For decades, there has been an increased interest in and awareness of the need for physicians and the medical community to work more closely with journalists and the mass media to guarantee the accurate and appropriate dissemination of health information. Training programs for both physicians and journalists now include innovative curriculum to promote collaboration and build a mutual respect between the professions that, in the end, promotes public health and safety. Publishing or broadcasting clear, consistent and contemporary health and medical information to the general public is a shared responsibility of physicians and journalists. But, what happens when the physician and the journalist is the same person?

The advents of 24-hour news, numerous magazines and blogs galore have opened the flood gates for professionals who want to share their knowledge with the public. And gain a little fame in the process. The world does need health care professionals with better-than-average communication skills to share the latest research or medical news in layman’s terms. But, the world does not need physicians who have more experience holding a microphone than a scalpel. Case after case of physician-journalists helping Haitian victims were broadcast on television over the last few weeks, making the physician the story rather than the Haitians in need of help. One would hope that the physicians were simply overcome by their desire to help, and forgot that there were cameras rolling. But, a cynical eye would notice that every network seemed to “one-up” the others with broadcasts of “our doctor did this” and “our medical correspondent did that.” If the physicians really wanted to help the devastated population, they could easily travel to Haiti with a volunteer medical staff, rather than with a producer and a camera crew.  Plus, if viewers wanted to see surgery performed on television, they could watch any of a number of reality series that depict medical procedures.

The sensationalizing of the story is hardly the only downside to this type of reporting. What happens if there are complications from the treatment provided by the physician-journalists? What about patient privacy? What happens when every reporter decides to jump into the story? What happens to the just-the-facts reporting that the public needs?

The public increasingly turns to the media for health information, and inaccurate or inappropriate medical reporting damages public welfare, as well as perception and opinion about the health care community. All reporters — trained journalists and physicians-turned-correspondents alike — have the responsibility to remain objective and report facts of stories, be it medical information or news of death and destruction in crisis-stricken areas.

References

Anthony, S., Lozano-Calderon, S., & Ring, D. (2007). Stigmatization of Repetitive Hand Use in Newspaper Reports of Hand Illness HAND, 3 (1), 30-33 DOI: 10.1007/s11552-007-9052-4

Campbell, N., Heath, J., Bouknight, J., Rudd, K., & Pender, J. (2009). Speaking Out For Mental Health: Collaboration of Future Journalists and Psychiatrists Academic Psychiatry, 33 (2), 166-168 DOI: 10.1176/appi.ap.33.2.166

Catherine, N., Ko, J., & Barr, R. (2008). Getting the Word Out: Advice on Crying and Colic in Popular Parenting Magazines Journal of Developmental & Behavioral Pediatrics, 29 (6), 508-511 DOI: 10.1097/DBP.0b013e31818d0c0c

Strasser T, Gallagher J. The ethics of health communication. World Health Forum. 1994;15(2):175-177.

Also, experimental evidence suggests that compared to females, male behavior and psychology is more inclined to aggression. Men are relatively more aggressive in inter-group games and display stronger ingroup loyalty in the presence of an inter-group threat. This idea is referred to by anthropologists as the male-warrior hypothesis. This general hypothesis leads to the prediction that men “have behavioral propensities to engage in male coalitional violence”. This is perhaps a product of a long evolutionary history, in which males who engaged in such behavior produced more genetic descendants than males without such propensities. Male coalitional violence is also exhibited by our closest living relative, the chimpanzee. Such behavioral propensities did not evolve in females of either species.

Since females in all cultures have greater parental investment than males in their offspring, engaging in openly aggressive acts to acquire resources, either individually or as part of a group, will be physiologically and genetically costlier for women. The mother is more critical to the offspring’s survival than is the father. If a mother wants her children to survive, then she must be equally concerned with her own survival. Because of this, it is believed that women would have evolved a psychology in which the costs of physical danger would have been weighted higher than that of a male.

Recognizing that our biological heritage has produced very different behavioral propensities in human males and females, can also lead to a solution of decreasing violence and warfare in modern times. Although the propensity for violence may be genetically programmed into the human brain, it can be controlled through cultural and social means. Behavioral genetics research on violence shows high heritabilities, suggesting that a substantial amount of genetic variance exists in such behavioral propensities within populations of human males.

By empowering women to be leaders in cultural, social, and political spheres, the violent propensities of men can be restrained, and perhaps men can learn to be less violent themselves. Public investment policies should also recognize that men with poor economic prospects have higher incidence of engaging in violence and being recruited into violent extremism.

Although war is a complex subject and a definitive understanding of coalitional violence is still lacking, women’s empowerment and a greater participation of women in the political arena could be the way for a more peaceful world.

References

Kaplan, H. (2009). Sex, War (and Ecology) Science, 326 (5950), 232-233 DOI: 10.1126/science.1176071

Van Vugt, M., De Cremer, D., & Janssen, D. (2007). Gender Differences in Cooperation and Competition: The Male-Warrior Hypothesis Psychological Science, 18 (1), 19-23 DOI: 10.1111/j.1467-9280.2007.01842.x

Campbell, A. (1999). Staying alive: Evolution, culture, and women’s intrasexual aggression Behavioral and Brain Sciences, 22 (02) DOI: 10.1017/S0140525X99001818

Have you ever wondered why some people grind their teeth at night? Some people clench their jaw and grind their teeth during the day, but nocturnal or night-time bruxism is what I’m referring to right now. I know many people who grind their teeth in their sleep and they have to wear night guards to protect the enamel on their teeth. There are many theories behind nocturnal bruxism, but I doubt that anyone really knows why people grind their teeth. There may be a host of different reasons why certain people struggle with bruxism. Allow me to share my thoughts on some of the major theories behind unexplained bruxism.

Anger: There are many who think that people who have suppressed anger release their anger at night by grinding their feet. Does it make sense that people would clench and grind their teeth if they were trying to release their suppressed anger? Is the brain releasing anger by clenching teeth? Perhaps it is a natural reaction that cannot be controlled unless the anger someone gets eliminated. I wonder if some people have a chronic level of anger that never goes away. If anger is building up and growing, then it could take many years before the anger goes away. Maybe if some people are not in touch with their feelings, then they may not realize how much anger they have building up inside of themselves. It’s important for people to be connected with their feelings so that they can recognize their feelings and deal with them appropriately. Otherwise, suppressed emotions may express themselves in unusual ways.

Anxiety: Anxiety comes in various forms. For some, it is generalized anxiety disorder (GAD). Others may have a combination of anxiety and depression. Anxiety may be suppressed or hidden in others. So, is bruxism a way the brain releases some of the tension caused by anxiety? Is it possible that the brain tries to escape anxiety by gnashing teeth? If my theory is correct, then people who receive treatment for their anxiety should have less bruxism. Does this happen?

Stress: Everyone experiences stress, but everyone doesn’t struggle with nocturnal bruxism. If some people live with a constant level of stress due to work or family problems, could this lead to bruxism? If people actively practice relaxation techniques, could this lead to a reduction in bruxism?

Mental trauma: Some people may encounter some type of severe mental trauma in their life. As a result, they may have Post-Traumatic Stress Disorder (PTSD). This type of mental trauma may manifest itself in different types of bodily symptoms ranging from headaches, body aches, and other types of ailments. At night, could this also be expressed through bruxism? Is it possible that the brain tries to escape this mental trauma by clenching the jaw?

In the future, perhaps we’ll understand what causes bruxism and discover a cure. Until that day arrives, we can only consider various theories offered by clinicians and researchers.

The regions of the brain engaged in processing religious knowledge can be studied using modern neuroimaging techniques. Experiments were done to determine the psychological components underlying religious belief and evaluate their neural foundations. These studies support the view that there is no specific domain for religion in the human brain. Religiosity is integrated in our cognitive processes and employs the same brain networks used in social and emotional interactions. Religious understanding probably emerged as a unique combination of several evolutionarily important cognitive processes. Humans are naturally inclined to faith due to these traits. Thus, religious thinking seems to be the path of least resistance for our cognitive systems and is a consequence of having a very ‘human’ type of brain.

By contrast, atheism is harder for the human brain to comprehend. Atheism is generally the result of a deliberate effort against our natural cognitive dispositions and is thus a more difficult ideology to propagate. It is therefore not surprising that despite the appeal of logic and rationality that atheism offers, it has few takers.

Perhaps a capacity for religious thinking — and not specifically religion in its present socio-political context — provided fitness benefits to our ancestors during the course of evolution. Religion can evoke very diverse and strong emotions, which can now be experimentally studied. Neuroscience is trying to provide a pragmatic explanation to the complex phenomenon called religion. Religion continues to dominate both the personal and political aspects of our modern society and it is unlikely that any understanding of the foundations of religious belief in humans will undermine the impact of religion in our lives.

References

Boyer, P. (2008). Being human: Religion: Bound to believe? Nature, 455 (7216), 1038-1039 DOI: 10.1038/4551038a

Kapogiannis, D., Barbey, A., Su, M., Zamboni, G., Krueger, F., & Grafman, J. (2009). Cognitive and neural foundations of religious belief Proceedings of the National Academy of Sciences, 106 (12), 4876-4881 DOI: 10.1073/pnas.0811717106

Such is the creed that has grown up around natural products. You want to market a new range of face cream –- make sure everyone knows it is natural. You want your expensive new yogurt to sell –- include the word “natural” on the packaging. The word “natural” has become byword for purity, health and goodness.

So, why are we so obsessed by natural products? It may be that we associate science with all that is bad in the modern world –- pollution, climate change, the nuclear threat. By rejecting science and its associated chemicals, perhaps we believe that we can return to a gentler time in which the honest farmer toiled the land and people’s lives were more in tune with nature. While it is true that we have drifted away from nature, largely to the detriment of the health of the planet, this view is in danger of romanticizing the past into a golden age that never really existed. At the start of the nineteenth century, global average life expectancy was less than 30 years; today it is around 67. The infant mortality rate in Europe in the 1860s was around 230 per 1,000, compared with less than 50 per 1,000 in the 1950s. If you asked parents of the nineteenth century whether they wanted their child to be vaccinated against the ravages of polio, they wouldn’t understand why you even needed to ask.

The current generation living in the Western world is the luckiest in history. We have forgotten what it is like to be surrounded by death, disease and infirmity. It is because we enjoy such comfort and security that we find ourselves in a position to be picky about what we eat, wear and put on our bodies. We demand that things be natural only because science has given us that luxury.

I am not arguing that natural is bad; I am simply saying that just because something is natural, it does not make it good. Even more, I am objecting to the artificial and facile distinction between natural and chemical. If you analyze a banana, you find 39 chemicals, including 2-heptyl acetate, isoamyl acetate. 2-methylbutyl acetate and 2-heptyl acetate. Try putting this list of ingredients on a package label and see how much you sell.

The separation into natural versus chemical may be tempting, it may be convenient, but I don’t believe it’s actually helpful. Some people may find this argument gives them a headache — in which case they may like to chew on the bark of a willow. Personally, I’d rather take a couple of aspirin.

References

Riley JC. Rising Life Expectancy: A Global History. New York, US: Cambridge University Press, 2001.

Bideau A, Desjardins B, Pérez Brignoli H. Infant and Child Mortality in the Past. Oxford, UK: Clarendon Press, 1997.

Pino, JA, Ortega A, Marbot, R, & Aguero, J (2003). Volatile components of banana fruit (musa sapientum L.) “Indio” for Cuba JEOR

Gender reassignment was not something I had learned about in medical school. It was mentioned in passing, but there were no lectures about how to correctly dose estrogen for the male-to-female transsexual. I frankly had no idea what to do. I think my surprise and confusion were apparent, as the man blushed a little and suggested that I might want to refer him to a specialist.

Chastity Bono’s recent announcement that she will be transitioning from female to male reminded me anew what a deeply personal and difficult decision gender reassignment is. Medically, it’s complicated as well. Before even embarking on the anatomically-altering regimen, a great deal of therapy is recommended, as well as a “test run” living as the desired gender. Following that, hormones are begun. The regimen for a woman becoming a man is relatively straightforward: testosterone shots once every twelve weeks. Such a regimen produces increased facial hair, body mass index, a deeper voice, and enlargement of the clitoris, sometimes to the degree that intercourse is possible without surgery. It can have adverse effects on serum triglycerides and may cause acne.

A man wanting to become a woman faces a bit more complicated hormonal regimen, as not only does estrogen need to be added, but testosterone needs to be suppressed. Surgery to remove the testicles will obviate the latter, but is not a procedure that some are willing to undergo right away. This hormonal one-two punch will result in breast growth, increased subcutaneous fat, some decrease in upper body strength, and atrophy of both the testicles and prostate. Facial hair growth and voice depth will not change appreciably, however, and usually require additional procedures to mitigate.

The ultimate step in sexual reassignment is surgery. The most common type of surgery involves the removal of sex-specific organs; beyond that is genital reconstruction, which is significantly more complicated. After the entire process is completed, only 1 to 2 percent of postsurgical transsexuals experience regret.

As for my patient, I never saw him again after I referred him to another physician. Hopefully he is now a she, and is living a happy and fulfilling life.

References

Benjamin H. International Gender Dysphoria Association’s Standards of Care for Gender Identity Disorders, Sixth Version. February 2001.

Lawrence, A. (2003). Factors associated with satisfaction or regret following male-to-female sex reassignment surgery Archives of Sexual Behavior, 32 (4), 299-315 DOI: 10.1023/A:1024086814364

For this article, the main questions are: “Is behavior biologically determined?” and “Do humans have free will?” I will not address in this post the argument between compatibilism and incompatibilism. In response to comments and questions about my previous post, I thought it necessary to attempt to define free will before I write further posts on this general topic of free will and biological determinism in the neurosciences.

In reading some comments to my post one fairly common definition — at least an operational definition — of free will was randomness. In other words, in a psychology experiment, for example, free will is part of the unexplained variance — the randomness in the data. Equating free will with randomness — overtly or not — is something I have heard and read repeatedly.

However, I do not believe that free will can simply equal randomness. Randomness is chance. It is the flip of a coin or the roll of a die. Randomness is unpredictable. However, let’s go with the assumption that free will equals randomness. One of the simplest forms of randomness is a coin flip. That coin flip might seem random, at least the outcome might seem random, but suppose we understand the composition of the coin. We know it has a particular mass; we know the density of the metal as well as any variations in density throughout the coin. We know its precise coefficient of friction, its air resistance, its rotational velocity, and so forth. We understand everything about the chemistry and physics of the coin’s flip. With this comprehension, we can predict with 100% certainty the outcome of the flip. Based on our knowledge we can predict perfectly the outcome. However, our knowledge or predictions do not cause the outcome.

In other words, even with a perfect prediction of the outcome of the coin flip, that knowledge did not cause the randomness of the result. So, am I arguing that randomness is a good definition of free will? No. If we can understand all the chemistry and physics of the coin and its flight, we can then state that the flip of the coin merely appeared random but was in fact determined by the particular interaction between physics and chemistry. In other words, the outcome of the coin flip was determined by the physical world – by the materials of the coin and the interaction of those materials with our material world – even if our knowledge of the material world did not determine the outcome. Therefore, we can create a deterministic explanation for the seemingly random event.

This demonstrates that what appears random can be explained away as determined. Researchers even have deterministic and indeterministic explanations for quantum theory, which also indicates that defining free will as randomness is not sufficient. Thus, randomness is a poor definition of free will because if free will is nothing more than randomness, once we understand our material world perfectly we will perfectly explain all randomness, all previously unexplained variance. This is what some neuroscientists are trying to do with human behavior, although few are willing to take the hard stance of completely denying free will.

So what is free will? I’ll start with an example. Free will is standing out in the sunlight and denying that the sun is shining. Free will can be defined as choosing one’s actions or course. Free will also is frequently defined as indeterminism. What is interesting is that this definition meaning “not determinism,” relies on determinism to define free will. Why do many use determinism to define free will? Because determinism is easy to define — it is a concrete concept. Additionally, it is one of the major philosophical foundations of modern science, in part because we can easily create operational definitions for determinism.

In the biological sciences and neurosciences, in particular, determinism is inextricably tied to biology and materialism (i.e., biological determinism). Most neuropsychologists seek to explain behavior as determined by the interaction between biology and environment (many may have a soft deterministic view but they still want to know the causes of behavior). In forensic (legal) cases, neuropsychologists often clash with the legal system; psychology assumes biological determinism (i.e., causal determinism) whereas the legal system assumes free will (while it does not necessarily deny some form of determinism, the main emphasis is on free will).

In the end, I did not really define free will other than saying that it is not randomness and it is not determinism. Even defining free will as choosing one’s own course or actions is an incomplete definition because as demonstrated above, it is still possible to explain those choices as determined if we resort to reductionism of behaviors. This leads to one of the major problems with determinism — that it cannot really be falsified by science (after all, science does assume determinism to start) but that is a different discussion altogether. As David Hume once said (I’m paraphrasing), “[The nature of free will is] the most contentious question of metaphysics.”

In my next post I’ll address an alternative set of assumptions (i.e., beliefs or explanations) to determinism, particularly biological determinism as is found in neuroscience.

Preconception

The earliest stopping point is held by many members of the Catholic Church, with their proclamation that “every sperm is sacred.” The held rationale is that every sperm has the possibility to fertilize an egg, become implanted, and eventually grow into a human being. Since God’s charge is to go forth and procreate, any type of hindrance to that process such as the use of condoms or birth control pills are interfering with God’s plan and therefore not allowed.

Conception

The greater religious community generally view the “moment of conception” as the standard for when life begins. However, the definition of conception is subject to variability. Some take the word conception to actually mean the act of ejaculation. Others consider conception to be the process of fertilization. Still others consider the fusion of genetic material into a new set of chromosomes to be meant by conception. The problem with any of these definitions is that the process is not instantaneous. From the time of ejaculation, sperm take 7 hours before they become active and able to fertilize an egg. Once the sperm meets the egg, a chemical cascade begins and the sperm begins to bore its way through the egg, which may take up to an hour. Once the sperm actually enters the egg, it’s another 12 hours before the sperm DNA makes its way to the egg’s DNA, and then another 24 hours for the restructuring and packaging process of new chromosomes. All told, the “moment of conception” could take anywhere from 2-3 days to complete.

Gastrulation

Another argument that is raised against the “moment of conception” line of thinking is the twinning argument. Once the genetic material is completely packaged together, a new individual is created. However, for as long as 12-14 days afterward, the embryo can split into twins or more multiples. That process would create more than one individual with identical genetic material from the same moment of conception. To account for this discrepancy, some argue that life begins at gastrulation, which is when the window has closed, the embryo has implanted in the uterus, and is now committed to grow into one human being. Supporters of this theory would therefore support stem cell research, which harvests embryos that have neither the intention nor ability to be implanted into a uterus.

Week 8

The eighth week of pregnancy is a special one, because at this point the precursors to all organs have been formed. Philosophers therefore argue that with the beginnings of a brain, the fetus now has the ability to think and react, and that marks the onset of life. Opponents argue that the rudimentary nervous system is not functional at 8 weeks, and the fetus cannot process information or move in response to a stimulus, therefore not making the fetus alive.

Quickening

Those same groups which argue against the week 8 model suggest that life begins with the “quickening,” which is when the fetus begins to exhibit voluntary movement inside the womb, usually around 14-16 weeks. At this point the fetus is able to react to external stimuli, which is held as the standard for life.

Week 20

Although the fetus can move at week 14, the movements are little more than jerky reflexes. They are not driven by higher cortical functioning. Therefore, another school of thought is that life begins at week 20, when the thalamus is completely formed. The thalamus is the relay center of the brain, and helps to connect the cerebral cortex to the spinal cord and peripheral nerves.

Week 25

A sizable contingent would assert that life begins at 25 weeks. The rationale for this starting point is based on our definition of death. The definition of death is not disputed, and is considered the time when electroencephalography (EEG) activity ceases. EEG measures brain activity and must demonstrate regular wave patterns to be considered valid. Therefore, by this rule the onset of life would be the time when fetal brain activity begins to exhibit regular wave patterns, which occurs fairly consistently around week 25. Previous to that time, the EEG only shows small bursts of activity without sustained firing of neurons.

Birth

Perhaps the second-most frequently held conviction is that life begins at the time of child birth. In Jewish Talmudic Law, for example, the writing states that once the head of the child is delivered it cannot be touched and is granted equal rights to life as the mother. Other religious groups maintain that the soul is delivered to the newborn with their first breath of air.

Self-consciousness

A minor group of philosophers maintain that the criterion for human life is self-consciousness, or self-awareness, which does not occur until well into childhood. This group believes that abortion is morally equivalent to infanticide, and that both are condonable under certain circumstances. Their viewpoint is extreme, and has generally been rejected by mainstream ethicists and theologians.

While this accounting is by no means comprehensive, and perhaps oversimplifies some concepts for the purpose of clarity, let it serve as a starting point for obtaining more information. With debate on this topic wide open, and no clear answers in sight, the best hope is to understand all viewpoints and draw an informed conclusion as to when life begins.

Reference

Gilbert, Scott F. DevBio, a Companion to Developmental Biology, Eighth Edition. Sinauer Associates Inc., March 2006. Chapter 2, subsection 1.

Do emotions come from our brains, our hearts, or from some other organ? Does it come from hormones and other chemicals circulating in our bloodstream? Perhaps that’s why people blame emotional flare-ups on variations on hormone levels. However, we all know that our brain ultimately controls our words and actions. How we react to our emotional flares are determined by our cognitive processes occurring in our brain.

Men (or the stereotypical man) can easily compartmentalize their emotions and place them into a box. Those boxes may never get opened for many years. Although some people may do this subconsciously, others do it consciously and intentionally. Certain people don’t want to feel specific emotions. They hide from them and they use any type of rationalization (yes, from the brain again) to tell themselves that they don’t need to be emotional. Others feel that they are stronger if they don’t display emotions. Much of this is culturally rooted since young boys may grow up conditioned and trained not to display their emotions. In some cultures, the display of emotions may be a sign of weakness. In certain cultures, men are expected to be so stoic that they forget how to connect with their emotions. They become so detached and removed that they ultimately lack emotions. In the East Asian culture, men tend to be very unemotional. Many remain detached even from their families. Maybe that’s why they can disown their children for seemingly menial things and be unemotionally affected.

We must not forget that we also have psychiatric conditions where people don’t display emotions. Or, they may display inappropriate emotions. I think that people who have antisocial personality disorder are classic examples of individuals who may be so disconnected from emotions like guilt that they rarely (or never) display remorse for their wrongful actions. It’s actually quite frightening when you think about it. Some people have no conscience and they are able to do some horrific things and be totally unaffected emotionally.

So have you ever wondered why we have emotions? Do animals also have emotions? Some would argue that animals feel love, sadness, anger, and other emotions. Others may think that animals are unable to feel as many emotions as people and they only react to instincts. I think emotions help us from killing ourselves. How would you know to run from a roaring lion in the middle of the jungle if you didn’t experience fear? Emotions ultimately help us maintain social order if we’re connected with them and use them appropriately. So are you an emotional person? Or are you emotionally detached?

When medical students would transition from the classroom environment to the clinical setting, they often relied on a pocket-sized notebook that they often called their “peripheral brain.” Some may have called that book their “second brain,” while others may have referred to it as their “ectopic brain.” Here’s a slight tangent: the word ectopic is defined as something that is in the wrong place. You’re probably familiar with the phrase “ectopic pregnancy” which is used when the developing embryo/fetus is not in the correct place (uterus) and is developing in the wrong place (e.g., in the fallopian tubes).

The medical student’s peripheral brain often lasts for several years because many students carry this book into post-graduate medical training (also called internship and residency). This book often gets very personalized with a wealth of hand-written notes, formulas, and other medical pearls.

Perhaps you think that I’m speaking of the stone ages when I speak of a paper book. Granted, the electronic PDA (personal digital assistant) and the smartphone have revolutionized the concept of a peripheral brain. Having access to the Internet on your handheld device is like having a gigantic book in your pocket. In the pre-PDA era, students had a finite amount of content they could carry in their pockets. Now, the sky is the limit because of revolutionary technology and increasing capabilities of micro computers (also known as ultra-mobile PCs or UMPCs).

So, you may not be a medical student, but do you rely on a peripheral brain? I think many of us have become utterly dependent on one but we may not realize it until we accidentally leave it at home. Then, when we’re somewhere and we suddenly realize that we don’t remember someone’s phone number, we are hopelessly lost! Technology continues to increase our efficiencies, but it also makes us more and more dependent on our peripheral brains. If you rely on a GPS (global positioning system) for directions as you’re driving, then you’re relying on a peripheral brain. If you keep all your phone numbers on your mobile phone, then that phone has become your peripheral brain. If you heavily use a PDA or smartphone and you keep a wealth of important information on that, then you’ve got an electronic peripheral brain in your pocket.

This is not the first octuplet birth to rock the medical community worldwide. In London 12 years ago the The Lancet produced an editorial on the story of Mandy Allwood. That case was also interesting for its many ethical questions: Ms. Allwood was secretly taking fertility drugs without medical supervision or informing her significant other. In the early stages of the pregnancy, doctors also recommended that she reduce the number to twins in order to ensure safe delivery and development, advice which she refused. Accusations that decisions were made based on financial incentives were compounded by statements made by her public relations consultant Max Clifford. He implied that the more children who were born, the more money there was to be made. Tragically, all eight of the babies died within an hour of birth at 22 weeks.

Exactly how many children can a woman carry safely to term and are there any limits imposed on fertility doctors?

Recommendations have been made by the American Society for Reproduction Medicine that a maximum of two embryos should be placed in a female. However, there are those who would argue that fertilized embryos are already a life, that selective termination of some fetuses to increase survival of the others should not be done and that all embryos should be implanted and given the opportunity to become a full term pregnancy. Last year, Evans and Britt presented a review that showed fetal reduction in cases of multi-fetal pregnancies improved the overall outcome. Despite these results, it is understandably a difficult decision for many to make. IVF parents are especially reluctant and feel a special attachment part partly because of their previous difficulties conceiving.

One of the major issues that has arisen out of the Suleman octuplet story is that the fertility doctor should not have made the choice to implant this many embryos. Also, there is the question of what if any, psychological screening was conducted on Ms. Suleman before proceeding with the procedure.

What are your thoughts on this issue? Should restrictions be placed on the practices of IVF? How far away are we from so-called “designer” babies, selecting not only gender but other desirable characteristics as well? Should there be stricter psychological testing for women and couples undergoing IVF and why should the process be different for women who have children naturally?

References

M DEAN (1996). British octuplet pregnancy upsets the medical applecart The Lancet, 348 (9027), 605-605 DOI: 10.1016/S0140-6736(05)64810-6

American Society for Reproduction Medicine

MI Evans, DW Britt (2008). Fetal reduction 2008. Current Opinion in Obstetrics and Gynecology. 2008 Aug;20(4):386-93.

To start this discussion, let’s clarify our definition of bias. How do you define bias? Well, Google defines bias as:

influence in an unfair way; a partiality that prevents objective consideration of an issue or situation.

The National Institute on Aging defines bias as:

A point of view or preference which prevents impartial judgment in the way in which a measurement, assessment, procedure, or analysis is carried out or reported.

This brings me to an interesting discussion on the topic of good or appropriate bias versus bad or inappropriate bias. Does appropriate bias exist in health education? If a certain drug or treatment is considered to be far better than all the others in a specific class, then doesn’t that constitute bias? After all, should all drugs be considered equal when they really aren’t? Then how do we free ourselves of bias? But what if all the evidence points to the superiority of a specific agent? That drug is biased as the best because all the evidence points that way. Is such a situation impossible?

Inappropriate bias should never be tolerated. As defined, that type of bias is inappropriate. Healthcare professionals should always be objective about the available levels of evidence when making clinical decisions. The practice of evidence-based medicine has been emphasized greatly and clinicians need to be familiar with the evidence behind specific therapies. Many doctors practice medicine based on their own experience and not based on the clinical evidence. As a result, they may become very biased in what they prescribe or how they treat a certain disorder.

National clinical practice guidelines are written by leading experts in the field as they evaluate the evidence that support the use of specific agents. Many guidelines refer to specific drugs as the “agent of choice” for specific situations. Are these guidelines biased? Some people may think that the clinician authors are being biased when in reality they are being as objective (as humanly possible) with the available amount of clinical evidence. Newer guidelines publish the levels of evidence and indicate the strength of the evidence (the highest levels represent the most robust forms of clinical studies).

Recent revisions to the PhRMA code have now taken into effect. Gone are the days of pens, notepads, soap dispensers, and other pharma-labeled freebies. Supply of such items will soon start dwindling in doctor’s offices and you may have a hard time finding a pen to sign your signature. Will the removal of such small items eliminate bias in the healthcare profession? What does the evidence suggest?

Since doctors and other healthcare professionals are human, we are all prone to bias. Our brains are all biased. What we learn during medical school is taught by faculty who are biased. What we hear from our peers and colleagues is always biased. Can we, as healthcare professionals, distinguish good versus bad bias? Can we judge what is appropriate and inappropriate? I certainly hope we can learn to so that we can do what is best for our patients.

These are just my opinions and I openly admit that I’m naturally biased since I’m human.

References

Pharmaceutical Research and Manufacturers of America. Code on Interactions with Healthcare Professionals.

Mainstream mobile phones have only been in existence for 25 years, and have steadily gained in popularity according to the CTIA. Since that time, mobile phones have been upgraded to “smartphones” which include everything from cameras, to email, web browsing, GPS navigation, and music and video playback. Also, in the past 5-10 years there has been a meteoric rise in the advent of text messaging, with 2007 data showing the number of texts messages sent per day at over 1 billion. Why would having so much available connectivity be a bad idea?

The answer is interruptions. Despite our newfound love of multitasking, the human brain is not very good at it. In 1976, the average adult had an attention span of roughly 15-20 minutes, according to Johnstone and Percival. According to most accounts that number has been steadily shrinking, by some studies down to a paltry 7 minutes. As we are interrupted, time is lost in something called a “context switch” in computing terms, when we have to re-orient our thought process to the new stimulus being presented, and then a second context switch has to occur to return back to the original project at hand. As the brain returns to the original project, however, it takes even more time to commit back to full focus, because our attention has now been split between the project and the interruption. Anybody who has had a deep train of thought interrupted by a phone call knows how diffucult it can be to regain that idea once the phone call is over. Interruptions therefore present a formidable challenge to productivity, as has been confirmed by this Basex study, which estimates that 28% of our work day is spent handling interruptions, resulting in almost $600 billion worth of lost wages. The more interruptions we have during the day, the less productive we can be, and the less money we can make.

From this framepoint, a device that buzzes or makes noise every time an email, text, voicemail, or picture message arrives is essentially an interruption machine. Establishing and maintaining a steady productive focus is almost impossible under these circumstances. Most interruptions are not necessary, either. Standard email etiquette dictates that messages should be sent a reply within 24 hours. Simply taking 10 minutes twice a day to check, manage, and respond to emails falls well within that parameter. Also, if a project involves deep concentration and focus, then the interruption machine must be turned off, and potential distractors like web surfing need to be limited as best as possible. Operating in this manner could help to boost productivity and decrease the constant stress of worrying about all things digital.

For the record, mobile phones are not a bad tool. Being able to make and receive an important phone call in a time of need is definitely advantageous. Some of the other functionality of modern phones, such as the ability to play music or take pictures, are excellent from a recreational standpoint. However, when it comes to work and productivity, a smartphone is undoubtedly a dumb idea.

Recommended Reading

Bittman M. I Need a Virtual Break. No, Really. New York Times. March 2, 2008.

Richtel M. Lost in E-Mail, Tech Firms Face Self-Made Beast. New York Times. June 14, 2008.

As a mental health practitioner, I’ve always been aware of the need to make some type of determination of whether or not clients might be a danger to themselves. There are various warning factors to consider — also considered “red flags” (e.g., feelings of hopelessness, depressed mood, thoughts of suicide, and experience of recent losses, just to name a few).

Given the current financial circumstances of many, exactly how many people would meet the criteria for me to start worrying about their safety? People have lost jobs, homes, and their life savings. Many are feeling the secondary, or tertiary, effects of our economy.

Suicide rates overall tend to reveal social problems. Individuals who attempt suicide can and do have multiple reasons for their behavior, but the impact of ecological factors on suicide and self-harm is undeniable. There is a connection between people and their environment. If the environment is in chaos, there is great potential for creating chaos within individuals. Insulating characteristics (social connectedness, for example) can help – but perhaps don’t guarantee safety, depending on the nature of the chaos-producing events.

Yang found that past suicide rates (between 1940 and 1984) did not increase during previous economic booms or busts, but there were social factors that were found as significant variables. Unemployment and divorce each had a relationship with higher suicide rates.

With unemployment on the rise, home foreclosures at an all time-high (and predicted to increase), the financial strains on individuals and families are likely to worsen. All of these factors are a recipe for disaster.

It is likely that the suicide rate will increase, at least over the next year. Although this time period is similar to the early twentieth century depression, it is not identical. The resources we possess make it unique. We cannot predict what or when the outcome will be — but we can be hopeful. In the meantime, let’s try to keep the chaos at a minimum. Be mindful of those who possess crucial warning signs relevant to our time period: unemployment, relationship problems, financial difficulties, housing loss, and substance abuse.

Even if the sky is falling, Chicken Little doesn’t help.

References

M WRAY, M MILLER, J GURVEY, J CARROLL, I KAWACHI (2008). Leaving Las Vegas: Exposure to Las Vegas and risk of suicide Social Science & Medicine, 67 (11), 1882-1888 DOI: 10.1016/j.socscimed.2008.09.002

Yang, B. (2006). The economy and suicide. American Journal of Economics and Society, 51, 87-99.

The hospital took care of all the arrangements for registering for surgery. On the day of the procedure, I was driven to the hospital with my wife, and walked right into the surgical check-in area. I waited in the waiting area until my time slot came, and then was placed on a stretcher and brought into the operating room. I met up with my doctor again, and spoke with the anesthesiologist who discussed the procedure in detail. Because I had to be face down for the procedure to grant access to my pelvis, I needed to be under general anesthesia with a breathing tube to make sure my lungs stayed inflated. An IV line was started, and they delivered the propofol to knock me out.

I don’t remember anything subsequently except waking up in the recovery room. I had a large bandage on my back, and I was ever-so-slightly sore when I moved around. The bigger problem was that I couldn’t speak well, and my lip was a little roughed up from the breathing tube. Still, I came around quickly, and left the hospital with my wife about an hour after waking up. Over the next two to three days the pain and stiffness in my back went from about a 2 out of 10, down to a 1, and then to just discomfort if I stayed in one position longer than a half hour or so. I was on strict voice rest for one week because of the breathing tube, then went back to normal speaking. I also developed some mild fatigue, which subsided about 10 days post-op. The only residual I have from the procedure is a small scar about the size of a head of a pin on each pelvic bone in the back. All in all, I would say that I came through the procedure well.

On the recipient’s end, things are a little more interesting. Once I was cleared for surgery, the recipient underwent intense chemotherapy and radiation to destroy all the bone marrow in his body. For that short window until my marrow arrived, the recipient did not have an immune system. As soon as the marrow was harvested from me, it was handed to a courier who rushed to the airport and was flown to wherever the recipient is (I’m not allowed to know due to international health information privacy laws), and he received the marrow through an IV. The marrow is smart enough to automatically take hold inside the recipient’s bones, and hopefully begin producing a new immune system, specifically my immune system, inside his body.

Part of that huge panel of bloodwork taken initially was a DNA screen to identify how many base pairs of “junk” DNA were present on the ends of my chromosomes. This number is a unique identifier for each individual, like a fingerprint. The same screen was done to the recipient. Once the new marrow starts producing red and white blood cells in the recipient, a blood sample will be taken and analyzed utilizing the same screen. If my number comes up, then the transplant was a success. If his number, or a combination of his and my numbers come up, then the transplant is a failure. What that means is that if the transplant takes hold, the recipient will be cured of leukemia, and will essentially have my blood flowing through his veins. That explains why the screening process was so rigorous.

Again, due to international health information privacy laws, I’m not allowed to find out if the marrow donation was a success or not. The only way I can get an update is if the recipient’s family goes out of their way to specifically request that I receive an update. All I can do is hope for the best, and know that if things don’t work out, at least that boy exhausted every possible avenue for treatment. Thank you to all of you for your support through this process. I definitely appreciate it.