Human Nature

Heartless Pigs

2008-07-25T11:45:00Z

Last week, during the discussion of Spain's new animal rights legislation, I pointed to an article by Donald McNeil Jr. in the July 13 New York Times. McNeil asked whether the most advanced animals, the great apes, deserved the "most basic right—to not be killed for food." My answer was yes. In fact, I'd argue—hypocritically—that it's wrong to kill animals for food, period. It's brutal and unnecessary.

But let's make the question a bit tougher for you animal lovers. Is it wrong to grow and kill animals for transplantable tissue?

I ask because a report out of England this week suggests that animals may become a rich source of tissue for repairing human bodies. "Currently, the use of animal tissue for human transplant is restricted, and of limited effectiveness," the BBC observes. The Daily Telegraph explains why:

Surgeons have been able to transplant heart valves from pigs into patients for more than a decade, but these have a limited life span as they do not become populated by the patients own cells and are unable to repair any damage, meaning they must be replaced every 10 years. For young patients this poses a particular problem as the valves do not grow with the child and so must be replaced frequently.

But scientists now think they may have figured out a solution. Professor John Fisher, a biological engineer at the University of Leeds, explains the method they've been successfully testing:

We can take a tissue from an animal, remove all the cells that carry the signals that trigger the immune system so just the biological scaffold is left. When this is implanted, the patient's own cells then grow in to replace the original cells we have removed. This has advantages as the transplant can then grow with the patient. ...

The patient's own cells then grow in. The transplant can then grow with the patient. I hope you "human dignity" fans on the right realize the import of what he's saying. He's talking about an animal tissue structure incorporating human cells and growing inside a human body. The code words are recellularization (PDF) and in vivo regeneration. In other words, interspecies integration. You can read all about it at the Web site of Fisher's company, Tissue Regenix.

But the harder question is for animal rights advocates. Fisher and his colleagues are collaborating with a British agency "to develop the technique so they can create new heart valves for children," the Daily Telegraph reports. Their research "opens the way for a range of new procedures using animal parts." So while tissue regeneration in vivo reduces the need to repeat each transplant, it will apparently increase "use of animal tissue such as blood vessels, tendons and bladders" overall, according to the BBC. The point of all this work, according to Tissue Regenix, is to "address the chronic shortfalls in donor tissue availability."

We're not talking anymore about killing animals for food. We're talking about killing them for transplantable body parts. Animal rights vs. children's lives.

Liberals often challenge pro-lifers with a dilemma: In a burning fertility clinic, you can save either a 5-year-old girl or a tray of 10 frozen embryos. The point of the challenge is to test whether pro-lifers really believe that an embryo is equal to a child. Now animal rights advocates, the pro-lifers of the left, face their own dilemma: save the girl or spare the pig?

Offed With Your Head

2008-07-24T13:31:00Z

The Human Nature article on Slate's cover today is about a military drone-piloting system that looks like a video game but kills real people. You control it with joysticks and buttons. The company that developed it, Raytheon, sees it as a logical progression for recruits who come into the military knowing how to play games like Doom and Halo.

The question is: Will the transition be too smooth? Will these young pilots, reclining comfortably in their "virtual cockpits" in Nevada as their drones fly over Iraq, feel as though they're playing a game?

Now imagine taking this merger of games and killing one step further. Imagine controlling the drone directly with your mind. Imagine firing the missile just by thinking it.

Imagination is a dangerous thing. It can already fire weapons in video games. Here's the report from this weekend's Sunday Telegraph:

British scientists are turning the vision into reality with a device that allows objects to be manipulated with brain waves. The prototype ... can already be used to play simple computer games. By imagining a movement, the wearer of the hat-shaped device can tell the computer to move an object around a screen or a robot around a room. ...
The development came as the video games maker Nintendo disclosed that it wanted to build on the success of the motion-sensitive technology used in the best-selling console, the Wii, by developing games that can be controlled by thought.
To pick up the signal from the brain, the scientists use a cap fitted with electrodes that detect changes in the electrical activity produced by the neurons. When a person wearing the cap imagines a particular action, such as moving a hand, it produces a distinct pattern of signals that a computer learns to recognise.

While Nintendo works on deploying this technology, two other companies are already there, according to the New York Times:

Put on the headset, made by Emotiv Systems in San Francisco, and when a giant boulder blocks the path in a game you are playing, you can levitate it—not by something as crude as a keystroke, but just by concentrating on raising it, said Tan Le, Emotiv's president. The headset captures electrical signals when you concentrate; then the computer processes these signals and pairs a screen action with them ... Emotiv plans to have its noninvasive, wireless EPOC headset ($299) on sale in time for Christmas, Ms. Le said. ... So far, [Emotiv's R&D manager] said, all 200 testers of the headset had indeed been able to move on-screen objects mentally.
Another headset, the Neural Impulse Actuator ($169), just released by the OCZ Technology Group in Sunnyvale, Calif., has three sensors in a headband that pick up electrical activity primarily from muscles and convert it into commands ... Players of shooting games, for instance, may use eye movement to trigger a shot, shaving milliseconds off of their response time and sparing their hands.

Scientific American has more on how the Emotiv headset reads your mind.

So now we're looking at two mergers: mind-controlled action with video games, and video games with killing. Firing weapons with your mind used to be imaginary. Now, like so many imagined things, it's becoming real.

Age, Wealth, and Medicare

2008-07-23T11:59:00Z

Should Medicare pay big bucks to extend people's lives past 100?

I've been noodling that question since Friday, when the New York Times ran a story headlined, "Rise Seen in Medical Efforts to Treat the Very Old." The story focused on a woman who got a pacemaker and defibrillator a month before her 100th birthday, apparently courtesy of Medicare. Estimated cost: $35,000. The doctor who did the surgery "said that he has implanted about two dozen devices like hers in patients 90 or older over the past five years," according to reporter Anemona Hartocollis. Other doctors said they've done similar procedures on patients in their mid- to late-‘90s.

There's going to be a lot more of this, Hartocollis pointed out. Doctors say they're doing more and more bypasses, cancer surgeries, cataract operations, and joint and valve replacements on people 90 or older. The population of U.S. centenarians (people 100 or older) has nearly doubled since 2000. Trends suggest that within 40 years, it could exceed 1 million.

The objection to spending Medicare funds on all these procedures is obvious: The money would be better spent on younger patients.

The rebuttal offered in the Times is that people who survive to very old age are particularly healthy. They've "demonstrated a survival prowess," said one medical expert. "The older you get, the healthier you've been." The implication is that they're worth spending money on because they'll live longer.

I wonder whether this rebuttal looks at the question the wrong way. Suppose we were talking about wealth instead of age. A woman with an unusually large fortune asks for an investment in some project of hers. Her advocate points out that people with lots of wealth tend to have accumulated it through unusual talent or connections and are therefore more likely to get the best return on money invested in them.

We'd see that argument as rewarding and compounding inequality. Why not look at age the same way? Isn't health, like wealth, an unequally distributed asset? Isn't it, in fact, the ultimate asset? And if that's the case, should we means-test people on Medicare not just for wealth, but for age?

Actually, means testing is the wrong term. Age isn't really a means; it's more like an end. So let's call it an ends test. The theory is that just as some people have enough money, others have had enough time.

If you make it to 100 and can fund your own surgery, that's terrific. But Medicare should focus its resources on people who haven't been as lucky as you. Living to 99 is no tragedy. It's a blessing.

Fetal Separation

2008-07-21T11:32:00Z

Starting this week, under orders from the state attorney general and the U.S. Court of Appeals for the 8^thCircuit, medical providers in South Dakota must present a scripted statement to women who seek abortions. The script, dictated by the legislature three years ago, declares that any abortion "will terminate the life of a whole, separate, unique, living human being."

Until now, I wasn't aware that the fetus—a term that, according to the South Dakota law, includes "the implanted embryo"—was a whole, separate, living human being. I thought it was ... you know ... implanted. I mean, I'm just a guy, not really an expert or anything. But, um, placenta? Umbilical cord? Do those terms ring a bell? And that's not even getting to the tricky stuff, like the role of maternal RNA in directing embryonic growth or all the work done by the womb to facilitate the embryo's attachment and nourishment.

I have to say, it's a relief to learn that the embryo is so complete and independent. I mean, it solves the whole problem. Here's this woman who just wants to be separated from her embryo. And lo and behold, it's already separate! No need to agonize. Just detach it and let it grow. It's separate, it's whole, it's living. Cancel the abortion. Perform a separation instead.

Sure, some cranky district attorney might take you to court, claiming your separation was really an abortion. Make sure you countersue for legal costs, because you've got a slam-dunk case. The law under which you're being prosecuted doesn't just declare that embryos and fetuses are separate. It also defines abortion as "the use of any means to intentionally terminate the pregnancy of a woman known to be pregnant with knowledge that the termination with those means will, with reasonable likelihood, cause the death of the fetus."

How can South Dakota claim that you should know separation will kill the fetus, when South Dakota has insisted on informing you, prior to the procedure, that the fetus is already whole and separate?

Don't give me some medical-school mumbo jumbo about obstetrics. The legislature mooted all that blather when it superimposed its judgment. Fetuses are whole and separate. Therefore, being a law-abiding citizen, you have no reason to believe that separation will cause fetal death. Therefore, under the law's terms, separation is not abortion. No need to bother with the onerous paperwork and liability threats the legislature has assigned exclusively to abortion. You're not in the abortion business anymore.

Look, I don't like abortions. Fortunately, neither do the women who ask for them. Most abortions happen because women get pregnant when they're not ready. Prevent the pregnancy, and you prevent the abortion. So, here's a word of advice to legislators like those in South Dakota: Stop withholding birth control and stop lying to women about their bodies. You can't even keep your lies straight. That's how you ended up telling doctors to tell women that separation will kill a separate human being. See you in court.

Crap and Trade, Revisited

2008-07-18T12:43:00Z

Last week, I looked at the economics of pay toilets and argued that the toilets should pay you. In India, a pilot project is cleaning up the environment and trying to generate fertilizer by paying people to use "eco-sanitation" toilets. Meanwhile, American cities are charging people to use expensive, high-tech, energy-consuming Automated Public Toilets (APTs). Does the American approach really make sense?

Now it turns out that in at least one city, we're not even getting nicer toilets for our money. Two days ago, Seattle dumped its APTs. Reason No. 1: They'd been taken over by druggies and hookers. Reason No. 2: They were "less cost-effective than regular public restrooms."

And how. Unlike other cities, Seattle wasn't charging APT users. But the eye-popping number is the cost of its units. The Seattle Post-Intelligencer reports that according to the manufacturer, "A single stall automated toilet now goes for $200,000 to $220,000 plus on-site installation." And that's not even the real number, by a long shot. The total cost to the city, including maintenance, has been about $1 million per toilet.

How can toilets cost that much? Read the reviews. They have "handsfree washing and drying ability and an emergency button that automatically dials 911." They have "automated floor scrubbers" and are "cleaned by jets of water between each use." They have "metal doors that open at the press of a button and stay closed for up to 20 minutes. The units clean themselves after each use, disinfecting the seats and power-washing the floors."

Nice, huh? So how did they get taken over by junkies and prostitutes?

One reason seems to be that Seattle put them in places where that was likely to happen. Another reason could be that the toilets were free. I doubt it, since free APTs on skid row in Los Angeles haven't suffered the same fate. A third explanation is privacy: 20 minutes to yourself in a sealed chamber is perfect for taking care of your next fix or giving a blow job.

The toilets ended up so gross and scary that even homeless people wouldn't use them. One woman supplies this fantastic quote to the New York Times: "I used to smoke crack in there. But I won't even go inside that thing now. It's disgusting."

As a result, the APTs failed at the basic job of any public toilet: curbing outdoor excrement. A city spokesman ruefully tells the Seattle Times: "Even when these restrooms were running, we were still getting reports of people urinating and defecating in public." The spokesman says that at this point, Seattle "doesn't have a plan for providing public-restroom services" and is still "trying to figure it out."

Here's a wild idea: Bag the high-tech fetish. Put up plain old public toilets. That seems to be the lesson from yesterday's New York Times:

Rather than automated toilets, some cities are looking for cheaper alternatives that would be cleaned by human attendants. One prototype, to be installed next month in Portland, Ore., would cost $50,000 each, compared with some $300,000 for an automated unit. Randy Leonard, a Portland city commissioner, helped design that toilet, which in addition has open gaps at the top and bottom of the door, a feature discouraging drug abuse, prostitution and the like. But given that lesser privacy, it is unclear how popular such a toilet might be ...

Sorry, folks: Lesser privacy is the price you have to pay to keep out the druggies and hookers. And human attendants are the price of keeping toilets affordable. For the cost of one APT, you could put up six to 20 of those low-tech Portland units.

Now, if the Indians can just figure out how to monetize the waste, we can start paying users. Eco-san, anyone?

Diets and Reality

2008-07-17T15:04:00Z

There's quite a dustup over the diet study published today in the New England Journal of Medicine. The study reports that for two years, 322 "moderatelyobese" people were assigned "to one of three diets: low-fat, restricted-calorie;Mediterranean, restricted-calorie; or low-carbohydrate, non-restricted-calorie." On average, each participant lost 6 to 10 pounds.

In her New York Times blog, Tara Parker-Pope laments the study's findings. "All it really showed is that dieters can put forth tremendous effort and reap very little benefit," she writes. Her report is headlined, "More Evidence That Diets Don't Work."

Diet guru Dean Ornish disagrees. Writing in Newsweek, he calls the study "extremely flawed" because participants "on the ‘low-fat' diet decreased their total fat intake from 31.4 percent to 30.0 percent, hardly at all." Their diet "was based on the American Heart Association (AHA) guidelines, which I have long criticized as not being enough of a change in diet to show much benefit."

Which writer is correct? Both, and neither. The study's lesson isn't that "diets don't work" or that the only diets worth studying are more radical. The lesson is that there's a tradeoff between results and compliance.

Look at the study's abstract on the NEJM Web site. It begins, "Background: Trials comparing the effectiveness and safety ofweight-loss diets are frequently limited by short follow-uptimes and high dropout rates." Scroll down, and you'll see that the first finding reported isn't average weight loss. It's compliance. "Results: The rate of adherence to a study diet was 95.4% at 1year and 84.6% at 2 years."

In other words, the study was designed in part to measure the cost of making diets easy enough to maintain. The lead author makes this clear in an interview with Parker-Pope:

In order to keep participants on the diet for long term as a way of life, we did not impose extreme diet protocols. More dramatic diet protocols could probably reduce more weight for the short term, but participants would have dropped out.

So Parker-Pope is right that the average weight loss was depressingly modest, and Ornish is right that more radical diets would probably have produced better results. But Ornish is wrong that this amounts to a damning flaw in the study, and Parker-Pope is wrong that it shows "diets don't work." The study set out to see what would happen if people were put on diets that the vast majority of them could psychologically sustain for two years. What happened was that by making the diets sustainable, the researchers made them less potent at reducing weight.

I've said this before, and I'll say it again: Compliance is part of a diet's effectiveness. Unless you plan on jailing people and sliding food under the door, their ability and willingness to adhere to the regimen are crucial factors in whether it works. If you want to complain about flaws in diet studies, complain about the studies with high dropout rates, which conveniently eliminate the real-world failure of diets that reduce weight if perfectly followed but are, for too many people, unsustainable.

This study isn't one of them. The news it brings is bad but important: We have to figure out how to design diets that are both potent and sustainable. We're not there yet.

The Paradox of Discrimination

2008-07-15T13:47:00Z

Look who's flirting with animal rights.

In recent days, the New York Times has published two in-house commentaries on Spain's move to legislate rights for apes. "We like to think of these as absolutes: that there are distinct lines between humans and animals," Donald McNeil, Jr., wrote Sunday. "But we're kidding ourselves." Yesterday, Adam Cohen added that "showing respect for apes would elevate humans."

I agree with my human colleagues. But that agreement is the beginning of a huge mess.

The mess starts when we abandon an old religious idea. "Ten years ago, I stood in a clearing in the Cameroonian jungle, asking a hunter to hold up for my camera half the baby gorilla he had split and butterflied for smoking," McNeil recalls. He remembers the words his guide spoke at the time: "A gorilla is still meat. It has no soul." This, McNeil notes, is the position of Spain's Catholic bishops: Humans have souls; animals don't.

Secular humanists reject this dogma. We understand that there's something wonderful and uniquely worthy of respect in the power, richness, and subtlety of the human mind. But to us, the soul doesn't explain these wonders. It describes them. That's one reason why the destruction of human embryos doesn't torment us the way it torments pro-lifers. We don't believe in ensoulment at conception. We believe in the gradual development of mental capacities.

This puts us in an awkward position. We call ourselves egalitarians, yet we deny the equality of conceived humans. We believe that a woman deserves more respect than a fetus. A 26-week fetus deserves more respect than a 12-week fetus. A 12-week fetus deserves more consideration than a zygote. We discriminate according to ability.

This is also why ape rights appeals to us. It's not a claim of equality among all animals. It's a claim that apes resemble us in ways that insects don't. It's a kind of discrimination. Cohen observes that Peter Singer, the philosopher behind the ape rights movement, believes that "species should be evaluated on a case-by-case basis." And McNeil reports:

In an interview, Mr. Singer described just such calculations behind the Great Ape Project: he left out lesser apes like gibbons because scientific evidence of human qualities is weaker, and he demanded only rights that he felt all humans were usually offered, such as freedom from torture -- rather than, say, rights to education or medical care.

This multi-tiered approach to species and rights isn't just Singer's position. It's your government's position. As Cohen points out, chimps get special protection under the Chimpanzee Health Improvement, Maintenance and Protection Act. McNeil adds:

Even animal cruelty laws have a bias toward big mammals like us. For example, in a slaughterhouse, chickens are sent alive and squawking into the throat-slitting machine and the scalding bath. But under the federal Humane Slaughter Act, a cow must be knocked senseless as painlessly as possible before the first cut can be made.

In other words, as the pigs of Animal Farm put it, some animals are more equal than others. And if that principle applies to other animals -- discriminating among them based on humanlike capacities -- does it also apply to us? Are some humans more equal than others?

We've already established that you accept this principle if, like me, you discriminate among preborn humans based on degree of development. And if you accept that humans and apes gradually evolved from common ancestors, then you'd also probably discriminate among born humans based on degree of evolution. As McNeil observes, the archaeological record of human bones "suggests that some of our ancestors exited this world as stew." Were the ancestors who gnawed those bones truly human?

We don't like to face such questions. Like creationists, we ridicule anyone who lumps us together with other primates. Cohen says animal rights activists "come off as loopy" when they say things like, "I am an ape." But according to the U.S. government, that statement isn't loopy. It's fact. All of us are great apes.

If preborn and prehistoric humans are less worthy of respect, what about born, living humans who seem functionally subhuman? McNeil says we're kidding ourselves when we imagine that "certain ‘human' rights are unalienable." He mentions a terrorist who beheaded a reporter. Is it possible, he asks, to forfeit your human rights for subhuman behavior?

On the other hand, if we deem some people less human than others, does it lead us back to the bad old days of racism? McNeil raises this question in the context of his African guide's comment about the butchered gorilla: that it was just "meat" because it had "no soul." The comment, he writes,

was an interesting observation for a West African to make. He looked much like the guy on the famous engraving adopted as a coat of arms by British abolitionists: a slave in shackles, kneeling to either beg or pray. Below it the motto: Am I Not a Man, and a Brother? Whether or not Africans had souls -- whether they were human in God's eyes, capable of salvation -- underlay much of the colonial debate about slavery.

To say the least, that's a controversial analogy. People for the Ethical Treatment of Animals made a similar comparison three years ago and was charged with racism. "They're comparing chickens to black people?" an NAACP spokesman protested at the time. Cohen offers the same objection, faulting PETA for "boneheaded moves, like the ad it ran juxtaposing photos of penned-up animals with starving Jews in concentration camps." He doesn't mention his own paper's juxtaposition of gorillas with Africans a day earlier.

Not that I should be throwing stones. I've got my own contradictions to sort out: that it's wrong to eat animals but not meat; that it's wrong to compare mistreatment of blacks to mistreatment of animals; that it's wrong to "predict the criminal propensity of unborn children based on the color of their skin"; that we should "prepare for the possibility that equality of intelligence, in the sense of racial averages on tests, will turn out not to be true"; and that it's pernicious "to group people by race and compare averages."

I'm still working my way through the puzzle of equality as we learn more about human and animal biology. So are McNeil, Cohen, and others. It's a communal dialogue between morals and science. Where it will lead, I can't say. But what strikes me at this point in the conversation is that equality and discrimination are intricately related. What we often call equality -- sorting creatures into biological groups and treating each group member as identical to the others, but different from members of other groups -- is also discriminatory. That's the paradox of "human rights."

Each of us mixes the two in our own way. Spain extends its "community of equals" to gorillas but not gibbons. Catholic bishops demand rights for zygotes but not chimps. PETA equates racial with interspecies equality. The NAACP discriminates between discriminations.

For my part, I've come to suspect that the first problem to deal with isn't inequality. It's indiscriminateness. Discrimination in the best sense means seeing each individual as she is. It takes effort. You have to look past the surface of things. It's easier to assign individuals to groups and judge them that way. But it's also, to the same extent, unfair. The unfairness arises not from inequality, but from how we organize it. Inequality, at the biological level, is mostly nature's fault. Indiscriminateness is ours.

Dog Lover Bites Man

2008-07-03T11:30:00Z

I love animals. I really do. But there's such a thing as loving animals the wrong way.

No, I'm not talking about that, you perverts. Or that. I've said enough about that sort of behavior.

I'm talking about Leona Helmsley and her dog.

Two weeks ago, I flagged a Reuters story about Helmsley's will. She left $12 million to her dog, Trouble, and zero to her grandkids. A court eventually cut the dog's share to $2 million, sufficient to support its "maintenance and welfare at the highest standards of care for more than 10 years."

Crazy, huh? But it turns out that wasn't the half of it. In Wednesday's New York Times, Stephanie Strom reports that according to two sources, a "mission statement" for Helmsley's charitable trust dictates that "the entire trust, valued at $5 billion to $8 billion and amounting to virtually all her estate, be used for the care and welfare of dogs."

That sounds really sweet, until Strom explains how dogs ended up with the whole bundle:

The two people who described the statement said Mrs. Helmsley signed it in 2003 to establish goals for the multibillion-dollar trust that would disburse assets after her death. The first goal was to help indigent people, the second to provide for the care and welfare of dogs. A year later, they said, she deleted the first goal.

This is exactly what critics of animal rights keep telling us: The more we elevate animals, they warn, the less we'll respect humans. I don't think it has to be that way. I think we're all animals along a continuum of capacities, some of us more rational or moral than others. Part of the majesty of humanity is its ability to recognize and honor these capacities in other species, even when it's inconvenient to us. To do so is to elevate humanity, not degrade it.

Writing indigent human beings out of your legacy is no way to love animals. All it shows it that you don't recognize or love the animals who matter most.

White-Collar Steroids

2008-07-02T14:20:00Z

Are people in your office using performance-enhancing drugs?

I'm not talking about steroids. I'm talking about brain enhancers, such as Ritalin for concentration and Provigil for sleep reduction. Two months ago, I wrote about a Nature survey in which 20 percent of a self-selected sample of scientists, academics, and journalists admitted using such drugs "for non-medical reasons to improve my concentration, focus and memory." In absolute terms, it's hard to argue against these neuroenhancers. But in relative terms, freedom of enhancement can become coercive. If your officemates are outworking you by popping pills, can you afford not to join them?

We know this is a problem in sports. Has it become a problem in the white-collar workplace? Neil Munro examines this question in a recent issue of National Journal. The answer seems to be: We don't yet know, but signs point to trouble ahead.

Munro goes through what little we know. First, there's the non-random Nature poll. Then there's a survey at one college in which one of every six students admitted to taking prescription drugs as a study aid. Munro also cites the recent doubling of adult prescriptions for Adderall and Ritalin, implying that the increase is too big and fast to be purely therapeutic. But the really interesting comment comes from Zack Lynch, the executive director of the Neurotechnology Industry Organization:

If you're GE Capital and you have offices in 154 financial centers around the planet, and these [brain-drug] tools are available in Dubai, and your workers there are trading more effectively, 5 to 10 percent better—they'll have a neuro-competitive advantage over workers where these tools are not legalized.

Neuro-competitive advantage. There's the leverage point for pushing brain boosters into the workplace. The good news is, these pills might make you more productive. The bad news is, if you don't take them, some guy in Dubai will, and he'll eat your job. Lynch flatly tells Munro that if the United States restricts performance-enhancing office drugs, "companies will shift their work offshore."

I don't want to make this scenario sound like it'll be here tomorrow. The brain is notoriously finicky, so there are a lot of obstacles and side effects to work out. But the same is true of performance-enhancing drugs in sports, and that hasn't stopped them from becoming a coercive presence.

Munro points out that neuroenhancement is a big emerging market and that one firm has already been caught exploiting it:

Cephalon, a large biopharmaceutical company, agreed to pay a $425 million settlement to the federal government last year after the firm's sales force was accused of marketing its Provigil anti-sleep drug for purposes other than those for which it has been approved. Provigil was approved for treating narcolepsy, but it was used as a stimulant by some of the scientists who responded to the Nature poll.

Next time you're chatting with your colleagues around the water cooler, ask what they're taking with their water.

Bubble Jobs

2008-06-24T12:35:00Z

Two months ago, I celebrated what seemed to be an emerging recession in cosmetic surgery. That assessment was based on anecdotes and sketchy data from Reuters and the Los Angeles Times. The good news, I argued, was that the rough economy was reminding people which medical procedures were necessary and which weren't. It was also forcing doctors to shift from cosmetic profit back to the real work of promoting health.

Last week, a follow-up Reuters story cast doubt on the trend. Britain's biggest cosmetic surgery company reported a 35 percent increase in procedures in less than a year, led by a 59 percent increase in tummy tucks and a 40 percent increase in breast augmentations. A company spokeswoman opined:

It's interesting to see what people cut back on during a credit crunch. Research among our patients has shown that despite cutting back across all other areas ... people aren't cutting back on money they spend on themselves. For many who are undertaking an abdomnoplasty this is something they've planned for years. For this reason, they're unlikely to want to now put this off and instead they consider their procedure to be an investment.

How depressing. I know it's now standard practice to peddle every product or service as an investment. But cosmetic surgery? It's not health. It's not even disposable property.

Now further data are backing up the original trend reports. Natasha Singer of the New York Times says the two-year waiting lists of a few years ago have dried up:

Earlier this month, this reporter, using a script, made identical anonymous calls to the offices of 48 prominent plastic surgeons in makeover meccas like Orange County, Calif., and the Upper East Side of Manhattan, asking staff members about the earliest possible appointment dates for consultations and cosmetic surgery. I selected plastic surgeons who have appeared regularly on television, or in glossy magazines, or who are listed in the 2007 edition of "America's Top Doctors" ... [A]bout 90 percent of the doctors' offices offered consultations in three weeks or sooner; and about 94 percent offered surgery dates in June or July.

More broadly, total cosmetic surgeries are still 3 percent below the levels of eight years ago.

Why the shrinkage? Because money is tight. "A survey in April and May of more than 600 plastic surgeons, by the American Society for Aesthetic Plastic Surgery, reported that almost 53 percent said the downturn in the economy has had an adverse impact on plastic surgery practices," Singer reports. Data show that the recession hasn't driven clients out of the cosmetic market altogether. But it has downshifted their spending from expensive surgeries to Botox and other cheaper nonsurgical procedures.

One plastic surgeon tells Singer that in previous years he had clients "refinancing their homes and using them as A.T.M.s" to pay for breast augmentations and liposuction. Ponder the insanity of that: risking the most expensive of life's three traditional needs—food, clothing, and shelter—for pure vanity. And then, when you can't pay the mortgage, we're supposed to bail you out? And your surgeon calls what you did an "investment"?

Fortunately, not every doctor has lost perspective. When asked to explain the drop in clientele, another plastic surgeon tells the Times: "We are a luxury item. People want us, but they don't actually need us."

Exactly. Skip the boob job. Keep the house.

Drugstore Choirboy

2008-06-17T11:56:00Z

The movement to stamp out birth control appears to have taken an ominous turn. Until now, women with contraceptive prescriptions were just being turned down by individual pharmacists. Now they're being turned down by whole pharmacies. Refusals from individuals behind the counter have "resulted in pharmacists being fired, fined or reprimanded," reports Rob Stein in Monday's Washington Post. "In response, some pharmacists have stopped carrying the products or have opened pharmacies that do not stock any." Pharmacists for Life International names seven pharmacies that have signed a "pro-life" pledge and says others are doing the same.

It's not clear how many of these proprietors object to birth control per se and how many are abstaining because they think emergency contraception is abortion. Stein points out that in some states, the only legal way to refuse a prescription for emergency contraception is to abstain from offering contraceptives generally.

What's the reaction from pro-choicers and bioethicists? Here are excerpts from the Post story:

1) "I'm very, very troubled by this," said Marcia Greenberger of the National Women's Law Center, a Washington advocacy group. "Contraception is essential for women's health. A pharmacy like this is walling off an essential part of health care. That could endanger women's health."

2) "Why do you care about the sexual health of men but not women?" asked Anita L. Nelson, a professor of obstetrics and gynecology at the David Geffen School of Medicine at UCLA. "If he gets his Viagra, why can't she get her contraception?"

3) "If you are a health-care professional, you are bound by professional obligations," said Nancy Berlinger, deputy director of the Hastings Center, a bioethics think tank in Garrison, N.Y. "You can't say you won't do part of that profession."

4) Critics also worry that women might unsuspectingly seek contraceptives at such a store and be humiliated, or that women needing the morning-after pill, which is most effective when used quickly, may waste precious time. "Rape victims could end up in a pharmacy not understanding this pharmacy will not meet their needs," Greenberger said.

5) "We may find ourselves with whole regions of the country where virtually every pharmacy follows these limiting, discriminatory policies and women are unable to access legal, physician-prescribed medications," said R. Alta Charo, a University of Wisconsin lawyer and bioethicist. "We're talking about creating a separate universe of pharmacies that puts women at a disadvantage."

Let's take these objections one at a time.

First: "Walling off" women's health care? Beware dramatic metaphors from lawyers. There is no wall. You bring your scrip to the pharmacy, and the guy at the counter says, "Sorry, we don't stock contraceptives." That's annoying and, in my view, stupid. But nobody's walling you in. Your burden consists of finding another pharmacy.

Second: Why Viagra and not contraception? Because some pro-lifers view hormonal contraception as potentially lethal. I don't share their anxiety about this theoretical risk to an early embryo, particularly when the alternative, in the event of pregnancy, is a high likelihood of fetal killing. But you can't blow off the argument by assuming that contraception should be covered because it's more important than Viagra. The whole point of the argument is that you're looking at it backward: The fact that contraception is more consequential than Viagra is a reason to be more wary, not less, of distributing it.

Third: "Professional obligations" to provide all health care? Actually, doctors and hospitals draw moral lines around their practices all the time. This doctor won't pull the plug; that one won't do abortions; this other one can't in good conscience collaborate in your faith-based treatment plan.

Fourth: Humiliation? Sorry, but part of true equality is brushing off people who don't respect you. If the guy behind the counter won't sell birth control, he's the one who should be embarrassed, not you. Walk out, and don't come back.

Fifth: Whole regions where pharmacies won't stock contraceptives? Come on. Only seven have even signed the "pro-life" pledge. It's true that abortions have been driven out of rural counties. But politically, the resistance to birth control is nothing like the resistance to abortion. A pharmacy that won't stock contraceptives looks pretty silly.

Greenberger does make a good point about wasting women's time when, as in the case of morning-after pills, speed is essential. And Stein's reporting suggests the abstaining pharmacies aren't making their policies clear enough. If they won't do this voluntarily—by posting them, for instance—the law should make them do it. If I were writing the regulations, I'd draw up a big, fat, standardized "We don't stock birth control" notice, complete with a 24-hour toll-free number that will direct you to the nearest pharmacy that has what you need.

But I wouldn't force pharmacies to sell birth control if they don't want to. In particular, I dread Charo's suggestion that providers should be compelled to offer "legal" drugs. One of this country's greatest achievements is its separation of legality from morality, so that individuals can hold themselves to a higher standard, as they see it, without forcing it on everyone else. This is the principle many pro-lifers have rejected as they press for abortion bans to "teach" the immorality of killing fetuses. Happily, some have shifted their energy from attacking abortion clinics to setting up "alternative" pregnancy centers. It's a shift from violence and harassment to exhortation and, at worst, deceit.

So, please, don't tell moralists they have to do or sell whatever's legal. If you do, you won't like what happens to the law.

Wake Up and Smell the Craniotomy

2008-06-10T11:41:00Z

Yesterday, Sen. Ted Kennedy got out of the hospital. He'd been there since last week, when he had surgery to remove a brain tumor. How long he'll live, nobody knows. The last report from his doctors was right after the operation: "Senator Kennedy was awake during the resection, and should therefore experience no permanent neurological effects from the surgery."

Awake during brain surgery? And this helped? How?

Awake craniotomy has been around for decades and is gradually becoming more common. Kennedy's surgery will certainly get more patients and doctors talking about it. Here's the initial problem: Your doctors need to cut out your tumor, but it's hard to tell where regular brain tissue stops and the tumor begins. Which parts can they cut out? Which parts can they cut through? Overall brain structure is similar from person to person, but details vary enormously.

If the operation were on your leg, the surgeons could check and map their route while you slept. That's where most of us would like to be during surgery: out cold. I don't know about you, but my feelings about going under the knife are pretty close to Woody Allen's feelings about death: It's not that I'm afraid of it; I just don't want to be there when it happens.

But when the surgery is on your brain, you need to be there, because the feedback that will tell your doctors where to cut or not to cut isn't strictly physical. It's mental. According to the Boston Globe, "Kennedy's tumor was located in a region of the brain involved with language and movement." How can doctors find out whether snipping the next bit of tissue in their path would mess with his verbal ability? By asking him questions. "Tiny electrodes are placed on the brain to introduce an electrical current," the Globe explains. If the electrified zone is verbally important, says a neurosurgeon, the charge "will stop their speech. You know then that's a region you usually try to stay away from or preserve while you're doing surgery."

Depending on the tumor and surgeon, the test may be as simple as counting to 10 or as complex as conversation. Here's one account from the San Francisco Chronicle a couple of years ago:

[Dr.] Perry starts flashing the pictures on the computer screen, and Hill hits them as if he's been studying. "Window, owl, elephant, football, scissors, hammer." Before Perry asks each question, [Dr.] Berger receives a cue to stimulate a tiny piece of brain with an electrical current ... Suddenly that line is crossed. Hill starts getting confused, his brain waves spiking on an EEG monitor. He calls a door a car. Then he starts calling every picture chicken.

And here's a British case reported by BBC News:

[Dr.] Marsh used an electrical pulse to find out where Adrian's tumor ended and where the region of the brain that controls speech began. The pulse temporarily slurred Adrian's speech, giving [Dr.] Marsh a clear idea of what tissue he needed to remove. Throughout the surgery, Adrian was asked to identify a series of pictures, such as a tripod, a compass and an accordion. ... Marsh decided to stop the surgery after Adrian started to become muddled.

This is the hardest thing to accept about brain surgery: What's being operated on isn't some body part you can think about or not think about it. What's being operated on is you. If the surgeon goofs, you don't wake up like Ronald Reagan in Kings Row, shouting at your missing legs, "Where's the rest of me?" The word me simply doesn't mean the same thing anymore. You may never know that there ever was a "rest of me."

This is why the surgeon in the British case warned his patient up front that

there was a risk in cutting so deep into the brain to remove as much of the growth as possible: the parts of the brain which govern speech, language or personality might be affected. "The difficulty is that you are operating very close to the regions of the brain that affect people's thoughts, feelings and speech. It could change their personalities forever," he said.

So take my advice: If you ever get a tumor next to the parts of your brain that think or speak, ask for the awake surgery. It'll be pretty weird trying to answer questions or hold a conversation while you're being zapped. But it's better to wake up and live the nightmare for a few minutes than to sleep and live it forever.

Unnatural Family Planning

2008-06-09T11:24:00Z

Friday morning, I thought I was all done investigating the ins and outs of the Chinese one-child policy. And then this happened. On Friday evening, Xinhua, the state news service, reported:

China's family planning authority are to send a medical team to conduct surgery to reverse sterilization operations on parents wanting another child in China's earthquake zone. Zhang Shikun, director of the science and technology bureau of the National Population and Family Planning Commission, said, "The team, comprised of experts on childbearing, will conduct surgery in the quake-hit areas to provide technological support for those wanting to give birth to another." The team was part of the commission's plan to provide free reproduction services, including counseling, guidance, surgery, and the implementation of artificial reproduction technology, for those who wish to have another child, she said.

You have to hand it to the Chinese government. First, they tell you not to give birth to more than one child (unless you run a farm, or you're an ethnic minority, or you and your spouse have no siblings, or a bunch of other exceptions). On the other hand, they're going all-out to make sure that if you obeyed that policy and lost your only child in the quake, you can get another.

Those tubes you tied, thinking you were done procreating? We'll untie them for you, gratis. Vasectomy? Schmectomy. In fact, if you're too old now to make babies the old-fashioned way, we'll provide "artificial reproduction technology" to help you along.

Now, that's what I call full-service public health insurance.

What's really going on here, of course, is public fury over all the kids who died in poorly built schools. The government limited those families to one child and then failed to protect their kids. The whole premise of Saving Private Ryan was that the U.S. government dare not cost a family its last child. But that's exactly what has happened in China, thousands of times over. According to Xinhua, family-planning authorities in Sichuan, the quake-hit province, estimate that 7,000 families lost their sole children in the disaster, and 16,000 sole children in other families suffered injuries or disabilities.

Through this combination of totalitarianism and incompetence, the Chinese government took away one of nature's greatest fulfillments: procreation. Now it's trying to make up for that theft by delivering surgeries and technologies to replace your lost child with a new one. You have to wonder what other options the government would be offering bereft parents in their 40s if reproductive cloning were sufficiently refined.

Would that be wrong, once the technology is safe? If the one-child limit is morally defensible, and if that child dies through government neglect, and if it's OK to use artificial technology to help the couple make a new child ... what's wrong with cloning the old one?

Go ahead, speak up. It's a free country.

The One-Child Warranty, Continued

2008-06-06T11:53:00Z

Last week I wrote about the warranty on children killed by the recent earthquake in China. I referred to an exemption to the country's one-child policy, allowing parents who lost their kids to replace them. At one point, I asked, "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?"

Many of you wrote in to correct me, noting that the replacement allowance is a general rule under the one-child policy. I wasn't satisfied with these assertions, so I went to the Chinese government's Web site for clarification. After some digging around, the only direct nationwide statement I could find was in the "Population and Family Planning Law of the People's Republic of China," adopted in 2001. Here's the basic language (Article 18):

The State maintains its current policy for reproduction, encouraging late marriage and childbearing and advocating one child per couple. Where the requirements specified by laws and regulations are met, plans for a second child, if requested, may be made. Specific measures in this regard shall be formulated by the people's congress or its standing committee of a province, autonomous region, or municipality directly under the Central Government.

And here's the sole reference to damaged children (Article 27):

Where the only child of a couple is disabled or killed in accidents, and the couple decides not to have or adopt another child, the local people's government shall provide the couple with necessary assistance.

So, the general policy is vague. Implicitly, at least, you can decide to have another child if yours is killed or even disabled, as long as the tragedy was an accident.

Slate's Lucy Morrow Caldwell contacted several China experts who helped us with the original "Explainer" on this topic. We couldn't find records of the policy being waived in previous disasters, but Vanessa Fong of Harvard and Wang Feng of the University of California confirmed that the policy has traditionally permitted a second child if the first is killed or disabled. Cindy Sun of Fudan University directed us to a May 28 statement from the National Population and Family Planning Commission of China. The statement includes a clause that an acquaintance of mine translates as follows:

To the families whose children were injured or killed in the earthquake, the benefit of additional birth should be given, according to the number, sex, and injury of the children who survived the disaster.

In other words, precise numerical replacement, with different values for boys and girls, since many rural parents are allowed to have a second child if the first is a girl.

We also found a link to the earthquake policy issued by the Family Planning Commission in Chengdu, the capital of Sichuan Province, which bore the brunt of the disaster. A second acquaintance paraphrases its main points this way:

1) A "green light" for parents whose only child was injured, disabled, or killed.
2) The government will proactively work with these parents if they wish to have another child. This includes registering them and providing reproductive services.

Here's his translation of the policy's fine print on injury or disability:

Medical identification shall be conducted on injured/disabled children of single-child families. If the child is certified to have second-degree or above injury or disability, the parents shall be assisted to apply for bearing a second child.

A third acquaintance translates the fine print somewhat differently:

For those whose only child was disabled in the earthquake, local Birth-Control Agencies shall record the cases and compare them to the "Medical Disability Standards for Children from One-Child Family." For those qualified, the local agencies shall help them file the applications for the birth of a second child. The Birth-Control Council of Chengdu city will perform medical assessment and approval process promptly.

One final note: Article 11 of Sichuan's family-planning regulations stipulates that couples may have a second child if "the first child has non-genetic defects and is unable to grow up to be a normal laborer."

So, here's the full policy, as far as I can piece it together from the available documents: You can replace your child (in the numerical sense) in the event of death or disability, as long as the cause was an accident. Extent of replacement depends on the number and sex of the children you lost. Replacement for disability requires medical certification that the damage is second-degree, as measured by official standards. Replacement is also available for disabling defects, but not if they're genetic, presumably because in that case the replacement might be similarly defective.

Got that? To me, it sounds a lot like the piece of paper that came with my PC monitor. So, there's your warranty. Let's hope you never have to use it.

Pass the Land Shrimp

2008-06-03T11:38:00Z

Here's something good you can do for your body and your planet: Eat more bugs.

Janet Raloff has the goods in this week's Science News. We're facing worldwide environmental, obesity, and food crises. Bugs are the answer.

Consider the nutritional value of the humble cricket: Each 100 grams of dehydrated tissue has 1,550 milligrams of iron, 340 milligrams of calcium, and 25 milligrams of zinc -- three minerals often lacking in the diets of third-world countries. If you're ever lost in the woods, three crickets a day will meet your iron needs. Compared to beef or pork, bugs deliver more minerals and healthier fats.

Bugs are also more energy-efficient. Crickets deliver twice as much edible tissue as pigs and almost six times as much as steers based on the same food input. And that's not counting their superior rate of reproduction. One scholar calculates that overall, they're 20 times more efficient than steers.

That global food crisis you've been reading about? No problem. An Asian expert reports that in Thailand, each family can raise crickets independently on a tiny parcel of land. In a pair of villages, 400 families are cranking out 10 metric tons of crickets during the peak season.

Bug-eating also reduces the need for pesticides. The more bugs you eat, the less you have to spray. That's what happened in Thailand, where locusts have been brought under control through culinary culling.

You've never eaten bugs? You're missing out. People in most countries eat insects. Central Americans eat butterfly larvae. South Americans eat beetles. Africans eat ants, caterpillars, and grubs. Asians eat fried crickets. Aborigines eat honey ants.

You say bugs are gross? Why? Is it the exoskeleton? The appendages? The weird eyes? Guess what: You already eat animals with these characteristics. They're called crustaceans. Shrimp, crabs, lobsters -- they're arthropods, just like crickets. They're also scavengers, which means their diets are as filthy as any bug's.

Many of these arguments have been around for more than a century. Vincent Holt made the original case in his 1885 manifesto, Why Not Eat Insects? Lately, a Web site called food-insects.com has taken up the cause. Three years ago, an Italian professor published Ecological Implications of Minilivestock: Potential Of Insects, Rodents, Frogs And Snails. A company called Sunrise Land Shrimp is bringing the movement to the United States. "Mmm," says the company's cricket logo. "That's good Land Shrimp!"

See what a few good euphemisms can accomplish? "Minilivestock" and "land shrimp" can do for bugs what "mountain oysters" have done for bull testicles. And for those of you who still can't stand the idea of beetle-munching, there's even better news. Remember that project I've been touting to grow meat without growing animals? Dutch researchers are extending it to insects. Raloff reports:

They're using biotechnology to produce vats of insect cells -- just isolated cells. The researchers described their efforts last year in Biotechnology Advances. The goal, explains Marjoleine C. Verkerk of Wageningen University, is to produce a sanitized source of bug proteins that can be dried and added to breads or perhaps molded into pseudo-burgers. Her team is mass producing isolated ovary cells of silkworms, fall armyworms, cabbage loopers and gypsy moths.

All that good insect protein, without the eyes and legs. What could be better?

Mmm. That's good land shrimp.

The One-Child Warranty

2008-05-29T11:53:00Z

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.

Meat Wagons

2008-05-27T15:02:00Z

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.

Marrow With Children

2008-05-22T11:46:00Z

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.

Incest and Delayed Motherhood

2008-05-19T15:11:00Z

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.