Last week we reported that researchers at the Oregon Health and Science University had finally cloned human embryos and successfully extracted embryonic stem cells. The study was published in the leading journal Cell and greeted with great jubilation. This was a feat which scientists agreed was possible but was proving unexpectedly difficult. The last time the claim was made, by South Korean Hwang Woo-suk in 2005, it turned out to be a colossal fraud which embarrassed leading journals and dampened enthusiasm for “therapeutic cloning”.
Unfortunately, the most recent paper has also been criticised for image duplication, evoking the nightmarish Hwang scandal. "It's a shame that this important area of research has come under scrutiny once again," Kevin Eggan of Harvard University told ScienceInsider. The researchers say that the duplication was unintentional and that these minor errors will not affect the validity of the results.
Cell was also criticised for approving the paper so quickly – it was accepted in only four days and published in another 12. “The four-day review process was obviously inadequate,” Arnold Kriegstein, director of the stem-cell programme at the University of California, San Francisco, told Nature. “It's a degree of sloppiness that you wouldn't expect in a paper that was going to have this high profile. One worries if there is more than meets the eye and whether there are other issues with the work that are not as apparent.”
Even if the researchers did manage to create a cloned embryo, it is no longer the big news that it once was. As the Boston Globe pointed out, “The emergence of reprogrammed stem cells, the difficulty of the involved method, and the obstacles to obtaining donor eggs for the procedure all make the advance more an important technical feat than a game-changer for stem cell scientists or a platform for new therapies.”
As a sign of the times, the leading lobby group for “therapeutic cloning” wound itself up this week and merged with another organisation. The president of the Coalition for the Advancement of Medical Research (CAMR) told its members in an email, “"Given the progress we are seeing in the field of regenerative medicine, the policy issues we now see go beyond the historical focus of CAMR."
Inferno: Robert Langdon is back with a globe-trotting thriller in which the symbologist has to decode clues left in a map of Dante’s masterpiece by a recently-deceased evil genius before one-third of the world perishes. Oops, we are about to give away too much of the plot. Suffice it to say that the master of transmuting highbrow trivia, European travel guides and clunky prose into dollars has framed transhumanism as the most dangerous threat to the future of mankind.
Brown says that transhumanism is a movement to change the destiny of humanity through genetic engineering. In Inferno, the villain is obsessed with over-population and creates a virus which will make one-third of the world’s population infertile, thus reducing the population dramatically in a single generation. From an interview in Timet, it appears that Brown himself believes that the world is seriously over-populated and that extreme measures are needed to curb population growth.
The publisher describes Inferno as “one hell of a read”. Perhaps that is true in more senses than one.
This 25-minute documentary by Al-Jazeera presents a balanced view of the campaign for euthanasia in Australia. No presentation will satisfy everyone, but this one, "Licence to Kill", presents articulate folk on both sides of the question. Philip Nitschke's do-it-yourself suicide classes are spine-tingling. Much better than YouTube kitty videos. (Some nice shots of the Opera House, too.)
Hollywood celebrity Angelina Jolie was hailed this week for her bravery in revealing that she has had a preventative double mastectomy. The New York Times published her explanation as a scoop on its op-ed page:
“For any woman reading this, I hope it helps you to know you have options. I want to encourage every woman, especially if you have a family history of breast or ovarian cancer, to seek out the information and medical experts who can help you through this aspect of your life, and to make your own informed choices.”
Susceptibility to breast and ovarian cancer runs in Jolie’s family. Her mother died at 56 of breast cancer and she carries the BRCA1 gene. Doctors told her that she had an 87% chance of contracting breast cancer. After the operation, she said, the risk is now only 5%.
The news was reported widely, so widely and extensively that columnist Brendan O’Neill, of Spiked, complained that it had overshadowed “everything from the savagery in Syria to the tussle over the future of the EU”.
Will the publicity help breast cancer sufferers? Daily Mail columnist Amanda Platell criticised Jolie for making the difficult and exhausting surgery seem too easy. Her doctor at the Pink Lotus Breast Center in Beverly Hills posted the whole procedure on her blog. It was staged over three months and it takes many weeks to recover. However, the doctor said that Jolie was filled with “bountiful energy”, worked hard on directing another film and took time out to visit the Congo to highlight violence against women.
“To imply, as she has done, that it is possible to bounce back in a few days places an unfair burden on those women who struggle physically and mentally in the aftermath of such major and life-changing surgery.”
There was a political edge to her essay as well. It appeared to be an attempt to influence the US Supreme Court to rule against Myriad Genetics's patents on the BRCA 1 and 2 genes.
“It has got to be a priority to ensure that more women can access gene testing and lifesaving preventive treatment, whatever their means and background, wherever they live. The cost of testing for BRCA1 and BRCA2, at more than $3,000 in the United States, remains an obstacle for many women.”
Media coverage, though, hardly scratched the surface of the complex ethical issues involved in Jolie’s decision to remove both breasts even though were no signs of cancer. According to the US government’s National Cancer Institute, “preventive mastectomy should be considered in the context of each woman’s unique risk factors and her level of concern.” In other words, worry itself is a factor. Many women with the BRCA gene fret so much about their future that they come to think that a mastectomy is the only solution. But there are other options, like frequent surveillance from an early age.
In fact, one study from the University of Michigan has shown that nearly three-quarters of women who decided to have one breast removed were actually at very little risk of developing cancer in the healthy breast. They were driven more by fear than by good medical reasons.
Jolie has had a very difficult personal history with a number of partners, including a lesbian relationship, estrangement from her father, adopting as a single parent, global fame as the world’s most beautiful woman, and intense scrutiny of her personal life by the media. Her case is obviously unique. While it is clear that she is brave and determined, it is far from clear that other women should take her as a role model.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) goes on sale on May 22 after more than a decade of revision by 1,500 experts. As the bible of psychiatry, it is enormously influential. Based on its diagnoses, patients will be able to claim sickness benefits, insurance and compensation. Drug companies can market new products. Odd behaviour will become a medical problem.
The purpose of DSM-5 is to enable doctors to make more reliable diagnoses of mental disorders by setting strict criteria. But most of the commentary that has accompanied its launch has been negative. As The Economist notes, “In the eyes of many critics it is a vehicle for misdiagnosis, overdiagnosis, the medicalisation of normal behaviour and the prescription of a large number of unnecessary drugs.”
The new edition adds to the ever-expanding number of diagnosable conditions: disruptive mood dysregulation disorder (children’s tamtrums), excoriation (skin-picking) disorder, hoarding disorder, binge eating disorder and grief at the death of a loved one. By one calculation, half of Americans will experience a diagnosable mental illness in their lifetime.
The critics of the new edition include the chairman of the last edition, Allen Frances. He claims that DSM-5 "includes new diagnoses and reductions in thresholds for old ones that expand the already stretched boundaries of psychiatry and threaten to turn diagnostic inflation into hyperinflation".
Thomas R Insel, director of the National Institute of Mental Health, the leading US government's agency for mental illness has attacked the manual's "validity". “Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”
And the Division of Clinical Psychology, an eminent UK body, wants doctors to abandon psychiatric diagnoses and to develop alternatives which do not use the language of "illness" or "disorder". It says: "Psychiatric diagnosis is often presented as an objective statement of fact, but is, in essence, a clinical judgment based on observation and interpretation of behaviour and self-report, and thus subject to variation and bias."
Every edition of the DSM has attracted strong criticism. Perhaps the ultimate reason is that the mind is a still a mystery. Psychiatrists have fundamental differences over how to explain mental illness: is it purely biological? Is it due to social stresses? Does it exist at all? No doubt they will be arguing just as heatedly over DSM-6.
The research, conducted by Oregon Health and Science University and published in Cell, involved the replacement of the nucleus of a normal egg cell with that of a skin cell. This procedure is known as somatic cell nuclear transfer. A few days after this, stem cells were extracted from the embryo.
The stems cells from cloned embryos are used to create tissue genetically identical to the DNA of the patient. This means that procedures like organ transplants could be performed without a risk of rejection.
The researchers are sceptical that the embryos could be developed into viable babies. They did not implant the embryos and said they had no intention of doing so. They said that this technique had been tried on monkeys for years, and never resulted in the birth of a cloned monkey.
Professor of Stem Cell Sciences at the University of Melbourne, Martin Pera, believes the breakthrough will lessen opposition to therapeutic cloning. "I think in general, where we look at the potential for alleviating disease, and when that potential becomes real, then some of the objections I think tend to diminish."
Is bioethics compatible with democracy? This is not a question that surfaces very often in policy debates featuring prestigious bioethicists. However, in a provocative column in The Guardian, Nathan Emmerich, a young bioethicist, asks whether bioethicists are turning into a priestly caste:
“In a secular age it might seem that the time for moral authorities has passed. However, research in the life sciences and biomedicine has produced a range of moral concerns and prompted the emergence of bioethics; an area of study that specialises in the ethical analysis of these issues. The result has been the emergence of what we might call expert bioethicists, a cadre of professionals who, while logical and friendly, have, nevertheless, been ordained as secularpriests.
“This suggestion – that there are expert bioethicists – might appear to have profoundly anti-democratic implications. Indeed handling expertise, including scientific expertise, is a central difficulty for democratic societies and its extension into the realm of moral values seems, on the face of it, to compound the problem. Nevertheless the Human Fertilisation and Embryology Authority (HFEA) has constantly made use of expert bioethicists and two members of the recently convened Emerging Science and Bioethics Advisory Committee (ESBAC) are listed as "bioethics specialists"…
“Expert bioethicists cannot allow themselves to become a priestly caste. They must engage with the public and, in doing so, become more fully engaged by and with their concerns. Bioethics must become part of the drive to make science public and part of the politics of scientific expertise.”
The German and Czech governments allow sex offenders to be surgically castrated – provided that they give informed consent to the procedure. This has put them at loggerheads with the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT). It has denounced the practice as degrading treatment which should be ended immediately.
Writing in the Journal of Medical Ethics, John McMillan, of the University of Otago, in New Zealand, argues that the CPT is mistaken. All the evidence shows that prisoners are not coerced and that they choose this option freely in an effort to pull their damaged lives together.
There are various options open to sex offenders who want physiological assistance in controlling their sex drive. Chemical castration is reversible – but more expensive. The Czech government says that it cannot afford it. An orchidectomy is the surgical removal of the testes. This is uncommon nowadays.
Instead, offenders are offered testicular pulpectomy, a procedure in which the core of the testes is removed. This technique has been refined by surgeons as it is often done in treating prostate cancer. It is less disfiguring than an orchidectomy but nearly as effective in removing the production of testosterone.
Dr McMillan concludes that surgical castration is an ethical option so long as there is informed consent:
“in cases where psychiatrists have good reasons for thinking that castration will lead to a transformation of self that is integrated and will enable sex offenders then castration might be the kindest cut. Leading a life in which the actions you perform are consistent with the considerations that you think you should act upon is one important aspect of agency. Despite the undeniable fact that chemical and physical castration are capable of changing people in ways that make most of us uneasy, when there are good reasons for predicting that it will result in a person being able to reconstruct their agency, then we should not view castration as cruel or inhumane treatment.”
The bill, proposed by minister for social inclusion Bill Hunter, is intended to overcome "discrimination" in current IVF regulations. Current law permits access to IVF services only for women deemed "medically infertile".
Mr Hunter said that the bill discriminated against women who were healthy but whose "social circumstances prevent them from conceiving without some sort of assisted reproductive treatment".
Both major parties have allowed a conscience vote on the bill. It has already passed in the upper house and is expected to pass in the lower house by a two vote majority.
Current restrictions mean that women have to travel interstate for IVF treatment.
State premier Jay Weatherill last week publicly supported the lifting of restrictions. However, Attorney-General John Rau and former health minister John Hill have said they would not support reproductive treatment for same-sex couples.
A Californian women has been sentenced to 5 years imprisonment after she misappropriated US$2.5 million from a surrogacy company. Tonya Ann Collins, 37, set up the company Surrogenesis in 2005, along with the escrow company Michael Charles Independent Financial Holding Group.
From then until 2010, Collins used money from the companies for various unauthorized expenses - automobiles, homes, jewellery, clothing, and vacations for herself and others. Over 50 surrogate mothers were defrauded of their payments, in addition to countless clients who lost tens of thousands of dollars. On top of her jail sentence Collins has been ordered to pay restitution to the victims.
Collins was able to avoid detection by pretending Michael Charles was an independent, impartial party in the financial transactions to pay for surrogacy procedures. Eventually, Surrogenesis and Michael Charles suffered substantial cash flow problems, and various surrogate mother fees and related surrogacy expenses were not paid by the companies as required.
"Tonya Collins orchestrated a cruel fraud, the effects of which are still being felt by the victims," US Attorney Benjamin B. Wagner said in a statement. "She not only stole victims' funds from their escrow accounts, but in many cases caused other injuries to victims, permanently foreclosing certain victims' ability to proceed with a surrogate pregnancy for which they had planned for many years."
"[I'm] devastated", said Beth Mardones of Chicago, one of the victims of the scam. "I thought this just couldn't be right because we had signed a contract. We did everything the right way," she said. "I just felt that all of our hopes of having our own biological child were shattered."
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| michael@bioedge.org
7:02:53 PM
A Californian women has been sentenced to 5 years imprisonment after she