. Ms. Robinson agreed to serve as the gestational carrier and intended to play a role in the life of the baby.
“She was going to be the doting aunt and live close by,” Dr. Treiser testified in a deposition.
Ms. Robinson sold her home in Texas and went to work in her brother’s Manhattan accounting office.
As the agreement proceeded, there were several things that should have waved cautionary flags. Foremost among them was that Ms. Robinson did not have her own children.
A previous birth provides proof that a surrogate can deliver a baby without medical complications, fertility doctors said. And it gives assurance that the surrogate understands the biological and emotional implications of pregnancy and childbirth.
“If a surrogate has not had a baby before, we won’t use her,” said Dr. Goldfarb of the Cleveland Clinic.
In an interview, Dr. Treiser said she made an exception because Ms. Robinson was carrying a child for her sibling and expressed no interest in children of her own.
In a deposition, Dr. Treiser said that she offered Ms. Robinson psychological screening, but that it was declined.
As her pregnancy progressed, Ms. Robinson now says, fissures developed in her relationship with her brother. At the same time, she says in court papers, she began to bond with the twins she was carrying.
It turned out to be an extremely difficult pregnancy that ended on Oct. 4, 2006, when Ms. Robinson was rushed to the hospital suffering from pre-eclampsia, a pregnancy-induced condition that includes extremely high blood pressure. Uncertain Laws on Surrogates Leave Custody at Issue
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Published: December 12, 2009
(Page 5 of 5)
In March 2007, after Mr. Robinson and Mr. Hollingsworth had custody of the children for five months, she filed papers for custody of the children in family court in Jersey City, where the men live. The two were married in California in September 2008, and Mr. Robinson has taken his spouse’s name.
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Ms. Robinson has also asked to be declared the legal mother of the children. Her lawyer, Harold J. Cassidy of Shrewsbury, N.J., has cited the Baby M decision two decades ago, in which the New Jersey Supreme Court upheld the maternal rights of Mary Beth Whitehead, who delivered her own biological child for another couple after artificial insemination with the man’s sperm. Mr. Cassidy also represented Ms. Whitehead.
The court ruled that even though Ms. Whitehead had agreed to a payment of $10,000 for the service, “There are, in a civilized society, some things that money cannot buy.”
Unlike Ms. Whitehead, Ms. Robinson has no genetic relationship to the girls. But as the case continues, the family court has temporarily awarded Ms. Robinson three days a week of parenting time, according to records. The girls are shuttled back and forth between Ms. Robinson’s frame house in Keansburg, N.J., and the home of their father.
Their fate may be determined by a trial as early as April.
Charges of Betrayal
Ethan and Bridget, the babies born in Michigan, are propped in their car seats in a booth at Stoney Creek Koney Island, a diner in a strip mall in Ypsilanti. They are out for breakfast with the woman who gave birth to them, Laschell Baker, and her husband, Paul.
The Bakers have picked out new names for them. They are calling the boy Peyton and the girl Dani. As soon as they can spare $320, they will file papers for legal name changes. It is a way to leave the past behind.
Someday, though, the twins will know all about what happened. “I’ll tell them the truth,” Ms. Baker said.
For Ms. Baker, 35, they are babies No. 8 and 9. In addition to her four children, she has delivered three other surrogate babies, including another set of twins. Her previous surrogacy arrangements went smoothly, and the children are with the family who requested them.
Ms. Baker said she had been vilified by the national community of professional surrogates, who chat regularly online. The Internet community is mad at her, siding mostly with the Kehoes. They even collected money for legal funds for the Kehoes, who say they were betrayed by Ms. Baker.
“They don’t want anything to do with me,” Ms. Baker said. “I’m the bad apple that ruins the name of surrogacy.”
But, she says, this is not a story about a surrogate who changed her mind.
“My husband and I would not do something like this unless we thought it was given to us to do,” Ms Baker said. “My belief is that God placed this on my heart for a reason.”
In the fall of 2007, Ms. Baker advertised in surromomsonline.com saying she would carry a baby for a Christian couple.
Amy Kehoe saw it and was delighted to find that Ms. Baker lived only two hours away.
Ms. Baker said she chose the Kehoes for the same reason. “I picked them because I wanted a couple that was local so they could enjoy the whole pregnancy with me,” she said.
They traded e-mail messages and phone calls and met for dinner before agreeing to go forward with the surrogacy.
Under Michigan’s law, commercial surrogacy is punishable by five years in prison and a $50,000 fine. Ms. Baker said she did not carry the children for money and was reimbursed only for actual expenses like doctor’s appointments. Neither she nor the Kehoes have disclosed exactly how much that was.
Ms. Baker said she was the one who recommended Dr. Jonathan Ayers of IVF Michigan for fertility services. Dr. Ayers was involved in her two previous surrogate pregnancies.
She has generally praised Dr. Ayers, but says the failed arrangement might have been avoided if IVF Michigan had required psychological screening.
A nurse at IVF Michigan said Dr. Ayers would not comment on his clinic’s policies because of patient privacy laws.
On Tuesday, July 28, the babies were born by Caesarean section. The following Monday, in court in Ann Arbor, Ms. Baker said she first learned of Ms. Kehoe’s psychiatric history.
During a hearing to transfer guardianship to the Kehoes, Scott Kehoe said his wife had paranoid schizophrenia. Ms. Kehoe’s psychiatrist listed the diagnosis as a “psychotic disorder not otherwise specified.” Ms. Kehoe takes an antipsychotic to control her symptoms.
Before her diagnosis in 2001, Ms. Kehoe told the judge, she had self-medicated, and that was the reason for her arrest on charges of cocaine use and driving under the influence.
Adoption experts said that mental illness was not a bar to adoption if the illness was under control and the patient went to doctor’s appointments and took medications. And Ms. Kehoe’s psychiatrist wrote a letter saying she would be a good mother because her disease had been fully controlled for eight years and she currently had no symptoms.
Ms. Baker, however, said she was stunned at the disclosure of Ms. Kehoe’s mental illness, which she believes she should have known in advance. And she became concerned that Ms. Kehoe might relapse and be unable to take care of the twins.
“I’m not going to be the one that’s going to feel guilty if something happens,” Ms. Baker said.
Ms. Kehoe said Ms. Baker’s decision made no sense in light of her doctor’s statement and other letters of strong support. “Does she really think she knows better than a psychiatrist who has known me for nine years?” Ms. Kehoe said.
Instead, she says, Ms. Baker “legally stole our babies from us.”
Because Michigan law states that surrogacy contracts are void and unenforceable, it was an easy matter for Ms. Baker to go to court and have the Kehoes’ guardianship rescinded.
Last month, Amy and Scott Kehoe made a decision.
“We are stopping the fight to get our babies back,” Ms. Kehoe wrote in an e-mail message. “The reason is because of the slow court system, and because of the terrible Michigan laws. JUSTICE DOES NOT PREVAIL in this case due to Michigan laws.”
Ms. Kehoe still has hope, though. It is stored in a tank of liquid nitrogen at IVF Michigan. The tank contains 20 frozen embryos made from the eggs and sperm she bought.
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Sunday, December 13, 2009
Wednesday, December 9, 2009
Addiction, Drugs, and Morality
Addiction on 2 Fronts: Work and Home
By SARAH KERSHAW
Published: December 7, 2009
WASHINGTON — His son had been dead from an overdose only three months when A. Thomas McLellan, among the nation’s leading researchers on addiction, got a call from the office of Vice President Joseph R. Biden Jr. Would he accept the nomination to be the government’s No. 2 drug-control official? e
Brendan Smialowski for The New York Times
A PERSONAL MATTER A. Thomas McLellan says he is working against not just drug abuse, but also the belief by many that it is a moral, not medical, issue.
Dr. McLellan, 61, makes no secret of his cynicism about government — “I hate Washington,” as he put it in an interview — and he had no intention of leaving his job as a professor of psychology at the University of Pennsylvania School of Medicine and scientific director of the Treatment Research Institute in Philadelphia.
But the loss of his younger son, who overdosed on anti-anxiety medication and Scotch last year at age 30 while his older son was in residential treatment for alcoholism and cocaine addiction, changed his perspective.
“That’s why I took this job,” said Dr. McLellan, who was sworn in as the deputy director of the Office of National Drug Control Policy in August. “I thought it was some kind of sign, you know. I would never have done it. I loved all the people I’ve worked with, I loved my life. But I thought maybe there’s a way where what I know plus what I feel could make a difference.”
Married to a recovering cocaine addict, Dr. McLellan has been engulfed by addiction in life and work. His own family has been a personal battleground for one of the country’s most complex and entrenched problems, while as an expert he has been a leading voice for the idea that addiction is a chronic illness and not a moral issue.
This view squares with that of his boss, R. Gil Kerlikowske, a former Seattle police chief who declared on taking office as drug czar in May that President Obama’s administration would no longer use the term “war on drugs” — and that the term implied the government was waging a battle against its citizens.
Instead, the two men say the government needs to change its drug-control strategy, redirecting some of the resources into prevention and treatment and away from law enforcement and antitrafficking efforts, which consumed 75 percent to 90 percent of the budget during the Bush administration.
Dr. McLellan said that of the 25 million substance abusers he estimated were in this country, only about 2 million were receiving treatment. He and Mr. Kerlikowske want to triple that number, partly by spending more money and partly through other tactics, like integrating addiction treatment into the primary health care system.
Many veterans of the long and frustrating fight against addiction say it is about time. “This is an extraordinary moment of opportunity,” said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse and one of the colleagues and friends who helped persuade Dr. McLellan to take the job.
Still, even Dr. McLellan’s most ardent supporters say the challenges are formidable. The federal drug-control office can do only so much, and the Obama administration decided the drug czar would no longer be a cabinet-level position. State and local governments, law enforcement agencies, the health care system and schools are all big players. And taxpayers tend to have little sympathy for addicts or for treatment programs with track records that are mixed at best.
“I can tell a state legislator that if you would only provide treatment for these guys, we’d have the greatest reduction in crime,” said Joseph A. Califano Jr., chairman of the National Center on Addiction and Substance Abuse at Columbia University. “But those constituents want computers in the schools, better roads, better sewage systems.”
Mr. Califano, who was been involved with government efforts to combat the drug problem since the days of President Lyndon B. Johnson, said that he had great admiration for the new leaders of the drug-control office but that “you need a presidential commitment here.”
“I think if Obama gave these two guys the spark, they would know how to turn into a fire,” he said.
The office is preparing its drug policy strategy, to be released in February along with Mr. Obama’s budget. “We are going to get the money to do this,” Dr. McLellan insisted. “I can’t tell you the amount or where it’s coming from, but we’re going to get it.”
The drug czar himself, who has made passing reference to his adult stepson’s struggles with drugs but does not discuss it openly, was more cautious, as he tends to be.
“I think for some folks, radical change will be their only measure of success,” Mr. Kerlikowske said in an interview. “I don’t think we’ll see that. I think we’ll make a lot of progress, we’ll slow the freighter down and start turning it in the direction of the more balanced view.”
The two make an interesting pair — the former police chief who has plenty of experience parsing words with reporters, and the plainspoken, quirky and mustachioed psychologist who says “ain’t” and “yeah,” and whose candor can make Washington insiders nervous.
Dr. McLellan, who has written or collaborated on more than 400 papers on addiction, is well known among his colleagues and friends for both his passion for the subject and his bluntness.
In a recent interview in his office here — still sparsely decorated except for a photocopied picture of his family, including his surviving son and two young grandsons (or “grand felons,” as he called them) — Dr. McLellan put his feet up on the coffee table and declared, “I hate this job.”
“This is a job that needs scientific background,” he went on. “But if you come to it with the kind of desires to turn everything into a scientific experiment, you will have your poor little heart broken.”
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Despite Mr. Kerlikowske’s insistence that putting more resources into prevention and treatment does not mean the government is going soft on crime, such policies are bound to be controversial. Conservatives point out, for example, that drug treatment and detoxification programs have relapse and dropout rates as high as 80 percent or 90 percent.
“I’m not sure the federal government has an obligation to try to rehabilitate addicts,” said Heather Mac Donald, a senior fellow at the Manhattan Institute, a conservative policy research group. “Government has an obligation to provide safe streets to people, and policing has an extremely effective track record in places in like New York City and Los Angeles.”
Dr. McLellan grew up in Mechanicsburg, Pa., and while his family was “riddled” with addiction, he says he wound up in the field almost by accident. He said that while he drank, he was “constitutionally unfit to be an alcoholic,” and therefore did not have what he and many others consider to be a genetic disease.
He earned his doctorate in experimental psychology, with a focus on animal learning, from the Bryn Mawr in 1976.
“You’ve undoubtedly — I think almost every American has read my Ph.D. thesis by now,” he said. “ ‘Negative Autoshaping in the Rat, Cockroach, Pigeon and Crayfish.’ And armed with this kind of knowledge and obvious preparation for the business world, I was shocked to find that there weren’t many jobs available.”
So he went to the veterans’ hospital in Coatesville, Pa., to see what was available. He was offered a job as a technician to evaluate the effectiveness of one of the nation’s first drug and alcohol rehabilitation programs, and that led him and a team of researchers to develop the Addiction Severity Index, now established as a standard assessment tool for drug and alcohol abuse.
In recent years, Dr. McLellan has focused on the lack of addiction screening in primary health care settings like doctors’ offices and emergency rooms. For example, he said, just as with hypertension or diabetes, there is a concrete way to measure whether someone has an alcohol problem.
The measuring stick is known as “3-14” — so if someone is having 3 or more drinks a day, or 14 per week, that should raise a red flag, and physicians should be much better equipped to intervene and offer treatment options if there is a problem. Ideally, Dr. McLellan said, that treatment would be available in the medical system itself, not segregated in rehabilitation and detox programs, with their high failure rates.
He said another goal was to get a better handle on measuring the use of drugs and alcohol by those under 21, the time of highest risk for the onset of addiction. His younger son was in eighth grade when he began to struggle with addiction, and by then Dr. McLellan was a prominent researcher in the field.
“If it has to happen, better it happens to me, I’m an expert, right?” Dr. McLellan said. “I didn’t know what to do and none of my buddies knew what to do, and let me tell you they were experts. So I said, ‘What the hell are we doing?’ ”
That prompted him to start the Treatment Research Institute to evaluate addiction treatment. But both of his sons continued to struggle with addiction.
Dr. Volkow, of the national drug-abuse institute, said the death of the younger son “epitomized how unprotected people who are addicted to drugs are, even with that father.” Of Dr. McLellan, she added, “He’s an absolute true warrior in the best sense of the word.”
The older son is doing well now, and the two enjoy working together to restore houses and sell them. “Maybe when I get out of here, I’ll do more of that,” Dr. McLellan said.
Then he quickly added, “There’s a lot of need for drug-free housing.”
By SARAH KERSHAW
Published: December 7, 2009
WASHINGTON — His son had been dead from an overdose only three months when A. Thomas McLellan, among the nation’s leading researchers on addiction, got a call from the office of Vice President Joseph R. Biden Jr. Would he accept the nomination to be the government’s No. 2 drug-control official? e
Brendan Smialowski for The New York Times
A PERSONAL MATTER A. Thomas McLellan says he is working against not just drug abuse, but also the belief by many that it is a moral, not medical, issue.
Dr. McLellan, 61, makes no secret of his cynicism about government — “I hate Washington,” as he put it in an interview — and he had no intention of leaving his job as a professor of psychology at the University of Pennsylvania School of Medicine and scientific director of the Treatment Research Institute in Philadelphia.
But the loss of his younger son, who overdosed on anti-anxiety medication and Scotch last year at age 30 while his older son was in residential treatment for alcoholism and cocaine addiction, changed his perspective.
“That’s why I took this job,” said Dr. McLellan, who was sworn in as the deputy director of the Office of National Drug Control Policy in August. “I thought it was some kind of sign, you know. I would never have done it. I loved all the people I’ve worked with, I loved my life. But I thought maybe there’s a way where what I know plus what I feel could make a difference.”
Married to a recovering cocaine addict, Dr. McLellan has been engulfed by addiction in life and work. His own family has been a personal battleground for one of the country’s most complex and entrenched problems, while as an expert he has been a leading voice for the idea that addiction is a chronic illness and not a moral issue.
This view squares with that of his boss, R. Gil Kerlikowske, a former Seattle police chief who declared on taking office as drug czar in May that President Obama’s administration would no longer use the term “war on drugs” — and that the term implied the government was waging a battle against its citizens.
Instead, the two men say the government needs to change its drug-control strategy, redirecting some of the resources into prevention and treatment and away from law enforcement and antitrafficking efforts, which consumed 75 percent to 90 percent of the budget during the Bush administration.
Dr. McLellan said that of the 25 million substance abusers he estimated were in this country, only about 2 million were receiving treatment. He and Mr. Kerlikowske want to triple that number, partly by spending more money and partly through other tactics, like integrating addiction treatment into the primary health care system.
Many veterans of the long and frustrating fight against addiction say it is about time. “This is an extraordinary moment of opportunity,” said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse and one of the colleagues and friends who helped persuade Dr. McLellan to take the job.
Still, even Dr. McLellan’s most ardent supporters say the challenges are formidable. The federal drug-control office can do only so much, and the Obama administration decided the drug czar would no longer be a cabinet-level position. State and local governments, law enforcement agencies, the health care system and schools are all big players. And taxpayers tend to have little sympathy for addicts or for treatment programs with track records that are mixed at best.
“I can tell a state legislator that if you would only provide treatment for these guys, we’d have the greatest reduction in crime,” said Joseph A. Califano Jr., chairman of the National Center on Addiction and Substance Abuse at Columbia University. “But those constituents want computers in the schools, better roads, better sewage systems.”
Mr. Califano, who was been involved with government efforts to combat the drug problem since the days of President Lyndon B. Johnson, said that he had great admiration for the new leaders of the drug-control office but that “you need a presidential commitment here.”
“I think if Obama gave these two guys the spark, they would know how to turn into a fire,” he said.
The office is preparing its drug policy strategy, to be released in February along with Mr. Obama’s budget. “We are going to get the money to do this,” Dr. McLellan insisted. “I can’t tell you the amount or where it’s coming from, but we’re going to get it.”
The drug czar himself, who has made passing reference to his adult stepson’s struggles with drugs but does not discuss it openly, was more cautious, as he tends to be.
“I think for some folks, radical change will be their only measure of success,” Mr. Kerlikowske said in an interview. “I don’t think we’ll see that. I think we’ll make a lot of progress, we’ll slow the freighter down and start turning it in the direction of the more balanced view.”
The two make an interesting pair — the former police chief who has plenty of experience parsing words with reporters, and the plainspoken, quirky and mustachioed psychologist who says “ain’t” and “yeah,” and whose candor can make Washington insiders nervous.
Dr. McLellan, who has written or collaborated on more than 400 papers on addiction, is well known among his colleagues and friends for both his passion for the subject and his bluntness.
In a recent interview in his office here — still sparsely decorated except for a photocopied picture of his family, including his surviving son and two young grandsons (or “grand felons,” as he called them) — Dr. McLellan put his feet up on the coffee table and declared, “I hate this job.”
“This is a job that needs scientific background,” he went on. “But if you come to it with the kind of desires to turn everything into a scientific experiment, you will have your poor little heart broken.”
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Despite Mr. Kerlikowske’s insistence that putting more resources into prevention and treatment does not mean the government is going soft on crime, such policies are bound to be controversial. Conservatives point out, for example, that drug treatment and detoxification programs have relapse and dropout rates as high as 80 percent or 90 percent.
“I’m not sure the federal government has an obligation to try to rehabilitate addicts,” said Heather Mac Donald, a senior fellow at the Manhattan Institute, a conservative policy research group. “Government has an obligation to provide safe streets to people, and policing has an extremely effective track record in places in like New York City and Los Angeles.”
Dr. McLellan grew up in Mechanicsburg, Pa., and while his family was “riddled” with addiction, he says he wound up in the field almost by accident. He said that while he drank, he was “constitutionally unfit to be an alcoholic,” and therefore did not have what he and many others consider to be a genetic disease.
He earned his doctorate in experimental psychology, with a focus on animal learning, from the Bryn Mawr in 1976.
“You’ve undoubtedly — I think almost every American has read my Ph.D. thesis by now,” he said. “ ‘Negative Autoshaping in the Rat, Cockroach, Pigeon and Crayfish.’ And armed with this kind of knowledge and obvious preparation for the business world, I was shocked to find that there weren’t many jobs available.”
So he went to the veterans’ hospital in Coatesville, Pa., to see what was available. He was offered a job as a technician to evaluate the effectiveness of one of the nation’s first drug and alcohol rehabilitation programs, and that led him and a team of researchers to develop the Addiction Severity Index, now established as a standard assessment tool for drug and alcohol abuse.
In recent years, Dr. McLellan has focused on the lack of addiction screening in primary health care settings like doctors’ offices and emergency rooms. For example, he said, just as with hypertension or diabetes, there is a concrete way to measure whether someone has an alcohol problem.
The measuring stick is known as “3-14” — so if someone is having 3 or more drinks a day, or 14 per week, that should raise a red flag, and physicians should be much better equipped to intervene and offer treatment options if there is a problem. Ideally, Dr. McLellan said, that treatment would be available in the medical system itself, not segregated in rehabilitation and detox programs, with their high failure rates.
He said another goal was to get a better handle on measuring the use of drugs and alcohol by those under 21, the time of highest risk for the onset of addiction. His younger son was in eighth grade when he began to struggle with addiction, and by then Dr. McLellan was a prominent researcher in the field.
“If it has to happen, better it happens to me, I’m an expert, right?” Dr. McLellan said. “I didn’t know what to do and none of my buddies knew what to do, and let me tell you they were experts. So I said, ‘What the hell are we doing?’ ”
That prompted him to start the Treatment Research Institute to evaluate addiction treatment. But both of his sons continued to struggle with addiction.
Dr. Volkow, of the national drug-abuse institute, said the death of the younger son “epitomized how unprotected people who are addicted to drugs are, even with that father.” Of Dr. McLellan, she added, “He’s an absolute true warrior in the best sense of the word.”
The older son is doing well now, and the two enjoy working together to restore houses and sell them. “Maybe when I get out of here, I’ll do more of that,” Dr. McLellan said.
Then he quickly added, “There’s a lot of need for drug-free housing.”
Saturday, December 5, 2009
U.S. OK's research on 13 stem cells
Please read this article from the Boston Globe discussing recent changes to the U.S.'s stem cell research policy and respond with your thoughts.
Wednesday, December 2, 2009
altruism
We May Be Born With an Urge to Help
By NICHOLAS WADE
Published: November 30, 2009
What is the essence of human nature? Flawed, say many theologians. Vicious and addicted to warfare, wrote Hobbes. Selfish and in need of considerable improvement, think many parents.
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But biologists are beginning to form a generally sunnier view of humankind. Their conclusions are derived in part from testing very young children, and partly from comparing human children with those of chimpanzees, hoping that the differences will point to what is distinctively human.
The somewhat surprising answer at which some biologists have arrived is that babies are innately sociable and helpful to others. Of course every animal must to some extent be selfish to survive. But the biologists also see in humans a natural willingness to help.
When infants 18 months old see an unrelated adult whose hands are full and who needs assistance opening a door or picking up a dropped clothespin, they will immediately help, Michael Tomasello writes in “Why We Cooperate,” a book published in October. Dr. Tomasello, a developmental psychologist, is co-director of the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany.
The helping behavior seems to be innate because it appears so early and before many parents start teaching children the rules of polite behavior.
“It’s probably safe to assume that they haven’t been explicitly and directly taught to do this,” said Elizabeth Spelke, a developmental psychologist at Harvard. “On the other hand, they’ve had lots of opportunities to experience acts of helping by others. I think the jury is out on the innateness question.”
But Dr. Tomasello finds the helping is not enhanced by rewards, suggesting that it is not influenced by training. It seems to occur across cultures that have different timetables for teaching social rules. And helping behavior can even be seen in infant chimpanzees under the right experimental conditions. For all these reasons, Dr. Tomasello concludes that helping is a natural inclination, not something imposed by parents or culture.
Infants will help with information, as well as in practical ways. From the age of 12 months they will point at objects that an adult pretends to have lost. Chimpanzees, by contrast, never point at things for each other, and when they point for people, it seems to be as a command to go fetch something rather than to share information.
For parents who may think their children somehow skipped the cooperative phase, Dr. Tomasello offers the reassuring advice that children are often more cooperative outside the home, which is why parents may be surprised to hear from a teacher or coach how nice their child is. “In families, the competitive element is in ascendancy,” he said.
As children grow older, they become more selective in their helpfulness. Starting around age 3, they will share more generously with a child who was previously nice to them. Another behavior that emerges at the same age is a sense of social norms. “Most social norms are about being nice to other people,” Dr. Tomasello said in an interview, “so children learn social norms because they want to be part of the group.”
Children not only feel they should obey these rules themselves, but also that they should make others in the group do the same. Even 3-year-olds are willing to enforce social norms. If they are shown how to play a game, and a puppet then joins in with its own idea of the rules, the children will object, some of them vociferously.
Where do they get this idea of group rules, the sense of “we who do it this way”? Dr. Tomasello believes children develop what he calls “shared intentionality,” a notion of what others expect to happen and hence a sense of a group “we.” It is from this shared intentionality that children derive their sense of norms and of expecting others to obey them.
Shared intentionality, in Dr. Tomasello’s view, is close to the essence of what distinguishes people from chimpanzees. A group of human children will use all kinds of words and gestures to form goals and coordinate activities, but young chimps seem to have little interest in what may be their companions’ minds.
If children are naturally helpful and sociable, what system of child-rearing best takes advantage of this surprising propensity? Dr. Tomasello says that the approach known as inductive parenting works best because it reinforces the child’s natural propensity to cooperate with others. Inductive parenting is simply communicating with children about the effect of their actions on others and emphasizing the logic of social cooperation.
“Children are altruistic by nature,” he writes, and though they are also naturally selfish, all parents need do is try to tip the balance toward social behavior.
The shared intentionality lies at the basis of human society, Dr. Tomasello argues. From it flow ideas of norms, of punishing those who violate the norms and of shame and guilt for punishing oneself. Shared intentionality evolved very early in the human lineage, he believes, and its probable purpose was for cooperation in gathering food. Anthropologists report that when men cooperate in hunting, they can take down large game, which single hunters generally cannot do. Chimpanzees gather to hunt colobus monkeys, but Dr. Tomasello argues this is far less of a cooperative endeavor because the participants act on an ad hoc basis and do not really share their catch.
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An interesting bodily reflection of humans’ shared intentionality is the sclera, or whites, of the eyes. All 200 or so species of primates have dark eyes and a barely visible sclera. All, that is, except humans, whose sclera is three times as large, a feature that makes it much easier to follow the direction of someone else’s gaze. Chimps will follow a person’s gaze, but by looking at his head, even if his eyes are closed. Babies follow a person’s eyes, even if the experimenter keeps his head still.
Advertising what one is looking at could be a risk. Dr. Tomasello argues that the behavior evolved “in cooperative social groups in which monitoring one another’s focus was to everyone’s benefit in completing joint tasks.”
This could have happened at some point early in human evolution, when in order to survive, people were forced to cooperate in hunting game or gathering fruit. The path to obligatory cooperation — one that other primates did not take — led to social rules and their enforcement, to human altruism and to language.
“Humans putting their heads together in shared cooperative activities are thus the originators of human culture,” Dr. Tomasello writes.
A similar conclusion has been reached independently by Hillard S. Kaplan, an anthropologist at the University of New Mexico. Modern humans have lived for most of their existence as hunter gatherers, so much of human nature has presumably been shaped for survival in such conditions. From study of existing hunter gatherer peoples, Dr. Kaplan has found evidence of cooperation woven into many levels of human activity.
The division of labor between men and women — men gather 68 percent of the calories in foraging societies — requires cooperation between the sexes. Young people in these societies consume more than they produce until age 20, which in turn requires cooperation between the generations. This long period of dependency was needed to develop the special skills required for the hunter gatherer way of life.
The structure of early human societies, including their “high levels of cooperation between kin and nonkin,” was thus an adaptation to the “specialized foraging niche” of food resources that were too difficult for other primates to capture, Dr. Kaplan and colleagues wrote recently in The Philosophical Transactions of the Royal Society. We evolved to be nice to each other, in other words, because there was no alternative.
Much the same conclusion is reached by Frans de Waal in another book published in October, “The Age of Empathy.” Dr. de Waal, a primatologist, has long studied the cooperative side of primate behavior and believes that aggression, which he has also studied, is often overrated as a human motivation.
“We’re preprogrammed to reach out,” Dr. de Waal writes. “Empathy is an automated response over which we have limited control.” The only people emotionally immune to another’s situation, he notes, are psychopaths.
Indeed, it is in our biological nature, not our political institutions, that we should put our trust, in his view. Our empathy is innate and cannot be changed or long suppressed. “In fact,” Dr. de Waal writes, “I’d argue that biology constitutes our greatest hope. One can only shudder at the thought that the humaneness of our societies would depend on the whims of politics, culture or religion.”
The basic sociability of human nature does not mean, of course, that people are nice to each other all the time. Social structure requires that things be done to maintain it, some of which involve negative attitudes toward others. The instinct for enforcing norms is powerful, as is the instinct for fairness. Experiments have shown that people will reject unfair distributions of money even it means they receive nothing.
“Humans clearly evolved the ability to detect inequities, control immediate desires, foresee the virtues of norm following and gain the personal, emotional rewards that come from seeing another punished,” write three Harvard biologists, Marc Hauser, Katherine McAuliffe and Peter R. Blake, in reviewing their experiments with tamarin monkeys and young children.
If people do bad things to others in their group, they can behave even worse to those outside it. Indeed the human capacity for cooperation “seems to have evolved mainly for interactions within the local group,” Dr. Tomasello writes.
Sociality, the binding together of members of a group, is the first requirement of defense, since without it people will not put the group’s interests ahead of their own or be willing to sacrifice their lives in battle. Lawrence H. Keeley, an anthropologist who has traced aggression among early peoples, writes in his book “War Before Civilization” that, “Warfare is ultimately not a denial of the human capacity for cooperation, but merely the most destructive expression of it.”
The roots of human cooperation may lie in human aggression. We are selfish by nature, yet also follow rules requiring us to be nice to others.
“That’s why we have moral dilemmas,” Dr. Tomasello said, “because we are both selfish and altruistic at the same time.”
By NICHOLAS WADE
Published: November 30, 2009
What is the essence of human nature? Flawed, say many theologians. Vicious and addicted to warfare, wrote Hobbes. Selfish and in need of considerable improvement, think many parents.
Skip to next paragraph
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• Get Science News From The New York Times »
Enlarge This Image
Sylvio Tuepke
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Readers shared their thoughts on this article.
• Read All Comments (147) »
But biologists are beginning to form a generally sunnier view of humankind. Their conclusions are derived in part from testing very young children, and partly from comparing human children with those of chimpanzees, hoping that the differences will point to what is distinctively human.
The somewhat surprising answer at which some biologists have arrived is that babies are innately sociable and helpful to others. Of course every animal must to some extent be selfish to survive. But the biologists also see in humans a natural willingness to help.
When infants 18 months old see an unrelated adult whose hands are full and who needs assistance opening a door or picking up a dropped clothespin, they will immediately help, Michael Tomasello writes in “Why We Cooperate,” a book published in October. Dr. Tomasello, a developmental psychologist, is co-director of the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany.
The helping behavior seems to be innate because it appears so early and before many parents start teaching children the rules of polite behavior.
“It’s probably safe to assume that they haven’t been explicitly and directly taught to do this,” said Elizabeth Spelke, a developmental psychologist at Harvard. “On the other hand, they’ve had lots of opportunities to experience acts of helping by others. I think the jury is out on the innateness question.”
But Dr. Tomasello finds the helping is not enhanced by rewards, suggesting that it is not influenced by training. It seems to occur across cultures that have different timetables for teaching social rules. And helping behavior can even be seen in infant chimpanzees under the right experimental conditions. For all these reasons, Dr. Tomasello concludes that helping is a natural inclination, not something imposed by parents or culture.
Infants will help with information, as well as in practical ways. From the age of 12 months they will point at objects that an adult pretends to have lost. Chimpanzees, by contrast, never point at things for each other, and when they point for people, it seems to be as a command to go fetch something rather than to share information.
For parents who may think their children somehow skipped the cooperative phase, Dr. Tomasello offers the reassuring advice that children are often more cooperative outside the home, which is why parents may be surprised to hear from a teacher or coach how nice their child is. “In families, the competitive element is in ascendancy,” he said.
As children grow older, they become more selective in their helpfulness. Starting around age 3, they will share more generously with a child who was previously nice to them. Another behavior that emerges at the same age is a sense of social norms. “Most social norms are about being nice to other people,” Dr. Tomasello said in an interview, “so children learn social norms because they want to be part of the group.”
Children not only feel they should obey these rules themselves, but also that they should make others in the group do the same. Even 3-year-olds are willing to enforce social norms. If they are shown how to play a game, and a puppet then joins in with its own idea of the rules, the children will object, some of them vociferously.
Where do they get this idea of group rules, the sense of “we who do it this way”? Dr. Tomasello believes children develop what he calls “shared intentionality,” a notion of what others expect to happen and hence a sense of a group “we.” It is from this shared intentionality that children derive their sense of norms and of expecting others to obey them.
Shared intentionality, in Dr. Tomasello’s view, is close to the essence of what distinguishes people from chimpanzees. A group of human children will use all kinds of words and gestures to form goals and coordinate activities, but young chimps seem to have little interest in what may be their companions’ minds.
If children are naturally helpful and sociable, what system of child-rearing best takes advantage of this surprising propensity? Dr. Tomasello says that the approach known as inductive parenting works best because it reinforces the child’s natural propensity to cooperate with others. Inductive parenting is simply communicating with children about the effect of their actions on others and emphasizing the logic of social cooperation.
“Children are altruistic by nature,” he writes, and though they are also naturally selfish, all parents need do is try to tip the balance toward social behavior.
The shared intentionality lies at the basis of human society, Dr. Tomasello argues. From it flow ideas of norms, of punishing those who violate the norms and of shame and guilt for punishing oneself. Shared intentionality evolved very early in the human lineage, he believes, and its probable purpose was for cooperation in gathering food. Anthropologists report that when men cooperate in hunting, they can take down large game, which single hunters generally cannot do. Chimpanzees gather to hunt colobus monkeys, but Dr. Tomasello argues this is far less of a cooperative endeavor because the participants act on an ad hoc basis and do not really share their catch.
Skip to next paragraph
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• Get Science News From The New York Times »
Readers' Comments
Readers shared their thoughts on this article.
• Read All Comments (147) »
An interesting bodily reflection of humans’ shared intentionality is the sclera, or whites, of the eyes. All 200 or so species of primates have dark eyes and a barely visible sclera. All, that is, except humans, whose sclera is three times as large, a feature that makes it much easier to follow the direction of someone else’s gaze. Chimps will follow a person’s gaze, but by looking at his head, even if his eyes are closed. Babies follow a person’s eyes, even if the experimenter keeps his head still.
Advertising what one is looking at could be a risk. Dr. Tomasello argues that the behavior evolved “in cooperative social groups in which monitoring one another’s focus was to everyone’s benefit in completing joint tasks.”
This could have happened at some point early in human evolution, when in order to survive, people were forced to cooperate in hunting game or gathering fruit. The path to obligatory cooperation — one that other primates did not take — led to social rules and their enforcement, to human altruism and to language.
“Humans putting their heads together in shared cooperative activities are thus the originators of human culture,” Dr. Tomasello writes.
A similar conclusion has been reached independently by Hillard S. Kaplan, an anthropologist at the University of New Mexico. Modern humans have lived for most of their existence as hunter gatherers, so much of human nature has presumably been shaped for survival in such conditions. From study of existing hunter gatherer peoples, Dr. Kaplan has found evidence of cooperation woven into many levels of human activity.
The division of labor between men and women — men gather 68 percent of the calories in foraging societies — requires cooperation between the sexes. Young people in these societies consume more than they produce until age 20, which in turn requires cooperation between the generations. This long period of dependency was needed to develop the special skills required for the hunter gatherer way of life.
The structure of early human societies, including their “high levels of cooperation between kin and nonkin,” was thus an adaptation to the “specialized foraging niche” of food resources that were too difficult for other primates to capture, Dr. Kaplan and colleagues wrote recently in The Philosophical Transactions of the Royal Society. We evolved to be nice to each other, in other words, because there was no alternative.
Much the same conclusion is reached by Frans de Waal in another book published in October, “The Age of Empathy.” Dr. de Waal, a primatologist, has long studied the cooperative side of primate behavior and believes that aggression, which he has also studied, is often overrated as a human motivation.
“We’re preprogrammed to reach out,” Dr. de Waal writes. “Empathy is an automated response over which we have limited control.” The only people emotionally immune to another’s situation, he notes, are psychopaths.
Indeed, it is in our biological nature, not our political institutions, that we should put our trust, in his view. Our empathy is innate and cannot be changed or long suppressed. “In fact,” Dr. de Waal writes, “I’d argue that biology constitutes our greatest hope. One can only shudder at the thought that the humaneness of our societies would depend on the whims of politics, culture or religion.”
The basic sociability of human nature does not mean, of course, that people are nice to each other all the time. Social structure requires that things be done to maintain it, some of which involve negative attitudes toward others. The instinct for enforcing norms is powerful, as is the instinct for fairness. Experiments have shown that people will reject unfair distributions of money even it means they receive nothing.
“Humans clearly evolved the ability to detect inequities, control immediate desires, foresee the virtues of norm following and gain the personal, emotional rewards that come from seeing another punished,” write three Harvard biologists, Marc Hauser, Katherine McAuliffe and Peter R. Blake, in reviewing their experiments with tamarin monkeys and young children.
If people do bad things to others in their group, they can behave even worse to those outside it. Indeed the human capacity for cooperation “seems to have evolved mainly for interactions within the local group,” Dr. Tomasello writes.
Sociality, the binding together of members of a group, is the first requirement of defense, since without it people will not put the group’s interests ahead of their own or be willing to sacrifice their lives in battle. Lawrence H. Keeley, an anthropologist who has traced aggression among early peoples, writes in his book “War Before Civilization” that, “Warfare is ultimately not a denial of the human capacity for cooperation, but merely the most destructive expression of it.”
The roots of human cooperation may lie in human aggression. We are selfish by nature, yet also follow rules requiring us to be nice to others.
“That’s why we have moral dilemmas,” Dr. Tomasello said, “because we are both selfish and altruistic at the same time.”
Monday, November 23, 2009
stem cell human research
Human trials of ES cell research could begin soon
23 November 2009
By Alison Cranage
Appeared in BioNews 535
Stem cell therapy came one step closer to being tested for the first time in people this week, as a US company applied to the Food and Drug Administration (FDA) for a licence to start a clinical trial. The embryonic stem (ES) cell therapy is being developed to treat Stargardt, a currently incurable disease that causes blindness in young people.
Advanced Cell Technology, a Massachusetts-based firm, has tested the treatment on rats and mice which model the human Stargardt disease, and found it prevented further vision loss without adverse side effects.
Stargardt's macular degeneration destroys a part of the retina, leading to loss of vision. The treatment involves a single injection of a type of retinal cell that supports the photoreceptors needed for vision. The researchers have generated the retinal cells from ES cells derived from day-old human embryos left over from IVF (in vitro fertilisation) treatment and donated for research purposes. ES cells have the potential to develop into any type of cell in the body and, as such, scientists envisage they could be used to mend any broken part of the body, from kidney and liver to brain. They hold promise as a treatment for a range of diseases from Parkinson's to heart disease. However, using ES cells in medical research is controversial as many view the embryo as sacrosanct and inviolable, and oppose the use of human embryos in research.
'After years of research and political debate, we're finally on the verge of showing the potential clinical value of embryonic stem cells,' said Dr Robert Lanza, the chief scientific officer at Advanced Cell Technology. He added: 'We've seen absolutely no adverse effects whatsoever in any of the preclinical experiments and our cells are more than 99.9 per cent pure.'
'Our research clearly shows that stem cell-derived retinal cells can rescue visual function in animals that otherwise would have gone blind. We are hopeful that the cells will be similarly efficacious in patients,' Dr Lanza continued.
The trials would involve 12 Stargardt patients, and could begin early next year if the FDA grants approval. The clinical trial could be the first in the world as US company Geron, the only company so far to have received a licence from the FDA, has delayed the start of its clinical trial until the end of next year due to safety problems.
A similar proposal to treat age-related macular degeneration with ES cells is being developed by scientists in the UK led by Professor Pete Coffey of University College London, but this clinical trial is unlikely to start until early 2011.
RELATED ARTICLES FROM THE BIONEWS ARCHIVE
Spinal stem cell treatment gets go ahead from the FDA
08 November 2009 - by Jay Stone
American company Geron Corporation (GC) has been given permission to resume its clinical trials testing the embryonic stem cell treatment GRNPOC1....[Read More]
FDA approves trial of neural stem cells to treat Lou Gehrig’s disease
28 September 2009 - by Marianne Neary
The US Food and Drug Administration (FDA) has granted approval to NeuralStem Inc., a Maryland-based biotherapeutics company, to conduct the first human trial using neural stem cells for treatment of amyotrophic lateral sclerosis (ALS). ALS is a type of motor neuron disease often referred to as 'Lou Gehrig's' and 'Maladie de Charcot'. The late-onset condition, of unknown cause, affects approximately two in 100,000 people, including the UK physicist Stephen Hawking and US rock gui...[Read More]
Geron issues statement on halted stem cell trial
06 September 2009 - by Nishat Hyder
Information has come to light regarding the US Food and Drug Adminstration (FDA)'s freeze on the clinical trails of GRNOPC1, a groundbreaking therapy for spinal cord injury derived from human embryonic stem (ES) cells being undertaken by biotech company Geron...[Read More]
US company's stem cell trial put on hold
23 August 2009 - by Alison Cranage
The US Food and Drug Administration (FDA) has delayed the start of a clinical trial that plans to use human embryonic stem cell(ES) cells to treat spinal cord injury. The trial is being run by Californian based company Geron. The FDA originally gave the go-ahead for the trial in January, but now has halted the start in order to review new data submitted by Geron....[Read More]
SOURCES & REFERENCES
Company seeks FDA permission to conduct clinical trial using human embryonic stem cells
LA Times | 19 November 2009
Embryonic stem cells to cure eye disease
Nature blogs | 19 November 2009
First human trials for stem cell blindness therapy
The Daily Telegraph | 20 November 2009
Huge potential balanced against ethical fears
The Independent | 20 November 2009
People facing blindness may pioneer stem-cell therapy
The Times | 20 November 2009
Stem cells: the first human trial
The Independent | 20 November 2009
HAVE YOUR SAY
Be the first to leave a comment.
You need to Login or Register to view or add comments.
By posting a comment you agree to abide by the BioNews terms and conditions
23 November 2009
By Alison Cranage
Appeared in BioNews 535
Stem cell therapy came one step closer to being tested for the first time in people this week, as a US company applied to the Food and Drug Administration (FDA) for a licence to start a clinical trial. The embryonic stem (ES) cell therapy is being developed to treat Stargardt, a currently incurable disease that causes blindness in young people.
Advanced Cell Technology, a Massachusetts-based firm, has tested the treatment on rats and mice which model the human Stargardt disease, and found it prevented further vision loss without adverse side effects.
Stargardt's macular degeneration destroys a part of the retina, leading to loss of vision. The treatment involves a single injection of a type of retinal cell that supports the photoreceptors needed for vision. The researchers have generated the retinal cells from ES cells derived from day-old human embryos left over from IVF (in vitro fertilisation) treatment and donated for research purposes. ES cells have the potential to develop into any type of cell in the body and, as such, scientists envisage they could be used to mend any broken part of the body, from kidney and liver to brain. They hold promise as a treatment for a range of diseases from Parkinson's to heart disease. However, using ES cells in medical research is controversial as many view the embryo as sacrosanct and inviolable, and oppose the use of human embryos in research.
'After years of research and political debate, we're finally on the verge of showing the potential clinical value of embryonic stem cells,' said Dr Robert Lanza, the chief scientific officer at Advanced Cell Technology. He added: 'We've seen absolutely no adverse effects whatsoever in any of the preclinical experiments and our cells are more than 99.9 per cent pure.'
'Our research clearly shows that stem cell-derived retinal cells can rescue visual function in animals that otherwise would have gone blind. We are hopeful that the cells will be similarly efficacious in patients,' Dr Lanza continued.
The trials would involve 12 Stargardt patients, and could begin early next year if the FDA grants approval. The clinical trial could be the first in the world as US company Geron, the only company so far to have received a licence from the FDA, has delayed the start of its clinical trial until the end of next year due to safety problems.
A similar proposal to treat age-related macular degeneration with ES cells is being developed by scientists in the UK led by Professor Pete Coffey of University College London, but this clinical trial is unlikely to start until early 2011.
RELATED ARTICLES FROM THE BIONEWS ARCHIVE
Spinal stem cell treatment gets go ahead from the FDA
08 November 2009 - by Jay Stone
American company Geron Corporation (GC) has been given permission to resume its clinical trials testing the embryonic stem cell treatment GRNPOC1....[Read More]
FDA approves trial of neural stem cells to treat Lou Gehrig’s disease
28 September 2009 - by Marianne Neary
The US Food and Drug Administration (FDA) has granted approval to NeuralStem Inc., a Maryland-based biotherapeutics company, to conduct the first human trial using neural stem cells for treatment of amyotrophic lateral sclerosis (ALS). ALS is a type of motor neuron disease often referred to as 'Lou Gehrig's' and 'Maladie de Charcot'. The late-onset condition, of unknown cause, affects approximately two in 100,000 people, including the UK physicist Stephen Hawking and US rock gui...[Read More]
Geron issues statement on halted stem cell trial
06 September 2009 - by Nishat Hyder
Information has come to light regarding the US Food and Drug Adminstration (FDA)'s freeze on the clinical trails of GRNOPC1, a groundbreaking therapy for spinal cord injury derived from human embryonic stem (ES) cells being undertaken by biotech company Geron...[Read More]
US company's stem cell trial put on hold
23 August 2009 - by Alison Cranage
The US Food and Drug Administration (FDA) has delayed the start of a clinical trial that plans to use human embryonic stem cell(ES) cells to treat spinal cord injury. The trial is being run by Californian based company Geron. The FDA originally gave the go-ahead for the trial in January, but now has halted the start in order to review new data submitted by Geron....[Read More]
SOURCES & REFERENCES
Company seeks FDA permission to conduct clinical trial using human embryonic stem cells
LA Times | 19 November 2009
Embryonic stem cells to cure eye disease
Nature blogs | 19 November 2009
First human trials for stem cell blindness therapy
The Daily Telegraph | 20 November 2009
Huge potential balanced against ethical fears
The Independent | 20 November 2009
People facing blindness may pioneer stem-cell therapy
The Times | 20 November 2009
Stem cells: the first human trial
The Independent | 20 November 2009
HAVE YOUR SAY
Be the first to leave a comment.
You need to Login or Register to view or add comments.
By posting a comment you agree to abide by the BioNews terms and conditions
Wednesday, November 18, 2009
fyi
What About Ethics?
November 18, 2009
A group of doctors, medical ethicists, and others sent NIH director Francis Collins a letter yesterday urging the NIH "to fund studies on medical ethics, conflicts of interest in medicine and research, and prescribing behavior." The 96 authors add that moving research funded by NIH "into clinical practice is strongly affected by the complex web of relationships that exists among industry, academicians, medical educators and clinicians." The letter was organized by PharmedOut, an independent project run by Georgetown University's Adriane Fugh-Berman and she told ScienceInsider that many ethics research projects aren't funded by NIH. "I think that NIH has thought that it doesn't comes under their domain, and the trouble is that it doesn't come under anybody's domain," she says.
The Hastings Center's Thomas Murray, who did not sign the letter, says that Collins may consider the request. "The letter is actually quite gentle and modest in what it requests," he says to the Chronicle of Higher Education.
November 18, 2009
A group of doctors, medical ethicists, and others sent NIH director Francis Collins a letter yesterday urging the NIH "to fund studies on medical ethics, conflicts of interest in medicine and research, and prescribing behavior." The 96 authors add that moving research funded by NIH "into clinical practice is strongly affected by the complex web of relationships that exists among industry, academicians, medical educators and clinicians." The letter was organized by PharmedOut, an independent project run by Georgetown University's Adriane Fugh-Berman and she told ScienceInsider that many ethics research projects aren't funded by NIH. "I think that NIH has thought that it doesn't comes under their domain, and the trouble is that it doesn't come under anybody's domain," she says.
The Hastings Center's Thomas Murray, who did not sign the letter, says that Collins may consider the request. "The letter is actually quite gentle and modest in what it requests," he says to the Chronicle of Higher Education.
Tuesday, November 17, 2009
BIO NEWS- Many new articles
http://www.bionews.org.uk/
TOP NEWS STORIES
Trial to re-grow breasts after cancer surgery planned for next year
16 November 2009 - by Charlotte Maden
Scientists in Australia have developed a way for women diagnosed with breast cancer to regrow their breasts after a mastectomy. The group at the Bernard O'Brien Institute of Microsurgery in Melbourne plan to start clinical trials with the technique next year. It is believed that this will be only the second time in the world that tissue engineering has been carried out in a human....[Read More]
Stem cell treatment in irradiated rats offers hope for radiotherapy patients
16 November 2009 - by Marianne Neary
Following radiation to the head, rats transplanted with stem cells had greater improvements in learning and memory, showed a research team at the University of California....[Read More]
Public consulted on research involving animals with human genes
16 November 2009 - by Ben Jones
The UK's Academy of Medical Sciences has launches a broad study into the scientific, social, ethical and legal implications of research on animals containing human genetic material. Such animals, mostly mice, are found in labs across the UK and mostly consist of animals into whose DNA (deoxyribonucleic acid) single sequences of human genetic code have been inserted. However, with developing stem cell and other technologies, there is a perceived ethical crisis point ahead which t...[Read More]
TOP NEWS STORIES
Trial to re-grow breasts after cancer surgery planned for next year
16 November 2009 - by Charlotte Maden
Scientists in Australia have developed a way for women diagnosed with breast cancer to regrow their breasts after a mastectomy. The group at the Bernard O'Brien Institute of Microsurgery in Melbourne plan to start clinical trials with the technique next year. It is believed that this will be only the second time in the world that tissue engineering has been carried out in a human....[Read More]
Stem cell treatment in irradiated rats offers hope for radiotherapy patients
16 November 2009 - by Marianne Neary
Following radiation to the head, rats transplanted with stem cells had greater improvements in learning and memory, showed a research team at the University of California....[Read More]
Public consulted on research involving animals with human genes
16 November 2009 - by Ben Jones
The UK's Academy of Medical Sciences has launches a broad study into the scientific, social, ethical and legal implications of research on animals containing human genetic material. Such animals, mostly mice, are found in labs across the UK and mostly consist of animals into whose DNA (deoxyribonucleic acid) single sequences of human genetic code have been inserted. However, with developing stem cell and other technologies, there is a perceived ethical crisis point ahead which t...[Read More]
Monday, November 16, 2009
genetic testing the deceased
Families Could Benefit From Gene Tests in Sudden Cardiac Death Victims Identifying mutation in deceased cuts costs for evaluating risk in relatives, study shows
Posted November 15, 2009
SUNDAY, Nov. 15 (HealthDay News) -- Genetic testing of people who've suffered sudden unexplained death is an effective and cost-efficient way of identifying genetic mutations that may put surviving relatives at increased risk for potentially deadly heart rhythm disturbances, a new study suggests.
Genetic defects that can cause sudden cardiac death occur in 25 percent to 30 percent of victims of sudden unexplained death. The current recommended approach is for first-degree relatives of sudden unexplained death victims to undergo comprehensive cardiac testing.
In this study, U.S. researchers compared the results and costs of postmortem genetic/molecular autopsy testing in 146 sudden unexplained death cases and found that 40 of the victims (26.7 percent) had either a catecholaminergic polymorphic ventricular tachycardia mutation (18 people) or a long QT syndrome mutation (22 people). Both are known to cause sudden death.
The researchers then estimated the costs of testing the 584 relatives of the sudden unexplained death victims. The total cost of postmortem genetic testing, genetic confirmation testing of the 160 relatives of victims who tested positive for mutations, and cardiac tests for both relatives of mutation-positive and mutation-negative sudden unexplained death victims was $6.78 million.
In comparison, comprehensive cardiac testing for all 584 relatives of the sudden unexplained death victims, followed by directed genetic testing, would have been more than $7.7 million.
"With less than 150 sudden unexplained death cases, use of a cardiac channel molecular autopsy would be estimated to save almost $1 million indicating a much less expensive way of evaluating those left behind," study co-author David Tester, a senior research technologist at Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minn., said in a news release.
"If you identify a mutation in a sudden unexplained death victim, you can do a simple genetic test in first-degree relatives to assess their risk and perform a disorder-directed clinical evaluation rather than a full clinical evaluation. If a relative is negative for the causative mutation, they may not need to undergo further clinical evaluation at all, and that saves money," Tester explained.
The study was to be presented Sunday at the American Heart Association's annual meeting in Orlando, Fla.
Posted November 15, 2009
SUNDAY, Nov. 15 (HealthDay News) -- Genetic testing of people who've suffered sudden unexplained death is an effective and cost-efficient way of identifying genetic mutations that may put surviving relatives at increased risk for potentially deadly heart rhythm disturbances, a new study suggests.
Genetic defects that can cause sudden cardiac death occur in 25 percent to 30 percent of victims of sudden unexplained death. The current recommended approach is for first-degree relatives of sudden unexplained death victims to undergo comprehensive cardiac testing.
In this study, U.S. researchers compared the results and costs of postmortem genetic/molecular autopsy testing in 146 sudden unexplained death cases and found that 40 of the victims (26.7 percent) had either a catecholaminergic polymorphic ventricular tachycardia mutation (18 people) or a long QT syndrome mutation (22 people). Both are known to cause sudden death.
The researchers then estimated the costs of testing the 584 relatives of the sudden unexplained death victims. The total cost of postmortem genetic testing, genetic confirmation testing of the 160 relatives of victims who tested positive for mutations, and cardiac tests for both relatives of mutation-positive and mutation-negative sudden unexplained death victims was $6.78 million.
In comparison, comprehensive cardiac testing for all 584 relatives of the sudden unexplained death victims, followed by directed genetic testing, would have been more than $7.7 million.
"With less than 150 sudden unexplained death cases, use of a cardiac channel molecular autopsy would be estimated to save almost $1 million indicating a much less expensive way of evaluating those left behind," study co-author David Tester, a senior research technologist at Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minn., said in a news release.
"If you identify a mutation in a sudden unexplained death victim, you can do a simple genetic test in first-degree relatives to assess their risk and perform a disorder-directed clinical evaluation rather than a full clinical evaluation. If a relative is negative for the causative mutation, they may not need to undergo further clinical evaluation at all, and that saves money," Tester explained.
The study was to be presented Sunday at the American Heart Association's annual meeting in Orlando, Fla.
Monday, November 9, 2009
sample ethical issue
An Ethical Question: Does a Nazi Deserve a Place Among Philosophers?
Published: November 8, 2009
By PATRICIA COHEN
For decades the German philosopher Martin Heidegger has been the subject of passionate debate. His critique of Western thought and technology has penetrated deeply into architecture, psychology and literary theory and inspired some of the most influential intellectual movements of the 20th century. Yet he was also a fervent Nazi.
Now a soon-to-be published book in English has revived the long-running debate about whether the man can be separated from his philosophy. Drawing on new evidence, the author, Emmanuel Faye, argues fascist and racist ideas are so woven into the fabric of Heidegger’s theories that they no longer deserve to be called philosophy. As a result Mr. Faye declares, Heidegger’s works and the many fields built on them need to be re-examined lest they spread sinister ideas as dangerous to modern thought as “the Nazi movement was to the physical existence of the exterminated peoples.”
First published in France in 2005, the book, “Heidegger: The Introduction of Nazism Into Philosophy,” calls on philosophy professors to treat Heidegger’s writings like hate speech. Libraries, too, should stop classifying Heidegger’s collected works (which have been sanitized and abridged by his family) as philosophy and instead include them under the history of Nazism. These measures would function as a warning label, like a skull-and-crossbones on a bottle of poison, to prevent the careless spread of his most odious ideas, which Mr. Faye lists as the exaltation of the state over the individual, the impossibility of morality, anti-humanism and racial purity.
The book is the most radical attack yet on Heidegger (1889-1976) and would upend the philosophical field’s treatment of his work in the United States, and even more so in France, where Heidegger has frequently been required reading for an advanced degree. Mr. Faye, an associate professor at the University of Paris, Nanterre, not only wants to drum Heidegger from the ranks of philosophers, he wants to challenge his colleagues to rethink the very purpose of philosophy and its relationship to ethics.
At the same time scholars in disciplines as far flung as poetry and psychoanalysis would be obliged to reconsider their use of Heidegger’s ideas. Although Mr. Faye talks about the close connection between Heidegger and current right-wing extremist politics, left-wing intellectuals have more frequently been inspired by his ideas. Existentialism and postmodernism as well as attendant attacks on colonialism, atomic weapons, ecological ruin and universal notions of morality are all based on his critique of the Western cultural tradition and reason.
Richard Wolin, the author of several books on Heidegger and a close reader of the Faye book, said he is not convinced Heidegger’s thought is as thoroughly tainted by Nazism as Mr. Faye argues. Nonetheless he recognizes how far Heidegger’s ideas have spilled into the larger culture.
“I’m not by any means dismissing any of these fields because of Heidegger’s influence,” he wrote in an e-mail message referring to postmodernism’s influence across the academy. “I’m merely saying that we should know more about the ideological residues and connotations of a thinker like Heidegger before we accept his discourse ready-made or naïvely.”
Although the English text published by Yale University Press won’t be out in the United States for a few weeks, it is already making waves, as signaled by an essay in The Chronicle Review, the opinion and ideas journal of The Chronicle of Higher Education. In an essay titled “Heil Heidegger!” Carlin Romano, a critic for The Review, called Heidegger a “Black Forest babbler” and fraud who was “overrated in his prime” and “bizarrely venerated by acolytes even now.”
Few people have read the book, but the article has generated more than 150 online comments from vehement advocates and detractors, more than any other piece The Review has printed this year, said Liz McMillen, the editor. Others joined the fray.
Ron Rosenbaum, the author of “Explaining Hitler,” even extended the argument to the German Jewish philosopher Hannah Arendt, a former student and lover of Heidegger’s. Citing a recent essay by the historian Bernard Wasserstein, Mr. Rosenbaum wrote in Slate.com that Arendt’s thinking about the Holocaust and her famous formulation, “the banality of evil,” were contaminated by Heidegger and other anti-Semitic writings.
Commentators heatedly rejected the notion that significant ideas could not be distilled from vile ones. Writing for The New Republic’s Web site, tnr.com, Damon Linker declared it was “absurd” to “implicate Heidegger’s entire philosophical corpus.
He and others echoed the views of the influential American philosopher Richard Rorty, who once wrote in The New York Times, “You cannot read most of the important philosophers of recent times without taking Heidegger’s thought into account.” Mr. Rorty added, however, that “the smell of smoke from the crematories” will “linger on their pages.”
In Mr. Faye’s eyes Heidegger’s philosophy cannot be separated from his politics in the way, say, T.S. Eliot’s poetic skills or D. W. Griffith’s cinematic technique might be appraised independently of his own beliefs. While he doesn’t dispute Heidegger’s place in the intellectual pantheon, Mr. Faye reviews his unpublished lectures and concludes his philosophy was based on the same ideas as National Socialism.
Without understanding the soil in which Heidegger’s philosophy is rooted, Mr. Faye argues, people may not realize that his ideas can grow in troubling directions. Heidegger’s dictum to be authentic and free oneself from conventional restraints, for example, can lead to a rejection of morality. The denunciation of reason and soulless modernism can devolve into crude anti-intellectualism and the glorification of “blood and soil.”
Passions about Heidegger have simmered for years. He joined the Nazi party in 1933 when he became rector of Freiburg University and oversaw the dismissal of all Jewish professors. After the war Heidegger was banned by a de-Nazification tribunal from teaching. In the 1950s Arendt re-established ties with him and labored to revive his reputation.
Heidegger was a critic of modern technological society and of the Western philosophical tradition that gave rise to it. He argued that we must overcome this tradition and rethink the very nature of human existence or being.
His prose is so dense that some scholars have said it could be interpreted to mean anything, while others have dismissed it altogether as gibberish. He is nonetheless widely considered to be one of the century’s greatest and most influential thinkers.
Theologians have used his critique of reason to explain the leap of faith; architects have been inspired by his rejection of conventional rules to introduce a buffet of new styles, materials and shapes to building design. His criticism of mechanistic technology has attracted environmentalists and planners.
A verbal brawl over Heidegger’s theories should not be surprising, though. After all, the classic American position on how liberal societies should treat dangerous ideas is with more discussion.
That is precisely what Mr. Faye says he wants. In his view teaching Heidegger’s ideas without disclosing his deep Nazi sympathies is like showing a child a brilliant fireworks display without warning that an ignited rocket can also blow up in someone’s face.
Published: November 8, 2009
By PATRICIA COHEN
For decades the German philosopher Martin Heidegger has been the subject of passionate debate. His critique of Western thought and technology has penetrated deeply into architecture, psychology and literary theory and inspired some of the most influential intellectual movements of the 20th century. Yet he was also a fervent Nazi.
Now a soon-to-be published book in English has revived the long-running debate about whether the man can be separated from his philosophy. Drawing on new evidence, the author, Emmanuel Faye, argues fascist and racist ideas are so woven into the fabric of Heidegger’s theories that they no longer deserve to be called philosophy. As a result Mr. Faye declares, Heidegger’s works and the many fields built on them need to be re-examined lest they spread sinister ideas as dangerous to modern thought as “the Nazi movement was to the physical existence of the exterminated peoples.”
First published in France in 2005, the book, “Heidegger: The Introduction of Nazism Into Philosophy,” calls on philosophy professors to treat Heidegger’s writings like hate speech. Libraries, too, should stop classifying Heidegger’s collected works (which have been sanitized and abridged by his family) as philosophy and instead include them under the history of Nazism. These measures would function as a warning label, like a skull-and-crossbones on a bottle of poison, to prevent the careless spread of his most odious ideas, which Mr. Faye lists as the exaltation of the state over the individual, the impossibility of morality, anti-humanism and racial purity.
The book is the most radical attack yet on Heidegger (1889-1976) and would upend the philosophical field’s treatment of his work in the United States, and even more so in France, where Heidegger has frequently been required reading for an advanced degree. Mr. Faye, an associate professor at the University of Paris, Nanterre, not only wants to drum Heidegger from the ranks of philosophers, he wants to challenge his colleagues to rethink the very purpose of philosophy and its relationship to ethics.
At the same time scholars in disciplines as far flung as poetry and psychoanalysis would be obliged to reconsider their use of Heidegger’s ideas. Although Mr. Faye talks about the close connection between Heidegger and current right-wing extremist politics, left-wing intellectuals have more frequently been inspired by his ideas. Existentialism and postmodernism as well as attendant attacks on colonialism, atomic weapons, ecological ruin and universal notions of morality are all based on his critique of the Western cultural tradition and reason.
Richard Wolin, the author of several books on Heidegger and a close reader of the Faye book, said he is not convinced Heidegger’s thought is as thoroughly tainted by Nazism as Mr. Faye argues. Nonetheless he recognizes how far Heidegger’s ideas have spilled into the larger culture.
“I’m not by any means dismissing any of these fields because of Heidegger’s influence,” he wrote in an e-mail message referring to postmodernism’s influence across the academy. “I’m merely saying that we should know more about the ideological residues and connotations of a thinker like Heidegger before we accept his discourse ready-made or naïvely.”
Although the English text published by Yale University Press won’t be out in the United States for a few weeks, it is already making waves, as signaled by an essay in The Chronicle Review, the opinion and ideas journal of The Chronicle of Higher Education. In an essay titled “Heil Heidegger!” Carlin Romano, a critic for The Review, called Heidegger a “Black Forest babbler” and fraud who was “overrated in his prime” and “bizarrely venerated by acolytes even now.”
Few people have read the book, but the article has generated more than 150 online comments from vehement advocates and detractors, more than any other piece The Review has printed this year, said Liz McMillen, the editor. Others joined the fray.
Ron Rosenbaum, the author of “Explaining Hitler,” even extended the argument to the German Jewish philosopher Hannah Arendt, a former student and lover of Heidegger’s. Citing a recent essay by the historian Bernard Wasserstein, Mr. Rosenbaum wrote in Slate.com that Arendt’s thinking about the Holocaust and her famous formulation, “the banality of evil,” were contaminated by Heidegger and other anti-Semitic writings.
Commentators heatedly rejected the notion that significant ideas could not be distilled from vile ones. Writing for The New Republic’s Web site, tnr.com, Damon Linker declared it was “absurd” to “implicate Heidegger’s entire philosophical corpus.
He and others echoed the views of the influential American philosopher Richard Rorty, who once wrote in The New York Times, “You cannot read most of the important philosophers of recent times without taking Heidegger’s thought into account.” Mr. Rorty added, however, that “the smell of smoke from the crematories” will “linger on their pages.”
In Mr. Faye’s eyes Heidegger’s philosophy cannot be separated from his politics in the way, say, T.S. Eliot’s poetic skills or D. W. Griffith’s cinematic technique might be appraised independently of his own beliefs. While he doesn’t dispute Heidegger’s place in the intellectual pantheon, Mr. Faye reviews his unpublished lectures and concludes his philosophy was based on the same ideas as National Socialism.
Without understanding the soil in which Heidegger’s philosophy is rooted, Mr. Faye argues, people may not realize that his ideas can grow in troubling directions. Heidegger’s dictum to be authentic and free oneself from conventional restraints, for example, can lead to a rejection of morality. The denunciation of reason and soulless modernism can devolve into crude anti-intellectualism and the glorification of “blood and soil.”
Passions about Heidegger have simmered for years. He joined the Nazi party in 1933 when he became rector of Freiburg University and oversaw the dismissal of all Jewish professors. After the war Heidegger was banned by a de-Nazification tribunal from teaching. In the 1950s Arendt re-established ties with him and labored to revive his reputation.
Heidegger was a critic of modern technological society and of the Western philosophical tradition that gave rise to it. He argued that we must overcome this tradition and rethink the very nature of human existence or being.
His prose is so dense that some scholars have said it could be interpreted to mean anything, while others have dismissed it altogether as gibberish. He is nonetheless widely considered to be one of the century’s greatest and most influential thinkers.
Theologians have used his critique of reason to explain the leap of faith; architects have been inspired by his rejection of conventional rules to introduce a buffet of new styles, materials and shapes to building design. His criticism of mechanistic technology has attracted environmentalists and planners.
A verbal brawl over Heidegger’s theories should not be surprising, though. After all, the classic American position on how liberal societies should treat dangerous ideas is with more discussion.
That is precisely what Mr. Faye says he wants. In his view teaching Heidegger’s ideas without disclosing his deep Nazi sympathies is like showing a child a brilliant fireworks display without warning that an ignited rocket can also blow up in someone’s face.
Saturday, November 7, 2009
several bioethics stories
British mother asks court to turn off her infant's machine
Nov 07, 2009
"Amicably separated" parents in Britain are at loggerheads over whether to let their disabled 13-month-old son die. RB, as the boy is called to protect the family's privacy, has congenital myasthenia syndrome, a rare neuromuscular condition that prevents him from breathing on his own and severely restricts his power to move his limbs. The British health service has applied to the High Court in London to allow life-saving care to be withdrawn.
His doctor, who cannot be named, has described the child as at the "most severe end" of physical disability. He lacks the ability to cough or swallow and must be moved every two hours to prevent pressure sores. The mother believes that her child will be better off dead. But the father contends that he should have a tracheotomy so that he can be cared for at home. Unlike many children with severe developmental disorders, RB may have normal intelligence. The father contends that he can see, hear, feel, and recognise his parents and deserves to live.
Although most of the media presented a very dark picture of RB's future, the Daily Mail published an open letter from the mother of a 10-year-old with a similar condition who went on to have a tracheotomy. He goes to school in a wheelchair and is a popular and well-loved child. "Today I look at my gorgeous, funny, cheeky little boy and I am endlessly grateful we gave him a chance to live," writes Niki Shisler. She says that doctors are normally cautious and pessimistic and speculates that they may be too concerned about the cost of care. -- BMJ, Nov 4
Aborted foetus cells used to make beauty cream
Nov 07, 2009
A San Francisco cosmetics company, Neocutis, has admitted that it used cells from an aborted male foetus as an ingredient in a beauty cream. The Swiss product is manufactured from patented processed skin proteins (PSP), and is used for conditions such as psoriasis and eczema, and, unsurprisingly, ageing. It is controversial because the proteins were obtained from a postage stamp-sized rectangle of skin taken from a terminated 14-week old male foetus in Switzerland.
Anti-abortion groups were particularly scandalised by the company's brazenness in defending the use of aborted tissue in beauty creams. Neocutis contends that harvesting the skin cells was responsible and ethical. "The small skin donation" taken to develop this cosmetic treatment "originated from a single terminated pregnancy that could not survive to term and that was deemed medically necessary by the attending physicians." The company compared this use of foetal tissue to the 1954 Nobel Prize, which was awarded to "researchers who utilized fetal kidney cells to develop the polio vaccine."
The PSP is used in Neocutis bio-restorative skin cream, Journée bio-restorative day cream, Lumière bio-restorative eye cream and Bio-gel bio-restorative hydrogel. The Neocutis website says that "Through years of research, physicians [have] discovered fetal skin has a unique ability to heal wounds without scarring."
The moral status of foetal material is widely disputed. For some, as an entry in the American Journal of Bioethics Blog suggests, "foetal proteins in a face cream aren't any different from animal or plant protein because for them the moral status of the aborted foetus doesn't have the moral status to give one concern if consent to both abortion and research took place."
On the other hand, the Vatican discussed the use of "biological material of illicit origin" in its recent statement on bioethics, Dignitas Personae. This insisted that "The corpses of human embryos and fetuses, whether they have been deliberately aborted or not, must be respected just as the remains of other human beings." ~ Washington Times, Nov 3,
My genes made me do it, says Italian murderer
Nov 07, 2009
An Italian of Algerian descent who stabbed a man to death in 2007 has had his sentence reduced because he has a gene which predisposes him to violence. Abdelmalek Bayout originally received a relatively mild sentence of 9 years and 2 months because he had a psychiatric illness. But his lawyer succeeded in knocking another year off by pointing out that he had gene variants linked to aggression, notably the gene encoding the neurotransmitter-metabolizing enzyme monoamine oxidase A (MAOA). A molecular neuroscientist and a cognitive neuroscientist testified that this would make him more prone to violence when provoked.
This is not the first time that MAOA has been invoked as a defence in criminal law. In the last 5 years, it has come up more than 200 times in US trials, according to Nita Farahany, of Vanderbilt University. She specialises in the ethical and legal perspectives on neuroscience and is sceptical of the "my genes made me do it" defence. "The point is that behavioural genetics is not there yet, we cannot explain individual behaviour, only large population statistics," she told Nature News.
Genetic determinism is far from being a dogma amongst geneticists. "90% of all murders are committed by people with a Y chromosome -- males. Should we always give males a shorter sentence?" says Steve Jones, of University College London. "I have low MAOA activity but I don't go around attacking people." -- Nature News, Oct 30
Genetic tests used to prove nationality in UK
Nov 07, 2009
British immigration officials want to use genetic tests to determine the nationality of asylum seekers, a move which scientists have criticised as "fundamentally flawed science". "Genes are not aware of national borders," said Sir Alec Jeffreys, a geneticist at the University of Leicester. "Nationality is a legal concept, and it's got nothing to do with genetics at all."
And bioethicist John Harris, of Manchester University, commented: "Genetic testing may be able to tell you where somebody's ancestors started out, but it doesn't tell you where they're from. It won't give them anything worth knowing, and it's very likely that what it will give them is misleading."
The United Kingdom Border Agency launched a pilot project in September because it feels that many African asylum seekers are claiming that they have come from a dangerous and war-torn country like Somalia or Sudan rather than a relatively peaceful place like Kenya. The refugees are asked to give a voluntary cheek swab or hair or nail sample which the Agency says yields valuable, if not conclusive, evidence about their country of origin. So far the tests are only being used on people who claim to come from Somalia, Ethiopia, Eritrea, Kenya, Uganda and Sudan.
According to AP, the agency originally planned to use the tests as definitive proof of nationality, but retreated after scientists protested. Now the agency declares that they will only be used in combination with other ways of determining a refugee's nationality, such as language analysis and interviews. ~ AP, Nov 6
British IVF clinic makes worst mistake possible, says industry watchdog
Nov 07, 2009
A serious error in a British fertility clinic's screening processes has led to concerns about the safety of IVF procedures. The London Women's Clinic (LWC) was found this week to have produced a large quantity of embryos using unscreened sperm. The sperm had a serious chromosomal abnormality which could be passed on to any of the unborn children, the Independent newspaper found. The mistake led to a miscarriage for at least one of the couples to whom these embryos were donated. Twenty-two other embryos resulting from the sperm were destroyed.
The incident could spark more investigation into the practices of British IVF clinics and the industry's current regulatory system. The Human Fertilisation and Embryology Authority (HFEA), the UK's fertility industry watchdog, has stated that it will name and shame similar errors in future. The LWC's mistake has been described as the worst possible for a fertility clinic.
Current HFEA figures reveal that there have been 182 "incidents" in British fertility clinics in 2008, eight of them "serious". But lawyers are sceptical of these figures and say that the actual numbers could be far higher. A number of affected couples are initiating legal proceedings.
The LWC was pulled up earlier this year in an HFEA inspection, after the required number of "witnessing stages" crucial to correct screening procedures, was not carried out. However, the clinic was found still producing embryos using unscreened sperm in June, according to some prospective parents.
The couple later demanded compensation from the LWC. "It made us so aware that IVF is a business and it all comes down to money," the couple told the Independent. They were eventually remunerated; the LWC sent them abroad for fertility treatment; and they are now expecting a child. ~Independent (UK), Nov 1
Oklahoma abortion reporting law "misrepresented"
Nov 07, 2009
A new law affecting patient privacy has become the centre of political controversy in Oklahoma. As reported last week in BioEdge, abortion advocates complained that women could easily be identified using the information gained from a new questionnaire. But the state chairman of Oklahomans For Life, Tony Lauinger, says that this misrepresents the new abortion-reporting law.
He says that new law actually repeals the existing law's requirement for identifiable residential information. The legislation reads: "Nothing in the Individual Abortion Form shall contain the name, address, or information specifically identifying any patient." However, the form is highly comprehensive. Doctors are required to tick about 37 boxes, many of which are comprised of several (in one instance around 40) sub-questions about the patient's reasons for abortion, number and nature of past abortions, method of payment, as well as the mother's race, age, marital status and other details. The new legislation also requires information about abortion complications.
Lauinger points out that the abortion industry, particularly the Guttmacher Institute (formerly the research arm of the Planned Parenthood Federation of America) already collects and publishes demographic information through annual surveys.
Medical privacy is a major concern in the age of the internet. As the amount of publicly available information grows, medical information can be increasingly matched to demographic data. Latanya Sweeney, of Harvard's Center for Research on Computation and Society, says that "policies on data sharing are not very good, and the result is that data tend to flow around and get linked to other data." ~ BioEdge, Oct 30 , National Right to Life Committee Oct 21, Harvard Magazine Sept-Oct 2009
New suicide drug available next year, says Nitschke
Nov 07, 2009
A "peaceful pill" for people who want to commit suicide will be made available by mail order in 2010. The pill is a stable solid form of the barbiturate Nembutal. Developed by the euthanasia group Exit International, it is designed to withstand transport and can be stored for up to 50 years. Customers will only have to mix it with water. An activation kit with the chemicals for reconstitution and a test kit to check the strength of the resulting product are nearly finished so that the pill can be distributed.
Dr Philip Nitschke, a leading right-to-die advocate and director of Exit International, said "Exit believes that all seniors of sound mind should have the option of a peaceful death at the time of their choosing should this be their wish - this Exit Pill will go some way to ensuring this." Nitschke is set to hold instructional suicide talks in San Francisco this Sunday. ~ Assisted-Suicide Blog Oct 30, CBC News Nov 4
Next year, says Geron, embryonic stem cell trials will begin. We hope
Nov 07, 2009
One of the most convincing advocates of human embryonic stem cell research, quadriplegic actor Christopher Reeves, died without seeing any substantial progress towards a cure for spinal cord injury. However, he was buoyed up by the hope that hESC research at Geron Corporation might help him walk again. Geron has announced many times that it would soon start human hESC trials -- but so far no trials have begun. The latest announcement came last week when it announced that the trials would begin next year. Its share price rose 4.2% at the news.
Dr David Prentice, of the Family Research Council, a critic of embryo research, has been logging Geron's announcements since 2002 and found that trials were going to begin "next year" every year since 2004. He argues that "the obsession with embryonic stem cells has obscured the real hope for patients-adult stem cells. Peer-reviewed evidence of adult stem cell success for spinal cord injury patients has already been published by groups in Portugal, in Australia, in Ecuador,and in Brazil". The trials with embryonic cells have usually been delayed over safety concerns, as they could cause tumours. --Forbes, Oct 30
Nov 07, 2009
"Amicably separated" parents in Britain are at loggerheads over whether to let their disabled 13-month-old son die. RB, as the boy is called to protect the family's privacy, has congenital myasthenia syndrome, a rare neuromuscular condition that prevents him from breathing on his own and severely restricts his power to move his limbs. The British health service has applied to the High Court in London to allow life-saving care to be withdrawn.
His doctor, who cannot be named, has described the child as at the "most severe end" of physical disability. He lacks the ability to cough or swallow and must be moved every two hours to prevent pressure sores. The mother believes that her child will be better off dead. But the father contends that he should have a tracheotomy so that he can be cared for at home. Unlike many children with severe developmental disorders, RB may have normal intelligence. The father contends that he can see, hear, feel, and recognise his parents and deserves to live.
Although most of the media presented a very dark picture of RB's future, the Daily Mail published an open letter from the mother of a 10-year-old with a similar condition who went on to have a tracheotomy. He goes to school in a wheelchair and is a popular and well-loved child. "Today I look at my gorgeous, funny, cheeky little boy and I am endlessly grateful we gave him a chance to live," writes Niki Shisler. She says that doctors are normally cautious and pessimistic and speculates that they may be too concerned about the cost of care. -- BMJ, Nov 4
Aborted foetus cells used to make beauty cream
Nov 07, 2009
A San Francisco cosmetics company, Neocutis, has admitted that it used cells from an aborted male foetus as an ingredient in a beauty cream. The Swiss product is manufactured from patented processed skin proteins (PSP), and is used for conditions such as psoriasis and eczema, and, unsurprisingly, ageing. It is controversial because the proteins were obtained from a postage stamp-sized rectangle of skin taken from a terminated 14-week old male foetus in Switzerland.
Anti-abortion groups were particularly scandalised by the company's brazenness in defending the use of aborted tissue in beauty creams. Neocutis contends that harvesting the skin cells was responsible and ethical. "The small skin donation" taken to develop this cosmetic treatment "originated from a single terminated pregnancy that could not survive to term and that was deemed medically necessary by the attending physicians." The company compared this use of foetal tissue to the 1954 Nobel Prize, which was awarded to "researchers who utilized fetal kidney cells to develop the polio vaccine."
The PSP is used in Neocutis bio-restorative skin cream, Journée bio-restorative day cream, Lumière bio-restorative eye cream and Bio-gel bio-restorative hydrogel. The Neocutis website says that "Through years of research, physicians [have] discovered fetal skin has a unique ability to heal wounds without scarring."
The moral status of foetal material is widely disputed. For some, as an entry in the American Journal of Bioethics Blog suggests, "foetal proteins in a face cream aren't any different from animal or plant protein because for them the moral status of the aborted foetus doesn't have the moral status to give one concern if consent to both abortion and research took place."
On the other hand, the Vatican discussed the use of "biological material of illicit origin" in its recent statement on bioethics, Dignitas Personae. This insisted that "The corpses of human embryos and fetuses, whether they have been deliberately aborted or not, must be respected just as the remains of other human beings." ~ Washington Times, Nov 3,
My genes made me do it, says Italian murderer
Nov 07, 2009
An Italian of Algerian descent who stabbed a man to death in 2007 has had his sentence reduced because he has a gene which predisposes him to violence. Abdelmalek Bayout originally received a relatively mild sentence of 9 years and 2 months because he had a psychiatric illness. But his lawyer succeeded in knocking another year off by pointing out that he had gene variants linked to aggression, notably the gene encoding the neurotransmitter-metabolizing enzyme monoamine oxidase A (MAOA). A molecular neuroscientist and a cognitive neuroscientist testified that this would make him more prone to violence when provoked.
This is not the first time that MAOA has been invoked as a defence in criminal law. In the last 5 years, it has come up more than 200 times in US trials, according to Nita Farahany, of Vanderbilt University. She specialises in the ethical and legal perspectives on neuroscience and is sceptical of the "my genes made me do it" defence. "The point is that behavioural genetics is not there yet, we cannot explain individual behaviour, only large population statistics," she told Nature News.
Genetic determinism is far from being a dogma amongst geneticists. "90% of all murders are committed by people with a Y chromosome -- males. Should we always give males a shorter sentence?" says Steve Jones, of University College London. "I have low MAOA activity but I don't go around attacking people." -- Nature News, Oct 30
Genetic tests used to prove nationality in UK
Nov 07, 2009
British immigration officials want to use genetic tests to determine the nationality of asylum seekers, a move which scientists have criticised as "fundamentally flawed science". "Genes are not aware of national borders," said Sir Alec Jeffreys, a geneticist at the University of Leicester. "Nationality is a legal concept, and it's got nothing to do with genetics at all."
And bioethicist John Harris, of Manchester University, commented: "Genetic testing may be able to tell you where somebody's ancestors started out, but it doesn't tell you where they're from. It won't give them anything worth knowing, and it's very likely that what it will give them is misleading."
The United Kingdom Border Agency launched a pilot project in September because it feels that many African asylum seekers are claiming that they have come from a dangerous and war-torn country like Somalia or Sudan rather than a relatively peaceful place like Kenya. The refugees are asked to give a voluntary cheek swab or hair or nail sample which the Agency says yields valuable, if not conclusive, evidence about their country of origin. So far the tests are only being used on people who claim to come from Somalia, Ethiopia, Eritrea, Kenya, Uganda and Sudan.
According to AP, the agency originally planned to use the tests as definitive proof of nationality, but retreated after scientists protested. Now the agency declares that they will only be used in combination with other ways of determining a refugee's nationality, such as language analysis and interviews. ~ AP, Nov 6
British IVF clinic makes worst mistake possible, says industry watchdog
Nov 07, 2009
A serious error in a British fertility clinic's screening processes has led to concerns about the safety of IVF procedures. The London Women's Clinic (LWC) was found this week to have produced a large quantity of embryos using unscreened sperm. The sperm had a serious chromosomal abnormality which could be passed on to any of the unborn children, the Independent newspaper found. The mistake led to a miscarriage for at least one of the couples to whom these embryos were donated. Twenty-two other embryos resulting from the sperm were destroyed.
The incident could spark more investigation into the practices of British IVF clinics and the industry's current regulatory system. The Human Fertilisation and Embryology Authority (HFEA), the UK's fertility industry watchdog, has stated that it will name and shame similar errors in future. The LWC's mistake has been described as the worst possible for a fertility clinic.
Current HFEA figures reveal that there have been 182 "incidents" in British fertility clinics in 2008, eight of them "serious". But lawyers are sceptical of these figures and say that the actual numbers could be far higher. A number of affected couples are initiating legal proceedings.
The LWC was pulled up earlier this year in an HFEA inspection, after the required number of "witnessing stages" crucial to correct screening procedures, was not carried out. However, the clinic was found still producing embryos using unscreened sperm in June, according to some prospective parents.
The couple later demanded compensation from the LWC. "It made us so aware that IVF is a business and it all comes down to money," the couple told the Independent. They were eventually remunerated; the LWC sent them abroad for fertility treatment; and they are now expecting a child. ~Independent (UK), Nov 1
Oklahoma abortion reporting law "misrepresented"
Nov 07, 2009
A new law affecting patient privacy has become the centre of political controversy in Oklahoma. As reported last week in BioEdge, abortion advocates complained that women could easily be identified using the information gained from a new questionnaire. But the state chairman of Oklahomans For Life, Tony Lauinger, says that this misrepresents the new abortion-reporting law.
He says that new law actually repeals the existing law's requirement for identifiable residential information. The legislation reads: "Nothing in the Individual Abortion Form shall contain the name, address, or information specifically identifying any patient." However, the form is highly comprehensive. Doctors are required to tick about 37 boxes, many of which are comprised of several (in one instance around 40) sub-questions about the patient's reasons for abortion, number and nature of past abortions, method of payment, as well as the mother's race, age, marital status and other details. The new legislation also requires information about abortion complications.
Lauinger points out that the abortion industry, particularly the Guttmacher Institute (formerly the research arm of the Planned Parenthood Federation of America) already collects and publishes demographic information through annual surveys.
Medical privacy is a major concern in the age of the internet. As the amount of publicly available information grows, medical information can be increasingly matched to demographic data. Latanya Sweeney, of Harvard's Center for Research on Computation and Society, says that "policies on data sharing are not very good, and the result is that data tend to flow around and get linked to other data." ~ BioEdge, Oct 30 , National Right to Life Committee Oct 21, Harvard Magazine Sept-Oct 2009
New suicide drug available next year, says Nitschke
Nov 07, 2009
A "peaceful pill" for people who want to commit suicide will be made available by mail order in 2010. The pill is a stable solid form of the barbiturate Nembutal. Developed by the euthanasia group Exit International, it is designed to withstand transport and can be stored for up to 50 years. Customers will only have to mix it with water. An activation kit with the chemicals for reconstitution and a test kit to check the strength of the resulting product are nearly finished so that the pill can be distributed.
Dr Philip Nitschke, a leading right-to-die advocate and director of Exit International, said "Exit believes that all seniors of sound mind should have the option of a peaceful death at the time of their choosing should this be their wish - this Exit Pill will go some way to ensuring this." Nitschke is set to hold instructional suicide talks in San Francisco this Sunday. ~ Assisted-Suicide Blog Oct 30, CBC News Nov 4
Next year, says Geron, embryonic stem cell trials will begin. We hope
Nov 07, 2009
One of the most convincing advocates of human embryonic stem cell research, quadriplegic actor Christopher Reeves, died without seeing any substantial progress towards a cure for spinal cord injury. However, he was buoyed up by the hope that hESC research at Geron Corporation might help him walk again. Geron has announced many times that it would soon start human hESC trials -- but so far no trials have begun. The latest announcement came last week when it announced that the trials would begin next year. Its share price rose 4.2% at the news.
Dr David Prentice, of the Family Research Council, a critic of embryo research, has been logging Geron's announcements since 2002 and found that trials were going to begin "next year" every year since 2004. He argues that "the obsession with embryonic stem cells has obscured the real hope for patients-adult stem cells. Peer-reviewed evidence of adult stem cell success for spinal cord injury patients has already been published by groups in Portugal, in Australia, in Ecuador,and in Brazil". The trials with embryonic cells have usually been delayed over safety concerns, as they could cause tumours. --Forbes, Oct 30
Friday, November 6, 2009
Monday, October 26, 2009
Direct to Consumer Fertility Tests
Warning on self-test fertility kits
20 October 2009
By Rebecca Robey
Appeared in BioNews 531
Women have been warned against relying on 'over-the-counter' home fertility tests to gauge whether they can afford to delay starting a family. Scientists and doctors cautioned that such tests may provide false hope, encouraging women that they have several years of fertility left without looking at all the important factors.
Women are born with their complete supply of eggs for their lifetime contained within their ovaries. Over time this supply steadily diminishes, eventually leading to the menopause when the supply is exhausted. Home fertility tests, or 'ovarian reserve' tests, cost as little as £25 to £180 and use a blood or urine sample to estimate the number of eggs a woman has left by measuring her levels of a hormone called follicle-stimulating hormone (FSH). As the number of eggs falls, the level of FSH in the woman's blood rises, and so the information can be used to predict how many child-bearing years a woman might have left.
However, fertility experts are concerned as they feel these tests do not offer a complete picture. Such tests do not give any information about the quality of the eggs or other factors that may be crucial for fertility. Stuart Lavery, a consultant gynaecologist at the IVF (in vitro fertilisation) unit at Hammersmith hospital, London, explained: 'The concern with over-the-counter tests is that although they are helpful, because they focus the mind on fertility, they can also give false reassurance. If the fallopian tubes are blocked or the partner doesn't have fabulous sperm, it may be giving you false hope'.
These concerns were raised after research presented at the American Society for Reproductive Medicine's annual meeting in Atlanta, Georgia, US, provided evidence that the same tests may be useful indicators of the likelihood of successful IVF when used in a clinical setting. A study at the Advanced Fertility Centre of Chicago used FSH tests in conjunction with ultrasound examinations that also estimate the size of a woman's egg reserve to predict the fertility of 1,380 women under the age of 35 who were undergoing IVF. IVF was successful in 59 per cent of women with normal results in both tests compared to 35 per cent of women with abnormal FSH levels and just 9 per cent of women who had abnormal results in both tests.
Ovarian reserve tests are routinely used in women over 35 years old considering IVF in the UK, and the new study indicates it may also be useful for younger women to help them decide whether to pursue the often costly procedure. Dr Todd Deutch, managing director of the Advanced Fertility Centre of Chicago, emphasised that this did not mean the tests were good indicators for women trying to conceive naturally. He said: 'I think relying on these tests to gauge fertility generally... is not a good extrapolation of this data. These tests don't tell the whole story'.
RELATED ARTICLES FROM THE BIONEWS ARCHIVE
Increase in UK women over 40 seeking fertility treatment
11 June 2007 - by Danielle Hamm
Recent figures released by the UK fertility regulator, the Human Fertilisation and Embryology Authority (HFEA), show a tenfold plus increase in women over 40 seeking fertility treatment using their own eggs. The number of women over 40 seeking fertility treatment using donated eggs is not know, but...[Read More]
Over-the-counter fertility test to go on sale
05 January 2006 - by BioNews
Scientists at the UK's Birmingham University have developed a fertility test kit that can be bought over-the-counter at chemists and used by couples at home. The Fertell test, which will cost about £80, takes less than an hour to work and is said to give accurate results in nearly all...[Read More]
DIY fertility test
09 July 2001 - by BioNews
Doctors and scientists from the University of Birmingham and Genosis, a medical devices company in the UK, have developed a 'fertility test kit' that can be used - both by men and women - at home. The kit is called 'Fertell' and is designed to measure fertility levels in couples trying to...[Read More]
Test measures ticking biological clock
12 July 1999 - by BioNews
A fertility test that measures the viability of eggs in a woman's ovaries may soon give women the ability to tell the time on the proverbial biological clock. The test is the result of six years of work by Oxford scientists who discovered that levels of the hormone, inhibin B...[Read More]
SOURCES & REFERENCES
Doctors warn against over-the-counter fertility tests for family planning
The Guardian | 20 October 2009
High Street fertility tests could give wrong results, experts warn
The Daily Telegraph | 20 October 2009
Home tests on biological clock 'could give women false hope'
The Times | 20 October 2009
Why home fertility tests fail to deliver
The Daily Mail | 20 October 2009
20 October 2009
By Rebecca Robey
Appeared in BioNews 531
Women have been warned against relying on 'over-the-counter' home fertility tests to gauge whether they can afford to delay starting a family. Scientists and doctors cautioned that such tests may provide false hope, encouraging women that they have several years of fertility left without looking at all the important factors.
Women are born with their complete supply of eggs for their lifetime contained within their ovaries. Over time this supply steadily diminishes, eventually leading to the menopause when the supply is exhausted. Home fertility tests, or 'ovarian reserve' tests, cost as little as £25 to £180 and use a blood or urine sample to estimate the number of eggs a woman has left by measuring her levels of a hormone called follicle-stimulating hormone (FSH). As the number of eggs falls, the level of FSH in the woman's blood rises, and so the information can be used to predict how many child-bearing years a woman might have left.
However, fertility experts are concerned as they feel these tests do not offer a complete picture. Such tests do not give any information about the quality of the eggs or other factors that may be crucial for fertility. Stuart Lavery, a consultant gynaecologist at the IVF (in vitro fertilisation) unit at Hammersmith hospital, London, explained: 'The concern with over-the-counter tests is that although they are helpful, because they focus the mind on fertility, they can also give false reassurance. If the fallopian tubes are blocked or the partner doesn't have fabulous sperm, it may be giving you false hope'.
These concerns were raised after research presented at the American Society for Reproductive Medicine's annual meeting in Atlanta, Georgia, US, provided evidence that the same tests may be useful indicators of the likelihood of successful IVF when used in a clinical setting. A study at the Advanced Fertility Centre of Chicago used FSH tests in conjunction with ultrasound examinations that also estimate the size of a woman's egg reserve to predict the fertility of 1,380 women under the age of 35 who were undergoing IVF. IVF was successful in 59 per cent of women with normal results in both tests compared to 35 per cent of women with abnormal FSH levels and just 9 per cent of women who had abnormal results in both tests.
Ovarian reserve tests are routinely used in women over 35 years old considering IVF in the UK, and the new study indicates it may also be useful for younger women to help them decide whether to pursue the often costly procedure. Dr Todd Deutch, managing director of the Advanced Fertility Centre of Chicago, emphasised that this did not mean the tests were good indicators for women trying to conceive naturally. He said: 'I think relying on these tests to gauge fertility generally... is not a good extrapolation of this data. These tests don't tell the whole story'.
RELATED ARTICLES FROM THE BIONEWS ARCHIVE
Increase in UK women over 40 seeking fertility treatment
11 June 2007 - by Danielle Hamm
Recent figures released by the UK fertility regulator, the Human Fertilisation and Embryology Authority (HFEA), show a tenfold plus increase in women over 40 seeking fertility treatment using their own eggs. The number of women over 40 seeking fertility treatment using donated eggs is not know, but...[Read More]
Over-the-counter fertility test to go on sale
05 January 2006 - by BioNews
Scientists at the UK's Birmingham University have developed a fertility test kit that can be bought over-the-counter at chemists and used by couples at home. The Fertell test, which will cost about £80, takes less than an hour to work and is said to give accurate results in nearly all...[Read More]
DIY fertility test
09 July 2001 - by BioNews
Doctors and scientists from the University of Birmingham and Genosis, a medical devices company in the UK, have developed a 'fertility test kit' that can be used - both by men and women - at home. The kit is called 'Fertell' and is designed to measure fertility levels in couples trying to...[Read More]
Test measures ticking biological clock
12 July 1999 - by BioNews
A fertility test that measures the viability of eggs in a woman's ovaries may soon give women the ability to tell the time on the proverbial biological clock. The test is the result of six years of work by Oxford scientists who discovered that levels of the hormone, inhibin B...[Read More]
SOURCES & REFERENCES
Doctors warn against over-the-counter fertility tests for family planning
The Guardian | 20 October 2009
High Street fertility tests could give wrong results, experts warn
The Daily Telegraph | 20 October 2009
Home tests on biological clock 'could give women false hope'
The Times | 20 October 2009
Why home fertility tests fail to deliver
The Daily Mail | 20 October 2009
Sunday, October 25, 2009
choosing who should survive in a swine flu pandemic
Worst Case: Choosing Who Survives in a Flu Epidemic
James Estrin/The New York Times
Published: October 24, 2009
New York state health officials recently laid out this wrenching scenario for a small group of medical professionals from New York-Presbyterian Hospital: A 32-year-old man with cystic fibrosis is rushed to the hospital with appendicitis in the midst of a worsening pandemic caused by the H1N1 flu virus, which has mutated into a more deadly form. The man is awaiting a lung transplant and brought with him the mechanical ventilator that helps him breathe.
New York’s governor has declared a state of emergency and hospitals are following the state’s pandemic ventilator allocation plan — actual guidelines drafted in 2007 that are now being revisited. The plan aims to direct ventilators to those with the best chances of survival in a severe, 1918-like flu pandemic where tens of thousands develop life-threatening pneumonia.
Because the man’s end-stage lung disease caused by his cystic fibrosis is among a list of medical conditions associated with high mortality, the guidelines would bar the man from using a ventilator in a hospital, even though he is, unlike many with his illness, stable, in good condition, and not close to death. If the hospital admits him, the guidelines call for the machine that keeps him alive to be given to someone else.
Would doctors and nurses follow such rules? Should they?
In recent years, officials in a host of states and localities, as well as the federal Veterans Health Administration, have been quietly addressing one of medicine’s most troubling questions: Who should get a chance to survive when the number of severely ill people far exceeds the resources needed to treat them all?
The draft plans vary. In some states, patients with Do Not Resuscitate orders, the elderly, those requiring dialysis, or those with severe neurological impairment would be refused ventilators, or admission to hospitals. Utah divides epidemics into phases. Initially, hospitals would apply triage rules to residents of mental institutions, nursing homes, prisons and facilities for the “handicapped.” If an epidemic worsened, the rules would apply to the general population.
Federal officials say the possibility that America’s already crowded intensive care units would be overwhelmed in the coming weeks by flu patients is small but they remain vigilant.
The triage plans have attracted little publicity. New York, for example, released its draft guidelines in 2007, offered a 45-day comment period, and has made no changes since. The Health Department made 90 pages of public comments public this week only after receiving a request under the state’s public records laws.
Mary Buckley-Davis, a respiratory therapist with 30 years experience, wrote to officials in 2007 that “there will be rioting in the streets” if hospitals begin disconnecting ventilators. “There won’t be enough public relations spin or appropriate media coverage in the world” to calm the family of a patient “terminally weaned” from a ventilator, she said.
State and federal officials defend formal rationing as the last in a series of steps that would be taken to stretch scarce resources and provide the best outcome for the public. They say it is better to plan for such decisions than leave them to besieged health workers battling a crisis.
“You change your perspective from thinking about the individual patient to thinking about the community of patients,” said Rear Adm. Ann Knebel of the Department of Health and Human Services.
But some health professionals question whether the draft guidelines are fair, effective, ethical, and even remotely feasible.
Most existing triage plans were designed for handling mass casualties. They sort injured victims into priority categories based on the urgency of their medical needs and their potential for survival given available resources. Much of the controversy over the state plans focuses on two additional features.
These are “exclusion criteria,” which bar certain categories of patients from standard hospital treatments in a severe health disaster, and “minimum qualifications for survival,” which limit the resources used for each patient. Once that limit is reached, patients who are not improving would be removed from essential treatment in favor of those with better chances.
A version of these concepts was outlined in a post-9/11 medical journal article that suggested ways to handle victims of a large-scale bioterrorist event. The author, Dr. Frederick Burkle Jr., said he based his ideas in part on his experiences as a triage officer in Vietnam and the gulf war and on a cold war-era British plan for coping with a nuclear strike. Dr. Burkle said that during the gulf war he once instructed surgeons to halt an operation and work on another patient who was more likely to survive. Surgeons later returned to the first patient.
Dr. Burkle’s ideas were key aspects of guidelines Ontario authorities drew up after SARS to plan for avian flu and other pandemics. This approach and one by a team of Minnesota doctors were modified by groups developing similar guidelines in the United States.
There were important distinctions. Dr. Burkle’s original paper did not anticipate withdrawing care from patients and stressed the need to reassess the level of supplies “sometimes on a daily or hourly basis” in a fluid effort to provide the best possible care.
Some states’ triage guidelines are rigid, with a single set of criteria intended to apply throughout the severe phase of a pandemic. That disturbs Dr. Burkle. “I have said to my wife, I think I developed a monster here,” he said.
Recent research highlights the problem of a one-size-fits-all approach to triage. Many state pandemic plans call for hospitals to remove patients from ventilators if they are not improving after two to five days. Studies show that people severely ill with H1N1 flu generally need a week to two weeks on ventilators to recover.
There is also controversy over what values and ethical principles should guide triage decisions, how to engage the public, and whether withdrawing life support in the hospital and withholding it at the hospital door are distinct.
Normally, removing viable patients from life support against their or their families’ will would be considered murder. The New York-Presbyterian Hospital employees who participated in the recent exercise said they would not comply unless given legal protection.
They also never figured out what to do with that hypothetical patient who had his own ventilator, said Dr. Kenneth Prager, a pulmonologist and ethicist. “The issue of removing patients from ventilators,” he said, “was so overwhelming that it precluded discussion of further case scenarios.”
James Estrin/The New York Times
Published: October 24, 2009
New York state health officials recently laid out this wrenching scenario for a small group of medical professionals from New York-Presbyterian Hospital: A 32-year-old man with cystic fibrosis is rushed to the hospital with appendicitis in the midst of a worsening pandemic caused by the H1N1 flu virus, which has mutated into a more deadly form. The man is awaiting a lung transplant and brought with him the mechanical ventilator that helps him breathe.
New York’s governor has declared a state of emergency and hospitals are following the state’s pandemic ventilator allocation plan — actual guidelines drafted in 2007 that are now being revisited. The plan aims to direct ventilators to those with the best chances of survival in a severe, 1918-like flu pandemic where tens of thousands develop life-threatening pneumonia.
Because the man’s end-stage lung disease caused by his cystic fibrosis is among a list of medical conditions associated with high mortality, the guidelines would bar the man from using a ventilator in a hospital, even though he is, unlike many with his illness, stable, in good condition, and not close to death. If the hospital admits him, the guidelines call for the machine that keeps him alive to be given to someone else.
Would doctors and nurses follow such rules? Should they?
In recent years, officials in a host of states and localities, as well as the federal Veterans Health Administration, have been quietly addressing one of medicine’s most troubling questions: Who should get a chance to survive when the number of severely ill people far exceeds the resources needed to treat them all?
The draft plans vary. In some states, patients with Do Not Resuscitate orders, the elderly, those requiring dialysis, or those with severe neurological impairment would be refused ventilators, or admission to hospitals. Utah divides epidemics into phases. Initially, hospitals would apply triage rules to residents of mental institutions, nursing homes, prisons and facilities for the “handicapped.” If an epidemic worsened, the rules would apply to the general population.
Federal officials say the possibility that America’s already crowded intensive care units would be overwhelmed in the coming weeks by flu patients is small but they remain vigilant.
The triage plans have attracted little publicity. New York, for example, released its draft guidelines in 2007, offered a 45-day comment period, and has made no changes since. The Health Department made 90 pages of public comments public this week only after receiving a request under the state’s public records laws.
Mary Buckley-Davis, a respiratory therapist with 30 years experience, wrote to officials in 2007 that “there will be rioting in the streets” if hospitals begin disconnecting ventilators. “There won’t be enough public relations spin or appropriate media coverage in the world” to calm the family of a patient “terminally weaned” from a ventilator, she said.
State and federal officials defend formal rationing as the last in a series of steps that would be taken to stretch scarce resources and provide the best outcome for the public. They say it is better to plan for such decisions than leave them to besieged health workers battling a crisis.
“You change your perspective from thinking about the individual patient to thinking about the community of patients,” said Rear Adm. Ann Knebel of the Department of Health and Human Services.
But some health professionals question whether the draft guidelines are fair, effective, ethical, and even remotely feasible.
Most existing triage plans were designed for handling mass casualties. They sort injured victims into priority categories based on the urgency of their medical needs and their potential for survival given available resources. Much of the controversy over the state plans focuses on two additional features.
These are “exclusion criteria,” which bar certain categories of patients from standard hospital treatments in a severe health disaster, and “minimum qualifications for survival,” which limit the resources used for each patient. Once that limit is reached, patients who are not improving would be removed from essential treatment in favor of those with better chances.
A version of these concepts was outlined in a post-9/11 medical journal article that suggested ways to handle victims of a large-scale bioterrorist event. The author, Dr. Frederick Burkle Jr., said he based his ideas in part on his experiences as a triage officer in Vietnam and the gulf war and on a cold war-era British plan for coping with a nuclear strike. Dr. Burkle said that during the gulf war he once instructed surgeons to halt an operation and work on another patient who was more likely to survive. Surgeons later returned to the first patient.
Dr. Burkle’s ideas were key aspects of guidelines Ontario authorities drew up after SARS to plan for avian flu and other pandemics. This approach and one by a team of Minnesota doctors were modified by groups developing similar guidelines in the United States.
There were important distinctions. Dr. Burkle’s original paper did not anticipate withdrawing care from patients and stressed the need to reassess the level of supplies “sometimes on a daily or hourly basis” in a fluid effort to provide the best possible care.
Some states’ triage guidelines are rigid, with a single set of criteria intended to apply throughout the severe phase of a pandemic. That disturbs Dr. Burkle. “I have said to my wife, I think I developed a monster here,” he said.
Recent research highlights the problem of a one-size-fits-all approach to triage. Many state pandemic plans call for hospitals to remove patients from ventilators if they are not improving after two to five days. Studies show that people severely ill with H1N1 flu generally need a week to two weeks on ventilators to recover.
There is also controversy over what values and ethical principles should guide triage decisions, how to engage the public, and whether withdrawing life support in the hospital and withholding it at the hospital door are distinct.
Normally, removing viable patients from life support against their or their families’ will would be considered murder. The New York-Presbyterian Hospital employees who participated in the recent exercise said they would not comply unless given legal protection.
They also never figured out what to do with that hypothetical patient who had his own ventilator, said Dr. Kenneth Prager, a pulmonologist and ethicist. “The issue of removing patients from ventilators,” he said, “was so overwhelming that it precluded discussion of further case scenarios.”
Friday, October 23, 2009
Oldest Woman to Give Birth Dies
To read the article in its original form, go here.
19 October 2009 (BioNews 530)
By Antony Blackburn-Starza
Maria Bousada, 69, once the world's oldest mother, died in July this year leaving behind two young children born following IVF only two years earlier. Her death reignited the debate surrounding 'older mothers' - or more specifically, post-menopausal women who require fertility treatment to conceive. In response to media attention surrounding Ms Bousada's death, Professor Sammy Lee, an expert in medical ethics, embryology and biomedical sciences based at University College London (UCL) arranged a conference co-sponsored by the Progress Educational Trust entitled '21st Century Motherhood', with the aim to engage the public and stakeholders in rigorous debate. The event took place at UCL on 18 September. What emerged from the day-long discussion directed by informed presentations from an array of experts from scientific, ethical, social, feminist and other academic backgrounds was the 'problem' is both, of course, important to fertility patients and society at large but, as yet, surprisingly under-explored. Media sensationalism aside, what exactly were the objections to Ms Bousada having children beyond the age of 60 and on what grounds were such objections founded?
The issues
Reproductive autonomy versus the best interests of the child
From an ethical perspective, the issue of 'older mothers' creates tension between the principles of the reproductive autonomy of the mother and the best interests of the child, but also the interests of wider society. It is a classic exposition of the clash between neo-liberal attitudes towards private behaviour, facilitated by the rise of the fertility industry to meet the demands of 'consumers', and paternalistic efforts to protect women from their own possibly ill-founded decisions and also to protect the unborn child.
Naomi Pfeffer raised the point first of all when speaking of the woman's right to choose what to do with her body. Surely this is absolutely central to the whole issue - if a woman believes she is fit and healthy to raise a children then why should be prevented from doing so? The problem is that Maria Bousada thought just this, believing that longevity ran in the family, yet was diagnosed with fatal cancer just months before her children were born. It is a trite point but statistically speaking 'older' mothers are more likely to die sooner after giving birth than younger mothers. Commenting on the issue at the time, Josephine Quintavalle of Comment on Reproductive Ethics, summed up the ethical problem: 'Why would a woman want to become a mother at an age when she knows her children are much more likely to be orphaned when they're young?' she asked.
Yet the rights of the women cannot be ignored. The 'right' to bear children is evidenced in Article 16 of the Universal Declaration of Human Rights: 'Men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family.' Whether rights discourse covers fertility treatment is unclear but for these purposes assuming that it does, the question arises as to at what point is the state permitted to interfere with a woman's right to bear children? The only true principle, I believe, that justifies such a measure, is the best interests of the children which, in other areas of the law such as consent, operates above the decision-making rights of the parents.
Health and wellbeing of mother and child
Practically, the question of safety both for the mother and the unborn children featured prominently in the discussions. First and foremost, children born to 'older mothers' are arguably placed at risk of physical harm during the pregnancy and birth, but also to psychological harm if their mother dies of 'old age' whilst they are still in their infancy. Anna Smajdor of the University of East Anglia pointed out that pregnancy is inherently risky anyway but mothers choose to assume this risk rather than not having children at all. But this inherent risk of pregnancy increases as the mother becomes older and this cannot be ignored when providing IVF to, say, a woman over 60. It is a question of thresholds and where we must draw the line is when the risks to either to mother or child become excessive to make such a pregnancy unadvisable.
Second, there is the problem of 'fertility tourism', whereby residents who are either denied or cannot access fertility treatment in their own countries travel abroad to countries with more permissive regulations. This issue is always relevant when limits to IVF are considered. Such patients are exposed to exploitation and health risks as fertility services in some countries is not regulated as strictly as they are elsewhere. Further, if, for example, a clinic in the UK denies a 65 year old woman IVF on the basis of risks to her and the child's health, despite the fact that a clinic in, say, India, may be willing to perform the service, the risk to mother and baby remain exactly the same. Fertility tourism does not get around the problem but merely allows women to circumvent protectionist rules.
Social attitudes towards 'older mothers'
The conference also touched upon social attitudes towards older mothers. Here, the discussion moved towards changes in social attitudes over the last few decades. Peter Brinsden, Consultant Medical Director at Bourn Hall Clinic, told the audience that in the 1980s mothers were considered 'old' at the age of 40. Today, many women would contest this view and indeed women between the age of 40-44 have a 65 per cent of conceiving naturally. The lifestyle choices of women have also developed over the years with an increasing number choosing to postpone motherhood to pursue a career. Yet the difference between a women who conceives naturally at 40, or for that matter any age, to a women who requires fertility treatment is the crux of the issue here. Fertility technology allows women as old as 70 to successfully conceive - but should they?
There may be in-built sexism in the way society views older parents. Sammy Lee illustrated how the media portray older mothers as being selfish yet they appear to congratulate older fathers. When approaching the issue we must there be mindful that we are not simply expressing prejudice about the woman's role in bringing up a child - if possible, both parents are in it for equal measure.
Conclusion
The conference provided an opportunity to discuss various perspectives and left those attending with no clear answer. Indeed, none was expected. The conference met its purposes to the engage the public in debate and to delineate the approaches to the issue but there is more that needs to be done. From a regulatory perspective, this concoction of various issues invites the question whether IVF is indeed properly regulated at present and whether there should be greater regulation of the provision of IVF for older mothers, either in guideline or legislative form.
The central question that emerged was when is it legitimate to interfere with the reproductive rights of the woman and on what grounds such an intervention should be justified. Introducing the debate, Professor Lord Robert Winston stressed that the medical profession should not interfere with what is essentially a personal decision for the woman. Analogies to abortion may be drawn here, which remains in the hands of doctors, in theory at least.
Yet I do not feel that the decision to have a child is solely the mother's decision and the best interests of that child should always be paramount. Guidelines make it clear that the primary factor to be considered when providing fertility treatment to older mothers is the wellbeing of the child. This includes both physical and psychological risks and I believe where the is a 'real' risk of either materialising then fertility treatment should not be offered. This is essentially a medical question and when we introduce the notion of safety into the decision-making process then it unavoidably medicalises the issue.
Another approach is to withhold fertility treatment on the basis that is does not take away from the mother - nothing lost, nothing gained. If IVF is viewed as a positive intervention dependant on the will of the medical profession (a woman cannot perform IVF alone) then those offered such services as legitimately permitted to deny treatment - as they are today. This merely infringes reproductive autonomy in an indirect manner. Yet such an approach leads to a negative conclusion that fertility treatment is a 'luxury' rather than akin to other medical interventions.
What is clear, however, is that if further regulatory steps are to be introduced, however, it must be done is a sensitive and measured fashion so not to alienate older fertility patients and to not put pressure on patients to seek treatment abroad. The conference has set the scene for further avenues of debate but what is yet to emerge is a clear normative principle to guide it. I feel this can only be the welfare of the child, a principle that should never be curtailed, but then not everyone would readily agree.
RELATED ARTICLES FROM THE BIONEWS ARCHIVE
The problem with 21st Century Motherhood
17 August 2009 - by Dr Sammy Lee
Did the death of Maria Bousada change public attitudes to the modern phenomenon headlined as 'Oldest Mums'? The world's media certainly made hay and the news reverberated for a few days; and it seems likely that the Channel 4 documentary 'the Worlds Oldest Mums' was rescheduled to screen early to catch the media wave which the death generated. The aftermath, though, of this tsunami seems to have largely been relative indifference....[Read More]
World’s oldest IVF mother dies from cancer two years after giving birth
20 July 2009 - by Antony Blackburn-Starza
The world’s oldest mother has died from cancer aged 69. María Carmen del Bousada de Lara, from Spain, gave birth to twins two years ago through IVF. She received fertility treatment in Los Angeles, California, after misleading doctors about her age and gave birth to two boys in Barcelona at the age of 66. It is reported that Ms Bousada paid around £30,000 for treatment at the Pacific Fertility Centre where she told doctors that she was 55 to avoid the clinic’s age limit for treatment. Her...[Read More]
60 year-old woman gives birth to twins in Canada after fertility treatment abroad
16 February 2009 - by Sarah Guy
A 60 year-old woman has sparked controversy in Canada by travelling to India to receive fertility treatment after years of failed attempts to conceive naturally. Ranjit Hayer, originally from India, has become the oldest woman in Canada to give birth after receiving IVF at Dr Anoop Gupta's Delhi fertility clinic; her twin boys were delivered seven weeks prematurely by Caesarean section at the Foothills hospital in Calgary last week....[Read More]
19 October 2009 (BioNews 530)
By Antony Blackburn-Starza
Maria Bousada, 69, once the world's oldest mother, died in July this year leaving behind two young children born following IVF only two years earlier. Her death reignited the debate surrounding 'older mothers' - or more specifically, post-menopausal women who require fertility treatment to conceive. In response to media attention surrounding Ms Bousada's death, Professor Sammy Lee, an expert in medical ethics, embryology and biomedical sciences based at University College London (UCL) arranged a conference co-sponsored by the Progress Educational Trust entitled '21st Century Motherhood', with the aim to engage the public and stakeholders in rigorous debate. The event took place at UCL on 18 September. What emerged from the day-long discussion directed by informed presentations from an array of experts from scientific, ethical, social, feminist and other academic backgrounds was the 'problem' is both, of course, important to fertility patients and society at large but, as yet, surprisingly under-explored. Media sensationalism aside, what exactly were the objections to Ms Bousada having children beyond the age of 60 and on what grounds were such objections founded?
The issues
Reproductive autonomy versus the best interests of the child
From an ethical perspective, the issue of 'older mothers' creates tension between the principles of the reproductive autonomy of the mother and the best interests of the child, but also the interests of wider society. It is a classic exposition of the clash between neo-liberal attitudes towards private behaviour, facilitated by the rise of the fertility industry to meet the demands of 'consumers', and paternalistic efforts to protect women from their own possibly ill-founded decisions and also to protect the unborn child.
Naomi Pfeffer raised the point first of all when speaking of the woman's right to choose what to do with her body. Surely this is absolutely central to the whole issue - if a woman believes she is fit and healthy to raise a children then why should be prevented from doing so? The problem is that Maria Bousada thought just this, believing that longevity ran in the family, yet was diagnosed with fatal cancer just months before her children were born. It is a trite point but statistically speaking 'older' mothers are more likely to die sooner after giving birth than younger mothers. Commenting on the issue at the time, Josephine Quintavalle of Comment on Reproductive Ethics, summed up the ethical problem: 'Why would a woman want to become a mother at an age when she knows her children are much more likely to be orphaned when they're young?' she asked.
Yet the rights of the women cannot be ignored. The 'right' to bear children is evidenced in Article 16 of the Universal Declaration of Human Rights: 'Men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family.' Whether rights discourse covers fertility treatment is unclear but for these purposes assuming that it does, the question arises as to at what point is the state permitted to interfere with a woman's right to bear children? The only true principle, I believe, that justifies such a measure, is the best interests of the children which, in other areas of the law such as consent, operates above the decision-making rights of the parents.
Health and wellbeing of mother and child
Practically, the question of safety both for the mother and the unborn children featured prominently in the discussions. First and foremost, children born to 'older mothers' are arguably placed at risk of physical harm during the pregnancy and birth, but also to psychological harm if their mother dies of 'old age' whilst they are still in their infancy. Anna Smajdor of the University of East Anglia pointed out that pregnancy is inherently risky anyway but mothers choose to assume this risk rather than not having children at all. But this inherent risk of pregnancy increases as the mother becomes older and this cannot be ignored when providing IVF to, say, a woman over 60. It is a question of thresholds and where we must draw the line is when the risks to either to mother or child become excessive to make such a pregnancy unadvisable.
Second, there is the problem of 'fertility tourism', whereby residents who are either denied or cannot access fertility treatment in their own countries travel abroad to countries with more permissive regulations. This issue is always relevant when limits to IVF are considered. Such patients are exposed to exploitation and health risks as fertility services in some countries is not regulated as strictly as they are elsewhere. Further, if, for example, a clinic in the UK denies a 65 year old woman IVF on the basis of risks to her and the child's health, despite the fact that a clinic in, say, India, may be willing to perform the service, the risk to mother and baby remain exactly the same. Fertility tourism does not get around the problem but merely allows women to circumvent protectionist rules.
Social attitudes towards 'older mothers'
The conference also touched upon social attitudes towards older mothers. Here, the discussion moved towards changes in social attitudes over the last few decades. Peter Brinsden, Consultant Medical Director at Bourn Hall Clinic, told the audience that in the 1980s mothers were considered 'old' at the age of 40. Today, many women would contest this view and indeed women between the age of 40-44 have a 65 per cent of conceiving naturally. The lifestyle choices of women have also developed over the years with an increasing number choosing to postpone motherhood to pursue a career. Yet the difference between a women who conceives naturally at 40, or for that matter any age, to a women who requires fertility treatment is the crux of the issue here. Fertility technology allows women as old as 70 to successfully conceive - but should they?
There may be in-built sexism in the way society views older parents. Sammy Lee illustrated how the media portray older mothers as being selfish yet they appear to congratulate older fathers. When approaching the issue we must there be mindful that we are not simply expressing prejudice about the woman's role in bringing up a child - if possible, both parents are in it for equal measure.
Conclusion
The conference provided an opportunity to discuss various perspectives and left those attending with no clear answer. Indeed, none was expected. The conference met its purposes to the engage the public in debate and to delineate the approaches to the issue but there is more that needs to be done. From a regulatory perspective, this concoction of various issues invites the question whether IVF is indeed properly regulated at present and whether there should be greater regulation of the provision of IVF for older mothers, either in guideline or legislative form.
The central question that emerged was when is it legitimate to interfere with the reproductive rights of the woman and on what grounds such an intervention should be justified. Introducing the debate, Professor Lord Robert Winston stressed that the medical profession should not interfere with what is essentially a personal decision for the woman. Analogies to abortion may be drawn here, which remains in the hands of doctors, in theory at least.
Yet I do not feel that the decision to have a child is solely the mother's decision and the best interests of that child should always be paramount. Guidelines make it clear that the primary factor to be considered when providing fertility treatment to older mothers is the wellbeing of the child. This includes both physical and psychological risks and I believe where the is a 'real' risk of either materialising then fertility treatment should not be offered. This is essentially a medical question and when we introduce the notion of safety into the decision-making process then it unavoidably medicalises the issue.
Another approach is to withhold fertility treatment on the basis that is does not take away from the mother - nothing lost, nothing gained. If IVF is viewed as a positive intervention dependant on the will of the medical profession (a woman cannot perform IVF alone) then those offered such services as legitimately permitted to deny treatment - as they are today. This merely infringes reproductive autonomy in an indirect manner. Yet such an approach leads to a negative conclusion that fertility treatment is a 'luxury' rather than akin to other medical interventions.
What is clear, however, is that if further regulatory steps are to be introduced, however, it must be done is a sensitive and measured fashion so not to alienate older fertility patients and to not put pressure on patients to seek treatment abroad. The conference has set the scene for further avenues of debate but what is yet to emerge is a clear normative principle to guide it. I feel this can only be the welfare of the child, a principle that should never be curtailed, but then not everyone would readily agree.
RELATED ARTICLES FROM THE BIONEWS ARCHIVE
The problem with 21st Century Motherhood
17 August 2009 - by Dr Sammy Lee
Did the death of Maria Bousada change public attitudes to the modern phenomenon headlined as 'Oldest Mums'? The world's media certainly made hay and the news reverberated for a few days; and it seems likely that the Channel 4 documentary 'the Worlds Oldest Mums' was rescheduled to screen early to catch the media wave which the death generated. The aftermath, though, of this tsunami seems to have largely been relative indifference....[Read More]
World’s oldest IVF mother dies from cancer two years after giving birth
20 July 2009 - by Antony Blackburn-Starza
The world’s oldest mother has died from cancer aged 69. María Carmen del Bousada de Lara, from Spain, gave birth to twins two years ago through IVF. She received fertility treatment in Los Angeles, California, after misleading doctors about her age and gave birth to two boys in Barcelona at the age of 66. It is reported that Ms Bousada paid around £30,000 for treatment at the Pacific Fertility Centre where she told doctors that she was 55 to avoid the clinic’s age limit for treatment. Her...[Read More]
60 year-old woman gives birth to twins in Canada after fertility treatment abroad
16 February 2009 - by Sarah Guy
A 60 year-old woman has sparked controversy in Canada by travelling to India to receive fertility treatment after years of failed attempts to conceive naturally. Ranjit Hayer, originally from India, has become the oldest woman in Canada to give birth after receiving IVF at Dr Anoop Gupta's Delhi fertility clinic; her twin boys were delivered seven weeks prematurely by Caesarean section at the Foothills hospital in Calgary last week....[Read More]
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