Living in the Biotech Century -- April 17, 2006

Bladder

The bladders were grown from patients’ own cells

“US scientists have successfully implanted bladders grown in the laboratory from patients’ own cells into people with bladder disease.

“The researchers, from North Carolina’s Wake Forest University, have carried out seven transplants, and in some the organ is working well years later.

“The achievement, details of which have been published online by The Lancet, is being described as a ‘milestone.’

“The team is now working to grow organs including hearts using the technique....”

Another major advance in tissue engineering—using an ink-jet printer rather than a scaffold to produce the 3^rd dimension...

“Sitting in a culture dish, a layer of chicken heart cells beats in synchrony. But this muscle layer was not sliced from an intact heart, nor even grown laboriously in the lab. Instead, it was ‘printed,’ using a technology that could be the future of tissue engineering.

“Gabor Forgacs, a biophysicist at the University of Missouri in Columbia, described his ‘bioprinting’ technique last week at the Experimental Biology 2006 meeting in San Francisco. It relies on droplets of ‘bioink,’ clumps of cells a few hundred micrometres in diameter, which Forgacs has found behave just like a liquid.

“This means that droplets placed next to one another will flow together and fuse, forming layers, rings or other shapes, depending on how they were deposited. To print 3D structures, Forgacs and his colleagues alternate layers of supporting gel, dubbed ‘biopaper,’ with the bioink droplets. To build tubes that could serve as blood vessels, for instance, they lay down successive rings containing muscle and endothelial cells, which line our arteries and veins. ‘We can print any desired structure, in principle,’ Forgacs told the meeting....”

Editor’s Note: Additional information on the work of Dr. Gabor Forgacs is available at the University of Missouri-Columbia website of the Forgacs Lab.

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Anne Gersbach treats Noelle, the pregnant robot, in Vallejo, California.

“Noelle’s given birth in Afghanistan, California and dozens of points in between. She’s a lifelike, pregnant robot used in increasing numbers of medical schools and hospital maternity wards.

“The full-sized, blond, pale mannequin is in demand because medicine is rapidly abandoning centuries-old training methods that use patients as guinea pigs, turning instead to high-tech simulations. It’s better to make a mistake on a $20,000 robot than a live patient.

“The Institute of Medicine, an arm of the National Academy of Sciences, estimates that as many as 98,000 U.S. patients die annually from preventable medical errors.

“‘We’re trying to engineer out some of the errors,’ said Dr. Paul Preston, an anesthesiologist at Kaiser Permanente and architect of the hospital chain’s 4-year-old pregnancy-care training program, in which Noelle plays a starring role....”

“Suppose Grandmother has a living will. It says that if she falls into a vegetative state, like Terri Schiavo did, she wants to be kept alive on a feeding tube. How long? ‘Until the good Lord takes me away.’ One terrible day, she is thus stricken, and in goes the feeding tube. OK, who pays for her care?

“Most of the fist-waving a year ago was over whether Michael Schiavo had the right to order the removal of his wife’s life support. Terri’s parents said that they wanted their daughter kept alive, and that if Michael did not wish to care for her, they would.

“The parents’ view clashed with reality. The reality was that the nurses at a Florida hospice were taking care of Terri, and Medicaid was paying for them. Clearly, the taxpayers also had a stake in these painful decisions, though no one talked about it much.

“The time has come for that conversation, and it ought to be frank. Medicaid, the health-insurance plan for the poor, is supported by federal and state taxpayers. Medical technology can keep people with no hope of recovery floating between life and death for decades. The taxpayers have a right to set limits on how much of this they will finance....”

Predicting the death of 90% of the human population to academic applause...

“A University of Texas professor says the Earth would be better off with 90 percent of the human population dead.

“‘Every one of you who gets to survive has to bury nine,’ Eric Pianka cautioned students and guests at St. Edward’s University on Friday. Pianka’s words are part of what he calls his ‘doomsday talk’—a 45-minute presentation outlining humanity’s ecological misdeeds and Pianka’s predictions about how nature, or perhaps humans themselves, will exterminate all but a fraction of civilization.

“Though his statements are admittedly bold, he’s not without abundant advocates. But what may set this revered biologist apart from other doomsday soothsayers is this: Humanity’s collapse is a notion he embraces....”

Editor’s Note: No link is available to this article since it was removed from the website of The Seguin Gazette-Enterprise following the firestorm created by Prof. Pianka’s lecture.

Another first-hand account of Dr. Eric Pianka’s speech is provided by Forrest Mims, a member of the Texas Academy of Science and chair of its Environmental Science Section. Prof. Pianka’s speech was given at the March 2006 meeting of the Texas Academy of Science, at which he was named “2006 Distinguished Texas Scientist.”

Why is fetal pain defined in terms that require ‘conscious understanding’ before the stimulus can be considered painful?

“Fetuses are physically incapable of feeling pain until the end of the second trimester, and unlike newborn children have not developed the processes that would allow them to recognize pain as a signal of a harmful encounter, a researcher here asserted.

“‘An absence of pain in the fetus does not resolve the question of whether abortion is morally acceptable or should be legal,’ wrote Stuart W.G. Derbyshire, Ph.D., a senior psychologist at the University of Birmingham, in the April 15 issue of the BMJ, formerly the British Medical Journal. ‘Nevertheless, proposals to inform women seeking abortions of the potential for pain in fetuses are not supported by evidence.’

“The states of Arkansas, Georgia, and Minnesota have all enacted legislation requiring that women seeking an abortion be told that fetuses may feel pain after 20 weeks of gestation; and 22 other states have similar legislation pending. A comparable federal law has been proposed....”

The credo of the immortality project: “The highest expression of human nature and dignity is to strive to overcome the limitations imposed on us by our genes, our evolution and our environment....”

Scientific progress promises us far longer, happier lives. Yet the ‘bioconservatives’ want to stop it

“By the end of this century, the typical European may attend a family reunion in which five generations are playing together. Great-great-great grandma, at 150 years old, will be as vital, with muscle tone as firm and supple, skin as elastic and glowing, as her 30-year-old great-great-granddaughter with whom she’s playing tennis.

“After the game, while enjoying a plate of vegetables filled with not only a solid day’s worth of nutrients but medicines she needs to repair damage to her ageing cells, she’ll be able to chat about some academic discipline she studied in the 1980s with as much acuity and memory as her 50-year-old great-grandson, who is studying it now.

“The younger members of her extended family will have never caught a cold. From birth they will have been immune to most of the shocks to which human flesh has long been heir, such as diabetes and Parkinson’s disease. Her grandson, who recently suffered a car accident, will be sporting new versions of the arm and lung that got damaged in the wreck. He’ll be playing a game of football as skilled and energetic as anyone else there....

“Although you would think most people would devoutly wish for this vision, an extraordinary coalition of left-wing and right-wing bioconservatives is resisting the biotechnological progress that could make it real. Forget Osama bin Laden and the so-called clash of civilisations. The defining political conflict of the 21st century will literally be the battle over life and death....”

Editor’s Note: Ronald Bailey’s vision of human redesign and enhancement brings to mind two other commentaries on the same subject. First, C. S. Lewis, in The Abolition of Man, warned that “Man’s conquest of Nature, if the dreams of some scientific planners are realized, means the rule of a few hundreds of men over billions upon billions of men. There neither is nor can be any simple increase of power on Man’s side. Each new power won by man is a power over man as well. Each advance leaves him weaker as well as stronger. In every victory, besides being the general who triumphs, he is also the prisoner who follows the triumphal car.... For the power of Man to make himself what he pleases means...the power of some men to make other men what they please.... [The scientific planners] are, if you like, men who have sacrificed their own share in traditional humanity in order to devote themselves to the task of deciding what ‘Humanity’ shall henceforth mean. ‘Good’ and ‘bad,’ applied to them, are words without content: for it is from them that the content of these words is henceforward to be derived.... It is not that they are bad men. They are not men at all. Stepping outside the Tao, they have stepped into the void. Nor are their subjects necessarily unhappy men. They are not men at all: they are artefacts. Man’s final conquest has proved to be the abolition of Man.”

Second, the writers of Beyond Therapy: Biotechnology and the Pursuit of Happiness (a report produced by the President’s Council on Bioethics in 2003) issued a similar warning that is boldly couched in biblical language: “What’s at issue is not the crude old power to kill the creature made in God’s image but the attractive science-based power to remake ourselves after images of our own devising.”

Both books are profound discussions of the dangers inherent in the project of human redesign and enhancement advocated by Ronald Bailey and others. However, even those of us who disagree with Bailey’s idyllic vision of “scientific progress” should pay heed to one of his statements that will likely prove prophetic: “The defining political conflict of the 21st century will literally be the battle over life and death....”

Before the invention of the ventricular assist device, some surgeons implanted a ‘piggy-back’ heart...

“A 12-year-old girl given a heart transplant 10 years ago is believed to have become the first person in the UK to have the donor organ removed and her own heart reconnected.

“Hannah Clark was two when diagnosed with cardiomyopathy, which made her heart twice the size it should have been and placed it under such strain that it would probably have given out within a year. A team led by Sir Magdi Yacoub operated on Hannah when she was a baby and put a ‘piggy-back’ donor heart next to her own, which remained in place while the new organ took over the job of pumping most of her blood. All had seemed well until last November when a routine checkup revealed that Hannah had begun to reject the new heart.

“Mr and Mrs Clark, of Mountain Ash in south Wales, asked surgeons at Great Ormond Street Hospital in London to remove the donor heart and reconnect the dormant one, but they said they were reluctant because it had never been done before. The parents approached Sir Magdi, world famous as the heart transplant pioneer, and the 70-year-old agreed to come out of retirement to advise the surgical team. The operation was performed on February 20, and proved a remarkable success....”

Sorting out the medical and economic realities of the new genetic diagnostics...

Peter DaSilva for The New York Times

At a Genomic Health laboratory, genetic material from tumor samples is used to predict the risk that a patient’s breast cancer will recur.

“When her hairdresser asked her last fall whether she would continue wearing her hair long, Elizabeth Sloan broke down crying. Unbeknown to the hairstylist, Ms. Sloan had recently had a breast tumor removed and was expecting to begin chemotherapy, which would probably mean losing her hair.

“But later that day, Ms. Sloan received the results of a new $3,500 genetic test, which indicated that her cancer probably would not come back even if she skipped chemotherapy.

“‘It was a huge relief,’ said Ms. Sloan, 40, a mother of two young boys who lives in Manhattan. ‘I did not want to napalm-bomb my body with chemicals.’

“The test taken by Ms. Sloan, known as Oncotype DX and offered by a company called Genomic Health, is part of a new wave of sophisticated genetic or protein tests that are starting to remake the diagnostics business, both for the technology they use and the way they are developed and sold....”

“On the back of dire poverty, legal shortcomings and religious conservatism, a new mafia is prospering in Egypt and turning the country into the regional hub for the human organs trade, experts say.

“There are no official statistics but in a country where social inequality is high and a quarter of the population is believed to live under the poverty line, more and more destitute Egyptians are falling prey to the phenomenon.

“The large scars slicing the sides of many Egyptians in impoverished Cairo neighborhoods most probably testify to an illegal kidney sale to a rich fellow countryman or a Gulf Arab who could not find a donor.

“‘A Saudi patient can pay up to 80,000 dollars split between the doctor, the donor and the go-between,’ says Hamdi al-Sayyed, the head of Egypt’s doctors’ union.

“‘For example, a Jordanian or a Saudi who needs a transplant comes to Egypt accompanied by a relative as an official cover and then looks for an Egyptian or a Sudanese who is ready to sell his organ,’ he explains.

“While most donors are poor and hoping for a better life, not all are volunteers, with grisly accounts of forced organ ‘donations’ earning Egypt the sinister reputation of ‘Brazil of the Middle East....’”

“Since, in a consumer society, we see ourselves as individuals and as free agents when we exercise consumer choice, it is not difficult for pharmaceutical companies and other privatized health-care deliverers to convince us that it is empowering to think of ourselves not as patients but as consumers. This conversion from patient to consumer also paves the way for the erosion of the doctor’s role as expert. A startling report of this was described in a recent New York Times article: ‘For a sizable group of people in their 20’s and 30’s, deciding on their own what drugs to take—in particular, stimulants, antidepressants and other psychiatric medications—is becoming the norm. Confident of their abilities and often skeptical of psychiatrist’s expertise, they choose to rely on their own research and each other’s experience in treating problems like depression....A medical degree, in their view, is useful but not essential.’ This phenomenon, the article suggested, is ‘driven by familiarity’ with the drugs. The emergence of this potentially dangerous situation demonstrates an unchecked expansion of the drug industry into an already accepted mode of thought—that ‘every minor mood fluctuation,’ as the article reported, can and should be remedied.

“Promoting consumer familiarity with drugs is one example of the very broad influence of the pharmaceutical industry. This influence extends to clinical trial administration, research publication, regulatory lobbying, physician and patient education, drug pricing, advertising and point-of-use promotion, pharmacy distribution, drug compliance, and the legal and ethical norms by which company practices themselves are to be evaluated. Actors traditionally found outside the ‘distribution channel’ of the market are now incorporated into it as active proponents of exchange. Physicians, academic opinion leaders, patient advocacy groups and other grass roots movements, nongovernmental organizations, public health bodies, and even ethics overseers, through one means or another, have one by one been enlisted as vehicles in the distribution chain. The inclusion of patients in the distribution chain fundamentally changes their role from recipients of medical care to active consumers of the latest pharmaceuticals, a role which surely helps to support industry profits....

“.... [I]n our pursuit of a near-utopian promise of perfect health, we have, without realizing it, given corporate marketers free reign to take control of the true instruments of our freedom: objectivity in science, ethics and fairness in health care, and the privilege to endow medicine with the autonomy to fulfill its oath to work for the benefit of the sick.”

“Pharmaceutical Marketing and the Invention of the Medical Consumer,” by Kalman Applbaum, is one of eleven articles on “disease mongering” in the April 2006 issue of the open-access journal PLoS Medicine. Disease mongering is defined as “the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments.” Further clarification of this definition is provided in the first article in the series, “The Fight against Disease Mongering: Generating Knowledge for Action.” All articles in the series are available here.

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