Tuesday, July 20, 2010

Conscience Rights Revisited In Washington State

Some possible good news coming out of Washington state. For the past several years there has been quite a fight over the dispensing of Plan B by pharmacies in that state.  A couple of pharmacists stated they would refuse to dispense it because it causes abortions, and so the state turned around and forced them to dispense it upon penalty of losing their license.  However, now there is a chance that pharmacists will maintain some of their freedom of conscience, though not based upon the ruling of the Federal Appeals court.  The Board of Pharmacy wants to revisit their regulation requiring all legal prescriptions to be filled.  The proposed change would only require a 'referral' by the pharmacist to another pharmacist who will accommodate.  Now, anyone with any basic understanding of moral theology knows that referring is still too proximal to the moral act to be justified.  If a pharmacist cannot dispense, then they cannot refer, because they are still aiding the person in the completion of the action, ie abortion. 

The Story:

Pharmacy board takes another run at Plan B rule

Published: 07/15/1012:05 am
The state Board of Pharmacy and pharmacists suing it over Plan B want out of court.

The litigants asked federal district court Judge Ronald Leighton last week to put their legal fight on hold pending the resolution of a new rule-making process.
The move angered advocates of unfettered access to Plan B emergency contraception. They contend the delay signals an undoing of a 2007 victory: the passage of rules requiring pharmacists to dispense a drug unless another pharmacist is available in person or by phone to step in.
The pharmacy board voted last month to reopen the rule-making process to consider “facilitated referral,” which is essentially the “refuse and refer” rule that the board embraced in 2006.
Under that rule, pharmacists with moral objections to Plan B – some consider it tantamount to abortion because it prevents implantation of a fertilized egg – could refuse to dispense it as long as they took steps to help patients get it elsewhere.
Back then, the proposal prompted Gov. Chris Gregoire to threaten to remove any pharmacy board members who voted for it. Her spokesman recently said she plans to make her opinion known to the board once again.
Pharmacy board members – most of whom have joined since 2007 – may indeed be headed for an about-face, but it’s too soon to assume that’s where they’ll end up.
Certainly, the goal is to write a rule that answers the concerns of the two pharmacists and Olympia grocer who are suing the state.
State lawyers hope to head off several more years of litigation – and a possible constitutional finding. The plaintiffs say that the state’s rule violates a pharmacists’ religious freedom. It is not a negligible argument, even if the often reversed 9th Circuit Court of Appeals last year ordered Leighton to apply a standard more deferential to the government.
But any proposed rule will still have to be vetted by an extensive public process – a process likely to raise the same concerns as were voiced in 2006 and 2007.
The pharmacy board will have to again wrestle with situations in which a pharmacy’s refusal to dispense Plan B effectively blocks a patient from receiving the drug.
The pill should be taken within 72 hours – preferably 24 hours – to be effective at preventing pregnancy. Under “facilitated referral,” a patient in the hinterlands might have to travel some distance to find a pharmacy willing to stock Plan B.
Pharmacy board members probably haven’t spared themselves any grief by trading a legal battle for a public policy fight. They have more than a court case to settle; they also have to convince a lot of concerned people that any new rule protects access.

Read more:

Here is something else to consider.  Washington state has legalized assisted suicide.  Now, some pharmacists don't have too much of a problem with Plan B, but what about the drugs used for suicide?  Will the state force more pharmacists to fill these drugs or make them refer?  And if the state is willing to do this to pharmacists, then how long will it be before physicians are forced, as a condition of their license, to perform abortions and assist in suicides?

For more, see Wesley J. Smith's commentary.

Tuesday, July 13, 2010

U.S. Army Knows Truth About Stem Cells

Excellent news that I wanted to share:

U.S. Army Gives $700,000 to Stem Cell Therapy Research

Tuesday, July 13, 2010

International biopharmaceutical company NeoStem announced Monday it was awarded a $700,000 contract by the U.S. Army Medical Research and Materiel Command, to advance adult stem cell therapies in treating traumatic wounds.
The contract was to evaluate the use of topically applied bone marrow-derived adult mesenchymal stem cells for rapid wound healing.
Robin Smith, board chairman and chief executive officer of NeoStem, said the company was thrilled to have the U.S. government's support to advance its technology and honored to become part of the Telemedicine and Advanced Technology Research Center’s regenerative medicine portfolio.
"It is our goal with this important project to leverage adult stem cell technology to help our soldiers avoid amputations and immobilization from injuries that they may sustain while fighting for our country," Smith said.
"Wound healing could represent just the beginning of more collaborative projects involving other clinical indications, such as spinal cord injuries and retinal damage, both of which affect American warriors who serve our country in the global war on terrorism," he added.

The US Army recognizes that the future of stem cell research lies in Adult stem cells and NOT embryonic stem cells.   I am excited to hear that this kind of research is being done because when I am a physician taking care of our military men and women, I hope that I can better treat their injuries with this type of technology.  This is just one more piece of evidence of why funding for embryonic stem cells should be shifted entirely to adult stem cells.

Thursday, July 01, 2010

New Prenatal Testing: Search and Destroy Mission or Advancement in Science?

A recent article announced the the promising advancements of using maternal blood to test for fetal genetic anomalies.  The premise is that there is a very small amount of fetal DNA that passes into the mother's blood stream.  This DNA is not fully degraded, and if the proper techniques are used, it could theoretically be isolated and amplified in order to be tested for genetic anomalies such as mutations or aneuploidies.  This technology is very challenging to master.  I worked in a lab for a year that was pursuing this very technique.  During that time, I continued to struggle with the ethical nature of this research.  I was blessed that in the particular lab the research was performed within the paradigm of advancing the good of both mother AND child.  In this light, I was able to reconcile my work with my ethical standards because I knew that the basic research that I was performing had the potential of helping eliminate the risks of the current screening tests. Moreover, it could theoretically lead to the potential for treatment and cures, following in the footsteps of Dr. Jerome Lejune.  However, not all research done in this field follows such ethical standards.  In fact, as posted before, much of this research and testing is simply to promote the search and destroy missions against any 'imperfect' child.  Here is the story from FoxNews:

Cheap Blood Test Could Detect Disorders in Fetus

A simple blood test may one day become a safer alternative for checking if an unborn baby has Down syndrome or other disorders, the Daily Telegraph reported.
The test, which takes a blood sample from a pregnant woman to examine the DNA of the fetus, would cost as little as $36, and could be available within four years, according to the report.
It would provide an inexpensive and much less invasive way to detect many genetic abnormalities in fetuses, but it also raises concerns among pro-life advocates who say it could result in more abortions.
“If it might more conclusively prevent false positives, it might have some benefit, but it will also likely lead to more abortions of children with disabilities,” Mailee Smith, staff counsel for Americans United for Life, told
The tests currently used to determine if an unborn child has Down syndrome are both quite invasive. One is an amniocentesis, where doctors extract amniotic fluid from around the fetus. The other is a procedure known as chorionic villus sampling, which involves the removal of a small piece of placenta tissue. Researchers hope the new test will become a safer alternative to the current procedures, which are highly accurate, but raise the mother’s risk of suffering a miscarriage.
"The age is swiftly coming where not all possible technologic advances may bring welcomed change. Parents who have children with Down syndrome have already found much richness in life with an extra chromosome," Skotko wrote in an article published in the BMJ in October 2009.Dr. Brian Skotko, a physician at the Children's Hospital Boston who is on the board of directors of the National Down Syndrome Society, told that many doctors aren't adequately trained to counsel women on having children with Down syndrome, and worse, some who diagnose an expecting couple's child with Down syndrome encourage them to terminate the pregnancy.
Dr. Suzanna Frints, of Maastricht University Medical Center in the Netherlands, began the ongoing research with her team in 2009, and claims that their technique is 80 percent reliable. Her team has proven their technique works by using the mother’s blood to identify the Y chromosome from the fetus.
Twenty-one women who have either had abortions or underwent amniocentesis, or other prenatal screening procedure, have participated in the research. But to establish the accuracy of the test, Frints said the next phase of development would need to involve more women.
Frints described the results as “promising,” and hopes that their technique will be able to screen for other abnormalities, like muscular dystrophy, hemophilia, Edwards syndrome and Patau syndrome.
“When we succeed in developing the procedure for use in maternal blood, we will be able to offer a safe, cheap, fast, reliable and accurate non-invasive test, which will be of immediate benefit to pregnant women, young and old, all over the world,” Frints said.
Professor Stephen Robson, spokesman for the Royal College of Obstetrics and Gynecology, considers a non-invasive test for detecting Down syndrome the “holy grail” and said there was an ''enormous research effort’’ behind it.
Down syndrome is a genetic abnormality that affects around 1 in 800 babies born in the U.S., and is the most common genetic cause of severe learning disability.

Here is an excellent commentary on the story from Wesley J. Smith:

A new test is in the works that will allow Down fetuses to be detected without the risks of current screening.  From the story:
A quick inexpensive blood test for Down’s syndrome that could save the lives of hundreds of unborn babies each year is being developed by scientists.  The ‘holy grail’ of diagnosis, it would pick up signs of the disease from a few drops of the mother’s blood. The test could save lives by removing the risk of miscarriage associated with current tests…Dr Frints, of Maastricht University Medical Centre in the Netherlands, has already created a kit that can work out if the baby is a boy or a girl. She is adapting the kit to test for Down’s syndrome and other genetic conditions could follow. Around 25,000 British women a year have invasive tests for Down’s syndrome, so the test has the potential to save 250 lives annually.
The statement in the story really meant “save the lives of normal babies.” These tests are intended as a search and destroy mission,  to find and promote eradication of Down fetuses.  The babies miscarried now as a result of invasive testing might be called collateral damage in the larger eugenic drive.
I am certainly in favor of preventing those miscarriages.  And, of course, some families will use the information provided to prepare themselves and family for the arrival of a child with a disability, as did the Palins (for which some will never forgive them).  But the latter benefit isn’t the primary point of the test and certainly not why the medical establishment promotes universal pre-natal testing so enthusiastically.  Frankly, they are not satisfied with a 90% termination rate.
But isn’t it ironic–that we will save some “good” babies, in order to find a better way to identify others to terminate.   If babies of color were being similarly targeted it would be called racism.

As future physicians and current physicians, we need to work hard to shape the culture so that we are able to promote research to alleviate the negative impact of genetic anomalies.  We have the obligation to fully inform our patients of the use and impact of these tests and encourage them to use the knowledge in such a way as to promote the sanctity of life.