Wednesday, June 02, 2004

Today on Marketplace
"these priorities strike me as shameful."

Today's Marketplace broadcast mostly was about the issues of military recruiting during wartime.  Not a lot of controversy there.  Equally noncontroversial was their actual economic news.

The commentator, Robert Reich informed us that there will be cuts in Section 8 housing vouchers, which, he reports, will result in greater numbers of homeless persons  -- including children.  He reiterated the point, mentioned previously at Corpus Callosum, that the gap between rich and poor is growing.  He added something that I had not known previously:  the income gap is now the largest it has been in the USA in one hundred years. 

In this post, I elaborate on the serious consequences of the income gap, demonstrate why it is counterproductive and contrary to the values that are claimed by certain politicians, and ponder the question of why the average life expectancy in the USA is falling and the infant mortality rate is rising.

Dr. Reich's Marketplace report , Rich Man, Poor Man,  can be heard at Audible.com.  He describes the cuts in Section 8 housing, summer jobs for low-income youth, job training for low-income youth, after-school programs, and cuts in education funding that will affect primarily "poorer communities."

"That means millions of poor kids on the streets this August, with nothing to do...This is not trickle-down economics: nothing is trickling down...Pardon me, but these priorities strike me as shameful."

This is not the whining of some meddlesome idealistic advocate for the poor.  Dr. Reich happens to be a professor of Social and Economic Policy at Brandeis University, and is a former Labor Secretary.  He also served as an assistant to the solicitor general in the Ford administration.  The recent tax cuts will benefit him directly, yet he is critical of them.  He argues that the tax cuts should not be made permanent, if it means cuts to social services such as the ones he mentioned. 

I was curious about the cuts in Section 8 housing funding, so I went to the HUD website.  There is no mention of it, even though the site has news dated 6/2/2004.  Of course, the federal government is not always prompt about updating their web pages, as this example  shows.

http://yourtaxcutsatwork.orgDr. Reich is not alone among affluent citizens who are critical of the very economic policies that are profitable to the wealthy. The  NGO, United for a Fair Economy, has a membership that includes Bill Gates and Warren Buffet.  Another organization, Inequality.org, is sponsoring a national conference, Inequality Matters, on June 5 and 6 in New York City.  This is described in a CBS Marketwatch news article here  (free registration required.)  The Inequality.org features articles written by such luminaries as John Kenneth Galbraith (former president of the American Economic Association), and Robert H. Frank (Professor of Economics at Cornell University.)  Speakers at the conference include Bill Moyers (PBS journalist,) Robert Franklin (the sixth president of the Interdenominational Theological Center) and Barbara Ehrenreich (author of The Clinton Fiasco.) 

Curious about this?  Excerpts from the CBS Marketwatch article explain more:

Rich-poor gulf widens
'Inequality Matters' conference puts nations on alert
By Thomas Kostigen, CBS.MarketWatch.com
Last Update: 11:27 AM ET June 1, 2004 

[...]The Congressional Budget Office says the income gap in the United States is now the widest in 75 years.

While the richest one percent of the U.S. population saw its financial wealth grow 109 percent from 1983 to 2001, the bottom two-fifths watched as its wealth fell 46 percent.

Alarming? You bet. And here's why: The number of Americans without health insurance climbed 33 percent during the 1990's, according to the U.S. Census Bureau. The biggest indicator of a healthy society -- average life expectancy -- has dropped. People in the U.S. now don't live even as long as people in Costa Rica. Meanwhile the U.S. infant mortality rate has risen, so much so Cuba has a better success rate of bringing healthy children into the world.   [...]

In an election year, you'd think these issues would be on the "front burner" already. But these overarching social trends reflect poorly on politicians and the government -- those supposedly elected to protect those members of society who can't protect themselves.

Why should we care about inequality?  According to the UN General Assembly:

The broad consensus on addressing terrorism went hand in hand with a recognition of the need to deal in parallel with the many concerns that had been on the United Nations agenda before the 11 September events, including the fight against poverty, underdevelopment, inequality, disease, and other economic and social problems.

In December 2001, less than three months after 9/11, former winners of the Nobel Peace Prize went to Oslo when UN Secretary general Kofi Annan won the prize.  According to the Christian Science Monitor, one of the major themes that emerged from their discussions was the link between poverty and terrorism. 

 I don’t think that many people believe that poverty in general, and income disparity in particular, are direct causes of terrorism (see this essay  for discussion,) but it appears that many people think it is a contributing factor.  Indeed, some persons have tried to argue that there is a direct connection between US policies, inequality, and terrorism.   At least some of these arguments are downright offensive (example here.)  A more reasoned approach is taken by Strobe talbot in his article, The Other Evil - Poverty and Terrorism.   This implies that reducing poverty is necessary but not sufficient in the War on Terrorism:

[...]We must distinguish between, on the one hand, the assassins and those who mastermind and abet their operations and, on the other hand, their constituencies--those millions who feel so victimized by the modern world that they want us to be victims, too; those who see Osama bin Laden as a combination avenging angel and Robin Hood. As the mug shots and bios of the suicide pilots emerged, it became apparent that for the most part they did not come from the ranks of the world's desperate and aggrieved. Their fanaticism, like bin Laden's, was nurtured in privilege and in individual madness. During the immediate aftermath of the attacks on New York and Washington, the focus has rightly been on that species of menace, difficult to fathom, find, or deter, yet utterly deserving eradication.

However, the other set of images so memorable from September 11--Palestinians and Pakistanis dancing in the streets--is a reminder of a parallel challenge. Disease, overcrowding, undernourishment, political repression, and alienation breed despair, anger, and hatred. These are the raw materials of what we're up against, and they constitute a check on the willingness of Arab and other regimes to take effective action against networks of conspirators. [...]

See Global Terrorism after the Iraq War  for a more complete treatment of the subject. 

Anyone patient enough to have read this far will be wondering: why talk about terrorism and poverty, after leading with a discussion of cuts in social programs in the USA?  The Corpus Callosum is interesting in making connections, sometimes direct, sometimes not.   The connection is this: just as there is a link between poverty and terrorism abroad, there is a link between poverty and crime in the homeland.   It is not a direct causal link; sociopathy of the individual criminal is a necessary -- and more direct -- cause as well.   And the same policy of cutting social programs in the homeland is likely to lead to more crime, or to greater costs needed to control crime.  Neither outcome is desirable, and neither is consistent with a policy of compassionate conservatism or of fiscal conservatism.
Violent crime in the USA is a bigger problem, and a cause of more death, that terrorism.

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Monday, May 31, 2004

Bioethics of Gender Selection
Gender Selection using PGD

This is the conclusion of a series regarding gender selection, the practice of influencing the gender of a baby before it is born.  The prior two parts are here  and here.  In part II, I described the ethical considerations that arise when sperm are selection prior to conception.  Today, I describe the additional issues that arise when gender is selected after conception.  I am not going to get into the practice of selective abortion, which is a controversial and widespread practice in Asia (see 1  2  3).  Rather, I am referring to the process known as Preimplantation Genetic Diagnosis (PGD).  Note that PGD has medical uses apart from gender selection.  It can be used to select embryos that are free of a known genetic illness, such as as Tay-Sachs Disease.  It also can be used to select embryos that will develop into children who then can provide matching tissues for transplantation.  Less commonly, the technique is used to assist couples with certain types of infertility, or who have known risk factors other than a specific carrier gene.  The medical uses of PGD raise ethical issues as well, but most people seem to think that there is a significant difference between the ethical issues presented by medical PGD, compared to its use for gender selection. 

The Genetics and Public Policy Center at Johns Hopkins University has prepared a report on PGD, entitled Preimplantation Genetic Diagnosis: A Discussion of Challenges, Concerns, and Preliminary Policy Options Related to the Genetic Testing of Human Embryos.  The also did a survey, Genetic Testing of Embryos (144KB PDF) which shows that 61% of the US public thinks that it is OK to use PGD to produce a savior baby, but 57% disapprove of its use for gender selection. 

When PGD is done, unfertilized egg cells are removed from a woman, then mixed with sperm cells.  Early embryos develop from this process of in vitro  fertilization.  The embryos are then tested until one (or more) is found that meets selection criteria.  In the case of gender selection, the criteria would include the presence or absence of a Y chromosome.  Unlike sperm sorting, this method results in near-perfect reliability of gender selection.

Their PGD report summarizes the most important and potentially contentious ethical issue as follows:

For some, the creation and potential destruction of embryos through PGD does not raise moral or ethical concerns.  Others do view this as morally or ethically problematic but nevertheless think it may be defensible in some limited situations and that PGD should be strictly regulated and limited in order to minimize the creation and destruction of embryos. Still others believe the creation and potential destruction of embryos is categorically unacceptable and thus are opposed to PGD and IVF under all circumstances.

Other ethical issues are:
  1. Potential for changing the attitudes of the parents toward the child who was born via PGD
  2. Potential for changing the attitude of the child who was born via PGD
  3. Potential for changing the family dynamics between the child born via PGD, and any other children of the couple who were born without PGD.  
  4. Potential for erroneously selecting the wrong gender  -- which could invoke any or all of the three items above
  5. Potential for emotional dehumanization or loss of dignity to the species as a whole, arising from out efforts to intervene in what previously was left solely to nature (or a supreme being)
  6. Potential for producing a child who develops abnormally as a result of the procedure. 
  7. Potential for producing a child with some defect not related to the procedure, and that was not screened out by the PGD
This is not an exhaustive list.  Some of the issues with gender selection via PGD are the same as those that arise with sperm sorting, and have been addressed in part II of this series.  Beyond that, because in vitro fertilization is a prerequisite for PGD, all of the ethical issues that pertain to IVF also pertain to PGD.  I will not go into this in detail here.  For a review of the issues regarding IVF, see this, and this.  See also the report  from the President's Council on Bioethics, mentioned in Part II of this series.  Note that ethical concerns arise with respect to the mother who will be carrying the pregnancy, and to the child who results from that pregnancy.  The risks ot the mother can be addressed using standard medical ethics, especially the process of informed consent.  Risks to the child are more difficult to deal with, since no informed consent is possible.  However, there are no qualitative differences in physical risk to the child produced with PGD than there are for children born otherwise.  

Presumably, the fist four risks in the list are similar to those facing anyone who is pregnant.  There are many factors that can influence people's attitudes, or family dynamics.  The magnitude of these risks probably is not great, given that they are the kind of thing that any family can struggle with, even without having used PGD.  The risk of item #4 is a risk that is inherent in any technology.  Presumably, the couple will have been informed of the risk of human error, and will be prepared to accept that risk. 

Item #5 is a tricky one.  It is an intangible risk that will bother some people and not others. 

The BrothersJudd  weblog has a post entitled Man as Meat, which, as the title suggests, indicates that the brothers are concerned about the dehumanization of humanity through the use of biotechnology.  They link to a long review  of a book, Our Posthuman Future, by Francis Fukuyama.  In it, they say:

[...] biotechnical scientific innovation may well bring about fundamental changes, but these changes will be so massive that their main effect won't just be to our political arrangements but to our very humanity. [...]

Related to this is the concern that, somehow, preselecting the gender of a child is encroaching upon territory that is the sole purview of a supreme being; or, for the more secularly-minded folks, it could be phrased as an incursion into something best left to nature.  Until recently, the uncertainty about the gender of the child has been an universal part of the experience of pregnancy and delivery.  Even now, with the more commonplace techniques of ultrasound, amniocentesis, and chorionic villus sampling, parents do not know the gender of the child until well into the pregnancy.  Some parents chose to be told; others choose to wait.  But in all cases, there is a prolonged period of uncertainty.  Is it dehumanizing to remove this uncertainty?  It seems to me that some people might believe so, but personally, I do not.  Direct intervention into one aspect of pregnancy still leaves much mystery and inspiration of awe, and does not make the process so clinical as to be inhuman.

Item #6 is something that has been addressed, although only in retrospective studies.  Probably the only way to get a definitive answer would be to select a random sample of the population, offer them no choice as to whether to get pregnant, and divide them into two groups.  One group gets PGD, the other gets no intervention.  Obviously, such a study would be unethical to perform, so it will not be done.  The existing information  (link requires free registration) suggests that there is a higher risk of malformations in offspring who result from in vitro  fertilization.  The baseline risk for a natural pregnancy is about 4.2%.  The risk for IVF children is 9%.  Because this is based upon a retrospective study, it is not possible to draw firm conclusions.  Also, it may not be applicable to PGD when used for gender selection.  Couples using IVF because of infertility may be at a higher risk than those who use PGD for bender selection.  Another factor to consider is that a large number of embryos never implant, or they abort spontaneously.  Some of these fail to progress to term because of genetic problems.  Use of assisted reproduction technology might sidestep some of the screening that takes place naturally.  By this I mean that nature has screening mechanisms that reduce the risk of carrying an abnormal fetus to term; it is possible that human intervention could reduce the effectiveness of this process. 

Item #7 is another risk that is inherent in any pregnancy, related to #6.  Using PGD for gender selection, any embryos that look funny will not be implanted in the uterus.  This will screen out some, but not all, defects.  Therefore, it is possible for a woman to have PGD done, and still have an abnormal child.   The difference between this and a natural pregnancy is that the parents could have an unrealistically optimistic expectation for delivery of the exact baby they want, and they might not get it. 

I don't see risks 1-7 as reasons to ban or to regulate the procedure, other than to make sure that the risks are explained in the informed consent process.  This leaves us with the first issue, specifically, that some of the embryos created in the process will be destroyed.  To some, this is ethically equivalent to murder; to others, it is a replication of something that happens all the time anyway, and is not a matter of concern.  in the process of normal procreation, as many as half of all fertilized eggs either never implant, or spontaneously abort.  In the case of nonimplantation, the woman never even knows about it.  In the case of spontaneous abortion (miscarriage) this may or may not be known to the woman, depending on how far the gestation goes. 

The ethical problem here often is boiled down to the question: when does life begin?  The idea here is that, if we can define the moment that life begins, we can use that moment as the dividing line between permissible intervention, and those interventions than are not permissible.  One could argue that an individual sperm or egg cell is alive, in the sense that a single-cell organism is alive; or, one could argue that life begins at conception; or, one could argue that life begins when the embryo is capable of survival outside of the uterus.  Still others would argue that life begins at birth. 

There are problems with all of these arguments.  Ununited sperm and egg cells have only half of the genetic material needed to produce a fully-grown human, but using cloning technology, even an unfertilized egg could potentially give rise to a human.  Defining life as beginning at conception raises problems, because often there is no way to know when a conception has occurred, and the product of the conception is not capable of independent life for many weeks.  Likewise, there are problems in using the time of the capability of independent life.  There is no clear-cut divider.  As the fetus develops, past a certain point, the probability of independent survival progresses from zero to something approaching -- but never attaining -- 100%.  Using the time of birth has problems, too.  Whether you define the the time of birth as the moment any part of the fetus emerges from the birth canal, or the moment when the last part emerges, there will be people who argue that a fetus of 38 or 39 weeks gestation should be accorded the same rights as a person already walking around. 

So far, no one has been able to resolve this question in a way that satisfies everyone.  Personally, I do not think that the problem can be resolve using the "when does life begin?" approach.  I also do not find it satisfactory to argue that it is permissible to destroy an early embryo just because it is something that happens all the time anyway.  Everyone dies eventually; this does not mean that murder is OK. 

Thus, we are left with the question: at what point in the process, from the generation of gametes (eggs and sperm cells), through conception, implantation, gestation, and delivery, does it become unethical for us to stop the process?  If the answer cannot be reached using science (When does life begin?) it must be reached using some other means.  For some, the usual legal process is satisfactory: take the case to the supreme court, and see what they say.  Others will turn to religious, philosophical, or sociological means.  The fact is, the public is deeply divided on this issue, and we cannot wait for a consensus to emerge.  These issues are with us today.  As a result, we are left with the legal process to decide the issue.  So far, there is no law that specifically refers to gender selection via PGD, so people who wish to use this method are free to do so. 

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China Update

Notes about China:  China is becoming a major economic and political force in the world, with a population of 1.3 billion, and an economy that is expanding rapidly.  The most recent news stories about China pertain to the democracy rally  in Hong Kong, commemorating the 15th anniversary of the Tiananmen Square crackdown; Chinese allegations that the USA is meddling with China-Taiwan relations; tension over the new Taiwanese president's position on Taiwanese independence; and news that China may be rethinking its military strategy, in response to their observations of US strategy and tactics in the Iraq war. 

It is difficult for those of us outline the political loop to know what is really going on with US-China relations.  The Chinese embassy website recently ran an article  about a phone call between President George Bush and President Hu Jintao, stating that China was reassured of our commitment to the One China Policy.  But the article was published at the same time that the Xinhau news agency reported  that the USA is interfering in China's internal affairs. 

Indeed, the China-Taiwan issue continues to be the overriding factor in defining US-China relations.  In this CC post, I describe some of the hopeful signs that China might be moving -- slowly, in their own way -- toward a more democratic internal organization, and conclude with some comments about the ongoing difficulties. 

China to further promote grass-roots democracy (28/05/04)

 Political Bureau of the CPC Central Committee

Party organizations and governments at all levels are required to further promote transparent and democratic administration in villages, according to a high-level meeting of the Communist Party of China (CPC) held in Beijing on May 28.

Participants in the meeting of the Political Bureau of the CPC Central Committee, presided over by General Secretary Hu Jintao, held that improving the transparency in village affairs and democratic administration of villages, as well as safeguarding the fundamental interests of villagers, constituted a major part of improving self-government by villagers and promoting socialist democracy.

It would also help to improve the Party's style of work, build a closer relationship between officials and the masses, and promote reform and all-round development of the rural areas.

Currently, 31 provinces, autonomous regions and municipalities in China have formulated procedures for the election of villagers' committees. The election of villagers' committees of the fifth or sixth terms have been completed in most areas.

More than 90 percent of the villages throughout the country have formed a system to publicize village financial and administrative affairs regularly.

China considers easing control over capital accounts

    BEIJING, May 31 (Xinhuanet) -- China is working on ways to ease restrictions on capital accounts, including lifting a ban on emigrants' transfer of legitimate assets abroad, a high-level foreign exchange official has said.

    According to a document made available to Xinhua on Monday, Ma Delun, deputy director of the State Administration of Foreign Exchange (SAFE), said that China is also discussing lifting bans on transfer of legacy abroad by non-Chinese residents, further opening up capital markets, doing away with restrictions on cross-border transfer of foreign exchange capital by multinationals.

    Ma also disclosed other measures being considered to further open China's capital market, including establishing a qualified domestic institutional investor (QDII) system and allowing social security funds to invest abroad.

    The QDII system would allow domestic institutional investors to invest in capital markets abroad.

    China has few restrictions on nearly half of 43 categories of capital market dealings as defined by the International Monetary Fund, said the official.

These would suggest that there is a prospect for real, fundamental change in the internal political and economic organization of China.  The first article indicates that they are moving toward greater reliance on local elections to determine leadership; the second indicates that the central government is making additional progress toward a free-market economy. 

Taiwan's exclusion from WHO unjustified: health department

Protest in Taiwan

With a population greater than those of three quarters of the member states of the World Health Organization (WHO), Taiwan exemplifies the principle of the unconditional right to health care. Despite this, for more than three decades it has been excluded from WHO activities, to the obvious detriment of the world community. On the occasion of Taiwan's bid to participate in the May 17-21 2004 meeting of the World Health Assembly -- the WHO's governing body -- it behooves the world to reflect on the logic of that exclusion, as summarized in the following critique adapted from the document titled "Rebuttal to PRC Arguments Against Inviting Taiwan to Participate in the WHO," published on the Department of Health's Web site. [...]

The article from Taiwan goes on to lay out the background for the argument that Taiwan should be permitted to join the WHO.  The points of their argument, not coincidentally, parallel the arguments made by pro-independence Taiwanese.  Thus, all three sides (China, Taiwan, and the rest of the world) see the controversy about WHO membership in symbolic terms, not merely practical terms.

The thing is, inclusion of Taiwan in the WHO would make sense, from a medical standpoint.  This was illustrated well last year, during the SARS outbreaks.  Thus, although inclusion of Taiwan might be seen as a symbolic acceptance of Taiwan as an independent political entity, it would be better for world health overall to set aside this concern.  Perhaps doing so would ease tensions a bit, especially if no particular negative consequences ensued.  If WHO inclusion were granted, and Taiwan wisely kept quiet about it, and the US and UN did not publicize it, it could show that practical concerns can outweigh the symbolic ones.

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