The Price of Preemies
And other news from the techno-frontier.
You and I are cultural and political creatures living in an age of science and technology. From sexuality to liposuction to surveillance to cloning, we're being overrun by technologies full of implications about who we are and how we should live. The purpose of Human Nature is to expose and discuss those implications. In the weeks to come, what you'll find here is a steady diet of news updates and quick takes, coupled with longer columns exploring some topics more thoroughly.
Let's start with a few updates.
Item: Most premature babies who survive to age six have disabilities.
Source: New England Journal of Medicine
Outlet: Associated Press, Jan. 6
Gist: Eighty percent of 6-year-old children who were born between the 22nd and 25th weeks of pregnancy (the current lower limit) have disabilities, and 46 percent have severe or moderate disabilities (cerebral palsy, learning disabilities, hearing loss, vision problems, etc.).
Implication drawn by the researchers: "Parents need to go into this situation with their eyes wide open and with an open dialogue with their doctors as to what they should do."
Translation: Pull the plug.
Other implications: According to the AP, "The rate of premature births in the United States has crept up in recent years, in part because of a rise in multiple births and older mothers." So think twice about IVF, ladies.
Item: Reducing inflammation may reduce heart disease.
Source: New England Journal of Medicine
Gist: Two studies suggest "C-reactive protein," an inflammation marker, may correlate as strongly with heart disease as cholesterol does.
Skeptical view: CRP may be the symptom, not the cause. Either way, the less you have, the safer you are.
Lifestyle implications: To reduce CRP, quit smoking, exercise, eat healthy, lose weight, and take statin drugs. Oh, wait—that's the same stuff you're already supposed to do. ... 10:50 a.m. PT
Wednesday, Jan. 5, 2005
Item: A guy has been arrested for aiming a laser pen at aircraft.
Outlet: New York Times, Jan. 5
Gist: Several pilots have reported distraction or temporary vision loss from ground-based lasers since Christmas. Some people thought it might be terrorism. But now prosecutors are blaming one incident on a guy fooling around with a laser pen he bought online for $100. The charge, interference of the operator of a mass transit vehicle, is based on the USA Patriot Act. Prosecutors say they're sending a message that after 9/11, no funny business will be tolerated.
Security implication: Now anyone can blind a pilot.
The good news: The lasers haven't downed any planes, and this incident wasn't terrorism.
The bad news: 1) This guy had nothing to do with the other incidents, so those could still be terrorism. 2) The government has no mechanism to regulate laser pens. 3) The only reason this idiot was caught is that he aimed his pen at the helicopter that came back to search for the source of the original beam. Otherwise, good luck enforcing a ban.
Item: Morning-after pills don't lull women into risking unprotected sex.
Outlet: Washington Post, Jan. 5
Gist: Last year the Food and Drug Administration refused to allow nonprescription sales of Plan B, a morning-after pill, on the grounds that its easy availability might lull young women into having more unprotected sex. A study by CRHRP finds no such effect.
Liberal spin: This cuts the scientific legs out from under what was really a political decision. Now give us the pill.
Item: The FDA will let some terminally ill people take Ecstasy.
Source: Food and Drug Administration
Gist: The FDA has approved a study to see whether Ecstasy can help terminally ill cancer patients mellow out, connect with their families, and find spiritual transcendence. Another study is testing Ecstasy on post-traumatic stress disorder. Two others are testing psilocybin ("magic mushrooms") on obsessive-compulsive disorder and terminal cancer.
Positive spin: 1) Maybe we're finally admitting it's OK to get high. 2) Psychedelic drugs and FDA-approved antidepressants affect the same parts of the brain. Why allow one but not the other?
Negative spin: The study still needs approval from the Drug Enforcement Administration. Good luck.
Item: A woman has given birth to her own grandchildren.
Outlet: Washington Post, Dec. 29
Gist: A Virginia woman couldn't bear children, so her 55-year-old mom accepted her IVF embryos and carried triplets to term.
Positive spin: It's the greatest gift a mother can give to her daughter.
Negative spin: Yuck. 1) The kids' gestational mom is their genetic grandma, and their genetic mom is their gestational sister. 2) The grandma may think of herself as the kids' real mom, and if she goes to court, some states will agree with her.
Quote: The dad says watching his mother-in-law carry his child was "surreal." ... 11:53 a.m. PT
Tuesday, Jan. 4, 2005
Item: We're going to live longer than Social Security administrators expect.
Source: "many population experts"
Outlet: New York Times, Dec. 31
Gist: Life expectancy at birth rose 21 years from 1900 to 1950 (47.3 to 68.2) and another nine years from 1950 to 2002, reaching 77.3 years. The Social Security Administration assumes life expectancy will now grow more slowly, increasing only six years by 2075. Longevity experts say this assumption is too low. Why? 1) Life expectancy has increased by three months per year pretty regularly for 160 years. 2) Government projections have historically underestimated increases in longevity. 3) After 1950, although the rate of increase declined for the general population, it increased for the population over age 65. 4) Our average life expectancy is far below any biological "ceiling."
Financial implication: We're doing such a good job of keeping people alive that we're going to bankrupt ourselves.
Critique: Three of the four "expert" arguments are social science dressed up as natural science. They're just demographic extrapolations from the past to the future, with no biological theory to explain why we could increase the longevity of old people as easily as we increased the longevity of young people. The fourth argument is biological but tells us only about a ceiling. It doesn't matter how high the ceiling is if we don't have a ladder to get there—and that's the argument on the other side. As the token skeptic puts it in the Times, "There are no lifestyle changes, surgical procedures, vitamins, antioxidants, hormones or techniques of genetic engineering available today with the capacity to repeat the gains in life expectancy that were achieved in the 20th century."
Buried political story: Read down to the 10th paragraph of the Times article.
For the American population as a whole in the last century, most of the gains in life expectancy at birth occurred from 1900 to 1950. But most of the gains in life expectancy among people who had already reached age 65 were seen after 1950. Last year an expert panel advising the Social Security Administration found "an unprecedented reduction in certain forms of old-age mortality, especially cardiovascular disease, beginning in the late 1960's."
In other words, as old people increased their share of the country's economic and political power, they consumed more of the country's medical attention. Further down, the Times adds, "Nor do economists generally foresee a reversal of the trend toward early retirement. Though researchers have observed a significant decline in chronic disability among the elderly, most workers retire and begin drawing Social Security benefits before they reach 65."
Disability down. Cardiovascular disease down. Longevity up. Social Security benefits earlier. This isn't a biological problem. It's a political problem.
Punch line: Two other problems may solve this one. One expert observes that obesity is proliferating and lethal infectious diseases are thriving in our increasingly connected world. Human self-destruction may spare us the financial cost of human self-absorption.
Item: More adult women are having unprotected intercourse.
Outlet: Washington Post, Jan. 4
Gist: From 1995 to 2002, the percentage of sexually active adult women not using contraception rose from 5.2 to 7.4. This could increase unintended pregnancies by more than 20 percent.
Liberal spin: This is the tragic result of insufficient sex education, too much abstinence-only curriculum, more people without insurance coverage, and lower federal funding of family planning relative to inflation. One liberal complains that drug companies "have cut way back" on free samples and tells the Post, "It is absolutely unconscionable that women have a co-pay of $20 or $25 [a month] for contraceptives and men are getting off scot-free."
Critique: 1) If erosion of sex ed is the problem, why is contraceptive use increasing among teenagers? 2) Before you blame health insurers and drug companies, ask how safe, reliable, and expensive birth control was before they got into it. 3) Doesn't "co-pay" mean we're socializing some of the cost, and nobody's getting off scot-free? 4) Have we really been relying on free samples to get birth control to poor women? If so, shouldn't we make that subsidy public and stop leeching off greedy drug companies?
Conservative spin: Women are rejecting birth control because they want to get pregnant or don't like birth control's side effects. An abstinence proponent tells the Post, "The women making these choices are making a conscious choice. They are not stupid."
Critique: We'll quote you on that next time you propose legislation—like, say, S. 2466—to regulate women's choices on the grounds that they're dupes of the abortion industry.
Item: There's no evidence that commercial weight-loss programs work.
Source: Annals of Internal Medicine
Outlet: New York Times, Jan. 4
Gist: 1) Virtually no commercial diet program has "published reliable data from randomized trials showing that people who participated weighed less a few months later than people who did not participate." 2) Since there's no good evidence, maybe you should avoid the most expensive programs. 3) The most expensive programs are supervised by doctors. 4) "Doctors could do as well as these programs" just by telling people to diet and exercise. 5) All diet programs fail because "they're fighting biology."
Critique: Thanks for the help.
Item: Medicare will pay for alcoholism screening and for counseling to quit smoking.
Source: Medicare administrators
Outlets: New York Times, Dec. 24; Los Angeles Times, Jan. 2
Gist: Alcoholism screening begins this week. Coverage of smoking cessation counseling begins in March. Both will cost a lot of money but save more by preventing cancer, heart and liver disease, and other maladies.
Cultural analysis: We're socializing treatment of smoking and drinking because we now view them as diseases, not vices.
Economic analysis: We socialized treatment of the consequences of smoking and drinking when we created Medicare 40 years ago. Now we're just cutting costs. ... 10:30 p.m. PT
Will Saletan covers science, technology, and politics for Slate and says a lot of things that get him in trouble.