Wednesday, May 15, 2013

Informed Consent: Cool PEG tube video edition

Here's a great Youtube video on PEG tube placement; it seems to be up as a marketing move by the company that made it. Is there any reason why patients and their families shouldn't always watch something like this in connection with informed consent for any procedure? BTW, I have no connection to Nucleus Medical Art, I just think it's a great video. Of course, it's not the whole of informed consent--someone contemplating PEG placement for a loved one with advanced dementia, for example, ought to be given data about whether PEG feeding actually increases lifespan. But videos like this are a great way to tell patients about procedures.


Somatic Cell Nuclear Transfer Used to Create Human Embryonic Stem Cells

A international team including scientists from Oregon Health & Science University and the Oregon National Primate Research Center have just announced in Cell that they have successfully used somatic cell nuclear transfer (SCNT) to develop human embryonic stem-cell lines. As I understand the paper, the team removed genetic material from the core of multiple oocytes from two different human donors, and replaced it with nuclear material taken from the skin cells of an embryo. Some portion of the eggs from each donor then proceeded to develop to the blastocyst stage, at which point their cells were plated and tested for pluripotency. Pluripotency was proven when the cells, injected into immuno-deficient mice, formed tumors containing tissue- and cell-types representing all three germ layers.This paper, then, is the most powerful proof of principle to date that we may one day be able to combine SCNT and embryonic stem-cell technologies to generate made-to-order, genetically-compatible replacement tissue for humans with diseases such as diabetes or Parkinson's.

It's important to note that the blastocysts were imperfect in various ways, and could not have successfully been implanted into a woman to make a child. (Members of the same team have not yet been able to create a cloned monkey embryo capable of implantation.) This has created some verbal problems that will no doubt be fodder for the culture wars. Strangely, the mostly-liberal National Public Radio is reporting that the scientists created and destroyed human embryos, while the mostly-conservative Wall Street Journal is saying that the team's achievement "is a long way from creating a human embryo."

Here's how I think of it: while the team used cloning technology to create human embryonic stem cells, they didn't exactly create and destroy a human embryo along the way; they created what they knew to be a faulty approximation of a human embryo, but one close enough to the real thing to generate pluripotent human embryonic stem-cell lines. (Think of the fact that human embryonic stem-cell lines can also be generated from parthenotes which are completely incapable of developing into embryos.)

Nonetheless, I'm pretty sure these scientists would have no problem with creating a perfect, and in principle perfectly implantable, human blastocyst--though they have no intention of implanting one, and no research oversight body anywhere would permit them to, even if they did. They want to generate tissue, and if perfecting human embryo cloning helps them do that, they will. Even if you agree with me that the toughest ethics questions aren't quite yet raised by this work, this work certainly implies that they'll be raised sooner or later.

Vermont Legislature Passes Physician-Assisted Suicide Law

The Vermont legislature has passed a new physician-assisted suicide law and is sending it to Governor Shumlin, who supports it and is expected to sign. The Oregon-style legislation will be the third such state law in the country and the first adopted by a legislature, as opposed to via popular referendum. The strange feature of this law, though, is that while it begins by mandating (in section 5283) a number of Oregon-like anti-abuse measures to make sure that the program doesn't help the wrong people to die by mistake (two different oral requests, 15 days apart; a written request for self-administered lethal medication signed by two disinterested witnesses; findings of terminality and capacity entered into the chart; and so on), most of these requirements sunset in 2016 in favor of the much shorter section 5289, which says only:

"A physician with a bona fide physician–patient relationship with a patient with a terminal condition shall not be considered to have engaged in unprofessional conduct under 26 V.S.A. § 1354 if:
(1) the physician determines that the patient is capable and does not have impaired judgment;
(2) the physician informs the patient of all feasible end-of-life services, including palliative care, comfort care, hospice care, and pain control;
(3) the physician prescribes a dose of medication that may be lethal to the patient;
(4) the physician advises the patient of all foreseeable risks related to the prescription; and
(5) the patient makes an independent decision to self-administer a lethal dose of the medication."

A subsequent section immunizes any physician from civil or criminal liability for any actions performed in good faith compliance with the law.

The legislators's assumption, according to press coverage, is that physicians will have developed adequate professional standards for physician-assisted suicide by 2016. I wonder whether the law's repeal of safeguards will really last, or whether the Vermont legislature will re-think the matter in the next year....

And I know, I'm supposed to say aid-in-dying, not physician-assisted suicide. But I'm an academic, not an advocate, and even though the term "suicide" scares some folks, and others argue that it's not really suicide if you're dying of a disease you didn't choose, my own view is that if you give a terminally ill person some pills with which she can kill herself faster than her underlying disease would have, you're assisting in her suicide. (Wow! On that one verbal point, I actually agree with Wesley Smith! Though, unlike him, I approve of physician-assisted suicide with appropriate safeguards, and think that the Oregon safeguards are appropriate. And I'm not a fan of slippery-slope arguments.)

Friday, May 3, 2013

Friday Not-So-Frivolity: Sherlock Holmes Alzheimer's edition

This is in fact a lovely sketch, funny at the start and then just plain moving. It's the final bit with which Mitchell & Webb closed their last show.

Friday Frivolity: Not Intolerant to Wheat Edition

Thursday, May 2, 2013

Our Voting Public: Uninsured revolt against the Anti-Christ behind the climate hoax edition

An April survey from Kaiser Family Foundation found that four in ten Americans (42%) are unaware that "Obamacare" is actually the law of the land. 12% thought the health reform measure had been repealed by Congress, 7% thought it had been overturned by the Supreme Court (which actually upheld the law in June of 2012), and 23% didn't know enough to say whether the law was in force or not. Overall, 49% of Americans didn't know enough to say whether the law will impact their own families--but, depressingly, the percentage of people lacking that knowledge was highest in the two groups the law is likely to benefit most: the uninsured (of whom 58% said they didn't know how the law would affect them) and the poor (56%).

Another poll--from PublicMind at Farleigh Dickinson University--shows that 29% of all Americans (18% of Democrats, 27% of Independents, and a whopping 44% of Republicans) believe that an armed revolution might be necessary in the next few years, in order to protect our liberties. An armed revolution. In the next few years. Another 5% of Americans aren't sure about that. Well, that's good, I guess; one doesn't want to decide these things too precipitously.

And in other polling news from what appears to be this planet, Public Policy Polling (a well-respected polling firm known for asking the occasional oddball or controversial question) has found (among many other amusing and/or scary things) that 58% of Republicans think global warming is a hoax, while 77% of Democrats disagree; and that 20% of Americans think vaccines cause autism, while 34% aren't sure.

And 20% of Republicans believe that President Obama is the Anti-Christ. Well, I guess we know why they think armed revolution might be necessary. Hope your health insurance covers gunshot wounds.