Pink Viagra sales tank


A few weeks ago "pink Viagra", more properly known as Addyi, got a green light from the FDA. The drug purports to treat “hypoactive sexual desire disorder” in women. The day after the approval, Sprout Pharmaceuticals, a small company with the patent, was sold for US$1 billion in cash to Valeant Pharmaceuticals International. Valeant obviously thought it had a winner. 

It turns out that it has backed the wrong horse. In the first few weeks, only 227 prescriptions have been filled. “I thought there was going to be this huge onslaught,” the director of the Women’s Health Clinic at the Mayo Clinic told Bloomberg Business

Addyi has a lot of drawbacks; it has potentially deadly side effects, women can't drink alcohol while using it; it costs US$780 a month; and it must be taken daily. But the biggest problem might be that Valeant believed Sprout's canny public relations campaign which promoted sex as "a basic human right" and one of the FDA's "priority areas of unmet medical need". Perhaps women are more interested in commitment than a Viagra they can call their own. 

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Paris attacked by terrorists


As I write, at least 127 people have died after coordinated attacks on several venues in Paris. President Hollande has declared a state of emergency, imposed border controls and called out hundreds of troops. It appears to be the handiwork of ISIS.

President Hollande has declared defiantly that his nation would be “merciless” in responding to “the barbarians of ISIS”.

The aftermath will test the mettle of France – as it would any nation. Hostility towards the large Muslim population will grow, some French Muslims may become more radicalised, refugees will be unwelcome, and the government could be provoked into putting boots on the ground in the heartland of ISIS, in Syria.

Terrorism depersonalises people, turning innocent men and women into faceless, infrahuman enemies. Islamic terrorism does this in the name of Allah, using God as an ideological pretext for bloodlust and savagery.  

The temptation for France – and other Western nations – will be to depersonalise its enemies and to smite them with the same depersonalised, ideological rage. That, of course, is exactly what ISIS want them to do. But the nation must respond forcefully to this atrocity without losing its liberté, égalité, y fraternité. It will be difficult. 

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An excursion into time machine ethics


We missed this, sorry, but October 21 was #BackToTheFutureDay, the day Marty McFly travelled to in Back to the Future II. The internet was abuzz with the kind of stuff the internet buzzes about better than anyone else and even POTUS tweeted “Ever think about the fact that we live in the future we dreamed of then? That's heavy, man.”

But with all the palaver about time travel, the only person who studied the bioethical conundrums of time travel was Dr Janet D. Stemwedel, a columnist for Forbes who specialises in time machine ethics. She took seriously a question posed on Twitter by the New York Times Magazine: “If you could go back and kill Hitler as a baby, would you do it?” (Only 42% said yes!)

First of all, she notes that this is question that only a utilitarian will take seriously. Killing an innocent child now is deemed right because it will prevent great evils later. But she counters:  “Given all the moving parts in a world of many people who raised, nurtured, enabled, and assisted Adolf Hitler, why is baby Hitler the moving part to eliminate? If you gamble on killing this baby, who has done nothing wrong and for whom there is no guarantee yet of eventually committing the horrors you hope to prevent, aren’t you using the kind of logic that could justify mass exterminations of other people?"

Furthermore, given the large number of people who shared Hitler’s depraved ideas, someone else would probably step into the gap left by his non-existence. She concludes: “In the process of trying to avoid a great harm that, at the stage of Hitler’s infancy, is in no way inevitable, you’ve made yourself a baby killer, which is surely a harm to baby Hitler, to his survivors, and (if you have any kind of conscience) to you.”

Sound advice, readers, if you ever get your hands on a reliable time machine. 

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Are there limits to informed consent?


If you don’t have a strong stomach, you are allowed to skip what follows and proceed directly to the article links below.

Earlier this month the New York Post, a great source of bioethical conundrums, reported the strange case of 30-year-old North Carolina woman Jewel Shuping.

Ms Shuping is convinced that she was always meant to be blind. But by some terrible accident at birth, she had normal eyesight. “I really feel this is the way I was supposed to be born, that I should have been blind from birth,” Shuping explained. Doctors say that she has Body Integrity Identity Disorder.

Finally she found an obliging psychologist in 2006. After giving her some counselling, he gave her some eye-numbing drops and then washed her pupils with drain cleaner. “It hurt, let me tell you,” she says in a YouTube video. “My eyes were screaming and I had some drain cleaner going down my cheek burning my skin,” she said. “But all I could think was, ‘I am going blind, it is going to be okay.”

So here is the bioethical conundrum: was the psychologist right to destroy his patient’s eyesight if she freely requested it, was happy with the treatment, and was living in psychological torment because she could see?

And if he was wrong and unethical, why is participating in gender reassignment surgery or euthanasia right and ethical? 

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Supervision of euthanasia breaking down in Belgium


The theme of control is at the heart of debates about assisted suicide and euthanasia. For the patients, it’s control of their own lives. For legislatures, it’s control of doctors who end lives. Wherever legalisation has failed, it is due to fears about whether people who have been authorised to kill without police supervision will be adequately monitored. Wherever it has succeeded, those fears have been allayed. 

At the moment euthanasia in Belgium, where it is legal, is not being adequately monitored even by the loose local standards. Its parliament has delegated oversight to a commission of 16 professionals who are supposed to review the file for each case of euthanasia. That system is breaking down. Members are resigning, perhaps because of the huge workload, and the vacancies have been mounting. Legally speaking, the commission has lost its mandate. 

But even though control has manifestly broken down, doctors continue to euthanise their patients at the rate of at least five a day. Is this the system that Belgians voted for in 2002?

PSas you may know, we have launched a drive to raise $15,000 to cover our costs at BioEdge. Please consider a donation. Click here for more information
http://www.bioedge.org/supportbioedge

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More gendercide


We overlooked an amazing story three years ago -- a study of abortion rates in Nepal. Lately Nepal has been in the news as a hotspot for surrgacy. But it is also a natural experiment in sex-selection.

Abortion was legalised in Nepal in 2002. Almost immediately the sex-ratio in the country began to change. Around 2002 the ratio of girls born to boys born was 942 to 1000 for second-born children. By this ratio had fallen to 742. Amongst the richest urban women, just 325 girls were born for every 1000 boys.

In other words, the legalisation of abortion has been a death warrant for Nepalese girls. Abortion provider Marie Stopes International calls Nepal a "unusual success story" because fertilty there has fallen from 4.1 to 2.6 in just 10 years, one of the most dramatic declines in history. But this was achieved by allowing gendercide to flourish. 

PS -- apologies to our readers. We mixed up mailing lists last week and some of you may have received a daily newsletter meant for subscribers to MercatorNet. We have fixed the issue and I hope that it will not happen again. 

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An historic moment


This week YouTube made history. Literally. Assisted suicide became legal in California after Governor Jerry Brown put his signature on a law passed by the state's legislative assembly and senate. And it would never have happened without a YouTube video which was released on this day, exactly one year ago. 

Compassion & Choices, America's leading right-to-die group, financed, produced and promoted a short video about Brittany Maynard, a 29-year-old, recently married woman with a brain tumour. She was "forced" to move to Oregon where assisted suicide is legal. The video went viral and was seen by millions of people who watched Brittany plead tearfully for the right to die.

It shows the immense power of story-telling in an era which respects emotions more than reasoned argument. 

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The virtuous surgeon


There is a hoary medical joke which runs: “What is the difference between God and a surgeon? God does not think he is a surgeon.” Perhaps there is a bit of truth in the implication that surgeons tend to be brash and bullying. Certainly the disturbing allegations made against Australian surgeons bear it out, as we report in our lead story.

After some appalling reports of sexual harassment by surgeons hit the media, the surgeons’ professional body asked a group of eminent experts to investigate. They found that “discrimination, bullying and sexual harassment are pervasive and serious problems in the practice of surgery in Australia and New Zealand” and called for “a profound shift in the culture of surgery”.

A noble goal, indeed, but how will it be achieved? By creating new lists of standards and writing more reports? The most natural way, surely, is to make character, not just competence, part of medical training. Unless surgeons are virtuous, in the old-fashioned sense of the word, I suspect that it will be impossible to eliminate this seedy behaviour.  

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Is there a “right” to euthanasia?


Milou de Moor committed suicide after her doctor refused to euthanize her.    

When it comes to lawsuits, doctors are extremely gun-shy. Their business is healing people, not lining the pockets of lawyers. That's why the fall-out from a euthanasia case in the Netherlands may be highly significant.

As you can read in this week's BioEdge, a family doctor refused to sign off on the euthanasia of a 19-year-old woman suffering from lupus-related depression, so the teenager committed suicide. Her bereaved family believes that she was denied the right to a peaceful death and has brought the case to a disciplinary tribunal. 

If the doctor is censured, will this effectively lead to euthanasia on demand in the Netherlands? Rather than fight to have their professional judgement respected, I'll bet that most doctors will just rubberstamp every request that passes across their desks. It will be interesting which the Dutch respect more: the informed consent of the patient or the informed consent of the doctor. 

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Euthanasia for unbearable mental suffering in Belgium


Euthanasia in Belgium is an increasingly popular subject for documentaries. The latest comes from Dateline, a program of Australia’s SBS network. (See the video below). Journalist Brett Mason interviews several people who have featured in BioEdge reports over the years. But the main focus is on Simona, an 85-year-old woman whose only reason for requesting death is grief over the sudden death of a beloved daughter.

“It was, without question, the most difficult day I’ve had as a journalist,” he told Daily Mail Australia. “As a foreign correspondent, I’ve seen a lot of people dying. I’ve witnessed a lot of final moments. All of those people, I remember very clearly, didn’t want to die. They had something to live for, something they feared losing.

“What I struggled with most, was that despite being in near perfect physical health, Simona believed she had nothing and no one in her life worth living for,” he said.

Simona is adamant that she wants to die. “I don’t have to justify myself to anyone,” she says defiantly. However, it seems like a pretty miserable way to depart. A doctor, a friend, a nurse, a journalist and a cameraman at her bedside – no relatives. She drinks a lethal dose, asks to put her feet up and dies. It is a scene which will make anyone ask whether Belgian doctors understand what compassion for the vulnerable, the disabled and the elderly means. 

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