German scientists and doctors are still coming to grips with the grim story of how their colleagues collaborated with the Nazis. A recent issue of the journal Science sketches the link between German anatomists and the regime. Before Hitler came to power, about 20 civilians were executed each year in Germany and their bodies were made available to anatomists. Between 1933 and 1945, however, at least 16,000 civilians were executed – apart the death camps. By 1942, all the bodies of prisoners executed for high treason were being turned over to anatomists.

With the emergence of more historical data, Germany’s Anatomical Society plans to hold its first meeting on “Anatomy in the Third Reich” on September 29. “We hope that this will contribute to a global debate on ethical standards for the use of human cadavers in research and teaching,” Andreas Winkelmann, an anatomist at Charité Medical University in Berlin, told Science. Indeed, it is still an issue, as there have many allegations that the plastinated bodies in some travelling exhibitions come from executed prisoners.

Historians have uncovered abundant information about how callous the anatomists of the Third Reich became. In Vienna, for instance, a special streetcar ran between the place of execution and the medical school morgue. If the morgue was full, executions were delayed. At least 1,337 bodies were delivered in this way.

In another distressing example, the director of the Berlin Institute of Anatomy from 1935 to 1952, Hermann Sieve, dissected the bodies of 200 female prisoners to understand how their reproductive system was affected by the stress of learning the date of their execution. “The picture is one of a very gradual slippage in moral values among anatomists,” says Christoph Redies, a professor of anatomy at the Jena University Hospital. ~ Science, July 16

Even though many US states demand that doctors report colleagues whose performance is impaired by alcohol or drug use or by physical or mental illness, a survey in a recent issue of JAMA suggests that a third of them would not do it.

Catherine M. DesRoches, of Massachusetts General Hospital, in Boston, found that only 64% of American physicians agreed with the professional commitment to report physicians who are significantly impaired or otherwise incompetent to practice.  About 17% of the physicians surveyed had dealt with an impaired colleague, but on 67% of these had blown the whistle.

Overseas doctors and underrepresented minority physicians were significantly less likely than other physicians to report. The most frequently cited excuses included the belief that someone else was taking care of the problem; the belief that nothing would happen as a result of the report; fear of retribution; the belief that reporting was not their responsibility; or that the physician would be excessively punished.

"These… raise important questions about the ability of medicine to self-regulate,” say Dr DesRoches and her colleagues. “More than one-third of physicians do not completely support the fundamental belief that physicians should report colleagues who are impaired or incompetent in their medical practice. This finding is troubling, because peer monitoring and reporting are the prime mechanisms for identifying physicians whose knowledge, skills, or attitudes are compromised…

“Reliance on the current process results in patients being exposed to unacceptable levels of risk and impaired and incompetent physicians possibly not receiving the help they need." ~ JAMA, July 14

An 11-year-old UK schoolgirl, with the approval of her parents, has decided to have her leg amputated so that she can become a para-olympian. Danielle Bradshaw, of Newton, near Manchester, has no medical need of an amputation, but would like to have one so that she can follow her dream of being a world-class disabled athlete.

Danielle was born with congenital dislocation of both hips and the right knee. She has a healthy left leg but she does not want to spend the rest of her life “dragging the other one” behind her.  

Surgeons have told her that a number of operations and skin grafts could be performed on the right leg, which has been damaged since birth. However, they also told her that while she could keep the leg, she would not be able to use it. Her parents were astounded by her decision, but soon agreed. The operation has been scheduled for August.

This raises some thorny ethical issues. Can an 11-year old make an informed decision about a procedure of this gravity? Should parents allow their children to do so?

Her mother Debbie Quigley, 36, said: “Danielle suggested it to the doctors. They could have done reconstructive surgery but she said: ‘What’s the point of dragging around something that doesn’t work?’” Stepfather Darren Quigley, 49, said: “We couldn’t get our heads around it at first. But when we heard the options it makes sense.”

Danielle will be fitted with a prosthetic replacement leg once the wound heals. Her friends have begun raising funds to buy her a running blade and sports wheelchair. “I’m not scared, I’m excited. I can’t wait for it to be done so I can start running and training,” she said. “I just want to be a normal kid. I see people running and I want to know how that feels.” ~ Manchester Evening News, Jul 15

The fertility doctor for “Octomom” Nadya Suleman implanted too many embryos in yet another patient, resulting in the death of a fetus, the California state licensing board alleges. The Medical Board of California says that Dr Michael Kamrava acted negligently in implanting seven embryos in a 48-year-old woman, identified as “L.C.”

Four of these embryos became viable, but the woman lost one during pregnancy and gave birth to triplets, one of whom is profoundly developmentally delayed, the board said.

For a patient over 35, the US fertility industry recommends implanting only one or two embryos. However the medical board found that Kamrava "placed L.C. at great risk for high order gestation, which was confirmed by a quadruplet pregnancy that ended with catastrophic results".

The Beverly Hills doctor has been under investigation since Suleman gave birth to octuplets in January last year. He was expelled from the American Society for Reproductive Medicine last September.

Dr Kamrava faces another complaint – that he failed to refer another patient, H.L., for cancer screening, despite a history of cancer and her ovarian cysts. Allegedly he ruled out cancer on his own “rather than refer H.L. to a specialist for further evaluation”. In April 2009 she was diagnosed with cancer and had to have her ovaries, cervix, uterus and fallopian tubes removed. ~ AP, Jul 13

Stem cells derived from reprogramming adult cells may have limited usefulness as an alternative to embryonic stem cells, leading researchers said this week.

The study found that induced pluripotent stem cells, which have been the darling of stem cell scientists for the past couple of years, retain a “memory” of their original adult tissue. This may make it difficult to convert them to other cell types for medical treatment, say researchers from Harvard and Johns Hopkins. The findings were published online in Nature. Similar results from other Harvard researchers were published in Nature Biotechnology.

This could be a setback for regenerative medicine because iPS cells are a promising and ethical uncontroversial alternative for embryonic stem cells. However, researchers have already begun finding ways around the limits that the study has identified, so that the iPS cells could still be used for treating illnesses such as diabetes and Parkinson’s disease.

“It’s a challenge to be understood and overcome,” George Daley, a researcher at the Harvard Stem Cell Institute and Children’s Hospital in Boston and lead author of the Nature study, told Bloomberg Businessweek. “We already have strategies for overcoming this.” ~Bloomberg Businessweek, Jul 19

A Norwegian woman who engaged an Indian woman to be a surrogate mother of twins may not be able to bring them back home because they are not genetically hers.

Andras Bell (name changed), 31, commissioned a surrogacy at India’s Rotunda fertility clinic. She was suffering from premature ovarian failure, so she chose a Scandinavian sperm donor and an Indian egg donor. Twin boys were born in April.

Ms Bell did not anticipate a mandatory DNA test, which is demanded by many European consulates following a string of recent surrogacy controversies. This revealed that there was no biological link between her and the boys. Her only claim on them was that she had commissioned the surrogacy and signed a few forms at the IVF clinic stating that she would be their “legal mother”. The consulate refused to grant them citizenship.

“We provided all the relevant documents and two to three informed consent papers that she had signed,” said medical director of Rotunda, Dr Gautam Allahabadia. He added that the clinic had done nothing illegal or unethical. “Embryo adoption is a well-accepted choice, and probably the only option for women who are unable to conceive naturally,” he said. Dr Allahabadia helped to draft India’s proposed guidelines for surrogacy, which stipulate that fertility clinics should ensure that foreign clients liaise with their consulates to avoid visa problems. But these were framed only this year, months after Bell had commissioned the surrogacy.

Why didn’t Ms Bell just adopt a child rather than going through the surrogacy process? One IVF expert surmises that “One reason could be that she wanted to avoid the stringent adoption laws and believed that surrogacy was an easier path.” ~Times of India, Jul 21

October 6 is "Stem Cell Awareness Day". But where are the celebrations? Extensive googling failed to yield news of festivities. The California Institute for Regenerative Medicine, which was set up to promote research on human embryonic stem cells, has a section on its website dedicated to “Stem Cell Awareness Day 2010”.  But if you click on the link, you come to a half-finished site, without graphics or information, a scientific Marie Celeste bobbing on the internet.

The only feature that works is a video made for Stem Cell Awareness Day last year in which a high school teacher tells his students that stem cell research is more important than health care, that stem cell research is health care. “Hopefully, in the future, we’ll see everybody rejoicing about stem cell awareness because it has a fantastic potential to play a very important part in our lives,” said the CIRM’s director, Australian scientist Alan Trounson, in the 2009 video. Has the helium leaked out of the balloon?

Two Melbourne couples are suing hospitals because doctors failed to diagnose Down Syndrome in their unborn children, thus denying them the choice to have an abortion.

In the first case, at Royal Women’s Hospital, a four-year-old girl has heart, kidney and thyroid problems, needs help to eat and cannot talk. The parents want compensation for their trauma and specialist care costs.

In the second, at Sunshine Hospital, the parents complain that doctors failed to "exercise reasonable care" of the mother, "advise (her) in relation to the risks of Down syndrome given her age" and "provide (her) with the option of ante-natal screening. "In the event that Down Syndrome had been detected, (she) would have elected to undergo a termination of her pregnancy," say documents presented to the court. The parents claim to have suffered "depression, shock and anxiety" and "pain and suffering during pregnancy and delivery".

In the Australian state of Victoria, parents are able to sue for compensation to cover the costs of raising a child until they are 18 if the child was born as a result of negligent care.

Wrongful birth lawsuits are uncommon in Australia, but not unprecedented. In 2003 the Australian High Court's found, in Cattanach v Melchior, that parents could claim damages for raising an unplanned child. However, in 2006 the High Court rejected two claims for “wrongful life” by disabled children whose lawyers argued that they would be better off had they never been born. “Life with disabilities, like life, is not actionable,” the court declared. ~ ABC, July 21; Herald-Sun, July 21; Medical Journal of Australia 2006

A Canadian Army officer has been found guilty over the “mercy killing” of a wounded Taliban insurgent in Afghanistan. Captain Robert Semrau could face up to five years in jail for “disgraceful conduct”. However, the jury of fellow officers found him not guilty of second-degree murder and attempted murder.

The incident occurred in 2008 in the Afghan province of Helmand. The prosecution alleged that Captain felt bound by a “soldier’s pact” to end the suffering of a gravely wounded man. “He told us that he shot the Taliban, he put him out of his misery and if anything came of it, he would wear it,” a corporal told the court. However, with no body, no autopsy, and conflicting witnesses, it was difficult for the prosecution to establish a case for murder. There is no defence for mercy killing in Canadian law.

In 2004 an American soldier tried to excuse a battlefield execution in Baghdad's Sadr City suburb as “mercy killing”. However, he was found guilty of unpremeditated murder and sentenced to three years in jail. ~ Globe and Mail, July 19

 

Here is a startling case from the UK. A severely brain-damaged 43-year-old father of two, Richard Rudd, became a quadriplegic, unable to move or communicate after a motorcycle accident last October. He had left no advance directives, but his family clearly recalled remarks about a friend who had become a paraplegic. "If ever this happens to me, I don't wanna go on. I don't wanna be like him," he told them.

So after his situation stabilised, his family felt that doctors should withdraw his life support system.

However, Mr Rudd’s doctor noticed that he could move his eyes. This meant that even though he was “locked in”, it was possible to communicate with him. After six months, the doctor asked him if he wanted to continue living. The answer was an unequivocal Yes. “I asked him again and on three occasions he made it clear, just with yes/no answers, that this was a consistent response," said Professor David Menon of the Neuro Critical Care Unit (NCCU) in Addenbrooke's Hospital in Cambridge..

Since them Mr Rudd has made steady improvement. He can smile and his long-term memory is intact.  

His father, also named Richard Rudd, told the BBC: "We all sit round and talk in the pub or at work and say 'if this happened to me, turn the machine off'. It's all hypothetical and you don't know until it happens to yourself. As a family and friends, if that person can't decide for themselves, sometimes you feel that you can decide for them…

"But now Richard's in the situation where that's actually happened. It's real life - it's not pretend. He is in that situation. The will to live takes over… For my part, I'm glad he's alive and didn't make a living will." ~ BBC, July 13

While doctors are divided over whether medical practices should be active on social media networks, Dr Jeff Livingston says that Facebook and Twitter are effective tools for educating patients and marketing his Texas OB-GYN practice.

Over the past two years, MacArthur OB/GYN has ventured into the world of social media, where doctors post news about their own practice and the medical world at large. Its Facebook page has almost 700 fans. “People are looking for information online,” he says. “I wanted them to look at our page.”

Many doctors have been deterred from social media by concerns over time and patient privacy.
"No matter how you parse it, doctors don't avoid the Internet and social media because they're simply Luddites," Westby Fisher, an Illinois cardiac electrophysiologist, wrote last month on his blog, Dr. Wes. "They avoid the Internet because they enjoy the benefits of anonymity, privacy, efficiency and legal protection that come with dropping off the grid."

Livingston says that these have not really been issues for his practice. In the two years since he launched the Macarthur Obgyn Facebook page, he has only had to remove content posted by others three times.  "What I'm watching for is that no private personal health information gets relayed via social media," says Livingston, who says he keeps a close watch on the page with his iPhone and iPad. ~USA Today, Jul 9

The UK’s first major study of a disease using stem cells that do not require the creation and destruction of embryos is being launched.

An Oxford University research team will use induced pluripotent stem (iPS) cells to examine Parkinson’s disease. iPS cells, first developed in 2007, are adult stem cells which are able to become any kind of cell in the human body.

These cells will then be used to grow the brain neurons that are killed by the disorder. When iPS cells were developed, scientists said they had potential to offer many of the benefits of embryonic stem cells without any of the ethical downsides.

The team at Oxford University is one of the first in the world to use IPS cells to implement a large-scale clinical investigation of a major disease. The iPS cells may enable researchers to produce limitless quantities of nerve cells for experimentation and for testing new drugs.
Skin cells will be taken from 1,000 patients with early stage Parkinson’s and turned into nerve cells carrying the disease.

"Parkinson's disease is the second most common neurodegenerative disease in the UK and is set to become increasingly common as we live longer," said Dr Richard Wade-Martins, head of the Oxford Parkinson's Disease Centre. "Once we have neurons from patients we can compare the functioning of cells taken from patients with the disease and those without to better understand why dopamine neurons die in patients with Parkinson's." ~ BBC News, Jul 13

Debate over the issue of foetal pain continues, as research by the Royal College of Obstetricians and Gynaecologists was disputed this week. A statement from a US lobby group, the Family Research Council statement contends that the RCOG used a “faulty definition of pain” by saying that foetuses under 24 weeks cannot experience it.  

A summary of the RCOG statement says that the foetus is unable to experience pain before 24 weeks because connections between the cortex (which plays an important role in consciousness) and the periphery (outer tissue of the brain) are not intact before this point in the pregnancy. The statement goes further, saying that these connections are “necessary for pain experience but not sufficient”, and that there is “increasing evidence that the fetus never experiences a state of true wakefulness in utero and is kept, by the presence of its chemical environment, in a continuous sleep-like unconsciousness or sedation.

An FRC blog entry described this as “politically timed and motivated”, and that the study could be used by pro-abortion activists in the US to argue against a new Nebraska law stating that an unborn baby feels pain at 20 weeks, outlawing abortion from that point on. The FRC report
states: “At 20-30 weeks, the human being has the highest number of pain receptors per square inch, more than any other time in development. Fibers which help to moderate pain do not begin to develop until 32-34 weeks, thus making the argument that babies feel pain more severely between 20-32 weeks.”

As BioEdge last week reported last weeks, the politicisation of science in the US remains a hot-button issue. The foetal pain debate is the latest chapter. ~ Family Research Council, Jun 24, Jul 12; Royal Council of Obstetricians and Gynaecologists, Jun 25

This sounds like a good plot for a spooky Twilight Zone episode – or an argument for scepticism about neuroscience determinism. A neuroscientist studying psychopaths and sociopaths finds that they tend to have low activity in the orbital cortex of the brain. It can’t do its job of inhibiting the amygdala, the part of the brain which regulates that id-type behaviors like rage, violence, eating, sex, and drinking. Like his own brain scan…

Then he learns that his family line contains at least eight murderers, including the famous Lizzie Borden (who took an axe and gave her father 40 whacks).

Then he examines family members for the MAO-A gene (monoamine oxidase A), nicknamed the “warrior gene” because it regulates the calming chemical serotonin in the brain. The neuroscientist discovers that he is the only one in his family without the low-aggression variant of the gene.

The light goes on -- deep organ music -- “I'm a born killer."

However, it’s not science fiction, but the real life story of Dr Jim Fallon, of the University of California-Irvine. Why isn’t he a killer, then? Dr Fallon speculates that brain patterns and genetic makeup are not enough: a childhood of abuse or violence is needed to top up the toxic mix.

This intriguing story attracted many scathing comments on the NPR website. One contended that the genes and the scans hadn’t lied at all: “it's intriguing to consider that in this case the gene for 'sociopathy,' led to tenure.” ~ NPR, June 29

 

End-of-life care is one of the key areas of contemporary bioethics. The Economist has just published a 40-page survey of how 40 mostly rich countries care for the dying. Its conclusions are summarised in an index which places Britain at the top with a score of 7.9 and India at the bottom, with 1.9.

This is not a matter of cultural bias, The Economist explains -- although Australia, New Zealand and Ireland rank 2, 3 and 4. “For all the health care system's faults, British doctors tend to be honest about prognoses, the mortally ill get plentiful pain killers and a well-established hospice movement cares for people near death. Countries such as Denmark and Finland rank lower because they concentrate more on preventing death than on helping people die without suffering pain, discomfort and distress.” ~ Economist, July 14

Even top-flight hospitals like UCLA Medical Center can improve the way they manage dying patients, according to a study in Archives of Internal Medicine.

Researchers found that the doctors were excellent at pain control, but did less well in discussing prognosis and goals of care with patients and families. Although they performed well in ordering comfort care, they did less well at follow-up to make sure the care was effective.
The head of the study, Dr Anne Walling, of the University of California Los Angeles, and her collaborators analysed the charts of 496 adults hospitalised at least three days before dying. The patients’ end-of-life care was assessed based on 13 quality indicators in three areas: eliciting goals of care, pain assessment and management, and assessment and management of dyspnea (difficulty in breathing).

Patients received recommended care for 70% of the quality indicators. Goals of care were addressed in a timely manner about half the time, pain assessments were performed 94% of the time, and pain treatments (95%) and dyspnea treatments (87%) were administered as recommended.

Follow-up for distressing symptoms, however, was not performed as well as initial assessments, and only 29% of patients whose ventilation tubes were removed before death were evaluated for dyspnea. "The findings suggest much room for improvement in treating patients dying in the hospital," the investigators concluded. ~Reuters, Jul 8

The Philippines Health Secretary appointed by the  new president, Benigno Aquino III, is a strong supporter of allowing Filipinos to sell kidneys to foreigners.

Enrique Ona, 71, is one of the country’s leading transplant surgeons. He was director of the National Kidney and Transplant Institute for 11 years, and the president of the Transplantation Society of the Philippines since 1989.

Shortly after joining the administration, Dr Ona announced that he was opposed to the total ban on organ transplants from Filipino donors to foreigners. He also said he was open to giving a gratuity package to donors, which could go as high as P150,000 Pesos (approximately US$3,200). A few days later he was forced to backtrack, saying that “the ban stays as of now”.

Under President Arroyo transplant tourism was restricted, but Dr Ona fought tooth and nail to liberalise organ donation. He wrote a letter in 2008 to his international critics in which he argued: “In our part of the world, transplantation is the only avenue of our people to escape certain death, and the use of living non-related donors is only one of the strategies we use… We are in the receiving line of the developed world’s problem in kidney donor shortage which cannot be solved by the blanket prohibition you [in the developed world] propose for us to adopt.”

Dr Ona’s proposal was opposed by Dr. Alberto Chua of the Philippine Society of Nephrology. "These establishments offer P150,000 in gratuity package for donors. If I was a tricycle driver who only earns P3,000 a month, maybe I would sell my own kidney to get that P150,000," he said.  ~  Philippine Star, July 7; abs-cbnNEWS.com, July 2;Gulf News, July 14 

This falls in the category of bioethical fantasy rather than bioethical argument, but it was published in the respected Journal of Medicine and Philosophy. Libertarian academic Walter Block, of Loyola University, in  New Orleans, has a radical solution to the stalemate over human embryonic stem cell research. On one side, he says, pro-choice activists argue that embryos are just biological material. On the other, pro-life activists regard it as fully human.

Dr Block cuts the Gordian knot with libertarian reasoning which draws upon the work of Murray Rothbard. Yes, the foetus is indisputably a child, he says, but children are the quasi-property of their parents, who are responsible for a valuable asset which they should not mistreat, but they can dispose of.

Hence the solution: foetuses belong to the researchers provided that no one else wants to claim them as their own and raise them:

“Will the demand on the part of potential adoptive parents outstrip the supply of fetuses that can be created in the laboratory? If so, then not a single one of them will be killed, and no research will take licitly place, under the legal regime we are now considering. Or, will the ability of the medical technicians to create fetuses in this way overwhelm the willingness of adoptive parents to bring them up? If so, then some fetuses will be saved, those who are adopted, and others will be used and/or destroyed in medical research, the ones that exceed the demand of adoptive parents.” 

Dr Block acknowledges that his solution is unlikely to be very popular. ~ Journal of Medicine and Philosophy, July 11

 

Lesbian couples and anonymous sperm donors seem to be going mainstream. Attracting rave reviews is “The Kids are All Right”, a comedy about a lesbian couple in Southern California whose two teenaged children contact their sperm donor dad. He shows up full of smiles and fecklessness and testosterone. In short, he spells Trouble for this normal suburban family. A.O. Scott, of the New York Times, describes it as a beautifully acted and highly original film. From the reviews, the theme seems to be that anonymity is the best policy. The personal life of the director, Lisa Cholodenko, mirrors the situation in the film, as she has a partner and their son’s biological father is an anonymous sperm donor.  

The controversy over President Obama’s healthcare package has flared up again with the appointment of a Harvard professor who will implement many of the reforms, including the expansion of Medicaid and controlling Medicare costs. Donald Berwick will become Administrator of the Centers for Medicare & Medicaid Services (CMS).

This is a significant appointment, as the CMS Administrator oversees a third of all health care spending in the United States, more than US$800 billion. Since Congress is in recess, the President was able to appoint Dr Berwick for one year without seeking Senate approval.

Obama’s political opponents warn that Dr Berwick will implement healthcare rationing and the socialisation of American medicine. They have trawled through interviews and articles to find evidence of this.

Last year, they found, Berwick said society makes decisions about rationing all the time, and that the "decision is not whether or not we will ration care -- the decision is whether we will ration with our eyes open. And right now, we are doing it blindly."

He also esteems the UK's National Institute for Health and Clinical Excellence (NICE), which he said had "developed very good and very disciplined, scientifically grounded, policy-connected models for the evaluation of medical treatments from which we ought to learn."

And his praise of the UK’s National Health Service was fulsome in 2008: “one of the truly astounding human endeavors of modern times… The NHS is a bridge – a towering bridge – between the rhetoric of justice and the fact of justice.”

However, a number of medical groups and healthcare organisations defended his “patient-centered” record. President Bush’s two former CMS administrators also defend the appointment. ~ ABC News, July 6

The bitter debate over President Obama’s healthcare plan can be baffling. With a finite supply of money, surely the cost of treatment has to be taken into account, one side argues. The other side contends passionately that lives cannot be measured with dollars.

Most of the time, the battle rages over grey areas. However, the controversial freelance bioethicist Jacob M. Appel, writing in the Huffington Post, helpfully discusses a case which makes the issue black and white. This involves a dispute over a New Jersey man, Ruben Betancourt. Mr Betancourt was in a vegetative state, after his brain had been starved of oxygen. His relatives wanted him kept alive; the Catholic hospital wanted to withdraw his respirator and other care because they were merely prolonging his death.

Mr Betancourt passed away before New Jersey's Superior Court was able to issue an order. However, it may soon clarify whether hospitals can discontinue care in such cases. Mr Appel believes they should.

He says: “[the] court [should] decide that physicians and taxpayers only have a duty to provide unlimited care to patients who have a meaningful chance of returning to consciousness. Let us make no mistake about what this would mean: It would mean declaring that the lives of PVS patients are worth less than those of others. Rather than shying away from this outcome, progressive bioethicists should have the courage to acknowledge and to embrace this proposition.”

There you have it: an example of “healthcare rationing” in its starkest form. If care of the estimated 25,000 PVS patients in the US were withdrawn all at once, the system would save US$6 billion a year, according to futility law expert Thaddeus Mason Pope.

In response, on Bioethics Forum, at the Hastings Center Report, L. Syd M Johnson says it’s not that simple – even the Betancourt case. Johnson points out that Betancourt was not actively dying, that some PVS patients recover; that some PVS patients are misdiagnosed; and that other patients are unlikely to benefit from the savings. Besides, Johnson continues, “There are substantial social costs to declaring an entire class of patients ‘worthless’.” ~ Bioethics Forum, July 2; Huffington Post, June 23  

A leading Scottish health campaigner has implored the Scottish Government to urgently address the problem of malnutrition of the elderly and vulnerable in National Health Service hospitals in Scotland.

Dr Jean Turner, executive director of Scotland Patients Association, warned that hundreds of patients, especially the elderly, are undernourished and deteriorating in hospital beds because they are not receiving help with feeding. She says that it is “a form of euthanasia”.

She says nursing staff rarely express their concerns about patient welfare for fear of repercussions from senior management.

A recent report estimated 50,000 patients die annually in NHS hospitals in an undernourished state, which may have hastened their deaths. The warning by the SPA follows a Scottish Public Services Ombudsman report that severely criticised a Lanarkshire hospital’s care of a 66-year old patient.

The woman’s death was attributed to kidney failure after a 14-week stay in Wishaw General Hospital, and her family says poor standards of care, especially in nutrition, hastened her end. One family member told the Sunday Herald: “Staff would tell me, ‘It takes an hour to feed your mother and we don’t have an hour’.” ~ Herald Scotland, Jul 7

 

The archeologists of a 2,000-year-old Roman villa in the Thames Valley are puzzled by the discovery of a mass burial of 97 new-born infants. Forensic examination of the skeletons found at the Yewden villa in Buckinghamshire suggests the inhabitants must have been systematically killing the children. Archaeologist Jill Evers believes that the villa may have been a brothel. She says that without contraception or abortion, the Romans would have had to kill newborns.

While shocking to modern sensibilities, researchers told the BBC that infants were not considered to be human beings in the fullest sense until they were about two years old. Children younger than this were seldom buried in cemeteries, but in the grounds of domestic sites.

The bones were actually unearthed and catalogued in 1921 and stored in cigarette and cartridge boxes in the Buckinghamshire County Museum. However they were lost until recently. Now archaeologists  plan to carry out DNA tests to establish the sex of the infants and whether they were related. ~ BBC, June 25

Recent media coverage of a blood test for Down’s syndrome suggests that children with the condition are being depicted as non-persons. The Daily Mail, Britain’s second-largest newspaper, announced that “A quick inexpensive blood test for Down's syndrome that could save the lives of hundreds of unborn babies each year is being developed by scientists”. However, the main result of the test would to terminate hundreds of unborn babies with Down’s syndrome.

The lives of unaffected babies could be considered “saved” only in the sense that they would not be miscarried as a result of invasive investigations to detect and destroy Down’s syndrome babies.

Despite the publicity given to this preliminary report of research by Dutch scientists at the annual conference of the European Society of Human Reproduction and Embryology, a successful test is still several years away. Professor Stephen Robson, a spokesman for the Royal College of Obstetrics and Gynaecology, described it as the “holy grail” of pre-natal testing. ~ Daily Mail, June 30

Embryos produced using IVF can be screened for genetic defects before implantation into the womb, a German high court ruled on Tuesday. Leipzig’s Federal Supreme Court ruled in favour of a Berlin gynaecologist who carried out pre-implantation genetic diagnosis (PGD) for three couples and implanted only the healthy embryos. The other embryos, which possessed hereditary defects, were left to die off.

The doctor, 47, unidentified by the court, brought the case to court himself in 2006 to clarify the legal situation. He was acquitted by a Berlin regional court, but the city’s state prosecutor appealed.

Judge Clemens Basdorf told German news agency DAPD that IVF embryo screening should be legal "if there is a danger of grave genetic defects for the desired children of the patients." ~ AP, Jul 7

It’s expensive to treat the dead with dignity. This seems to be the message from a bizarre story from Lagos, Nigeria’s largest city. A waste disposal contractor for Lagos University Teaching Hospital has been  arrested after he was caught looking for a burial spot in the bush for about 70 dead babies. He claimed that he was employed to bury them in a cemetery but was not given enough money. A hospital official said that the incident was “embarrassing” and declared that the hospital was investigating the incident.

According to the BBC, many families are too distraught or too indigent  to care for dead babies and they abandon them outside hosptitals. It seems to be a case of gross mismanagment, but police are inquiring whether ritual ceremonies or organ trafficking was involved. ~ BBC,  July 7

Two recent neuroscience articles in important journals claim to undermine free will and “human exceptionalism”.

In the journal Science Dutch researchers claim that an overview of the literature shows that conscious decisions are deeply affected by the “unconscious will”.

"People often act in order to realize desired outcomes, and they assume that consciousness drives that behavior. But the field now challenges the idea that there is only a conscious will. Our actions are very often initiated even though we are unaware of what we are seeking or why," says Ruud Custers, of Utrecht University.

Custers told Time magazine that our conscious selves not really in charge, but that this is not necessarily a problem. "We have to trust that our unconscious sense of what we want and what is good for us is strong, and will lead us largely in the right direction."

In a similar vein, a study in the Journal of Neuroscience claims that brain scans can predict behaviour better than the people whose brains were scanned. Scientists at UCLA were able to predict whether subjects would use suntan lotion more accurately than the people themselves.

This could be a major finding for advertisers. While advertising agencies often use focus groups to test commercials and movie trailers, in the future they and public health officials perhaps should add "neural focus groups" to test which messages will be effective while monitoring the brain activity of their subjects. “We're just at the beginning,” says Matthew Lieberman, a UCLA professor. ~ Science Daily, June 23; Time, July 2

The US is poorly prepared to care for the growing number of aged with intellectual disabilities, according to a commentary in the Journal of the American Medical Association. Nowadays these adults live nearly as long as the general population. “Consequently, the relatively rapid increase in a new population of aging adults with complex medical and mental health problems has resulted in inadequate geriatric health care provision,” say Elizabeth A. Perkins and Julie A. Moran.

The problem is not new. A 2002 report by the US Surgeon General complained about problems with health status, access to care and lack of training for doctors. “Nearly a decade later,” say Perkins and Moran, “progress is slow, and efforts affecting the well-being of older adults are even more marginal.” Stigmas and stereotypes persist, hampering attempts to treat these people with dignity. ~ JAMA, July 7

An interesting example of politicised science has emerged during Senate hearings on Elena Kagan's nomination to the Supreme Court. Documents reveal that she doctored a draft statement on partial-birth abortion by the American Council of Obstetricians and Gynaecologists (ACOG) while she was an associate White House counsel for the Clinton administration in 1996. The documents, released by the Clinton Library, include a memo, a draft ACOG statement on partial-birth abortions, and a set of undated notes in Kagan’s handwriting.

At the time, the Clinton Administration opposed any restrictions on partial-birth abortions which did not include health exceptions. ACOG asked the White House for advice about how to describe its positions. Its draft statement said that it “could identify no circumstances under which this procedure . . .  would be the only option to save the life or preserve the health of the woman.” This clearly undermined Clinton's stand.

Kagan helpfully rephrased the statement. It then read: "A select panel convened by ACOG could identify no circumstances under which this procedure, as defined above, would be the only option to save the life or preserve the health of the woman. An intact D&X, however, may be the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman, and only the doctor, in consultation with the patient, based upon the woman's particular circumstances can make this decision."

Unsurprisingly, the discovery of the documents has enraged the pro-life lobby. But Slate columnist William Saletan said what concerned him most was that ACOG consented to Kagan's editorial assistance, and that subsequently her additions were cited by the Supreme Court to allow partial-birth abortions to continue. ~ Slate, Jul 3; National Review Online, Jun 29; CNSNews, Jun 29

We missed this story when it broke, but it is too good to pass up. British serial surrogate Louise Pollard has announced that she is giving birth to the grandchild of Osama bin Laden.

Omar bin Laden, 29, fourth son of the world’s most wanted man, hired Louise via a website, and offered her £30,000 for her services. Omar is the sixth husband of 54-year-old Jane, who took the name Zaina Mohamad al-Sabah bin Laden after converting to Islam. She is a grandmother who suffers from MS and has three adult children from previous relationships.

Ms Pollard, a previously married single mother with one son of her own, has given birth twice to other people’s children. She became a surrogate mother for the first time at 21 and may be the youngest surrogate mother in the UK. She aspires to eclipse Carol Horlock, who has had 12 babies for other couples and is believed to be the UK’s most prolific surrogate mother.

A relative of Pollard told The Sun: "It doesn't matter to her who she's doing it for. All she's interested in is the money. She is a single mum with her own three-year-old son." Mr bin Laden says he “hates” his father and that he has had no contact with him for nearly 10 years. But if anything is likely to bring Osama bin Laden into the open, surely it is his grandchild-to-be. ~ Daily Mail, May 20, Jun 11; The Sun, Jun 12

An investigation by the Swiss newspaper Beobachter has suggested that the assisted suicide business has made the head of Dignitas, Ludwig Minelli, a millionaire. Assisted suicide is lawful in Switzerland, but those assisting may not “selfishly” profit from the death. The Beobachter points out that Minelli declared that he had no taxable personal fortune in 1998, when he established Dignitas. Ten years lager, he has an annual income of about US$150,000 and a personal fortune of $1.8 million. How did he become so wealthy, asks Beobachter.

Andreas Brunner, a Swiss prosecutor, claims that Minelli is hiding behind Swiss privacy laws. ”We have never had a good look at their book-keeping but in order to demand that we need a good reason and a concrete example that there is something suspicious to investigate,” he said. “He has promised for years to make the accounts public but it has never happened.”

Soraya Wernli, a nurse who worked for Dignitas between 2003 and 2005, has accused it of being a “production line of death concerned only with profits”. Minelli acknowledges that selfishly assisting a suicide is illegal, but that profiting from it is not, so long as “you are helping and abetting without selfish motives”. London Telegraph, June 24 

Amongst scientists who promoted the use of human embryonic stem cells five years ago, in the middle of passionate debates in the US, Australia and elsewhere, few were more influential in shaping the ethical debate than Harvard’s George Q. Daley. “We must support the vitally important applications of embryonic stem cells to medical research,” he testified to a Congressional committee in 2005.

He contended that work on hESCs was so important that it could not be delayed. It was needed for cures, drug development and genetic research. The fact that years had passed without results made no difference. “The field of human embryonic stem cell research is a mere 7 years old, so it is premature to expect successful cell therapies to have already been delivered to patients.”

Now, he has transferred the same sense of urgency and excitement to an ethical non-controversial alternative to hESC research which he dismissed before the committee – induced pluripotent stem cells (iPS cells). At the time, he said, “Although this strategy is worth pursuing, it is extremely high-risk, and may take years to perfect, and may never work as well as nuclear transfer, which we know we can practice today.”

However, in 2007 iPS cells were developed by Shinya Yamanaka. Professor Daley immediately stopped campaigning for hESCs. In an interview with Nature Medicine, he says, “Once Yamanaka solved the problem, I turned around virtually my entire program to take advantage of that breakthrough.”

In language remarkably similar to his 2005 testimony, he now promotes iPS cells: “There's no reason in my mind to think that we're not going to have iPS cells that function as well as embryonic stem cells.” Why haven’t there been any cures yet? “You can't hold the field to too high a standard. It's only been two years, and a lot of this stuff is in the pipeline.” ~ Nature Medicine, June

Derek Humphry’s well-known assisted-suicide manual “Final Exit” will now be distributed free to US public lending libraries upon request. The book (link to extract) explores various methods of committing suicide and assisting suicide for the dying, including self-starvation, inert gases and lethal drug dosages. The book begins with a note of caution to readers who are suicidal, stating that the book is meant for those who are "hopelessly physically ill".

Humphry states that the true intention of "Final Exit" is "explaining the right of a terminally ill person with unbearable suffering, or one with advanced degenerative condition, to know how to choose to die". As reported in BioEdge in May, a new edition of the book was released earlier in the year.

Humphry explained on his blog that a large donation to the Euthanasia Research & Guidance Association (ERGO) meant that complimentary copies of the book could be distributed to public lending libraries, whose acquisition budgets had been cut “severely”.

Women in their late 30s are freezing their eggs because they have not yet found “Mr Right”, research indicates. Half of the women surveyed by a Belgian clinic presented at a fertility conference intended to freeze their eggs to take the pressure off finding a partner. A third froze their eggs as an “insurance policy” against infertility.

A separate UK survey found that many students would also consider the procedure to focus on a career before becoming a mother. This survey of nearly 200 students showed that eight in 10 studying medicine would freeze their eggs to postpone motherhood.

Younger, healthier eggs pose a higher chance of success, but many women currently freezing their eggs are in their late 30s and are doing it as a “last resort”. The process costs around £3,000 per cycle and some women may need to undergo as many as three cycles.

Dr Julie Nekkebroeck, speaking at the European Society of Human Reproduction and Embryology conference, who carried out the small Belgian study of 15 women, also found that 27% wanted their relationship to blossom before they broached the topic of children. The average age of the women was 38, and they did not expect to use their eggs until around age 43.

"We found that they had all had partners in the past, and one was currently in a relationship, but they had not fulfilled their desire to have a child because they thought that they had not found the right man," she said. ~ BBC News, Jun 28

Australian surgeon Jayant Patel has been sentenced to 7 years in jail after being found guilty of three counts of manslaughter and one count of grievous bodily harm.

The prosecution described Patel as a “bad surgeon motivated by ego and suffering from lack of insight”. He had been criminally negligent in his work. "Over 19 to 20 months there had been poor decision-making, misdiagnosis, performing surgery on patients who could not withstand it, performing surgery at the wrong hospital and the removal of healthy organs".

The defence maintained that Patel acted only in the best interests of his patients, who had consented to the operations.

The Patel case has been on the front page of Australian newspapers since 2005. The doctor was trained in India and moved to the US. He was censured for negligence and had his licence to practice restricted in both New York and Oregon. However, he managed to talk his way into becoming a surgeon at country town in Queensland where there was a shortage of doctors. There he bullied and bluffed his way through his work until a whistleblower finally convinced authorities to investigate his horrendous record. Patel then fled to the US and had to be extradited to face charges.

Patel will face a separate trial for eight counts of fraud and a second charge of grievous bodily harm. ~ ABC News, Jun 29, Jun 30

 

Nearly half of people with dementia are mistreated by their caregivers, according to recent American research.

The study, run by the University of California Irvine Program in Geriatrics and published in the Journal of the American Geriatrics Society, surveyed 129 patients. The researchers found that 46% of participants with dementia   had been mistreated by their caregivers, with 42% experiencing psychological abuse, 10% physical abuse and 14% caregiver neglect.

Risk factors for one or more types of mistreatment for caregivers included higher anxiety, fewer social contacts, greater perceived burden, as well as more depressive symptoms. For patients they included more psychological aggression and any physical assault behaviours.

According to the study, the behaviour of people with dementia towards their caregiver is the best combination of factors for predicting which of the people with dementia had been mistreated. ~ Center of Excellence on Elder Abuse and Neglect, Jun 23

A woman who sought treatment from a prominent Connecticut fertility clinic received embryos belonging to a woman with the same last name. The blunder occurred in April 2009 at the Center for Advanced Reproductive Services at the University of Connecticut Health Center. It will pay a US$3,000 fine for the mix-up.

The lab technician apparently checked only the last name on the container of embryos and removed the wrong ones from frozen storage. The woman who received the embryos was informed of the error within an hour and used a “morning after pill” to terminate the pregnancy. The embryos belonged to a woman who had been out of treatment since 2006, but had continued to store them at the centre. She was also informed of the error.

The centre said that this incident was the first of its kind in its 24-year history. “Thousands of babies have been born via The Center’s efforts without issue - and more than three million babies have been born through IVF world wide - and mix ups remain exceedingly rare. Nevertheless, however uncommon they may be, each one is important and emotionally difficult for patients and centers alike.”

The centre has agreed to have a consultant review its laboratory policies and procedures. It will be required to provide new training for employees on policies and procedures on securing frozen embryos and verifying their ownership. ~ NBC Connecticut, Jun 28

Want to live forever? KrioRus, the first cryonics company outside the United States, has a solution for you. For US$10,000 it will freeze your brain ($30,000 for your whole body) and store them in its warehouse until scientists are able to “reboot” the brains and restore the frozen corpses to life. There is an annual $500 storage fee for keeping the body parts in liquid nitrogen.

Alcor, a US company which offers a similar service, has about 100 clients; KrioRus only 12, but there seems to be real interest. "I don't ever want to die... It wouldn't suit me," Innokenty Osadchy, a 35-year-old investment banker told AFP. "Why do I have to die in a couple decades? I don't see any logic in this… I don't ever want to die ever. Not in a year, not in a million years."

As in the US, two-thirds of the firms’ clients choose the brain-only option. "We know that the personality is stored in the brain. So when a person's body is old, there's no reason to keep it," said manager Danila Medvedev. "We tell our clients it's cheaper, safer and probably better preservation just to freeze the brain." ~ AFP, Jul 1

Chinese petitioners, troublemakers and corruption whistleblowers are being locked up in psychiatric institutions, according to the BMJ. Liu Feiyue, founder of Civil Rights and Livelihood Watch, says that he has documented more than 500 cases.

"When normal citizens are put into psychiatric hospitals the situation is very grave. They are often forced to take medicine or injections, and when they don’t cooperate they report being bound, beaten up, force fed and electrocuted," Liu says. "As social conflicts in China have intensified in recent years the number of petitioners has increased and so has the number of normal citizens being incarcerated in psychiatric hospitals."

Part of the problem is that sweeping economic changes in China have left psychiatric hospitals short of money. Incarcerating inconvenient people for a fee is one way to make ends meet. "Treatment is only available when there is someone willing to pay. If they have the money and the motive they can send someone to psychiatric hospital," says Huang Xuetao, a lawyer who handles involuntary psychiatric commitment.

In addition to hospitals run by the Ministry of Health, there are at least 23 others run by the Public Security Bureau. All of the staff, including doctors and nurses, are members of the police. Like the old Soviet psychiatric system on which it has been modelled, these institutions are used for locking away political dissidents.

The BMJ says that abuse of psychiatry has received very little attention in the world media, apart from complaints about Falun Gong members. However, the number of politically troublesome people locked away in asylums is likely to be greater than the persecuted Falun Gong sect. ~ BMJ, June 25

A decision on end-of-life treatment in Germany is sending confusing signals about the state of the law there. An appeals court has struck down the conviction of a lawyer, Wolfgang Putz, who had advised his client to cut a feeding tube which was keeping her elderly mother alive.

Erika Küllmer had been in a vegetative state for five years and was being poorly cared for. Apparently her gangrenous arm had to be amputated at one stage after it had been neglected by nursing home staff. Relations between the woman’s daughters and the nursing home staff had broken down completely.

Germany's highest criminal court has ruled that withdrawal of treatment is legal if the patient has explicitly expressed a wish to avoid burdensome treatment. "Turning off a ventilator or cutting a feeding tube fall under the category of permissible forms of terminating treatment," declared a judge in the Federal Court of Justice.

Because – on top of a language barrier -- most newspaper accounts have confused euthanasia, assisted suicide and refusal of burdensome treatment, it is difficult to determine the significance of the case. But an opinion piece in Die Zeit described it as ground-breaking. Although German courts have dealt with similar cases, this case clarifies that a “living will” need not be written. Her daughter said that Mrs K. had expressed a wish not to be kept alive in such circumstances and this verbal request was sufficient, the court decided.

This was criticised by Eugen Brysch, the director of the German Hospice Foundation. “The verdict transmits a fatal signal that does not comply with the critically sick people’s fundamental right to self-determination and care,” he said. Mr Brysch was particular critical of an unwritten living will. “If, as in this case, a casual private conversation without sufficient witnesses is enough to determine the patient’s wishes, then the floodgates for misuse are wide open.” ~ New York Times, June 26

After being cleared of murder charges and saying nothing at a medical tribunal, a British family doctor has admitted to the London Telegraph that he deliberately administered fatal doses of painkillers to three terminally ill or elderly patients.

Dr Howard Martin, 75, of Country Durham, finally spoke out after he was deregistered as a doctor. He says that he feels deeply hurt because he was acting out of “Christian compassion” and trying to limit the patients’ suffering rather than “playing God”. “My conscience is clear,” he says in a video.

In two cases, he said, he hastened the deaths of patients without their consent. There was too little time and too much paperwork to do anything else. He also said that he had administered a final injection to his son, Paul, 31, in May 1988 when he was dying of cancer. He accepted that his confession posed the risk of imprisonment if police were prompted to reopen his case.

Martin was removed by the General Medical Council for professional misconduct. The council ruled that he had assisted the deaths of 18 of his patients in conduct that was “egregious, despicable and dangerous”.

Martin remained silent during his trial for triple murder, the GMC hearing, or succeeding inquests. But in a startling interview with the Telegraph he spoke very candidly.  

“A vet would put a dog down, but under the current system a doctor is not allowed to take positive action to help a patient in a humane way,” he said. “I don’t believe I’ve killed any patients. I believe I’ve made them comfortable in their hour of need. But I am deemed to be arrogant because I used my discretion.

“They want to extrapolate that to say I’m choosing to kill people. It’s not like that. The patients are about to die and I want to make sure they are comfortable. How can a so-called caring society not understand that? How can I be reckless with someone who is about to die?”

A disciplinary hearing, beginning in May and ending last week, heard that Dr Martin was “arrogant and single-minded” as well as “reckless”, and found that the injections given to 18 patients “hastened their death, thereby removing their fundamental right to life”. It was said that his actions were “extremely serious and widespread”, and that he had an “autocratic” attitude and “exploited his position”.

Apparently Dr Martin was investigated in relation to 30 or 40 deaths, although subsequent legal investigations failed to pin anything on him. The Telegraph pointed out that Dr Harold Shipman, Britain’s worst serial killer, with at least 258 victims, had been a locum at his practice for a brief time. ~ London Telegraph, Jun 18

India has become a world centre for surrogate motherhood. Now the government proposes to legalise commercial surrogacy. The Assisted Reproductive Technology (ART) [Regulation] Bill 2010  will allow unmarried women to act as surrogates for both couples and singles, including homosexuals. It is a radical measure in socially conservative India which could deliver big profits to the country’s aggressive IVF industry.

A Law Commission report had described the ART industry in 2009 as a “pot of gold”. “Wombs in India are on rent which translates into babies for foreigners and dollars for Indian surrogate mothers,” the report stated.

The commission recommended legalising only altruistic surrogacy arrangements and not commercial ones. But the draft Bill legalises commercial surrogacy as well.

A Mumbai clinic which specialises in services for gay couples, Rotunda, welcomed the news. “Renting a womb could soon become a completely legal and hassle-free experience, both for Indian as well as foreign couples looking for surrogate mothers in the country,” it said in a press release. ~ Hindustan Times, June 21

A complication from stem cell therapy has led to the death of a patient with kidney disease. The patient suffered tissue damage and died from an infection after stem cells were injected into the kidney, according to a report by Canadian and Thai researchers in the Journal of the American Society of Nephrology.

The incident highlights the gap between stem cell research and treatment. Animal studies appeared to show that injecting stem cells directly into the kidney would be safe. Instead, it caused tissue damage -- called angiomyeloproliferative lesions -- at the injection sites.

Dr Duangpen Thirabanjasak, from Chulalongkorn University, who led the research, said: "This type of lesion has never been described before in patients, and we believe that this is either formed directly by the stem cells that were injected or that the stem cells caused these masses to form."

Andras Nagy, of Toronto's Mount Sinai Hospital, and Susan Quaggin, of the University of Toronto wrote in the journal that caution was needed with stem cell therapies - particularly if unregulated private clinics are offering them.

They wrote: "Premature enthusiasm and protocols that are not fully vetted are dangerous and result in negative publicity for the field of stem cell research, and more importantly, may result in disastrous outcomes with no benefit to the patient. Although there is promise, a large gap still exists between scientific knowledge and clinical translation for safe and effective stem cell-based therapies." ~BBC News, June 17

Patients who were blinded in one or both eyes by chemical burns were restored their sight after healthy stem cells were extracted from their eyes and reimplanted, according Italian researchers at the University of Modena’s Center for Regenerative Medicine.

The stem cells were drawn from an area called the limbus, where cornea and the white part of the eye meet. The extracted tissue was grown on fibrous tissue, and then layered onto the damaged eyes. The cells grew into healthy corneal tissue, turning disfigured, non-functional eyes into working eyes with normal colour and appearance.

More than 75% of the 112 patients treated had their sight restored using this stem-cell treatment, according to Graziella Pellegrini, the leader of the research team. In an interview at the meeting in San Francisco where the report was published, she said: “We have a couple of patients who were blind in both eyes. Can you imagine for these patients the change in their quality of life?”

Ivan Schwab, professor of ophthalmology and stem cell researcher at the University of California, Davis, praised Pellegrini’s work, particularly for its long-term success. Schwab has treated patients in clinical trials using a procedure based on Pellegrini’s research. Although his patients showed some short-term improvement, the benefits did not last long. Pellegrini’s showed long-term improvement, Schwab told Bloomberg last week.

Many of her patients were blind for many years before the transplant, as a result of blood vessels and tissue growing over the damaged parts of the eye. Some had undergone failed surgeries and other treatments. ~Bloomberg, Jun 18

Reflections, both sanguine and sombre, on a decade of research after the decoding of the human genome continue in the science media. Back in 2000 President Bill Clinton and Prime Minister Tony Blair held a press conference with Francis Collins and Craig Venter, who headed the two teams working feverishly on the project. They looked forward to “a new era of molecular medicine, an era that will bring new ways to prevent, diagnose, treat and cure disease”.

But now, despite an explosion of new information, that era seems even further away as scientists realise how complex the genome is. It’s like building a particle accelerator without knowing anything about the underlying theories of quantum mechanics, quantum chromodynamics or relativity, a Princeton geneticist told Nature.

Has human health benefited from this knowledge? In articles in Nature, both Collins and Venter say, “not much”. As Nature points out:

“But the complexity of post-genome biology has dashed early hopes that this trickle of therapies would rapidly become a flood. Witness the multitude of association studies that aimed to find connections between common genetic variants and common diseases, with only limited success, or the discovery that most cancers have their own unique genetic characteristics, making widely applicable therapies hard to find.”

However, the promise alone, without the achievement, still makes some observers giddy with excitement. Take The Economist. In its editorial on the anniversary it declares that analysis of the genome will “will do what philosophers have dreamed of, but none has yet accomplished: show just what it is that makes Homo sapiens unique.” It will also solve the “the age-old question of original sin” by showing how flexible and perfectible human beings really are. Hmmm. Does anyone else think that this is above a geneticist’s pay grade?   

What follows is taken from a press release. It doesn’t require much editorial comment.

www.BeautifulPeople.com, the dating site with a strict ban on ugly people, has launched a virtual sperm and egg bank for people who want to have beautiful babies…

Managing director Greg Hodge said: "BeautifulPeople.com has launched a fertility introduction service to help members and non-members alike procreate.  There are no financial benefits for us in doing so - we are simply responding to a demand for attractive donors.  Every parent would like their child to be blessed with many fine attributes, attractiveness being one of the most sought after.  For a site with members who resemble Brad Pitt, George Clooney and Angelina Jolie you can imagine the demand."

Founder Robert Hintze added: "Initially, we hesitated to widen the offering to non-beautiful people.  But everyone - including ugly people - would like to bring good looking children in to the world, and we can't be selfish with our attractive gene pool."…

Entry to BeautifulPeople.com is only possible after passing a democratic rating process, where members of the opposite sex vote 'yes definitely,' 'hmm yes, O.K.,' 'hmm no, not really' and 'NO Definitely NOT' based on photographs and a brief profile submitted by new applicants. After a recent cull of 5,000 members who had gained weight, over 600,000 members remain on the site, representing 190 countries and every ethnic and cultural background.

BeautifulPeople.com member James Frederiksen is one of many singles who have used the fertility forum and expressed an interest in donating sperm. "I'm from Norway and it's very common for young, healthy men there to donate sperm. There seems to be a shortage worldwide, being a BeautifulPeople.com member I wanted to do whatever I could to help others create beautiful babies."

A US group, the Final Exit Network (FEN), plans to put up billboards with the slogan “My Life, My Death, My Choice”, to spread their message that people have the “right to die”. According to the FEN website, the non-profit organisation does not seek to change existing legislation but rather to offer support to mentally competent patients who seek to end their lives “when they when they suffer from a fatal or irreversible illness or intractable pain, when their quality of life is personally unacceptable, and the future holds only hopelessness and misery”. ~ Time, June 16

Despite criticism the University of California Berkeley is sticking to its plan to offer incoming freshmen and transfer students a genetic test as part of the orientation experience. In the past the University’s “on the same page” program required studnets to read the same book. This year, they can get their DNA tested for three genes for tolerance of alcohol, folate and lactose. The test would be followed up by lectures  and seminars on genetics and personalised medicine. Professors were encouraged to incorporate material on genetics into their courses.

The program is voluntary and confidential. Each freshman will reveive two bar code labels, one to place on the sample and one to keep. After the genotyping is complete, the results will be posted on a Web site using the bar code identification. Only the student can access the information.

A number of bioethicists objected. “It’s a bad precedent to set up mass testing without some sort of counseling support,” said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania. “I’d rather people get their results in a medical setting, where they can ask questions about the error rate or the chances of passing it on to their children, and not just see it posted on some Web site.”

Others were sceptical about how private the tests really are or whether peer pressure mihgt add an element of coercion.

Some critics pointed to commercial involvement. Originally four students were to have been awarded a full genetic analysis donated by 23andMe, a genetic testing firm, as a prize for the best essays or art relating to personalised medicine. This was dropped in favour of a cash prize to avoid the appearance of endorsing direct to consumer medicine.

Berkeley is convinced that it is on the right track. “In the decade ahead, the new genetics is going to penetrate everyday medical practice,” Mark Schlissel, dean of biology told the New York Times. “We wanted to give students a sense of what’s coming, through genes that can provide them with useful information. I think it’s one of the best things we’ve done in years.” ~ Inside Higher Education, May 28

British researchers believe that they have found a way to communicate with people who appear to be in a vegetative state. Recent studies have shown that responses from some of these people can be detected with an fMRI scanner. Damian Cruse, of the Medical Research Council’s Cognition and Brain Sciences Unit in Cambridge, has found that electrodes pasted to a patients scalp can detect the difference between imagining a clenched hand and imagining wiggling one’s toes. The electroencephalogram (EEG), is far cheaper and more portable than a fMRI machine. This makes it possible to ask patients Yes and No questions.

Their conclusion is that it may be possible to communicate with people who were thought to be brain dead, but who have really been locked in without any way to communicate. There may be only a few of these people, but for them, it could be transforming. As The Economist notes, “Given that solitary confinement is one of the harshest punishments known, and that such people are condemned to the worst sort of solitary imaginable, [this] would… be wonderful.” ~ Economist, Jun 17

The number of Dutch euthanasia deaths in 2009 has risen by 13% over 2008 to 2,636. It appears that the rate of growth is increasing, as the 2,331 deaths in 2008 represented a 10% growth over 2007. Legalised euthanasia came into effect in the Netherlands in 2003, when there were 1,815 reported deaths.

Authorities are puzzled by the growing popularity of euthanasia. Jan Suyver, the chairman of the government's euthanasia monitoring commission, wondered if the "taboo" once attached to euthanasia has begun to fade. "It could also be that doctors are more likely to report it," he said.

It is well known that many cases – no one knows how many – go unreported because doctors are reluctant to do the paperwork which official euthanasia requires. The Dutch health ministry will begin an inquiry into the working of the 2002 euthanasia law at the end of June. The committee, headed by Professor Bregje Onwuteaka-Philipsen, will report next year.

Opponents of euthanasia claim that the growth is the result of a collapse in Dutch palliative care since euthanasia was legalised. Whether or not this is true, 85% of those who applied for euthanasia had cancer. ~ London Telegraph, June 20

Well, at 22% this is one of the lowest ranking films on Rotten Tomatoes, but Repo Men does have something to do with bioethics, so here is the trailer. The idea is that sometime in the future, artificial organs are repossessed if the recipients fail to pay their gigantic debts promptly. This is a task which Jude Law and Forest Whitaker carry out mercilessly, giving an opportunity for lots of knives, blood, gunfire and explosions. Then Jude Law’s character needs a new heart. And he can’t pay. The imagination boggles. Well, actually, it doesn’t because the action scenes have been cloned from every other B-grade action movie. But it does make you think, however fleetingly, about the ethics of organ markets.

A Catholic bishop in Phoenix, Arizona, has come under fire for excommunicating a nun who authorised an abortion in a Catholic hospital. A searing op-ed piece in the New York Times by columnist Nicholas Kristof denounced the incident as a “travesty” and described the nun as “saintly”.

The hospital’s story, which Kristof supported, is that a 27-year-old mother of four “suffered from a serious complication called pulmonary hypertension. That created a high probability that the strain of continuing pregnancy would kill her.” The treatment of her condition required the termination of the 11-week-old foetus.

Not many voices have been raised to defend the bishop on medical grounds. Just for the record, here are remarks from a doctor who thinks that an abortion is not an adequate treatment for pulmonary hypertension.

Dr Paul Byrne is director of neonatology and pediatrics at St. Charles Mercy Hospital in Toledo, Ohio, and a former president of the Catholic Medical Association. He told the National Catholic Register that – based on reports in the media – the hospital should have tried to protect both the mother and the child.

“That condition alone will not suddenly take the life of a mother that has been pregnant for 11 weeks. Simple medical treatment, such as bed rest and oxygen supplementation, can be very effective…

“Good medicine follows good morals. You can’t have good medicine without good morals. Life is a gift, and doctors and nurses are called to protect and preserve human life from conception to natural end.

“While acknowledging the lack of specific information regarding the Phoenix case, I cannot recall any similar situation in which abortion was advised to treat pulmonary hypertension. In my experience, when you think your way through a medical problem, you come up with solutions that provide better treatment for the mother, and these solutions allow the baby to grow large enough to survive outside the uterus.”~ National Catholic Register, June 10

When controversy erupts, some people dive below the parapet and some people stand up and shoot back. Whatever you think of his views, Peter Singer at least defends his consistently. Last week, the Princeton bioethicist appeared on an Australian TV show which throws hardball questions at a panel of local luminaries.

Inevitably his two most controversial stands were brought up: infanticide and bestiality. After years of criticism, he still sees nothing wrong with either of them. It probably helped that he was speaking to a sympathetic audience which applauded the former and laughed uproariously at the latter.

Professor Singer sighed that he was not championing bestiality as a lifestyle choice in the notorious book review he published in 2001; he was merely expressing his view that there is nothing wrong with it. He felt gratified that many people subsequently read the review and were relieved to find a justification for something which they had previously regarded as a “terrible moral evil”.

As Professor Singer pointed out, this video clip would not have appeared on mainstream American television. It is rather coarse. For the full transcript, see Q&A, June 14.