New insights into the process of dying...and intriguing philosophical questions about the relationship of the mind to the brain...

Back from the Dead

by Jerry Adler

Doctors are reinventing how they treat sudden cardiac arrest, which is fatal 95 percent of the time. A report from the border between life and death.

“Bill Bondar knows exactly where he died: on the sidewalk outside his house in a retirement community in southern New Jersey. It was 10:30 on the night of May 23, a Wednesday, and Bondar was 61—a retired computer programmer with a cherry red Gibson bass guitar, an instrument he had first picked up around the same time as Chuck Berry. He was 6 feet 1 and 208 pounds, down about 50 pounds over the last several years. On that night he had driven home from a jam session with two friends and, as he was unloading his car, his heart stopped. That is the definition of ‘clinical death,’ one of several definitions doctors use, not always with precision. He wasn’t yet ‘brain dead,’ implying a permanent cessation of cerebral function, or ‘legally dead,’ i.e., fit to be buried. But he was dead enough to terrify his wife, Monica, who found him moments later, unconscious, not breathing, with no pulse. His eyes were open, but glassy—‘like marbles,’ Monica says, ‘with no life in them. They were the eyes of a dead man....’

“Bondar arrived at [University of Pennsylvania Hospital] at about 1:30 a.m., still comatose, minutes ticking away while he was evaluated for cooling. Once the decision was made, the team sprang into action, injecting him with an infusion of chilled saline—two liters at about 40 degrees—then wrapping him in plastic tubes filled with chilled, circulating water. Becker believes, based on animal work, that cooling patients even sooner—ideally, on their way to the hospital—would be even more effective, and part of the work of his lab involves perfecting an injectable slurry of saline and ice that could be administered by a paramedic. Bondar was kept at about 92 degrees for about a day, then allowed to gradually return to normal temperature. He remained stable, but unresponsive, over the next three days, while Monica stayed at his bedside. She finally went home Sunday evening, and was awakened Monday by a call from the hospital that she was sure meant bad news....”

Newsweek – July 23, 2007

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More intriguing questions about the relationship of the mind to the brain...

Man with Tiny Brain Shocks Doctors

“A man with an unusually tiny brain manages to live an entirely normal life despite his condition, which was caused by a fluid build-up in his skull.

“Scans of the 44-year-old man’s brain showed that a huge fluid-filled chamber called a ventricle took up most of the room in his skull, leaving little more than a thin sheet of actual brain tissue.

“‘It is hard for me [to say] exactly the percentage of reduction of the brain, since we did not use software to measure its volume. But visually, it is more than a 50% to 75% reduction,’ says Lionel Feuillet, a neurologist at the Mediterranean University in Marseille, France.

“Feuillet and his colleagues describe the case of this patient in The Lancet. He is a married father of two children, and works as a civil servant....”

New Scientist/Reuters – July 20, 2007

Is this medicine?  Or, is it social experimentation?

IVF Hope for Child Cancer Cases

Israeli scientists say that they have extracted and matured eggs from girls as young as five to freeze for possible fertility treatment in the future.

“The team said that the technique could give child cancer sufferers left infertile by chemotherapy treatment a shot at parenthood later in life.

“The team took eggs from a group of girls between the ages of five and 10 who had cancer.

“They artificially matured the eggs to make them viable and froze them.

“Experts had previously thought the eggs of pre-pubescent girls could not be used in this way....”

BBC News – July 2, 2007

More social experimentation using IVF...

Girl Could Give Birth to Sibling

A Canadian mother has frozen her eggs for use by her seven-year-old daughter, who is likely to become infertile.

“Should the girl opt to use the eggs and gain regulatory approval, she would effectively have a baby that was her half-brother or sister.

“Critics said the work, presented at a fertility conference in Lyon, was deeply concerning.

“But the doctors from the McGill Reproductive Center, Montreal, called the donation an act of motherly love....

“‘Such a baby would be a sibling of the birth mother at the same time as the direct genetic offspring of the grandmother donor.

“‘In psychiatry we are hearing more and more of children suffering from identity problems, and specifically a condition called “genealogical bewilderment.” Could it possibly get more bewildering than this?’”

BBC News – July 3, 2007

Good reasons to be concerned about the use of Ritalin by young children...

Pediatric Ritalin May Affect Young Brains

“U.S. medical researchers have discovered use of the attention deficit hyperactivity disorder drug Ritalin by young children might affect their brains.

“The Weill Cornell Medical College animal study is among the first to investigate the effects of Ritalin (methylphenidate) on the neurochemistry of the developing brain.

“Between 2 percent and 18 percent of U.S. children are thought to be affected by ADHD and Ritalin—a stimulant similar to amphetamine and cocaine—remains one of the most prescribed drugs for the behavioral disorder.

“‘The changes we saw in the brains of treated rats occurred in areas strongly linked to higher executive functioning, addiction and appetite, social relationships and stress,’ said Professor Teresa Milner, the study’s lead author....”

ScienceDaily/UPI – July 18, 2007

The outcome of a fraudulent marketing campaign...

OxyContin Maker, Execs Fined $634.5 Million

Judge ruled that drug company misled the public about addiction risk

“Purdue Pharma L.P., the maker of OxyContin, and three of its executives were ordered Friday to pay a $634.5 million fine for misleading the public about the painkiller’s risk of addiction.

“U.S. District Judge James Jones levied the fine on Purdue, its top lawyer and former president and former chief medical officer after a hearing that lasted about three-and-a-half hours. The hearing included statements by numerous people who said their lives were changed forever by addiction to OxyContin, a trade name for a long-acting form of the painkiller oxycodone.

“Designed to be swallowed whole and digested over 12 hours, the pills can produce a heroin-like high if crushed and then swallowed, snorted or injected....”

MSNBC/Associated Press – July 20, 2007

Another move to institutionalize libertarian individualism in medical ethics...

Why Can’t You Buy a Kidney to Save Your Life?

A growing legal movement to recognize a new fundamental right – ‘medical self-defense’ -- could bring jarring social changes

“Given the makeup of the Supreme Court, this is supposed to be a time when conservative judges are reining in some of the ‘rights’ established by liberals over the past four decades.

“Yet there is a growing push in medical, legislative, and legal circles—both liberal and conservative—to recognize an expansive new right that some are describing as ‘medical self-defense.’ The movement is rooted in a desire to help patients who have run out of options. Some medical experts, including Dr. Emil Freireich, director of a leukemia research program at the University of Texas, have called on the Food and Drug Administration to let terminally ill patients try unapproved drugs that might offer their last chance at survival. And Republican Senator Sam Brownback of Kansas is working to introduce legislation that would force the FDA to do just that.

“Even more significant is a potential landmark case before the D.C. Circuit Court of Appeals—brought by a group called the Abigail Alliance for Better Access to Developmental Drugs—that could make access to unapproved drugs a full-blown constitutional right. Last year, a panel of three judges on the appellate court declared that patients with terminal diseases ought to have access to unapproved drugs, surprising many legal scholars. The case is now being considered by all 10 members of the court, and a decision is expected this year.

“The decision could have sweeping implications. A right to medical self-defense, some legal scholars argue, implies that there is a right to offer cash for human organs, if one is dying or suffering—a practice currently banned. Such a right could even force the courts to overturn any federal ban on stem-cell research because, these scholars argue, the government’s interest in protecting a 10-cell embryo could not trump the right of a Parkinson’s patient to save himself....”

The Boston Globe – July 1, 2007

Chemical contraception vs the environment:  Guess which wins?

Contracepting the Environment

by Wayne Laugesen

Birth-control poisoning of streams leave U.S. environmentalists mum

“When EPA-funded scientists at the University of Colorado studied fish in a pristine mountain stream known as Boulder Creek two years ago, they were shocked. Randomly netting 123 trout and other fish downstream from the city’s sewer plant, they found that 101 were female, 12 were male and 10 were strange ‘intersex’ fish with male and female features.

“It’s ‘the first thing that I’ve seen as a scientist that really scared me,’ said then 59-year-old University of Colorado biologist John Woodling, speaking to the Denver Post in 2005.

“They studied the fish and decided the main culprits were estrogens and other steroid hormones from birth-control pills and patches, excreted in urine into the city’s sewage system and then into the creek.

“Woodling, University of Colorado physiology professor David Norris, and their EPA-study team were among the first scientists in the country to learn that a slurry of hormones, antibiotics, caffeine and steroids is coursing down the nation’s waterways, threatening fish and contaminating drinking water....”

National Catholic Register – July 11, 2007

After 17 years of using PGS:  “Vulnerable patients should no longer be exploited financially under the impression that it works.”

Expensive ‘Fertility Aid’ Fails

“An expensive treatment designed to improve a woman’s chance of pregnancy actually does the reverse, Dutch research suggests.

“Preimplantation genetic screening (PGS) checks embryos for abnormalities so the best ones can be implanted.

“A fertility conference in Lyon heard women who used PGS were nearly a third less likely to get pregnant than those who opted for conventional IVF.

“Experts said women desperate for a baby were being exploited financially....”

BBC News – July 4, 2007

Editor’s Note:  Sebastiaan Mastenbroek’s research on PGS was published in the July 5, 2007 issue of The New England Journal of Medicine.  The abstract is available online.  Another helpful overview of this research is available from the Genetics & Public Policy Center at John Hopkins University.

Robot assisted therapy...

In Latest Robotics, New Hope for Stroke Patients

by Amanda Schaffer

“Mary O’Regan more or less ignored her left arm for 20 years.

“As a sophomore in college, in 1986, she fell off the back of a friend’s dirt bike and hit her head on concrete, later suffering a stroke. After intensive medical and physical therapy, she learned to speak and walk again. She went back to school and then to work. (And, as it happened, two of her brothers ended up marrying two of the nurses who had taken care of her.) Still, much of her left side remained numb, and she did not regain use of her left arm.

“Last year, however, Ms. O’Regan, now 40 and living in Westwood, Mass., enrolled in a clinical trial for a new robotic device called the Myomo e100, designed to help stroke patients regain motion in their arms. The device, worn as an arm brace, works by sensing weak electrical activity in patients’ arm muscles and providing just enough assistance that they can complete simple exercises, like lifting boxes or flipping on light switches. By practicing such tasks, patients may begin to relearn how to extend and flex the arm, rebuilding and strengthening neurological pathways in the process....”

The New York Times – July 10, 2007 (Free registration required)

Worth considering...

From The Verbal Corrosion of Medical Morality

by Brent Waters, D.Phil.

At what point do the benefits of biomedical research outweigh their cost to the human spirit?

“...The spirit grows numb when moral constraints are honored only when nothing of great value is at stake. We will refrain from doing x until it is feasible to do y; we will abstain from exploiting embryos until it is profitable to do so. Such cheap morality should trouble us, and the pangs of conscience are seemingly accompanying various policy proposals. We are assured that procedural safeguards and regulations will preserve a respect for embryos, preventing them from becoming mere biomedical commodities. We can have our research and dignity too.

“Yet such reticence seems inconsistent if we are pursuing a worthwhile objective. If stem cell research, for instance, will benefit so many people in so many different ways, why should we concern ourselves with how (or how many) embryos are procured and exploited? If we have already determined that longer, healthier, and more productive lives are of great value, then should we not also be dedicated to pursuing the most promising means of achieving this goal? To paraphrase Martin Luther, why not sin boldly in attaining something so good?

“The highest cost to the spirit in this new age of biomedical research, however, may be its corrosive effect upon our capacity to endure suffering. With each new advance, the range of so-called unnecessary or pointless suffering shrinks. Medicine becomes primarily focused on the prevention or elimination of suffering in societies where suffering is no longer explicable in moral or religious terms. But this also means that we will grow increasingly intolerant of suffering, both in ourselves and others. For suffering will be perceived not so much as a result of circumstances beyond our control, but as a failure in mastering human biology. We will fixate on eliminating the physical causes of suffering rather than keeping company with those who suffer. The cost will be diminishing the greatest depths of the spirit, which is often disclosed in our capacity to suffer with and for others.

“This is not to suggest, of course, that suffering is inherently good and should not be prevented when it is within our power to do so. Although suffering may inspire praiseworthy behavior, it can also crush or destroy the spirit. We may rightly praise medical research for the preventive, therapeutic, and palliative treatments it has produced.

“Yet the purpose of medicine has never been to eliminate suffering. (Recall the first two prime directives of the Hippocratic oath: first, do nothing, and second, do no harm.) Rather, it enables us, as embodied creatures, to live lives we believe to be good, and right, and true. And part of such a life requires honoring moral constraints when confronted by the prospect of benefits that promise to be so beneficial. Our quest for longer, healthier, and more productive lives must weighed against the content of goodness, righteousness, and truth. As we enter this new age of biomedical research, it may often prove better for the spirit to suffer our moral constraints than to enjoy the riches gained for the wrong reasons.”

“The Verbal Corrosion of Medical Morality” is available online at the website of Science & Spirit.  Dr. Brent Waters is Associate Professor of Christian Social Ethics at Garrett-Evangelical Theological Seminary.  His most recent book is From Human to Posthuman: Christian Theology and Technology in a Postmodern World (Ashgate, 2006).