Friday, June 03, 2005

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Thursday, June 02, 2005

Americans as Survivors

A long time ago, I changed the background color of The Corpus Callosum to black, because I was upset about the involvement of the medical profession in interrogations at Gitmo and Abu Ghraib, and in Afghanistan. Now it is white, at least for now.  That does not mean that I have forgotten, nor do I wish to be complicit is denying the horrendous nature of what our country has done.

In a strange instance of irony, the two leading medical journals in the US have published articles on the same theme, and both are open-access articles: NEJM published Americans as Survivors by Robert Jay Lifton, M.D., and JAMA published Treatment of Complicated Grief by Katherine Shear, M.D., et.al.

The JAMA article is a technical report of the outcome of a clinical trial, comparing two types of psychotherapy for the treatment of persons who have prolonged severe grief reactions after a major loss.  The NEJM article is a thoughtful essay about the ways that survivor reactions to war and to terrorist attacks have shaped society in the US.  

I think the most interesting thread that can be picked out of these two articles is this one (from NEJM):
A survivor is one who has been exposed to the possibility of dying or has witnessed the death of others yet remained alive. The responses of survivors vary greatly, depending on the particular encounter with death and on personal traits. But I have found certain psychological patterns to be quite consistent. Survivors struggle with images of death and dying — what I call a "death imprint." They feel a sense of debt to the dead, a need to placate them or carry out their wishes in order to justify their own survival. Survivors embark on an anguished quest for meaning and form, for what Erich Lindemann, in his classic study of the Cocoanut Grove nightclub fire in Boston in 1942, called "an acceptable formulation of [one's] future relationship to the deceased." Human beings are meaning-hungry creatures, and survivors can epitomize this need by undertaking lifelong missions on behalf of the dead. [...]

Any experience of survival can connect psychologically with earlier traumas, with the losses and separations of ordinary life. Similarly, large-scale traumas can become intermingled. The war in Vietnam, the attacks on September 11, and the war in Iraq may blend within the individual American psyche, becoming virtually indistinguishable sources of pain and anger. This psychological blurring of the perceptions of events can contribute to collective confusion and a susceptibility to political manipulation. [...]

Leading advisers of the administration of President George W. Bush were also deeply affected by the defeat in Vietnam, which, as the writer James Mann observed, "led to a preoccupation with first regaining and then maintaining American military power." Thus, in an important collective psychological sense, both the Gulf War and the war in Iraq can be understood as survivor missions in response to the Vietnam War. [...]

The war in Iraq is being fought as a manifestation of survivor missions stemming from both the Vietnam War and the attacks in 2001. Yet once any war begins, it takes on meanings of its own. The dead become the ultimate moral focus, and the traditional survivors' mission is to ensure that they did not "die in vain" and to complete their work by prosecuting the war ever more vigorously. This survivor mission began with the first American death in the invasion of Iraq and extends to the continuing deaths of American soldiers and civilians at the hands of Iraqi insurgents. [...]

Most Americans seem to be hovering between traditional and alternative responses to the war in Iraq. Though troubled by deaths in a war whose justifications are seen as contradictory, they are nevertheless loath to admit that Americans may have died in vain. [...]
In constructing this series of excerpts, I have left out a lot of the author's points.  That's not really fair, but in atonement, I urge everyone to go read the whole article.  Twice.  

The author points out that the current leadership contains persons whose psyches were shaped by two wars: Viet Nam, and the Gulf War.  They were very different wars, but with a particular commonality.  Both wars left unfinished business.  He suggests that this led to, or at least increased the probability of, the Iraq war.  This is an interesting point, although it seems untestable.  Even if the point cannot be proven, it is thought-provoking.

Interestingly, Dr. Lifton's hypothesis runs counter to a common liberal interpretation of the war.  Many who oppose the war point out that the top leadership: Bush and Cheney, both avoided military service.  They refer to those who avoided service of their own, but started a war to be fought by other people's children, as Chickenhawks.  In fact,  the New Hampshire Gazette compiled what they can the Chickenhawk database, listing prominent Republicans who avoided service.  A site, AWOLBush.com, compiled a list comparing the service records of top Democrats with top Republicans.  These took a lot of effort, which implies that at least some people think it is important. They also came up with some graphics to drive home the message:

The liberal interpretation is that leaders who have not actually served in the military do not fully understand the horrors of war, so it is easier for them to think war is justifiable.  Lifton's view is that it may be a kind of survivor guilt that motivates such leaders to start another war, to finish the job symbolically, so no one will have died in vain.  

The other article, JAMA's Treatment of Complicated Grief, is more straightforward.  The authors devised a hypothesis, that a particular well-validated form of psychotherapy could be modified to address the particular difficulties faced by those with "complicated grief."  It turns out that there is some evidence to support their hypothesis.  This is not a trivial problem, by any means:
Prevalence rates are estimated at approximately 10% to 20% of bereaved persons.17-18 Approximately 2.5 million people die yearly in the United States.19 Estimates suggest each death leaves an average of 5 people bereaved, suggesting that more than 1 million people per year are expected to develop complicated grief in the United States.
It is nice to see a group making an effort to address this problem specifically, and to try to improve the rate of treatment response for a group of persons who otherwise may be refractory to treatment.  

The NEJM article focused on a sort of collective grief, something that pervades society.  The JAMA article looked at the grief experienced by individuals.  

Is there any significance to the fact that these two articles came out at the same time, and that they both were made available for free?  Most of the articles in those two journals are available only to paid subscribers, or to others for a fairly stiff fee ($30).  NEJM will make certain articles available openly on the 'net, if they are deemed to have an important place in contemporary public debate.  JAMA usually has one or two articles openly available, but they select which ones will be free based upon criteria similar to the NEJM criteria.  So here we have the nation's two leading medical journals, both deciding independently, that grief and survivor guilt are pertinent to contemporary pubic debate.  

It makes me wonder, if perhaps the editors have some survivor guilt of their own.  Perhaps the entire medical profession does.

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Tuesday, May 31, 2005

Ozymandias of the West Wing

I was a bit surprised by the traffic my last Grand Rounds post generated, until I looked at my Sitemeter and found that a significant percentage of the new traffic had nothing to do with my apolitical post about stem cells research.  With great effort, I went through that post and removed all the political commentary.  I figured it might be more effective if I presented just the facts.  Anyway, part of the traffic came, not from that, but from the O'Neill NSC memo, which has gotten some renewed interest in the wake of the Downing Street memo.  

I've always been curious about what makes certain stories attractive to the mainstream media.  Conservatives accuse them of having a liberal bias, while liberals accuse them of sweeping things under that rug, if they might embarrass the President.  Various groups have tried to do research on alleged media bias, but they don't seem to find any consistent, replicable trends.  

Therefore, I have developed my own pet theory about the media.  They don't have a political bias.  Rather, they are looking for the next Pet Rock®.  Those of you aged 40 and up will remember the Pet Rock®.  It was a rock that came in a cute cardboard box, that cost a few dollars.  It was no different than any rock you might pick up off the ground, except it was a Pet Rock®.  Somebody must've made a gazillion dollars selling ordinary rocks.  It was an inexplicable fad that just took off.  There was no particular reason for the popularity of the darn things, it just sort of happened.  

News stories are like rocks.  One is pretty much like another.  But for some reason, some of them just capture the public's fancy, and take off.  Then the echo chamber starts.  Media professionals refer to that indefinable characteristic as "traction," as in "that story just doesn't have any traction."  But if the story turns into a Pet Rock®, then it has traction.  

The Downing Street memo story has traction.  There are scads of other stories that, from a logical standpoint, are every bit as damaging to the Administration.  This one is only a ordinary bad story, compared to Abu Ghraib etc., but it seems to be getting popular.  I though I would help build momentum by compiling a list of blogs that have commented on it, but that is not going to be feasible.  Blogpulse lists over 1,300 of them.  I went through the first 50, and they were all liberal blogs making negative comments.  I am tempted to conclude that conservative blogs are just staying quiet about it, although there could be some making exculpatory comments in the remaining 1,250.

The logical part of my brain says that we shouldn't be making a big deal out of this, since, as I've mentioned, there are many worse things.  But hey, it's not just a rock, it's a Pet Rock®.  It's a sad thing that it would take a fad to expose Bush as the Ozymandias of the West Wing.  


Torture?  No problem.  No-bid cost-plus contracts?  No problem.  Plamegate?  No problem.  Unjust war?  No problem.  Federal deficit?  No problem.  Widening income gap?  No problem.  Record levels of homelessness, child poverty, bankruptcy, and uninsured persons?  No problem.  Distortions and misuse of science?  No problem.  Loss of international credibility?  No problem.  Environmental damage?  No problem.  Pet Rock®, now that's a problem!  I try to be pragmatic: if it works, I'm all for it.

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Monday, May 30, 2005

An Explainer Regarding Cloning

Grand Rounds
South Korean scientists announced an advance in the development of stem cells, and Congress has been working on legislation that would broaden federal funding for such research in the USA.  These developments have brought the controversy to the forefront of the national consciousness.

The South Korean team created stem cells using a technique known as somatic-cell nuclear transfer (SCNT).  SCNT is performed by taking the nucleus, which contains the genetic material, from one cell from a donor.  The nucleus is then transferred to an egg cell that has had its own nucleus removed.  The resulting cell then can be coaxed into dividing, much as a fertilized egg cell divides.  

This method sometimes is referred to as cloning, or more precisely as therapeutic cloning.  It is different than reproductive cloning, which is done with the intent of producing a fully developed human, or other animal, or even a plant.  SCNT results in a cells that is genetically identical to the cells of the person who donated the somatic cell.  However, the stem cells that result from SCNT are not  identical to cells that would have been present in the donor, when the donor was an embryo.  That is, they are not the same as embryonic stem cells.

To explain: the purpose of a gene is to serve as a template for the production of a protein.  Genes consist of a sequence of parts known as nucleotides.  Proteins consist of a sequence of amino acids.  It is the sequence that determines what function the protein will serve.  When a protein is made in the cell, the sequence of the nucleotides in the gene determines the sequence of amino acids in the protein.  However, not all genes in any particular cell are used to make protein.  Some of the genes are turned on, some off.  Those that are turned on, are turned on to various degrees.  That is, some produce a little bit of protein, some a lot.  The gene is said to be expressed  when it is used to make a protein.  The fact that different genes produce different amounts of protein can be referred to as differential expression.  The processes that result in differential expression are referred to as programming, since they direct the function of a cell much the way that a computer program directs the function of the computer.

A computer is capable of doing a wide range of things.  Once a particular program has been loaded, the computer can do only those things that are directed by the program.  Once a cell has been programmed, it is limited in what it can do.

The factors that control differential expression are not well understood.  Part of the mechanism, at least for some of the genes, involves interaction between the DNA that genes are made of, and small molecules of RNA.  The genes in each individual cell are regulated differently, so that some cells produce the proteins needed for muscle cells, some for skin cells, and so forth.  

Scientists do not have the ability to control differential expression in all ~25,000 genes, which is why we cannot turn ordinary cells into stem cells, and cannot turn skin cells into muscle cells.  Stem cells derived from anything other that a very early embryo have undergone some programming.  Some stem cells are part of the way along the process of turning into specialized cells.  For example, hematopoietic stem cells are able to turn into various types of blood cells, but not nerve cells.  

The cells produced via SCNT can be used to produce an entity that looks very much like a zygote (an early stage in the development of an embryo).  However, the genes already have undergone some programming.  To underscore the differences between the zygotes produced by SCNT, and the zygotes produced by normal fertilization, some scientists refer to the product of SCNT as a clonote.

A more detailed explanation of SCNT can be found here.  The link goes to a transcript of a presentation conducted by the President's Council on Bioethics (PCOB).

One of the Council members, Paul McHugh, has written an article about the subject of SCNT.  The article was published in the New England Journal of Medicine, which is arguably the most prestigious medical journal in the USA.  Dr. McHugh explains his own position on the distinction between therapeutic and reproductive cloning:  
I, however, see a distinction between the two procedures that sanctions different practices involving their products. In my view, SCNT resembles tissue culture, whereas in vitro fertilization represents instrumental support for human reproduction. Specifically, SCNT is an engineered culturing of the nucleus of a somatic cell, accomplished by implanting this nucleus into an enucleated ovum, thereby forming a new diploid cell with the genetic characteristics of the "donor" of the nucleus. [...]

I argue that this process of SCNT, by causing the expression of an intrinsic potential for growth and replication that is found in every somatic cell, can extend and expand a donor's cellular mass into extracorporeal space, as any form of tissue culture does. The stem cells that issued from the process would, in this view, be licitly used as the donor allowed. To specify this fundamental difference between in vitro fertilization and SCNT, I suggested that, since we call the first cell produced by fertilization the zygote, we dub the combination of nucleus and enucleated ovum that launches SCNT the "clonote."
Dr. McHugh states that SCNT results in clonotes rather than zygotes, and points out the distinction is not merely a semantic one.  Clonotes are fundamentally, biologically, different than zygotes.
My distinction rests on the origin of cells in SCNT, not on the process's vaunted potential for producing a living replica (clone) of the donor, as with Dolly the sheep. My confidence in making origins rather than potential the crux of the argument rests first on a reductio ad absurdum: if one used the notion of "potential" to protect cells developed through SCNT because with further manipulation they might become a living clone, then every somatic cell would deserve some protection because it has the potential to follow the same path. But I became more sure of this opinion when strong testimony was presented to the council3 indicating that SCNT performed with primate cells produces embryos with such severe epigenetic problems that they cannot survive to birth.
His footnote (3) is linked to the PCOB discussion that I linked to earlier.  The "epigenetic problems" that he is referring to, are the problems that result from programming of the genes.  

In various media reports, those epigenetic problems usually are not mentioned.  This leaves the public with the misperception that SCNT could be used to produce a normal, viable human adult: reproductive cloning.  Such an outcome is hypothetically possible, but highly unlikely.  To do so, it would be necessary for us to learn how to program, in a suitable manner, all of the genes in the donor nucleus.  

One way to do that might be to produce two cells via SCNT, coax one into becoming a sperm cell, then coax the other into becoming an egg cell; then combining the two via in vitro fertilization.  Nobody knows if that would work with human cells.

Ethicists considering the issue of SCNT may be repulsed by the notion that the process could, hypothetically, lead to the development of a viable human.  They also may be attracted to the idea that SCNT could be used to treat serious illnesses.  At this point, both possibilities remain hypothetical, although research into the therapeutic application has progressed to the point that one might reasonably conclude that SCNT is likely to result in therapeutic techniques.  Thus, the hypothetical therapeutic applications are much closer to reality that the hypothetical application of reproductive cloning.  

Some persons may argue, as Dr. McHugh does, that the seemingly imminent maturation of therapeutic SCNT outweighs the more distant possibility that SCNT could be used for reproductive cloning.  Others may say that SCNT is always wrong, because there is a possibility -- however remote it may be -- that SCNT could be used for reproductive cloning.

Following their investigation into the issue, the President's Council on Bioethics was not able to come to full agreement on many of the issues raised by SCNT.  If they cannot reach agreement, it is unlikely that the general population could reach any kind of consensus.  We will have to travel on the path of discovery, in the light provided by the scientists, while knowing that the available light does not extend to the end of the path.

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Sunday, May 29, 2005

Question: What is this, and why is it important?

I got the document here, on the website about Ron Suskind's book about Paul O'Neill, The Price of Loyalty.  It is the agenda for President Bush's first National Security Council meeting.  The agenda is stamped "January 31, 2001."  That was less than two weeks after the inauguration.  The purpose of the meeting was "To review the current state-of-play (including a CIA briefing on Iraq) and to examine policy questions on how to proceed."  The third item on the agenda: "Tab C: Executive Summary: Political-Military Plan for Post-Saddam Iraq Crisis."  

This indicates that the Bush administration thought that planning for Post-Saddam Iraq was the most important security issue they faced.  Why else would it be the topic at the very first NSC meeting?  It would be a matter of interest to see what conclusions they reached "on how to proceed," but that remains secret information.  

I blogged about this a while back; in fact, it was one of the first things I posted.  As it happens, it was my thirteenth post.  The formatting is a little dorky now because I changed my template a few times, and changed to a different commenting system twice since then.  Any comments that may have been made are long gone, although it is highly doubtful that there were any.  (At the time, I was rated as a prion in the Blogosphere Ecosystem.)

Back to the point.  Now I find, via Ron Beasley at Middle Earth Journal and Simbaud at King of Zembla, that a couple of groups are forming to publicize the Downing Street Memo.  Those two posts follow Cyndy's post at Mousemusings, which expresses concern about the same topic.  (I'm sure that many others have blogged about this; I'm citing only the ones that inspired my own post.) Their concern is that the memo indicates that the US and UK were set on war even before the UN Security Council debated the matter.  That is, the war was going to happen no matter what the outcome of the Council meetings.  The groups publish at www.afterdowningstreet.org and shakespearssister.blogspot.com.  Their point:
Bonifaz's memo, made available today at www.AfterDowningStreet.org, begins: "The recent release of the Downing Street Memo provides new and compelling evidence that the President of the United States has been actively engaged in a conspiracy to deceive and mislead the United States Congress and the American people about the basis for going to war against Iraq. If true, such conduct constitutes a High Crime under Article II, Section 4 of the United States Constitution" . . . .
Following Cyndy's link, we can see the questions contained in a letter written, to Mr. Bush, by US Rep John Conyers (D-Mich) and 88 other Congresspersons on the topic:
1) Do you or anyone in your administration dispute the accuracy of the leaked document?
2) Were arrangements being made, including the recruitment of allies, before you sought Congressional authorization to go to war? Did you or anyone in your Administration obtain Britain's commitment to invade prior to this time?
3) Was there an effort to create an ultimatum about weapons inspectors in order to help with the justification for the war as the minutes indicate?
4) At what point in time did you and Prime Minister Blair first agree it was necessary to invade Iraq?
5) Was there a coordinated effort with the U.S. intelligence community and/or British officials to "fix" the intelligence and facts around the policy as the leaked document states?
As I mentioned back in January 2004, the O'Neill memo isn't really conclusive; perhaps the Downing Street memo isn't really conclusive, either.  Perhaps no smoking gun has been found, yet; but the two memos smell like gunpowder to me.

The O'Neill memo was picked up by the media, briefly.  Katie Couric asked O'Neill about it on the Today Show. Shortly afterward, the media dropped it.  I never understood why the media failed to give this the attention that it deserved.  O'Neill himself stated:
O'Neill said Tuesday that he did not mean to imply that the administration was wrong to begin contingency planning for a regime change in Iraq but that he was surprised that it was at the top of the agenda at the first Cabinet meeting.

O’Neill said he also had qualms about what he felt was the pre-emptive nature of the war planning. “For me, the notion of pre-emption, that the U.S. has the unilateral right to do whatever we decide to do, is a really huge leap,” he said on CBS.

He later told Time magazine that during his 23 months as secretary, which included a permanent seat on the National Security Council, he never saw evidence that Saddam had weapons of mass destruction. 
Want to find the smoking gun?  Mr. Conyers does too, which is why he wants people to sign a petition endorsing an investigation.  While you're at it, perhaps you would consider sending additional emails to all of your US Reps, here. The Downing Street memo appears to be gaining more traction than the O'Neill memo ever had, so let's not let them drop this one.  

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