Eugenics History and the Culture Wars (Lombardo)

Posted on: April 28, 2008  |   Author: Garrett
Filed Under: Bioethics, Center for Health Law Studies Symposia, Disability   |   Leave a Comment

As the summary of Paul Lombardo’s presentation, Eugenics History and the Culture Wars: Sterilization and Reproductive Rights, states, 2007 marked the 100th Anniversary of eugenic sterilization in the United States. This commemoration provides the rare motivation to look back at the history of sterilization legislation in the United States and abroad, and to examine the societal context in which it evolved. Eugenics development in history was largely based on the cultural idea of eliminating feeble mindedness based on the now defunct theory that preventing the criminal and disabled from reproducing could eventually rid society of crime and poverty. The basic predecessor for the development of the eugenics movement was the work of Francis Galton and Gregor Mendel, which led to the “Mendelian” theory of inheritance. Ultimately the eugenics movement peaked in the early part of the 20th century with eugenics inspections at Ellis Island, laws against certain classes of people reproducing, and books analyzing the family history of the characteristic of “feeble mindedness.”

However, this less than noteworthy history of eugenic sterilization was not the take-away point of Lombardo’s presentation. Professor Lombardo was careful to explicate that while the popularization of evolutionary theory, courtesy of Darwin and others, was a necessary cog in the development of the eugenics movement, this association should not be used as a “political epithet in the ongoing culture wars.” This association has been further illuminated, rather extensively, in the recent documentary by Ben Stein, Expelled: No Intelligence Allowed. It is precisely the stance taken by Stein that so disturbs Lombardo. There is a scene in Stein’s documentary – and if Michael Moore’s works can be qualified as documentaries, I suppose that rather broad category with all its connotations of simply reporting the facts can apply here as well – where he states that evil can sometimes be rationalized by science, while standing in the Dachau concentration camp. This is a perfect example of the implication argued against by Lombardo, that acceptance of evolutionary theory somehow necessarily results in an acceptance of genocide and ethnic cleansing. It cannot be argued that the association exists, however, the reliance on evolutionary theory, actually social Darwinism, by groups that performed horrible acts does not by implication make evolutionary theory equally as contemptible. The Nazis relied perhaps as extensively on the anti-Semitic writings of Martin Luther, yet no one is rushing to condemn the entire protestant movement because of this association. As Lombardo stated, “We must be careful not to try to shape history to tell the story that we want to tell, and by doing this tie Darwin to all the evils of modern culture.”

Finally, Lombardo ended by discussing the current challenges to the principle of reproductive liberty in the context of the history of American eugenics. However, here it could be argued that Lombardo was making a similar logical error to those that wish to associate Darwinism with ethnic cleansing. It is true that current issues regarding abortion practices that are making their way to the Supreme Court fall under the general category of “reproductive rights.” These rights at issue, however, are very different from the rights that were restricted by eugenic sterilization legislation. The right to be free of any inhibitions that would prevent a person from reproducing is simply not analogous to a right to be free to control all aspects of the reproductive process.

No Freebies for Medical Students

Posted on: April 28, 2008  |   Author: Elizabeth
Filed Under: Drug & Device   |   Leave a Comment

The New York Times reports today that the Association of American Medical Colleges (AAMC) has proposed banning all drug and medical device companies from offering “free food, gifts, travel and ghost-writing services” to students in all 129 medical colleges in the United States. The proposal is the product of two years of work by the AAMC. Currently, most medical schools do not have strong conflict-of-interest policies in place. If AAMC’s proposal is implemented, it will provide a model policy for medical schools. In addition to the ban on free gifts and services, the AAMC also proposes that medical schools discourage faculty participation in drug and device promotion, medical schools establish centralized systems for accepting free drug samples or create other alternative systems where risks to professionalism are not as prevalent as they are with current set-ups, and that medical schools audit medical education seminars given by their faculty members for any inappropriate pharmaceutical industry influence.

Medical schools have long been a target of the pharmaceutical industry because the schools are “packed with prominent professors and impressionable trainees.” Prior to the release of the proposal, several big pharma leaders predicted that the proposal would be weak. In contrast to these predictions, the proposal outlines specific behavioral changes, and numerous medical schools have already pledged support. The AAMC’s proposal is a logical way to attack big pharma’s influence on the practice of medicine: teach fledgling doctors not to get involved with pharmaceutical company freebies, and perhaps they will continue to avoid conflicts of interest when they begin to practice.

AAMC’s proposal, if implemented, would supplement other efforts to reduce conflicts of interest in medical research and the medical profession in general. Conflict of interests in medical research are currently governed by a variety of authorities, including the “Common Rule” (45 C.F.R. part 46), FDA regulations, NIH, FDA and CDC oversight of research, National Science Foundation Grant guidelines, Medicare anti-kickback laws, the False Claims Act, and state conflict of interest laws. Pharmaceutical companies spend billions of dollars annually to influence the prescribing practices of physicians. The efforts of physician groups and institutions to self-regulate the influence of pharmaceutical companies in the medical profession may lead to further legislation in this area.

http://www.nytimes.com/2008/04/28/us/28doctors.html?_r=1&ref=health&oref=slogin

Reproductive Technology: Changing Fantasy and Reality

Posted on: April 27, 2008  |   Author: Amanda
Filed Under: Center for Health Law Studies Symposia, Other, Technology   |   Comments Off

A Commentary on Judith Daar’s Presentation

It started with a current story—Oprah’s male guest who is pregnant. A fantasy in most people’s minds, but what is now a reality being flashed across every news station. In reality, however, the guest on Oprah had gone through a sex change operation early in his life, but he had kept his female reproductive organs as he knew that some day he wanted to have a baby. He married, and later he and his wife decided that they wanted to have a child of their own. His wife having had a hysterectomy could not carry the child, so the pregnancy fell on the husband. This story is just one of many used to exhibit the non-traditional conception of a child using assistive reproductive technology, and the use of reproductive technology is making the fantasy of a pregnant man become a reality.

One such method of reproductive technology is in vetro fertilization (IVF), which is very successful. Using 2005 data (because of the lag time between pregnancy and birth), the United States experienced 52,041 births after the woman used the IVF process and about 60,000 births using artificial insemination. That is almost 3% of all the births in the United States, which is far greater than families formed by adoption. Ms. Daar commented that in about twenty years 3 out of every 100 law students that would sit in her class met life through these artificial methods. Reproductive technologies will become integrated into popular culture, and the increasing efficiency and use of reproductive technology make it imperative to discuss (and perhaps change) the definition of “healthy” in the era of reproductive technology.

However, the use of these reproductive technologies is generally accepted by society, but the method of choosing a child’s genetic composition through Pre-Implantation Genetic Diagnosis (PGD) is commonly debated.

It is understood and accepted that most parents want the best for their child. Under this assumption, a parent would choose the best environment for the child to ensure that he grows up to become a successful and productive member of society, and society would not have an objection to the parents choosing this environment. What then is the difference with parents choosing the best genetics for their child to prevent that child from suffering from a serious disease?

Using PGD, a parent may be able to deselect a genetic disorder; thereby, making it easier to know if a child will be “healthy.” However, some concerns/questions surround this opportunity. The first question is in regards to adult onset diseases. Should these diseases distinguish a child or should we look to therapeutic methods rather than a move to a model that will eliminate a disease? The second concern surrounds the orphaning of a certain disease. Should a parent be able to use PGD to deselect mild anomalies? Under this concern, Ms. Daar presented a very interesting fact—Eight percent of those parents who receive an amniocenteses choose an abortion if the child has Down syndrome. If the use of PGD is expanded to detect mild anomalies, will the percentage of parents who choose to abort the fetus be as high or higher? If so, are we using PGD for the right reasons? Finally, there is the expressive argument to using PGD to produce a “healthy” child. The use of PGD will increase the stigmatization of those with a disability and increase the discrimination of these anomalies, especially since PGD is expensive and these children will already (most likely) be low income.

The second opportunities surrounding PGD is its uses to determine and choose a “savior sibling,” or the selection of one embryo for the health of another child. Does a parent have the duty to save a child whether or not that means creating another child or the parent simply using the second child as a means to an end?

The third opportunity for using PGD is to satisfy parental choice. Here, Ms. Daar used an example of a deaf, lesbian couple using PGD to select only embryos that carry the deaf gene. Therefore, they argue allowing them to be the best parents that they can be for their child. However, is this a clash of the medical model (disease) versus the social model (culture) with which the couple and society will grapple?

Should the same rules apply to pre-birth decision making as they do to post-birth parental decision-making? Ms. Daar argues yes. All parents want is to maximize the child’s well-being; therefore, the same rules should apply. When the fantasy of dinner and a movie is no longer reality, many things in society will have to change with the new reality of assistive reproductive technology, including the definition of healthy.

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