Anti-psychotics and civil liberties

One job perk of the position I'm set to leave in two months (sigh...) is attending the monthly seminars. An invited guest gives a lunch talk and people from a great diversity of professions around the hospital gather at the bioethics center. These discussions are a real pleasure for me - I'm often the only non-MD/PhD/RN in the room (and the only person under 40). Today we had veggie wraps. We also had a fantastic speaker - the nursing manager on the psychiatric floor - answering our questions on the involuntary treatment of psychiatric patients. It's the only specialty of medicine where physicians can more-or-less "incarcerate" patients who need treatment.

So, interesting tidbit of the day: Psychiatric patients, even when forcibly treated by court-mandate, still have the capacity to give and refuse consent for non-psychiatric medical procedures, say, for gall-bladder surgery. If they object to their involuntary internment on the psychiatry ward, they can contest it in the state's mental health court. If their request is denied, they can appeal in 45-60 days. Courts have three options in these cases: they can (1) release the patient, (2) mandate that the patient stay in hospital custody, and (3) mandate that the patient be treated. Occasionally, the court will mandate internment without authorizing treatment. "When that happens," said our speaker, "we're basically jailers." It drives the medical staff insane. Still, it seems appropriate that the threshold for forcibly administering psychopsychotic drugs to someone would be higher than the threshold for merely detaining him or her. But it does put the medical staff in an uncomfortable position.

One last point: The speaker noted that just as people with mental illness are stigmatized, people who work in psychiatry are also stigmatized and not considered "real" doctors and nurses.

What do you do, exactly?

Last week I submitted my resignation, effective this summer. It was a really tough move, deciding to leave a job I like when I don't know where I'm going. My boss processed the paperwork, and as I carried the forms down the hill to HR, I felt a bit like Jesus carrying his own crucifix. But all things considered, now is my time to seek out a different world. I might head toward some sort of advocacy work or teaching related to criminal justice.

I will have spent the last two years as a research assistant to nine (yep, nine) professors in the bioethics department of a medical school. I haven't written much about my work here, occasionally noting a quiet moment of appreciation, or a more perilous Indiana Jones moment in the library basement. So it's probably worth explaining what I do on a regular basis - and why I love this job.

For the most part, I spend my days working through questions asked by the faculty:

"what's the organ donation acquisition policy in Europe?"
"how many health care workers get HIV on the job?"
"what's case law on the right of prisoners to refuse treatment?"
"what's the penalty for falsifying insurance forms in NYS?"
"of organs recovered, how many are actually transplanted?"
"what criteria do insurance companies use to evaluate requests for coverage?"
"can you track down transcripts for the Abigail Alliance case?"
"which states or cities have banned trans fats?"
"where is donation after cardiac death being done?"
"how does the ratio of working people to retired people vary by country?"
"can you find info on the rising rates of obesity around the world?"
"can you find the text of NY's law on decision-making for developmentally disabled patients?"
"how much money do pharmaceutical companies spend on marketing each year?"
"does the AMA have a position on the matter? other medical professional societies?"
"do illegal immigrants have Medicaid coverage for post-organ transplant medical care?"
"how do insurance companies evaluate whether to respect an appeal for coverage?"
"is there evidence that tobacco companies target African Americans more than whites?"
"can a plaintiff require its medical expert witness to testify for its side only?"
"which countries are least car-dependent? can you find data on vehicles per capita?"
"are poor patients really the beneficiaries of free drug samples?"
"who pays for the court-ordered treatment of a minor patient?"
"how does the Veterans Administration ration its high-cost diagnostic tests?"
"does New York have an 'I'm sorry' law for physicians?"

So I have exciting workdays. The faculty are experts in their niches - global health, medical professionalism, medical creative writing, hospital policy, etc. - but everyone requires background details, especially for survey courses. So snippet by snippet, I meander through the topics. It's a wonderful job. In much of academia, people are driven to become experts in obscure topics, to know a lot about a little. My work is the opposite: I am expected to know a little about a lot.

Finally, I can't understate how wonderful it is to work for a place where people dress in comfortable clothing (well, most of the time; I still tuck in my shirt), where there's often blueberry pie or oatmeal cookies or "Friday chocolate" (or a chocolate-tasting contest) on the kitchenette counter, where the rotating "selections from the Center library" include books like Rafael Campo's book of poetry, What the Body Told and Paul Farmer's Pathologies of Power. I do feel loved and supported in this office - and am so glad to have landed here among mentors and friends.

Liar liar pants on fire

Is it ever okay to lie?

Seems like a dumb question. But I’ve been thinking about it in the wake of a report from the Center for Public Integrity that recorded 935 lies by President Bush and his administration about the threat posed by Saddam Hussein. Some lies, of course, are worse than others. Compare Clinton's “I did not have sexual relations with that woman, Ms. Lewinsky” with Cheney's “there is no doubt that Saddam Hussein now has weapons of mass destruction.” (Or more recently, Bush's escalation with Iran, despite the intelligence reports.) Bush distorted the truth in rushing to war in Iraq. That was the worst kind of lie. It killed hundreds of thousands of people, shifted money from domestic priorities, and destroyed US standing abroad.

How about other sorts of lies? Most people think of themselves as motivated by principle, meaning: Lying is a form of deception; deception is wrong; we shouldn’t do things that are wrong. Ergo, don’t lie. Yet everyone knows it’s not that simple, that deception may not always be wrong, and that there are multiple ways to prevaricate and embellish and hide the truth. Before passing judgment, we want to know the intent of the person who's lied and the consequences of that lie.

Lying comes up a lot in medical institutions. Is it ever okay for doctors to lie? To tell the patient’s family that the death was peaceful when it was in fact horrific? To hide from the patient’s mother that her seventeen year old daughter had an abortion? Here are three of the most obvious reasons not to lie in the medical setting, as I count them: (1) A lack of honesty in the medical setting can compromise the trust between doctor and patient. (2) An incomplete medical record may mislead future doctors and hinder future treatment. (3) Dishonesty may violates the contractual relationship with payers (whether public or private). Dr. Martin Donohoe posts a quiz that illustrates some of the nuances of truth-telling in medicine. I've pared down the quiz.

If you were a physician, would you “lie” in the following situations?

1. A 26 year old male presents to the ER after crashing his vehicle and suffering a radial fracture. His blood alcohol level is 0.17. When he sobers up, he asks you not to report him to the DMV, as he is afraid of losing his license. Do you report him?

• yes
• no
• only if he hit another vehicle rather than, say, a lightpost
• only if someone else was injured in the accident
• if he’s a pizza delivery guy, and needs the job to support his sick infant

2. A 33 year old female is admitted to the ICU with severe pneumonia. An HIV test is positive. She dies after 3 days. Her parents request that you leave the diagnosis of HIV off of the death certificate. Do you accede?

• yes
• no
• if she is a celebrity or public figure, and the media may find out
• if the parents are fundamentalist Christians and would be ostracized from their church if the obituary said HIV

3. A 45 year old nurse comes to your office with symptoms of depression. She requests that you leave off any information about her mental illness from the chart, as she fears that her colleagues could access the computerized medical record, in which case, she thinks, she'd be ostracized or lose her job.

4. Other situations: Would you lie if a patient asked you to not record a STD? Would you fudge the date of disease-onset so the patient isn't disqualified for having a pre-existing condition? Would you downcode (bill for less than provided) visits for self-paying patients and upcode (bill for more than provided) for insured patients?

What the doctor ordered

Here's this week's New Yorker cartoon caption contest (drawn by Leo Cullum):


My captions are below. I've submitted the first one and friends are submitting the second, third, and fourth. Others are up for grabs. Do you have other captions? Deadline to submit is Sunday.

“Oh him? He's allergic to blood. Now, where was I? Oh right, this isn't going to hurt one bit.”

“I told your wife you're not contagious, but she insisted.”

“If you're not comfortable in the gown, we do have one alternative.”

“Surgery wasn't successful. Let's just say you're a wreck.”

“The insurance company rep has some bad news... Looks fishy to me.”

“Trust me, I saw it on House last night... Or was that the Discovery Channel?”

“Like I said, we're gonna have to dive deeper.”

“Captain Nemo will be performing your surgery.”

“We've been expanding our medical school applicant pool.”

“Now do you want that second opinion?”

Accident report

It's midnight on a Friday night (a week ago), and I'm sledding with friends. I'm feeling adventurous and jolly. The snow is a bit loose, flying everywhere as we fly south down the hills. I take off my glasses which keep fogging up during the fast descent. The visibility is awful, but I'm content to take in the world through my other senses: the unmistakable smell of winter, the cold against my face, the good-natured yelps of my fellow sledders, having fun. And then, in the delight of unrestrained youthfulness, I sled head-on - well, actually foot-on - into a tree.

I hobble back to the car, friends take me home, and my housemate Jake helps prepare a few bags of ice that I saran-up around my ankle. I sit mostly stationary through the weekend. On Monday, one of the med school professors I work for examines my ankle, and says: "Uh Eli, that's not good." She insists I go to the emergency room, and since all the local orthopedists seem to be booked (except the one who could only see me two days later), I said what the heck, this could be fun.

It turns out I broke my medial malleolus at the base of the tibia. Of course that wasn't obvious at first. I spent the downtime investigating ER culture: the EMS personnel rushing in with patients strapped to gurneys, the ER staff telling them to wait their turn, the secretaries too busy to look up when asked for a tissue, the elderly woman to my left pulling out her IV and yelling for attention... Over the course of the 4.5 hour visit, I spoke to four doctors, three nurses, a half-dozen x-ray technicians, and one very pretty resident who stopped by only to ask if it would hurt if she flicked my big toe. One or two asked about the book I was reading, Steinbeck's In Dubious Battle. I had arrived at 10 am. It was now 1 pm, and I had to leave by 2:30 to make a 3 pm opthalmology appointment. Time was running thin.

"Your particular fracture," says the doctor, "is commonly associated with a second fracture higher up on the tibia. So we'd like to take a second x-ray to rule out such a break."

"But doc," I say, "I've got no pain or tenderness higher up on the tibia."

"Well, you see," he says nervously, "it's a liability issue, standard of care."

"Ah, I understand.... I'll tell you what. I'll consent to it if you can get me out of here by 2:30."

It worked. A friend Nate drove me to the ophthalmologist with six minutes to spare.

It's been a week now. Probably 1-2 more on crutches, and another 3-5 with a cast.

Thanksgiving stem cells

Two nights ago, a friend and I discussed new findings on stem cells that "could ease ethical concerns" (NYT). I think "religious concerns" would be more accurate. In any case, scientists report that they can create the equivalent of embryonic stem cells without having to destroy a fertilized cell in the process. This new "breakthrough" seems unnecessary to me, at least on an ethical level. But it seems highly important in allowing stem cell research to go forward. The news meant more to this friend of mine (who approved this post, by the way). You see, he's a Christian. He was saying that cells 10-14 days after conception should be protected because they were, at the very least, life-on-its-way. I was saying, as I've written before, that something that could become life does not, by that very fact, have a right to it.

The conversation eventually moved on to other, more seasonal, topics.

"Hmm," said the friend, "I've got to pick up a turkey tomorrow."

"You know what the funny thing about all this is?" I asked. "That I believe that turkeys deserve life, and you don't."

* * *

Below are two cartoons on stem cells research. I love the first because I like to think that religious people don't always agree with their spokespeople. The second cartoon, which I don't like, illustrates the great struggle that some religious people face in deciding where they stand on stem cell research. For that, I think it's worth posting. But I should add: It's not actually true that embryonic stem cells destroyed in research would have become cute little kids had they not been used. As long as I'm on the topic, see this other cartoon about stem cells and this political video by Michael J. Fox from the 2006 elections.

More on Ashley X

I want to follow-up on an earlier post about Ashley X, the profoundly disabled girl whose parents had her breast buds removed, her growth attenuated, and a hysterectomy performed.

The case generated a lot of controversy in both the media and in the bioethics community. Last month in DC for the annual bioethics conference, I heard one of the pediatricians who treated Ashley, Dr. Doug Deikema, speak about the case (he wrote about it here). Deikema, who's also a medical ethicist, used his talk to reply to what he saw as the five most common objections to the growth attenuation component of the "Ashley Treatment," as it's been dubbed. I think his replies (paraphrased below) were excellent.

(1) It's not natural.
Reply: Neither are immunizations, antibiotics, or organ transplants.

(2) You're playing God.
Reply: Anytime you intervene medically (or decide not to intervene), you are playing God.

(3) It's a slippery slope.
Reply: Yes, there's potential for abuse. But ascending a slippery slope is sometimes worth the risk of slipping. The view atop a mountain, for example, is often worth the perils of the climb.

(4) Stunting Ashley's growth benefits the parents, not the child.
Reply: No, it benefits both. Their interests are intertwined.

(5) It violates her dignity.
Reply: That's an assertion without content.

Caring for Ashley X

Two random questions: (1) what is 'personhood'? and (2) does it matter?

Consider the case of "Ashley X," a six-year-old girl from Washington State with profound mental impairment. She cannot think, speak, or form relationships. She cannot move on her own and lies still wherever she's put (say, on a pillow), hence her nickname, "pillow angel." Her parents faced a problem: As Ashley grew older, she grew bigger. In order to continue caring for Ashley at home, the parents ordered a hormonal treatment to attenuate her growth to 4'6''. Her parents also directed doctors to perform a hysterectomy so Ashley could avoid the discomfort of menstruating, and to remove her breast tissue to reduce the chance of abuse. The parents kept a blog and generously opened their case to media scrutiny. Ashley is now 10.

Some people have criticized the therapy. What, some ask, would Ashley herself have wanted?

Ordinarily in these situations, family and friends try to decide according to the patient's prior wishes. But Ashley never had capacity to begin with. As an alternate approach, decision-makers sometimes follow a "best interests standard." In that, we think about what any "reasonable" person would want. Mostly it works: Giving someone a blood transfusion even without consent is clearly in his or her "best interest." But this approach has been fraught with uncertainly: In our liberal tradition, we hesitate to make substantive claims about the good life. So instead of asking "what should be done?" we ask, "who should decide?" But the notion of "best interests" failed for Ashley X, as it did with Terri Schiavo, because people can't agree on what's best for someone with little or no mental capacity. It's also hard to say whether Ashley has any "interests" at all.

So what to do?

In a wonderful and reader-friendly essay on decision-making for children with severe neurological impairments, philosopher-doctor Carl Elliott sets up the problem this way:

"[I]n order to determine the moral status of severely damaged or limited human beings, we must ask ourselves whether or not they are persons. Why? Because we all know, more or less, what the moral status of a person is – that persons deserve a kind of respect, that they have rights, that we owe them duties that we do not owe animals or nonsentient life, and so on. If a neurologically damaged child (or for that matter, an anencephalic, a fetus, or an adult in a persistent vegetative state) is a person, then we must treat her morally as we treat other persons. But if she is not, then we are justified in treating her in other ways – say, as a being whose interests can be safely overridden for the interests of those who are persons."

--Attitudes, Souls, and Persons: Children with Severe Neurological Impairment. Mental Retardation & Developmental Disabilities Research Reviews. 9:16-20 (2003).

But having set up the debate, Elliott proceeds to point out the deficiencies in this line of reasoning. He thinks it’s futile and perhaps deceptive to delineate the elements of ‘personhood.” Simply describing the capacities of an animal, for example, is not sufficient to discern whether its life is "meaningful." Like "cruel" or "coward" or "bully," the word "person" contains both factual and evaluative elements. Personhood is an ethical evaluation, informed not only by what capacities we as humans exhibit, but by the meanings and societal attitudes associated with them. Elliott, writing four years before the Ashley story broke, doesn’t speak in the language of interests and rights. He thinks dignity and respect may be more helpful concepts (though he says they won’t suffice either). What I admire most about this essay is the inconclusiveness of the conclusion:

"We are the inheritors of a strong tradition of rights and equality that makes us reluctant to withhold treatment from a person on the grounds of her intelligence or disabilities. … [Yet] we recognize that these lives fail to meet the criteria by which we count our own lives as meaningful. We try to convince ourselves that we should protect vulnerable lives, but we cannot imagine this as a life we would want to continue living. We say all lives deserve respect, but our measure of the good life for ourselves does not include a life like this."

That divide speaks to me: the space being too judgmental and not being judgmental enough.

Medical tourists

It's October now and students are deep into the grind. The midterms are rolling in. It’s been a few months since many of the medical students returned from their summers abroad in various developing countries – Kenya, Guatemala, El Salvador – but people are still sharing notes. I've been cynical about these trips. Three-week, or even two-month, visits are utterly unsustainable. They don't offer much to the host community and seem little more than a chance for medical students to gawk at global poverty. Sure, students may come back with greater "awareness" or "appreciation" of their privileged place in the world, but who really does that serve?

So how do these medical student missions work? Just days after finishing their first year of medical school, students run off to poor countries to perform procedures they wouldn't be able to perform on American patients. One student recently wrote to the PIH listserv to endorse a particular volunteer organization: "I have had several friends who have traveled to South Africa and India to work at medical clinics that are so underfunded and in need of help, that within a couple of weeks they were assisting in procedures, administering medication, and doing whatever needed doing. " As if that were a good thing! First-year medical students don't know anything about medicine, except perhaps a rudimentary physical exam. Second-year medical students don't know much more. Yet that doesn't stop them from practicing medicine abroad (with emphasis on "practicing").

I think many students who go abroad recognize these concerns. It may even add to the guilt they already feel as "healthy, educated, middle-class medical student[s] from the United States." They assuage this guilt by telling themselves that if they weren't "serving" these people, no one would. Or say that their own inexperienced care is better than no care at all. That may or may not be true. Clinical errors aren't the only potential pitfalls. As representatives of their nationalities, students must be careful to avoid mistakes that can precipitate a breakdown in trust or fuel resentment against the more legitimate older Western doctors. And above all, everyone must guard against subverting the local public health sector and pillaging its resources. When Paul Farmer spoke at my campus last month, someone asked him: "What if there is no functioning public sector?" Farmer corrected him: "There is always a public sector. Find it."

I don't really think these medical missions do as much good as they're purported to do. Of course, the intentions of the participants are good. I don't doubt that these students are eager to reduce global poverty or to take a stand for human rights. But I think these 'do-gooders' should be more honest about who's really gaining from these experiences. Some of these 'doctors without borders' are really no more than doctors without qualifications - medical tourists as much as medical trainees. Indeed, one article promoting international "service" concludes by noting: "What is acquired frequently outweighs what is given if a person is open and intent on gaining new insights and strategies." Great, I am loathe to think, another way of feeding off the world's poor.

Blood escapades

Another post on my saga with blood donation:

Instead of donating through my workplace, I donated yesterday at the Red Cross blood center. Apparently, my blood is cytomegalovirus (CMV) negative, meaning I don’t have a virus that “nearly everyone” has. CMV is not a serious virus. The vast majority of carriers never know they have it. But, for those with compromised immune systems, e.g., premature babies and cancer patients, CMV can be quite serious. Rather than expose them to the virus in a blood transfusion, the Red Cross and hospitals solicit CMV negative donors specifically for these patients. For that, I had to go directly to the blood bank. (Plus, I’m now in a raffle for a free I-Phone.)

At the blood bank, I asked if I could give a double-donation through apheresis. I would be able to help more people, and it would extend the wait time till the next donation from 56 days to 112. It all seems very efficient to me. Apheresis takes more time than a regular donation, but physiologically, it's easier on the donor. I've done it before. The little old lady behind the desk replied, “Well, do you meet the requirements? You have to be at least 150 and 5’1.”

I stared at her. Did she think I was standing on a stool? She, meanwhile, stared blankly at me.

“Uh, I meet the requirements,” I finally said.

But it turns out I couldn’t do apheresis because the necessary staff members were out.

They escorted me to a small room for the pre-donation interview. My interviewer told me that to speed up the process, donors may now answer the questions on a computer themselves.

“But then you can’t ask me all those awkward questions about my sex life,” I said.

“You should see it when the nuns come,” he tells me jovially. “Try asking a nun those personal questions: ‘Have you ever had sex with a man who’s had sex with a man?’”

We laugh. I can just imagine the nuns crossing themselves.

Too much of a good thing

One of my duties as a bioethics research assistant is to monitor the news on a whole range of topics in health policy, clinical medicine, and global health. Well, here's what I found today:

Mom sues after IVF brings 2 babies instead of 1 (Sept 18, 2007)
Australian woman seeks $332,000 to cover cost of raising extra child

Wacky. The requested $332,000 would pay for private school fees and would allot $12,427 to compensate for time off work. But as my mother always says, "If one child takes 100% of your time, two children can't take any more." (She's a mathematician.) I handed the article to the professor here who specializes in health law and reproductive medicine, who said, "Good god! They should take both kids away!" He hopes the children will grow up to be fertility specialists.

Also not to be missed, check out the New York Post's article, "A 'Baby Bjorn' Sperm Crisis: Shortage hits wannabe parents." I actually saw the article in print, which had the additional headline, "Sperm Blank: City Shortage Causing Panic." Panic?! As the article reports, NYC sperm banks are running out of seed 'donated' (for $75 a pop) by tall, blond, blue-eyed people. Why? Because "the Food and Drug Administration banned sperm samples from 30 countries to prevent the spread of Creutzfeldt-Jakob disease, a rare, fatal disorder caused by eating beef contaminated with mad-cow disease." Pictured at right is a profile of one of those handsome Nordic sperm donors, named "Oluf," who quite sadly may have no more American progeny.

Sicko

I can't remember ever having been so excited for a movie. Sicko comes out this weekend. I hear it's a rare piece of objective and unbiased journalism, adorned of course with Michael Moore's sex appeal.

Here's the trailer:



At the bioethics center today, we crowded around my computer to watch. As one professor put it: "Sometimes, you don't need angry philosophers clamoring for justice. Satire works much better."

Gross anatomy: eww or awe?

Of course the smell lingers. If formaldehyde can preserve dead bodies, how can it not stay on my hands?? After leaving the cadaver lab, I rushed home, flung off my shirt, and dashed to the shower. I scrubbed furiously, as if I were allergic to my own skin. No avail. "What could possibly, possibly, make it go away?!" It had to be something strong, something formidable. So I took out the cough syrup. Instead of smelling dead, I smelled sick (and a little dead). Small improvement.

I saw about a dozen dead bodies today. A med school friend, Brendan, graciously took me to his "Gross Anatomy" lab, as the first-year course in anatomy is appropriately called. At this point in the year, the bodies were heavily dissected. Just a little skin clung on, a bit on the eye-lids, some on the toes. One body still had its fingerprints, mostly eroded but just visible.

My task was to help Brendan memorize the parts of the nasal cavity. At times, or so I told myself, it was like preparing a Thanksgiving turkey. But every once in a while, a distinctly human element came through: eyelashes, fingernails, toes, tongue, chest hair. One body had bright pink painted fingernails, as if to tell its future medical students, "DO NOT FORGET: I was once a person!" Meanwhile, bits of human flesh hang around the table. The medical students don't notice, or try not to, or at least don't notice anymore. For a future doctor, it really is more important to identify the sphenopalatine artery than to think about the person, now dead, who once looked through those dried out eyeballs.

Some critics bemoan this "dehumanization." But I am mostly grateful for it. I bet this anatomized view of the human being solves more problems than it causes.

The highlight was identifying the the malleus and incus in the middle ear. Brendan pointed them out amid a maze of veins and arteries and nerves that wound through even more veins and arteries and nerves. Out of this mess, I come away amazed at how many things could go wrong in the human body, but generally don't. I think I have a deeper appreciation for the body, for medicine, and for the over-achieving doggedness of medical students - who, god help them, have to put up with that utterly relentless smell.

Hey! Scientists! Leave them sheep alone!

Over New Year's in NYC, I saw a Pink Floyd cover band called The Machine at a club near Times Square. I adore Pink Floyd's "Another Brick in the Wall." The lyrics:

We don't need no education
We don't need no thought control
No dark sarcasm in the classroom
Teachers leave them kids alone
Hey! Teachers! Leave them kids alone!
All in all it's just another brick in the wall.
All in all you're just another brick in the wall.

To me, the song epitomizes a generation fed up with lies about the "evil empire" and the necessity of war. It's the mantra of free thought (if that makes sense). The mantra side of it came out at the club last weekend, when I saw a crowd of punk-rockers nodding their heads in unison, mouthing exactly the same words: "We are all individuals" - or maybe it was "We don't need no thought control," but it sure sounded like the former.

Where do the sheep come in? Well, one of my adoring fans (or at least someone who occasionally reads this blog) asked me to cover a story that's been shaking the bioethics world this past week. In 2002, a study revealed that as many as 10% of sheep are gay. The findings were celebrated as evidence that gayness is biological and cannot be changed. Well, now it can be changed. At two universities in Oregon, scientists are attempting to adjust hormone levels in the brains of "gay" sheep (i.e. rams that wear tight pants - I mean, rams that screw other rams) so that they start screwing ewes instead.

The motive, they say, is not homophobia, but rather profitability. Gay sheep that don't reproduce simply aren't as profitable. The real worry is that this research would ultimately be used to change the sexual orientation of human beings. At least one bioethicist, Udo Schuklenk of Glasgow Caledonian University, has asked that the research be stopped: “I don’t believe the motives of the study are homophobic, but their work brings the terrible possibility of exploitation by homophobic societies." We've been through nuclear energy, reproductive technology, cloning, and now, gay sheep: another episode in the saga of "dangerous knowledge."

Some people conceive of scientists (and science oversight committees) as a bunch of laboratory rats, filling test-tube after test-tube in a blind search for knowledge, and therefore incapable of thinking deeply about the uses of their research. But, strangely enough, scientists are people, too. They do think about the consequences of their research (it's why they do research in the first place). I am generally skeptical of people who insist that "such-and-such a topic is too dangerous." It's not the knowledge that's the problem, but what we do with it. Still, there really are some projects that shouldn't go forward, like trying to weaponize smallpox. But I'm going to hold out and say: It's not "thought control" we need, but policy control.

It's a sticky subject. I don't want to sound like NRA advocates who say, "guns don't kill people, people kill people," as an excuse for promoting gun ownership. Guns really do kill people. I'm also sympathetic to the argument that once some kind of knowledge exists, there's no going back. Nuclear weapons is the obvious example. But I also know that it's impossible to predict how any research will be used. The best we can do, I think, is to cultivate avenues of free thought. And then Pink Floyd shall live.

Beethoven's Genetic Profile

It's a good thing that Beethoven didn't live in the era of genomic medicine. Nowadays, a genetic test performed from a blood sample or even from a cheek swab can detect whether a person is likely to develop diabetes, cancer, mental illness, or, say, deafness. So then there's the ethical question: Who should have access to this information? Siblings? Future lovers? Prospective employers, who would have to pay health insurance costs and accommodate sick leave?

Check out this hilarious conversation from Managed Care Magazine, excerpted below, between young Beethoven and the HR director of the Vienna Orchestra:

"Your audition impressed the selection committee. Composing would have been an excellent career for you."

"What do you mean, 'would have been,' Maestro?"

"You see, we have also reviewed your pre-employment health appraisal. ... I'm talking about your genetic profile. ... Our analysis shows that you will be significantly deaf before you are 30 years old. Obviously, this predisposition makes you quite unsuited to a career in music."

"Mein Gott!"

"We've decided to offer the position to Wolfgang Amadeus Mozart. He's just 34 years old, with a sparkling genetic pedigree and doubtless a long, illustrious career ahead of him."

And here it is again, now in cartoon form:

Evolution in a Petri Dish

Here's something on evolution that my brother sent me from The Onion. So, moving from animal life to human life (get it?):

Kansas Outlaws Practice of Evolution

TOPEKA, KS—In response to a Nov. 7 referendum, Kansas lawmakers passed emergency legislation outlawing evolution... The new law prohibits all living beings within state borders from any willful adaptation to changing environmental conditions.

[As one intelligent design proponent said,] "butterflies who mimic the wing patterns and colors of other butterflies for an adaptive advantage, well, their days of flaunting God's will are over." Human beings may be the species most deeply affected by the new legislation. Those whose cytochrome-c molecules vary less than 2 percent from those of chimpanzees will be in direct violation of the law.

Evolution is still with us. So, moving from human life to "transhuman life," check out the World Transhumanist Association, whose members want to use technology to "extend human capabilities." They want to start using reproductive technologies not only to help people reproduce, but to create smarter, stronger human beings. We already use treatments like IVF fairly regularly. In fact, in Denmark and the Netherlands, 1 in 25 babies is conceived in a dish. So we're evolving: We once had sex to reproduce. Now we have sex for fun, and use IVF to reproduce.

Enhancement technologies could be our new opposable thumb.

But is it a good thing? Certainly not in Kansas.

Naw, they're not like us...

Another thought on vegetarianism: A professor at my bioethics center uses this cartoon to illustrate the rift between doctors and patients. It shows the rift between different species as well.

It's also funny.

Michael J. Fox on Stem Cells

A powerful ad in the Missouri Senate race.

Michael J. Fox endorses Democratic challenger Claire McCaskill over Republican incumbent Jim Talent, who, Fox says, "even wanted to criminalize the science that gives us a chance for hope."