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In yesterday's post on the proposed HHS abortion "conscience" regulation, I overlooked a very important quote from Secretary Leavitt. Rob Stein of the Washington Post relates the following exchange from Leavitt's Aug. 21 conference call with reporters:
But when pressed about whether the regulation would protect health-care workers who consider birth control pills, Plan B and other forms of contraception to be equivalent to abortion, Leavitt said: "This regulation does not seek to resolve any ambiguity in that area. It focuses on abortion and focuses on physicians' conscience in relation to that."
Ambiguity is precisely what pharmacists have asserted in lawsuits demanding the right to withhold hormonal contraceptives. While framing the regulation as neutral, Leavitt is lending support to their position. And, as noted yesterday, the regulation explicitly applies to pharmacies (see page 24 of the PDF) which dispense contraceptives but do not perform surgical abortions.
When it comes to conscience rights, I'm a libertarian. As a pharmacist, you have every right to refuse to fill contraceptive prescriptions. But your customers have every right to boycott your store, and your employer has every right to fire you. If you don't like your employer's policy, open your own pharmacy.
The HHS regulation is not neutral. It uses government leverage to prevent employers from insisting that their employees honor consumer choice. In the name of one freedom, it suppresses another. And in the name of ambiguity, it lends official support to lawsuits that would extend this government intervention from abortion to contraception.
You can add your own views, pro or con, at consciencecomment@hhs.gov.
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HHS Secretary Michael Leavitt has issued a final version of his proposed regulation to protect medical conscience (PDF). As predicted, he has dropped the sentence that originally defined abortion as "any of the various procedures—including the prescription, dispensing and administration of any drug or the performance of any procedure or any other action—that results in the termination of the life of a human being in utero between conception and natural birth, whether before or after implantation."
Leavitt has also chosen to leave open the possibility that the regulation will be applied that way. In that case, it would protect a provider's right to withhold oral contraception, which theoretically could prevent implantation of an embryo. Pharmacists and Catholic hospitals are already waging legal battles to assert this right.
The proposed regulation is 42 pages long. I'm embarrassed to tell you that I read it last week during my vacation. I was looking for a definition of abortion. I'll save you the trouble: There is none. The regulation draws no distinction between abortion and contraception.
In his blog, Leavitt has twice addressed the contraception question. On Aug. 7, he said his intent was to protect the right of conscience, not to define contraceptives as abortion. This left open the obvious next question: Intent aside, does the right of conscience protected by the regulation include the right to withhold hormonal contraception on the grounds asserted by pharmacist litigants: that it might be abortifacient? Two weeks ago, I invited Leavitt to answer that question. He has ignored it.
He has, however, answered a similar challenge from Mary Jane Gallagher, the president of the National Family Planning and Reproductive Health Association. In an Aug. 11 blog post, Leavitt quoted and rebutted her:
"Who's going to provide access to contraceptives services if the administration provides this large loophole to deny services?" [said Gallagher.] CQ reported Ms. Gallagher continued: "Providers are ‘given an oath—now they get to pick and choose what they want to do' if a regulation is issued, she said."
So, according to Ms. Gallagher's ideology, if a person goes to medical school they lose their right of conscience. ... There is something I'd like to point out to Ms Gallagher and the people she represents. It is currently a violation of three separate federal laws to compel medical practitioners to perform a procedure that violates their conscience.
Gallagher is explicitly talking about contraception. And Leavitt's response is to invoke conscience rights.
Last week, Leavitt said some practitioners might "press the definition" in the final HHS regulation and argue that hormonal contraception is abortion. They certainly will. Pharmacists for Life International is already on the case. So is the Christian Legal Society. Concerned Women for America says the equation of hormonal contraception with abortion, explicit in the original draft of the regulation, was right all along.
And when these litigants argue that the regulation implicitly covers contraception, they'll have lots of help from Leavitt. They can cite his response to Gallagher. They can also point out that the regulation explicitly lists pharmacies as a category of "affected entities." (See Page 24.) Last time I checked, pharmacies didn't do surgical abortions.
The argument on the other side will be that Leavitt has said he's not targeting birth control. "This regulation is not about contraception," he said in a conference call last week. "It's about abortion and conscience." But Leavitt has said the same thing about abortion itself. "This is not a discussion about the rights of a woman to get an abortion," he wrote in his blog. "This is about the right of a doctor to not participate if he or she chooses for reasons they consider a matter of conscience." Leavitt's point, in other words, is that the regulation doesn't ban anything; it just protects the right not to facilitate it. As he put it in the conference call, "There is nothing in this rule that would in any way change a patient's right to a legal procedure." But in asserting this right of refusal, the rule doesn't distinguish between surgical abortion and theoretically abortifacient drugs.
The rule is open to public comments until Sept. 20. You can submit your comments to consciencecomment@hhs.gov. Here's mine: Mr. Secretary, if this rule doesn't extend the right of refusal to hormonal contraception, say so.
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Yesterday I asked whether Michael Phelps lost to Milorad Cavic in the 100-meter butterfly final at the Olympics. I took a pretty good pounding in the Fray.
Looks like I deserve it.
The reason I looked back at Phelps-Cavic this weekend is that Omega finally released its pictures of the finish. Because Omega is the official timekeeper and its pictures had previously been withheld, I attributed great importance to them. And the company's characterization of the pictures as proving Phelps won was total garbage.
As many of you point out, the fact that these pictures prove nothing proves nothing, since we had better pictures from underwater to begin with. I'd seen the underwater shots on TV, but I hadn't looked at them closely on the Web. Look at the sequence:
Right before the swimmers touch
The touch
A closeup of Cavic's fingers, cropped from the preceding photo (No. 5):
Phelps has clearly touched at this point. Has Cavic touched? His left middle finger is bent back. But if you look at the first of these three photos (No. 4), you can see that the finger is also bent back slightly as he's approaching.
My eye says the finger isn't touching yet. But my eye, as a judge of Olympic photo finishes, sucks. So here are two ways of resolving the question.
1. Do a CSI-style 3-D analysis of photo No. 6, the close-up. See if you can assess the height of Cavic's fingers relative to the cross on the wall. Assuming the fingers are pretty well below the top of the cross, case closed.
2. Calculate the delay between touch and pad compression using the speed of the race. If the speed is fast enough that the delay can't equal one one-hundredth of a second, case closed. There's already a Fray thread pursuing this calculation.
One fascinating thing in underwater photo No. 5: Even if Cavic is touching, you can see that Phelps is touching harder. Theoretically, thanks to the touch pad, that could be enough to win him the race, even if the touches were virtually simultaneous.
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Can we please stop fussing over every new Olympic record?
A new record means that an athlete using today's equipment outperformed an athlete using yesterday's equipment. It's not a fair fight.
In swimming alone, today's advantages include:
1. LZR Racer suit. It reduces friction (compared with skin) and is structurally designed to compress and streamline the body for maximum speed. Estimated drag reduction: 5 percent to 10 percent. Estimated average improvement in top swimmers' best times: 2 percent. Designed by NASA scientists and computers, among others. Cost: $500.
2. Pool depth. This is the deepest pool ever used in the Olympics. Depth disperses turbulence, reducing resistance.
3. Pool width and gutters. Two extra lanes at the margins disperse waves to gutters, reducing ricochet and resistance.
4. Lane dividers. The plastic ones in Beijing deflect turbulence down instead of sideways, reducing resistance.
5. Starting blocks. Nonskid versions have replaced the old wooden ones, boosting dive propulsion.
6. Video. Recordings and analysis identify target variables such as stroke distance and turns.
7. Medical tests. Swimmers are blood-tested after each race to measure lactic-acid buildup.
8. Sports scientists. They run the monitoring and analysis. The U.S. swim team has four.
And here's a partial list of advances in other sports:
1. Lighter shoes. The latest material is carbon nanotubes.
2. Asymmetric shoes. Stronger carbon base in the right shoe tilts you to the left to increase speed as you round the track. Left shoe is designed to stabilize you.
3. Ice vest. It lowers your temperature before the race so you can delay overheating for better performance.
4. Hypoxic tents. Sleeping in low-oxygen chambers increases red blood-cell levels.
5. Aluminum javelins. They reduce vibration compared with the old carbon ones.
6. Bicycle wheels. Front wheels with fewer spokes (eight instead of 32) reduce weight and air resistance. So do composite one-piece rear wheels. All frames are carbon.
Michael Phelps' coach says the LZR suit is fair. "Everybody is in the suit so it's across the board," he argues. That may be true of today's top swimmers. But it's not true of yesterday's. So comparing today's performances to the performances of 20, eight, or even four years ago—which is what "new Olympic record" means—is generally unfair.
If you want to compare today's athletes to yesterday's, the ideal method would be an inflationary formula. We already calculate how much $1 in 1980 would be worth today, based on price increases. We ought to be able to devise a similar multiplier for each Olympic event, based on average year-to-year improvement among top athletes. Averaging would wash out idiosyncratic ups and downs. The effects of aging could be measured and factored out.
Olympic inflation indexing wouldn't devalue new records. It would isolate and elevate records that truly stand out. Scores of media reports have boasted that every team in this year's 4 x 100 men's swimming relay beat the time that won that event four years ago. But by inflationary standards, the British, who beat the 2004 winning time by three-tenths of a second in constant time, actually failed to keep pace with it. The Americans, who beat it by five seconds, produced a genuine achievement.
And now, if you'll excuse me, I'm off to watch the latest high-definition broadcast from Beijing on my 46-inch flat-screen TV. It beats the crap out of the 20-inch tube I was squinting at in 2004. But that doesn't make my eyesight any better.
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Last Tuesday, I wrote about a draft regulation, circulated by the Department of Health and Human Services, that would protect the right of private employees to refuse to facilitate any abortifacient chemical or activity. The draft rule defined abortion as "any of the various procedures—including the prescription, dispensing and administration of any drug or the performance of any procedure or any other action—that results in the termination of the life of a human being in utero between conception and natural birth, whether before or after implantation." It would thereby encompass the right to withhold oral contraception, which theoretically could prevent implantation of an embryo.
On Friday, HHS Secretary Mike Leavitt wrote a blog post about the draft rule. According to the Washington Post, Leavitt "denied that [the] draft regulation would redefine common birth control methods as abortion and protect the rights of doctors and other health-care workers who refuse to provide them."
Really? Where's the denial?
Here's the relevant part of Leavitt's post:
An early draft of the regulations found its way into public circulation before it had reached my review. It contained words that lead some to conclude my intent is to deal with the subject of contraceptives, somehow defining them as abortion. Not true.
The Bush Administration has consistently supported the unborn. However, the issue I asked to be addressed in this regulation is not abortion or contraceptives, but the legal right medical practitioners have to practice according to their conscience and patients should be able to choose a doctor who has beliefs like his or hers.
The Department is still contemplating if it will issue a regulation or not. If it does, it will be directly focused on the protection of practitioner conscience.
Leavitt's post says his intent is to protect the right of conscience, not to define contraceptives as abortion. It doesn't deny that the final version of the rule will have the effect of treating some contraceptives as abortion. And there's every reason to believe it will do just that.
Leavitt writes as though conscience protection is a separate issue from the blurring of abortion with contraception. It isn't. A rule that guarantees the pro-life conscience rights of doctors, pharmacists, and other private employees is limited only by what those employees believe. And what many of them believe, as the Post's Rob Stein has documented, is that oral contraceptives are wrong because they can prevent implantation.
If you think Leavitt won't extend conscience protections that far, you haven't met his boss. Nine years ago, when George W. Bush was running for president, Tim Russert asked him: "Do you believe life begins at conception?" Bush replied: "I do." Two years later, as he prohibited federal funding of embryo-destructive stem-cell research, Bush repeated, "I think life begins at conception." Referring to pre-implantation embryos, Bush wrote that "it is unethical to end life," even to save the lives of others.
How can Leavitt fail to extend conscience protections to a pharmacist who refuses to fill a birth-control prescription because, like Bush, he believes that life begins at conception? If that belief is good enough to bar funding of stem-cell research, why isn't it good enough for the pharmacist?
If Leavitt really wants to clarify this question, he can do so by writing one more post in which he stipulates that the HHS rule, if issued, will not extend to drugs or procedures that act prior to implantation. I'm betting a month's supply of birth-control pills that he won't.
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When is a life-threatening disease not worth treating? When something else will kill you first.
This week, the U.S. Preventive Services Task Force issued new guidelines for prostate cancer screening. The New York Times explains:
Prostate cancer often progresses very slowly, and a large number of these cancers discovered through screening will probably never cause symptoms during the patient's lifetime ... Past task force guidelines noted there was no benefit to prostate cancer screening in men with less than 10 years left to live. ... The new guidelines take a more definitive stand, however, stating that the age of 75 is clearly the point at which screening is no longer appropriate.
Well, sort of. The new guidelines do draw the line at 75. But the rationale hasn't really changed. Here's the key paragraph from the report:
In men age 75 years or older, the USPSTF found no direct evidence of benefits of prostate cancer screening. However, the USPSTF was able to establish an upper bound for the potential magnitude of the benefit of treating screening-detected prostate cancer in this age group, by extrapolating from evidence of treatment for clinically detected prostate cancer in this age group. For a population of men with an average life expectancy of 10 years or fewer, the USPSTF determined that the benefits of prostate cancer screening and treatment would range from small to none.
In other words, men 75 years or older aren't worth screening because their life expectancy is 10 years or less. This matches the logic of the previous guidelines ("Older men ... who have a life expectancy of fewer than 10 years are unlikely to benefit") and, as the report notes, similar guidelines issued by professional medical associations. It also matches a study, cited in the key paragraph, that compared "radical prostatectomy" to "watchful waiting" in two groups of men. The study found that with prostate removal, "The absolute reduction in the risk of death after 10 years is small."
More to the point, the 75-10 equation matches current U.S. life expectancy tables. The guidelines clearly identify life expectancy as a key factor in setting limits to screening:
The USPSTF found convincing evidence that treatment for prostate cancer detected by screening causes moderate-to-substantial harms, such as erectile dysfunction, urinary incontinence, bowel dysfunction, and death. These harms are especially important because some men with prostate cancer who are treated would never have developed symptoms related to cancer during their lifetime.
According to the latest U.S. government data, remaining life expectancy for a 75-year-old man is 10.8 years. But that number applies only to the most recent year on the table, 2005. If you scan up the column of numbers, looking back in time, you'll see that remaining life expectancy for men at 75 has been edging up. Since 1980, it has increased by two years. And if you look at tables going further back, you'll see that a 75-year-old man today can expect as much remaining life as a 70-year old man could expect in 1975.
In other words, life expectancy is increasing, and as it does, the age at which slow diseases are worth testing and treating also increases. Three decades ago, by the logic of the 10-year limit, a 70-year-old man wasn't worth screening for prostate cancer. Today, he is. We have extended his remaining life to the point at which prostate cancer would shorten it. By preventing and treating other diseases, we have made this one worth preventing and treating, too.
So don't count on the screening line to hold at 75. Over the next few decades, it could easily rise to 80.
One way to look at this trend is that the job never ends. The more we accomplish, the more work we have to do. It's exhausting. Maybe we should back off and respect nature's limits.
The other perspective is that there's nothing more liberating -- nothing more human -- than shattering old expectations. This boring little tweak in the recommendations for prostate cancer is actually this week's episode of the biggest story in the universe: biological emancipation. In the beginning, we accept a cause of death as nature's course. Then we call it a disease and study it. Then we push life expectancy to the point at which the disease is worth treating. The truest measure of progress isn't what we achieve. It's what we undertake.
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If you're looking for interesting bathroom reading, allow me to recommend Urology. The July issue is chock full of page-turners: "Robotic Prostatectomy," "Scrotal Mass with Bladder Outlet Obstruction," "Histologic Comparison of Pubovaginal Sling Graft Materials," "Multi-Drug-Resistant Bacteremia After Transrectal Ultrasound Guided Prostate Biopsies," and my favorite, "Modern Management of Adult-Acquired Buried Penis" (it's "a result of obesity" - don't ask).
Seriously, though, I want to talk about an article in the July issue. It's called, "Does ‘Normal' Aging Imply Urinary, Bowel, and Erectile Dysfunction?" Here are key excerpts from the abstract:
We assessed if urinary, bowel, and sexual dysfunction and associated bother were part of the "normal" aging process in the general male Dutch population. ... Three thousand eight hundred ten (3810) men responded (81%), mean age 67 years, range 58 to 78. ... Bowel dysfunction and bother were not related to age. Erectile dysfunction was reported by 19%, ranging from 12% in the youngest to 26% in the oldest group ...
Conclusions: Urinary and bowel dysfunction were not part of the "normal" aging process. Erectile dysfunction was significantly more prevalent in older men.
And here's the headline on the Reuters write-up: "Erectile dysfunction may be ‘normal' with age."
The curious thing here is the word normal. It's being used in this context to mean age-related. Most men in the sample didn't have erectile dysfunction. But because ED's frequency increases with age, and because we think of aging as a universal process accompanied by physical decline, ED seems normal.
Since "urinary and bowel dysfunction were not part of the ‘normal' aging process," the authors conclude, they "may well be related to prior treatment" in men who have been treated for prostate cancer. This appears to make them logical targets for prevention or remedy. Does the opposite implication follow for ED? Does its "normality" make it a less compelling target?
There are many plausible ways to think about normality and health. Age-dependence is one of them. To me, the authors' framework makes sense: Medicine should focus first on maladies that strike some people unusually early in life. Maladies that accumulate with age are less unfair. They're also less tractable, since they're more biologically inherent.
ED, however, is a confounding example because it's in the process of being transformed from a "normal" to a commonly treated condition. Bob Dole made his famous ad for Viagra in 1999, when he was 76. In the last decade, 35 million men have used Viagra. Millions more have taken similar drugs such as Cialis or Levitra. Modern man has set out to conquer the ancient loss of manhood.
Which brings us back to the question posed in Urology: Does normal aging imply ED? The answer seems to be: It used to. And that's not just a change in the way we think about erections. It's a change in the way we think about aging.
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Chalk up another victory for the gambling-addiction defense.
Yesterday, attorneys for Tim Donaghy, the former NBA referee who admitted to betting on basketball games he officiated, filed a psychological "evaluation" that blames his crimes on compulsive gambling. The author is Stephen Block, a gambling treatment counselor. Sample quotes from the evaluation, as reported by the Associated Press: 1) "In my professional opinion, Mr. Donaghy would never have committed these offenses if he was not a pathological gambler." 2) "His gambling history demonstrates the need to gamble to fulfill the underlying need for 'action.' " 3) "He could not stop himself from gambling." The Washington Post supplies one more: 4) "His judgment and insight were impaired by his gambling behavior."
The plea worked. Today, Donaghy was sentenced to 15 months in prison instead of the 27 to 33 months that had been expected. According to the Post, the judge "said she took Donaghy's gambling addiction into account, as well as his cooperation with the government's investigation." Reuters quotes the judge on Donaghy's gambling addiction: "Although it contributed to his criminal conduct, it does not excuse it." No excuse, but a nice contribution: His sentence gets halved.
I'm not going to sit here and claim that compulsive gambling doesn't exist. But disorders that are powerful and real for some people have a way of being diagnosed in other people who don't share many of the symptoms but just happen to need a legal excuse. In this case, all we have is an evaluation solicited and supplied by the defendant's attorneys.
More to the point—and this is the crazy part—in this case, the crime is gambling. If you plug that information into the evaluation, here's what it boils down to: "Mr. Donaghy would never have committed this gambling if he was not a pathological gambler." No kidding! He committed gambling because "he could not stop himself from gambling," because "his judgment and insight were impaired by his gambling." How do we know his gambling is compulsive? Because of his "gambling history." The circularity is shameless.
And don't even get me started on the idea that Donaghy had a "need to gamble to fulfill the underlying need for 'action.'" An "underlying need for action" pretty well describes the motivation for half the world's crimes.
If you really believe Donaghy's gambling was addictive, don't just make it a mitigating factor in sentencing for the crime of gambling. Abolish the crime. Because a crime can't excuse itself.
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The female suicide bombers have struck again. And again. And again.
Yesterday morning, I wrote about a woman who blew herself up in Iraq last Thursday. The body count in that attack was eight. I don't remember what the count was in terms of how many women had done the deed this year.
Anyway, that number is already obsolete. By the end of the day, three more women had killed themselves. The body count in yesterday's attacks exceeds 60, with more than 200 others wounded. The Los Angeles Times reports:
According to U.S. Army figures, 27 suicide attacks this year have been carried out by women, compared with eight in all of 2007 ... A tally by The Times indicates that about a quarter of all suicide attacks this year in Iraq have been conducted by women.
Again, the Washington Post explains why women are delivering the bombs:
Wearing their flowing black garments, they can carry hidden explosives past most checkpoints because customs of modesty prevent male guards from frisking them. On Monday, four female suicide bombers in two Iraqi cities used this tactic to enter areas defended by hundreds of soldiers and police officers.
The New York Times adds:
Police officers interviewed at the scene said that the authorities had heard that six women would blow themselves up in the area. "We can't search women," complained Atheer Allawi, a police officer. "They are wearing abayas, and God knows what they can hide under them."
And again, Iraq failed to provide enough female security officers to do the job. The Associated Press reports:
Iraqi security forces had deployed about 200 women this week to search female pilgrims in Kazimiyah, but the attacks took place along the procession some six miles southeast of the shrine. There were too few women guards to search people in the procession itself.
The bombings will continue until we get the message: Stop treating women as though they're too meek to fight and kill. They're already killing. Search women. Deploy women.
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Another suicide bombing in Iraq last week. Another female perpetrator. The bomb "killed a pro-American Sunni militia leader, an Iraqi police captain, a local politician, and five other people," according to Friday's New York Times. Apparently, it's "at least the 16th time that a woman has donned a bomb and exploded herself in Diyala Province since last year."
Why women? The Times explains:
Wearing billowy, black head-to-toe garments, the female bombers have been able to conceal powerful explosives and slip into crowded areas too heavily guarded for a male suicide bomber to ease through undetected. While men often undergo physical searches, Islamic rules do not allow male security officers to pat down women.
How many more women have to blow themselves up before we get the message? Female suicide bombing is a logical extension of suicide bombing. Suicide bombing exploits your disbelief about what people will do. Female suicide bombing exploits your disbelief about what a particular group of people—women—will do. Your biases are no longer somebody else's problem. They're your problem. Look for Arab bombers, and terrorists will send an American-born Hispanic instead. Look for men, and they'll send a woman.
Actually, I don't like the way I wrote that. These women aren't just "sent" by somebody else. We've had enough socio-babble about how women commit such atrocities because they've been "marginalized" and "exploited" by men. It reminds me of the pro-life dogma that women shouldn't be prosecuted under abortion bans because the woman is just the abortionist's pawn. Spare these women your condescension. If you're going to make abortion a crime, charge the woman. If you're handling security where bombs are a threat, search everyone. And if you don't have enough female security officers to search the women, go hire some.
But this is just a Muslim problem, right? We Judeo-Christian Americans don't have these hang-ups, right? As the Washington Post noted two months ago:
In Afghanistan as well as Iraq, female soldiers are often tasked to work in all-male combat units -- not only for their skills but also for the culturally sensitive role of providing medical treatment for local women, as well as searching them and otherwise interacting with them.
But—oops!—the Post story is about Pfc. Monica Brown, who won
a Silver Star in March for repeatedly risking her life on April 25, 2007, to shield and treat her wounded comrades, displaying bravery and grit. She is the second woman since World War II to receive the nation's third-highest combat medal. Within a few days of her heroic acts, however, the Army pulled Brown out of the remote camp in Paktika province where she was serving with a cavalry unit -- because, her platoon commander said, Army restrictions on women in combat barred her from such missions.
Enough with the sexism. We can't afford it.
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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?
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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.
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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.
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Starting this week, under orders from the state attorney general and the U.S. Court of Appeals for the 8th Circuit, 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.
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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?
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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 "moderately obese" 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 of weight-loss diets are frequently limited by short follow-up times 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 1 year 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.
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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.
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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.
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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.
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