Thursday, March 27, 2008

BMJ Paper on Tackling Aging

My Commentary Analysis entitled "Has the Time Come to Take on Time Itself?" has been accepted for publication in the British Medical Journal.

That paper should be out in print within the next two months or so. This article will be my second published contribution on the topic of retarding human aging (the first being this one). I have a few more forthcoming and in the works. For now, here is a brief abstract for this forthcoming BMJ paper:

In an era where media headlines are dominated by the war on terror and global warming, and much of the world’s population live in conditions of poverty and disease, one might feel it is insensitive and unfair to suggest that we should divert more scarce public funding into the goal of tackling aging. But such a knee-jerk reaction can be overcome once one considers the science, and the ethics, behind the proposal.


Tuesday, March 25, 2008

Harm of Secondhand Smoke

The World Health Organization has this interesting report on the Global Tobacco Epidemic. Here are the 10 facts they list about the tobacco epidemic:

Tobacco is the leading preventable cause of death in the world. It causes 1 in 10 deaths among adults worldwide. In 2005, tobacco caused 5.4 million deaths, or an average of one death every 6 seconds. At the current rate, the death toll is projected to reach more than 8 million annually by 2030 and a total of up to one billion deaths in the 21st century.

Second-hand tobacco smoke is dangerous to health. It causes cancer, heart disease and many other serious diseases in adults. Almost half of the world's children breathe air polluted by tobacco smoke, which worsens their asthma conditions and causes dangerous diseases. At least 200 000 workers die every year due to exposure to second-hand smoke at work.

And the latest issue of the American Journal of Public Health has a Research and Practice study on the effects of secondhand smoke by Heather Wipfli et. al. Here is the abstract:

Secondhand Smoke Exposure Among Women and Children: Evidence From 31 Countries By Heather Wipfli et. al

Objectives. We sought to describe the range of exposure to secondhand smoke (SHS) among women and children living with smokers around the world and generate locally relevant data to motivate the development of tobacco control policies and interventions in developing countries.

Methods. In 2006, we conducted a cross-sectional exposure survey to measure air nicotine concentrations in households and hair nicotine concentrations among nonsmoking women and children in convenience samples of 40 households in 31 countries.

Results. Median air nicotine concentration was 17 times higher in households with smokers (0.18 µg/m3) compared with households without smokers (0.01 µg/m3). Air nicotine and hair nicotine concentrations in women and children increased with the number of smokers in the household. The dose–response relationship was steeper among children. Air nicotine concentrations increased an estimated 12.9 times (95% confidence interval=9.4, 17.6) in households allowing smoking inside compared with those prohibiting smoking inside.

Conclusions. Our results indicate that women and children living with smokers are at increased risk of premature death and disease from exposure to SHS. Interventions to protect women and children from household SHS need to be strengthened.

It's tragic that smokers not only endanger their own lives by continuing to smoke, but they also endanger the health prospects of their loved ones.


Monday, March 24, 2008

Science Editorial on Importance of Science Education

The latest issue of Science has a really powerful, sage editorial by Bruce Alberts. Alberts' message is one I think we really need to take seriously (and I would also add Richard Dwakins's message to this as well).

I think Alberts's message is an especially important one for political philosophers to hear. For the dominance of respect for multiculturalism and value pluralism has dulled the critical edge of too many (potential) social critics. The true stakes of these debates are often trivialized when framed as a debate about respect for "pluralism". It wasn't that long ago that people believed the world was flat, and many still believe that men and women are unequal. And yet the purported value of respecting such pluralism is dwarfed by the benefits of overcoming them. Overcoming false beliefs and dogma is necessary for lasting and significant social progress. And there is still a long ways to go before we can emancipate humanity from dogma and prejudice (recall this troubling survey).

Education about science impacts many dimensions of our social lives, from our ability to tolerate others to the speed of advances in science, medicine and economic prosperity. Given how high the stakes are, it is a sad reflection on the state of contemporary political philosophy that a huge divide separates science and political philosophy. But perhaps if enough philosophers listen to the message of people like Alberts, then things could change. Here is a sample from his editorial:

The scientific enterprise has greatly advanced our understanding of the natural world and has thereby enabled the creation of countless medicines and useful devices. It has also led to behaviors that have improved lives. The public appreciates these practical benefits of science, and science and scientists are generally respected, even by those who are not familiar with how science works or what exactly it has discovered.

But society may less appreciate the advantage of having everyone aquire, as part of their formal education, the ways of thinking and behaving that are central to the practice of successful science: scientific habits of mind. These habits include a skeptical attitude toward dogmatic claims and a strong desire for logic and evidence. As famed astronomer Carl Sagan put it, science is our best "bunk" detector. Individuals and societies clearly need a means to logically test the onslaught of constant clever attempts to manipulate our purchasing and political decisions. They also need to challenge what is irrational, including the intolerance that fuels so many regional and global conflicts.

So how does this relate to science education? Might it be possible to encourage, across the world, scientific habits of mind, so as to create more rational societies everywhere? In principle, a vigorous expansion of science education could provide the world with such an opportunity, but only if scientists, educators, and policy-makers redefine the goals of science education, beginning with college-level teaching. Rather than only conveying what science has discovered about the natural world, as is done now in most countries, a top priority should be to empower all students with the knowledge and practice of how to think like a scientist.

Scientists share a common way of reaching conclusions that is based not only on evidence and logic, but also requires honesty, creativity, and openness to new ideas. The scientific community can thus often work together across cultures, bridging political divides. Such collaborations have mostly focused on the discovery of new knowledge about the natural world. But scientists can also collaborate effectively on developing and promulgating a form of science education for all students that builds scientific habits of mind.

Recall, from my earlier post, how high the costs are when we combine political power with dogma. So we cannot afford to neglect the importance of science education.


Sunday, March 23, 2008

Enhancing Skeletal Muscle Mass and Strength

The latest issue of PNAS has this article about a promising genetic therapeutic for improving skeletal muscle mass and strength. Here is the abstract:

"Long-term enhancement of skeletal muscle mass and strength by single gene administration of myostatin inhibitors"
By Amanda M. Haidet et. al.

Increasing the size and strength of muscles represents a promising therapeutic strategy for musculoskeletal disorders, and interest has focused on myostatin, a negative regulator of muscle growth. Various myostatin inhibitor approaches have been identified and tested in models of muscle disease with varying efficacies, depending on the age at which myostatin inhibition occurs. Here, we describe a one-time gene administration of myostatin-inhibitor-proteins to enhance muscle mass and strength in normal and dystrophic mouse models for >2 years, even when delivered in aged animals. These results demonstrate a promising therapeutic strategy that warrants consideration for clinical trials in human muscle diseases.


Thursday, March 20, 2008

Money and Happiness

They say "money can't buy happiness". Well, this report in the latest issue of Science suggests that spending money on others can actually promote one's happiness. Here is the abstract:

Spending Money on Others Promotes Happiness
Elizabeth W. Dunn et. al.

Although much research has examined the effect of income on happiness, we suggest that how people spend their money may be at least as important as how much money they earn. Specifically, we hypothesized that spending money on other people may have a more positive impact on happiness than spending money on oneself. Providing converging evidence for this hypothesis, we found that spending more of one's income on others predicted greater happiness both cross-sectionally (in a nationally representative survey study) and longitudinally (in a field study of windfall spending). Finally, participants who were randomly assigned to spend money on others experienced greater happiness than those assigned to spend money on themselves.


Bad Government 101: Lessons to be Learned from the Bush Administration

The following are two popular (though contrary) sayings:

"Experience is the best teacher"

"History has a way of repeating itself!"

I seldom comment on contemporary politics on this blog, but today I want to make an exception. I was motivated to write this post by a number of factors. One major impetus has been my interest in the hotly contested, and sometimes inspirational, Democratic race going on between Obama and Clinton. While many commentators have suggested that dragging out this contest could harm the Democratic Party I think its likely impact will be the opposite. To have the nightly news dominated by issues like gender and race is a welcome (and long overdue!) distraction from the almost exclusive media coverage that has been given to the "war on terror" and the fear instilled by 9/11. So to watch CNN's Lou Dobbs partaking in a humane debate about racial tensions in American (rather that his usual tirade against immigration and the outsourcing of jobs) suggests, at least to an outsider like me , that it is reasonable to assume that the Democratic race could have a significant positive impact on American culture. If nothing else, it might help awaken Americans from the haze of fear and despair that has taken hold since 9/11.

The primary goal of this post is not to critique the Bush Administration (which would be an obvious and uninteresting contribution) nor do I intend to offend or chastise Americans. Rather my aim is more positive, and it aspires to help us (all of us, not just Americans) live up to the sage insight that "experience is the best teacher".

If we can learn from the mistakes of the past 8 years of the Bush Administration then perhaps this period of American history will serve as a useful reminder of how high the stakes of good government really are, and that we can not become complacent about this issue. And so I offer some brief reflections on two central policy decisions that the Bush Administration has pursued which effectively reveal the dangers of a government that lacks a sense of proportionality and is guided by dogma. The combination of these two things can be devastating for the citizens of a polity. So let me highlight why by reflecting on the war on terror and Bush's veto of the stem cell bill.

When assessing these two issues I want to limit my examination to concerns of just domestic justice. In other words, the impact the war on terror and stem cell research have had on the lives of Americans (rather than the impact on the world in general). This is something all Americans should consider as they deliberate about the future direction of their country.

As I noted in many previous posts, all societies face many, many problems. There is crime, traffic accidents and congestion, natural disasters, risk of infectious disease, terror attack, obesity, etc. Humans are intrinsically vulnerable, and thus if we want to derive some sage general insights concerning what constitutes a just government (and society), we really need to start at the level of non-ideal theory.

So how should a government go about prioritizing among the many, many problems that it could address. There are concerns about terror attacks, global warming, disease (e.g. cancer), poverty, etc. After 9/11 the Bush Administration decided to make the "war on terror" the #1 priority of America. This was in direct response to the attacks on 9/11. The costs of the war on terror (from 2001-2117), according to this estimate, will be approximately $2.4 trillion ($21,500 per American household).

And so the question to ask is this: how wise was this investment? The attacks of 9/11 resulted in almost 3000 deaths. And yet 300,000 U.S. deaths a year are associated with obesity and excess weight (see here). Furthermore, 400,000 deaths a year are associated with cigarette smoking (which has enormous costs in terms of human lives and direct and indirect costs to the economy). But a war on obesity and tobacco have not been concerns of the Bush Administration. Bill Clinton, by contrast, has done a lot to emphasis the importance of tackling obesity, especially childhood obesity. And Al Gore has been a vocal critic of the tobacco industry. Here is an excerpt from his passionate 1996 speech at the Democratic Convention, one of the most inspirational political speeches I have ever heard:

Some of the most powerful forces that do the most harm are often hard to see and even harder to understand. When I was a child, my family was attacked by an invisible force that was then considered harmless. My sister Nancy was older than me. There were only the two of us and I loved her more than life itself. She started smoking when she was 13 years old. The connection between smoking and lung cancer had not yet been established but years later the cigarettes had taken their toll.

It hurt very badly to watch her savaged by that terrible disease. Her husband, Frank, and all of us who loved her so much, tried to get her to stop smoking. Of course she should have, but she couldn't.

When she was 45, she had a lung removed. A year later, the disease had come back and she returned to the hospital. We all took turns staying with her. One day I was called to come quickly because things had taken a turn for the worse.

By then, her pain was nearly unbearable, and as a result, they used very powerful painkillers. And eventually it got so bad they had to use such heavy doses that she could barely retain consciousness. We sometimes didn't know if she could hear what we were saying or recognize us.

But when I responded to that call and walked into the hospital room that day, as soon as I turned the corner - someone said, "Al's here" - she looked up, and from out of that haze her eyes focused intensely right at me. She couldn't speak, but I felt clearly I knew she was forming a question: "Do you bring me hope?"

All of us had tried to find whatever new treatment or new approach might help, but all I could do was to say back to her with all the gentleness in my heart, "I love you." And then I knelt by her bed and held her hand. And in a very short time her breathing became labored and then she breathed her last breath.

Tomorrow morning another 13-year-old girl will start smoking. I love her, too. Three thousand young people in America will start smoking tomorrow. One thousand of them will die a death not unlike my sister's, and that is why, until I draw my last breath, I will pour my heart and soul into the cause of protecting our children from the dangers of smoking.

And that is also why I was intensely proud last week when President Clinton stood up for American families by standing up to tobacco advertising aimed at getting our children addicted. He proposed - he proposed the first-ever comprehensive plan to protect children from smoking; to ban tobacco advertising aimed at our children, and to ban it for good.

Contrast the compassion and insight of Gore's comments with Bush's speech on the War on Terror almost a decade later:

The terrorists in Iraq share the same ideology as the terrorists who struck the United States on September the 11th. Those terrorists share the same ideology with those who blew up commuters in London and Madrid, murdered tourists in Bali, workers in Riyadh and guests at a wedding in Amman, Jordan. Just last week they massacred Iraqi children and their parents at a toy giveaway outside an Iraqi hospital.

This is an enemy without conscience, and they cannot be appeased. If we're not fighting and destroying this enemy in Iraq, they would not be idle. They would be plotting and killing Americans across the world and within our own borders. By fighting these terrorists in Iraq, Americans in uniform are defeating a direct threat to the American people.

Against this adversary there is only one effective response: We will never back down, we will never give in, and we will never accept anything less than complete victory.

So both a war on smoking and a war on terror seek to save American lives. And to determine how sage waging either war is one must consider what the costs (in both human lives and to the economy) of both inaction and intervention will be and the likelihood of success. To do this government must have (in addition to credible empirical facts) a sense of proportionality, and this comes from having a competent grasp of the "big picture" of things. Many things kill Americans. Americans are much more likely to die from an unhealthy diet or smoking than they are from a terrorist attack. Furthermore, tackling obesity and smoking are more cost-effective measures than invading other countries. And so the lesson to be learned from the response to 9/11 is that it is imperative to keep things in perspective, and respond in a proportionate fashion. The money spent on the war on terror is money that could have been spent on other laudable goals. Goals that would have saved more American lives and increased American prosperity.

And so Bush's track record fails even the benchmarks he outlined with his philosophy of compassionate conservatism. A central commitment of that philosophy was that the government would only spend money on those things it could actually achieve. And so one can ask if the benefits of the war on terror are proportionate to the costs of the war. And I think it is fair to say that, of the various things the Bush administration could have done to improve the health prospects of Americans, the war on terror was way down the list in terms of cost-effective interventions.

The second policy issue I want to draw attention to concerns Bush's decision to veto the Stem Cell Bill. Recall my earlier post here. In September 2006 Bush vetoed the embryonic stem-cell bill, a bill that both the House of Representatives and the Senate supported. When explaining his decision to veto the bill Bush replied: "It crosses a moral boundary that our decent society needs to respect. So I vetoed it." The real tragedy of Bush's contempt for science and democracy is that those who will pay the highest price are among the most vulnerable Americans- citizens afflicted with diseases like Parkinson's disease. And so once again we can ask about proportionality in this case- how many American lives has Bush's decision saved vs how many it will likely kill? And once again the numbers are stacked up against Bush's decision. The embryos used for this scientific research would not become real people anyways (barring someone agreeing to have the embryo implanted in their uterus and even then there is no guarantee that this would result in a live birth). Of course there is no guarantee that stem cell research will result in effective medical interventions. But there is a credible scientific basis for this belief. Bush's decision was not based on an informed and humane sense of proportionality, it was based on dogma. And so the second lesson to be learned from the Bush Administration is that power and dogma make for a very dangerous combination.

So this completes my brief lecture on Bad Government 101. If there is any truth to the motto "Experience is the Best Teacher" then the past 8 years of American politics should prove very valuable to all of us. And we should remain optimistic that the next President of the United States will help inspire the best of the American people and culture.


Wednesday, March 19, 2008

Nature Article on Prisoner's Dilemma

The latest issue of Nature has an interesting article on punishment and the Prisoner's Dilemma here. Here is the abstract:

Winners Don't Punish
By Anna Dreber et. al.

A key aspect of human behaviour is cooperation. We tend to help others even if costs are involved. We are more likely to help when the costs are small and the benefits for the other person significant. Cooperation leads to a tension between what is best for the individual and what is best for the group. A group does better if everyone cooperates, but each individual is tempted to defect. Recently there has been much interest in exploring the effect of costly punishment on human cooperation. Costly punishment means paying a cost for another individual to incur a cost. It has been suggested that costly punishment promotes cooperation even in non-repeated games and without any possibility of reputation effects. But most of our interactions are repeated and reputation is always at stake. Thus, if costly punishment is important in promoting cooperation, it must do so in a repeated setting. We have performed experiments in which, in each round of a repeated game, people choose between cooperation, defection and costly punishment. In control experiments, people could only cooperate or defect. Here we show that the option of costly punishment increases the amount of cooperation but not the average payoff of the group. Furthermore, there is a strong negative correlation between total payoff and use of costly punishment. Those people who gain the highest total payoff tend not to use costly punishment: winners don't punish. This suggests that costly punishment behaviour is maladaptive in cooperation games and might have evolved for other reasons.

I always knew that Peter Kropotkin was ahead of his time! Maybe these empirical studies will motivate political theorists to revive Kropotkin's ideas and insights. If I had more time that would be a project I myself would be interested in pursuing. But alas, time is becoming more and more of a scarce commodity. So little time, so many things to ponder!


Thursday, March 13, 2008

Risk of Harm in Sport

Almost everything we do in life poses some risk of harm to ourselves or others. Every time you get into your car there is a chance you will get in an accident. The same applies when you walk across the street or board an airplane. Undergoing a medical procedure has some risk of harm, as does taking a prescription drug. Even mundane activities like walking down a stairway or getting out of the bath could result in an injury ....

When faced with such an onslaught of risks of harm we need to think rationally about responsible risk management.

On Monday my "Genetics and Justice" class will be discussing the President's Council of Bioethics Report on "Beyond Therapy". And chapter 3 of that report deals with "Superior Performance". This is a timely topic given the current attention (from the Tour De France to the Mitchell report in MLB) that has been given to the issue of enhancing performance drugs in sport.

The issue of enhancements and sport is a fascinating topic. And as I was preparing things for my class on Monday I came across a series of interesting videos (like this one) that you can find on You Tube. The full debate is available from the Intelligence Squared US site here.

This debate, hosted by Bob Costas, focused on the following suggestion: "We Should Accept Performance-enhancing Drugs in Competitive Sports"

Now this question raises a diverse range of issues, like what the value of sport is, etc. But perhaps the most obvious reaction people are likely to have against permitting performance-enhancing drugs is that it poses a risk of harm to the athlete (and thus should be banned). At one point in his argument against this point Julian Savulescu makes the great rejoinder that sport is inherently risky, and so pointing out that some enhancements pose a risk of harm is not sufficient for claiming they (rather than other risky things) should be banned from sport.

There are many ways of making the point that sport poses a risk of harm to athletes. Firstly, just ask yourself if you have ever suffered an injury while playing a sport. No doubt the answer is "yes!". Indeed, if you are serious about sport you may have even suffered a major injury. Growing up in a family that was active in sport I have always been aware of the risks sport poses to our health (though this risk is much smaller that the risks of being inactive!).

I myself was never a serious athlete but my sister was a competitive swimmer (until she suffered a serious shoulder injury) and my father was in the 1976 Olympics for racewalking (an activity that put a lot of strain on his knees). This study here, for example, examines the risks of injury with racewalking and it notes that those who train 6 or 7 times a week have a much higher risk of injury than those who only train 3 or less times a week. And this perfectly illustrates the dilemma facing our decision about permitting performance enhancing drugs: how much risk of harm should we allow athletes to pursue in their quest to be the best? Training only 3 times a week is safer but if others train 6 times a week they will have a competitive advantage. So if you want to win races you will train almost every day (even though it poses a higher risk of harm).

One could accumulate endless statistics of this sort noting how many injuries (and deaths) occur in various sports. But to really capture this point few things match the drama and vividness of visual images. And so I will show my class the following videos which I gathered from You Tube which show the risk of harm in certain sports.

Now just a word of warning..., these videos are not for the squeamish. But they effectively reveal the point that we already tolerate some pretty serious risks of harm for athletes. No doubt these risks vary depending on the sport in question. Boxing, for example, is a brutal sport with obvious risks (e.g. brain damage). But even something like cheerleading can pose significant risks of harm (as is evident in the last video below).

So here are the videos:

(1) The first is the tragic video of the death of race car driver Dale Earnhardt in 2001.

(2) This video, obviously put together by a boxing fan with an unhealthy appetite for seeing pain inflicted on other human beings, effectively illustrates the brutality of the sport.

(3) This video captures the horrific accidents that frequent skiing.

(4) And finally this tragic live News video captures the dangers of cheerleading. This ABC NEWS story notes that a recent study found that 16,000 cheerleaders get injured every year doing stunts and tumbles.

Is there a difference between allowing boxers to repeatedly receive blows to their heads, and skiers to fall at perilous speeds down steep mountains and permitting an athlete to boost their performance by taking performance enhancing drugs in pursuit of athletic excellence? It's a tough question, one we cannot answer without a great deal of empirical facts concerning the likely risks of activities we already tolerant (like those in the videos above) and the risks of things like steroids and gene doping. It is arbitrary to simply ban certain risky actions but tolerate those that pose an even more significant risk of harm.

So to answer the ""Should We Accept Performance-enhancing Drugs in Competitive Sports?" question we really need to answer the question: "How much risk of harm should we tolerate in sport?" and then try to figure out where different kinds of performance-enhancing drugs fit in this picture (e.g. below or above that risk threshold). Answering this question would also permit us to re-think those risks we currently tolerate (but should not), especially in brutal pursuits like boxing.


Wednesday, March 12, 2008

Thinking Outside the Box

We face numerous challenges as we aspire to promote our health prospects. Humans are intrinsically vulnerable to disease. In some cases we do not (at least yet) know how to effectively treat or cure certain diseases. There is currently no cure for cancer, or Huntington’s disease, Parkinson’s, etc. But we soldier on, searching for new ways to mitigate the often tragic consequences of our biological vulnerabilities.

And yet in other cases we already know that there are certain preventative measures people could pursue that would reduce disease and extend the number of healthy years they enjoy. For example, limiting the consumption of alcohol, quitting smoking, consuming a healthy diet, exercise, etc. All these things would reduce the risk of disease, and if everyone did them the benefits (to our health and economy) would be enormous. And yet people don’t do this. Despite knowing the things we know, smoking still kills millions every year, and obesity is a global epidemic.

So getting people to actually pursue the course of actions that could extend their health prospects can be tricky. The real value of particular interventions largely depends on the *likelihood* that they will have the desired benefit. And so knowing that intervention X can promote our health is only part of the battle. Getting people to utilize X can also be a challenge. And as this recent NICE report illustrates, these challenges can be very formidable.

What got me thinking about these issues? The latest issue of The Lancet has an interesting study (of a phase 2 clinical trial) on a new vaccination for hypertension. You can listen to the podcast here.

According to this report from the World Health Organization, hypertension is estimated to cause 4.5% of the current world disease burden and is almost equally prevalent in both developed and developing countries. And in the summary of this WHO report it is noted that: “Whereas the treatment of hypertension has been shown to prevent cardiovascular diseases and to extend and enhance life, hypertension remains inadequately managed everywhere”.

So even though we know that changes in lifestyle (e.g. diet and exercise) can help reduce the risk of hypertension, this environmental intervention is only effective if people actually comply with these guidelines. And many of us do not. Should we try harder? “Yes!” But at the same time, we need to entertain the prospect that other, less burdensome, interventions might also be available. And if they increase the likelihood of the benefit in question (i.e. reducing risk of disease) being realized then we should pursue them.

I was really struck by the fact mentioned in The Lancet Podcast, that when it comes to just taking drugs to treat hypertension, 50-80% of patients fail to take their recommended prescriptions. So even something as basic and simple as taking a pill can prove to be a formidable obstacle (forget about getting people to exercise and watch what they eat!).

And these kinds of considerations are a large part of the reason why I think we really need to take seriously the prospect that the biological manipulation of humans may prove to be a very effective way of expanding our health prospects. The less burdensome the measure, the more likely it is that the expected benefits would be realized. Though of course we have a very long way to go in terms of the safety and efficacy of new interventions like genetic manipulation. But the burdensomeness of an intervention is extremely important. And those who eschew new biotechnologies by saying “People just need to eat better and exercise!” are, in my opinion, not giving these complex issues due consideration. Redesigning our cities, to make them more conducive to human health, could prove to be an even bigger challenge than modifying our biology!

So, this all ties in with The Lancet article as researchers are exploring the prospects of a vaccine for hypertension. And this is somewhat similar to the imaginative strategies being pursued with resvertraol and the treatment of diabetes. The moral of the story: “we shouldn’t limit ourselves in terms of the strategies we consider for promoting human health!”. Few recognized the magnitude of the health benefits of the sanitation revolution when it was occurring in the 19th century. And I suspect the same might be true of the genetic revolution in this century.


Monday, March 10, 2008

Interesting Globe Story on Vitamin D

When the weather is as cold and snowy as it has been this past week it is nice to think of the warm and sunny days to come. And so I want to blog (yet again!) about the importance of the sun for human health and well being. My previous posts have noted the purported benefits and harms of sun exposure. Today's Globe and Mail has this fascinating story on vitamin D. I find the story of vitamin D and sun exposure interesting for a number of reasons.

Firstly, it reveals how complex the relationship between our environment and our well being is. Of course there are often obvious ways in which we see the impact our environment can have, like when there is a drought and this destroys a harvest. But even the brutal snow storm Ontario experienced this past weekend can have an adverse impact on our health (e.g. increasing the number of serious falls, increased car accidents, delays getting to the hospital, impact on our mood, physical activity, etc.), not to mention the costs of snow removal, delays travelling, etc. For example, this story notes that, for the city of Toronto alone, the clean-up cost of this latest storm was about $4 million and as of late last week, the city had already spent $40 million of its $67 million snow budget for the year.

A second reason why I am really interested in the story of sun exposure and vitamin D is that it reveals how provisional we should be about complex empirical matters, even those things that are taken to be established parts of the medical orthodoxy. Too much exposure to the sun, for example, can be harmful. It can increase the risk of skin cancer. But we must also be aware of the possibility that harms (e.g. increased risk of other types of cancer) can result from lack of sun exposure. And the real challenge is to find what constitutes a reasonable balance between these two potential dangers. And this is were the story of taking vitamin D is interesting. When assessing the potential harms of pursuing something we must also consider the potential harms of not doing anything. So the story of vitamin D supplements illustrates the importance of evolutionary history and the complex challenges we face in trying to pursue responsible risk management.

Here is a sample from the Globe story:

In the summer of 1974, brothers Frank and Cedric Garland had a heretical brainwave.
The young epidemiologists were watching a presentation on death rates from cancer county by county across the United States. As they sat in a lecture hall at Johns Hopkins University in Baltimore looking at the colour-coded cancer maps, they noticed a striking pattern, with the map for colon cancer the most pronounced.
Counties with high death rates were red; those with low rates were blue. Oddly, the nation was almost neatly divided in half, red in the north and blue in the south. Why, they wondered, was the risk of dying from cancer greater in bucolic Maine than in highly polluted Southern California?

...It seems almost inconceivable that geography could damn someone to a life-threatening illness - that the mere fact of living in a northern country such as Canada could be a health hazard.

...The idea behind the research is simple: Humans evolved in a sunlight-filled environment near the equator, and still have countless biological processes exquisitely calibrated to the rich vitamin D levels we would have if we were still basking under the hot sun year-round.

But by migrating to higher latitudes, where strong sunlight is not present during the fall and winter, most humans upset their vitamin D metabolism, creating susceptibilities to chronic ailments that research is now linking to insufficiencies.

...One study, in the journal Circulation, found that those with low vitamin D status had a 62-per-cent increased risk of heart failure. Another, published in Archives of Internal Medicine, found that those who take vitamin D supplements cut mortality risk by 7 per cent. A third report, by scientists at the U.S. National Cancer Institute, found that, while vitamin D didn't affect overall cancer-death risk, those with relatively high levels of it in their blood had a 72-per-cent lower risk of dying from colorectal cancer.

Other studies have found that low blood levels are an excellent predictor of who goes on to develop cancer and heart disease and that people diagnosed with cancer during the vitamin D-rich summer have a better prognosis than those diagnosed during winter.

...But even though Ms. Logan says the Canadian Cancer Society agrees that all the science on vitamin D may not be in yet, evidence to date strongly suggests that not acting on the implications of the research is risky. Cancers affected include such big killers as breast, prostate and colon, which will claim more than 10,000 Canadians this year.

"You don't need to wait for every scientific question to be answered before you take action," Ms. Logan says. "Where there is evidence of harm, even in the face of scientific uncertainty, you should do something about it."


Friday, March 07, 2008

Genes and Our Evolutionary History

Over on my right "Links" sidebar you will find a link to the informative and entertaining video on "Becoming Human". The video tells the amazing story of our evolutionary development, a story spanning over 4 million years.

The latest issue of PNAS has this interesting article which examines the genetic underpinnings of key phenotypic features that are distinctive of humans, like our enlarged cerebral cortex and long life spans.

Appreciating the complex interaction between our biology and our environment is important for a variety of reasons. Understanding how we arrived at the situation we are now at helps us appreciate how incredible the achievement of just being here is in the first place! But it also helps us appreciate the possibilities that may be open to us as we aspire to push human evolution into new frontiers through the application of new biomedical interventions (like gene therapy or enhancement). Frontiers that go further than the current limitations we have inherited from our evolutionary past.

We live in truly fascinating times. And this article in the latest issue of PNAS further illustrates how fast things are moving in terms of putting together the pieces of our evolutionary past. Here is the abstract:

"Distinct genomic signatures of adaptation in pre- and postnatal environments during human evolution"
By Monica Uddin, et. al.

The human genome evolution project seeks to reveal the genetic underpinnings of key phenotypic features that are distinctive of humans, such as a greatly enlarged cerebral cortex, slow development, and long life spans. This project has focused predominantly on genotypic changes during the 6-million-year descent from the last common ancestor (LCA) of humans and chimpanzees. Here, we argue that adaptive genotypic changes during earlier periods of evolutionary history also helped shape the distinctive human phenotype. Using comparative genome sequence data from 10 vertebrate species, we find a signature of human ancestry-specific adaptive evolution in 1,240 genes during their descent from the LCA with rodents. We also find that the signature of adaptive evolution is significantly different for highly expressed genes in human fetal and adult-stage tissues. Functional annotation clustering shows that on the ape stem lineage, an especially evident adaptively evolved biological pathway contains genes that function in mitochondria, are crucially involved in aerobic energy production, and are highly expressed in two energy-demanding tissues, heart and brain. Also, on this ape stem lineage, there was adaptive evolution among genes associated with human autoimmune and aging-related diseases. During more recent human descent, the adaptively evolving, highly expressed genes in fetal brain are involved in mediating neuronal connectivity. Comparing adaptively evolving genes from pre- and postnatal-stage tissues suggests that different selective pressures act on the development vs. the maintenance of the human phenotype.


Monday, March 03, 2008

Gene Patents Paper Now Published

My paper "Gene Patents and Justice" is now available in the latest issue of the Journal of Value Inquiry. This paper brings together my interests in genetic justice and my interests in the methodological debates concerning ideal vs non-ideal theory. If we want to think sensibly about how we can help some of the most disadvantaged individuals in our societies then we must acknowledge the potential pros and cons of intellectual property rights. And in this paper I attempt to show how a moral analysis of gene patents cannot rely simply on conceptual commitments to liberty or equality. Rather we need to tackle the complex empirical issues that arise concerning the purported efficiency and inefficiency of gene patents and their impact on the life prospects of the genetically disadvantaged. Here is a sample:

Intellectual property rights over a finite number of human genes is arguably one of the most important and challenging issues facing policy makers and society in general. Nearly twenty percent of human genes are explicitly claimed as American intellectual property. This represents 4, 382 of the 23, 688 genes in The National Center for Biotechnology Information gene database (Jensen and Murray, 2005) . Patents grant the patentee with rights to exclude others from making, using, selling, offering for sale, or importing patented items for twenty years. Are such rights morally justified? Like the issue of private property in general, we can expect that libertarians and egalitarians will come to different conclusions concerning the stance they will likely take on the issue of gene patents. These conclusions will stem for the different priority libertarians and egalitarians give to the values of liberty and equality, respectively. Libertarians take property rights to be the foundation of a theory of justice; they believe that private property is a natural right. Gene patents are a form of property rights, thus gene patents should be permitted. Egalitarians, in contrast, might hold that the obvious policy to defend is one that prohibits gene patents. They may believe that our genes are part of the common heritage of humanity and thus genetic information should not be appropriated by private industries seeking to make a profit from what is collectively owned. Furthermore, egalitarians might believe that private appropriation of this information will impede our ability to ensure that all people who need genetic interventions will have access to them. The state of affairs that the egalitarian wants to avoid is that where only the rich have access to important therapies and enhancements. To permit gene patents would be to make such a state of affairs a reality.

The libertarian and egalitarian arguments are ill-equipped to help us tackle the central issue which currently dominates policy debates concerning gene patents - how robust genomic intellectual property rights should be. The theoretical position best suited for advancing serious debate about genetics and justice is prioritarianism. In order to take the issue of directly mitigating genetic disadvantage seriously, I argue we should adopt a pluralistic prioritarian position... Consideration must be given to the severity and pervasiveness of different forms of disadvantage, the costs of mitigating them, and the likelihood that the benefits of mitigation will be realised. The fundamental distributive principle that should regulate the development of new genetic technologies is the lax genetic difference principle which maintains that “inequalities in the distribution of genes important to the natural primary goods - health and vigour, intelligence and imagination - are to be arranged so that they are to the greatest reasonable benefit of the least advantaged (Farrelly, 2004).” When applied to the issue of gene patents, the lax genetic difference principle prescribes that there is a conditional moral presumption in favor of gene patents that satisfy a stringent utility requirement. Such a prescription gives due consideration to the interests of the genetically disadvantaged.

Addressing the issue of gene patents from a libertarian, egalitarian and prioritarian perspective helps to illustrate the insights, as well as the limitations, of a philosophical analysis of intellectual property rights. In addition to the weight we should accord to the values of liberty and equality, complex empirical and legal issues arise in the context of these debates, issues that philosophers may not be well suited to address. A defense of a pluralistic prioritarian theory of justice allows us to take the complexities seriously. We can begin to make some progress in terms of determining how stringent the duty to mitigate genetic disadvantage is. Unlike libertarianism, pluralistic prioritarianism provides us with an account of justice that allows us to take seriously the duty to mitigate genetic inequalities. Unlike egalitarianism, pluralistic prioritarianism allows us to balance the duty to mitigate genetic disadvantage with other competing demands of justice. Pluralistic prioritarianism does not require us to take the insular view that mitigating genetic disadvantage is the only requirement of justice. This is an important insight given the facts of pervasive disadvantage, scarcity and the important role environment plays in the development of disease and disadvantage.


Saturday, March 01, 2008

More Thoughts on the Virtue of "Acceptingness"

Last night I was reflecting some more on my previous post about "acceptingness" as a parental virtue. I suspect an important part of my unease could be addressed if we stipulated that virtuous parents ought only to be accepting of those things that are in fact beyond their influence or control but less so about those things that are not. So if we think in terms of Aristotle's idea of the mean, virtuous parents occupy the mean between the parent who says "hey, life is unpredictable so why bother to care for my children as there is no 100% guarantee my hard work and love will secure their flourishing!" versus the control freak parent who says "I want to control every specific detail of my child's life, even if this is impossible!". But I don't think the notion of "acceptingness" helps capture the idea that parental virtue occupies the mean, which I think is essential for a virtue theory. And this is so because I don't think most human characteristics are fixed and stagnant. That is why I have trouble thinking of "acceptingness" as a virtue.

Here is an example to illustrate my point. Suppose the following tragic accident occurs. A parent witnesses their child lose a leg in an accident with the lawn mower. In such a tragic scenario it is now true that the child possesses the characteristic of being a leg amputee. How does acceptingness play out in this context? Should a virtuous parent accept that this accident is just part of the unpredictable nature of life? In one sense "yes", but in another sense "no".

At the time of the accident the child could suffer much more than just the harm of losing a leg. They might also bleed to death without immediate medical treatment. So the parent will immediately seek medical intervention. Perhaps the parent can accept (after a few days) that the child's leg is lost, but they will not accept that the child's life may be lost. They will do everything they can to save their child's life (and leg if it is possible), no matter how small the chance of survival. And if the child does survive, the parent will help the child adapt to life with one functioning leg. "Accepting" that life is unpredictable and can result in tragic accidents does not mean mean a virtuous parent will not aspire to minimize the risks of harm where possible (and reasonable).

According to the account of parental virtue I want to endorse (see here), the question of whether acceptingness is a parental virtue depends on whether it makes sense to consider it a personal virtue. This is so, for me, because I premise parental love on self-love. A parent views their child as "another-self" (Aristotle NE 1161b19, 28).

So, is a virtuous agent "accepting" of their own characteristics? Well, maybe we should modify this a bit as a virtuous agent has humility and strives for, but may never attain, complete 100% virtue. So the more interesting question is: are those who are pretty much virtuous- but still less than perfect moral agents- and aspire to be yet even more virtuous, "accepting" of themselves?

My initial reaction is to say "no". We constantly strive to become more enlightened, more compassionate and understanding, etc. There never is a stage where we just say: "This is the way I am, so I don't need to grow or critically reflect any further!". No perfectly (or even just partially) virtuous agent would say this. Self-love entails a life-long commitment to critical self-reflection on how we live our lives. The same applies to the child-parent relationship, though as a child ages (and becomes an adult themselves) the dynamic of the parent-child relationship changes significantly. The parent's role becomes more "accepting" in the sense that, once their children possesses the capacities of autonomy, parents should restrain their desire to intervene (no matter how good willed their intentions might be). So maybe acceptance becomes more of a virtue when the parent and child are both adults? I'd have to think some more about that.

And perhaps acceptingness is also a personal virtue of sorts. It might help a virtuous agent deal with sudden life changes, like retirement, divorce or the death of a loved one. Or even not-so-sudden life changes, like a "mid-life" crisis. Accepting, for example, the human life cycle, and our own inevitable decline of physical capacities (e.g. reproductive functions, levels of vitality, etc.).

However, this does not lead us in the direction of not trying to mitigate, or postpone, these things if this is possible. Physical exercise and diet, for example, can expand our health span. And the more I think about these issues the more I see how they relate to another ongoing interest of my-- the duty to retard human aging. Maybe I'll say more about the link between these two things on another occasion. But I do think part of the unease some have with the aspiration to retard human aging is that it goes against the notion of "acceptingness". However, once we understand that aging is not immutable, AND we are clear on what virtues follow from self-love, then I don't think we will feel this unease. But a fuller examination of these issues will have to wait for another day!