The Logic of HPV

The Logic of HPV
If I want to peanut butter and jelly I go to the cabinet and get the bread, peanut butter, and go to the refrigerator and get the jelly. Now that brings back so many memories as well how disappointed I was when there was not any jelly. My mom forgot to pick up some jelly or my brother used the last of the jelly and decided not to tell anyone. At the end of the day I will not have my coveted sandwich. The vaccine HPV is currently marketed to young women as a way to prevent cervical cancer….One less as the ad proclaims. That is important as well if there was a vaccine to prevent breast cancer many parents would offer this vaccine to their sons and daughters because it effects us all. The controversy surrounding this vaccine is the ideology of pre-marital sex and particularly young women. If the young lady decides to have sex she is considered “protected” from cervical cancer or at least she has received preventable care. The fact is in order to have sex a partner is needed. True the young lady may become a lesbian so what are her worries…..that is not of issue the premise is that men induce the likely hood of a women developing cervical cancer. So why are boys not vaccinated. If this is a sexually transmitted disease why not offer the vaccine to all of the actors involve. The reality is that some boy may become sexually active while some will not. The reality is some girls may become sexually active and some will not. As well even though the marketing was directed at women I wonder how many people question the motive of the pharmaceutical company. The boys were left out. It is said in 2009 boys will begin receiving this vaccine, the question are parents willing to protect only their daughters and if so how protected are they if their future lover is not vaccinated.
KIRK
Article title: Vaccinating Boys for Girls’ Sake?
http://www.nytimes.com/2008/02/24/fashion/24virus.html?pagewanted=1

Treat me Please

Treat me please…
Pediatricians see children all of the time and most children keep their pediatrician until they are 18. When children are infants the parents stay in the room the doc. will ask how he is eating, sleeping, playing and etc. Does the formula upset his stomach and what vegetable does he really like? As time goes on the child will grow and the next visit the questions are how is he adjusting to school, does he seem behind to you developmentally if so I will refer you to Dr. Brown. The child gets older and pretty soon it is time for the parent to leave the exam room and give their pre-teen or teenager privacy. This fosters a relationship of trust and most importantly the pediatrician is able to speak privately with their patient. The first statement out of the child’s mouth is you are not going to tell me mom….and the answer is no. Of course the pediatrician is not going to tell the mother or father their conversation for the pediatrician needs a great relationship with their patients. Therefore, many pediatricians not only provide their discipline of care rather psychological care and the child just may need an ear. So what can you tell the parents? If the child is thinking about death is that a warning sign or rather the reality of growing up or just human nature. If the child is being bullied at school is that information to give to the parent or just a part of life. Not to trivialize certain issues rather it is important to assess the context of the conversation and the issues surrounding the situations. If your grandfather or mother passed away we would all question death. As well at some point in our lives we were teased we were not always this cool. I am sure that is still to be determined rather we have learned to accept ourselves. The point is a child truly autonomous when it comes to their care. The child does not decide their doctor, where they live, where they attend school, what car to drive, and etc. This is all determined by the parent. If my child was being bulled I would want to know and if my child was thinking of death I would want to know or would I want to know that if he has any issues he is able to seek counseling from an adult that I trust. I just hope the pediatrician will clue me by immediately suggesting that this is an interesting time in his life. That is a very broad statement but it says so much. Yet, at what time should the parent become informed of the child personal thoughts. The reality is as an adult no one truly knows our deep personal thoughts so what right does a parent have to their child’s.
KIRK
Article: What to Do When the Patient Says, ‘Please Don’t Tell Mom’
http://www.nytimes.com/2008/12/09/health/09klas.html?ref=science

The Right to Die

The Right to Die
The other night a documentary aired on Britain’s television and it was the actual last moment of Craig Ewert. Mr. Ewert actually died in 2006 at a clinic in Zurich. Craig Ewert traveled to this clinic because it is illegally to assist, counsel, and procure suicide. This places many individuals in a compromising position, Craig Ewert stated: “If I go through with it, I have death. If I don’t go through with it, my choice is essentially to suffer and to inflict suffering on my family, and then die.” That statement is a reflection of the how the individual feels about their right to die. Craig Ewert’s wife was not prosecuted for helping her husband travel to Zurich and recently another family assisted their son in traveling to Diginistas, a clinic located in Switzerland. This family was not charged due to public interest. As well, last month a young woman of the age 13, decided to forgo a heart transplant and die at home with her family. The parents did not object to her decision rather the hospital. The hospital threatens to send the parents to jail for neglect and not acting in the child’s best interest. The hospital also threatens to take legal action to receive a court order to force a transplant. Therefore, the question, is it ever right to end your life? Is my life truly my own or rather is it in the best interest of the government. If I decided to cut my hair no one would question my actions. If I decided to fly to Paris someone might wonder why yet, they may not question my actions. If I decide to forgo medical treatment someone might question my decision but it is predicated upon the end result. The reality is we will all die. No one can argue or question that statement. If I am a religious person I may believe that I am going to heaven or hell yet, I am content with my decision. So what interest does the government have with this decision? The British government has decided to forgo treatment for patients due to the fact that they are going to die based on evidence care. The individuals life is not work the amount of money it would take to prolong the person life if only for six months. The person may only need six months to prepare for death and an individual such as Craig Ewert may not need another day to live their life. So, if the government may decide to stop treating an individual that is dying then why is the individual unable to make that determination.
KIRK
Article titled: TV Broadcast of an Assisted Suicide Intensifies a Contentious Debate in Britain
http://www.nytimes.com/2008/12/11/world/europe/11suicide.html?_r=1&ref=health
Article titled: Britain Debates a Child's Right to Choose Her Own Fate
http://www.washingtonpost.com/wp-dyn/content/article/2008/11/13/AR2008111303879.html?hpid=moreheadlines

Should changing your sex be tax-deductible?

Last October, the Washington Post reported on a Massachusetts transgender woman's suit filed against the IRS for the right to claim her sex-change operation as a medical deduction on her income taxes.
http://www.washingtonpost.com/wp-dyn/content/article/2007/09/30/AR2007093001194.html

During the trial, Rhiannon O'Donnabhain, 64, described the struggles she faced as a gender conflicted young boy in a staunchly conservative, Catholic family. Growing up she played with boys, worked in construction and even ultimately married a woman and fathered three children.

In 1996, at 53, Rhiannon was diagnosed with gender identity disorder. In the following five years, she underwent intensive counseling and hormone treatments in order to complete her sexual reassignment surgery in 2001. According to the article, this was the first time in her life, that she felt at peace:
"I'm just so glad I did this," stated Rhiannon.

The article explains that Rhiannon spent more than $25,000 on sex-reassignment surgery in 2001, and claimed a $5,000 deduction. After sending Rhiannon the $5,000 check, the IRS denied the deduction, claiming the surgery was cosmetic and thus not a deductible medical condition.

According to leading medical experts, Gender Identity Disorder is a recognized medical condition that results in an estimated 1,000 to 2,000 sex-change operations a year in the U.S. alone.

Marshall Forstein, an associate professor of psychiatry at Harvard Medical School, asks: "When did the IRS suddenly become physicians?" Forstein reiterated that transgender identity is a condition expressly discussed in diagnostic manuals. Forstein continued:
“It seems the IRS is now in the business of practicing medicine without a license."

According, to Rhiannon's lawyers from the Gay and Lesbian Advocates and Defenders (GLAD), the case will likely set a precedent as to whether such procedures will be considered tax deductible.

Independent of whether Gender Identity Disorder is a medical condition, sexual reassignment surgery may have substantial legal repercussions. Firstly, in 31 states, documented proof of sexual reassignment surgery is necessary in order to change your legal sex status on your driver's license.

Secondly, in a 1997 unreported case of Vecchione v. Vecchione, a California Superior court held that a postoperative transsexual acquires his postoperative sex for purposes of marriage. In the middle of a custody battle dispute over her three year old daughter, Christie Vecchione, claimed her marriage to Joshua Vecchione should be annulled. After revealing to the court that her husband had been recognized as a female at birth, she pointed to the state's ban on same-sex marriages to argue that the marriage had never been valid. Superior Court Judge Gary Ryan held that the annulment and not the marriage was invalid. In ruling that Christie was legally a female, the court placed great weight on a state statue that expressly permits a post operative transgender individual the right to change the sexual designation on their birth certificate.

I would like to see the IRS explain to Mr. Vecchione that sexual reassignment surgery-- a procedure that directly prevented the annulment of his marriage and protected his custody rights over his 3 year old daughter--is merely a cosmetic operation.

The producers of Jurassic Park IV have announced that it is unlikely that they will go forward with the project .

Although our class devoted a sufficient amount of time on the issues on the frontier of genetics -- e.g. synthetic biology, hybrids, and chimeras-- for some inexplicable reason, Professor Herder failed to touch upon a subject incredibly relevant to our day to day world: the potential cloning of mammoths.

Okay, granted this topic is mostly only relevant in the worlds created by Michael Crichton (rest in peace). Nevertheless, what is a bioethics blog without a piece on mammoths?

According to a November New York Times piece, scientists believe that the extinct woolly mammoth could be scientifically regenerated for a mere $10 million.

http://www.nytimes.com/2008/11/20/science/20mammoth.html

However, in this month's Time magazine, Stephan Schuster, a prominent scientist with the project, warns us not to get too excited: "What I'm trying to say is that there is a workable route to do that, but it is at this time technically, and cost-wise and time-wise, not feasible." http://www.time.com/time/health/article/0,8599,1861136,00.html

Nevertheless, the scientific and legal community have been moderately excited about this for a while. Back in 2000, A Stanford Technological Law Review analyzed the legal implications of the matter and concluded there to be no national or international hurdles to pass.

Primarily, the brief is most excited about the project's “potential application to the conservation of the endangered and near-extinct species of our own time.”

The Law Review counter ecological and evolutionary arguments opposed to the project, by asserting that any such problems would be averted by keeping them in captivity.

To the Stanford Law Review's defense, I should add that Jurassic Park III had not yet been released.

Other common points/counterpoints on this issue include:

Con: These animals are extinct. Are we playing God by trying to resurrect them?

Pro: Humans had a role in killing off mammoths.

(Although studies point to climate change being the primary cause, it would be difficult to claim that humans didn't have at least a partial role in that as well. )

http://www.democraticunderground.com/discuss/duboard.phpaz=view_all&address=115x53524


Con: Cloning will create monsters that will destroy life as we know it.

Pro: Mammoths would actually be incredibly similar to an elephant, although hairier.

Consequently, the mammoth clone would be reared by an elephant mother.

Con: There are no modern environments suitable for these creatures.

Pro: Environmental conditions for mammoths can be replicated.

Con: It would be inhumane.

Pro: Mammoth clones would not be laboratory specimens.

Con: Such an endeavor would release a plague of unknown diseases on Earth.

Pro: There is no evidence of transmissible disease from defrosted specimens.

http://www.actionbioscience.org/biotech/agenbroad.html

Sadly, as Schuster points out, all this discussion is more or less moot at this point. Unfortunately, the world has considerably more important issues to face and then post about on bioethics blogs.

The "Three's Company" episode where they discuss bioethics

Last February the UK Telegraph announced that British scientists had created an embryo with three parents. Researchers at the University of Newcastle took the nucleus of an embryo produced during assisted reproduction and placed it inside an egg from which the original DNA was removed, leaving behind the donor's mitochondria. Thus, the resulting embryo contained genetic contributions from three people.
The researcher's goal is to create a procedure to prevent mitochondria-related diseases.
Although, these diseases are rare, the results can be devastating. By using the Newcastle method, a traditionally-formed embryo with a defective mitochondria could then be replaced with functional mitochondria.

The Telegraph explained that “in effect, the new technique would be like changing a battery in a computer without affecting the hard disk, the nuclear DNA that influences our appearance and other characteristics, so that an affected woman does not pass them on to her children.”

http://www.telegraph.co.uk/scienceandtechnology/science/sciencenews/3324321/Transplant-creates-embryos-with-three-parents.html

At this time, the legality of the operation in England is still in question.

Although the Telegraph piece focused on the pathological implications. The internet instantly buzzed about the cultural possibilities. A Wired.com article explained that the Newcastle procedure might be useful for people in a trinogamous relationship or “a long-term union of three people rather than two.” (The article notes that linguistically binogamous would be proper, however, the class of individual for which the term applies have apparently already taken the aforementioned term).
The article explains that “like anyone else, people in trinogamous relationships may want to have children with DNA from all the parents. Enter the Newcastle method. The same holds for same-sex couples for whom an embryo conceived through traditional assisted reproduction contains DNA from only one partner.”
http://blog.wired.com/wiredscience/2008/02/calling-jerry-s.html

Although I tend to believe that a human family is best structured around a monogamistic center (be of it any combination of gender and sex), I am not opposed to a trinogamous child. Indeed for individuals opposed to monogamy, such a unique child would certainly be an incredible way to reinforce their non-monogamistic union. As I type this, I'm finding more and more that I have strong conservative feelings as to monogamy; still, as I do not know any trinogamous individuals I can't get myself to judge such domestic situations as wrong per se.
On the other hand, in the event such a trinogamistic societies are structured around one male and multiple females I might be concerned with the implications of encouraging such domestic situations. Although, HBO's Big Love does make a relatively strong case for polygamy.
(incidentally the DNA used in the Newcastle method happened to be 2 women and 1 male).

Watching a Suicide

http://news.aol.com/health/article/british-tv-will-show-assisted-suicide/272690

An assisted suicide is being aired on television tonite. I do not have the stomach to watch it.

This man was dying of ALS, a very severe disease that inspires even additional sympathy in all healthcare workers caring for their patients. I am hoping that if this film is done in an appropriate manner, it will also generate sympathy and understanding from the general public.

The amount of pain and expense for dying patients is immense. Assisted suicide, if carefully controlled by healthcare is a viable option. Going forward we need to explore all options in controlling costs. This certainly would include educating the general public of the benefits of hospice and educating them realistically about their prognosis.

Patients have a right to choose their medical treatments under the law.

Jennifer Burns RN