Wednesday, June 20, 2007
The New York Times Science section, in a story by Dr. Richard Friedman, discusses research by scientists on personalized drugs. Focusing on depression, the article discussed how certain types of drugs for depression may work better for individuals depending on their biology.
Laura is a case in point. A successful management consultant in her late 30s, she sought help for lifelong depression. Her treatment began with four weeks of the antidepressant Lexapro, a selective serotonin reuptake inhibitor, or S.S.R.I., without any effect. Next, I switched her to Zoloft, another S.S.R.I., since the chance of response to another member of the same drug family is about 60 percent. Again, no response. Then we moved on to Wellbutrin, an entirely different type of antidepressant, but this didn’t work either. Laura was now ready to call it quits, and who could blame her?
After nearly three months, I had still not found an effective treatment for her. Then she came in one day and said her father had recently revealed that he had been depressed and had done well on Prozac, another S.S.R.I., and she wondered if she could try it. Within three weeks, she felt markedly better, and the symptoms of her depression began to melt away.
Instead of the hit-or-miss approach I had to use with Laura, it will soon be possible for a psychiatrist to biologically personalize treatments. With a simple blood test, the doctor will be able to characterize a patient’s unique genetic profile, determining what biological type of depression the patient has and which antidepressant is likely to work best.
Scientists have identified genetic variations that affect specific neurotransmitter functions, which could explain why some patients respond to some drugs but not to others. For example, some depressed patients who have abnormally low levels of serotonin respond to S.S.R.I.’s, which relieve depression, in part, by flooding the brain with serotonin. Other depressed patients may have an abnormality in other neurotransmitters that regulate mood, like norepinephrine or dopamine, and may not respond to S.S.R.I.’s.
This is very exciting news. The downside, I am sure that it is also extremely expensive.
The Associated Press reports on President Bush's latest embryonic stem cell research bill veto.
Vetoing a stem cell bill for the second time, President Bush on Wednesday sought to placate those who disagree with him by signing an executive order urging scientists toward what he termed "ethically responsible" research in the field.
Bush announced no new federal dollars for stem cell research, which supporters say holds the promise of disease cures, and his order would not allow researchers to do anything they couldn't do under existing restrictions.
Announcing his veto to a roomful of supporters, Bush said, "If this legislation became law, it would compel American taxpayers for the first time in our history to support the deliberate destruction of human embryos. I made it clear to Congress and to the American people that I will not allow our nation to cross this moral line."
Meanwhile state governments and private sources are moving forward with research in this area. Unfortunately, this isn't the best way to proceed. Newsday.com quotes Senator Corzine,
"At a time when states and the private sector are partnering to further discovery of this promising science, the federal government should be doing more to improve the lives of millions of Americans," Corzine said.
Corzine's comments came a day after New Jersey awarded $10 million in stem cell research grants, including money for embryonic stem cell work. The state has also approved $270 million for stem cell research facilities and plans to ask voters in November to approve borrowing $450 million for stem cell research grants.
Monday, June 18, 2007
Interesting update on the Flu Stories project and some information that may be helpful for personal use or perhaps in helping teach Health Law and Public Health Law courses:
TFAH ("Trust for America's Health") hosted a fascinating Fred Friendly seminar exploring a hypothetical flu pandemic breaking out in Indonesia (sound plausible?). What would President Lowell Weicker, Jr. and Governor Tom Kane do about the Super Bowl scheduled a week after the outbreak in Gov. Kane's state? What do the President's science advisors say? How would the media handle it? And how would blogging (yes, we were at the table in the form of a science blogger from Scientific American) change how media handled it?
The seminar was taped, and I hope it will wind up in a viewable slot on a PBS near you. . . .
To help you, tool kits are being created by HHS and by other interested parties (we'll help create and/or host some by fall at Flu Wiki). Simple checklists for individuals, schools and businesses are available at pandemicflu.gov.
Great post entitled, Twilight Years Should be Golden" at Daily Kos by mpwife discussing the tremendous burden that Medicare can place on the elderly. She concludes:
In an attempt to cut back costs and reform the programs, the Republican congress and President, over the past years, have converted Medicare and Medicaid plans to either health maintenance organizations or preferred provider organizations. Although most look good on paper, often times, doctors and patients are left jumping through hoops, trying to get needed tests, under these plans.
The enrollment process for these plans are often confusing to even the youngest of Medicare and/or Medicaid patients. They're deluged with information, that, unless you're an insurance specialist, or in the healthcare field, is often difficult to understand.
We can lay the blame on the doctors and facilities for wanting more money, but let's not. I work for a company that provides information systems to healthcare providers. The payments providers receive from MCR/MCD for services are often less then what it cost to perform the services that are approved. Should the insurance companies deny the claim, then practices who I work with usually end up writing off the cost of these services and continue to treat these patients. These are physicians who take their hippocratic oath seriously.
Rather then laying blame, our elected officials must continue to work at providing a healthcare package for those individuals who are in need our governments assistance. As the 2008 elections approach, our Presidential candidates on both sides of the aisle are jockeying for support to get them past the primary. While the candidates on the right discuss terrorism, abortion and family values, it's the Democratic candidates, or some of them, that are discussing healthcare reform and comprehensive healthcare packages.
It is imperative, that as our parents or even ourselves reach our twilight years, to elect an individual who is truly interested in ensuring that the elderly, especially the poorest of them, receives the quality of healthcare necessary to allow those years to be golden.
Friday, June 1, 2007
Several weeks ago, the New York Times Magazine contained an interesting article by Jeffrey Rosen on the developing field of Neurolaw (the application of neuroscience to law - particularly its relationship to certain aspects of culpability). The article provides a great overview of some of the latest research on the brain and how it has been introduced into the legal system:
The extent of that revolution is hotly debated, but the influence of what some call neurolaw is clearly growing. Neuroscientific evidence has persuaded jurors to sentence defendants to life imprisonment rather than to death; courts have also admitted brain-imaging evidence during criminal trials to support claims that defendants like John W. Hinckley Jr., who tried to assassinate President Reagan, are insane. Carter Snead, a law professor at Notre Dame, drafted a staff working paper on the impact of neuroscientific evidence in criminal law for President Bush’s Council on Bioethics. The report concludes that neuroimaging evidence is of mixed reliability but “the large number of cases in which such evidence is presented is striking.” That number will no doubt increase substantially. Proponents of neurolaw say that neuroscientific evidence will have a large impact not only on questions of guilt and punishment but also on the detection of lies and hidden bias, and on the prediction of future criminal behavior. At the same time, skeptics fear that the use of brain-scanning technology as a kind of super mind-reading device will threaten our privacy and mental freedom, leading some to call for the legal system to respond with a new concept of “cognitive liberty.”
Here is a further excerpt highlighting some of the research by Professor Steven Morse at the University of Pennsylvania, who has a more moderate approach to the new science:
Even as these debates continue, some skeptics contend that both the hopes and fears attached to neurolaw are overblown. “There’s nothing new about the neuroscience ideas of responsibility; it’s just another material, causal explanation of human behavior,” says Stephen J. Morse, professor of law and psychiatry at the University of Pennsylvania. “How is this different than the Chicago school of sociology,” which tried to explain human behavior in terms of environment and social structures? “How is it different from genetic explanations or psychological explanations? The only thing different about neuroscience is that we have prettier pictures and it appears more scientific.”
Morse insists that “brains do not commit crimes; people commit crimes” — a conclusion he suggests has been ignored by advocates who, “infected and inflamed by stunning advances in our understanding of the brain . . . all too often make moral and legal claims that the new neuroscience . . . cannot sustain.” He calls this “brain overclaim syndrome” …
But he does think that the study of our decision-making powers could bear some fruit for the law. “I’m interested,” he says, “in people who suffer from drug addictions, psychopaths and people who have intermittent explosive disorder — that’s people who have no general rationality problem other than they just go off.” In other words, Morse wants to identify the neural triggers that make people go postal. “Suppose we could show that the higher deliberative centers in the brain seem to be disabled in these cases,” he says. “If these are people who cannot control episodes of gross irrationality, we’ve learned something that might be relevant to the legal ascription of responsibility.” That doesn’t mean they would be let off the hook, he emphasizes: “You could give people a prison sentence and an opportunity to get fixed.” . . . .
The LaTimes has a story concerning a dispute between a former husband and wife over the disposition of frozen embryos. It states,
After two years of infertility treatments — from temperature monitoring and artificial inseminations to hormone injections and laparoscopic surgery — Augusta Roman felt her last, best hope for bearing a child was only hours away. Her doctor had retrieved 13 eggs from her ovaries, and six had been fertilized with the sperm of her husband, Randy Roman. Ten hours before the embryos were to be implanted in Augusta's womb, Randy emerged from their study and broke unfathomable news: Despite all she had endured, he couldn't go through with it. The doctor's call announcing the creation of the embryos had crystallized nagging doubts about their marriage that he had harbored for years. He insisted on canceling the procedure and freezing the embryos while they attempted counseling to work through their differences. . . .
Counseling failed, and in August 2003, 16 months after the canceled embryo transfer, the couple mediated the dissolution of their six-year marriage. She got the house in this Houston suburb, near NASA's Johnson Space Center, and most of the furnishings. He got the 32-inch Sony TV, a futon and dinette set, and the 1998 Honda Civic.
They could not agree, however, on the disposition of one piece of community property — the three embryos of the original six that had survived the freezing process.
Augusta wanted to take possession and have them implanted, agreeing to release Randy from any financial or parental obligation. Randy wanted the embryos destroyed, or at least frozen indefinitely. He argued that even though he did not want to raise children with Augusta, he would never disavow his genetic offspring. As he would point out in court, the couple had initialed a cryopreservation consent form stipulating that should they divorce, any frozen embryos "shall be discarded."
Roman vs. Roman now rests with the Supreme Court of Texas, one of a number of divorce cases nationwide in which the custody dispute has revolved around microscopic clumps of cells that are considered — by most states, at least — to be property and not human life.
The article provides a good overview of this couple's concerns as well as a brief discussion about where the law stands now and how it might develop in the future.