Thursday, July 15, 2004

Thursday Breast Blogging
Politicians Make Boobs of Themselves

PZ Myers has a good post about breastfeeding.  In it, he makes some good points.  One of his primary points is that the Bush Administration recently dropped an ad campaign that would have promoted breastfeeding.  Apparently, this decision was made in response to political pressure from the infant formula industry.  What is more shocking is that the American Academy of Pediatrics supported the industrial leaders in this. 

The fact that the Administration has established a pattern of misusing, manipulating, and distorting science is old news.  See the Union of Concerned Scientists' web site  for background on this.  I've looked through their updated report, though, and it appears that they have not yet listed this particular example.  For that reason, I will be submitting this post to them.

Likewise, the allegation that infant formula companies engage in unethical promotion of their products is not news.  See this BMJ article  for more information on that subject.  

Some of the material used by Dr. Myers came from an article in the Valley Advocate.  More details are present in the ABC News story, which was distilled from a 20/20 program by Brian Ross and Jill Rackmill. 

Feeding Frenzy
How big business and politics conspire against breastfeeding mothers

by Maureen Turner - April 15, 2004

Ask any healthcare professional and they'll say that there's no healthier way to feed a baby than breastfeeding. Human breast milk is a living substance that changes to supply a growing baby what he needs at various stages of development; no matter how much formula companies refine their product, it doesn't come close to matching breast milk.

"There are so many things in breast milk that aren't in formula," said Ruth Stevens, a lactation consultant at Cooley Dickinson Hospital. "There are over 200 different constituents in breast milk, and maybe 30 of them they've gotten into formula."

Breast milk contains antibodies that provide valuable immunities. Numerous studies conclude that breastfed babies have fewer colds, allergies, ear infections and other diseases, are less likely to suffer from respiratory problems or diarrhea and are less prone to Sudden Infant Death Syndrome. Long-term, they have higher IQs and are less likely to develop diabetes, asthma, obesity, coronary artery disease, digestive disorders like Crohn's and cancer. Women who breastfeed have lower rates of osteoporosis and certain cancers.

There are environmental benefits; breastfeeding doesn't involve the production and waste that formula does. It's cheap -- in fact, free. It's convenient -- no formula to mix, no bottles to warm or wash.

[...] "There's no excuse for the numbers we have in this country," said Dia Michels, co-author of Milk, Money and Madness: The Culture and Politics of Breastfeeding . She's unimpressed by the breastfeeding goals set by the federal Department of Health and Human Service's "Healthy People 2010" program. That calls for 75 percent of new mothers to initiate breastfeeding, 50 percent to continue to six months and 25 percent to make it to one year.

"Seventy-five percent -- what kind of shit-ass goal is that?" asked Michels, reeling off a list of other countries where the overwhelming majority of babies are breastfed.

[...] Last fall, Health and Human Services was poised to launch a major pro-breastfeeding public service campaign, with ads that focused on the risks of opting not to nurse and emphasized that formula was not comparable to breast milk. But before they ever aired, the campaign came to a screeching halt.

It seems the formula companies got wind of the ads and took their complaints about the campaign's "negative" tone to the government and to the American Academy of Pediatrics -- an organization to which, it's worth noting, they're heavy donors. Their strategy apparently worked; AAP President Carden Johnston sent a letter to DHHS expressing concern about the campaign. That angered the AAP's Section on Breastfeeding, whose chairman wrote in a letter to other pediatricians that the incident "raises many questions about the leadership of the AAP and the influence of formula companies on AAP activities."

In the end, the government pulled the plug on the ads.

Breast-feeding adThis print ad was part of the government's original campaign but was later dropped. It says that if a baby is not breast-fed, there is an increased risk of diabetes.

Advocates Say Government Pressured by Formula Companies to ‘Water Down’ Breast-Feeding Ads
By Brian Ross and Jill Rackmill; ABCNEWS.com

June 4, 2004— The U.S. government has unveiled a new advertising campaign to promote breast-feeding, after months of fierce lobbying to change its approach, ABC News has learned.

The campaign, announced today in Washington, D.C., is much different than what was first produced.

In what has been called a battle between mother's milk and corporate power, the companies that make infant formula put intense pressure on the government to change its approach.

ABC News has obtained the ads that were produced but never aired. One of the ads showed pregnant women at a roller derby violently competing and then the message: "You wouldn't risk your baby's health before it's born. Why start after?"

The other spots obtained by ABC News include pregnant women at a logrolling contest and riding a mechanical bull. They ended with a list of diseases that the ads said were more common among babies not breast-fed, including diabetes, leukemia and ear infections.

The ads were sponsored by the government and produced by the Ad Council, a nonprofit group that produces, distributes and promotes public service announcements. The ads were set to be released last December, but some formula companies complained after getting an early sneak preview of the ads before they hit the airwaves.

A spokesperson for the International Formula Council, the trade group for the formula industry, said they support breast-feeding and only objected to the commercials because they felt they were too negative in tone and inaccurate. No company official would talk to 20/20 about the efforts to kill the ads. In letters to the Department of Health and Human Services, the lobbyists praised the merits of breast-feeding while adding concerns over the message the ads would send to mothers.

[...] "The fact that they managed to get this campaign watered down is evidence that money can influence good medicine, and that large amounts of money can influence even good doctors," said [Dr. Jay] Gordon.

He suspects the campaign would have cost the formula manufacturers "hundreds of millions of dollars."

The campaign also killed a series of print ads that claimed that babies not breast-fed were at greater risk of certain diseases. The changes were so substantial that the ad agency that first conceived the campaign no longer wants to be associated with it. 

One point that should be emphasized is that the American Academy of Pediatrics  does not oppose breastfeeding; most of the material on their web site actively promotes it.  Their own official Policy Statement  is unequivocal:
  1. Human milk is the preferred feeding for all infants, including premature and sick newborns, with rare exceptions.75-77 The ultimate decision on feeding of the infant is the mother's. Pediatricians should provide parents with complete, current information on the benefits and methods of breastfeeding to ensure that the feeding decision is a fully informed one. When direct breastfeeding is not possible, expressed human milk, fortified when necessary for the premature infant, should be provided.78,79 Before advising against breastfeeding or recommending premature weaning, the practitioner should weigh thoughtfully the benefits of breastfeeding against the risks of not receiving human milk.
  2. Breastfeeding should begin as soon as possible after birth, usually within the first hour.80-82 Except under special circumstances, the newborn infant should remain with the mother throughout the recovery period.80,83,84 Procedures that may interfere with breastfeeding or traumatize the infant should be avoided or minimized.
Why the AAP President would side with the infant formula industry is baffling.  That he would do so is not only baffling, it is aggravating.  Granted, the Industry supports the AAP with large donations, but that should not be a factor at all.  It is possible that he was manipulated successfully by the Industry PR professionals.  After all, most physicians think so highly of themselves that they assume they cannot be manipulated.  This, in my opinion, actually makes them more susceptible to certain kinds of skillful manipulation, and I am sure the PR folks sent their best. 

But I don't want to burn bandwidth with a diatribe against the AAP.  The Bush administration is responsible for the actions of the Department of Health and Human Services; therefore, most of the blame goes to them.  The Secretary of HHS is Tommy Thompson.  How qualified is he to make scientific judgments?  He has a B.S. (1963), and a J.D. (1966) from the University of Wisconsin-Madison.  Here is part of his bio, from the Whitehouse.gov site:

Health and Human Services Secretary Tommy G. Thompson is the nation's leading advocate for the health and welfare of all Americans. He is the 19th individual to serve as Secretary of the department, which employs more than 60,000 personnel and has a fiscal year 2001 budget of $429 billion.  Secretary Thompson has dedicated his professional life to public service, most recently serving as governor of Wisconsin since 1987. Secretary Thompson made state history when he was re-elected to office for a third term in 1994 and a fourth term in 1998.  During his 14 years as governor, Secretary Thompson focused on revitalizing Wisconsin's economy [...]

So he is a successful attorney/politician who emphasizes economic matters. The darnedest thing about this is that the decision to water down the breast-feeding ad campaign is directly contrary to the stated goals of the Republican Party, including the ecomonic goals.  Sure, they are pro-business, and Dr. Jay Gordon is on record as having speculated that the ad campaign would have cost the formula manufacturers "hundreds of millions of dollars."  However, this economic cost is microscopic, compared to the benefits.  According to the Economic Research Service  of the US Dept. of Agriculture (in a report prepared during the Bush administration):

A minimum of $3.6 billion would be saved if breastfeeding were increased from current levels (64 percent in-hospital, 29 percent at 6 months) to those recommended by the U.S. Surgeon General (75 and 50 percent).

A significant amount of the money saved would come by reducing health care costs:

This figure reflected approximately $3.1 billion attributable to preventing premature deaths (necrotizing enterocolitis), and an additional $0.5 billion in annual savings associated with reducing traditional medical expenditures (for example, doctors’ or hospital visits, laboratory tests, among others) and indirect costs, such as lost earnings of parents.

The report states that their $3.6 billion figure probably is a misunderestimation.  So even if the ad campaign cost the infant formula industry hundreds of millions of dollars, the economy as a whole still would be better off with higher rates of breastfeeding.  One of the planks of the Republican platform is that they advocate improving the economy, and here they go, shooting themselves in the wallet. 

Another tenet of Republican policy is their supposed pro-life stance.  Breastfeeding is associated with lower infant mortality rates.  From the British Medical Journal:

For several decades we have known that artificially fed infants have much higher rates of morbidity and mortality than those who are breastfed. Breast milk contains immunoglobulins, phagocytes, T lymphocytes, enzymes such as lysozymes, and many other factors which help protect the infant against infections,4 including cells, antibodies, hormones, and other important constituents not present in infant formula.

To clarify, in medical parlance, the term morbidity  refers to illness that stops short of causing death.  From the AAP's policy statement:

Epidemiologic research shows that human milk and breastfeeding of infants provide advantages with regard to general health, growth, and development, while significantly decreasing risk for a large number of acute and chronic diseases. Research in the United States, Canada, Europe, and other developed countries, among predominantly middle-class populations, provides strong evidence that human milk feeding decreases the incidence and/or severity of diarrhea,1-5 lower respiratory infection,6-9 otitis media,3,10-14 bacteremia,15,16 bacterial meningitis,15,17 botulism,18 urinary tract infection,19 and necrotizing enterocolitis.20,21 There are a number of studies that show a possible protective effect of human milk feeding against sudden infant death syndrome,22-24 insulin-dependent diabetes mellitus,25-27 Crohn's disease,28,29 ulcerative colitis,29 lymphoma,30,31 allergic diseases,32-34 and other chronic digestive diseases.35-37 Breastfeeding has also been related to possible enhancement of cognitive development.38,39

To expand on the health benefits of breastfeeding, and provide additional evidence for reduction in health care costs, I cite also this article:

[...] Premature breastmilk contains different amounts of some nutrients than term breastmilk, more suited to the needs of premature babies. Necrotizing Enterocolitis, a serious bowel inflammation, is very rare for breastfed infants. And of course they get the same immune protection, which may be even more critical for prematures, and has been shown to reduce the risk of sepsis in these babies. Suckling at the breast, and digesting breast milk, cause less stress for the premature infant than bottle-feeding does; so most prematures can go to breast as soon as they are able to suckle. Because of the reduction in infections and the shorter time to full feeding, breastfed premature infants can usually leave the NICU sooner. For some babies, breastfeeding is a life-and-death matter. In addition to its known benefit where water supplies are unsafe or food supplies erratic, breastfeeding lowers the risk of SIDS in all populations. [...]

NICU stands for neonatal intensive care unit.  The cost of NICU care is well over $1000 per day.  Clearly, if you are pro-life, and favor economic expansion, you also must advocate breastfeeding. 

Part of the Republican platform, regarding health care, is the recognition of the seriousness of the obesity epidemic.  From the GOP.com statement on the Republican platform:

Children's Health. The huge strides we have already made in improving children's health must be balanced against sobering statistics. Asthma affects nearly five million children, and the incidence is dramatically increasing. Childhood obesity has jumped 100 percent in the last 15 years and can be a forerunner of the most serious illnesses later in life. Diabetes is now the second most common chronic disease in children. [...]

Although the evidence for the role of breastfeeding in reducing the risk of obesity is inconclusive, it is strong enough that a recent article in the Archives of Pediatrics and Adolescent Medicine recommends breastfeeding as a way to reduce the risk of obesity.  Thus, it would stand to reason that the Republican Party would support breastfeeding promotion to the fullest extent. I suppose the Platform for 2004 won't be finalized until the convention, so perhaps we should give them a little more time to include breastfeeding.  Perhaps someone from the La Leche League  will give a speech during the convention.

In conclusion, we see that the Administration has deliberately watered down the impact of their breastfeeding advocacy program, apparently in response to lobbying from the infant formula industry.  Although this is superficially consistent with their pro-economic-growth platform, closer examination reveals that the action actually contradicts their policies in many ways.  Not only that, but it was a dumb thing to do.

Some final words:

"That ye may suck, and be satisfied with the breasts of her consolations; that ye may milk out, and be delighted with the abundance of her glory."
-- Isaiah 66:11

"Thou art He that took me out of the womb: thou didst make me hope when I was upon my mother's breasts. I was cast upon thee from the womb: thou art my God from my mother's womb."
-- Psalm 22:9,10

"the breast may be waved for a wave offering before the
-- Leviticus  7:30

"Let her be as the loving hind and pleasant roe; let her breasts satisfy thee at all times; and be thou ravished always with her love."
-- Proverbs 9:15

"Thy two breasts are like two young roes that are twins, which feed among the lilies."
-- Song of Songs 4:5

"I have caused thee to multiply as the bud of the field, and thou hast increased and waxen great, and thou art come to excellent ornaments: thy breasts are fashioned, and thine hair is grown, whereas thou wast naked and bare."
-- Ezekiel 16:7

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Wednesday, July 14, 2004

The Stem Cell Debate

 Personal Account

Paralysis, Roman Reed, and a ban on stem-cell research

Lancet 2004; 364: 219
Don Reed c/o The Lancet diverdonreed@pacbell.net
Don C Reed is a retired schoolteacher and professional scuba diver. The author of five ocean books is currently working on TAKE A STAND: Roman Reed and the Secret Stem Cell Wars. He is the sponsor of the Roman Reed Spinal Cord Injury Research Act.

What is it like, being paralysed? Try this. Using the insides of your wrists, lift a pencil and write your name. Set the pencil down.

Now imagine picking up (still with your wrists) a flexible rubber tube--and inserting that into your urinary tract--every time you need the rest room. Want to schedule a bowel movement? Allow 2 hours.

Before my son Roman Reed was paralysed in a college football accident, on Sept 10, 1994, I never really thought about people in wheelchairs: about the dangers, hassles, and humiliations they face every day.

Roman considers himself fortunate. He can breathe without a machine; he does not live on charity; his girlfriend (now wife) Terri stood by him. Recovering the partial use of his upper arms, "Rome" can transfer himself from bed to wheelchair. He drives an adapted van, holds down a part-time job, continues his education. Defying doctors' expectations, he became a father. In his wheelchair, he coaches Roman Jr's soccer team. He lives life fiercely.

But I am his father, and I see what he goes through...

The latest issue of the medical journal, The Lancet, is devoted to stem cell research.  Access is free for the editorials and for the personal account excerpted above.  You need a paid subscription to view the original research articles, such as Functional antigen-presenting leucocytes derived from human embryonic stem cells in vitro,  but the editorials are more interesting for the nonspecialist. 

Carol Tauer, Ph.D.One of the editorials is by Dr. Carol Tauer, of the University of Minnesota Center for Bioethics.  Dr. Tauer must be an interesting person; she has degrees in Music, Mathematics, and Philosophy.  She began her career as a teacher in a Catholic high school, currently is an Emeritus Professor of Philosophy at The College of St. Catherine, and is a visiting faculty member at Minnesota.  Her dissertation was: The Moral Status of the Prenatal Human Subject of Research.  A bona fide  Gödel, Escher, Bach - type person. 

The Lancet's synopsis follows:

In late 2003, two international bodies were unable to resolve disagreements that involved bioethical issues. First, the United Nations General Assembly failed to pass a treaty on reproductive cloning because of insistence by some countries that the treaty include a ban on cloning for research. In view of the importance of enacting prohibition of reproductive cloning, the two issues should be separated and each argued on its own merits. Relevant objections to separation of the two issues can be refuted. Second, the European Union (EU) failed to agree on conditions for funding stem-cell research because of the diversity of views and policies of the countries of the EU. Because a stalemate was reached, funding decisions in the next programme cycle will be made on an ad hoc basis. Scientists will not have information they need to plan research programmes, suggesting that clear guidelines, even if restrictive, are preferable to vague unpublicised criteria.

Her editorial illustrates some interesting points about public policy in general, and about stem cell research policy in particular:

In development of public policy on embryonic stem-cell research, an international body or individual state must recognise that many people hold strong views on the moral status of the human embryo. Since a human blastocyst must be destroyed to obtain stem cells, people who believe that the blastocyst is a human being will regard the process as killing. If those who hold this view form a critical mass, public policy probably will not support embryonic stem-cell research. In some political contexts a compromise can be reached: to permit stem-cell extraction only from surplus embryos developed as part of fertility treatment and destined to be destroyed, or to allow research only with embryos or stem-cell lines already in existence at a particular date.

Issues in public policy on cloning overlap somewhat with general stem-cell matters but have additional dimensions. Prohibition of cloning for reproductive reasons is directed at prevention of the birth of children who are genetic copies of already existing individuals. Legislation on cloning for research, however, deals mainly with development of stem-cell lines through somatic cell nuclear transfer (SCNT), thus raising issues about a specific type of stem-cell research.

Right away, it is clear that Dr. Tauer is willing to take a broad-minded approach, yet incisive approach.  Rather than lumping all embryonic stem cell topics into one undifferentiated mass of taboo stuff, she understands that there are many different topics involved.  Only by maintaining clear distinctions, among the sub-topics, is any kind of compromise possible. 

The remainder of her editorial covers some technical details that are essential to the understanding of the various issues.  She also reviews the processes that the UN and the EU went through in failed efforts to develop policies covering embryonic stem cell research.  One of her main points is that there is nearly-universal consensus on the topic of reproductive cloning.  She argues that it would have been possible to enact a ban on that one particular application of embryonic cell research.  This approach was successful in the UK:

By separation of the issue of reproductive cloning from cloning for research, the UK was able to prohibit the former while allowing the latter under regulation and licensing.

Apparent, though, some parties to the UN and EU negotiations insisted on lumping everything together, thus creating an impasse.  In the EU, there have been consequences:

When the EU is faced with decisions about funding research these varied interpretations can clash. In December, 2003, an 18-month process for development of guidelines on funding stem-cell research within the Sixth Framework Programme collapsed. A 1-year moratorium in 2003 had allowed funding only for research on embryonic stem cells that had been derived before the end of 2002. During 2003 the European Parliament and Council of Ministers were to develop rules about whether additional stem-cell lines could be derived, studied, or both with EU funding. In November, 2003, the European Parliament approved permissive regulations, endorsing stem-cell research and eliminating any cutoff dates. However, the research ministers of the European Council had the final say and on Dec 3, 2003, they failed to reach agreement. Thus, the European Commission will have to make decisions about funding of stem-cell proposals on a case-by-case basis.18,19

[...]  Some observers believe that limitations on EU funding are not important. In the first round of applications for funding under the Sixth Framework Programme, only 126 of more than 12 000 proposals focused on stem cells and only one of those dealt with human embryonic stem cells.19 Researchers, however, argue that to plan research and develop proposals is difficult when uncertainty exists about what the rules are.

Writing proposals is a major effort for any researcher: a source of great angst.  A serious investment of time and emotional effort is necessary to write a good proposal.  Lacking clarity, there is a risk that researchers could waste a lot of time and effort, trying to establish projects that are doomed before they even get started.  This is not a trivial problem.   We, as a society, need these talented individuals to be as productive as possible. 

Dr. Tauer goes on to discuss the situation in the USA:

[...] But even when the rules are clear, as in the USA, severe restrictions on the funding of stem-cell research might have curtailed interest in the field. The number of applications for federal funding under the current guidelines is small, and Elias Zerhouni, Director of the National Institutes of Health, has lamented the scarcity of research scientists with expertise in stem-cell research.21

Her conclusion:

It is appropriate for the US government and the EU to distinguish "between permitting or tolerating an activity . . . and actively promoting it through governmental funding".22 Many reasons exist why a public body might decide not to fund a particular activity, and in view of the fact that public resources are not boundless, it can fund only some of the projects that are proposed. Yet decisions not to fund stem-cell research, or some categories of stem-cell work, are ordinarily based on deeper considerations than simply prioritising the allocation of limited resources. These decisions become a matter of principle based on the moral objections of (some of) the citizens of a country or certain member states of the EU.

A country or group of countries can legitimately not fund certain controversial types of scientific or biomedical research. But a decision is preferable to a stalemate. Scientists who do not know what types of research proposals can be considered for funding are likely to shy away from a particular area of investigation. In this respect, the US rules, while restrictive, might have some advantages over the EU's lack of agreement on rules. If clear rules exist about what can and cannot be publicly funded then scientists can plan and seek private funding if necessary. The EU needs to break its stalemate and agree on funding policies, if not within the Sixth Framework Programme then at least by the time of the next programme cycle.

At the conclusion of the editorial, The Lancet notes:

Conflict of interest statement

CT is a member of the ethics advisory board of Advanced Cell Technology, a for-profit company in Worcester, MA, USA, engaged in stem-cell research.

So here we have a former Catholic school teacher, who picked up Ph.D.'s in Mathematics and Philosophy, now advising a for-profit biotech company about bioethics.  I was not able to detect any obvious bias in her editorial.  Clearly, she does not stick to the religious party line; nor does she blatantly advocate for more funding that could benefit Advanced Cell Technology.  Instead, she argues for clear guidelines that would assist researchers in using their time and other resources most effectively.  How...pragmatic!

Another article by Dr. Tauer is available here  (small PDF file).  Children as Research Subjects: Guinea Pigs or Therapeutic Orphans?  Addresses issues pertaining to pharmaceutical research in children.  In it, she again argues for greater clarity in guidelines, rather than promoting either a carte blanche,  or any kind of blanket restriction on such research. 

In contrast, another editorial,  It is time for scientists to make the case for stem-cell research, is more open in actively advocating embryonic stem cell research.  Their conclusion:

A catalyst for the change in medicine has been the increasing ease of access to patient-friendly information through the internet. But in science there is little incentive for individuals to seek out the information behind the headlines. Kerry's pledge to make stem cells an election issue provides part of the solution to this dilemma. Perhaps if more scientific issues were forced into country-wide debate, then the public's trust could be more easily won.

But convincing critics of the value of embryonic stem cells poses especially difficult problems. Few other scientific advances have challenged such fundamental human values or posed such ethical dilemmas. The field is also unique in that the science has caught the public's imagination at a much earlier stage than previous developments, due in part to overly optimistic reporting of preliminary findings. The attention focused on stem-cell research unfortunately comes at a moment when there are few tangible clinical benefits to report, although, as many of the papers in this weeks' issue show, the field is advancing at such velocity that this evidence may not be far off. Stem-cell researchers and other proponents are faced with a challenge: how to win back support for this important work with only promises to bargain with?

The case for stem-cell research cannot be left to patient advocates alone. While the stories of Don Reed, and the profile of campaigners such as the actor Christopher Reeve, are important in galvanising public interest, scientists are even better placed to lead a public debate about the potential benefits--and costs--of working with stem cells. It is time for these scientists to step forward.  * The Lancet.

For a contrasting view, see Dan McChonchie's   recent article  in The Illinois Leader.  In it, he argues that, so far, there is little evidence that embryonic stem cell research holds greater promise than research carried out using adult stem cells.  This is true, but of course the limitation in funding for embryonic research hardly creates a level playing field. 

Is rational, informed debate possible?  In a book review in The Lancet,  the views expressed in Jane Maienschein's book, Whose View of Life?, are clarified:

[...] As always, the hype surrounding embryonic stem-cell research is being played out in newspaper headlines touting miracle cures and ethical crises. Religious and right-to-life groups are seemingly lined up against scientists, although the research community itself is not in universal agreement.  Amid this cacophony, reading Jane Maienschein's thoughtful book, Whose View of Life?, is a quiet pleasure.

[...] Her fundamental argument is that society should engage in a better-informed and wider-ranging debate about cloning, stem cells, and other bioscience issues, so that different points of view can be drawn together in light of historical developments. We're not on the brink of some bioethical catastrophe, she says, and what's more, society's view of when an embryo becomes "human" has shifted significantly over time.

[...]  Maienschein is careful throughout to keep her argument balanced and conciliatory. Her personal view on what sort of research ought to be allowed is pretty clear, especially in the concluding chapter, but never dominates. That isn't to say she shies away from pointing out her personal bad guys. For example, when she writes about Bush's decision to limit federal funding for embryonic stem-cell research she quotes him as saying, "I have made this decision with great care, and I pray it is the right one". Later, she ponders: "In a country founded on separation of church and state, it is not clear why it is prayer that should guide an American president to policy decisions about bioscience."

And when it comes to Leon Kass, the Bush-appointed chairman of the bioethics council, she pulls no punches. "These self-proclaimed ethicists insist that they know what is true and right and good, and they will dedicate themselves to its advocacy no matter what", she writes. "This is disturbing. This is, however, where . . . Leon Kass's 'wisdom of repugnance' may lead us, for he relies heavily on his own intuitions, on his assumptions that our intuitions will match his and that if they do not match there is something wrong with us."

Instead of prayer and intuition, Maienschein recommends tolerance, humility, and the avoidance of "false dichotomies" that pit science against religion, or saving the life of a sick person against taking the life of an embryo. Neither science nor religious morality alone have the answers, she argues.

So the answer is: Yes, rational, informed debate is possible, albeit uncommon.  I am glad to see articles such as McChonchie's showing up in a newspaper, I agree with The Lancet's  editorial that encourages scientists to join the public debate, and I concur with them that the Internet can and does play a role in educating the public. 

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