Living in the Biotech Century -- August 19, 2005

Sarah L. Voisin / The Washington Post

At Johns Hopkins Hospital in Baltimore, Judith May is visited by physician’s assistant Jeffery Piacitelli and her doctor, Louis Kavoussi, on the screen of Dr. Robot

“Ries Daniel was waiting in his hospital room the morning after bladder surgery when the door finally swung open. But it wasn’t his doctor. Instead, a robot rolled in, wheeled over and pivoted its 15-inch video-screen ‘head’ toward the 80-year-old lying in his bed at Baltimore’s Johns Hopkins Hospital.

“‘Good morning,’ said a voice from the robot’s speaker. It was Louis Kavoussi, Daniel’s urologist. His face peered down from the screen atop the 51/2-foot-tall device dubbed Dr. Robot. ‘So, how was your evening? No problems?’ Studying his patient through an image beamed back to his office by Dr. Robot’s video camera, Kavoussi was concerned because Daniel had run a fever overnight and developed a cough. ‘You’re not looking as good as yesterday,’ said Kavoussi, zooming in the camera for a closer look after having focused on Daniel’s chart moments before....

“Such robot-assisted exchanges are being repeated in dozens of hospitals across the country by doctors who use the machines to make their rounds, monitor intensive-care units, respond to emergency calls and consult with other physicians.

“Proponents say this and other new ‘telemedicine’ technologies are allowing doctors to use their time more efficiently and serve more patients, often at odd hours or in remote places where the sick would otherwise have a hard time seeing a doctor....

“Skeptics, however, fear that the technology is further depersonalizing health care, accelerating the trend of doctors spending less and less time with their patients, and eroding what remains of the doctor-patient relationship....”

Doctor and Anti-Euthanasia Advocate Discuss Dutch Assisted Suicides

“A leading doctor and advocate against euthanasia discuss a recent study conducted in the Netherlands about the state of assisted suicide there. They said the survey doesn’t give a full picture about what’s happening in the European nation.

“Conducted by researchers at the VU University Medical Center in Amsterdam, the study finds 44 percent of people who seek assisted suicide are killed, 13 percent change their minds and doctors refuse in only 12 percent of the cases.

“Dr. David Stevens, M.D., executive director of the Christian Medical Association, says that although it appears Dutch doctors are abiding by assisted suicide requirements, he says there is no way of verifying if protocols are being met.

“Stevens said his group looked into the situation there on its own and said Christian health groups sent a representative to the Netherlands to talk with the families of those affected by assisted suicide.

“The representative told Stevens that many families were split on or against the patient’s decision to ask a doctor to help them kill themselves....”

What do we really know about the problems produced by the “abortion pill”?

Abortion Pill Investigated in Four California Deaths

The FDA warns patients as federal, state and L.A. County agencies try to trace deadly infections.

“Health officials are investigating whether there are any links in the cases of four California women—at least two in Los Angeles County—who have died since 2003 of massive infection after taking the so-called abortion pill, RU-486, and a follow-up drug.

“The state and federal probe follows an announcement last month by the Food and Drug Administration, after the June death of a Sherman Oaks woman, warning doctors and patients of the potential for serious bacterial infection under certain circumstances.

“At the heart of the inquiry in California are why and how the deadly infections developed and whether more women might have been harmed.

“‘That’s something we don’t have an explanation for right now,’ said Dr. L. Clifford McDonald, an epidemiologist with the Centers for Disease Control and Prevention, which is investigating the deaths along with the Food and Drug Administration, the California Department of Health Services and the Los Angeles County Department of Health Services.

“The FDA is also working with the makers of the two drugs to see if they were contaminated with an unusual bacterium found in the bloodstream of two of the women who died. Complicating matters, neither woman showed all of the usual symptoms of an infection.

“The medical mystery in California is fueling the already charged debate over the risks, rights and morality of abortion....”

FDA to Decide Morning-After Pill’s Fate Soon

“By month’s end, federal health officials will decide whether to let women buy emergency contraception without a prescription — and if so, if the morning-after pill will be treated more like aspirin off the shelf or like cigarettes.

“Regardless of how the Food and Drug Administration ends the two-year saga, it isn’t likely to settle the issue. States already are moving to expand access to Plan B, the pill that can prevent pregnancy if taken soon after unprotected sex, amid some competing efforts to restrict it.

“And if the FDA does allow easier access, the pills probably would come with an age limit—anyone younger than 16 would still need a prescription. So drugstores would have to ‘card’ young customers seeking to prevent pregnancy much as they now check cigarette buyers’ ages....”

“What does it mean when ‘morning-after pill’ advocates assert to congressional leaders, ‘Emergency contraception cannot interrupt or disrupt an established pregnancy’? The implication is that post-coital hormones (‘emergency contraception’ pills) do not cause abortion. Stripped of its semantic bias, however, this claim is patently untrue. A scientifically objective review of human development separates propaganda from fact....

Medical research indicates abortifacient action of ‘emergency contraception’

“Does so-called ‘emergency contraception’ have a post-fertilization effect? In simple terms, does the ‘morning-after pill’ act to end a human life, defined as beginning at fertilization?

“A recent journal article (Obstetrics & Gynecology 1999;93:872-6) examines these crucial questions through a review of the world’s medical literature. The researchers sought to learn about the ‘mechanism of action’ of the pills’ hormones when given after intercourse. How do the pills prevent identifiable pregnancies? Is it only by preventing ovulation or by also preventing implantation of a fertilized egg?

“The authors conclude that the success of these hormones in preventing a recognizable pregnancy cannot be simply explained by preventing ovulation. Using conservative estimates, the study concludes that other mechanisms of action are at work up to 38 percent of the time. These mechanisms include postfertilization effects—actions against a fertilized but not yet implanted human egg....”

Dr. Gene Rudd is an Obstetrician and Gynecologist who serves as the Associate Director of the Christian Medical Association.

Hwang Plans World Stem Cell Hub

South Korean scientist envisages the new center as a kind of Jackson Labs for stem cells

“Hwang Woo Suk, the pioneer in cell nuclear transfer and cloning, is developing plans with the government of South Korea to launch an international stem cell research center in his hometown of Seoul later this year.

“The project, which is likely to be called the World Stem Cell Hub, is being conceived as something like a stem cell version of The Jackson Laboratory in the United States, said Hwang’s close collaborator, Gerald Schatten, from the University of Pittsburgh.

“The Jackson Laboratory, based in Bar Harbor, Maine, is a nonprofit institute that supplies researchers around the world with some 2 million mice annually, but also provides training and conducts research.

“‘What they’re envisaging is more than a stem cell bank, but also a collaborative research center...a place where people can go for research retreats and sabbaticals,’ Schatten told The Scientist. ‘It’s something more like the Jackson Labs...or Cold Spring Harbor, or the Sanger Centre....’”

Fertility Watchdog Considers Cancer Gene Screening

“Families with a history of cancers and other inherited diseases may soon be able to ensure their babies do not have the genes responsible by opting for IVF instead of natural conception.

“Fertility regulators [in Britain] are considering whether to widen the rules which already allow parents to ensure babies are not born with faulty genes that will inevitably lead to conditions such as cystic fibrosis and Huntington’s disease.

“This would enable clinics to offer parents the opportunity to prevent their offspring inheriting genes for conditions that may develop later in life, even though not all people with the genes will ever get the disease.

“Inherited breast, ovarian and colon cancer are likely to be among the first targeted if the change goes ahead.

“The move is likely to prompts ethical debate for two reasons. First, it might encourage families with no history of fertility problems despite other family health problems to seek IVF. Secondly, it would mean the destruction of embryos capable of forming life with no guarantee that genes they carried would be responsible to later disease....”

“Everybody does this.... It’s now common practice” — but is it ethical and legal?

“Doctors testing new drugs are sworn to keep their research secret until drug companies announce the final results. But elite Wall Street firms—looking to make quick profits—have found a way to harvest these secrets:

“A Seattle Times investigation found at least 26 cases in which doctors have leaked confidential and critical details of their ongoing drug research to Wall Street firms.

“The practice involves doctors at top research universities from UCLA to the University of Pennsylvania, and powerful financial firms including Citigroup Smith Barney, UBS and Wachovia Securities....

“Until now, the selling of drug secrets has been hidden from securities regulators and the public, but biotech and Wall Street insiders said the practice is widespread.

“‘Everybody does this.... It’s now common practice,’ said the chief executive of California biotech company Valentis, Ben McGraw, a former Wall Street analyst....”

Another potential alternative to embryonic stem cells...

US Scientists Find Flexible Stem Cells in Placenta

“Scientists looking for easier and less-controversial alternatives to stem cells from human embryos said on Friday they found a potential source in placentas saved during childbirth.

“They described primitive cells found in a part of the placenta called the amnion, which they coaxed into forming a variety of cell types and which look very similar to sought-after embryonic stem cells.

“With 4 million children born in the United States each year, placentas could provide a ready source of the cells, the team at the University of Pittsburgh said.

“It is not yet certain that the cells they found are true stem cells, said Stephen Strom, who worked on the study. But they carry two important genes, called Oct 4 and nanog, which so far have only been seen on embryonic stem cells.

“‘We were just blown away when we found those two genes expressed in those cells,’ Strom said in a telephone interview.

“‘The presence of these two genes suggests these cells are pluripotent, which means they should be able to form any cell type in the body....’”

Worth considering...

“As we grow old, we are also becoming more repulsed by the natural effects of aging. In our individualistic meritocracy, people are often judged by how ‘smart and pretty’ they are, and nobody is obliged to like or support or care for anybody else. Aging is generally bad for both our brains and our looks, and so to avoid failure and loneliness we try harder than ever to fend off and mask its effects. Any technology that keeps us looking young has an immediate and huge market. We are repulsed by the sight of old age, in part, because the appearance of the old brings death to mind. But we seem to fear dependence as much as death, and we know that the downside of living in a meritocracy is that the love of others is hardly guaranteed.

“For those used to thinking of themselves as free individuals, dependence is especially humiliating; we know too well that nobody really owes us a living. So increasingly we say that we would rather be dead than lose our autonomy, and we readily sign legal directives making that clear. But the choice for death made when healthy does not predict what each of us would choose when death is actually ‘imminent.’ Precisely because we live our lives believing the self is the measure of all things, we shudder at the prospect of the self’s oblivion, and cling to every living moment as if being itself depends on our individual existence.

“Some worry that the prolongation of life may turn society into ‘something like a giant nursing home.’ And this prospect provokes a certain backlash in the name of productivity. ‘Longer years of life,’ observes Audrey Chapman, ‘decrease the relative period in which people are contributing economically during their lifetimes and increase the period of dependency.’ A harsher way of expressing this observation is that insofar as we value productivity, we devalue the old. Productivity and creativity, on balance, are characteristics of the young....”

Peter Augustine Lawler is Dana Professor of Government at Berry College and author of Aliens in America: The Strange Truth About Our Souls. He is also a member of the President’s Council on Bioethics. This essay was published in the Spring 2005 issue of The New Atlantis and is available online.

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Robots Now Making Rounds in Hospitals