A California company which cloned the world's first cat nearly three years ago is starting to fill orders for cloned pets. Genetic Savings and Clone recently produced Bengal kittens Tabouli and Baba Ganoush. Now five customers are paying US$50,000 each for a clone of their cats, which should be ready by December. And several hundred clients are paying $150 a year plus an initial $900 to preserve tissue for future cloning. Critics say that the company is exposing animals to risks without any benefits. "The quest for immortality in ourselves and even in our pets opens the door to commercial interests who want to make a profit on it," says David Magnus, a Stanford bioethicist. However, the company is offering customers their money back or a new clone if their cloned pet has any defects.

A eight-year-old procedure for removing uterine fibroid tumours from women has highlighted a turf war between two medical specialities. The normal treatment for the tumours is a hysterectomy done by gynaecologists. But doctors in France discovered in the mid- 90s that it was possible remove the tumours with a much less invasive operation under local anaesthetic. The procedure, called uterine artery embolisation (UAE), seems to be as safe as a hysterectomy, although it is done by doctors who call themselves interventional radiologists.

However, says the Wall Street Journal, gynaecologists are keeping the news of the easier alternative to themselves, perhaps because they will lose the US$2,000 fee for a hysterectomy. About 200,000 hysterectomies are done each year in the US, so more than US$400 million is at stake. "When you're sitting in a gynaecologist's office, and they know that their livelihood is depending on the services that they provide, they are less likely to refer you to another specialist," comments Dr Ruth Shaber, a gynaecologist with Kaiser Permanente. Many women are learning about the possibility of UAE from the internet rather than from their doctor.

Most American states have informed consent laws which require doctors to inform patients about all "reasonable alternatives" to surgery. The American College of Obstetrics & Gynaecology declined to comment to the WSJ about whether UAE constitutes a "reasonable alternative". However bioethicist Arthur Caplan, of the University of Pennsylvania, says that resolving the conflict is a "no-brainer". "When a legitimate medical specialty is offering an alternative that's been around for eight years, you need to tell your patients about it," he says.

A 25-year-old German nurse has confessed to murdering seven female and five male hospital patients aged between 60 and 89. The man, identified only as Stefan L, has told police that he wanted to relieve them of their suffering. He was not suspected until officials at the hospital in the small Bavarian town of Sonthofen noticed that drugs were missing from the ward he worked on. Police are now investigating a further 70 deaths as well as deaths in his former workplace in Baden-Wurttemberg. Psychiatrist Karl-Heinz Beine, who has studied hospital staff who kill, says that most want to ward off their own fears of suffering and death. Their initial motivations of relieving suffering are overcome by aggressive fantasy and obsession.

In the wake of the September 11 attacks, the US Department of Health is pushing ahead with plans to build at least five maximum security laboratories to study deadly diseases like Ebola, anthrax and smallpox. Five of these "level 4" labs already exist in the US. The government feels that the labs are essential in the war on terror. "To know that we can do this research and not do it would be irresponsible," says Rona Hirschberg, of the National Institutes of Health.

A lab in Boston has drawn fierce opposition from community activists -- and even from 150 scientists, including two Nobel laureates from Harvard. They query whether housing dangerous pathogens in an urban setting is safe. "There's no way of having a system that's 100% foolproof," said Penn Loh, executive director of Alternatives for Community and Environment in Roxbury, an inner city, mainly black, Boston neighbourhood near the site. "Should something occur, you don't want it to happen in a densely populated area."

The first audit of non-human primates used in global research has found that not enough apes and monkeys are being bred for research, that the shortfall could be slowing scientific advances and that lack of information about the animals in papers makes it difficult to gauge their validity. A group at the University of Uppsala in Sweden conducted the survey. It estimates that in 2001 3,000 research papers were published based on experiments on primates, with 4,411 studies on 41,000 animals. However, the real number of animals used is likely to be 200,000, as many government studies are never published.

However large this may seem, it actually masks a shortage of primates, which are the only suitable animals for some types of research. Some grant proposals are being turned down because there are not enough animals to study. One sign of the shortage is that researchers, especially in the US, often have to perform successive independent studies on the same animals -- sometimes as many as six or seven times -- a practice which is criticised by animal defence groups.

A sensitive review of two books in The Lancet highlights the dignity of people afflicted with Alzheimer's disease. "Amazing Grace: Enjoying Alzheimer's", by Ray Smith (ISBN 1-84358-089-6) tells the story of a British man whose wife Grace developed Alzheimer's at 56. Rather than let her vegetate, he travelled the world with her, even though she was confused and incontinent, going to places as exotic as the Galapagos, India, and Sri Lanka; took her on long hikes; and continued to have sexual relations. "Ray never lost sight of Grace; he did not reduce her to her disease; he was able to see her as she once was and as she had become simultaneously." This is also the message of the other book, "Alive with Alzheimer's", by Cathy Stein Greenblat (ISBN 0-226-30658-5), a photo essay which stresses that sufferers must not be marginalised and devalued.

"Hippocratic oath a casualty of war"
By Michael Cook, Sydney Morning Herald, 23 August 2004

Why didn't the doctors at Abu Ghraib prison protect their patients? It is becoming clear that it was not just trailer trash who were corrupted by their power over Iraqi detainees in the prison...   

IN BRIEF:

Military doctors and medics in Iraq should "protest loudly and refuse cooperation with authorities" if they are aware of "torture and inhumane and degrading practices against detainees", says one of the world's leading medical journals, The Lancet, in a stinging editorial.

In its current issue, Dr Steven H. Miles, of the University of Minnesota, highlights the complicity of medical staff in the scandalous events which took place in the Coalition prison. These included "failure to maintain medical records, conduct routine medical examinations and to provide proper care of disabled or injured detainees. Medical personnel and medical information was also used to design and implement psychologically and physically coercive interrogations. Death certificates and medical records were falsified."

One case illustrates the abandonment of well-recognised principles of medical ethics by US doctors. In November 2003 Iraqi Major General Abed Hamed Mowhoush, a former air defence commander, died after his head was pushed into a sleeping bag while interrogators sat on his chest. A surgeon stated that he died of natural causes. Although knowledge of this and other cases of torture and degrading treatment was widespread, no one in the prison's medical staff blew the whistle on it.

The Lancet concludes that "Abu Ghraib should serve as an eleventh hour wake-up call for the Western world to rediscover and live by the values enshrined in its international treaties and democratic constitutions."

The feverish excitement surrounding therapies from stem cells from cloned human embryos needs "a dose of reality", says a Nature news feature. The recent announcement that a British team will soon begin therapeutic cloning has raised hopes of individualised cures for degenerative diseases. "In reality, say those in the field, such a prospect remains distant at best," Nature comments.

Researchers in human embryonic stem cells distinguish between short- term and long-term benefits. The short-term benefits are insights into diseases such as diabetes and Parkinson's. But because of the enormous obstacles that must be overcome, cures are a long-term benefit. For one thing, cloning is terribly inefficient. The South Korean team which announced earlier this year that it had created cloned embryos used 242 eggs from 16 women and produced a single stem cell line. "Until the success rate is improved, cures or treatments from therapeutic cloning will be impossible," says Nature. Improving the efficiency of the technique will require repeat trials, but "fewer than five labs around the world" are working on it.

This pessimism about the short-term benefits of embryonic stem cell research was echoed by a researcher at a US stem cell research symposium sponsored by Mount Desert Island Biological Laboratory and The Jackson Laboratory. Dr Louis M Kunkel, director of the genomics program at Children's Hospital Boston, reminded his colleagues that cures from stem cell research could be decades away. He recalled telling friends that a fund-raising telethon for muscular dystrophy would no longer be necessary after a medical breakthrough in 1990. "I can't believe I ever said that," he lamented. "We really can't mislead the public about where these things are and what it's going to take. It's going to take a long time."

As many as 195,000 people a year die in hospital because of easily prevented mistakes, says a US health research company, HealthGrades Inc. A 1999 study by the Institute of Medicine had found that the figure was 98,000, but Dr Samantha Collier, of HealthGrade, says that this underestimated the number of deaths. Her figures include failures to rescue dying patients and the death of low-risk patients from infections, neither of which were included in the previous study. "If the Centers for Disease Control and Prevention's annual list of leading causes of death included medical errors, it would show up as number six, ahead of diabetes, pneumonia, Alzheimer's disease and renal disease," commented Dr Collier.