Earlier today, my “in” box began to fill with info from everyone I’ve ever met letting me know that the Supreme Court had ruled on the Myriad case about patenting the breast cancer genes BRCA1 and BRCA2. I also received a dozen pitches from PR people offering me all manner of instant interviews with lawyers, doctors, bioethicists, and health care analysts.

No one offered me an interview with a geneticist – a person who knows something about DNA. So being such a person myself, I decided to take a look at the decision. And I found errors – starting right smack in the opening paragraph.

“Scientists can extract DNA from cells to isolate specific segments for study. They can also synthetically create exons-only strands of nucleotides known as composite DNA (cDNA). cDNA contains only the exons that occur in DNA, omitting the intervening exons.”

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

For 15 years, the film GATTACA has been synonymous with “genetic dystopian future,” and has become a mainstay of genetics classrooms. But I’ve found a better film. It’s called, simply, Jim.

I never could quite connect with GATTACA, the dark tale of an assumed genetic identity in a society where the quality of one’s genome dictates everything. Perhaps it was because 1997 was the pre-genome era, when the idea of ordering a DNA test over the Internet was still science fiction. But ironically GATTACA’s “not-too-distant” future, in which a genetically inferior “invalid” impersonates a “valid” to achieve a dream, sets up a too-obvious conflict, with the details and resolution contrived. I know this from years of reading fiction and watching soap operas.

Although Jim, released in late 2010, shares with GATTACA the premise of widespread genetic enhancement, it’s much more subtle and nuanced.

“Jim” is a terrific glimpse of a frightening future
from Jeremy Morris-Burke, a self-taught filmmaker.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

I have not been identified as a bioethicist for most of my career. I am a scientist. I trained in physiology and also worked in the realms of biochemistry and cell biology. Just like others in the disciplines a big part of my job was research and to be successful it was necessary to publish my findings. One of the determinations I needed to make on a regular basis was which journals did I submit my work to for consideration of publication. Early in my career as a doctoral student and later postdoctoral fellow and as a young faculty member in physiology there was an obvious choice, the American Journal of Physiology. This journal was highly regarded, had rigorous editorial standards, and publication in this journal was prestigious providing me an advantage in career advancement in my field and, importantly, competing for grant support to continue my work. As my career progressed I continued to seek to publish in high profile biomedical science journals and was pleased to be published in top-tier journals in biochemistry, hematology and immunology.

The journals I referred to above all had something in common. All of these journals were operated by the scholarly professional society representing the respective disciplines (e.g. the American Journal of Physiology was published under the auspices of the American Physiological Society).This society sponsored journal format had important implications for quality, standards, and operations. Most important it assured that editorial standards and criteria corresponded to the consensus standards of community. Moreover they were all run as non- profit entities. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

The decision by the Supreme Court affirming the Patient Protection and Affordable Care Act (ACA) caused many who follow health care closely to breathe a sigh of relief. About 32 million more Americans will now have access to health care insurance. One sticking point that worried many of us was the mandate in the bill requiring everyone to purchase health care. It was frustrating this past March to hear in the oral arguments comparing a requirement for citizens to buy broccoli to a requirement to buy health care, as though both are the same type of market commodities. Many on the right, such as Judges Scalia, Thomas and Alito, expressed concerns that the mandate to require everyone to buy health care was a unconstitutional, a violation of the commerce clause; whereas, many others see health care as a basic public good, which unlike broccoli, everyone requires or will require sooner or later. Fortunately, a legal consensus was reached in the ruling, with Chief Justice John Roberts moving over into the majority in the 5-4 vote. In their ruling, the mandate was not viewed as an expansion of the commerce clause, but rather as a tax, which congress has a right to impose. Regardless of the final legal justification of the ruling, many of us are pleased that the most important piece of health care legislation since Medicare and Medicaid in 1965 is now the law of the land.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

There appears to be hope for America, as a society, a democracy, and a nation. On Thursday, 6/28/2012, as everyone knows, the Supreme Court upheld the constitutionality of the Affordable Care Act (ACA) by a 5–4 vote. Much was at stake, not the least of which was the possibility of affordable health care for all Americans. But beyond this extremely important outcome, the very nature of our democracy was in play, as well as the potential success or failure of the American political enterprise.

For example, lack of affordable health care for every American diminishes our national enterprise in all sectors.

There are other important considerations involved in how the attack on the ACA played out, including the continuing degradation of our use of language. For example, the Supreme Court justices are consistently characterized as “conservative” or “liberal”. This is an immediate problem, as their individual identities are subsumed in the right vs. left dichotomy. But the meanings of the epithets are also lost. To be conservative means to uphold tradition. To be liberal means to uphold progress. However when justices hold their ideologies closely, neither tradition nor progress receive a fair evaluation. As Hannah Arendt states in Between Past and Future, “the very quality of an opinion, as of a judgment, depends upon the degree of its impartiality”. Ideology is not impartial, and Supreme Court opinions have long appeared to be based on politics rather than justice. Obviously, such a state of affairs is a major problem for a democratic society.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

“Human speech is like a cracked kettle on which we tap crude rhythms for bears to dance to, while we long to make music that will melt the stars.” — Gustave Flaubert, Madame Bovary

“The chances of factual truth surviving the onslaught of power are very slim indeed … ” — Hannah Arendt, Between Past and Future

Although this may be more apparent than real, it seems as if the lying and the lies are increasing in frequency on the national level. Politics has long been characterized as a blood sport, but the escalation of vicious contentiousness since 2008 is unusual and extreme. Factual truth has been cast aside, casually thrown to the wind as if one were systematically ripping the petals off a roadside wildflower and tossing them into the air as so much refuse. The losers are the public, of course, the citizens who depend on the government for sound fiscal policies, welfare for those unable to care for themselves, and protection in the form of national defense.

None of this is a surprise. As Arendt states in her essay “Truth and Politics”, modern ideologies “ openly proclaim them to be political weapons and consider the whole question of truth and truthfulness irrelevant”. Further, “it may be in the nature of the political realm to deny or pervert truth of every kind”. As the nature of truth as such is limiting (in other words, it is what it is) , politicians will naturally bend the truth to fit their purposes. As citizens, we need to be on our guard and strive to identify factual truth or the lack thereof in political pronouncements. But such activity requires substantial effort. Thinking is required, as is the concomitant ability to simultaneously hold two contrasting concepts or points of view in mind. A broad education is required, as is a good facility with language. Sadly for us, most of these requirements and capabilities are now in short supply.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

The front page of the Sunday, June 10, 2012, New York Times included an article by Alan Schwarz titled “Risky Rise of the Good-Grade Pill.” The one sentence teaser on the Internet copy read: “At high schools across the United States, pressure over grades and competition for college admissions are encouraging students to abuse stimulants.” The article also used a term that I had not heard or seen in some time: “study drugs.” The story describes how students are using prescription drug stimulants like Adderall XR® (mixed salts of a single entity amphetamine, Shire) so they can “focus” when preparing for examinations and taking tests, in hopes of achieving better scores. Sadly, in the article, one student compared taking stimulants as study drugs was just like taking a vitamin.

Amphetamines are indicated for attention deficit hyperactivity disorder and narcolepsy. They were first synthesized in 1887 as a chemical that was to be a substitute for ephedrine. In the US in the 1930s, the drug manufacturer Smith Kline & French sold a volatile base form of the drug as Benzedrine inhaler for nasal congestion. During World War Two, amphetamines were used extensively to combat fatigue and increase alertness.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

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Dr. Robert Klitzman is the author of the recently released “Am I My Genes: Confronting Fate and Family Secrets in the Age of Genetic Testing”, published by Oxford University Press. He is Professor of Clinical Psychiatry and the Director of the Masters of Bioethics Program at Columbia University. Dr. Klitzman co-founded and for five years co-directed the Columbia University Center for Bioethics, and is the Director of the Ethics and Policy Core of the HIV Center.

In our wide-ranging interview, Dr. Klitzman discusses

• The impact of genetic testing on patients with Huntington’s disease, breast cancer and ovarian cancer, and alpha-1 antitrypsin deficiency
• The implications of recent genetic breakthroughs for these people and their families
• Ethical issues involved in genetic testing, including disclosing results to family and friends, disclosing results to employers and insurers, whether to have children, whether to screen embryos, and privacy concerns
• How to confront fatalism, anxiety, and despair
• How to prepare, ethically and personally, for the likelihood of readily available genetic testing in the near future

Dr. Klitzman also discusses his previous book, When Doctors Become Patients, published by Oxford University Press.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

Does a person have a disease or disorder? Or is the person unwell with an illness? Are the concepts of disease and illness distinct? If we have been lulled to sleep by 100 years of Cartesian diktats from the medical establishment, we may miss the point. But if our thinking is super-sharp, we may be able to detect a critical difference.

A prominent legacy of Cartesian dualism, the mind/body problem, causes a split between the “I” that I know myself to be and the physical body that the “I” inhabits. “I” am a passenger in my body. My body carries “me” around, but we are two separate entities. Thus, my body is something separate from “me” and things can happen to it, e.g., my body can become diseased.

The practice of modern medicine is based on this seemingly real separation. But if that’s all there is, much is being missed. Investigation of the illness vs. disease antinomy offers a profound opportunity for improved medical care of people as patients.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

Is helping the lay public better understand how to interpret health information accurately – in the face of widely disseminated misinformation – one of the pressing challenges for today’s bioethicists?

The June 6, 2012 New York Times carried an article that may illustrate this point perfectly: “Abortion Qualms on Morning-After Pill May Be Unfounded.” The article highlights how politics-driven misinformation is so difficult to counter or contradict, even with sound medical and scientific data. Apparently, for some politicians just saying that emergency contraceptives are “abortive pills” is enough to make it so. Of course, there are other recent examples of this phenomenon too, such as Michele Bachmann claiming that HPV vaccine might cause “mental retardation.”

Regardless, if nothing else, clinical ethics is all about informed consent. Informed consent – in a nutshell – is met when the physician shares with the patient information about the working diagnosis, the available intervention options and prognoses, the benefits and burdens of each option (including the possibility of no intervention at all) and the likely outcomes, and the physician and patient – using a shared-decision making model – agree on an immediate course or plan to implement.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.