Living in the Biotech Century -- June 1, 2006

Welcome to the wild west of human reproduction—the California “gene rush”...

“The eye-popping price in the help-wanted ad in the Arizona State University State Press says it all. As making babies becomes big business, there is a bidding war for a key ingredient for the fertility industry: women’s eggs.

“Women can make thousands of dollars for giving up the microscopic cells to enable other women to get pregnant. And proximity to California, described as a ‘madhouse’ of egg demand, only makes the market hotter.

“As the advertising gets more aggressive and the paychecks bigger, the egg wars escalate, say doctors and others who act as middlemen between donors and recipients.

“A couple of years ago, the going rate for egg donors in the Phoenix area was about $2,500. It has now gone up to $3,500 largely because out-of-state companies are routinely offering as much as $7,500 to $10,000 to Valley women, said Dr. Drew Moffitt, president of Arizona Reproductive Medicine Specialists, a Phoenix-based infertility practice.

“More couples, including gay and lesbian partners, long for children so much that they will take out second mortgages and drain their bank accounts to have them. The demand is aided by ever more advanced technology to turn the childless into the expectant by using other men’s sperm and other women’s eggs and wombs....”

Premies have more short-term problems, and there is increasing evidence that they have long-term risks as well...

“More and more babies each year are being born just shy of spending a full pregnancy in their mothers’ wombs, putting more infants at risk of health and possibly developmental problems because they enter the world before they are ready.

“The percentage of babies born slightly early has been increasing steadily for more than a decade and is now at an all-time high. So many babies are being born a few weeks early—more than 350,000 annually—that the average U.S. pregnancy has shortened from 40 weeks to 39.

“The increase is driven by a combination of social and medical trends, including the older age of many mothers, the rising use of fertility treatments and the decision by more women to choose when they will deliver. At the same time, medical advances are enabling doctors to detect problem pregnancies earlier and to improve care for premature babies, prompting them to deliver more babies early when something threatens their lives or those of their mothers.

“Many obstetricians argue that the trend is positive overall because they are preventing thousands of stillbirths and avoiding potentially serious risks for mothers. But other experts worry because these babies are prone to a long list of serious, potentially life-threatening complications, which often require intensive, costly treatment. Moreover, growing evidence suggests that their long-term development may be more problematic....”

What was once a science fiction view of humanity is being accepted by mainline bioethicists...

“While America was rushing to see sharp metal blades jut from Wolverine’s fists during the opening of the third ‘X-Men’ movie last weekend, an academic conference was being held at Stanford University to discuss what might happen if people with special powers really existed.

“In the movie, the plot is driven by the government’s attempt to ‘cure’ the mutants so they’ll be ‘normal,’ the very sort of issue the conference, called ‘Human Enhancement Technologies and Human Rights,’ addressed.

“The meeting, sponsored by Stanford University’s Center for Law and the Biosciences, the Center for Cognitive Liberty and Ethics, and the Institute for Ethics and Emerging Technologies, was remarkable for several reasons.

“First, leaders of the latter two organizations are ‘transhumanists’ who believe better days are ahead if we take advantage of new technologies to magnify normal human abilities with a full menu of add-ons. Transhumanism has a long history, but in modern times, it has been dismissed by most as a fringe element of comic-book-reading, sci-fi aficionados. No more.

“Second, the question of enhancement and human rights is surprisingly topical rather than futuristic, and not just because of the ‘X-Men’ movie.

“Finally, the conference was surprising for how far some bioethicists, who were once largely silent on the issue, have come towards not only accepting the concept of human alteration, but asserting that it’s a right....”

Brain

The drug works on nerve cells in the brain

“A sleeping pill can temporarily revive people in a permanent vegetative state to the point where they can have conversations, a study finds.

“South African researchers, writing in the NeuroRehabilitation, looked at the effects on three patients of using the drug for up to six years.

“But one expert in neurological rehabilitation said it was possible the patients had a different condition....

“An improvement was seen within 20 minutes of taking the drug and wore off after four hours, when the patients restored to their permanent vegetative state....”

Raising new questions about classical Mendelian genetics—non-genetic modes of inheritance in animals...

Mouse (Rassoulzadegan)

Mice with the mutant gene have a white-tipped tail and white feet

“Scientists say they have demonstrated that animals can defy the laws of genetic inheritance.

“Researchers found that mice can pass on traits to their offspring even if the gene behind those traits is absent.

“The scientists suggest RNA, a chemical cousin of DNA, passes on the characteristic—in this experiment, a spotty tail—to later generations.

“But more work may be needed to confirm the conclusions of the study, which appears in the journal Nature....”

“More than 20 babies have been aborted in advanced pregnancy because scans showed that they had club feet, a deformity readily corrected by surgery or physiotherapy.

“According to figures from the Office for National Statistics covering the years from 1996 to 2004, a further four babies were aborted because they had webbed fingers or extra digits, which are also corrected by simple surgery. All the terminations took place late in pregnancy, after 20 weeks.

“Last year, according to campaigners, a healthy baby was aborted in the sixth month at a hospital in southeast England after ultrasound images indicated part of its foot was missing.

“News of the terminations has reignited the debate over how scanning and gene technology may enable the creation of ‘designer babies’. In 2002 it emerged that a baby had been aborted late—at 28 weeks—after scans found that it had a cleft palate, another readily corrected condition....”

With corrective surgery, “infants tend to adapt to these disabilities...they can adapt to changes in motor development...basically a child never misses a beat....”

Three-Armed Baby: How Does It Happen?

Jie-jie, a Baby Boy in China, Was Born With Two Left Arms and One Right Arm

China Baby

A doctor examines a 59-day-old baby boy who was born with three arms, at a hospital in Shanghai. (AP Photo)

“During his medical career, Dr. Larry Hollier has seen only two babies born with three arms.

“‘The third arm was not as developed, so it was a fairly easy decision to amputate,’ said Hollier, co-director of the cranial facial surgery program at Texas Children’s Hospital in Houston.

“However, a baby boy born in China poses a more difficult challenge for doctors. Known as Jie-jie, the 2-month-old was born with one right arm and two left arms—which do not seem fully functional.

“His Shanghai surgeons now must decide which arm to remove, and at this point, they aren’t sure which arm will be the one to go....”

Disease mongering—when the ordinary experiences of life become a diagnosis, making healthy people feel like they’re sick...

“The words ‘It’s frustrating,’ shaped to look like a pair of legs, float across the screen. A voice intones: ‘It’s frustrating. Just when you’re ready to relax, you feel the compelling urge to move.’ Eventually, the legs morph into those of a woman, draped lazily across a recliner.

“The television ad, and similar ones appearing in magazines and on the Internet, are hawking the first pill approved to treat a once-obscure condition known as restless legs syndrome, or RLS, which causes an irresistible, sometimes debilitating urge to move.

“Praised by some neurologists and patients advocates for raising the profile of an under-diagnosed, under-treated condition, the ads are also raising concerns. Although RLS is a bona fide condition that can make victims miserable, skeptics fear that fidgety people who simply have a hard time sitting still, or twitch a little in their sleep, will receive the inappropriate diagnosis of a serious neurological condition requiring treatment with a powerful prescription medication.

“The debate has focused attention on what some have dubbed ‘disease-mongering’—taking something that is within normal bounds and labeling it a disease needing pharmaceutical treatment.

“‘We’re increasingly turning normal people into patients,’ said Lisa M. Schwartz of Dartmouth Medical School....”

Freezing eggs for the sole purpose of circumventing reproductive aging in healthy women...

Freezing Young Eggs an Option for Women

“From the moment a baby girl is born, her fertility clock begins the countdown. Though she has millions of eggs in her immature ovaries, by the time she's a woman the viability of those eggs has already started to diminish.

“By age 40, her chances of conceiving have declined, while her chances of having a child with chromosomal abnormalities have increased. And if she's like thousands of women in their 30s who have yet to meet Mr. Right and whose careers and personal choices don't include, for now, child rearing, she may find herself wishing that she could freeze time.

“Actually, she may be able to. Although the procedure is still considered by many to be experimental, about 200 fertility centers around the country are using new technology to collect and freeze unfertilized eggs of women in their 30s for use in their 40s.

“Until now, egg banking has been employed mostly by women about to undergo chemotherapy for cancer. What is new is to whom it is being marketed: thirtysomethings who are postponing having families....”

What are the consequences of using growth hormone to enhance milk and beef production in cattle?

“Women who eat a vegan diet—a strict vegetarian diet that excludes all animal products including milk—are one-fifth as likely as other women to have twins, a U.S. researcher reported on Saturday.

“The reason may be hormones given to cattle to boost their milk and meat production, said Dr. Gary Steinman, an obstetrician specializing in multiple-birth pregnancies at Long Island Jewish Medical Center in New Hyde Park, New York.

“Writing in the Journal of Reproductive Medicine, Steinman said he compared twin births rates among women who ate a regular diet, vegetarians who included dairy products, and vegan women.

“The vegans had twins at one-fifth the rate of the milk-drinking women. Insulin-like growth factor may be responsible, Steinman said.

“All animals, including people, produce a compound called insulin-like growth factor or IGF in response to growth hormone. It is found in milk and it increases the sensitivity of the ovaries to follicle stimulating hormone, thus increasing ovulation....”

“Somewhere at the top of the Hundred Acre Wood a little boy and his bear play. On the surface it is an innocent world, but on closer examination by our group of experts we find a forest where neurodevelopmental and psychosocial problems go unrecognized and untreated.

“On the surface it is an innocent world: Christopher Robin, living in a beautiful forest surrounded by his loyal animal friends. Generations of readers of A.A. Milne’s Winnie-the-Pooh stories have enjoyed these seemingly benign tales. However, perspectives change with time, and it is clear to our group of modern neurodevelopmentalists that these are in fact stories of Seriously Troubled Individuals, many of whom meet DSM-IV3 criteria for significant disorders. We have done an exhaustive review of the works of A.A. Milne and offer our conclusions about the inhabitants of the Hundred Acre Wood in hopes that our observations will help the medical community understand that there is a Dark Underside to this world.

“We begin with Pooh. This unfortunate bear embodies the concept of comorbidity. Most striking is his Attention Deficit Hyperactivity Disorder (ADHD), inattentive subtype. As clinicians, we had some debate about whether Pooh might also demonstrate significant impulsivity, as witnessed, for example, by his poorly thought out attempt to get honey by disguising himself as a rain cloud. We concluded, however, that this reflected more on his comorbid cognitive impairment, further aggravated by an obsessive fixation on honey. The latter, of course, has also contributed to his significant obesity. Pooh’s perseveration on food and his repetitive counting behaviours raise the diagnostic possibility of Obsessive Compulsive Disorder (OCD). Given his coexisting ADHD and OCD, we question whether Pooh may over time present with Tourette’s syndrome. Pooh is also clearly described as having Very Little Brain. We could not confidently diagnose microcephaly, however, as we do not know whether standards exist for the head circumference of the brown bear. The cause of Pooh’s poor brain growth may be found in the stories themselves. Early on we see Pooh being dragged downstairs bump, bump, bump, on the back of his head. Could his later cognitive struggles be the result of a type of Shaken Bear Syndrome?

“Pooh needs intervention. We feel drugs are in order. We cannot but wonder how much richer Pooh’s life might be were he to have a trial of low-dose stimulant medication. With the right supports, including methylphenidate, Pooh might be fitter and more functional and perhaps produce (and remember) more poems.

This wonderful piece of satire first appeared in the Canadian Medical Association Journal (December 12, 2000). The authors, at that time, worked in pediatrics at Dalhousie University, Halifax, NS. The complete article is available online.

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