In an effort to make donation of IVF embryos more like adoption, the Australian state of Victoria is thinking of allowing donor couples to choose their child's future parents. They would be copying New Zealand's policy, a world first, which makes a meeting between the parties compulsory.
Of all the embryos generated in IVF clinics, few are donated. According Victoria's Infertility Treatment Authority, most couples choose to donate their embryos to research and the others are destroyed. However, a few dozen are donated.
Professor Ken Daniels, deputy chairman of the NZ government's advisory committee on assisted reproductive technology, says that embryo donation is more like adoption because couples are essentially donating potential full siblings of their own children. Both couples are making a "massive decision".
"We are talking, from the donating couple's point of view, of them providing for another couple an embryo that will be a forced sibling of the children that are growing up in their own family," he said. "From that point of view it's very important, especially in terms of the Victorian legislation and our legislation here in New Zealand, that offspring have the opportunity to know about their genetic origins. To know about their genetic origins means that they know who the donating couple were and the siblings that are in that family."
IVF clinics in Melbourne do not seem enthusiastic about what the ITA regards as an "enlightened, sensitive policy". Monash IVF managing director Donna Howlett said that it would just place one more hurdle in front of couples who are trying to have a family. ~ ABC, Age, Aug 21
"SCANDALOUS" CARE FOR ELDERLY IN BRITAIN
Scandalous and shameful: that's how care for British elderly in hospital and nursing homes has been described by its critics. A British parliamentary committee on human rights has just released a disturbing report on how the elderly are treated. Many patients endure neglect so severe that they are left lying in their own faeces or urine or suffer malnutrition and dehydration because they have no one to feed them properly.
The committee has recommended that the law should be given teeth to force hospitals and nursing homes to protect the human rights of the elderly in their care. "An entire culture change" is needed to ensure that patients are treated with dignity. The report says that as many as half a million older people are subject to some form of abuse in Britain.
Although many elderly do receive very high quality care, the report says that over one-fifth of nursing homes were failing to meet national minimum standards for privacy and dignity more than three years after they were introduced.
As for the root cause of this neglect, the committee takes, unsurprisingly, a human rights approach and singles out "the power imbalance between service providers and service users" and "historic and embedded ageism within healthcare". ~ Guardian, Aug 15; committee website
IS BEING DEPRESSED JUST PART OF LIFE?
The BMJ's new series of head-to-head debates has proved highly newsworthy. In the latest, two Australian psychiatrists clash over whether depression is over-diagnosed. Gordon Parker, of the University of New South Wales, in Sydney, claims that the threshold for clinical depression is far too low nowadays. He calls depression a "catch-all" diagnosis driven by clever marketing. It's normal to feel depressed at some stage in life, he says.
He notes that when the first anti-depressant was developed, its manufacturer, Geigy, thought that there would be too few patients to make it worthwhile. "Now, depression is all around, and antidepressant drugs have a dominant share of the drug market." The World Health Organisation even predicts that by 2020 depression will be the second biggest global burden of disease after chronic heart disease.
Professor Parker backs up his assertions with results from 242 teachers whom he has been studying since 1978. More than three- quarters of them met contemporary criteria for depression. This means, he says, that milder forms of depression are being pathologised.
His sparring partner, Ian Hickie, of the University of Sydney, contends that lives of many people who might have otherwise committed suicide have been saved by a diagnosis of depression. And people nowadays no longer feel stigmatised if they are depressed. If depression can be identified in young people earlier, their problems might be resolved with psychological treatments rather than drugs. ~ BMJ, Aug 18
TIMETABLED BIRTHS INCREASING IN US
Doctors in the US are taking another look at medically-managed childbirth, as the number of births scheduled for convenience rises. Fewer than 10% of women underwent induction in 1990, but more than 21% in 2004. Similarly, the rates of caesarean section rose from 23% to 29%. Estimates of the number of inductions for convenience range from 15% to 55% of the total. "People want to schedule their birth like they schedule their nail appointments," says Janie Wilson, of Intermountain Healthcare. For several years her organisation, which runs hospitals in Utah and Idaho, has been trying to reduce the number of elective inductions.
The problem is that the practice creates unnecessary risks and costs: more C-sections, more use of forceps and vacuum devices, longer hospital stays and sometimes, more painful labour. Admittedly, there is little evidence that elective induction causes long-term harm to the mother or baby.
Induced births are convenient for doctors, too -- another reason why they are being criticised. A recent study in the Annals of Family Medicine suggested that "preventive labour induction" may produce the best safety options. However, Dr Michael C. Klein, of the University of British Columbia, wrote a critical editorial in response. "This is another study saying to women, "you can't survive without us making things better; nature is completely off-track. And there is a huge reservoir of practitioners out there who want to hear this message. ~ Los Angeles Times, Aug 13
PAYOUT FOR INFAMOUS US EXPERIMENT
An infamous American case of doctors experimenting on orphans without their consent is close to settlement. The state of Iowa has agreed to pay US$925,000 to several people who were dragooned into a study on stuttering in 1939. The plaintiffs had sought $13.5 million.
The experiment, run by Dr Wendell Johnson, a pioneer of speech pathology, involved harassing and badgering children in the state- run Iowa Soldiers' Orphans' Home in an effort to turn them into stutterers. None did, but some became reluctant to speak or self- conscious. The experiment was kept secret for decades until it was exposed by the San Jose Mercury in 2001. ~ AP, Aug 17
FULL CREDIT FOR COSMETIC SURGERY
American cosmetic surgeons are turning their field of medicine into a big-ticket consumer item by helping patients finance their operations with easy credit. According to the New York Times, brochures in waiting rooms advertise "Get the cosmetic procedure you want -- today!". "One of my patients said: 'I financed my car. Why shouldn't I finance my face?' "Dr Lisa Cassileth, a plastic surgeon in Beverly Hills, California, told the Times. "Plastic surgery has become just like any other high-ticket item you put on credit and pay for later."
Easy credit is allowing cosmetic surgeons to expand their market and women on low incomes to pay for nose jobs, breast implants, and so on. "What does it cost to amortise a nose over the useful life of it?" says a Beverley Hills surgeon. "It costs 30 cents a day, cheaper than a can of soda, and unlike a car, you get the benefit of a nose for the rest of your life."
Not all doctors are happy about the "democratisation of cosmetic medicine". They say some younger patients are forgoing health insurance because it is too expensive, even though they are paying for breast implants. Easy credit might also encourage some to sign up for procedures which they will regret later on. ~ New York Times, Aug 16
FEDERAL FUNDING FOR EMBRYO RESEARCH UNLIKELY TO RISE AFTER BUSH
State governments and private donors will probably remain the biggest supporters of human embryonic stem cell research, even if President Bush's successor reverses his restrictions on federal funding. According to a survey of stem cell financing by James Fossett of the Rockefeller Institute of Government, "federalism by necessity" will remain the pattern of stem cell research. But despite its unwieldiness and complexity, this system is producing funds for American hESC research. California's stem cell institute, funded with a US$3 billion bond issue, has already doled out $200 million for hESC research, more than five times what the Federal government's annual allocation.
Several states are enthusiastic supporters of hESC research, including Massachusetts, New Jersey, New York and Maryland, and have promised substantial funding. Over the next ten years, their support could amount to more than $500 million a year. And most of these states will focus on embryo research as a priority.
"Even if as little as half of potential state funding is devoted to hESC research, states would be outspending NIH by a factor of six in this area," says Fossett. Another source of funding is private philanthropy, although this is less consistent. Fossett's research shows that at least $1.7 billion has been donated for hESC research. Two novel trends have emerged in this area. The first is that private donors have directed supported the work of government agencies. The second is that private money has been used to support political campaigns in support of hESC research.
Although Fossett is glum about the prospect of increased Federal funding after Bush, "federalism by necessity" has its advantages. States are competing amongst themselves, and with foreign countries, to attract the best researchers and to keep a competitive edge.
WASTE NOT, WANT NOT, IN IVF CLINICS
In partnership with IVF clinics, a California company is offering couples an opportunity turn their surplus embryos into medically useful stem cell lines for them and their children. StemLifeLine claims to be the first to offer this service. "Clients will have access to their own high quality, genetically-matched stem cells, which they may use when personalised therapies become available," promises the company's website.
The catch is that no one has yet developed stem cell lines for any of the touted cures. "It's a gimmick and many of the claims rest on hot air," says bioethicist Arthur Caplan, of the University of Pennsylvania. "The problem is that no one has made anything useful out of stem cells." ~ ABC News, Aug 14
LIGHTING CONDITIONS IN IVF CLINICS COULD DAMAGE EMBRYOS
The kind of light commonly used in IVF clinics could damage the development of human and other animal embryos in research, according to a study in the Proceedings of the National Academy of Sciences. Even a few minutes' exposure to sunlight and cool-white fluorescent lights damages mice embryos, says Ryuzo Yanagimachi, of the University of Hawaii.
Cool-white fluorescents, which are blue-white in appearance, are commonly used in office environments. Warm-white lights, which are yellow-white in colour and popular in residential settings, resulted in "far more" eggs developing into babies, Yanagimachi said. The study focused only on mouse embryos, but it is quite possible that human embryos could be affected as well, says Professor Yanagimachi.
He suggested that clinics should ensure that exposure to light is minimised during egg collection and insemination, and while fertilised eggs are examined before being transferred into the womb. "People do not pay much attention to light as a negative environmental factor," he said. Light exposure apparently places stress on the embryo, which responds by producing increased levels of radical oxygen that are toxic to cell structures. ~ AP, Aug 14
I MIGHT BE A GEEK'S SIMULATION, SAYS TRANSHUMANIST
Even if you haven't played geeky simulation games like Second Life, Sim City or World of Warcraft, you have probably heard of them: how widespread they are, now obsessive the gamers are, how absorbing these parallel universes become. Now, here's a question: how do we know that we are not someone else's simulation -- say, a distant, highly evolved descendant, or an alien experimenting with various life forms? It's an unsettling thought, says New York Times columnist John Tierney, but at least it solves the problem of evil in the world. Aren't most geeks into destruction and mayhem?
What provoked these musings was the work of Oxford philosopher Nick Bostrom, who wrote a paper on this possibility in 2003 which has provoked a great deal of interest, especially amongst the "transhumanist" community. Bostrom's gut feeling is that there is a 20% chance that we are actually living in a computer simulation. Highly evolved humans would no doubt run many simulations and scenarios on their computers, vastly multiplying the number of simulated humans. The sensible approach is to believe "with very high probability that we are among the simulated majority rather than the non-simulated minority," he says.
How can we know whether or not we are mere simulations? We can't, says Bostrom. The geeks in charge could inform us with a screen saying something like "you are living in a computer simulation. Click here for more information." But this seems unlikely. Even when we die, as Australian philosopher David Chalmers points out, our afterlife might also be simulated. ~ New York Times, Aug 14; Nick Bostrom website
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