Cybrid-gate in the UK

In last week’s blog (July 26), I highlighted an article from Wired magazine (August 2011) titled “Extreme Science”  in which Wired explores seven “shocking experiments” that scientists could learn from if they were willing to set aside their ethical concerns.  One experiment involves cross-breeding humans with chimpanzees in order to better understand human development.

What I find fascinating about all of this is that the Wired article was written as if unethical experiments don’t occur; as if, in reality, scientists are guided by a moral compass.  But are they?  Just 2 days before I wrote my blog, The Daily Mail (a British publication) reported that over a 3-year span scientists “have created more than 150 human-animal hybrid embryos in British laboratories.”  So, what Wired posed as a hypothetical thought experiment was already happening (albeit secretly) in the UK.

According to The Daily Mail, “155 ‘admixed’ embryos, containing both human and animal genetic material, have been created since the introduction of the 2008 Human Fertilization Embryology Act.  This legalized the creation of a variety of hybrids, including an animal egg fertilized by a human sperm; ‘cybrids’, in which a human nucleus is implanted into an animal cell; and ‘chimeras’, in which human cells are mixed with animal embryos.”  http://www.dailymail.co.uk/sciencetech/article-2017818/Embryos-involving-genes-animals-mixed-humans-produced-secretively-past-years.html

The Human Fertilization and Embryology Act of 2008, Section 4A, contains some of the following prohibitions:

“(1) No person shall place in a woman –

(a) a human admixed embryo,

(b) any other embryo that is not a human embryo, or

(c) any gametes other than human gametes.

(2) No person shall –

(a) mix human gametes with animal gametes,

(b) bring about the creation of a human admixed embryo, or

(c) keep or use a human admixed embryo…”

So far, so good.  Or so I thought.  The Act continues:  It is illegal to do #2 above (i.e., mix human gametes) “except in pursuance of a license.

In other words, it is still possible, with government authorization, to mix human gametes with animal gametes to create an admixed embryo.  The only restriction, according to the Act, is that the admixed embryo cannot be kept or used after the first 14 days of its existence.  Indeed, it is also possible, according to the wording of the Act, to create an admixed embryo, store it (i.e., freeze it) over a period of time, and then at some future point do research on it, as long as it is not allowed to live beyond 14 days.

(To view The Human Fertilization and Embryology Act of 2008, go to:  http://www.legislation.gov.uk/ukpga/2008/22/contents)

But the story’s intrigue deepens.  The creation of the cybrids” in the UK was apparently done in secret.  As noted in a recent Christian Medical Fellowship blog (July 26): “there seems to be a murky mix of confusion and secrecy from which the true facts and figures are difficult to extract.”  But why the secrecy if research was being done within the guidelines of The Human Fertilization and Embryology Act?

Furthermore, the research was not carefully documented.  It is less than clear the exact numbers of cybrids that were created.  The Christian Medical Fellowship reports that, “According to The Independent “many more cybrid embryos were created – 278.  That large number is naturally of concern, but also of concern is that the numbers don’t match the figure of 155 released last week.  The Government has avoided answering that question.  Moreover, if all funding (apparently) stopped in 2010 and the licence was revoked from the only researcher, when were these 155 (or 278) embryos created?  Were they all created before 2010?  Or are they still being created?  If so, by whom?” http://www.cmfblog.org.uk/2011/07/26/155-animal-human-embryos-created-in-the-uk-%E2%80%93-we-think/?doing_wp_cron

In other words, in spite of government oversight, an assortment of so-called “ethical guidelines,” and the best intentions of scientists, it’s less than obvious that research is done within any firm restrictions.  The CMF concludes that “the glaring discrepancies in the figures issued by The Human Fertilization and Embryology Authority shows it is not fit for purpose when it comes to regulating the scientists.  It is incapable of keeping accurate records and is unable to keep on top of what is going on in research, either with embryos or eggs.”

I ended last week’s blog with the following observation:  “Humans have also demonstrated a natural tendency to push the moral envelope, to give priority to what can be done over what should be done.  Time will tell whether experiments that are now considered unethical will one day be the norm.”  Apparently we no longer need to wait for “time” to make this announcement.

Is a CT Scan an Ethical Issue?

All third-year students at Texas A&M are required to attend Saturday-morning radiology lectures, and I was surprised to hear my professor speak for the final 30 minutes yesterday on when not to order imaging.   Radiology is his life’s calling, but he recognizes that imaging studies like the CT scan can be harmful.  Of the $2.3 trillion spent on healthcare in the U.S., the largest share is spent on imaging, totaling $800 million.  CT scans have become a part of the American vernacular, but it is estimated that 1/3 of them are unnecessary.  What ethical issues concern the use of imaging in healthcare?

  • Patient Safety: Concerning chest scans, an X-Ray exposes the patient to 0.1-0.2 mSv of radiation, but the CT dose is 8.0 mSv.  At 50 mSv a person is at increased risk of cancer, so minimizing the number of exposures to a CT scan should be an important goal in healthcare.
  • Cost: Some of the ballooning in healthcare costs over the last decade is due to tests ordered by physicians.  Many doctors order tests not because they are indicated by the patient’s symptoms but because they serve as an extra layer of protection in the case of a lawsuit.  The irony of such defensive medicine is that one day a doctor may find himself in court for exposing the patient to too much radiation.  Patients never see the thousands of dollars of imaging charges, so they often authorize such studies and let the insurance companies handle the rest.
  • Physicians Lining Their Pockets: Research has shown that physicians increase the number of scans ordered when they are able to bill for the use of their own equipment.  One gastroenterologist related to me how his clinic moves a number of unnecessary endoscopies through his office for various reasons.  An endoscopy does entail some risk and is certainly not comfortable, but every CT scan is sure to expose the patient to radiation.  Physicians should refrain from allowing revenue strategies to trump good medical practice.

For more information on radiology, visit www.radiologyinfo.org.

Stem Cells and Fast Pitches

In April 2010, Yankee pitcher, Bartolo Colon, received experimental stem cell therapy to mend torn ligaments in his elbow and shoulder and a torn rotator cuff. The procedure involved taking some of his stem cells from bone marrow and fat tissues and injecting them in the elbow and the shoulder. Since then, he has been back in the game again pitching as he did pre-injuries. The therapy was experimental and was done in the Dominican Republic. And while the Dominican Republic has dragged its heels on releasing Colon’s medical records, things seem to be on the up-and-up regarding this procedure. The MLB commission is investigating whether Colon received any banned substances along with the stem cell procedure as well as whether this procedure is within regulation. (See this New York Times article and this New York Daily News article for background.)

Here are the ethical issues that seem to be presented here:

  • Cheating

Human growth hormone (HGH) is a banned substance that is touted as a wonder drug for the veteran athlete. See this Mayo Clinic article for a brief description on myths and facts about HGH. In short, we all make HGH until we are about forty years old. If a teen or twenty-something were to take HGH, there would be no effect because they are already making the hormone. If a middle-aged person takes HGH, they will notice some slight changes, like firmer skin, scars that disappear, and bones and injuries that heal faster. Their bones and bodies are healing faster, like when they were young – think about the little boy who wears a cast for four weeks versus the middle-aged man who wears a cast for six-to-nine weeks to heal the same type of fracture. The doctor who did the stem cell therapy on Colon is known to use HGH which is illegal for professional athletes. Is Colon covering up the use of HGH by saying that he received experimental stem cell therapy? Maybe he actually did receive stem cell therapy, but did he also use HGH? This is still under investigation.

  • Stem Cells

It is worth noting that since adult stem cells are being used in this procedure, the stem cell source is not morally objectionable. As far as the procedure itself, obtaining bone marrow can be painful, but this procedure is technically minimally invasive. However, it is an experimental procedure, so not all risks are known.

  • Therapeutic vs. Enhancement

This seems to be a therapeutic procedure. I do not follow the Yankees or their stats nearly as much as my Texas teams, but from what I understand, Colon is throwing well, but not necessarily better than ever. He isn’t breaking his own personal record or other pitcher’s records at age 38, including oldest pitcher. He is, apparently, back to his pre-injury skill level. To me this seems to be a therapeutic procedure more than an enhancement procedure, but this is not a clear-cut, black-and-white issue. I wrote an article on the use of anabolic steroids several years ago when the Mitchell Report was out. The steroids make a player’s body do what it was never designed to do. Not everyone was designed to build that much muscle, and the consequences of stressing your joints and ligaments with loads they were never meant to take can cause permanent damage.

The reason why this is not a clear issue is because the therapy is to correct injuries are the result of age and use, but not every pitcher has the same problems as they age. The question is: Is this part of the natural consequences of aging or is it fixing an injury? Is Colon getting an unfair advantage over other players? Certainly, I am less likely to injure ligaments in my elbow and shoulders because it’s not part of my job to use them to their full potential every day. By way of example, however, I am a runner. Not a professional runner, by any means, but does this mean that if I am dealing with a nagging knee injury 20 years from now I should chalk it up to old age? Good-bye track; l hello pool? I do preventative things now for my knees, liking icing and stretching in hopes that I will not have to make that decision later, but some people have bad ligaments and some don’t. As one orthopedist I know said, “Some people have forty year knees, some have eighty year knees.” If there is a therapy out there to fix a knee injury, is it fair for runners with this therapy available to them to use it and compete in races in their age range?

  • The Athletes’ Attitude

The last issue is what I believe gets people a little uneasy about this procedure. It’s the athletes’ attitude. Whether we’re talking about Brett Farve or Michael Jordon or Lance Armstrong or some of the less famous, athletes are who they are because they are not quitters. They will push themselves to the limit and do what it takes to win. But the one foe that they will never beat, no matter how hard they try, is old age. Eventually they are going to get too old to play the sport professionally, and no amount of physical therapy, green tea, and weight lifting is going to stop it. But, they will most certainly try.  I am not a professional athlete (so this might be me stretching), but here’s what might be going through my mind: Is it fair that Colon at thirty-eight years old gets some experimental procedure and now gets to live even one more year in the spot light while I had to go through the difficult transition of retiring at a ripe old age of thirty-five? Is it fair that he gets to wipe away the wear and tear while I never had that opportunity? After all, at 38, your mind is sharper than ever, even if your body is “slowing down” a bit. How much better can an athlete be with experience and maturity under his belt?

Autonomous Robots Autonomous Children

I read an article recently in IEET, a transhumanist journal, about regulating autonomous robots. The author lays out reasons why it is hypocritical to regulate or prohibit the construction of autonomous robots. His initial premise is that we make children all of the time, and for all intents and purposes they are the same thing as autonomous robots:

My suggestion is this: If creating children is morally unproblematic, then so is creating autonomous robots, unless we can identify morally relevant differences between the two acts. But what exactly is the moral issue with creating robots that is avoided when we create human beings? Or, in other words, when we’re talking about autonomous beings, why is the responsibility of the parent seemingly less than the responsibility of an inventor?

He lays out several of the arguments people typically give for why children are different from robots and then proceeds to refute them. He concludes that “[u]ltimately, it could be that there is a defensible moral difference between creating children and autonomous robots. But it is not obvious what that difference is, despite our taking it for granted.”

Robots don’t mature from infant to adult. They don’t bleed. They don’t reproduce. They don’t suffer. Robots are assembled by people, and the only way they can “do” any of these functions is if they are programmed to mimic human beings. They cannot do these things on their own. Children are assembled by a series of hormonal and biological mechanisms, some of which remain a mystery to us today. Parents merely provide the parts; they don’t program children to bleed or suffer or rebel. And while the author makes a distinction that children born through IVF are constructed just as robots are constructed, I would contend that IVF doctors are putting the parts together, but that the child does not grow in the directional process to adulthood until it is put back in the uteral environment where that same set of signals and biological mechanisms can do its work.

Most importantly, human beings are more than the sum of their parts. They have personalities, creativity, and are capable of things that no mechanical object can be capable of without being programmed to mimic human behavior.  Humans suffer, and they hope. Even robots that solve novel problems are programmed to do so. The information and tools to assess a scenario is front-loaded by the programmer, while humans are capable of true creative innovation. To assume the premise that creating children is not morally different from creating a robot presumes a reductionistic and deterministic view of children that does not match with experience and observation. Robots are programmed by their inventor, but anyone who has children knows that while they may take on certain personality traits of their parents, they are most assuredly not “programmed” by their parents (See your nearest toddler).

Even my husband’s Mac which seems slightly autonomous because everything is automatic and it seems to correct its own problems, is not truly autonomous. The only way a Mac would “attack” a human being is if it is programmed to do so, and in that case it still comes down to the evil that men do to one another, the weapons are just smaller, faster, and more complex.

The Human Factory

I am sure many of you “foodies” have heard of the less than appetizing ingredient added to the long menu of strange “eats”—human breast milk. For those of you who are less than food savvy: do not fret, the milk you have been buying is likely from a cow (but I would still check the label).

This may seem to be a relatively obscure fact and even completely unrelated to the world of bioethics. However, you may think differently after reading the following article:

http://www.foxnews.com/health/2011/05/02/new-yorkers-sample-cheese-breast-milk/

For those of you who do not have the time or the interest to read this article…

Miriam Simun created a temporary art installation called the Lady Cheese Shop, which produces breast milk cheese, in hopes to make people think about the various ways human bodies are used as factories “producing blood, hair, sperm, eggs and organs that can all be harvested to be used by others.”

Can you think of any reason why human blood transfusions are generally accepted and human breast milk products “raise eyebrows”?

Contemplating “The Scandal”

CBHD Scandal of Bioethics Conference Graphic

CBHD Scandal of Bioethics Conference Graphic

This coming July, the Center for Bioethics & Human Dignity will host its 18th annual conference. This year’s theme is “The Scandal of Bioethics: Reclaiming Christian Influence in Technology, Science & Medicine.” The conference theme poses a number of interesting questions that, I believe, would be worth considering in advance of the meeting.

First, do you believe Christian moral reflection has been marginalized in bioethical discourse and public policy decision-making, and if so, in what ways?

Second, what may we cite as the evidence of a contemporary bioethics bereft of Christian influence? How might the bioethical terrain differ from its present state if the Christian voice had enjoyed a more sustained presence in public policy discourse?

Third, to what may one attribute this marginalization of Christian moral reflection in bioethics? Is the problem external to the Christian community, or do we share in the blame? If the latter, in what way?

We’ll save the question of a way forward for another post, but perhaps you have other questions pertaining to the diagnosis of a diminished Christian influence in contemporary bioethics and its underlying cause(s).

Your comments?