The hospital, to be commissioned in February next year, will be spread over four acres, with special dormitories to accommodate surrogate mothers, 25 rooms for IVF patients, 15 neo-natal ICUs and 40 special rooms for couples. The estimated cost is $8 million USD.
Dr. Patel wants the hospital to be a “family nest”, where biological parents, surrogate mothers and neo-natal children all live together as an integrated family. Patel intends for the hospital to be staffed largely by relatives and friends of the surrogates, so as to “improve the overall family atmosphere”.
They found that 15 out of 55 minimally conscious patients responded to the stimulation by becoming more responsive and two were even able to communicate nonverbally with researchers. Those in a vegetative state did not show any reaction.
“These results are all the more impressive because they can occur in chronic patients, i.e. years after their accident, when their state is often considered as no longer being able to evolve”, said Aurore Thibaut, the chief author of the paper. Unfortunately the improvement is only temporary and patients return to their original state after several hours.
In a minimally conscious state a patient will exhibit minimal or occasional signs of awareness, from following an image with their eyes to reaching for an object, but they can go weeks to months without responding to anything at all.
The researchers are now working on the effect of long-term stimulations to prolong and maintain the benefits of these electrical stimulations on the brain.
The safe and relatively cheap technique, known as transcranial direct-current stimulation (tDCS), has already been reported in previous studies as improving attention span, working memory and language functions.
Dr. Michael DeGeorgia, an American neurologist, said more research like this study is needed to understand how much information a minimally-conscious patient can process. Patients may just be “locked in”, and still understand what’s going on around them though they unable to respond.
Overseas hospitals are sometimes the only option for Afghans. In a recent Medecins Sans Frontieres (MSF) survey conducted in Afghan hospitals, one in five patients said they had a relative or close friend who had died as a result of lack of access to healthcare in the past 12 months.
The MSF report outlined major understaffing, lack of medicines, short opening hours and corruption as key problems in the Afghan public and private systems.
In Indian the quality of healthcare is higher – though perhaps not as outstanding as many Afghans think – and there are more specialists available.
As a raw figure the number of medical visas is high, but only a small proportion of the Afghan population can afford to travel overseas for healthcare. Middle class families need to mortgage houses and take out substantial loans to make the trip, and they often will run out of money when in India.
Indian hospitals have been eager to tap this new revenue stream. Many have websites in Dari and Pashto, and separate payment and service desks for Afghans. They offer prayer rooms, Halal food and Afghan cuisine. Almost all hospitals provide interpreters free of charge.
A US federal court recently declined to stop force-feeding of detainees at Guantánamo Bay. The Court of Appeals for the District of Columbia Circuit refused to issue a preliminary injunction.
“The rights of men being held in Guantánamo are being completely ignored, and the hunger strike is the only option they have left to protest their indefinite detention, which has lasted more than 11 years without charges for some of them,” said Dr Vincent Iacopino, of Physicians for Human Rights. “By allowing the cruel and degrading practice of force-feeding to continue, the court has essentially authorized the continuation of an abusive tactic that violates human rights and fundamental medical ethics.”
The detainees being forced-fed are being held in indefinite detention, which is in itself a violation of human rights, according to the PHR. A preliminary injunction would have at least stopped force-feeding, which constitutes ill-treatment and could rise to the level of torture.
However, two of the three judges said the detainees did have a right to challenge the practice in court, paving the way for a continuing legal battle over the issue. The judges also pointed that that “force-feeding is a painful and invasive process that raises serious ethical concerns.”
Informed consent and conscientious objection are easy to fulminate about, but tricky to discuss with consistency. Take, for instance, the delicate topic of requests for hymen restorations and virginity certificates. Worldwide, an estimated 5,000 women were victims of honour killings in 2000. If a young woman from a culture which sanctions honour killing approaches a doctor, what should he or she do?
Refusal is not a popular or even, in some jurisdictions, a legal option for doctors who are asked to refer for an abortion or to prescribe contraception. But a request which reinforces “patriarchal norms” is different.
Swedish ethicists surveyed about 1000 general practitioners and 1000 gynaecologists. They report in the Journal of Medical Ethics that a small majority would agree to the woman’s request. However, a large minority, supported by the Swedish community, insist that they would never do so. In other words, conscientious objection to patriarchal norms is socially acceptable, even if it involves refusing a woman’s fully informed request for a medical procedure:
“the political message in Sweden is that hymen operations should be considered a non-option and that the appropriate response to such requests should be information about the medical aspects of sexuality and human rights and, if necessary, referral to police or social authorities for protection. The main argument for this practice is that Swedish society should take a stand against practices expressing control of female sexuality. The official Swedish viewpoint hence expresses a zero tolerance policy against patriarchal norms and values.”
Opposition to these practices in Sweden is so vehement that doctors try to dissuade women. If this fails, it is not illegal to perform them, but they do so reluctantly and secretly.
The authors favour the pragmatic policy followed by doctors in the Netherlands. There doctors inform women of the issues involved, but do the procedure if they insist. This allows them to give women better health care.
While the US Food and Drug Administration examines the possibility of allowing “three-parent embryos” to fight some lethal mitochondrial diseases, the UK has decided to press ahead. This week the government launched a consultation on how to regulate the technique.
It is estimated that 1 in 200 children born every year in the UK have some form of mitochondrial DNA disorder. These disorders, including heart disease, liver disease, loss of muscle co-ordination and other serious conditions that can have a devastating, even fatal, impact on the people who inherit them. At present, mitochondrial donation techniques to prevent the transmission of serious mitochondrial disease are prohibited.
The UK’s Chief Medical Officer, Professor Sally Davies said: “Allowing mitochondrial donation would give women who carry severe mitochondrial disease the opportunity to have children without passing on devastating genetic disorders. It would also keep the UK at the forefront of scientific development in this area.”
This is more accurate than describing the technique as “life-saving”. Rather than helping existing children, the technique creates a “designed” embryo with genetic material taken from two eggs. Embryos which do not make the grade are presumably discarded.
David King, of Human Genetics Alert, a lobby group, was critical of the latest step. "If passed, this will be the first time any government has legalized inheritable human genome modification, something that is banned in all other European countries," he said in a statement. "Such a decision of major historical significance requires a much more extensive public debate."
An Italian woman in her 80s decided to die in an assisted suicide clinic in Switzerland because she was ‘losing her good looks’. Oriella Cazzanello – who was seldom visited by her children– caught a train to a clinic in Basel where her life was ended for a fee of €10,000. Her family, who reported her missing to the police, only learned of her death when her attorney received the ashes and the death certificate in the mail.
Mrs Cazzanello chose to end her life because she was ‘weighed down by ageing and the inevitable loss of the looks of which she was proud’ the Italian news agency ANSA reported. Assisted suicide is illegal in Italy, but legal in Switzerland, even if the person requesting it is not terminally ill.
Coincidentally, researchers at the University of Bern released a paper this week which indicates that 16% of those who die in Swiss suicide clinics do not have an underlying health problem. They just want to end it all because they are weary of life. They concluded:
"Assisted suicide in Switzerland was associated with female gender and situations that may indicate greater vulnerability such as living alone or being divorced, but also with higher education and higher socio-economic position."
New studies are suggesting that doctors need to be more cautious when they release genetic information to patients.
A recent article in the American Journal of Psychiatry has examined the effects of informing patients of genetic predispositions to disease on their subsequent cognitive performance. The authors of the article, from the University of Indiana and UC San Diego, found that respondents who were informed of a disposition to Alzheimer’s performed worse on memory tests and had reduced confidence in the current power of their memory.
In the study, which involved almost 150 participants, some of the patients were given the results of genetic test for Alzheimer’s predisposition, whilst others were tested but not told of their results.
The researchers found that those participants who were informed of their predisposition to Alzheimer’s performed far worse on the tests for objective and subjective memory. The ”informed” participants showed poorer comprehension when asked to recount narratives and recall images. In subjective memory tests they were far more pessimistic about the strength of their current memory.
In addition avoiding the negative psychological effects of the test, the authors of the study suggested doctors bear in mind this phenomenon when assessing whether a patient has Alzheimer’s: ‘Clinicians and researchers should consider patients’ knowledge of their genotype or knowledge of possession of other Alzheimer’s biomarkers when evaluating older adults who may or may not be at risk for developing dementia’.
The meeting focused on how to get more British parents to declare they have adopted a surrogate child (which is done through applying for a parental order). Many parents believe any such application will be rejected, for they have paid a woman more than out of pocket expenses to carry the child. This payment is technically illegal in Britain. Parents are also concerned that the regulations in foreign surrogacy clinics do not meet the standards required for the granting of a British PO. The upshot is that about 1,000 children of surrogate mothers enter Britain each year and many of them lack a clear parental status.
The conference has backed the establishment of a International Convention on Surrogacy, along the lines under consideration by the Hague Conference on Private International Law. Bilateral agreements between governments may be quicker way to address the issue. It was also suggested that the UK Government should make it easier to apply for Parenting Orders, by lowering the cost and quickening the process.
What is it about stem cells that attracts scientific misconduct? Even a decade after the exposure of one of the most egregious charlatans of the 20th century, Korean scientist Hwang Woo-suk, there is a long train of discoveries which turn out to be based on shoddy or even fraudulent work.
The latest scandal has come to light in Germany. Cardiologist Bodo-Eckehard Strauer, who retired in 2009, has claimed that stem cells derived from bone-marrow cells will repair damage in diseased hearts. Now a investigators at the University of Düsseldorf says that there is evidence of misconduct in his clinical trials. It has handed a report to police prosecutors.
Strauer’s work has been under attack in Germany for years, with his critics complaining that he had transformed the results of a single case into an amazing “global innovation”.
Last year, a commentary on an analysis of Strauer’s work in the International Journal of Cardiology was scathing in its assessment of his work:
“The analysis by Francis et al. suggests that there have been numerous publications of the same sets of data from Strauer’s group. Moreover what initially appear to be duplicate publications provide contradictory descriptions of experimental designs and of results. At the same time there are implausible agreements between data in populations of different sizes as well as statistical and arithmetic impossibilities in other datasets. I can see no logical option but to suspend belief in any of the data reported in these publications until an appropriate investigation has been performed.”