Access and allies

The Food and Drug Administration has revised the guidelines for a pill that induces abortion. The changes allow women to take the pill further into their pregnancy and reduced the number of required visits to the doctor. The pill, mifepristone has increased in use in recent years, and the debate over their use from anti-abortion leaders has heightened in parallel.

The new guidelines reduce the number of required visits from 3 to 2 and allow the medication to be taken up to 10 weeks into pregnancy, up 7. This has in fact been standard practice in most states as doctors have been following the new research and prescribing in line with that evidence under the common practice of off label use. Many states have passed laws to restrict the use of the pill since it was approved by the FDA.

These laws include requiring the pill to be administered by physicians rather than nurses or physician assistants, or requiring the prescribing doctor be present with the patient while the pill is taken which abortion rights activists point out as a strategy to block many women living in rural areas to receive the medication at all. Some states required that physicians follow the label instructions strictly, so the new language from the FDA could have a real impact.

In 2014, a mother of three in rural town Pennsylvania went to jail for ordering mifepristone online to induce a miscarriage for her 16 year old daughter. The nearest clinic to their home was about 75 miles away and  Pennsylvania requires women seeking abortions to get counseling and wait 24 hours before they can return for the procedure. A first-trimester abortion is typically between $300 and $600 and that does not include the added costs of time off work and travel. To order this pill cost this family $45.  This mother was charged with a felony for offering medical consultation about abortion without license and three misdemeanors for endangering the welfare of a child, dispensing drugs without being a pharmacist and assault.

Bioethicists, when discussing abortion, can often get mired in questions on personhood and the moral status of a fetus. Legal questions usually cover the rights granted to a fetus. This post takes for granted that abortion is part of medical practice and care for women in the United States and asks us to weigh the risks of the use of this pill without direct presence of a physician versus the large need for resources related to abortion for those who are lower income, or living in rural areas far from available clinics. It also brings to light the systemic criminal treatment of those who seek this abortions.

-Grace

A Brighter Futurism

I finally had a chance to listen to Neil Degrasse Tyson interview inventor/futurist/AI soothsayer Ray Kurzweil on the season premiere of Star Talk, and it turned out to be pretty much what I expected: Kurzweil rigidly answered the host’s hypothetical questions with robotic confidence, while guest neuroscientist Gary Marcus questioned the scientific validity of Kurzweil’s predictions and Pulitzer Prize-winning author and professor of cognitive science Douglas Hofstadter compared Kurzweil’s worldview with lunacy and dog excrement intermingled with a few scientifically-sound and reality-based predictions.

I’m not going to comment on the relative accuracy of Kurzweil’s science, but I do think the ethics of AI and nanotechnology are among the most pressing ethical issues of the next twenty years and thus worth exploring even in vague terms here.

Ethics have historically almost always lagged behind technology, so I was especially solaced to hear Dr. Marcus vow to meet these demands as the founder of aiforgood.com. While Kurzweil touts neurocognitive nanobots as a foregone conclusion and a positive step in evolution, he also seems optimistic about the nature of its use in discussing the moral imperative that accompanies it. Dr. Marcus is more measured in his predictions and the barriers that currently exist, taking a critical perspective of Moore’s law (or as Dr. Marcus calls it, Moore’s Trend) explaining the exponential acceleration of technological capability. The truth is that this acceleration has in fact slowed and so even with reference to the initial trend, future paces of advancement might not be easily determined. Dr. Marcus also acknowledges the negative side of this unharnessed technological advancement and stopping short of omens about grey goo, he notes the potential for terrorists, tyrannical governments, and other evildoers and stresses the need for early regulation and ethical codes since technology does often proceed quickly unrestrained.

Perhaps my biggest problem with Kurzweil’s predictions is not the scientific validity of the ideas he so adamantly proposes but his use of “we” to denote those who will be using/benefitting/engaging in “The Singularity” (the forthcoming date—he proposes the year 2045—in which machines will function, reproduce, and blend with human biology). Perhaps he mentions it in his books (which, full disclosure, I have not yet read), but I believe there will continue to be large swaths of the population who have no interest in merging with machine. From uncontacted tribes to the Amish to modern day hippies and naturalists, I don’t foresee the entire human race necessarily jumping aboard this invasive technology.

The other major flaw (albeit not related to ethics) in the predictions espoused in the interview was that of a variation of immortality achieved through creating digital copies of brain scans. Kurzweil describes it as “uploading to ‘the cloud’” but the idea is that the electrical impulses that travel the synapses of the brain can be technologically cloned to operate through computer systems. I don’t have a major problem with this idea except for the use of the word immortality or the notion that anything doesn’t reach a finite conclusion in this universe. Eventually the sun is going to become a white dwarf and engulf the Earth and even if that is somehow avoided, most competing theoretical physics models (including those proposed by host Neil Degrasse Tyson) conclude an eventual demise of the universe. In my view, it’s hard for immortality to endure the end of the universe.

But it does illuminate an interesting question to be explored in the future: if The Singularity does occur as Kurzweil describes, what will we ultimately fear? Death…or unrelenting existence past a natural lifecycle?

– Tyler

 

Cosmethics

The regulation of cosmetics by the Food and Drug Administration is near non-existent, and has been since the agency was founded eighty years ago. What can they do? Recall dangerous products with the voluntary consent of the company and require manufacturers to tell consumers about terrifying adverse health effects such as “death, disfigurement, or hospitalization.” There is zero pre-market testing, so what they’re saying is, people have to die or lose a limb before we hear about it. The average woman puts 515 synthetic chemicals on her body in one day, who is looking out for you ladies? 

To start, Senators Dianne Feinstein of California and Susan Collins of Maine, are sponsoring a bipartisan bill that would give the FDA the power to recall products and require companies report health hazards. This bill also mandates that the FDA start looking into the chemicals already on the market by reviewing five chemicals per year. Some of the first we hope may be on the list? Propylparaben, lead acetate, and methylene glycol, which releases formaldehyde

 
Eighty years ago the FDA declined to regulate this industry. But maybe with Justice RBG on the bench, the widespread protest of the tampon tax, and the whole nation watching a woman aim for the White House, we can have the luxury of knowing what carcinogens look best with our skin tone. 
-Grace

G.M.O-K?

Is knowledge of genetically-modified organisms more persuasive than fear based on their overall lack of transparency?  That’s the question that seems to be lost on the lobbying coalition working to defeat efforts like those in Vermont to mandate the labeling of genetically modified food. The corporate processed-food lobby led by Monsanto and Kellogg’s claims consumers “may demand companies remove bioengineered ingredients/G.M.O.s from products…lead[ing] to extreme disruptions in the nation’s food supply chain that could take many years to overcome.”

There are so many things wrong with the assertions made by the opponents of the labeling movement it’s hard to know where to start. But let’s begin with the egregious assumptions made by an outfit called “John Dunham and Associates Economic Research Firm” (Dunham being the former senior economist with tobacco conglomerate Philip Morris). Here’s an excerpt of their “research”:

Given consumers’ lack of science-based information on the subject, they may demand companies remove bioengineered ingredients/G.M.O.s from products, according to the study. It is possible 100% of products eventually would be reformulated to be non-bioengineered.

“This would lead to extreme disruptions in the nation’s food supply chain that could take many years to overcome,” the study said.

If only a small percentage of food manufacturers were able to switch to non-bioengineered ingredients, major costs still would be associated with the Vermont law.

“Companies would be forced to segregate G.M.O. and non-G.M.O. grains, for example, and document them as such, leading to higher wholesaling costs,” the study said. “Food manufacturers would be required to produce multiple versions of products, which would increase overall production costs as run-lengths would decrease. Also, a system with smaller volume sales of more product lines would lead to higher wholesaling costs as more trucks and equipment would be required to handle the smaller batches.”

The costs incurred by American food processors could lead to a 1.76% increase in average food prices nationwide in the first year and as much as 1.61% ongoing.

“These costs are incurred by consumers in every state and the District of Columbia and could be as high as $723 per household in the first year and $13,250 per household over the next 20 years, a cost which is highly dependent on the assumption that non-G.M.O. ingredients will continue to be expensive substitutes for G.M.O.-based products.”

 Wait, what? Did you just multiply $723 by 20 years and factor in slightly diminishing costs based on efficiency advancements in non-GMO cultivation? Why on earth would you use a hypothetical figure projected out for 20 years?! What relevance does that have in the 2016 debate? That “assumption” that non-GMO ingredients will continue to be expensive substitutes is—we might as well define it—an assumption that a) necessity will not drive innovation, b) consumer choice will work against companies that use GMOs and c) said companies will be unable to adapt to a business model that requires transparency. How sad of an assumption is that? No wonder they’re fighting against change.

Further opposition to mandated labeling is provided in a paper sponsored by the Corn Refiner’s Association (hmmm) wherein the authors claim “labeling would provide consumers with additional information but higher food prices would make consumers, especially low-income consumers, worse off.” This asserts that a) “worse off” would not include being better informed and b) consumers would not continue to choose genetically modified food. This is an interesting jump in logic, given that most people already eat genetically engineered food, despite that verified non-GMO alternatives are continuing to flourish.

Say you are a consumer (you are); and you really like Twinkies (you probably do); …is a label alerting you to the fact that the cornstarch has been genetically modified really going to change your behavior next time you’re craving that spongy cake-and-creamy goodness? Of course not. And those in favor of labeling have made it easy for food manufacturers to disclose by asking relatively little of them ranging from an asterisk, to a parenthesis to even a catch-all statement. That’s not too much to ask.

Having, I believe, thoroughly made my point about the reasonableness of mandating labeling, I’d like to point out that in my own consumer decisions and as a bioethicist, I am not in any way summarily against genetically modifying food. I believe the fear-based contention to GMOs has arisen largely due to the lack of transparency these labeling laws are striving to change. So, counterpoint food lobby: let people know what’s going on with their food, let them see it’s nothing to be afraid of, and maybe, just maybe, the anti-GMO hysteria will diminish. Win-win.

-Tyler

Zika fever pitch

With the Associated Press now reporting some 200 cases of Zika nationwide, concern about the spread and implications of the mosquito-borne virus has reached a new pinnacle this week. Adding to that, new reports on the severity of symptoms in certain cases is giving weight to the idea that Zika is among the most pressing concerns in public health since the eradication of Ebola from West Africa in January.

While solutions to the growing epidemic have varied, the ever-categorical Slate has suggested wiping mosquitoes off the face of the earth is a reasonable response. To be fair, it’s not just Slate, as a number of scientists are seriously considering if and how the rest of our shared ecosystem would suffer from a lack of what the Spanish call “little flies” (mosca being the word for fly and -ito being its diminutive suffix). Mike Turner, head of the department of infection and immunobiology at Wellcome Trust, an international charitable foundation “dedicated to improving health through science” is calling for a return to the notoriously banned DDT of Silent Spring infamy to eradicate the mosquito population.

Aside from the obvious and well-documented effects of DDT on bird populations and the human health consequences of pervasive use of an endocrine disruptor, here are three other reasons I think this should be at the very bottom of a list of possible solutions to the Zika problem:

  1. Mosquitos are not the source of Zika virus. Yes, they are its primary vector but taking the extraordinary measure of eradicating mosquitoes does not mean Zika cannot continue to be spread through sexual contact or even yet through an undiscovered vector.
  2. Only a specific genus of mosquito (aedes) is even a competent and capable carrier of Zika. There are some 4000 varieties of mosquitoes. There are far more tactful approaches on the horizon that don’t require eradication.
  3. It furthers the already nearly-ubiquitous idea that speciesist, anthropocentric solutions are viable options to public health concerns. While absolutists might argue that any bioengineering of ecosystems and their inhabitants represents this idea, eradication is the most extreme, pestilent form of this kind of outbreak resolution. It is the Donald Trump of contagion response, if you will.

– Tyler