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A lot of people in China are angry. The earthquake that struck there two weeks ago has destroyed their entire stock of the country's most strictly rationed item: children.
Here's the background from the New York Times:
Thousands of parents have openly challenged the government over why so many schools collapsed during the earthquake. An estimated 10,000 students are believed to have died. The anguish of parents and grandparents has been compounded by the one-child policy, which was introduced in 1979 to control population growth.
Imagine being one of these parents. The government has restricted you to one child, and now that child is dead. You've lost your whole family in one stroke.
But wait: The government has come up with a solution. You can replace your defunct child with a new one. The Associated Press explains the offer:
Chinese officials said Monday that the country's one-child policy exempts families with a child killed, severely injured or disabled in the country's devastating earthquake. Those families can obtain a certificate to have another child, the Chengdu Population and Family Planning Committee in the capital of hard-hit Sichuan province said. ... Chinese couples who have more than one child are commonly punished by fines. The announcement says that if a child born illegally was killed in the quake, the parents will no longer have to pay fines for that child-but the previously paid fines won't be refunded. If the couple's legally born child is killed and the couple is left with an illegally born child under the age of 18, that child can be registered as the legal child-an important move that gives the child previously denied rights including free nine years of compulsory education.
Got that? If your child is broken, you can apply for a certificate to get a replacement child. Or you can substitute a used child and transfer the license from your previous child, with all the attendant financial rights. However, there will be no refunds.
It reads like a warranty or a software agreement. Except we're not talking about consumer electronics. We're talking about children. This is what happens when you ration people like commodities.
A few years ago, I lambasted the one-child policy as a forced-abortion machine. Then, a couple of weeks ago, I was talking with a friend about global warming, and it occurred to me that the single most effective thing anybody has done to slow that process over the last 30 years is probably the one-child policy. I still think it's a colossal offense against human rights. And in the present context, it's a case study in the regulation of human beings as a kind of property. If you lose your quota through no fault of your own, you can get a coupon to refill it. Half of me is grateful to the Chinese government for giving these bereft couples a second chance. The other half is revolted that the government controls such things.
If you're going to replace children like broken toasters, one per customer, then you'd better standardize the warranty. When I looked for the earthquake exemption report on Xinhua, the state news agency, I couldn't find it. Then I realized why. It was granted by the authorities in Chengdu. It's a local exemption. The last thing the national government wants is to broadcast it in other provinces, where people are still being held to the one-child policy.
Sorry, but that won't do. Why should the warranty apply only to this earthquake? What about the floods of 1991 and 1998? What about the drought of 1988? How many couples lost their only kids in those calamities? Where's their compensation?
Forget it. You can't replace children like toasters. You shouldn't ration them like toasters, either.
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If you're old enough to imagine your dead body being carted away, you're probably old enough to remember "Meat Wagon Action Set," the sidesplitting (oops—wrong metaphor!) parody ad that first aired on Saturday Night Live in 1977. It looked like an ordinary commercial for a kids' race-car set until one car crashed and burst into flames. That's when the flagship vehicle arrived: an ambulance that picked up the bodies and hauled them away. In the background, you could hear the manly jingle, "Meat Wagon ..."
Back then, "meat wagon" was just slang for ambulance. No more. It's about to become quite real. Here's the skinny (oops—bad metaphor again!) from Rob Stein of the Washington Post. Backed by a three-year federal grant,
New York City is working on a plan to deploy a special ambulance to collect the bodies of people who have died suddenly from heart attacks, accidents and other emergencies and try to preserve their organs. If the "rapid-organ-recovery ambulance" succeeds, officials would like to expand the unique pilot program citywide with a fleet of ambulances and eventually duplicate it in other cities.
Stein explains how the plan would work:
Once all hope for resuscitation was gone, and as long as no family members objected, the victims' bodies would be transferred to the organ ambulance team, even if the victims' willingness to be organ donors was unclear. The crew could then perform measures on the body to prevent the organs from deteriorating, including chest compressions with an automated device and pumping oxygen into the lungs through a tracheal tube to keep blood and oxygen flowing. The crew might also administer the blood-thinning drug heparin to prevent clots while speeding to Bellevue. At the hospital, doctors could take additional steps, such as inserting a plastic tube known as a cannula into an artery, usually in the groin, to infuse the body with fluids to cool and preserve the organs. Organ bank workers would then assess whether the person was a suitable donor, determine whether they had an organ donor card or were listed on an organ donor registry, and try to locate a family member to give consent.
As you can imagine, the plan is freaking some people out. One bioethicist calls it "disgusting." But let's step back and understand what's going on here: Medicine is becoming ever more efficient and rational. Thanks to improving technology, organs that were previously useful only to their owners are now useful to other people, too. This has created pressure on doctors to think about dying people as resources, not just as patients. This pressure, in turn, has driven a movement to loosen organ-collection rules so that people who aren't yet brain-dead can be prepped for harvesting.
Meat wagons are the next step. They advance the rationalization of organ harvesting from the hospital to the street. Instead of letting perfectly good innards go to waste, they go out and get them.
If this creeps you out, you're not alone. But remember Human Nature's first law: In technology, bad things don't happen because they're bad. They happen because they're good. Nearly 100,000 Americans are officially waiting for organ transplants. Just yesterday, a friend of mine disclosed that her kidneys are failing, and she needs a donor. When you think about all these people, it seems crazy that healthy organs are being routinely thrown away with their owners. Stein reports:
Currently, New York City paramedics try for about 30 minutes to revive patients whose hearts have stopped before declaring them dead, while a doctor monitors their efforts remotely. The bodies are then taken to a funeral home, morgue or medical examiner's office.
The meat-wagon plan would end this presumption of nondonation. But the shift of presumption wouldn't start at death. It would start beforehand. Things you would never do to a hopelessly dying loved one—automated chest compressions, oxygen pumping, and injections of blood thinners of preservatives—make perfect sense when you start to think of that person as a failing organ bank. Nature doesn't give you the luxury of waiting for total, irreversible death. She starts ruining organs well before that. If you want them, you have to move fast.
Meat wagons won't be the last step in the movement toward efficient organ harvesting. The next steps are already underway. As Stein points out, the compressions and injections would begin on board the meat wagon "even if the victims' willingness to be organ donors was unclear," in order to keep open the harvesting option while organ collectors hustle to locate family members and lobby them for consent.
The next barrier to go will be the five-minute rule. Under the current plan, Stein reports, "The organ team would wait five minutes after EMTs give up on resuscitation, to create a clear demarcation between efforts to save lives and those to preserve organs." But in those five minutes, lots of organs will spoil. Once we've accepted the idea that dying people are also organ banks, it's hard to see why we'll tolerate this delay. We'll probably shorten it a minute at a time.
We'll also dispense with the distinction between ambulances and meat wagons. For now, officials are determined to keep these functions in separate vehicles, so families and neighbors don't freak out when the ambulance shows up. But in the long run, it makes no sense to have a vehicle on the scene that can do only half the job. I can't imagine cities assembling, staffing, and dispatching fleets of meat wagons when they already have fleets of ambulances ready to be dually equipped.
Until then, fear not the meat-wagon siren. As long as you can hear it, it wails not for thee. At least, not yet.
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If you're tired of reading about how dead Hillary Clinton is or how long it'll take her to admit it, fly with me across the Atlantic for a couple of minutes. A monumental debate is going on in the British House of Commons over the Human Fertilisation and Embryology Bill, which will influence how governments around the world regulate family and reproductive issues in the next century.
Everything's on the table in this free-for-all: late-term abortions, human-animal hybrids, and IVF for lesbians and unmarried women.
The liberals are steamrolling the conservatives. None of the proposed restrictions has passed. But what's really intriguing is the difference in vote counts among the various issues. It tells us something about which values people care about most. Is it life? Sex? Human dignity?
Here's how many members of Parliament voted for each proposed restriction:
A. Ban abortions after 22 weeks instead of the current 24 weeks: 233.
B. Require clinics to consider the "need for a father" in approving women for IVF: 217.
C. Ban abortions after 20 weeks: 190.
D. Ban the use of gutted animal eggs to make human embryos for research: 176.
E. Ban genetic testing of embryos to choose (for implantation and birth) those that could grow tissue for transplant to an already-born sibling: 163.
F. Ban abortions after 16 weeks: 84.
So the most popular restriction was on late-term abortions. Chalk one up for life.
But wait: The number of votes to prevent lesbian parenthood beat out the number of votes to prevent abortions after 20 weeks. From this, you could make a pretty good argument that feminists are right: Some supporters of abortion restrictions care more about regulating sex and family structure than about protecting life.
Personally, I'm sure of this. The proof is that most people who support abortion bans also support exceptions for rape and incest, where the life considerations are the same, but the sex and family-structure considerations are different.
Now look at the vote count on banning human-animal hybrids. The hybrids in question aren't equal mixtures of human and animal. They're fully human cell nuclei cloned inside eviscerated animal eggs, for lack of available human eggs. In other words, the animal contribution is minimal, almost inconsequential. Furthermore, the embryos are just for research and cell derivation, not for procreation. I'm not saying this is unobjectionable. I'm just pointing out that the degree of mixture is trivial.
Nevertheless, the number of votes to ban it is more than double the number of votes to ban abortions after 16 weeks. To that extent, "human dignity" beats out life. It seems that keeping our DNA separate from that of animals is more important than saving those second-trimester babies.
But that's still not the headline, in my book. The headline is that restrictions on lesbian IVF and trivial species mixture outpolled restriction of genetic testing to choose embryos for tissue harvesting. The common term for this practice is "savior siblings." Here's the prototypical situation: Your daughter has a serious disease. She needs compatible bone marrow. The best way to get it is for you and your spouse to make another baby and transplant its bone marrow to her. But not all your offspring will have tissue that matches hers. To guarantee a match, you need to make a batch of embryos, implant one that matches, and forget about the rest.
The happy ending is that your daughter is saved, and you've made another child to love. But you've also crossed a line. You've made a bunch of human embryos and then flushed them not because of anything wrong with them, but because they weren't useful. And if there's no tissue match, you've crossed that line for nothing.
In my view, the rise of this mentality -- the reconceptualization of human beings as medical tools and resources -- is way more dangerous than gender upheaval, species-mixing, or even abortion. Abortions, no matter what you think of them, are defensive. Tissue harvesting, on the other hand, carries an affirmative mandate. It entitles you, and arguably obliges you, to deliberately create new human life, which will then live or die based on its utility to others.
Contrary to pro-life rhetoric, there's no broad incentive to increase the number of abortions. But there's plenty of incentive to increase the number of sibling saviors. That's why sibling saviors scored so well in the House of Commons. This is one thing I've learned from covering biotechnology: Bad things don't happen because they're bad. They happen because they're good.
Keep an eye on this utilitarian mindset as we continue to take ourselves apart. As the British debate illustrates, it'll be hard to stop.
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On Friday I wrote about homosexuality, polygamy, and incest. The gist of the piece was that our categorical bans on these practices are losing their justification. As societies embrace privacy, the acceptable basis for restricting sexual behavior has been reduced to harm. And the evidence that these practices are harmful is weak.
In the case of incest, I looked at the scientific objection -- inbreeding -- at a level one step removed. That is, not in brother-sister coupling, but in cousin marriage. This is an emerging controversy in Britain, thanks largely to immigration from Pakistan, where the practice is common.
Over the weekend, two more articles on this topic appeared in the British press. Let's take a look at them.
First, an estimate of the scale of the practice. "Over a billion people worldwide live in regions where 20%-50% of marriages are consanguineous -- that is where the partners are descended from the same ancestor," reports Emma Wilkinson of BBC News. In Britain, Wilkinson cites an unfolding study in Bradford, where half the kids are from Pakistani parents. A pediatrician at the local teaching hospital reports that 70 percent of the first 1,100 Pakistani women recruited for the study are offspring of consanguineous marriages.
Second, some political background, courtesy of Ian Sample in the Guardian. Three years ago, a member of parliament from the left-leaning Labour Party was denounced for suggesting that cousin marriage should be discouraged as a genetically harmful practice. "We have campaigns about the health effects of drinking, smoking and overeating," the MP pointed out. Why not mount a similar information campaign about cousin marriage? A few months ago, a second MP echoed this argument and was rebuked by the prime minister's office.
The actual risk-multiplication effect of cousin marriage isn't clear. A study I cited six years ago concluded that having a child with your first cousin increased the risk of a significant birth defect from about 3-to-4 percent to about 4-to-7 percent. Wilkinson cites data showing that "since 1997 there have been 902 British children born with neurodegenerative conditions and 8% of those were in Bradford which only has 1% of the population." This appears to be the basis for Sample's report that "rare inherited brain disorders are eight times higher among Pakistani children born to married cousins than those born to unrelated parents." But Wilkinson adds that Australian geneticist Alan Bittles, supposedly the top expert on this subject,
has collated data on infant mortality in children born within first-cousin marriages from around the world and found that the extra increased risk of death is 1.2%. In terms of birth defects, he says, the risks rise from about 2% in the general population to 4% when the parents are closely related.
If Bittles' numbers are correct, they substantiate a somewhat embarrassing point made by defenders of cousin marriage. Embarrassing, that is, to all of us good Western folk who turn up our noses at the practice. The British Down's Syndrome Association has posted a chart showing the risk of producing a baby with the syndrome at various maternal ages. From age 20 to age 31, the risk doubles. From 31 to 35, it doubles again. From 35 to 38, it doubles again. From 38 to 41, it more than doubles again. Each delay multiplies the risk as much as cousin marriage multiplies the risks of all birth defects combined. By age 45, the probability of Down syndrome alone roughly matches the 4 percent cumulative risk of birth defects from cousin marriage.
Which brings us to the Elizabeth Edwards question. As Suz Redfearn reported in Slate four years ago, Edwards gave birth to her two youngest children, Emma Claire and Jack, when she was 48 and 50. Redfearn thinks Edwards used donor eggs. Edwards won't say. If Edwards used her own eggs, the Down syndrome chart puts her probability of the disease at 1 in 11 for Emma Claire and 1 in 6 for Jack. That's two to four times the risk of any birth defect from cousin marriage.
Should women be allowed to have babies well into their 40s? If so, how can you justify restrictions on cousin marriage? For that matter, what about sibling incest? Theoretically, given a pool of recessive disease genes, reproducing with a sibling instead of a first cousin quadruples the risk of defective offspring. This probably overstates the actual effect, since population studies don't show quadrupling as degrees of consanguinity increase. But even if the birth-defect rate is a worst-case 17 percent, that's no higher than the risk of Down syndrome at the age when Elizabeth Edwards had her fourth child.
For what it's worth, it looks as though Britain may take a middle course: no legal restrictions on cousin marriage, but no indifference, either. Bittles and others are proposing to reduce birth defects through counseling, genetic screening, and public education in communities that practice cousin marriage.
My guess is that this is how governments will manage unconventional sex practices in the next century. We can't stop people from doing what they want to do. We'll tell them what's generally dangerous. And if they can adequately reduce the medical risks, by wearing a condom or taking a genetic test, we'll look the other way. We'll speak the language of science, or none at all.
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The decisive battles in American culture wars often take place in the armed forces. That was true of racial integration decades ago, and it's true of homosexuality today. Now it's happening to mental health. If psychiatric disorders end up being culturally accepted as medical conditions, with all the attendant insurance coverage and workplace protections, the decisive player in this revolution will probably be the military.
The transition is taking place in three steps. First, mental illness has to be destigmatized. As Yochi Dreazen reports in the Wall Street Journal, this is already underway: Defense Secretary Robert Gates has changed department rules so troops with PTSD can seek counseling without losing their security clearances.
The next step is to treat mental illness like physical illness as an insurance matter. This is harder, because it's expensive. Dreazen reports that legislation in the Senate would take this step by opening Veterans Administration facilities to active-duty troops with psychiatric problems. The bill's architect argues that the expense is worth it because soldiers' mental wounds, like their physical wounds, can be fatal. Specifically, post-traumatic stress disorder (PTSD) can lead to suicide.
Now there's talk of a third step: awarding the Purple Heart for psychic wounds. Dreazen notes that earlier this month, Gates called it "an interesting idea" and "clearly something that needs to be looked at."
The argument against expanding eligibility for the Purple Heart is that mental wounds, unlike visible physical wounds, can be faked. Or they can be unrelated to combat, even if the affected service member thinks they are. In response, proponents of the change point out that PTSD is an officially certified disorder and that research has linked it to combat incidents.
The debate won't be settled overnight, any more than integration or homosexuality were. That's because the medicalization of mental health is in part a social issue. Yes, it's medical. But it's also defined and complicated by the problem of invisibility. You can't see psychic wounds the same way you can see physical ones.
Fortunately, science has already encountered and worked through this problem in other contexts. We can't see molecules, but we can measure their effects and correlate their existence with physical conditions. The same should be true of mental illness, even if the variables and data are far more complicated. My guess is that as research progresses, it will satisfy neither side. We'll find that PTSD is as real as any visible wound but that, like attention-deficit hyperactivity disorder, it's also widely overdiagnosed.
So let's be careful with the Purple Heart. People who want to award it for psychic wounds argue that this will eliminate stigma and encourage counseling. That's the wrong way to look at it. The Purple Heart isn't a policy instrument. It's an honor. In the words of George Washington's original order, it denotes "meritorious action." And honor isn't the first step in a cultural transformation, no matter how worthy that transformation may be. It's the last.
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The genetically engineered humans are here! The genetically engineered humans are here!
I didn't believe it when I heard the report was in the Sunday Times of London. This, after all, is the paper that butchered the gay sheep story and can't find any evidence to back up its disputed paraphrases of James Watson. But the original report, which the Sunday Times neglects to mention, turns out to have been published in a scientific journal, Fertility and Sterility. It's titled, "Genetic modification of preimplantation embryos and embryonic stem cells (ESC) by recombinant lentiviral vectors: efficient and stable method for creating transgenic embryos and ESC."
For those of you who don't have access to the pricey journal, the New York Times boils down the experiment: Scientists "put a gene for a fluorescent protein into the single-celled human embryo," and "after the embryo divided for three days, all the cells in the embryo glowed."
What's new in this experiment isn't genetic modification of humans. We've already done that in limited doses, through the same viral technique. What's new is that because this was a single-celled embryo, every cell it went on to produce, including egg and sperm cells, would (except for the diploid-haploid transition, which gets complicated) carry the same genetic tweak. If the embryo were implanted and grew into an adult, its fluorescent gene would be passed down like any other. This is called germline modification. If you wanted to transform our species or give your offspring an advantage that persists through generations, this is how you'd do it.
Naturally, genetic watchdog groups are freaked out. Human Genetics Alert calls it a prelude to "eugenics" and "designer babies" and demands an "international moratorium on such experiments." The Center for Genetics and Society says it "could push us toward a GATTACA-like world" dominated by "the genetically enhanced."
The scientists, based at Cornell University, offer several responses. First, they used no U.S. federal funds, so no legal restrictions were violated. Second, the gene conveyed no enhancements; it was just a green "marker" to help them see whether it was replicated in subsequent cell divisions. Third, the experiment "was done on an embryo that was never going to be viable," due to pre-existing chromosomal defects. Fourth, they destroyed the embryo after five days, as required by a Cornell review committee.
The watchdog groups are alarmed because Britain's parliament is presently debating legislation to lift restrictions on human embryonic genetic modification. (See yesterday's post about the bill's pregnant-man loophole.) But proponents of the legislation point out that the law would still ban growing such embryos beyond 14 days or transferring them to a womb.
When you line up the points made by scientists and liberalizers, it's easier to understand what's really going on here. It's not that we're plowing unimpeded toward genetic engineering of children. To the contrary, we've drawn lines to prevent that: the 14-day limit and the no-implantation rule. What's going on is that by drawing these lines, we've created a zone where virtually no legal or moral rules apply. Look at the American and British treatment of cloning, and you'll see the same pattern. You can clone embryos, mix species, and engineer all you want, as long as you don't implant the embryos or grow them beyond 14 days.
Maybe this system will allow us to make important scientific discoveries and conquer diseases without crossing the lines we've drawn. On the other hand, maybe it'll turn embryos into a testing ground for techniques that we'll use for people-engineering when we're ready to go there. Or maybe we'll relax the rules a bit at a time, extending our techniques to more advanced embryos as we test and refine them. We'll tell ourselves that we're curing genetic diseases in the womb so that babies and their babies will be born healthy.
The argument for the latter scenario is that, far from being diabolical, the idea of loosening the 14-day rule makes a lot of sense. The Cornell scientists point out that genetically modified embryos "could be used to study how diseases develop" and that "in order to be sure that the new gene had been inserted and the embryo had been genetically modified, scientists would ideally need to grow the embryo and carry out further tests." The longer you grow the embryo, the more you learn.
How long could we grow genetically modified embryos if we lift the 14-day rule? According to the New York Times, "A spokesman for the National Institutes of Health said the Cornell work would not be classified as gene therapy in need of federal review, because a test-tube embryo is not considered a person under the regulations." Roughly speaking, U.S. law confers personhood at viability. That's five months or so. Plenty of time for good work to be done.
I don't mean to make this scenario sound imminent. But as we ease ourselves into the world of genetic engineering, let's notice what we're doing. We're chalking off a zone where the ethics of human manipulation don't apply, on the grounds that the human entities we're manipulating aren't human beings. Seven years ago, scientists and supportive ethicists set up a similar ethics-free zone based on origin: Human embryos produced by fertilization were protected, while those produced by cloning were fair game. Now we've shifted to lines based on age and location.
Will these lines hold? You can't dismiss the fear that they won't as slippery-slope nonsense from the anti-abortion crowd. Embryo research is fundamentally different from abortion. If you're a woman with an unwanted pregnancy, you have no incentive to prolong it. But if you're a scientist with an embryo modified for research, you have lots of good reasons to keep growing it and studying it. The only things holding you back are your conscience, your review board, and the law.
Here's my prediction: We won't end up extending species-mixing beyond the 14-day line. Nor will we end up deliberately growing embryos past that point for harvestable tissue, as I previously speculated. But we will extend germline genetic engineering all the way through pregnancy and beyond, and our grandchildren will wonder why it was ever controversial.
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Today I've been reading up on the trans-Atlantic news about a genetically modified human embryo. I'll have some thoughts on that shortly. In the meantime, while reading Britain's Human Fertilisation and Embryology Bill as part of my research, I noticed what might be a loophole. I'll point it out here, since the bill is being debated by the British parliament right now.
The bill proposes to lift previous restrictions on tinkering with human embryos. To reassure critics and the public, it promises to prevent altered embryos from growing into people. Here's the relevant legislative language:
No person shall place in a woman—
(a) an embryo other than a permitted embryo (as defined by section 3ZA), or
(b) any gametes other than permitted eggs or permitted sperm (as so defined). ...
No person shall place in a woman—
(a) a human admixed embryo,
(b) any other embryo that is not a human embryo, or
(c) any gametes other than human gametes.
Now, here's my question: Is Thomas Beatie a woman? Here's his first-person account, published seven weeks ago in the Advocate:
I am transgender, legally male, and legally married to Nancy. ... Sterilization is not a requirement for sex reassignment, so I decided to have chest reconstruction and testosterone therapy but kept my reproductive rights. ... I always wanted to have children. However, due to severe endometriosis 20 years ago, Nancy had to undergo a hysterectomy and is unable to carry a child. ... [So] I stopped taking my bimonthly testosterone injections. ... My body regulated itself after about four months, and I didn't have to take any exogenous estrogen, progesterone, or fertility drugs to aid my pregnancy.
How did he get pregnant? By using donated sperm, as millions of women have done. He reports:
On successfully getting pregnant a second time, we are proud to announce that this pregnancy is free of complications and our baby girl has a clean bill of health. ... Despite the fact that my belly is growing with a new life inside me, I am stable and confident being the man that I am. In a technical sense I see myself as my own surrogate, though my gender identity as male is constant.
Beatie says his initial attempt at pregnancy produced ectopic triplets, which cost him a fallopian tube and could have killed him. So he has good reasons to do IVF and screen his embryos. Suppose doctors find a genetic flaw in his next embryo and can fix it. That's human germline modification. The British bill says the altered embryo can't be placed in a woman. But under the law, Beatie isn't a woman. He's a man.
I'll let you lawyers sort it out. But it sure looks like a loophole to me.
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If you've been thinking lately about how to dispose of your corpse—and I know I have—there's good news. You may soon have a new option: being dissolved in lye. Well, let's not call it that. Let's call it "alkaline hydrolysis." According to AP reporter Norma Love (what a byline!), the process leaves a "brownish, syrupy residue":
It uses lye, 300-degree heat and 60 pounds of pressure per square inch to destroy bodies in big stainless-steel cylinders that are similar to pressure cookers. ... In addition to the liquid, the process leaves a dry bone residue similar in appearance and volume to cremated remains. It could be returned to the family in an urn or buried in a cemetery. The coffee-colored liquid has the consistency of motor oil and a strong ammonia smell. But proponents say it is sterile and can, in most cases, be safely poured down the drain, provided the operation has the necessary permits.
I know it sounds bad. Lye is what we use to dissolve dead animals, and. over the years, mass-murdering dictators have given it a bad name, using it to torture people and get rid of bodies. But think of the benefits: "Alkaline hydrolysis doesn't take up as much space in cemeteries as burial. And the process could ease concerns about crematorium emissions, including carbon dioxide as well as mercury from silver dental fillings."
Oh, and in case you're worried about ending up in your grandkids' water supply:
George Carlson, an industrial-waste manager for the New Hampshire Department of Environmental Services, said things the public might find more troubling routinely flow into sewage treatment plants in the U.S. all the time. That includes blood and spillover embalming fluid from funeral homes.
Given the alternatives -- incineration, rotting, being eaten by worms—is it really so bad?
No wonder the life-exit industry is so excited. Funeral Service Insider (yes, that's a real publication) calls it a "game-changing technology." Those funeral directors -- what a riot.
But, wait, there's a problem. Opponents in New Hampshire are trying to ban the practice before a local funeral home starts using it. A spokesman for the local Catholic diocese tells Love: "We believe this process, which enables a portion of human remains to be flushed down a drain, to be undignified."
Undignified?
Hey, I'm all for human dignity. When it comes to hand-wringing about messing with the human body, me and Leon Kass are like this (holds two fingers together). (That's a joke for all you liberals, libertarians, and transhumanists.) But, hey, c'mon. We're not talking about live bodies here. We're talking about dead ones.
Let's be serious. The more we learn and think about biology, sentience, and intelligence, the more we're going to have to rethink the relationship between "human" and "dignity." On the one hand, stem cells and other technologies, such as bio-artificial organs, will force us to ask whether human parts deserve the kind of respect we accord to whole human beings. On the other hand, discoveries about animal intelligence will force us to rethink the sharp line we've drawn between our species and others. Does a dead human deserve more respect than a live pig?
I won't even to try to answer that today. But feel free to go at it yourself.
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The war on junk food is forging ahead. New York, Philadelphia, and Boston have banned trans fats. New York is forcing restaurants to post calorie counts. Britain has outlawed junk-food ads during kids' TV shows. South Korea's capital has banned soda from schools. Berkeley and other jurisdictions have prohibited new fast-food restaurants in certain neighborhoods, and last year, Los Angeles considered doing the same.
When I first outlined this crusade, I said it would rely on three arguments: that we should protect kids, that fat people are burdening the rest of us, and that junk food isn't really food. All of those arguments are certainly in play.
But a fourth argument has joined the mix as well: Junk food, like cigarettes, is addictive and should be similarly regulated. Initially, this was just a metaphor. Now it's becoming more than that. Scientists are trying to show that food literally addicts you like drugs.
Two days ago, Alain Dagher and colleagues from the Montreal Neurological Institute published a study in Cell Metabolism on the effects of ghrelin, a hormone associated with appetite. They concluded that "metabolic signals such as ghrelin may favor food consumption by enhancing the hedonic and incentive responses to food-related cues." The word addiction never appears in the journal article, but it's all over the spin and the coverage. Here are excerpts. Keep an eye on the phrases I've bolded.
First, the press release from Cell Metabolism:
The reward centers linked to ghrelin in the new study are also those involved in drug addiction. "That shows it's reasonable to think of high-calorie food as having addictive potential," Dagher said. If so, he suggests that the results could provide the basis for new policies aimed at treating fast food more like cigarettes—for instance, banning its sale in school cafeterias.
Here's the press release from MNI:
The study supports the view that obesity must be understood as a brain disease and that hunger should also be looked at as a kind of food addiction. Obese individuals may eat too much largely due to excess hunger. Dr. Dagher and colleagues found that ghrelin worked on regions of the brain known to be involved with reward and motivation, the same regions implicated in drug addiction. ... "These areas work together to assign incentive value to objects in the world and to actions, and exert very powerful control over our behavior. They are all targets of addictive drugs (like cocaine and nicotine), and are also targets of feeding signals like ghrelin," explains Dr. Dagher. ... This research may also inform public policy. If food is thought of as potentially "addictive," this would support action to limit or ban fast food from schools and junk food advertisements geared toward children, in the same way that results proving nicotine to be addictive spurred the current public policy toward nicotine.
In the Telegraph of London, Dagher links tobacco, cocaine, and chocolate:
Interestingly, the brain response to smoking pictures (in smokers) is very similar to the brain response to food pictures. In a previous study from our research unit, the brain response to eating chocolate was similar to the response to cocaine (in cocaine addicts). Finally, the evidence that high calorie foods are, in a way, addictive (something soft drink and fast food merchants have known for years) provides a justification for public policy.
In fact, Dagher suggests that food addiction may be the basis for drug addiction, rather than the other way around. Here's his interview with LiveScience:
"One theory is that addictive drugs act on brain systems designed to control food intake," Dagher said. "Our brains didn't evolve to make us vulnerable to addictive drugs." Neuroscientist and psychologist Dana Small at the John B. Pierce Laboratory affiliated with Yale University, who did not participate in this study, said these findings suggest it might make sense "to use what we know about drug addiction to understand and treat obesity." It may be reasonable to think "of high-calorie food as having addictive potential," he added. "If food can be thought of as 'addictive,' this supports doing things like banning fast food shops from schools, or advertising junk food to children. Note that public policy aimed at tobacco was really spurred by the science showing that nicotine was addictive."
In a HealthDay wire story, Dagher combines the addiction and harm arguments to make a direct case for regulating food like tobacco:
[I]t makes sense to think of appetite as a kind of addiction. So, if we want to address the fact that obesity is now the number one killer in the world, we're going to have to tackle the problem in the same way that we tackle cigarette smoking.
Scientifically, the evidence for food addiction isn't nearly this simple. Endocrinologist Barbara Kahn points out:
Overeating and drug addiction may converge on some of the same neurons. But other pathways are also involved. And from a biochemical point of view, the two are not the same thing. Drug addictions are much stronger. So to suggest that they are the same makes people feel that they can't do anything about overeating. That it's out of their control. So, I don't really buy that parallel. There may be aspects of overeating that may be related to aspects of addiction. But overeating is not just another addiction.
As a scientific matter, I suspect that Kahn is right and that Dagher is overselling the data. But as a media matter, simplicity beats complexity, and a good metaphor wins every time. Just look at the headline on New Scientist‘s report: "Stomach hormone turns hungry people into junkies."
As neuroscientists focus their attention on obesity, you can expect to see more studies comparing food cravings to drug addiction. As these studies accumulate, you can expect to hear them cited in campaigns to regulate junk food. But the people pushing this analogy had better hope the science is exaggerated. Because if we really do crave junk food the way addicts crave drugs, good luck prying those cheeseburgers from our hands.
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If I had a nickel for every time I've read the word "robot" in a headline about new technology, I'd ... well, given the current price of metals, I'd melt down all those nickels, sell the ingredients, and become a very rich man. Journalists and PR people use the word "robot" to mean anything from HAL to a remote-controlled toy car. Actually, robots come in various degrees. The revolution we're seeing in mechanization isn't so much in the proliferation of robots as in their increasing autonomy.
Case in point: Two stories from this morning's news batch.
First we have an AP story about a "Bum Bot" designed to disperse vagrants from an iffy neighborhood in Atlanta. It belongs to Rufus Terrill, a local bar owner and ex-Marine. The story says Terrill used to patrol the area on foot, but "guns were stuck in his face several times. His wife suggested he patrol a safer way - using a robot." In the AP photo, the robot looks like a small tank, about half as tall as Terrill. It weighs 300 pounds and has a camera and water cannon. (Terrill says he's never used the cannon.) The robot's exterior has been "nicked by rocks, bricks and other objects people Terrill was rousting have thrown at it."
The point of the robot, it seems, is to take the physical risks formerly taken by its human owner. Any guns that might previously have been stuck in his face now have to be pointed at his tank instead, which doesn't have quite the same effect. There's no report of the tank having been shot, but, as the story says, it has taken its share of rocks and bricks. That's fine. It's part of the plan. Sticks and stones may break my drones, but they can't hurt me.
In this way, the Bum Bot is a lot like the thousands of drones currently deployed by the U.S. military. The enemy can't kill American soldiers who patrol war zones from a safe distance via remotely-operated unmanned vehicles.
The tricky thing about drones, as I've noted before, is that they can desensitize you to the battlefield. I mean literally desensitize you: Your physical senses have no direct contact with what you're looking or shooting at. Can the same thing happen to civilians who use private security drones at home? Apparently so. "It's just like a video game," says Terrill, describing how he operates the Bum Bot. The Atlanta police warn that he might be prosecuted if he uses the water cannon. But there's no such constraint on the use of drones in Afghanistan, Pakistan, or Iraq.
The chief constraint on the Bum Bot isn't legal or moral. It's technological. The Bum Bot isn't really a robot. It's controlled entirely by the handheld remote, and it has no voice other than Terrill's, which he projects through an integrated walkie-talkie. Without constant human direction, the machine does nothing.
If you want to get closer to the cutting edge of robotics, so to speak, you're better off looking at a technology that's already well-commercialized: robotic lawn mowers. Today's New York Times salutes a new product, the Kyodo LawnBott LB3500, which mows your lawn by itself. Here's the manufacturer's description:
It operates automatically, and autonomously by means of its intelligent computer and a perimeter cable. It can move freely within an enclosed area, detecting the faint signal transmitted by the perimeter cable located on the ground, defining the areas to be mowed; it can also work without a perimeter cable as working area is enclosed by a fence or small border at least 4 inches tall. ... [I]t leaves its docking station and starts mowing your yard in a random direction. It will mow in a straight line until it bumps into an obstacle, such as a tree or flower pot, or until it runs over its perimeter cable, then it stops, backs up, turns and takes off again.
Well, at least it needs a human to recharge its batteries, right?
Wrong. The company explains:
When the batteries start running low, or at the end of its cutting cycle, the mower will search out the perimeter cable and follow it back to its docking station to recharge. After charging, it heads back out on its own! ... With the new LawnBott, you have One Less Thing to Worry About.
Well, yes. But you also have one more thing to worry about: Your lawnmower running amok while you're at the office. No human hassle means no human control.
Kyodo says the LB3500 comes with enhanced safety features: "a higher sensitivity, free-floating, 360° bumper shell, blade stop proximity sensor, and an on-board alarm system should an unauthorized user pick up the Lawnbott." Still, we're talking about a slicing machine that runs around by itself and can't even be stopped by power depletion. LawnBotts.com points out that "robotic lawnmowers are many times safer than its manual counterparts just because you eliminate the human needing to be around it while it's operating." This is the same sense in which military drones are safer than manned vehicles and weapons: They protect their owners. But if you're not the owner, look out.
In the AP story about Terrill's bar, some of the locals complain that the Bum Bot is "intimidating." They have no idea what's coming.
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I'm digging out after returning from a Pew Forum conference. I'll try to give you some highlights of it later. For now, I'll just pass along my favorite quote, from Penn Prof. Andy Newberg, on his terror of doing brain scans on people speaking in tongues: "Part of the problem is that I have to know when to give these people this injection of radioactive material."
See? Neuroscientists are just normal folks like us.
Just giving Andy a hard time. His work on meditation, religion, and the brain is really cool. Plus, he was fun to hang out with. Plus, he has this awesome prom photo.
I'm thinking of instituting a quick daily post that at least highlights some of what's most worth noting from the morning news batch. In this case, I've led with two items about food addiction and regulation. We have a study that compares the brain effects of food to the brain effects of addictive drugs, and we have a report on the first citations issued to restaurants for violating New York City's new law that requires posting of calorie counts for menu items. The important trend to notice is that scientists are moving to substantiate the case for regulating junk food like drugs. The comparison is no longer just metaphorical. It's becoming literal.
We also have a couple of surveys designed to show that other kinds of addiction are uncomfortably widespread: hookah use among college students, and gambling among young people. You can see how the idea of addiction is spreading from substances to behavior.
But -- oops -- we also have a study that shows the limits of controlling drug use through culture, since early use, at least in the case of alcohol, is influenced by genes.
We'd better figure out how to rationally classify which substances are drugs and which aren't, and which drugs are worse than others, since differential enforcement for different drugs in different neighborhoods is raising questions about official racism.
Shifting gears to neurotech: A report on Medtronic, a leading maker of implanted medical devices, illustrates that the brain is increasingly being treated as just another organ that's sometimes in need of electrical intervention.
Today's Catch-22: If you've got mental illness in your family, beware. It can double the risk of autism in your biological children. But if you're thinking of adopting instead, beware again: Adoption can double a child's risk of disruptive behavior disorder. In medicine, the grim joke is that everything gives you cancer. In psychology, I'm starting to get the weary feeling that everything gives you mental illness.
Also, keep your eye on stem-cell technology that mimics the human body. This was the theme of a series I wrote three years ago: To make tissues grow as they do in the human body, you need to supply living environments that resemble the body. The twist is that this work becomes increasingly creepy as we replicate in the lab more and more of what we previously regarded as living creatures.
Finally, don't miss today's study of pregnancy discrimination. Looks to me like classic meaningless soft science, simultaneously complaining that women who looked pregnant suffered "hostility" in some cases and "overfriendliness" in others.
I realize this kind of quick roundup can't substitute for a more thorough post or piece, but I hope it at least sheds some light on the news of the day, which otherwise might go unremarked. It's an experiment. Let me know if you'd like to see it instituted as a regular thing, or not.
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A week ago, I crunched some data and concluded that suicide bombing, despite its brutal rationality as a weapon, had not increased in recent years outside of Iraq, Afghanistan, and Pakistan. Many of you pointed out that this was one heck of a caveat. The number of attacks inside those countries is appalling and has been increasing.
Now there's a new twist to the trend in Iraq: Many of the people blowing themselves up are women. According to Farhana Ali, a former U.S. adviser who presented data at a Washington conference yesterday, women executed 12 suicide attacks in Iraq during the first four months of this year. That's already more than the number of such attacks executed by women in Iraq over the previous five years.
In an interview with Agence France Presse, Ali blames this trend on male violence and the invasion, which she says has widowed many women and "marginalized" others. But then the AFP story gets to the really interesting point:
Ali warned that U.S. soldiers face a cultural barrier in detecting women bombers. "A marine officer coming back from Fallujah said to me: 'How are we supposed to detect these women if we are taught before we are deployed to not even look at them?'" she explained.
And here's Ali's solution: "If you want to gain entrance into female jihadi organisations, you need female case officers. You need female police officers. You need women in Iraqi law enforcement."
Suicide bombing has always exploited common disbelief about what people will do: You don't expect somebody to walk into a market and blow himself up. Nor do you expect him to take 20 or 30 civilians with him for no apparent reason. Why shouldn't this tactical exploitation of disbelief extend to sexism? You certainly don't expect somebody to blow herself up, much less kill a bunch of innocents.
This is one of the lessons terrorism will gradually teach us: Stereotyping is an exploitable security weakness. To overcome it, we'll have to overcome our sexism about women in the military and in law enforcement, as well as our sexism about women in crime and terrorism. If the moral faults of such stereotypes aren't enough to make you push them aside, do it for your country.
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Housekeeping note: If you haven't bookmarked the Human Nature home page, I recommend it. It always has the best and freshest news from around the Web in easy-to-click format. Everything I discuss here, plus the stuff I can't get to, is posted there first. So are links to all the latest Human Nature essays and blog items. If you don't have it bookmarked, and the Slate URL is too hard to remember, just type humannature.us.com.
Here's one story you'll find there and in this morning's news batch: U.S. surgeons have begun the long process of repairing a 15-year-old Filipino girl, Jingle Luis, whose feet are so clubbed that they've twisted upside down and backward. The AP story explains:
Jingle's case is more severe than those usually seen by doctors in industrialized countries. "Generally speaking, with modern technology, it doesn't get to this point," said Dr. Terry Amaral, a pediatric orthopedic surgeon who performed the surgery. ... Clubfoot is a relatively common deformity, occurring in about one in 1,000 births. Children are usually treated in infancy with casts or braces that gradually bring the feet into correct alignment. The condition becomes harder to treat if it is not corrected early on.
It sounds like Jingle wasn't treated as a baby because the Philippines lacked the necessary technology. But that's not what happened. Read further:
Amaral said Jingle's case was complicated by the fact that her clubfoot was associated with spina bifida. ... He said doctors who saw Jingle as a baby thought that her spina bifida would shorten her life span and prevent her from walking, so they did not treat the clubfoot. "They felt it wasn't worth managing because of the life expectancy, so they decided to leave it alone," Amaral said.
This is a major factor in treatment decisions around the world. Often, the problem isn't that doctors in less-developed countries can't fix you. It's that resources are limited and that in this context, life-expectancy projections come into play.
In Jingle's case, doctors misjudged the severity of her spina bifida. If she'd been born in the U.S., it's likely that her doctors would have recognized that the defect wasn't so bad. But it's also likely that they would have calculated her prospects differently altogether. That's because life expectancies differ significantly between rich and poor countries, and life expectancies for infants with significant health problems differ even more. Life expectancy isn't a purely biological calculation. It's a socioeconomic calculation.
The interplay of economic progress, life expectancy, and treatment decisions doesn't end in childhood, or with the case of one disabled girl. In fact, it's going to be one of the most powerful forces driving the world in this century and beyond. Thanks to economic and technological progress, life expectancies are rising around the world. Some of this is due to reductions in child mortality. But a lot of it, if not most, is due to increases in the length of old age. As we conquer diseases and improve public health, people in India, China, and elsewhere can expect to live many years longer. That, in turn, is transforming calculations about which conditions are worth treating. If the average woman in Shanghai is probably going to make it to 75 instead of 65, a disease that strikes her at 60 and would take five years to kill her becomes, in utilitarian terms, a disease worth treating.
What's happening, in short, is an increase not just in our technological ability, but in our moral expectations. It's a wonderful thing. But it's going to be incredibly expensive.
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How do you feel about mass-producing and selling human tissue in machine form? I hope you like the idea. Because it's on the way.
A few days ago, the University of Michigan trumpeted a study validating the efficacy of its "bioartificial kidneys." In a clinical trial involving people with acute renal injury and failure, the kidney boosters cut the usual death rate (compared to patients using conventional "continuous renal replacement therapy") from two in three patients to one in three.
Pretty amazing. But just what is a "bioartificial" kidney? Here's U-M's description:
The bioartificial kidney includes a cartridge that filters the blood as in traditional kidney dialysis. That cartridge is connected to a renal tubule assist device [RAD], which is made of hollow fibers lined with a type of kidney cell called renal proximal tubule cells. These cells are intended to reclaim vital electrolytes, salt, glucose and water, as well as control production of immune system molecules called cytokines, which the body needs to fight infection. Conventional kidney dialysis machines remove these important components of blood plasma, along with toxic waste products, and cannot provide the immune regulation function of living cells. Initial testing in animals ... found the cells in the RAD perform the metabolic and hormonal functions lost in acute renal failure.
This is the point I've made in recent posts about biological pacemakers and limb regeneration. Prosthetics are nice, but flesh is better. That's why the U.S. Army is now funding tissue regeneration. Instead of trying to reengineer everything in biology, we're learning to borrow, cultivate, and replicate it. Let Mother Nature do the work: She already knows how to filter toxins while keeping what your body needs and regulating your systems.
David Humes, the professor behind the U-M study, is also the scientific founder of the company that's preparing to commercialize the RAD. He envisions the new paradigm this way:
[T]he nature of our new approach -- using living cells as therapeutic agents -- argues for the feasibility of developing whole classes of new cell-based and tissue engineered therapies. The ability to harness vital processes of cells, to target their living molecular machinery on restoring critical substances which have become disordered by disease, has vast implications for the future of medicine. The apparently successful use of living cells in this way validates our approach and should encourage others to investigate cell therapies for a range of disorders.
Technologically, this is a sensible and powerful idea. It will save lives. But as an inflection point in our thinking about human flesh, it's, well, pretty RAD. What we're getting into is not just the commercialization but the mass-production of body parts. It's a bit like PETA's campaign to commercialize lab-grown meat -- except that in this case, the meat will be human.
Where do we get the cells in the cartridge from? According to the American Society of Nephrology, they're "grown from donor kidneys." So we're starting with somebody's donated organ. Instead of transplanting it to one person, we're growing cells from it, which can then be farmed out to multiple patients. We're not just distributing the cells; we're incorporating them into what U-M calls a "living cell cartridge." It's bio -- it's artificial -- it's bio-artificial.
Like lab-grown meat, the living tissue in the cartridge may run into spoilage problems. U-M notes that its researchers are still working on the "challenges of mass producing, storing and shipping a living-cell device." But the goal, according to the nephrology society, is definitely "mass production." And the next step will be to repackage it as a "wearable kidney that performs natural functions unachievable through man-made technology alone." Real flesh, grown from somebody else, mass-produced, packaged into a cartridge, and worn on your body. Good luck sorting the bio from the artificial.
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I'm working on a post about bio-artificial organs for later this afternoon. In the meantime, I want to call your attention to a related item in this morning's news batch: a report in New Scientist about plastic red blood cells.
First of all, can I just say: I love New Scientist. It's one of the coolest things you could spend your time reading. They do just about the world's best job of keeping tabs on the latest far-flung developments in science. Believe me, I've been trying to do this for a month, and it's incredibly hard. It's not like politics, where everybody agrees on central characters and a narrative, like Hillary's latest photo op or what Obama ate for breakfast. You really have to scan the horizon and stay on your toes.
In this case, NS reporter Justin Mullins has flagged a patent application for plastic blood cells. If you get malaria or sickle-cell anemia, your red blood cells lose the agility to pass through small blood vessels. Wouldn't it be great if we could give you artificial blood cells to do the job? The patent application proposes exactly this: tiny "sacks" made of a chemical that's biologically harmless and binds easily so it can carry oxygen or carbon dioxide. Experiments in mice look OK so far.
The idea of having little plastic sacks pumped into your bloodstream sounds pretty freaky. We're talking about filling you with petroleum products in a way that challenges the meaning of "flesh and blood." For all I know, further animal or human testing may find unforeseen health risks from this kind of mixture, particularly at such a small scale and with such pervasion of the body. But if the technology turns out to be safe, it'll go a long way toward loosening our concept of ourselves as biological creatures.
So much for artificial technology replacing biology. Next, we'll talk about the reverse.