Saturday, August 07, 2004
It occurs to me that, perhaps, the technical difficulties involved in getting Linux to work are in some way similar to the technical hurdles that await stem cell researchers. I'll have to think about that some more.
Anyway, on to the subject: human embryonic stem cell research. This is turning into a big issue in the presidential election. It appears that the Democratic Party is making an issue out of this. From my reading of the headlines, I have the impression that the Republican Party would rather not argue this issue. From the Dallas News (free registration required):
[...] GOP leaders on Capitol Hill acknowledge growing bipartisan support for overturning Mr. Bush's order but want to delay action until next year. With only 20 legislative days left on the 2004 calendar, action this year appears doubtful.
"It becomes a very political issue very quickly," said Senate Majority Leader Bill Frist, R-Tenn.
Those who favor expanded research are not sympathetic to election-year concerns.
"My constituents are sitting in wheelchairs and they do not understand politics, and they do not care," said Michael Manganiello, a senior vice president with the Christopher Reeve Paralysis Foundation. [...]
Mark A. R. Kleinman anticipated the significance of this issue in his recent post:
[...] Who's going to vote for Bush this year? Very roughly speaking, four groups: social conservatives, hawks, corporate opponents of litigation and regulation, and fans of the tax cut. (Obviously, the last two groups overlap considerably, but they're distinct interests.)
Many hawks, corporatistas, and tax-cut beneficiaries have aging parents, or are themselves aging. Moreover, many of them are devout believers in the promise of science and technology.
Lots of the social-conservative agenda makes the hawks and the rich guys nervous, or even nauseates them (some are gay; many have gay friends or family members), but that stuff is mostly shadow-boxing and they know it: the gay-bashing amendment isn't going to pass, for example, and there's no imminent threat that prosperous women will be denied access to abortion services.
But stem cell research is different: it really matters to the social conservatives because they consider it part of the abortion fight, and Bush's resulting policies really threaten both the material interests and the ideology of the other parts of his coalition. And given the extremely tenuous link between the anti-abortion side of the abortion issue as it grabs normal people and the use of spare embryos from fertility clinics -- embryos produced for other purposes and which will never in any case be brought to term -- in clinical research, no one whose vote would otherwise be up for grabs is likely to turn against Kerry because he supports stem-cell research.
Bush's straddle on the issue was a gamble that he could keep the social conservatives in line without too badly outraging the others. If it had been true that the cell lines he approved were adequate to the research task, or that adult stem cells could be made to substitute, he might have mostly gotten away with it. But neither seems to be the case. (Which isn't to say that RR Jr.'s gee-whiz exposition is right; the path from the laboratory to the clinic is a long, hard path.)
So, potentially, Bush is in a world of hurt. He can't easily welsch on the social conservatives, especially with Kerry and Edwards doing such a good job of making themselves culturally unthreatening. The point of the Ron Reagan speech, followed by the reference in the Kerry speech (followed, no doubt, by lots of other activity by the campaign and by the 527 committees) is to make that potential hurt actual.
How many voters whose families make more than $100,000 per year want to see Leon Kass exercising censorship over stem cell research? A small minority, I'd bet. And for many in the majority, it could be a voting issue, or at least a staying-home-instead-of-voting-for-Bush issue. (And of course that's true for some social conservatives as well: their political leadership may be united on the issue, but for ordinary folks blood is thicker than doctrine; ask Nancy Reagan, who has pointedly refused to speak at the Republican convention.) [...]
In order to win the presidential election in 2004, either candidate must get some votes from the other's traditional voting block. Dr. Kleinman indicates that there are some social conservatives who might vote for Kerry, just because of the stem cell issue. It turns out that fundamentalist Christians are not the only social conservatives paying attention, as illustrated by two recent articles in The Jewish Journal of Greater Loss Angeles(1 2). The first quote here is from an editorial by Rob Eshman, Editor-in-Chief; the second is from Nancy Sokoler Steiner, Contributing Writer:
[...] I’ve come across a lot of anti-Bush sentiments among Jews of all sorts, but very little Kerry enthusiasm. Bush partisans tell me this phenomenon is further proof that, come November, Jews who usually vote Democrat will vote for the Republican president in numbers unseen since Ronald Reagan captured 39 percent of the Jewish vote against Jimmy Carter in 1980.
Because Jews are likely voters, that shift could make an important difference in swing states like Ohio, Pennsylvania and Florida. In an election that pollsters even now say is riding on 12 percent undecideds, a change in historic Jewish Democratic loyalties could be crucial. But is the shift itself likely to occur?
I say no. But I also say it may not be too late for Bush to change the one position that keeps Jewish like from turning into love.
Polls show that Jews are not so much moving from Democrat to Republican as they are migrating toward independent. Many of these Jews want to reward the president for his support for Israel and his decision to invade Iraq.
What’s wrong with this analysis is that it misses the one key issue that, for these potential new Bush supporters, is a deal breaker. Three words: stem cell research.
The president’s capitulation to the Christian right on this single issue will cost him dearly among conservative-leaning Jewish voters. I’ve spoken with numerous Jews who check the Bush box down the line on tax cuts, Iraq, Israel and leadership. They have no problem with his born-again Christian faith, even as he applies it to his anti-abortion stance or homosexual marriage. But squelching medical research on diseases that could threaten anyone and everyone they see not as faith, but folly. [..]
[...] While voters may still be deliberating the merits of stem cell research, authorities of halacha (Jewish law) are in favor of the technology, within certain limits. While not necessarily agreeing on their rationale, the Orthodox, Conservative, Reconstructionist and Reform movements have all released statements endorsing stem cell research, and have made their positions known to President Bush.
[...] Rabbi Elliot Dorff, rector and professor of philosophy at the University of Judaism, says that in Jewish tradition, embryos less than 40 days old are considered as "mere water," and do not have full status as a human life. Further, the cluster of cells from which stem cells are extracted cannot be considered a human being because these cells are incapable of developing outside the womb.
Dorff, who wrote the Conservative Movement’s Responsum on stem cell research, said the potential for saving lives takes precedence over a cluster of cells that have no potential to develop into a person.
"While we still have respect for the materials out of which life may ultimately come, the question is: Respect for what purpose? And how do you express that respect? Not at the cost of saving people’s lives," he said
To those who believe endeavors such as stem cell research cross the line into God’s realm, Rabbi Yitzchok Adlerstein, a professor of Jewish law at Loyola Law School, disagrees.
"The idea that we have no right tinkering with God’s work is fundamentally anti-Jewish," said Adlerstein, an Orthodox rabbi. "There are things that God fully expects mankind to do. One of those things is to use the wisdom and the tools that he gave us to expand the far reaches of the universe." [...]
Dr. Dorff's statement, that "While we still have respect for the materials out of which life may ultimately come, the question is: Respect for what purpose?" get to the heart of the second objection to human ESC research, out of the list of four that I mentioned in the first post in this series: We should not do it, because it is an affront to human dignity. Joe Carter, writing at the Evangelical Outpost, addresses this issue:
Dignity is defined as the quality or state of being worthy of esteem or respect. This definition is significant because it highlights the key differences between the two most dominant worldviews in our culture – a functionally atheistic materialism and the Judeo-Christian form of theism.
In the theistic view, human life has an inherent dignity. A generous and loving Creator not only provides our biological existence but retains this same gift for his own enjoyment. Human life, therefore, does not belong to us but to Him. Our purpose – to glorify and love our Creator – is not based on any particular state of our biological development. All life is intrinsically valuable because it is valued by our Creator. Dignity is not something that is earned, it is merely recognized.
In sharp contrast, the materialist narrative claims that human life only has a qualitative dignity. Humans are products of chance, created without purpose by an impersonal universe. Our existence is nothing but a fluke; our consciousness a cosmic accident. Since we have no personal Creator, the worth of the personal is determined by fiat – the worth of life is whatever we decide it shall be. Dignity, therefore, is not inherent to all human life but based on the existence of certain qualifying criteria.
Is it true that, in the "theistic view," there always is a sharp dichotomy? Apparently, Carter disagrees with Dorff and Alderstein. Is human dignity really an intrinsic quality of diploid (post-conception) human cells? Is there an objective test that can be applied to objects, that invariably distinguishes cells with dignity from those without dignity? If such dignity is inherent in human embryonic cells, then is it also inherent in all human cells? If so, does that mean that all research on human cells is undignified. If so, all medical research -- not just human ERC research -- should be banned. This argument does not seem reasonable. Of course, human ERC research necessitates that the embryo be rendered non-viable; that is, by removing just one cell from an embryo, that embryo is rendered unsuitable for implantation. It would seem, then, that the dignity argument does not lead to a valid objection to human ESC research, unless one also wants to ban all medical research. The factor that distinguishes human ESC research from other medical research is the rendering of an embryo to a non-viable state.
This illustrates the complexity of the debate regarding human ESC research. There are many fine points, subtle dichotomies, and esoteric technical issues involved. Therefore, it is a debate that is sufficiently complex that it is not going to be resolved before the election. But it may well be a factor that determines the outcome of the election.
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Wednesday, August 04, 2004
As far as I can tell, there are basically four arguments against human ESC research:
- We should not do it, because it results in the destruction of an human embryo, and since ensoulment occurs at conception, destruction of embryos always is wrong.
- We should not do it because it is an affront to human dignity.
- We should no do it, because adult stem cells are the same as embryonic stem cells.
- We should no do it, because it is not an especially promising line of research.
From a scientific standpoint, there is a smooth linear progression in the formation of a human life: atoms come together, form the building blocks of life, those come together, create cells, and so forth, until a human exists. There is no point at which you can say that the assemblage now has the potential to become a human, whereas it did not have that potential the moment before. These niggling technicalities disappear when one abandons the idea of finding a scientific definition of when human life begins. I would argue that, for the purposes of social discourse, human life begins at that point that society agrees it begins. That is the point of ensoulment.
The use of the term 'ensoulment' correctly takes the controversy out of the realm of science, and places it into the realm of social or religious constructs. If an entity has a soul, then society grants to it inalienable rights. So far, science has not supplied us with an objective test for the presence or absence of a soul. Thus, ensoulment is a subjective process. By this I do not mean to discount it; on the contrary, as a social construct, it is supremely useful. Notice that people are free to come up with their own definitions of 'soul', just as they are free to come up with their own definitions of a higher power. People are may choose to adopt one of the ready-made definitions, such as those provided by various churches; or, they can come up with a custom definition, according to personal values.
The problem with that, is that society cannot come to an agreement. Absent that agreement, we still have to find some way of making a decision about ESC research, for the purposes of defining policy and law.
So, should ESC research be allowed, and if so, should it be supported by the federal government?
First, we should decide if there is any scientific rationale for pursuit of this line of research. This is not 100% clear-cut. As mentioned above, there are editorials in the world's two leading medical journals indicating that at least some knowlgeable, respected scientists believe there is. Countering this, there is a statement put forth by the Christian Medical Association that argues for investment in research that uses other types of stem cell. (In addition to embryonic stem cells, there also are adult stem cells, and stem cells derived from umbilical cord blood.)
Stem Cells: Over 2,000 Christian Medical Association Doctors Petition Congress to Invest in "Affordable Cures for Our Patients in the Quickest Time"
July 30, 2004 10:03 AM US Eastern Timezone
WASHINGTON--(BUSINESS WIRE)--July 30, 2004--
As Democrat convention speakers promoted human cloning and embryonic stem cell research, over 2,000 Christian Medical Association doctors signed a letter sent today to Congress and the President urging investment in adult stem cell research that is already providing therapies for patients.
Executive Director David Stevens, M.D. noted, "As the nation's largest faith-based organization of physicians, we have a vested interest in such research because we care for patients every day who desperately need cures that might arise from regenerative medicine. We also have the motivation, knowledge and experience to analyze stem cell research without the inherent bias of fund-seeking firms and researchers who have hyped embryonic stem cell research far beyond scientific integrity."
Stevens said, "Cloning human beings for stem cells--as Ron Reagan Jr. urged in his convention speech Tuesday--would produce abnormal embryonic stem cells while exploiting women to gain the millions of human eggs needed for human cloning. Ron Jr.'s speech was "political science" of the worst sort."
Stevens noted, "We want to see cures quickly as our patients do. Adult stem cells are giving results now, but even the most optimistic predictions put any possible help from embryonic stem cells 10-15 years away. Adult stem cell treatments are economical while embryonic stem cells are prohibitively expensive. Private investors are not investing in these so called miracle cures, so scientists seeking fame and fortune are making outrageous promises and using gullible celebrities to help them pick the public's pocket."
The CMA doctors' letter emphasized scientific evidence that human embryonic stem cells have proven difficult to develop and maintain, are unstable and mutate in culture, often act abnormally and tend to form cancerous tumors.
The letter highlighted adult stem cell benefits: "Verified accomplishments of adult (non-embryonic) stem cell research are already providing hope and therapy for patients suffering from heart muscle injury, diabetes and brain damage from stroke--with realistic promise for treating other diseases on the horizon."
Stevens said, "We reviewed the literature over the last three years since President Bush's policy was initialized and have found that he made the right choice. The government needs to put taxpayers' money into ethical research that will get us the most affordable cures for our patients in the quickest time."
This sentiment is found in a number of places, among those who seem opposed to ESC research. For example, it is seen in this article at the New Trommetter Times. It strikes me as an odd kind of argument to make. It does not mean that ESC research is unethical per se. However, it implies that it is relatively unethical to pursue ESC research over adult stem cell (ASC), because ASC research is more promising.
The problem with the argument is that, when more than one line of research is available, it does not make sense to abandon completely the line that seems less likely to produce results quickly. If that were the case, all we even would do would be applied research. We would not do any basic research, because applied research, by definition, is more likely to produce usable results quickly. If such a strategy were invoked, we eventually would run out of lines of applied research: it is basic research that supplies the material for applied research. Likewise, in the case of stem cell research, if we abandon ESC completely, and pursue only ASC, we eventually would get to the end of the line. Perhaps an argument could be made, that it would be better to put the majority of research funding into ASC research, just as it may be reasonable to put more money into applied research over basic research. That is a policy matter, though, not an ethical one.
In my view, this dismisses the fourth out of the series of four objections listed near the top of this post.
The third objection is equally dismissable. There is an article on the LewRockwell.com site. It contains this quote:
You see, the thing about stem cells is that they are undifferentiated. They have not yet specialized. That’s what the hubbub is all about. The whole promise of stem cell research lies in turning cells from generalists to specialists. Kind of like grad schools make doctors and engineers out of regular old undergrads. We are attempting to take a generic cell and turn it into one that specializes in producing insulin or making a heart beat or some other necessary function. It is wonderful and amazing stuff. But a stem cell is a stem cell is a stem cell. That’s the point.
This simply is not true, although the reasons are highly technical. To illustrate, I have quoted two excerpts from a text, Stem Cells and the Future of Regenerative Medicine. (Committee on the Biological and Biomedical Applications of Stem Cell Research, Board on Life Sciences National Research Council, National Academy Press, Washington, D.C., 2002.) This book is readable online, although the text is from an uncorrected OCR scan. For that reason, the online version has errors introduced by the process of scanning it and running optical character recognition.
I have taken the liberty of correcting it. The original, erroneous text is included in strikeout format. I can assure you that I have not changed the meaning. The original scans are available at the National Academies Press website, if you care to check.
The full potential of bone marrow transplantation to restore a healthy blood system in every needy patient is currently limited by the unavailability of HSCs in the quantity and purity that are crucial for successful transplantation. Because of their relative rarity (one in every 10,000 bone marrow cells) and the difficulty of separating them from other components of the blood, so-called bone marrow stem cell trans- plants are generally impure (NIH, 2001
If HSCs derived from human ESCs could be successfully trans- planted into the blood system of a transplant recipient (by using immu- nosuppressive drugs), any further implant tissue (say kidney or pancreas) developed with the same ESCs would not, in theory, be rejected by the recipient because the immune cells produced in the recipient's blood by the HSCs would see the implant tissue as "self''. But that is a
These quotes illustrate some of the hurdles that have to be surmounted before ESCs would have any therapeutic use. They are not trivial by any means; no one can guarantee that clinically-usable results will be possible. The point is, though, that ASCs are not equivalent to ESCs.
As it is getting late, I am going to post this now, even though it is not finished. I will post the rest as time permits.
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Sunday, August 01, 2004
Bush Using Drugs to Control Depression, Erratic Behavior
By TERESA HAMPTON
Editor, Capitol Hill Blue
Jul 28, 2004, 08:09
President George W. Bush is taking powerful anti-depressant drugs to control his erratic behavior, depression and paranoia, Capitol Hill Blue has learned.
The prescription drugs, administered by Col. Richard J. Tubb, the White House physician, can impair the President’s mental faculties and decrease both his physical capabilities and his ability to respond to a crisis, administration aides admit privately.
“It’s a double-edged sword,” says one aide. “We can’t have him flying off the handle at the slightest provocation but we also need a President who is alert mentally.” [...]
After reading the article quoted above, I noticed that the same source has a similar article:
Sullen, Depressed President Retreats Into Private, Paranoid World
By TERESA HAMPTON & WILLIAM D. McTAVISH
Capitol Hill Blue Staff
Jul 29, 2004, 09:08
A sullen President George W. Bush is withdrawing more and more from aides and senior staff, retreating into a private, paranoid world where only the ardent loyalists are welcome.
Cabinet officials, senior White House aides and leaders on Capitol Hill complain privately about the increasing lack of “face time” with the President and campaign advisors are worried the depressed President may not be up to the rigors of a tough re-election campaign.
“Yes, there are concerns,” a top Republican political advisor admitted privately Wednesday. “The George W. Bush we see today is not the same, gregarious, back-slapping President of old. He’s moody, distrustful and withdrawn.” [...]
I checked on the citations at Blogpulse, and they mostly just echo the article. I did not see any thoughtful commentary. Since this is a subject I happen to know something about, and I did not find any other informed commentary, I decided to chime in. Although I tend to be critical of Mr. Bush, and do not think he should be re-elected, I hate to see incorrect information about any important topic. This critique is not so much a defense of Mr. Bush, but an effort to clarify certain aspects of the two articles reported by Capitol Hill Blue.
Of course, I have no way of knowing if any of the information in the articles is correct or incorrect. For the purpose of this critique, I will assume that the authors are reporting the truth as they know it. I also will assume that they are correct in describing the specific medication used as an antidepressant.
First, the 7/28/04 article mentions "powerful antidepressant drugs." This is a peculiar statement, as all antidepressant drugs are equally likely to have a beneficial effect, when used properly. There really is not any meaningful way to rate some as more powerful than others.
Second, the same article states that they medication "can impair the President's mental faculties and decrease both his physical capabilities and his ability to respond to a crisis." While it is true that such medication can have adverse effects, normally one would not expect any significant impairment. If such adverse effects occur, the physician ordinarily would address that by stopping the medication, changing the dose, or switching to something else. There are times when it is advisable to continue the medication even in the face of adverse effects that result in impairment. However, that would only be the case in the presence of severe, treatment-refractory illness.
Third, in a section of the 7/28 article that I did not include above, it is stated that "the reports were later confirmed by prominent George Washington University psychiatrist Dr. Justin Frank in his book Bush on the Couch: Inside the Mind of the President." They do not tell us which reports were confirmed. Does Dr. Frank have some way of knowing that Mr. Bush is taking medication? Probably not. What Dr. Frank allegedly confirms is not any report about Mr. Bush; rather, what he confirms is the conclusion that Mr. Bush has behavioral problems.
Dr. Frank's book sounds interesting, but not enough so that I would actually spend money to buy it. I did, however, read some of the reviews at Amazon. It appears that Dr. Frank has written thoughtfully about Mr. Bush, but I would be cautious about drawing any specific conclusions from it. Like any academic work, it requires a certain amount of training to be able to interpret it accurately.
Fourth, in the 7/29 article, it is stated that "Psychiatrists say the increasing paranoia at the White House is symptomatic of Bush’s 'paranoid, delusional personality'.” I do not know what meaning I can derive from a statement that says, essentially, the paranoia is symptomatic of paranoia. Furthermore, it is not technically correct to refer to a 'paranoid , delusional personality." I hope that there are not very many psychiatrists who would say that. Technically, there are two levels of paranoia. Paranoid Personality Disorder (DSM-IV 301.0) refers to a form of paranoia in which the person is excessively suspicious, but is not out of touch with reality. Delusional Disorder (DSM-IV 297.1) refers to a condition in which a has paranoid delusions, meaning that the person really believes that he is being persecuted (as opposed to being excessively suspicious). In Delusional Disorder, the suspiciousness is incongruent with reality. By definition, then, there is no such thing as a paranoid delusional personality. If a person has paranoid delusions, he or she does not have Paranoid Personality Disorder.
Fifth, in the 7/29 article, they mention, "Dr. Frank also concludes that Bush’s years of heavy drinking 'may have affected his brain function – and his decision to quit drinking without the help of a 12-step programs puts him at a far higher risk of relapse'.” This is true -- the drinking may have affected his brain function. And it generally is true that those recovering alcoholics who attend AA are at lower risk for relapse than those who do not. But again, I would be hesitant to present those as firm conclusions. I happen to agree that some of the behaviors described in the Capitol Hill Blue articles often are seen in persons who have brain disease as a result of alcoholism. (In fact, I said so myself, in my 2/16/2004 post.) Without knowing more specifics, though, inferring a causal relationship is questionable. Furthermore, if the behaviors are due to alcoholism, whether or not the person is drinking currently, it would not be correct to give a diagnosis of either Paranoid Personality Disorder or Delusional Disorder. Instead, one would use either the Personality Disorder Due to Alcohol Abuse diagnosis (310.1), or Psychotic Disorder due to Alcohol Abuse, with Delusions (293.81).
Finally, in the 7/29 article, the authors state: "The doctors also worry about the wisdom of giving powerful anti-depressant drugs to a person with a history of chemical dependency." This does not seem realistic. Antidepressant medications do not have properties that would lead to abuse, and often are given to persons with chemical dependency. Thirty years ago, such concerns were held widely, and even now, some of the more traditional AA adherents will say "a pill is a pill," meaning that all persons with chemical dependency should avoid all mind-altering substances. This attitude is becoming much less prevalent, as we gain more experience with the medications.
In conclusion, I must say that that the inaccuracies and misperceptions in these two articles lead me to suspect that they were not researched very well, or they were deliberate attempts to criticize Mr. Bush, with a casual disregard for accuracy. I still won't vote for the guy, but hate to see him criticized unfairly. There are plenty of valid reasons to be critical; we do not need to rely on ones that are not verifiable.
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