Category Archives: health

All Posts, ethics, health, justice, science

WOULD YOU LIKE TO CHANGE YOUR GENES?

Today I’m introducing epigenetics, a subject that will soon be added to our list of scientific and ethical debates.  Few of us know the word or its meaning, but this emerging branch of science already affects our lives in many ways.

We know that genetic makeup inherited from our parents and nurture provided by families and society are powerful influences on our development.  Epigenetics has demonstrated that environmental factors continuously adjust how our genes affect us. Ethical and legal questions will arise as we learn to manipulate how genes are expressed. Before those discussions begin, we’ll need to understand the possibilities that may unfold.

Every cell in an organism contains the same genes but natural epigenetic stimuli tell cells in a fetus to differentiate into skin, eyes and so forth.  Many kinds of internal and external events can stimulate genes to activate or deactivate.  External factors including nutrition, stress, climate and chemicals have been demonstrated to cause epigenetic change.  In some cases this creates identifiable “tags” on genes.

We have long known that taking certain chemicals into our bodies can cause cancer, addiction, and other health problems but we didn’t understand how it happened.  Now it appears that epigenetic change can cause of some kinds of cancer, diabetes and other illnesses. There are also adaptive and useful epigenetic changes. Here are some examples.

In rat colonies with a safe environment and plentiful food, baby rats (called pups) that have attentive mothers who lick and groom them a lot tend to mature as calm, relaxed adults with high social standing and long life expectancy.  Pups with less attentive mothers display anxiety and are more likely to suffer from heart disease and diabetes.  The difference in pup behavior is correlated to an epigenetic tag.  In dangerous environments, where food is scarce, mother rats have less time to be attentive. In those harsh surroundings, their anxious pups are less likely to be eaten by a predator and more likely to find food.  Both of these environmentally caused epigenetic changes help pups adapt to their environment without conscious learning.

A study of men who were obese and sedentary seems to show that several months of regular vigorous exercise stimulated an epigenetic change that reduced their production of fat.  Another study implies that it is a natural epigenetic process that allows certain animals to grow new limbs when one is severed.  Wouldn’t that be a helpful trick to learn?  Extreme stress and prolonged exposure to stress are being studied as possible epigenetic causes of PTSD and depression.

In much of the research only correlation is proven, not causation. I’ve oversimplified the subject to demonstrate opportunities to prevent and cure illnesses.  They will be accompanied by troubling questions that could have come from science fiction novels.  If epigenetic change can be used to produce more meat from one animal or bigger eggs or sweeter strawberries, should it be legal to do that?  Who will own the intellectual property?

If we could increase our life expectancy by epigenetically delaying the aging process, should we?  Should access to that epigenetic change be a “right” for everyone who wants it?  If we could use our knowledge of epigenetics to pick the kind of children we want, should we?  Would you choose smart?  aggressive?  peaceful?  tall?  studious?  creative?  What if a trait that you want also brings an increased risk of mental illness, violence, diabetes, or heart attack?  If such possibilities become real who can help you use the knowledge?  Will it become a medical specialty limited to physicians or will it be treated like nutritional supplements where anyone can charge a price for coaching you?

What about victims of epigenetic harm caused by pollution or harmful products?   Is it just their bad luck? Do they get compensation from whoever put the chemical into the environment?  Or would society as a whole share the cost?

Some epigenetic changes will be unintentional because we lack sufficient knowledge to predict the outcomes of our actions.  Some decisions will be made by legislatures and others by individuals.  As with nuclear energy, we will find both threats and opportunities. Today is not too soon to start acquiring the knowledge we’ll need to make intelligent choices.

 

 

 

 

All Posts, health, lgbtq, north carolina

Exposing the Republican Bogeyman

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A law passed by NC Republicans bans the two transgender Americans in the picture above from restrooms that match their physical appearance unless they can get revised birth certificates. 

READ THE NEW NORTH CAROLINA LAW HERE HB 2

The bogeyman will get you if you don’t watch out!  As a child, I heard that myth from adults who wanted me to be properly frightened of dark places, new ideas and people who looked or sounded “different”.  I never met him, but somehow I inferred that the bogeyman was a lot like the Jews, Negroes, Catholics, and Gypsies that we were expected to fear.  Children learned, without being explicitly taught, that some of “those people” were nice but many of them were dangerous and “we” should avoid them.  When I was a little older, I began to hear about “queers” and the awful things that they did to boys, so if anyone acted “that way” I should stay away from him.  Most people of my age learned some version of the myth.  If not from parents, it seeped in from the world around us.

By now I’ve been fortunate to have personal and work relationships with individuals from those groups. I learned that there is nothing about their religions, race, culture, ancestry, sexual orientation or gender identity that makes them dangerous or threatening.

The City of Charlotte passed an ordinance which extended its non-discrimination policies beyond the traditionally protected groups to include discrimination based on “marital status, familial status, sexual orientation, gender identity, and gender expression”.  The new rules apply to public accommodations, public transportation, and the practices of businesses that have contracts with the City. North Carolina’s Republican legislature and governor have called the bogeyman back into service to overturn that ordinance.

With only stories and fear-mongering, the Republicans created the myth of the transgender bogeyman who will “get” you or your children if you don’t watch out.   Then they called an emergency legislative session and introduced him to justify passing a law that not only overruled Charlotte’s ordinance; it also banned local governments from setting minimum wages and took away existing rights of individuals to file discrimination suits in state courts.  By eliminating the role of state courts in protecting many civil rights, they turned discrimination concerns over to the federal government.  They did all that in only one day.  When you’re running from the bogeyman there is no time for thoughtful deliberation.

Janet Mock, a transwoman who was born male is not allowed to use womens restrooms in NC unless she gets a revised birth certificate.
Janet Mock, a transwoman who was born male is not allowed to use women’s restrooms in NC unless she gets a revised birth certificate. The new law allows her to use only men’s restrooms. If she complies, will most NC men be more comfortable with her than with Teo Drake, below?

 

 

In more than 250 American cities that have laws similar to Charlotte’s, there is no evidence of an increase in sexual assaults and no pattern of men pretending to be transgender so they can commit crimes in women’s restrooms. In reality, transgender people are generally the victims, not the assailants.  About half of transgender people have been victims of sexual assaults.

Teo Drake, a transman who was born female is not allowed to use men’s restrooms in NC unless he gets a revised birth certificate. The new law allows him to use only women’s restrooms. If he complies, will most NC women be more comfortable with him than with Janet Mock, above?

Bank of America, Wells Fargo, IBM, Red Hat, and others among the crown jewels of the North Carolina economy want the law repealed.  Because of the law,  Pay Pal announced today that it has cancelled plans to locate their global operations center in North Carolina. The state lost 400 new jobs.  Leaders of these companies are realists who know that discrimination, hate, and fear are bad for business.  But the most serious damage is not to the  economy.  It is to the lesbian, gay, transgender, and bi-sexual people who have been clearly told that they are not welcome in North Carolina.

My niece and nephew are raising a bright, energetic transgender teenager.  He looks like a slender teenage boy but because he’s anatomically female North Carolina Republicans insist that he use the women’s washroom.   His mother shared these thoughts with me,  “As a mom with a transgender child, I feel anything but protected or safe.  Quite the opposite in fact.  I am a mom and he is my child and I worry about something as simple as him walking into a bathroom. Unfortunately, some people think that a bathroom is related to sexual behavior and predators…Predators are criminals who won’t stop because there is a sign on the door that says men or women only. If criminals obeyed signs, we could use them to get rid of heroin! Seriously? Criminals don’t work like that. As you know, my son is looking at a university in NC. Now, we’ll have to consider whether it is safe for him to travel there and stop for a restroom. It’s sad. Very, very sad.”

Years ago, public acceptance of marriage equality left North Carolina’s Republican leadership behind.  Their constitutional amendment to prevent it yielded only unnecessary expenses and animosity.  This Deja-vu law is similar.  It might be funny if it wasn’t so painful.  Sadly, the new bogeyman sports an American flag and a Christian cross on his lapels while he demands laws to hurt people who are different from him.  He’ll get you if you don’t watch out.

 

All Posts, budget, guns, health

GUNS IN AMERICA – WHAT SHOULD WE DO?

My thinking would be described by many people as “liberal”; yet  I’m happy to have many friends who are very conservative. We’re friends, but when we talk about public policy we often preach our ideas without really listening to each other.

As I watched the CNN town hall meeting “Guns in America” I saw a remarkable opportunity squandered.  Anderson Cooper of CNN did a good job asking hard questions.  So did some of the invited guests.  President Obama responded clearly but he didn’t take time (or have time during the program) to really draw out opponents of his policies and understand their concerns.  He preached.  So did many of the questioners who were more concerned with getting their points across than with understanding the President’s thinking.  It did not appear that anyone learned something new or changed their minds in any way.

Watching that meeting prompted me to write this experimental column.  I hope to use it to listen rather than to be heard.  I’m inviting all who are interested in the debate about gun ownership to think it through and then clearly state what you want from our gun related laws.  I’ve designed a short survey that also allows comments in your own words.  You can access it HERE or  at the end of this column.  I will compile  responses and report them in a future post – one that I hope will enlighten us all about how others see this issue.

Here is some background information on the subject:  Our Constitution provides a right to keep and bear “arms”.  It doesn’t mention guns.  Our three major national laws governing arms were passed in 1934, 1968, and 1993.  The first law severely restricted private ownership of machine guns, sawed off shotguns and various kinds of guns that were designed to be disguised as canes or other devices.  It was passed in response to violent organized crime during the prohibition era.    The 1968 law prohibited gun possession by various kinds of criminals and other individuals thought to be dangerous.  It also regulated gun commerce and importing “Saturday night specials”.  The “background check” system that is operated by the FBI originated with the 1993 “Brady Bill”.  The combined laws also ban ownership of “destructive devices” like chemical weapons, grenades, and bombs.  The FBI has a good summary of current rules  on its website.

Current enforcement practices allow many  purchases at gun shows and from private individuals without background checks.  One of the President’s proposals is to require background checks on all purchases.  Under some circumstances, the law allows corporations and organizations to own otherwise banned weapons like machine guns.  That exception was intended  for purposes like corporate security at nuclear power plants but its use has expanded significantly.   President Obama has proposed re-examining that program.

The context of the current American debate about guns is important.  Gun related deaths have declined but our conversation about them is increasingly heated and emotional.  In 2013 there were 33,169 gun deaths in the US.  Suicides accounted for 21,175; homicides 11,208; accidents 505 and 281 unknown intent.  Gun homicides accounted for 67% of all American murders.  They peaked at over 18,000 in 1993, dropped rapidly until 1999 and have begun to gradually increase in the 21st century.  Most of the shooters are young – under age 25.

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In the US, we have about 3.5 gun homicides per 100,000 population each year.  The other nations closest to that rate are Nicaragua and Barbados.  There are a lot of nations that American tourists might consider dangerous who are doing much better than us:  Chile – 1.02, Greece and Kyrgyzstan – 0 .53, Azerbaijan – 0.27.  Our closest neighbors show an extreme contrast:  Mexico – 14.2 and Canada – 0.51.

These deaths are not confined to someone else’s neighborhood.  There have been shootings and deaths across our nation, ranging from terrorist attacks to invasions of public schools to drive by shootings.  We can accept it and take our chances or we can try to improve.

What do you think we should do?  Please take five minutes to complete the survey.  Perhaps we can have more intelligent conversations if we know each other’s opinions.

CLICK HERE TO COMPLETE THE SURVEY (PLEASE)

 

 

 

All Posts, Congress, health

Drug Prices and Corporate Influence

Prescription drug prices are again in the news.  Prices are rising quickly, even for drugs that have been on the market for years.  This column quantifies the problem and presents ideas to improve the situation.

A good benchmark for “fairness” is to compare US prices to other nations.  The best objective research that I can find was done by the Organization for Economic Cooperation and Development (OECD) in 2011.  They looked at prices for the thirty most commonly prescribed drugs and found that for every dollar spent by Americans, residents of other nations paid $0.51.  In other words, we were paying twice as much, on average, as residents of other western democracies (Europe, Canada, and Australia).  Americans spent 13% more in 2014 than in 2013, so the situation appears to be getting worse.

There are many reasons why drug prices are higher in the US but underlying most of them is the influence of big campaign contributions and related corporate influence in our nation’s capital.  For example, when the George W Bush administration wanted to create the Medicare Drug benefit (Medicare Part D) there was concern in Congress about whether to expand the Medicare entitlement program.  Drug companies could have killed the idea if they had lobbied against it.  The price for their support was a provision in the law which prohibits Medicare from negotiating drug prices, setting prices or establishing a uniform list of covered drugs, known as a formulary.  That provision made Medicare Part D a goldmine for them.   Efforts to allow Medicare to negotiate prices have failed under both Republican and Democratic leadership due to inability to muster 60 votes to break Senate filibusters.

The negotiating power which Medicare was denied is the tool used by other nations to drive prices down.  When several effective drugs are available for a particular problem,  those nations pay only for the ones that are priced at an acceptable level.  Companies reduce prices in order to have their products covered.  Drug companies say that they need high American prices to pay for research and development.  The undeniable need for R&D does not justify charging Americans more than Europeans for the same drugs.   Medicare should be allowed to negotiate prices and to exclude over-priced drugs from the Medicare benefit.

A second action to drive down drug prices would be to increase government spending on research and development.  It would be good government policy to fund research in targeted areas (prevention of strokes and heart attacks and treatment of Alzheimer’s disease for example) under a policy where all resulting intellectual property such as patents belongs to the taxpayers who funded the research.  We could then allow production of resulting drugs by any drug company which would do the manufacturing here in the US but charge a royalty to companies doing the manufacturing outside the US. The net effect would be more R&D funding at American universities and corporations, lower drug costs and new US manufacturing jobs.  Strong opposition to such ideas can be expected from the US and foreign drug companies who are currently profiting from an American market where taxpayers and patients subsidize the world’s highest prices and have no ability to negotiate them down.

Another idea is to tighten intellectual property laws so that patents don’t seem to run forever and more companies can manufacture drugs at lower costs.  There are loopholes in current laws that allow companies to extend patents by making very minor changes in a drug and preventing expiration of the patent on the original.

A fourth strategy for driving down costs might be to reduce utilization of pharmaceuticals by banning or restricting direct-to-consumer advertising of prescription drugs.  Should corporations have free speech rights to promote prescription drugs directly to patients?  Do the ads encourage patients to imagine symptoms and ask doctors for unnecessary prescriptions?  Current research isn’t adequate to answer that question but most other nations don’t allow such advertising and many have lower utilization of heavily advertised drugs including antidepressants and sleep aids.  This is obviously another public policy question in the hands of legislative bodies that have a hard time saying “no” to corporate influence.

In each case, the barrier to action appears to be the influence of big corporations on American government.  Perhaps we need a prescription for raising the interests of consumers and taxpayers to be as important as the interests of drug companies.

 

 

All Posts, Congress, health, justice

GOP vs Planned Parenthood – New revelations

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My previous post argued that charges against Planned Parenthood are false.  Click any of the green links for added evidence.  Investigation of allegations that Planned Parenthood sold fetal tissue for profit has shown that

  1. The charges are baseless.
  2. The videos used to support the accusation were carefully edited to mislead viewers.
  3. Fetal tissue is vital to medical research and it is governed by appropriate rules.
  4. Carly Fiorina’s horrific claims about Planned Parenthood in the second GOP Presidential debate were false.  Yet she recently complained about other candidates creating their own facts.

The situation reminds us of an important life lesson: What we don’t know is often less dangerous than what we think we know that turns out to be untrue.  Congressional Republicans and GOP Presidential candidates are now so heavily committed to actions based on lies about Planned Parenthood that they can’t (or won’t) admit their error.  Where is Republican outrage at being deceived by anti-choice radicals?  Are they so committed to their current course of action that they’re unable to see that it is based on lies, or are they just unwilling?  Either a terribly dangerous state of affairs.

 

All Posts, Congress, health, religion

THOUGHTS ABOUT PLANNED PARENTHOOD

Is it OK to use unethical methods to accomplish goals that you think are good?  Does the end justify the means?  Anti-abortion forces are using dishonest propaganda and character assassination in their assault on Planned Parenthood.  They have adopted devilish methods in pursuit of goals that they consider godly. They posed as representatives of companies seeking to acquire fetal tissue for medical research and secretly recorded conversations with Planned Parenthood executives.  Then they extensively edited the recordings to make it appear that Planned Parenthood was selling fetal tissue for a profit.  The accusation is unproven, but their propaganda has convinced a lot of people. Continue reading THOUGHTS ABOUT PLANNED PARENTHOOD →

All Posts, Congress, health, religion, taxes

WILL LOSING IN COURT HELP WIN ELECTIONS?

On the horizon of America’s sometimes bizarre political landscape are two Supreme Court decisions with unusual implications.  Most conservatives and Republicans want the Court to rule that states can ban same-sex marriage and that Obama Care can’t subsidize the cost of health insurance in states that haven’t set up their own insurance exchanges.  Most liberals and Democrats are wishing for the opposite.  It may be that the political fortunes of the two parties will be better if they lose these cases than if they win. If Democrats and Liberals win both cases, then Republicans can continue to demonize the health care law for its imperfections and complain about activist judges who overturned the “will of the people” by allowing same-sex marriage. Republicans seem well prepared for losing in court, but not for the consequences of winning.  They have no plan for delivering affordable health care to low and middle-income Americans.  It isn’t free.  It is a fact that many people of modest means will suffer and die without health care if there is no tax-funded means to help pay for it.   Continue reading WILL LOSING IN COURT HELP WIN ELECTIONS? →

All Posts, health, medicaid, taxes

DOING THAT COULD MAKE YOU BLIND

A South Carolina man is learning that there are some things that feel good at the time but, yes, they can make you go blind.  Here’s a recap of his story, much of it from the Charlotte Observer.  Luis Lang was self-employed with a good income and a 3300 square foot house worth more than $300,000.  He knew that the law (Obama Care) required him to buy health insurance, but it felt good to spend the money  on other things. Continue reading DOING THAT COULD MAKE YOU BLIND →

All Posts, Christianity, health, religion

DEATH WITH DIGNITY?

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Do we humans have a “right to die” and a “right to assistance in dying”? These questions will soon take center stage in the American culture war. If you choose someone to make your decisions about dying in the event that you are unable, will that person be allowed to carry out your wishes? In the US today, that depends on where you live and whether someone powerful wants to intervene, as Governor Jeb Bush and Senator Bill Frist intervened against Terri and Michael Shaivo, forcing Terri’s brain-dead body to function for seven years after Michael authorized removal of her feeding tube. Continue reading DEATH WITH DIGNITY? →

All Posts, Congress, health, taxes

Can Republicans survive success in the Obama Care lawsuit?

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What happens next if the Supreme Court rules that Obama Care can’t subsidize health insurance premiums in states that did not set up their own exchanges?  The pundits are saying that neither Republicans not Democrats have a contingency plan for that.  Maybe.  But there may be a way for the President to snatch victory from the jaws of a defeat at the court.  It might go something like this. Continue reading Can Republicans survive success in the Obama Care lawsuit? →