A Man in Search of an Audience

Updated 12/5, 12/9 (We just can't slow this story down!): The Culture of Life people reported 12/1 on the news that the stem cell debate will soon be 'solved':

A member of the President's Council on Bioethics believes he may have found a way to obtain stem cells with the same potential as embryonic stem cells without creating or destroying a human embryo.

At last, a brilliant idea for getting around the big problem with embryonic stem cell research. It comes from President's Council on Bioethics member William Hurlbut, who constantly complains that those who favor embryonic stem cell research are - his term - "not morally serious" enough (take a listen). But he's had his idea vetted by "prominent Catholic clerics and other ethicists," to see if the technology he proposes is morally acceptable. The idea? Gushes the prolife newsletter:

in Hurlbut's method the gene responsible for creating the placenta is turned off. Hurlbut contends that this prevents an embryo from ever being created. But like traditional cloning, the egg still generates inner cell mass, or the "blank" cells, that some scientist believe have the greatest research potential. The [Boston] Globe reports that parts of the technique are currently being performed on mice.

Sounds great, right? It even sounds oddly familiar, probably. That is because it has been proposed in several forms by at least a dozen scientists who actually work in the area, and published in (among other places) Nature, although not by Hurlbut. Some of the papers are catching on to the idea that maybe the suggestion isn't so novel. But Hurlbut thinks his solution is important and scientifically significant, and conservatives are everywhere trumpeting the significant scientific breakthrough.

There's just one problem with taking him at face value: He has no publications in stem cell biology, ethics, theology or any part of clinical IVF. Nor is he, an MD, in clinical practice in that or any other area. Stanford faculty who have asked the president of that institution to release him point out that he has allowed and personally encouraged the description of him as a "Stanford scientist."

Hurlbut bases the moral utility of his claim on the fact that he vetted it with priests

The Boston Globe covered his theory, and right to lifers are beside themselves with joy at the morally serious solution. (UPDATE: Actually, some of the pro-life leaders are beginning to see the fix Hurlbut's idea puts them in) But there are many, many problems with Hurlbut's claims that even a visit to the Pope won't fix: 1) he makes assumptions about what counts as an embryo, a matter on which no ten embryo researchers agree, 2) he thus makes assumptions about when the destruction of embryonic material would count as destruction of an embryo, a person, or a human life for either scientists or clerics, 3) he makes no effort whatever to describe why his proposal is somehow less objectionable than other nuclear transfer technologies that he has campaigned against so vigerously.

UPDATE: Washington Post reports that Hurlbut's idea was mocked by a visiting scientist at the council, but that nonetheless the council is trading on the prominence afforded to it by Hurlbut's "big ticket idea," and as a direct result Leon Kass did in fact hold hearings on "solutions" to the stem cell problem, which (surprisingly to me, anyway) were hailed by Kass himself (chair) as important stuff. One might have guessed that Professor Kass would be a bit embarrassed that his handpicked council would advance ideas as potentially repugnant (following his analysis in his own writing) as Hurlbut's, designed to sidestep rather than engage a debate. And Kass does try his best to make the ideas sound thoughtful:

Kass said the ideas raise the possibility that "the partisans of scientific progress and the defenders of the dignity of nascent human life can go forward in partnership without anyone having to violate things they hold dear."

But the idea is neither an artful dodge nor a successful one. - GM

Cleveland Clinic's Top Heart Surgeon Profits from Criticizing Vioxx?

The Cleveland Plain Dealer follows a trail set out by David Blumenthal, director of Mass General's Institute for Health Policy. Eric Topol, one of the best heart docs in the world, if not the best, and long the face of innovation (and the most significant backer of bioethics) at Cleveland Clinic, has been researching Vioxx for three years:

Dr. Eric Topol, the Clinic's top heart doctor, published studies as early as 2001 warning that Vioxx and a similar drug, Celebrex, now made by Pfizer Inc., posed potential risks to some patients. The drugs, called cox-2 inhibitors, were instant hits when they came on the market in the late 1990s because they are easier on the stomach than aspirin and other painkillers.

The Plain Dealer - following details published in this week's Fortune magazing - describes Topol's subsequent hiring as biomedical advisor by a risky hedge fund called Great Point Partners LLC. (What is a hedge fund? It is what it does, which is "sell shares on the belief that they will lose value, then buy them back when they are cheaper.") What happened while Topol advised the hedge fund?

Fortune magazine reports in its Dec. 13 issue that Great Point bragged in a recent letter to investors that the hedge fund made a killing by "shorting" Merck stock -- that is, selling shares on the belief that they would lose value, then buying them back when they were cheaper. Since Merck pulled Vioxx off the market, the company's shares have dropped 37 percent.

Great Point said Topol's warnings about Vioxx were one reason the fund was on "the right side of that situation." But Topol took issue with the Fortune report, saying in a written statement that his views on Vioxx were well known long before he signed on with the hedge fund, that he did not know the fund was trading Merck stock, and that he had no personal investment in the fund.

Topol wrote to Fortune refuting this and other accusations of conflict of interest made the magazine:

Topol took issue with the Fortune report, saying in a written statement that his views on Vioxx were well known long before he signed on with the hedge fund, that he did not know the fund was trading Merck stock, and that he had no personal investment in the fund. Topol said he quit the advisory board in October "because of the concern about an appearance of a conflict of interest, even though there was none." He said Great Point was paying him $12,000 a year to evaluate new technologies for treating heart disease.

Blumenthal stops short of describing Topol's activities as conflicted, and predicts more expert-as-investment-advisor behavior in the future. There's no indication in the stories that Merck revealed Topol's role, and Certainly Fortune could have dredged it up from the fund's press release, but you have to wonder how many people are going to step up to advise companies on matters of profits when the backlash can be this strong.

If Eric Topol in fact earned $12,000 for advising a little hedge-fund company about the state of biomedical technology, including his view about Merck, which was already well published, one would be hard-pressed to accuse him of trying to profit. Topol could have made a small fortune hedging Merck himself, in someone else's name to cover his tracks. Would he really be stupid enough to take a tiny fee instead, in full public view? Unless there is much more to this story than is reported, it looks like a fancy way to tar the biggest critic of a certain pharmaceutical company... (Wait, should I have written that? Maybe a Philadelphia Inquirer writer will 'discover' that I own a retirement mutual fund with $14 worth of Merck stock in it...) - GM

Privacy, but Not So Much

Economist reports today on a new idea that really is half-baked. Because of rising complaints among British patients of abuse by physicians during intimate examinations, particularly sexual abuse, the Virtual Chaperone has been invented. It is a clever name, sort of, for a video camera and microphone in the examination room, recording every detail of the examination so as to protect both patient and physician. Sounds like the sort of solution a malpractice lawyer would work out.

One of my favorite passages in The Republic involves Socrates' discussion of a ring that allows the wearer to become invisible and undetectable. The discussion that ensues is about what sort of thing those with whom Socrates is in dialog would do with that kind of power. Eventually they are honest and admit that with that power they would be unable to resist using the power to get away with all sorts of evils. Socrates makes the interesting point that one can only be trustworthy when there is the temptation to violate the trust of someone, that is, there's no point in discussing whether or not you are a good person until you have the opportunity to be bad without anyone's knowing it. This is the essence of clinical trust. If you are going to violate patients unless there is a camera in the room, you really shouldn't be a physician. But that is no argument for cameras to root out dangerous docs.

Cameras cannot protect a patient from a physician, and there is simply no way to justify the additional invasion of privacy - from a camera designed only to protect physicians from charges of sexual abuse. Think about it - the physician has you naked. They do exams that are intimate. If they are drawing enjoyment from that, beyond what is appropriate for a clinician, how in the world are you going to prevent that by exposing the patient to a further violation of privacy? The risk is also pretty obvious that the tapes will be stolen: keep in mind that the cameras are supposed to be super-discrete (says the Economist), so how long do you think it will be before those videos are traded among residents, or even uploaded or sold as porn tapes? This is a really stupid idea, and the Economist appears to have thought about it for all of fifteen minutes.

Please, Someone, Teach These Journalists?

In the fiftieth poorly-researched assisted reproductive technology piece of the year, New Scientist lets us all in on the big news of the week: the Brits have "applied for a license" for something that is "banned" - yes banned - in the U.S., supposedly: "creating children with three parents." You have to be curious as to whether they just make these little snippets up...three person reproduction isn't banned in any national or even in any state law. The truly interesting thing is that New Scientist was able to miss any of the facts about the multiple egg issues in either the literature or even among those who work on these questions all the time. So get ready for a spate of "three moms" pieces!