Post Marketing Surveillance…No wonder doctors are skeptical to the point of confusion

For another class, I had to write a paper on the safety of statins (you’ll see why in the second paragraph). (But for now – a little background)…Statins are well established first-line drugs for the treatment of hypercholesterolaemia and dyslipidaemia implicated in the pathogenesis of coronary heart disease and atherosclerosis.1 Stains lower cholesterol levels by blocking the enzyme HMG CoA (don’t worry about the acronym for now) in the liver involved in the synthesis of cholesterol.2 There are five drugs (use to be 6 – again, second paragraph) in this drug class – each associated with certain toxicities (particularly myopathy) which may lead to a debilitating condition called rhabdomyolysis.3-5 One problem is, statin-induced myopathy is not well understood.1, 6-8 The other problem is, rhabdomyolysis is a rare muscle wasting disorder that results in muscle cell breakdown and release of the contents of muscle cells into the bloodstream. If unchecked, this could lead to renal (kidney) damage. Symptoms of rhabdomyolysis include muscle pain, weakness, tenderness, malaise, fever, dark urine, nausea, and vomiting. The muscle groups involved most frequently are the calves and lower back; however, some patients report no symptoms of muscle injury. The FDA states “in rare cases” (this probably came from the product information or package insert – can’t remember what they are calling it these days – you know, the PI) the muscle injury is so severe that patients develop fatal organ damage, including renal failure.9

The controversy (here we go) over statin use stems from Bayer Pharmaceutical’s voluntary withdrawal of Baycol®/Lipobay® (cerivastatin) in August 2001.10 Bayer received numerous reports of side effects involving muscular weakness, particularly in patients treated concurrently with gemfibrozil. Subsequently the FDA reported 31 deaths associated with cerivastatin use; 12 were associated with concurrent use with gemfibrozil.9 (What happened?) In 1997 the FDA approved cerivastatin labeling for 0.2 – 0.3 mg/day; in 1998 0.4 mg/day; and in 2000 0.8 mg/day was approved without recommendations for a maximum dose.5, 11 However, reports indicate that many physicians prescribed cerivastatin at 0.8 mg/day instead of starting at the lower dose then titrating up.5 Furthermore according to an FDA report, the rate of fatal rhabdomyolosis associated with cerivastatin is up to 80 times as high as the rates for any other statin.5 Also, concomitant medications are pervasive in statin-patient populations with high-risk factors for cardiovascular mortality. Therefore, the risk of drug-drug interactions (DDI) is quite high.

What caught my attention was a report by Psaty et al (2004) who stated that internal company reports from Bayer, specifically case reports, suggested cerivastatin-gemfibrozil DDI data was available within 100 days of the 1998 drug launch; yet the company did not add contraindications about concomitant use to the product information until 18 months after launch.11 (Okay – they knew there was a potential problem but they waited for…what to report it)? According to a 2003 European news report, Bayer fought back (of course they did!) against “claims that it was aware of possible dangers long before the drug was voluntarily withdrawn…”12 Yet, Bayer paid out $125 million to 450 individuals who experienced “serious side effects” and was in negotiations with another 500 cases through 2005.10

Ultimately, who is responsible for post-marketing surveillance? Drug companies! Pharmaceutical companies are responsible for conducting their own post-marketing trials but this is usually more beneficial to the company than it is for the safety of patients. Post-marketing trials are usually conducted to expand the label: new indications, new patient populations (e.g., children), and voila patent extension. Physicians are also responsible to report adverse drug events to the FDA – however, this is voluntary. In collaboration with the FDA’s, CDER, division of pharmacoepidemiology, safety data is gathered and shared with the product firm and an agreement is reached with the firm to determine the next step. In essence, the responsibility to pull a drug lies with the company in question; the FDA may “support” the decision and in some cases engage in litigation when companies do not comply with specific FDA recommendations. Confusing?

How must doctors feel? One minute a drug is on the market and being marketed aggressively then the next its being recalled. One minute a drug is deemed safe and “well tolerated” by patients and the next it could be a lethal weapon. Let’s face it, drugs (I do mean drugs, plural) are a necessary part of life (so is food and yes, cosmetics, too for many of us). But who is ultimately accountable for ensuring, beyond a shadow of doubt, that what we put in and on our bodies will not cause harm (including death)? Surely, drug companies cannot be the sole bearers of responsibility – for reasons, shall we call it, conflict of interest…! Then the government needs to do its job and be allowed to do its job by expanding resources which means more money more money more money…! Less we forever ride the roller-coaster of post-marketing surveillance.

Holly Tomlin
Blog 9

References

1. Tiwari A, Bansal V, Chugh A, Mookhtiar K. Statins and myotoxicity: a therapeutic limitation. Expert Opin Drug Saf. 2006;5(5):651-666.
2. Evans M, Rees A. Effects of HMG-CoA reductase inhibitors on skeletal muscle: are all statins the same? Drug Saf. 2002;25(9):649-663.
3. Kashani A, Phillips CO, Foody JM, et al. Risks associated with statin therapy: a systematic overview of randomized clinical trials. Circulation. 2006;114(25):2788-2797. Epub 2006 Dec 2711.
4. Moride Y, Hegele RA, Langer A, McPherson R, Miller DB, Rinfret S. Clinical and public health assessment of benefits and risks of statins in primary prevention of coronary events: resolved and unresolved issues. Can J Cardiol. 2008;24(4):293-300.
5. Staffa JA, Chang J, Green L. Cerivastatin and reports of fatal rhabdomyolysis. N Engl J Med. 2002;346(7):539-540.
6. Smogorzewski M. The myopathy of statins. J Ren Nutr. 2005;15(1):87-93.
7. Jamal SM, Eisenberg MJ, Christopoulos S. Rhabdomyolysis associated with hydroxymethylglutaryl-coenzyme A reductase inhibitors. Am Heart J. 2004;147(6):956-965.
8. Strippoli G, Navaneethan S, Johnson D, et al. Effects of statins in patients with chronic kidney disease: meta-analysis and meta-regression of randomised controlled trials. BMJ. 2008;336:645-651.
9. FDA. http://www.fda.gov/bbs/topics/ANSWERS/2001/ANS01095.html; 2001.
10. Bayer Withdraws Baycol/Lipobay. PR Newswire; 2001.
11. Psaty BM, Furberg CD, Ray WA, Weiss NS. Potential for conflict of interest in the evaluation of suspected adverse drug reactions: use of cerivastatin and risk of rhabdomyolysis. Jama. 2004;292(21):2622-2631. Epub 2004 Nov 2622.
12. Milmo S. Bayer Defends Itself on Baycol. Chemical Market Reporter. 2003;263(9).

Red Wine and Heart Disease: A Riddle Wrapped in an Association – Not Causation

In 1991, the widely popular CBS television news show, 60 Minutes, featured a story that attributed the lower risk of heart disease in France to drinking red wine. Since the original story aired, red wine sales skyrocketed1 along with the public’s consumption of the beverage and thirst for evidence about this proposed cardioprotective effect. Seemingly everyone attempted to “cash in” on the phenomenon, particularly red wine producers2 and nutrition “experts” who marketed the nutritional value in books like the New York Times Bestseller, French Women Don’t Get Fat by Mireille Guiliano (2004 hardcover; 2007 paperback). Earlier this year CBS followed-up on the 1991 story with additional information about the so-called French Paradox.3 The “French Paradox” refers to the low rate of cardiovascular mortality in France compared to the United States despite a high fat diet.4-6 The term “French Paradox” comes from the work of an Irish physician, Dr. Samuel Black (1891), interested in the observed differences in angina pectoris in Irish patients compared to the lack of discussion about coronary diseases in French patients.7 More than a century after Dr. Black’s query, evidence of biological mechanisms for cardioprotective effects continues to emerge – slowly; yet, the momentum has not died down in the popular media where the focus is primarily the medium of ethyl alcohol (ethanol) and red wine.

The truth is epidemiologic data demonstrates an association between heart disease, health and nutritional benefits, and alcohol and red wine consumption5, 6 but the association has been misinterpreted as causally related to heart disease. While biomedical research systematically explores the relationship between red wine and heart disease by exploring the biological pathways associated with cardiovascular risk factors (e.g., obesity, diabetes, blood pressure) as well as outcomes (e.g., heart attack or myocardial infarction, death), conclusive evidence for human benefit is lacking. Yet, a lack of evidence has not stopped the paucity of marketing campaigns postulating the benefits of red wine or the benefits of resveratrol (as a nutritional supplement or pharmacologic agent) for a healthy heart, anti-aging, or to combat cancer (all types of cancer).5, 8

Resveratrol is a polyphenol found on the skin of red grapes which protects the grape from bacteria and fungi. The compound is available in detectable quantities of red wine because skins of grapes are not fermented in the production process. In vitro data for resveratrol in human tissue and in vivo mice models of obesity, cardiovascular disease, and anti-aging effects is positive;9 however, its effects are the subject of ongoing clinical investigation in humans (see clinical trials.gov for a list of 10 active trials studying resveratrol). Numerous academic institutions and pharmaceutical companies such as Sitris, a Glaxo-Smith Kline (GSK) company, have jumped on the resveratrol-anti-aging/anti-cancer/anti-obesity/decreased-heart-disease-band wagon. As such, resveratrol has been isolated and marketed as a dietary constituent despite repeated warnings from the FDA to cease selling the product as a pharmacologic agent since there are no definitive results from clinical trials.8 In fact, there are warnings against purchasing resveratrol on many sites linked to Google.

Although alcohol has a well documented cardiovascular pathway, its pathway is independent of beverage type (i.e., wine, beer, or other alcoholic spirit).10, 11 The cardioprotective effects of alcohol includes increased high-density lipoprotein (HDL), antithrombotic effects, improved endolethial function, and decreased insulin resistance.5, 6, 10, 11 These effects, however, are confounded by individual characteristics such as gender, race, age, quantity, and type of alcohol (e.g., beer may be more beneficial for men while wine or a distilled spirit may be more beneficial for women).

Established risk factors for heart diseases include smoking, systemic hypertension, type II diabetes, blood lipids, atherogenic lesions, and thrombosis damage.6, 7 Both alcohol and red wine polyphenols antioxidant properties have antithrombotic and antiatherogenic action as well as significant impact on blood lipids (HDL and LDL); however, their association to other risk factors is confounded by intake and lifestyle variables. Alcohols’ positive impact on acute physiologic events (such as high blood pressure and heart rate) is a plausible explanation for the heightened interest in the association between alcohol, red wine, and heart disease. These findings excite nutrition proponents who fail to understand that red wine and alcohol independently impact heart disease risk factors; in fact, the non-alcohol related benefits (e.g., resveratrol) can be found in non-alcoholic beverages such as grape juice, other fruits and vegetables. Furthermore, the amount of property relates significantly to the benefit such that alcohol in large quantities has equally harmful consequences.


Fortunately, biomedical researchers, pharmaceutical companies, and legitimate organizations such as the American Heart Association are not marketing red wine or alcohol as beneficial mechanisms to decrease heart disease. In fact, it appears that only independently owned organizations such as Nutra-Smart.net by Stuart Adams or Bio-Medicine.org use evidence of an association between moderate alcohol consumption and acute cardioprotective benefit as explanations for the French Paradox while purporting causal relationships. Therefore, in light of the complex evidence for mechanisms of heart disease as well as the multiple pathways for alcohol and non-alcohol benefits people should be leery of the hypothesis that red wine decreases heart disease. Since alcohol consumption to the point of abuse represents a problem for a significant portion of American adults,12 it is not wise for popular news to continue promoting red wine consumption as a legitimate benefit for a healthy heart. Instead, promoting a low-fat diet with fruits and vegetables and exercise is a much more responsible message.

Holly Tomlin
Blog 8

References


1. McGraw A. Wine drinkers spark up sales. Central Penn Business Journal. 1995;11(5).
2. Dolan C. Marketing: Wineries and Government Clash over Ads that Toast Health Benefits of Drinking. The Wall Street Journal, 1992.
3. Fountain of Youth in Wine Rx. Jan 25, 2009, 2009.
4. Opie LH, Lecour S. The red wine hypothesis: from concepts to protective signalling molecules. Eur Heart J. 2007;28(14):1683-1693. Epub 2007 Jun 1687.
5. Saiko P, Szakmary A, Jaeger W, Szekeres T. Resveratrol and its analogs: defense against cancer, coronary disease and neurodegenerative maladies or just a fad? Mutat Res. 2008;658(1-2):68-94. Epub 2007 Aug 2017.
6. Saremi A, Arora R. The cardiovascular implications of alcohol and red wine. Am J Ther. 2008;15(3):265-277.
7. Klatsky AL. Alcohol, wine, and vascular diseases: an abundance of paradoxes. Am J Physiol Heart Circ Physiol. 2008;294(2):H582-583. Epub 2007 Dec 2014.
8. FDA. Warning Letter (09-ATL-01). In: Services DoHaH, ed; 2008.
9. Baur JA, Sinclair DA. Therapeutic potential of resveratrol: the in vivo evidence. Nat Rev Drug Discov. 2006;5(6):493-506. Epub 2006 May 2026.
10. Pearson TA. Alcohol and heart disease. Circulation. 1996;94(11):3023-3025.
11. Sato M, Maulik N, Das DK. Cardioprotection with alcohol: role of both alcohol and polyphenolic antioxidants. Ann N Y Acad Sci. 2002;957:122-135.
12. CDC/NCHS, Survey NHI. Figure 31. Cigarette smoking and alcohol use among young adults 18-29 years of age, by sex: United States, 1997-2006. In: Health US, ed: CDC; 2008.

Health in the News is not the Health News

The media distorts the nature of our country’s challenges, especially those pertaining to our public health. One of those challenges is what the government calls “homicide by discharge of firearms.” While it is a more prevalent cause of death for certain demographic groups (I will use age as an example), firearms homicide is far from the predominant cause of death in society as a whole. When it comes to protecting the life and health of our citizens, several other health issues are much more important than firearms homicide. My intention here is not to defend guns as much as shed light on how the media emphases different public health issues disproportionately to the issues' true effects on society.

Here is the CDC’s list of the leading American causes of death for 2005 (all statistics in this article are from 2005):

Top Death Causes (Actual #) (% of Total)
All causes (2,448,017) (100.0)
Cardiovascular disease (856,030) (35.0)
Cancer (559,312) (22.8)
Cerebrovascular diseases (143,579) (5.9)
Chronic lower respiratory diseases (130,933) (5.3)
Diabetes mellitus (75,119) (3.1)
Alzheimer's disease (71,599) (2.9)
Non-transportation accidents (69,368) (2.8)
Influenza and pneumonia (63,001) (2.6)
Motor vehicle accidents (45,343) (1.9)
Kidney failure (42,868) (1.8)
Infection (34,136) (1.4)
Suicide (32,637) (1.3)
Chronic liver disease and cirrhosis (27,530) (1.1)
Hypertension / hypertensive renal disease (24,902) (1.0)
Parkinson's disease (19,544) (0.8)
Lung Tissue Inflammation (17,129) (0.7)
Human immunodeficiency virus (12,543) (0.5)
Homicide by discharge of firearms (12,352) (0.5)

Granted, the above data is for the entire population and is skewed toward natural causes and disease because of the inclusion of the elderly.

However, if we isolate the age group with the highest number of firearms homicide victims, firearms homicide is still far from the number one cause of death. Just as the general population numbers are skewed by the elderly against firearms homicide, the numbers for ages 15-24 are skewed in favor of firearms homicide (plus auto and other accidents) because of this group’s superior overall physical health and lack of world experience. In plain language, when people between the ages of 15 and 24 die, it is least likely from natural causes and most likely from their own stupidity.

Top Death Causes Ages 15-24 (Actual #) (% of Group)
All causes (34,234) (100)
Motor vehicle accidents (10,908) (31.9)
Homicide by discharge of firearms (4,499) (13.1)
Non-transportation accidents (4,465) (13.0)
Suicide (4,212) (12.3)
Cancer (1,717) (5.0)

This 15-24 age group is an extreme example. While the number of firearm homicides is unacceptably high for this age group, where is the outcry over the number of deaths from motor vehicle accidents? While a discussion about outlawing cars would be absurd, why is there not a similar (let alone a greater)media lust for traffic safety as there is for gun control? Why is it that motor vehicle accidents kill twice as many people as firearm homicide, yet the latter is hyped up in the news while the former is not?

To put it in perspective, let us look at an age group that 1) eliminates the very young and very old outliers and 2) has the firearm homicide death rate (4.6 per 100,000) closest to the firearm homicide death rate for the entire population (4.2 per 100,000). That age group is 35-44.

Top Death Causes Ages 35-44 (Actual #) (% of Group)
All causes (84,785) (100)
Cardiovascular disease (15,852) (18.7)
Cancer (14,566) (17.2)
Non-transportation accidents (9,624) (11.3)
Motor vehicle accidents (6,748) (8.0)
Suicide (6,550) (7.7)
Human immunodeficiency virus (4,363) (5.2)
Chronic liver disease and cirrhosis (2,688) (3.2)
Diabetes mellitus (2,045) (2.4)
Homicide by discharge of firearms (2,010) (2.4)

Going by the statistics for this demographic group, if the primary motivation of the media was the welfare of Americans, then there would be over three times as many stories in the national news about traffic safety as there were about firearm homicide. There would also be three times as many stories about suicide as there were about firearm homicide. One would think there might be at least twice as many (let alone eight times as many) stories about cardiovascular disease as there were about firearm homicide.

It is pretty safe to say that is not the case.

It would seem that the media is less motivated by the health, safety, and well-being of the American people than it is motivated by a hatred of guns.

Here is one last point, to emphasize that I am not defending gun violence but attacking what the media chooses to emphasize. During the darkest days of the Iraq war, the media howled incessantly about our soldiers dying in Iraq, while a much worse slaughter was happening here at home. In 2005, 673 Americans were killed in action in Iraq, while 18,124 Americans (27 times that number) were firearms homicide victims here at home. Relying on the media, one would not have realized that.

The lesson here is, when it comes to health news (and all news in general), view the stories that the media chooses and thus emphasizes with a great deal of skepticism.


Sources
Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: Final data for 2005. National vital statistics reports; vol 56 no 10. Hyattsville, MD: National Center for Health Statistics. 2008. http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf Accessed 4/25/09

United States Department of Defense. Global War on Terrorism - Operation Iraqi Freedom
By Month http://siadapp.dmdc.osd.mil/personnel/CASUALTY/oif-total-by-month.pdf Accessed 4/26/09

Homeland Security? For Swine Flu?

I watched the press conference today in which the Homeland Security Secretary, Janet Napolitano, was coordinating the United States’ Swine Flu efforts.

From its inception, the Department of Homeland Security has been chargrd with taking the lead in a pandemic (which we do not yet have). I need convincing that this is the best policy.

Not only does a DHS Secretary lack the medical qualifications and expertise to lead the planning for this possible crisis, but this takes her attention away from the whole reason her position exists—protecting the United States from terrorism. The message is that we are not offering the most appropriate response in one area of concern while taking our eye off the ball in another area of concern.

She has been put in charge over the Cabinet Secretary (or actually Acting Secretary—that this position is still not officially filled three months into the administration points to another problem) whose assumed area of expertise is in the current area of concern—public health. The DHS Secretary was placed in charge over the Department of Health and Human Services (HHS) Acting Secretary Charles E. Johnson and the various agencies under his direction, including the Centers for Disease Control.

The Department of Homeland Security was created specifically to guard against terrorism on U.S. soil. Being the DHS Secretary requires one’s area of expertise to be protecting the U.S. against terrorism. If her area of expertise is in health rather than terrorism, then why is DHS Secretary in charge of health policy? One can argue that a possible pandemic IS a matter of domestic security, but that is wrong, especially at this juncture. The Department of Homeland Security should only become involved only if a pandemic had caused a breakdown of society with the resulting chaos placing the country’s infrastructure and citizens at greater risk of terrorism. We are not even near that situation, but even then, the DHS Secretary would not have the lead but be one of many considerations. Instead, a Department Secretary whose supposed area of expertise is not even in the area of current concern is in charge of Secretaries who are better qualified to handle the situation than she is.

Swine Flu and the Right Thing to Do?

The outbreak of swine flu in Mexico (which has spread to the U.S.) raises some difficult questions.

As of this writing early Saturday evening (4/25/09), news outlets were reporting that 20 to 80 are dead in Mexico with over 1000 infected, and 0 dead in the U.S. with roughly 15 infected (California, Texas, Kansas and New York). The Mexican president has declared an emergency, giving himself broad powers to impose quarantines and cancel events. The Mexico City government has closed school indefinitely and canceled other activities involving gatherings. This strain of swine flu does not kill only the very young or very old. An unnamed Mexican government source claimed most of the dead there are between 25 and 45 years old.

I am not an expert in the spread of disease, so I do not know if it is too late for travel and trade restrictions, should conditions in Mexico deteriorate to the point where they may be needed. When should health-related travel restrictions be placed between countries, essentially placing a country under quarantine? A pre-mature travel ban could spark cries of racism or xenophobia. If a travel ban should be necessary, will authorities wait longer than they otherwise would out of racial or diplomatic sensitivity? Feelings and pride are irrelevant when lives are at stake.

There are other questions. What are the rights of private citizens to move around and conduct commerce vs. society’s right to be protected from the spread of disease? How far should worldwide swine flu conditions have to deteriorate before the World Health Organization (WHO) declares a pandemic? A pandemic declaration by the WHO asks for voluntary worldwide trade and travel restrictions. With the world economy already in shambles, there will doubtless be pressure to postpone a pandemic declaration as long as possible. Some countries would comply, while others would not. What actions should be taken against countries that are not complying and are thought to be endangering other populations?

If we are fortunate, we will not have to learn the answers to these questions.


Sources
http://in.reuters.com/article/oilRpt/idINN2443181920090424
http://www.bloomberg.com/apps/news?pid=20601087&sid=aEsNownABJ6Q&refer=worldwide
http://www.alertnet.org/thenews/newsdesk/N24449988.htm
http://www.breitbart.com/article.php?id=D97PNI383&show_article=1

A Non-Religious Case against Abortion

I have concluded that abortion is wrong, but my reasons are not based on religion. Don’t get me wrong. Unlike the specious Bill Maher, I am not anti-religion. However, “the Bible says so” is not an acceptable basis from which to argue a point. While I am religious, my conclusions about abortion are based on humanistic and (yes) secular considerations.

First off, life begins at conception. Once the egg is fertilized, a chain of events is unleashed that, outside of malformation, medical problems, homicide or accidental death, invariably result in a fully formed adult human.

From conception through their mid-teens, human beings are in a constant state of physical development, gaining physiological capabilities and self-sufficiency. Not being fully physically developed is not an acceptable rationale for discounting one’s humanity. Does a pre-pubescent inability to reproduce make a child any less human? Does a baby’s inability to walk or speak make her any less human? Does not having teeth make an infant any less human? Does an infant’s inability to feed or defend himself make him any less human? Does having a soft skull make an infant any less human?

Of course, it does not.

By that rationale, not breathing air but getting nutrients from an umbilical cord does not make a baby any less human. Not having fully formed eyes does not make her any less human. Not having a fully developed brain does not make him any less human. Thus, development at any stage, including nascent development, does not make a person less human.

Human beings are physically dependent on their parents (especially, and increasingly so in modern times, their mothers) for nutrition and protection to varying degrees from conception through their mid-teens. A ten-year old depends on her parents for protection (no one is inclined to go to extremes to protect a child as is that child’s biological parents) and the means to acquire food. A five year old depends on his parents for protection and nutrition (lacking the means and knowledge to acquire proper food, both today and in prehistoric times). A six month old is dependent on her parents for protection and nutrition (mother’s milk or formula). In the same way, a person in utero is dependent on her mother for nutrition and protection from conception to birth.

It is intellectually inconsistent that society charges parents with the responsibility of providing nutrition and protection to their post-utero children but not in utero.

Many people mistakenly think that a child in the beginning is not human but a mere glob of cells. Let us look at in utero child development.

In a previous blog, I wrote about how genetic testing of fertilized eggs is now used to pick traits in children such as eye color, skin pigmentation, hair color, sex and more. If those traits are already determined in a fertilized egg, it is difficult to argue that the egg, zygote, fetus, or whatever one wants to call it, is non-human. While not yet manifested at this age, the child’s traits, including eye color, hair color, sex and even (to a large extent) personality are set. He or she is more than mere nondescript cells.

For some reason, pregnancy is officially calculated as starting on the first day of the woman’s last period, though conception generally takes place two weeks after that. Thus, most discussions of child development are misleading, since people are left with the impression that the child is two weeks older then he or she really is. In reality, the child initially develops and manifests widely known human characteristics much more quickly than people are led to believe. Therefore, I am going to describe child development in terms of “weeks after conception” instead of the common (and in my opinion, misleading) “gestational weeks.”

The first week begins with conception, and the child instantly starts to grow new cells as she travels down the fallopian tubes and lands in the lining of the uterus.

In the second week after conception, the child continues to grow new cells that divide into different groups, laying the initial groundwork for different areas of the body.

In the third week after conception, the child’s heart, spine and brain begin to form, though he is only 1/25 of an inch long. (This is about the time generally when a woman is missing her period and suspecting an unplanned pregnancy.)

In the fourth week after conception, while she is not more than of an inch long, the child’s heart starts to beat, pushing her own blood around her own circulatory system.

In the fifth week after conception, the mouth and digestive system are beginning to develop. Arms, legs and hands are starting to form. The baby is roughly 1/8 of an inch long.

In the sixth week after conception, the baby is about 1/3 inch long, and the eyes and nostrils are developing. Fingers, toes, and genitalia are beginning to develop. (Roughly, 62% of abortions are performed by this time (8 weeks gestation)).[1]

In the seventh week after conception, fingers and toes are taking shape, and the baby is at least ½ inch long.

In the eighth week after conception, the internal organs (including testes or ovaries) are all formed and the baby is about 1 inch long.

In the ninth week after conception, the baby is 2 inches long, and his skeleton is developing.

In the tenth week after conception, the genitalia are identifiable and sex is distinguishable.

In the eleventh week after conception, the baby is 3 inches long and has fingernails and toenails. (Roughly, 88% of abortions are performed by this time (13 weeks gestation)).[1]

There are many social and economic reasons why women feel compelled to abort their children. However, whatever motive one has for aborting a child, one cannot claim that abortion does not kill a human being. It does. An aborted baby is more than a discarded glob of random, unorganized cells. "It" is a dead human being.


References

[1] Abortion Surveillance — United States, 2005. Centers for Disease Control and Prevention. November 28, 2008 / Vol. 57 / No. SS-13. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5713a1.htm Accessed 4/24/09

Fetal development: What happens during the first trimester? Mayo Clinic. http://www.mayoclinic.com/health/prenatal-care/PR00112/METHOD=print Accessed 4/24/09

Pregnancy calendar. Nemours. http://www.nemours.org/e-service/kidshealth.html?p4if_ps=102 Accessed 4/24/09

¿Tu hablo inglés?

What did you say? ¿Cómo? Many hospitals, emergency rooms, clinics, and healthcare personnel must deal with language barriers every day. With the numbers of immigrants in the United States increasing rapidly, the need for translators also increases dramatically. But, it seems that the lack of translators is not the problem, as is the doctors’ attitude towards using translators. In the article, “Lost in Translation,” physicians admit to not using translation services because it takes too much of their time, which can be used for more time with more patients. They admit to having a negative attitude toward employing translators when visiting patients in the hospital, even surgical patients. Dr. Pauline Chen, author of the article, when meeting with a Spanish-speaking patient after performing kidney transplant surgery, admits, “Pressed for time and acutely aware that a couple dozen more patients were always waiting, I never called an interpreter to Armando’s room during my daily rounds after his operation. Although interpreters were available at all times, it would take time, I thought, for one to arrive, and then the translation itself could slow things down.”

The article reports that there has been numerous research studies conducted on the use of translators and the effect of language barriers in healthcare. “…according to a new study published in The Journal of General Internal Medicine, doctors’ assumptions about communication — what they deem important in a conversation — may also have a role.” Dr. Chen says that although she would use translators to speak with patients about lab results, potential complications, or medication regime, she did not use them for “more routine checks.” She admits to “getting by” by feebly stumbling “through three, maybe four, words of Spanish.” In the recent study published by the Journal of General Internal Medicine, Dr. Alicia Fernandez and her research team at the University of California, San Francisco, studied language barriers at two hospitals with “excellent translator services.” Her study found that “While the doctors acknowledged that they were underutilizing professional interpreters, many made the decision not to call an interpreter consciously, weighing the perceived value of patient information against their own time constraints. Moreover, despite their personal misgivings, the doctors often felt that this kind of shortcut was acceptable and well within the norms of their professional environment.”

It seems clear from the results of the study that many physicians are bothered by the need for translators and see them as irrelevant and a waste of time. But what does this say about their attitude toward the patient? Does not their attitude toward using translators emote an attitude of resentment toward non-English-speaking patients? Do they not value their quality of life the same as those of English-speaking patients? Is it not the creed of physicians to “first do no harm,” regardless of race, creed, or in this case, language? Dr. Fernandez even admits about herself that she if “‘rounding late at night, (I) might just decide not to use an interpreter.” Through conducting this study, Dr. Fernandez realized that not employing the use of translators “‘…has become an acceptable shortcut in care. But the truth is that the patient deserves to speak to the doctor as well.’” She admits that this negative attitude towards using translators is not reflective of their feelings toward translators, their patients, or even their time pressures, but “yet “how we (as doctors) think about communication with our patients.”

According to the study, 43 percent of people in California do not speak English in their homes. So, the use of translators in a medical setting is critical to their ability to communicate with almost half of the California population. Too, not only does the doctors’ lack of translator use cause a problem, but the study also cites costs of translator services as a cause. Acknowledging this issue, Dr. Fernandez reports that “…many doctors simply do not have access to basic interpreter services…(however) California recently passed an unprecedented law mandating that health and dental plans supply interpreters and translated material to H.M.O. and P.P.O. patients.” Although this law may be a positive step towards increasing the number of translators in a medical setting, the article reports that “…still leaves a growing segment of the population – more than 20 million people in the United States – with inadequate care.”

If we are to improve quality of care for all United States residents, congress must acknowledge the growing need for quality healthcare for every one, even those non-English-speaking people. But where in the long line of problems with healthcare does the need for translators fall? With all the issues with healthcare today, including the millions of people without healthcare insurance, rapidly increasing nursing shortages, and the FDA coming under fire for controversial drug approvals, where does the effect of language barriers on quality of life fit in? What gets first priority? Not to knock language barrier problems or FDA drugs, but as one without healthcare insurance, I hope it is first in line. But that’s just my selfishness showing. Forgive me, I am working on it.

Poor Justice for the Innocent

Living a Life Sentence

Kelly Cobiella

CBS Sunday Morning

April 19, 2009

 

Anything can happen to anyone at anytime and good things do not always happen to good people. One of the worst nightmares that can happen in a person’s life is to be falsely imprisoned and, even worse, executed. But this recurring nightmare has been experienced by thousands of people through the years. Some spend the remainder of their lives in prison, never returning to the life they once knew. Thanks to the breakthrough of DNA evidence, many have been fortunate to be exonerated of rape and murder charges after years and even decades behind bars. Others are freed as a result of determined sleuth work on the part of supporters or loved ones, people recanting original testimonies, suppressed evidence being revealed, or the surfacing of new evidence. Whatever the circumstances of their release, all of the newly freed face the same challenges of reintegrating into society.

 

After the initial elation of finally achieving the dream of freedom, reality is a real slap in the face for the newly exonerated. While decades passed, society moved on, technology advanced, and life slipped away. Homes were lost, careers destroyed, families broken up, insurance coverage stripped away, and children grew up. Release brings a new beginning for the wrongfully accused, with a prison record on their resumes. Many were imprisoned based on little or no evidence. In some cases, evidence was suppressed by police or prosecutors, physical evidence planted by police, other evidence manufactured by forensic scientists, and lying witnesses knowingly placed on the stand by prosecutors, all for the purpose of getting a conviction, whether to advance a career or for political or other reasons.

 

Beverly Monroe was 55, with a successful career as a chemist, when she was convicted of murdering her companion, Roger de la Burde, in 1992, even though police thought it was a likely suicide. There was no other evidence against Beverly but the prosecutor withheld this crucial information during her trial. Beverly’s daughter, Kate, was just starting her career as a lawyer and she quit her job to devote the next six years to freeing her mother, which she was able to do in 1999 based on the suppressed evidence. Beverly is now 62 and trying to piece her life together. Although potential employers have been sympathetic to her story, her prison record remains, and she has only been able to find a job as an administrative assistant with no benefits, a stark contrast to the success she had enjoyed before her conviction.

 

Following her mother’s release from prison, Kate Monroe moved to Utah to work as executive director of the Rocky Mountain Innocence Project, which has worked to pass a compensation law to aid the wrongfully convicted upon their release from prison. The law, which was passed in 2008, awards about $35,000 for each year of false imprisonment up to 15 years, and expunges the person’s criminal record. Only 25 states have such a program. Virginia, where Beverly Monroe lives, is not one of them. Another group called the Innocence Project has helped free 235 people with DNA evidence; 17 of them were on death row. The Innocence Project also works to reform the criminal justice system in order to prevent recurrences of such stories, many of which are far worse than Beverly Monroe's.

 

It’s true that mistakes can happen. But it’s hard to imagine the sheer powerlessness and devastating bitterness one must feel at the hands of someone who deliberately steals your life from you for personal gain. We never hear the names of the prosecutors or police officers who tamper with evidence or suppress information. There must be a law that is protecting them. We need laws that provide accountability for such misconduct. Or maybe we have them but the victims simply don’t have the fight left in them or the resources to engage in another battle. Or maybe they’re just grateful to be free. It seems that there is a conspiracy of silence regarding this issue. It is fair that victims of the justice system should be compensated and their records expunged in the case of wrongful incarceration. State governments should all adopt laws similar to the one passed in Utah and I further propose that resources should be allocated to psychological counseling and job counseling, as well as job placement and other services to ease the transition from prison to society. It wouldn’t give back the lost years but it would help to make the remaining ones better.

How Green Is the Color of Money?

Stick Your Damn Hand In It: 20th Birthday of the Exxon Valdez Lie

Greg Palast

March 23, 2009

Twenty years after the Exxon Valdez dumped 11 million gallons of crude oil into Prince William Sound in Alaska, marine life still struggles to recover from the largest oil spill in US history. The oil spill was a result of negligence on the part of Exxon. The Valdez was sailing with faulty radar equipment and lacking other equipment that could have prevented the crash and contained the spill, as required by law. Exxon was not merely negligent: Executives made a deliberate decision to do without the oil spill equipment in order to save money, after they had promised to use it. Exxon blamed the spill on human error caused by a drunken captain, who was actually not even navigating the vessel at the time.

Prince William Sound is in a remote enclosed area that made it especially difficult to contain and clean up the spill. The effects were devastating on the environment, wildlife, and commerce in an area that was already fragile from the ravages of pollution. Some species, including one group of orcas, or killer whales, now face extinction, while another group of orcas is taking longer than expected to recover. Some species that do eventually recover (this may take another 10 years for the orcas) will never be the same due to altered family systems and stunted growth patterns caused by the spill. Air pollution carried across the Pacific Ocean from China and Southeast Asia has exacerbated the situation by causing toxic substances to lodge in the fatty tissue of the whales, resulting in a diminished ability to reproduce. The human toll included bankrupt businesses and individuals, suicide, starvation, and increased alcoholism within the Native Alaskan community of fishing villages. The $5 billion in punitive damages that Exxon was required to pay to the 30,000 Natives and fisherman of Prince William Sound was reduced to half a billion dollars, one-tenth of the original award. The litigation continued for 20 years, promises made to the villages and fisherman were never kept, and about one-third of the fisherman have died waiting for their award to start trickling in from Exxon. Meanwhile, Lee Raymond, who was president of Exxon at the time of the spill, retired in 2006 and received a $400 million retirement bonus.

Exxon Mobil recorded a $45.2 billion profit in 2008, up almost 19% from 2007, setting a new US record and toppling Fortune 500 giant Wal-Mart from its six-year number one spot in the process. This against the backdrop of soaring gas prices of well over $4 per gallon, which left many Americans unable to afford travel for the basic necessities of life, such as commuting to work or buying groceries. Exxon is currently running a PR campaign for green energy alternatives. These television advertisements are heavy with gender and racially diverse scientists and technicians idealistically singing the praises of Exxon’s explorations into eco-friendly fuel innovations. One such ad makes the claim that liquefied natural gas is a clean fuel. The UK Advertising Standards Authority (ASA) adjudicated that the ad was misleading and could not be aired, after some astute viewers notified the authority. Liquefied natural gas causes significant carbon emissions. Some of Exxon’s innovations have merit but fossil fuels remain the basis of Exxon’s business.

Most people have forgotten the Exxon Valdez, but the community and wildlife that have suffered the consequences of Exxon’s negligence and lack of accountability will never be the same. Twenty years later, proudly touting a newer, greener image, Exxon Mobil, with it’s policy of deception, contempt for the environment, and greed, remains essentially the same.

Have we become uncomfortably numb?

Are We Numb to Mass Murder?
Jeff Glor
CBS News
April 5, 2009

In the wake of the mass shooting at the Binghamton, NY American Civic Association where 41-year-old Vietnamese immigrant Jiverly Wong gunned down 13 people who were studying for their citizenship exam before he finally shot himself, the writer of this article asks us, “Are we numb to mass murder?” The writer asserts that this is so, that the public’s reaction has become ritualized, and that people are more concerned with economics than gun control. Furthermore, it doesn't appear that our political leaders are inclined to do much about the problem, aside from offering condolences to the towns and the families that have been traumatized by these events, while hundreds hold vigil for the unfortunate victims.

Everyone still remembers the Columbine shootings 10 years ago, when 15 high school students and teachers were shot down by a fellow student, and Virginia Tech two years ago where the death toll was more than double that of Columbine. There were others before and after that. In the past month 47 people died as a result of six mass shootings. The trend has migrated to Europe as well: Finland had two mass shootings within one year in 2007-2008 and a teenager in Germany shot 15 people in Germany this past March.

These events are tragic, horrifying, and gruesome. And they have become common. But I don’t think people are numb to mass murder—I think they just feel powerless. Honestly, what can anyone do? We can all become paranoid and start mistrusting everyone we see and avoiding public places, but that would put a halt to our lives as we know them. Unless they are actually experiencing the event, people are of necessity going to detach from these events—you could go insane with grief, outrage, and incredulity over the commonality of these events and the fact that the virus has migrated to the rest of the world, as well. People have to go on with their lives. Look at Israel and the Middle East, where a suicide bomber could kill an entire café full of people enjoying an afternoon cappuccino in a matter of minutes: The citizens of these countries continue to live their lives, even though they could die at any moment. They just take precautions. Philosophers state that we should live each day as though it is our last—well, here it is in action. The human spirit can rise about tragedy.

Quite realistically, the economy is a far more immediate danger to survival for most people today than the possibility of being murdered in a mass shooting spree. People are justified in worrying about the economy. They are protecting their families. The chances of losing your investments or your home seem more likely than the chance of getting murdered.

I don’t think tougher gun laws are necessarily the answer. I think we need to focus on stricter enforcement and follow-up of existing laws, with new provisions for mental illness. I don’t want everyone touting a gun, either. But I also don’t want my Constitutional rights curtailed. The right to bear arms was an essential freedom that our Founding Fathers insisted on for the protection of our people against a (despotic) government that misused its power. I don’t want just the army and the police to be allowed to have guns and then private citizens are left without a means to protect themselves against potential abuses of power. I don’t have a gun and I don’t want one but I want to be able to know that I can have one when I need it. I hate guns.

Clearly, our society requires an overhaul of its system of dealing with troubled teenagers and people who exhibit the warning signs of potential violence. It may not be politically correct, but it can save lives. I think there is an element of copycatism involved in these crimes. One crazy person got the idea more than a decade ago and it caught on like wildfire. So, should we stop reporting on these crimes and giving these people their 15 minutes of fame? It might actually stop some of the violence but that’s not a solution, either. I believe it is time for our lawmakers and mental health experts to begin studying this problem in earnest and drafting a workable plan for stopping these crimes of rage.

Personally, I feel a little sadder, a little more frightened each time I hear about one of these slayings because, to me, with each new incident, I feel that the odds of my life being touched by such an event are increasing, that it is coming a little closer to home. I feel a little more worried each time I read about a mass murder. I feel a little less inclined to spend time in public places, a little more watchful of my surroundings. I feel that my freedoms are being replaced by fears. I don't like it but I don’t know what to do about it, other than pray for the victims, pray that the violence stops, and continue with my life.

Memory erasing/enhancing: the possibilities...

A recent New York Times article asks: What would your life be like if you could erase certain memories by tinkering with a single substance in the brain? Imagine being made to forget a chronic fear, a traumatic loss, or even a bad habit. This notion seems like a cheesy Sci-Fi movie; however researchers are on the verge of making memory erasing a reality.

Dr. Todd C. Sacktor and his team of scientists from SUNY Downstate Medical Center have been able to show how a single dose of an experimental drug can, in animals, block the ability of the brain to hold onto specific types of memories.

The positive side to this research includes the fact that the drug blocks the activity of a substance that the brain apparently needs to retain much of its learned information. And if enhanced, the substance could help ward off dementias and other memory problems. With an estimated 100 million Alzheimer's and dementia sufferers worldwide by the year 2050, this appears to be a clearly beneficial target treatment.

This possibility of memory editing has enormous possibilities; yet it also raises huge ethical issues. For example, how will erasing specific memories affect humans? Any such drug could be misused to erase or block memories of bad behavior, even of crimes. It may seem beneficial to erase traumatic memories, but the erasure of other troubling memories, and the healthy dread of them, form the foundation of moral conscience.

I know that memories of punishments from parents and other authority figures have had a major impact on my decision making and resultant actions. If I had no recollection of the way I felt during punishments, then I would probably be apt to repeat the same mistakes. If somebody erased those types of memories, then it would be like somebody squashing my internal "Jiminy Cricket".

A substance that improves memory would raise larger social concerns in addition to ethical concerns. For example, when scientists find a drug to strengthen memory, will everyone feel compelled to use it? People already use smart drugs and performance enhancers of all kinds; so a substance that actually improved memory could lead to an arms race.

At this point in time, the ethical and social implications of memory erasing/enhancing are just another future dread. However, we can all find comfort in the fact that such drugs may never even make it to human trials. Also, we can always rely on our government to halt any possibilities of future research. I say this because there may actually be positive aspects to this type of drug, such as Alzheimer's treatment, and we know how the government has reacted to promising studies (pre-Obama days)…case in point: will stem cell treatments ever get off the ground?

BW706: Blog #12
Lisa Menard

Humanising Medicine

Currently, I am a medical writer for clinical trials. The human aspect of my job is hard to ignore considering that I am writing about subjects' immunology and safety results. However, a recent New York Times article took me back to my earlier days of working as a medical technologist in a hospital microbiology laboratory; a time when the human aspect was not always present.

As a technologist, I spent many hours processing serum samples through machines, and, at times, feeling like a machine myself. In other respects, I had to force myself to de-humanize the certain samples due to their inherent nature. For example, I would pretend that stool samples were actually mud; however, it was difficult to keep the mental image of mud when that mud also contained corn.

The main point is the fact that the job duties became extremely mechanical in nature. The workload was high, and the manpower was low. Therefore, tasks must have been performed efficiently without extended thought, and it was very easy to forget about the human aspect of the job.

Dr. Yehonatan Turner, a radiologist from Jerusalem, appears to have the same problem in his field, but he thinks that he has come up with a solution.

When Dr. Turner began his residency in radiology, he was frustrated that the CT scans he analyzed revealed nothing about the patients behind them. So to make things personal, he imagined each patient was his father. But then he had another idea; to attach a photograph of the actual patient to each file.

Dr. Turner’s hunch turned into an unusual medical study. Its preliminary findings suggested that when a digital photograph was attached to a patient’s file, radiologists provided longer, more meticulous reports. And they said they felt more connected to the patients, whom they seldom meet face to face.

In the digital age, adding a photo to a file is a simple procedure, and the study’s authors say they hope it becomes a standard procedure; not just for radiologists, but also for pathologists and other doctors who rarely have contact with patients.

However, attaching photos to patient files could prove difficult in the United States. Privacy rules might require patient consent each time a photo was used.

Putting aside any ethical implications concerning privacy, the logistical considerations alone should be enough to thwart any thoughts of this photo system. Who supplies the photo? Would photo costs be covered under health insurance? What is done with the photos after a X-ray is processed? Would healthcare institutions need a separate filing area for all of these photos?

While Dr. Turner's heart seems to be in the right place, I think that his passion for photography and art should remain separate from his radiology career. I mean, where would the photograph madness end? If I were still a medical technologist, would I want to see the face of the patient's stool that I am plating?

I think the answer is that each individual in the medical field should take it upon themselves to find their own human inspiration behind mundane and mechanical tasks. For me, it was my once week expeditions out of the microbiology lab. I volunteered to be the individual to maintain the bloodgas machines in the Intensive Care Unit. If seeing people dying doesn't make you see the human aspect, then you're definitely in the wrong business.

BW706 Blog #11
Lisa Menard

You Mean I Don’t Need a Pap Every Year!

I am flabbergasted and stunned. After reading the article in the New York Times, “DNA Test Outperforms Pap Smear,” I am speechless. And, I’m not just referring to the new development that a new DNA test for the virus that causes cervical cancer will eventually replace the Pap smear. I’m referring to the fact that the article reveals a fact of which I was not aware. “Since 1987, she (Debbie Saslow, director of gynecologic cancer for the American Cancer Society) said, the cancer society and the American College of Obstetricians and Gynecologists have recommended Pap smears only every three years after initial negative ones. In 2002, they recommended the HPV test too, and evidence is mounting that the Pap smear can be dropped.” Dr. Saslow went on to say that, “‘But we haven’t been able to get doctors to go along… The average gynecologist, especially the older ones, says, ‘Women come in for their Pap smear, and that’s how we get them in here to get other care.’ We’re totally overscreening, but when you’ve been telling everyone for 40 years to get an annual Pap smear, it’s hard to change.’”

The article then reveals that this new development, DNA testing for cervical cancer, may only have to be done every 3 years. “Not only could the new test for human papillomavirus, or HPV, save lives; scientists say that women over 30 could drop annual Pap smears and instead have the DNA test just once every 3, 5 or even 10 years, depending on which expert is asked.” However, the significance of this test will depend on the gynecologists’ willingness to administer this test instead of the Pap smear. In the 1950s, when cervical cancer was a leading cause of death for women, the Pap smear was extremely effective. However, today, cervical cancer only accounts for less than 4,000 deaths each year. So, the importance or significance of the Pap smear has lost its validity. The article notes that most countries may have been reluctant to administer the DNA test because of its overwhelming cost. But, “In poor and middle-income countries, where the cancer kills more than 250,000 women a year, cost is a factor, but the test’s maker, Qiagen, with financing from the Gates Foundation, has developed a $5 version and the price could go lower with enough orders, the company said.” In this country, Pap smear results may take several days. But the DNA screen will be read by machines, providing results much quicker. In third-world countries, Pap smears fail because women often can not return and there are fewer available trained gynecologists. A study conducted in India revealed, “…none of the women who were negative on their DNA test died of cervical cancer.” With this test, women over 30 may not need testing but every 5 to 10 years, improving quality of life and reducing deaths due to cervical cancer.

So, if this is true, why would the doctors in the United States not provide this type of information to their patients? I’ve been having unnecessary panic over getting a Pap smear annually, when I could have been getting them every 3 years. Why would the doctors not inform us of this fact? Is it to make more money, and not necessarily to improve our quality of life? I have several sisters, and after speaking with them, they revealed that they were never told this by their gynecologists. Why? Other research revealed that:
* If you are younger than 30 years old, you should get a Pap test every year. If you are age 30 or older and have had 3 normal Pap tests for 3 years in a row, talk to your doctor about spacing out Pap tests to every 2 or 3 years. If you are ages 65 to 70 and have had at least 3 normal Pap tests and no abnormal Pap tests in the last 10 years, ask your doctor if you can stop having Pap tests. (http://www.womenshealth.gov/faq/pap-test.cfm#pap04).
* You should have your first Pap smear when you start having sex or by age 18. Continue having a Pap smear once a year until you've had at least 3 normal ones. After this, you should have a Pap smear at least every 3 years, unless your doctor thinks you need them more often. Keep having Pap smears throughout your life, even after you've gone through menopause. (http://familydoctor.org/online/famdocen/home/women/reproductive/gynecologic/138.html).
* If you are over age 30 or your Pap smears have been negative for 3 years in a row, your doctor may tell you that you only need a Pap smear every 2-3 years. (http://www.nlm.nih.gov/medlineplus/ency/article/002125.htm).

So, I have to continue to wonder about the motivation behind gynecologists’ insistance on annual Pap smears, especially for women over 30 years old. Is it monetary based or quality of life concern? According to the article, the hesitation is not because of high costs of the DNA test. “Dr. Jan Agosti, the Gates Foundation officer overseeing its third world screening, said Qiagen’s new $5 test — which proved itself in a two-year study in China — runs on batteries without water or refrigeration, and takes less than three hours. In countries where women are ‘shyer about pelvic exams,’ she added, it even works ‘acceptably well’ on vaginal swabs they can take themselves.”

You can be sure that I’ll be bringing up this matter with my gynecologist, especially since the dreadful time has come this month. Now, I can’t wait to go to the doctor.

Three Steps Back for Women

Worse Than the Taliban
Jon Boone
The Guardian
March 31, 2009

Afghanistan’s President Karzai reportedly signed a law last month that contradicts the country’s own constitutional provisions for equal rights for women. The new law, which was rapidly passed with little debate, and has not been published, allows for the Shia sect to have its own jurisprudence regarding family law, much to the dismay of some female parliamentarians. This law is also in conflict with international treaties. The new law comes out in time for the upcoming presidential elections in Afghanistan, which are expected to be a close battle this year, as Mr. Karzai has become increasingly unpopular. It is believed that the new legislation curries the votes of Shia Muslims, which comprise about 10% of the Afghani population, as well as the Hazara, who are also Shia, and a powerful minority in Afghanistan. The Hazara represent about 20% of Afghanistan’s population.

The articles of the new law are believed to include provisions that women are required to have their husbands’ permission in order to leave the house, seek work or education, or visit the doctor. Additionally, women are not allowed to refuse sex when demanded by their husbands. The law also gives custody of children to fathers and grandfathers. Some female parliamentarians argue that, although the law is not perfect, it is an improvement over earlier drafts of the law, which included a proposed marriage age of nine for girls (it was raised to 16) and provisions for temporary marriages. According to the ministry of justice, the law still has “technical problems” that must be resolved before it will be published.

The United Nations Development Fund for Women (UNIFEM) have decried the new law but the international community appears to be avoiding the issue, Presdident Obama included, hiding behind the shield of cultural sensitivity. I have to admit I was truly disappointed as I watched Mr. Obama’s response to a reporter’s question regarding the new law at a news conference following the NATO summit in Strasbourg, France this weekend. The president appeared to lose his customary poise and articulate fluidity, as he hesitated, stammered, and fidgeted with his notes. He referred to the law as “abhorrent” but he was clearly discomfited by the question as he requested that the reporter remember the reason for our being in Afghanistan and the culturally sensitive nature of the issue.

Cultural sensitivity is a very important issue, and I understand the delicacy of the situation, but it can also be a cowardly excuse not to address the basic human rights of women…again. Shouldn’t women, who comprise roughly half of humankind, have equal say in the direction that their culture is taking? Yet the abuse, rape, and false imprisonment of women and girls and the disregard for women’s basic rights continues to be systematically sanctioned by societies and governments, to greater or lesser degree. Sexism is the most insidious of injustices because it begins in the family and permeates every aspect of life. Men behave the way they do because they can—it is the world boys’ club sanctioned by religion and tradition.

The rights of women (followed by children and animals) are the last to be acknowledged, codified, and enforced in every society. Women suffer twice in an oppressive society: first at the hands of the law, then at the hands of their husbands and fathers. Human rights in general take a back seat to economics (especially oil). Remember Uganda, Rwanda, Darfour? What about China? The United States (reluctantly) had sanctions against South Africa during Apartheid, where half the population were oppressed—how is this different? (Kudos to us for taking action in Kosovo in the 1990s: they didn’t even have oil!) I’m not declaring war: I am asking for awareness and action on the part of the international community. No society will ever be whole, ours included, until every voice is heard, and has weight, and the rights of the most vulnerable are protected.

Social Darwinism’s Impact on Personalized Medicine

The educational and health complexities in American society cannot be explained by a single theory. However, no one theory continues to have as much of an impact on our social construct than Charles Darwin’s theories of evolution and natural selection. It is doubtful that Charles Darwin himself predicted the impact his assertions would have on our interactions within present-day society as well as the effects propagated throughout the world. Yet, his theories of genetic variations, incorrectly applied, filter into our socio-political and health paradigms and permeate our educational and health infrastructure while politicians and corporations quibble over moral and ethical obligations that drive a wedge between cultures defined more by economics than biological differences.

A central theme of population genetics is that “race is an inherent biological characteristic that accurately reflects human ancestry and the flow of common threads of genetic material in biologically distinct populations over time and geography” (Fine et al., 2005). As such, genetics research has the potential to identify populations at risk of developing particular diseases, thereby providing the opportunity for tailored preventive medicine therapies as well as personalized medicine by use of identified biological markers (Burchard et al., 2003). Although mapping race and genes is not a new phenomenon, modern technology has the propensity to propel these theories into research and, if proven true, actual practice.

Opponents of using the biological notion of race argue that the species Homo sapiens consists of a single population not biologically distinct while citing the Human Genome project that shows humans share 99.9% of their genetic makeup (Fine et al., 2005; Lee 2005). According to this theory, race is not a biologic construct but a social construct with detrimental consequences that sustain arguments for racial profiling. However, racial profiling based on phenotypic and socio-demographic characteristics already exists and is the foundation for disparities in education, health, and health care. It is not in society’s best interest to ignore the impact of biologic variations particularly when the differences adversely impact health and health economics for large portions of the population that suffer from rare biologic anomalies that are unique to specific racial groups: for example, sickle cell anemia and Tay-Sachs disease just to name two.

Arguments for and against biologic notions of race and race-based research are circular with no clear beginning (origin) or end (definitive conclusion). However, the adverse applications of Social-Darwinism and the subsequent racism that stems from its theories continue to plague logical, data-based decision making with respect to health and health care. Genomics and pharmacogenomics technologies have the capacity to propel society beyond petty aggravations of antiquated notions of race and, subsequently thwart health disparities while paving a clear path toward personalized medicine.

However, it is important to assure society that genomics technologies do not go unchecked. One way of ensuring that genomics technology does not exacerbate health disparities is the application of a public health code of ethics (Thomas, et al 2005) routed in the principles of medical ethics while ensuring questions related to the allocation of resources for the overall good of the community are adequately addressed; less society continues to sweep notions of race and health disparities under the proverbial rug of genetic and social equipoise. Such notions are steeped in obsolete ideas of genetically dominant-survivalist-theories that propagate health disparities while leading us further away from superior medical technologies and optimal health.

Note: This blog is based on articles from the 2005 issue of the American Journal of Public Health – Race and Genetics

References

Burchard EG, Ziv E, Coyle N, et al. The importance of race and ethnic background in biomedical research and clinical practice. N Engl J Med. 2003; 348:1170-1175.

Fine MJ, Ibrahim, SA, Thomas, SB. The role of race and genetics in health disparities research. Am J Pub Health. 2005; 95(12): Editorial 2125-2128.

Lee SS. Racializing drug design: Implications for pharmacogenomics for health disparities. Am J Pub Health. 2005; 95(12) 2133-2138.

Thomas JC, Irwin DE, Zuiker ES, and Millian RC. Genomics and the public health code of ethics. Am J Pub Health 2005; 95(12) 2139-2143.

Reaching Out to God at the 11th Hour

One Man’s Ambivalent Retreat from His Racist Past
Helen O’Neill
Associated Press
April 4, 2009

Call it human nature. But why do people wait until it’s almost too late to change?

Elwin Hope Wilson is a 72-year-old man near the end of his life, suffering from the complications of diabetes and a very guilty conscience. Mr. Wilson was a Klu Klux Klansman for much of his life and performed many despicable acts against Black people in South Carolina. He is now seeking forgiveness by reaching out to Black men his age and apologizing in Black churches. He owed a special apology to Congressman John Lewis of Atlanta, who was a civil rights leader during the Freedom Rides 48 years ago, and brutally beaten by Mr. Wilson at a bus station in 1961.

A group of nine Friendship Junior College students, who became known as the Friendship Nine, took the brave stand of ordering food from a "Whites only" lunch counter in Rock Hill, SC on January 31, 1961. They were arrested and took the “jail, no bail” stand that landed them in prison for a month doing hard labor in a chain gang. This policy was subsequently taken up by other Freedom Riders throughout the south. Mr. Wilson never knew the name of the man he had beaten until he read a story about Congressman Lewis’ return to Rock Hill, SC in 2008 for a public apology from the York County Council and presentation of a plaque to the Friendship Nine. That lunch counter now has the names of the nine protesters engraved on its stools, a proud yet sad reminder of their bravery on that fateful day.

Apparently Mr. Wilson was a drinker and just plain old mean to everybody, but he especially hated Blacks (at least he wasn't a hypocrite). He was an embarrassment to his family. His conscience began to tug at him several years ago, most poignantly when he saw the ghost of a Black man in his rocking chair that caused Mr. Wilson to beat his fists in the air. Mr. Wilson is unable to explain his hatred of Blacks or how it originated, and why it ended. His change of heart appeared to be sudden and surprised his family, but it appeared to increase as his health declined. He began to apologize to family members whom he had embarrassed and people he had threatened or harassed. He felt a great burden lifting from his heart.

Some of the Friendship Nine accepted Mr. Wilson’s apologies, while others questioned his motives and declined a meeting. He also receives threats from the KKK for betraying them. But many, Blacks and Whites included, consider Mr. Wilson a hero and have been healed by his actions. Now he is a celebrity, with many demands on his time and his health to appear at churches to speak and tell his story. By his own admission, he is still a curmudgeon but he now understands the impact of his behavior.

I don’t much care about Mr. Wilson’s current state of health. And I don't much care if he goes to heaven or hell. I truly wonder what his attitude would have been if his health hadn’t failed and he was guaranteed another 20 years of quality life. But I do hope that his remorse is heartfelt and that his apologies have helped to heal some hearts that have been victimized by him. I hope that there is closure for some whom he has scarred. People change when they are ready. I suppose that growth and insight can come at any age, and I believe that it does, but I just wish people would get their religion a little earlier in life when it has more meaning. But I am also changing and forgiving him as I write this blog. Better late than never.

What is happiness, really?

I recently purchased a book titled, The Geography of Bliss, in which the author, who spent 10 years as a foreign correspondent for National Public Radio visiting some of the unhappiest places on earth, decided to visit some of the happiest. There is actually a map of the happiest and unhappiest places on earth. Denmark has topped the charts for the past 30 years as the happiest country on earth. The United States is currently ranked number 17 out of 95, up from 23 in 2006 (Zimbabwe and Moldova ranked at the bottom), and number 97 out of 140 in peacefulness.

We as Americans believe that we have such a high standard of living. We have convinced ourselves, rightly so, that we are the greatest nation on earth, but we have so much to learn from other countries that appear to have so much less, yet are ranked higher in happiness. People in other countries have enough. We have excess everywhere we turn: extremes of wealth and poverty, consumerism, obesity, you name it.

I think that our American need to be the best and have the most has created a very unhealthy lifestyle, especially in areas like the Northeast. We spend too many hours working and driving and too little time relating, exercising, and enjoying ourselves. Parents compensate for being absent by spending guilt money on their children. More and more stuff and less and less quality time is the name of the game. We have also lost the fine art of conversation. People don’t have anything to talk about except who worked more hours than whom (which often turns into a p*ssing contest), what they bought, and everyplace they had to drive the kids to. People don’t talk about books they’ve read, or a meal at a special restaurant that they enjoyed, or the beauty of a sunset at their vacation island.

I had a conversation yesterday with a lovely man from Columbia. He described life in his town, where people dress up in the evening to go for a stroll through the square, the streets are closed off for walking on the weekend, and people don’t have a whole lot of money, but seem to really enjoy themselves and their relationships. And they are much healthier. I find that this is sadly lacking in our American lifestyle. People really do have a lot but no one seems to be enjoying any of it very much. Stress levels are very high and satisfaction is low.

But I think the authors might be confusing satisfaction and contentment with happiness. Morley Safer of 60 Minutes did a segment on Danish happiness in 2008 to find out why the Danes are so happy. A Danish research team concluded that, although the Danes do a lot of complaining, they have modest expectations; therefore, they are rarely disappointed. I lived in Denmark for 13 months from 1978-1979 and I can tell you that my stay there was one of the happiest times in my life. As a people the Danes have a very high self-esteem that borders on arrogance. They are very outspoken and not at all politically correct. But they sure are a lot of fun to hang out with. I recently asked a Danish friend what he thought of the researchers’ finding and he told me that, because of their social welfare system, “I know that whatever happens, I cannot fail.”

My friend’s statement pinpointed the contrast between life in the US, which can be one long adrenaline rush, and life in some of the happier, safer places on earth. People come to the United States for challenge, excitement, and the chance for a new life. It’s a crap shoot. We fight for our survival everyday here because failure can put us out in the street, as we have seen with our recent economic crisis. But that is also what makes us so creative, innovative, and competitive. We have to be—it really is a matter of survival.

But our failure right now can be a good thing. I think we have traded our health and happiness for having more stuff. This economic crisis is forcing young people in their 20s to move back home. It’s not the ideal, but families are getting closer. For the first time in decades, people are saving more, buying less. Everyone is getting more conscious of the environment now, too. We are resetting our values. I think this will all lead to healthier lifestyles in general. People are switching to new careers and learning new skills that they never would have considered before. I think we as Americans can adopt a healthier lifestyle, maybe tone it down a bit, but I don’t think we can ever be the happiest nation on earth—that would mean that we have stopped searching, exploring, daring, taking chances. Innovators and dreamers are never satisfied or content, and that is what we are. But we can be healthier while we are pursuing our bliss and that is something that we can achieve.