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On September 25, 2006 President Bush used his veto powers for the first time. What did he veto? A bill allowing federal funds to be used for embryonic stem cell research. (I wish he had used his veto powers on big spending bills, but that is another story.) The veto was a welcome blessing for many religious folks, but seen as a curse for many folks stricken with degenerative diseases like Alzheimer’s, Parkinson’s, and Multiple Sclerosis.

At the bill signing ceremony, children who started out life as frozen embryos designated “to be discarded” were brought to the center stage. The image of President Bush and parents holding these precious kids tugs on your heart strings and makes you glad that the kids were given a chance at life instead of being tossed into the bio-trash bin. But as usual we need to set emotions aside and rely on research and reason when seeking a clearer understanding of what is going on.

Most people, including Christian folks, don’t have issues when couples with fertility problems use in vitro fertilization. In vitro fertilization involves fertilizing an egg (ovum) with a sperm outside of the womb. One approach is to inject a sperm directly into an egg (called intracytoplasmic sperm injection). The fertilized egg, called a zygote, is then placed in an incubation chamber and cultured until it reaches the embryonic stage of development, at which time it is transferred to a woman’s uterus.

Because embryos fail during the incubation phase, or fail later after being transferred to a uterus, multiple embryos are created. Why go to all the trouble and expense of creating a single embryo that might fail? It seems reasonable to create multiple embryos. But what happens to the extra embryos when a pregnancy is successful, assuming the parents want no more children? They are discarded.

Where is the uproar over discarding embryos? There really isn’t any. If there isn’t a fuss over discarding unwanted embryos, then why the fuss over using ‘unwanted’ embryos for stem cell research? It seems to me that people opposing embryonic stem cell research should also be opposing discarding embryos with equal fervor, but they aren’t.

Are we, as a society, morally obligated to give every frozen embryo a chance at life? Does tossing out an unwanted embryo translate into a spirit not having a chance at life? I think most Mormons would say no. Wouldn’t it be great if every unwanted embryo were given to adoptive parents? Yes, but that does not always happen for one reason or another. If it is acceptable to discard unwanted embryos created for birth, then why not use them for stem cell research?

Good news: Adult stem cell research is proving much more promising that embryonic stem cell research. This will hopefully prevent the creation of embryonic stems cells for research purposes and minimize the use of unwanted embryos in research - a win win situation for everyone, inlcuding people who may one day be adopted as embryos. 
 
 
Here I go with one of those I told you so moments.

A short while ago I posted an article on the pros and cons of the Canadian Healthcare model. (For those of you who do not know, Canada has government run, socialized medicine.) President Obama’s administration is in the process of building a similar model in the United States. 

One of the cons I mentioned in that post is that the Canadian model is not effective at controlling costs. That’s right, costs are spiraling out of control in Canada just like they are in the US. And on the other side of the ocean, healthcare costs are also rising sharply in most European nations with socialized medicine.

Funny thing is, the Democratic healthcare bill was passed largely to control spending. Apparently the current US administration didn’t look into what is happening to medical costs in socialized countries; if they had, they might have reconsidered. I suppose they think they can do socialized medicine better than the rest of the world.

Good luck!

And now I'll sign off with an amazing revelation:

Health care costs can only be controlled by reforming health care delivery, not by reforming healthcare insurance, which, unfortunately, is all the recent health care bill does.
 
 
In 1998 British physician Andrew Wakefield authored an article in the prestigious medical journal Lancet linking the MMR (measles, mumps, and rubella) vaccine to autism. Recently he has been accused of scientific misconduct leading to the vaccine-autism scare. Now he is banned from practicing medicine in England.   

I am not going into the allegations against the study – you may look them over here if you like. Critics maintain that Wakefield’s results were intentionally falsified to support the conclusion that MMR may influence incidences of autism. The British General Medical Council agrees. Earlier this year the council concluded that Wakefield “acted dishonestly and irresponsibly in his controversial research.” I have no reason to doubt these accusations.

Wakefield’s critics are now claiming that he has blood on his hands. Because of the vaccine-autism scare which he perpetuated, many parents refused the MMR vaccine for their children, leading to a spike in rates of measles, mumps, and rubella and an increase in serious illness and deaths from these diseases.

I think Wakefield took a bold gamble and lost. There are two ways this could have gone. (1) If subsequent research had confirmed his conclusions (it has not, by the way), he would have been hailed as a hero and we would have given him a Nobel Prize in medicine. (2) Subsequent research did not confirm his conclusions, so investigations and accusations followed to the point where he has been branded a charlatan by the larger medical community. Poor Wakefield – he flipped a coin and called “heads”, but it came up tails.

Scientific misconduct aside, I think Wakefield deserves some credit. You see I am a parent of young children. When I find out that they are going to get 3-5 vaccines in one day according to the guidelines set forth by the American Academy of Pediatrics, I cringe. Common sense tells me that 3-5 shots are overloading my kid’s immune systems, which is why they are sometimes cranky and feverish for the next 24 hours. Hey you guys setting the vaccine schedule, do ya think we could spread this out a bit?

In all likelihood Wakefield’s research also contributed to the recent debate on the use of Thimerosal in vaccines. Thimerosal is a mercury-containing preservative used in some vaccines. While there is no evidence to suggest that it increases the risk of autism and other disorders, in 1999 the American Academy of Pediatrics agreed to reduce or eliminate Thimerosal in childhood vaccines as a precautionary measure. As a parent I think this is a good thing regardless of what the science says or does not say.

I am not trying to take sides on the Wakefield debate; I am pointing out that some good has come from it. The debate prompted a lot of research that definitively answered whether vaccines influence autism, and it raised awareness of the heavy vaccine schedule for children and the use of Thimerosal as a preservative.

While his article may have prompted some parents to forgo the MMR vaccine, thus leading to increased rates of these diseases, let’s be careful about putting all the blame on Wakefield. There are other reasons why people don’t get their children vaccinated (e.g., financial, distrust, religious, complacency, etc.), and vaccines are not 100% effective at preventing disease.

2 cents.
 
 
What do all these events have in common?

Copernicus’ book “On the Revolution of Celestial Spheres” (1543)
Newton’s book “Mathematical Principles of Natural Philosophy” (1687)
Einstein’s Relativity (1907)
Alexander Fleming’s Penicillin (1928)
The Human Genome Project (2003)

They are all scientific discoveries and advancements that have had a major impact on the world, yet when the discoveries were made, life went on as usual. Consider that on a certain day in 2003 when the Human Genome Project was declared finished, you woke up and went about your daily affairs as though nothing of huge importance happened. Yet on that day Francis Collins and his colleagues completed a major genetics project that has greatly advanced science and human health and will continue to do so into the future.   

When major discoveries are made, life tends to go on as usual. There are exceptions to this rule, however. Our parents or grandparents likely remember the great excitement that resulted when Jonas Salk (not to be confused with the Jonas Brothers, younger folks) introduced a safe Polio vaccine in 1955. Or they remember the excitement that arose when, in 1922, two physicians from Canada walked onto a hospital diabetes ward full of grieving parents and dying children, gave the children injections of their newly discovered hormone called insulin, and quickly brought the comatose children back from the clutches of death.

Did you know that a major medical discovery was made over the last year, a discovery that will likely go down in the history books as having a significant impact on heart health? As the discovery unfolded, you and I probably went about our daily affairs as though nothing hugely important occurred. Interesting, isn’t it? Here is what happened.

Researchers at the University of Utah and other locations discovered that stem cells taken from the bone marrow of heart failure patients, incubated in a bio-reactor, and then inserted into failing hearts, rejuvenated heart muscle. Researcher Dr. Amit Patel said that the inserted stem cells "send out little chemicals that go to all the local heart muscle, and throughout the body . . . recruit[ing] other cells to the heart [that] work together to actually rebuild and remodel [the heart]." Dr. Patel described the remodeling and rebuilding process as “very dramatic." The procedure is not yet a cure, but it is prolonging lives and giving heart patients and their loved ones new hope.

The Lord is the benefactor of great latter-day scientific discoveries. The apostle Paul testified that in the last days, God would pour out His spirit upon all flesh (Acts 2:17). Joseph Fielding Smith taught that that spirit, the Light of Christ, inspires men to “invent and discover the great truths which, until now, the Lord has seen fit to keep hid from the inhabitants of the world.”

The Spirit of the Lord will continue to bless us with scientific discoveries just as the apostle Paul testified nearly 2000 years ago. We might not know when breakthroughs occur, but they are happening, thanks to the Lord.
 
 
Canada has socialized medicine and a government run, single payer insurance system.  I work in healthcare in the US and have heard several times that the US can’t go the way of Canada. I have also heard talk radio saying that the Canadian model doesn’t work.

I am writing this post to defend the Canadian healthcare model. Here are 5 positive and 2 negative observations about Canadian healthcare.

Positive.

1. In all my years of growing up in Canada, I have never once had a problem with getting quick primary and catastrophic care in Canada. Whenever I called my primary care physicians, I was in the doctors’ offices within 0-3 days. When a surgeon and I agreed that I needed elective surgery, that surgery was scheduled within 3 weeks. And whenever I went to the ER, I was seen within 1-2 hours, sometimes less.

2. Canadian healthcare is not free. Everyone pays a premium because fair and equitable premiums are automatically deducted from your paycheck. I think this is a good way of ensuring that everyone pays into the system – there are very few freeloaders in Canada. Also, premiums are automatically adjusted based on income, so poor families pay less. Making sure that everyone pays something into the system prevents the “entitlement” mentality (“I deserve care even if I don’t pay for it”).

3. If you get real sick in Canada, you don’t lose your home and risk bankruptcy.

4. If you require catastrophic care in Canada, you get it quickly. Last year my uncle had a massive heart attack. He was flown to Vancouver and in surgery with a specialist the very next day. He had follow up surgeries a few weeks later in a timely fashion. 

5. The story about the Canadian premier from Newfoundland who recently went to Florida for heart surgery that we keep hearing about was not denied heart surgery nor was he placed on a long waiting list in Canada. He was offered surgery in Newfoundland that would have saved his life, but he opted for an alternative, less invasive procedure by a specific physician in Florida who was recommended to him by someone else. So this is not a case of someone not being able to get decent care in Canada. It is a case of a wealthy politician shopping around for a specific doctor and procedure that was more to his liking.

Negative.

1. Last year I attended a healthcare conference where data were presented showing that the cost of healthcare is rising at an alarming rate in nations with socialized care. So Canada’s socialized medicine is not controlling costs very well. Obama’s insurance reforms will not, in all likelihood, bring rising costs under control. I believe that controlling rising costs can be achieved by changing the culture of healthcare delivery.

2. Canada does not have a co-pay system. Absence of co-pays leads to unnecessary visits at primary care and ER facilities. A co-pay is needed in Canada. It would force some Canadians with mild conditions like sore throats and coughs to think twice about whether they need to see a doctor, assuming they tend to run off to the doctor at the first sign of a cold .

So there you have it - one person’s viewpoint. Whether the Canadian model would work in American is unknown, but it works fairly well for Canadians.
 
 
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Pioneering research on the localization of brain functions by the eminent neurosurgeon Wilder Penfield (1891-1976) provides scientific evidence for the existence of a spirit.

Penfield was attempting to identify the origins of epileptic seizures by stimulating exposed regions of patients’ brains with an electrode. If the initial seizure location could be identified then he would consider removing tissue at the trigger site. By repeatedly stimulating brain regions in conscious patients and noting the effects, Penfield was able to construct a remarkably detailed map of localized functions in the brain. Equally impressive was what he did not find. In all his work on stimulating the human brain, Penfield could not locate the mind.

When Penfield carried out his investigations, patients would report all sorts of sensations, memories, and movements, but the electrode never activated the patients’ mind. He could not stimulate the brain and cause a patient to make a choice, to believe something, or to reason. This discovery led him to conclude that “it will always be quite impossible to explain the mind on the basis of neuronal activity in the brain.”

Penfield noted that throughout his research the mind was manifested in the patients’ reports of what his electrode caused them to do and feel. For example, when the electrode caused a hand to move, the patients did not say, “I wanted to move my hand;” they said, “I didn’t do that, you did.” He concluded that “The patient’s mind, which is considering the situation in such an aloof and critical manner, can only be something quite apart from the neuronal reflex action.”

When Penfield began his studies of the human brain, he had hoped to discover how the brain causes the mind. However, unable to find the physical correlates of the mind in the brain and at the same time ever aware of the presence of mind during his research, Penfield reached an unexpected conclusion. He determined that a human spirit must be the source of the mind. This conclusion brought him great joy. “What a thrill it [was],” he declared, “to discover that the scientist, too, can legitimately believe in the existence of the spirit!”

(Source: an excerpt taken from Truth and Science: An LDS Perspective)
 
 
When Rudy Giuliani was running for president he cited data comparing healthcare in England and the United States. This is the essence of what he reported:

In Britain about 44% of men diagnosed with prostate cancer were alive 5 years later. On the other hand, in the US about 81% men diagnosed with prostate cancer were alive 5 years later. So Giuliani concluded that the 5-year survival rate for prostate cancer in the US is nearly double what it is in England (44% for England vs. 82% for the US). He was wrong. The risk of death from prostate cancer is virtually the same in both countries. 

In the US most prostate cancer screening involves looking for prostate-specific antigens (PSA). British doctors do not rely on PSA testing near as much as their American counterparts. In England most prostate cancer is identified through symptoms. These different approaches to diagnosing prostate cancer are key.

Here is how different screening practices lead to different survival rates.

The US has a higher proportion of prostate cancer diagnoses because US physicians rely on PSA screening. PSA testing often identifies small tumors that grow so slowly they do not harm a man before he dies from natural causes due to old age. These are sometimes called nonprogressive cancers. Nonprogressive cancers meet the pathological definition of cancer but never cause symptoms during a patient’s lifetime. On the other hand, because British physicians rely more on symptoms to diagnose prostate cancer, they usually do not diagnose men with nonprogressive cancers. 

So if PSA testing in the US identifies 3000 men with prostate cancer, 2000 of those may have nonprogressive cancer while 1000 may have progressive cancer. The 2000 nonprogressive cancer patients survive along with 440 of the 1000 progressive cancer patients. Thus the survival rate is 2440/3000 = 81%

If England relies on symptoms to identify prostate cancer, then it will miss the 2000 with nonprogressive cancer and just diagnose the 1000 with progressive cancer. Among the 1000 progressive cancer patients, 440 survive, just like in America. However, England’s survival rate is 440/1000 = 44%.

The upshot is that over diagnosing prostate cancers with PSA testing in the US is inflating survival rates. In reality, the risk of dying from prostate cancer is virtually the same in both countries. A 2001 report showed that there were 26 prostate cancer deaths per 100,000 men in the US and 27 cancer deaths per 100,000 men in England (Shibata & Whittemore).

The other dark secret of PSA testing is that it may be leading to unnecessary treatment. If PSA identifies a tumor then a man may choose surgery and/or radiation therapy. These treatments may be unnecessary if the tumor is nonprogressive, yet the man could be left with impotence and incontinence as a consequence of being treated.

If PSA testing identifies a cancer tumor, I think the next important question should be: "Is it progressive?" The answer(s) to this question and a thorough discussion between patient and doctor should inform one's decision to withhold or undergo treatment. (Source: Gigerenzer et al., 2008. Helping Doctors and Patients Make Sense of Health Statistics)
 
 
Recently there have been a number of advertisements claiming that drugs like Lipitor can cut your risk of stroke in half. Is this something to get excited about? It all depends on your risk of stroke.

If your risk of stroke is low, say 2%, then Lipitor will cut your risk of stroke to 1%. Is that reduction worth the extra expense and potential side effects associated with taking the medication? On the other hand, if your risk for stroke is 20%, then Lipitor may cut your risk down to 10%. That sort of reduction would convince many people at risk to take Lipitor. In both scenarios there is a 50% reduction in risk, but the need to take the drug is different. It all depends on level of original risk.

The same logic applies to screening and testing for health problems. With the recent death of Senator Ted Kennedy from a brain tumor, we may witness a phenomenon called the availability heuristic. Availability heuristic refers to people overestimate the future probability of an event occurring because of recent dramatic, publicized events. Thus some people may overestimate their chances of getting a lethal brain tumor because of Kennedy’s highly publicized death. If you are one of those people, there are plenty of places willing to give you a costly brain MRI even though you are currently asymptomatic (healthy) (www.brainscans.com is one such place).  

Well, if you are rich, then what is there to worry about? Why not get the screening done? The answer is that some tests can be harmful and others can lead to false positive results that may result in unnecessary additional testing and therapies.

Take, for example, those full body scanning centers that have recently popped up around the USA. Otherwise healthy people go to these centers to get scanned for diseases for which they are at low risk. Well, if they are rich enough to light their cigars with 100 dollars bills, then why worry, right? Wrong.

Several of the scans utilize CT technology. CT scans typically irradiate at higher levels than traditional x-rays. For instance, a chest x-ray delivers a dose of approximately 0.06 mSv, while a chest CT scan can deliver anywhere from 2.0 to 8.0 mSv, depending on the type of CT scan. That's a major increase in levels of irradiation for healthy individuals.
(Source: http://www.hps.org/publicinformation/ate/q2372.html).

Such tests are usually called for if a patient is symptomatic, has a history of disease, or has other risk factors. If none of these apply and a patient is in good health, the test may do more harm than good. Most physicians are aware of these issues, so check with your doc when considering screening tests.
 
 
How many times have you heard a claim like: Doing X increases your risk of getting disease A by 75%? Or how about a claim like: Taking supplement Y cuts your risk of getting a disease B in half? Such statements of relative risk can be very misleading. Here’s why.

In 1995, Britain’s National Committee on Safety of Medicines issued the following warning to women taking contraceptives: Rigorous studies have found that women taking 3rd generation contraceptives (contraceptives made after 1990) experienced a twofold (100%) increase in blood clots compared to a similar cohort of women who took 2nd generation (pre 1990s) contraceptives. In other words, newer contraceptives are doubling a woman’s risk of blood clots compared to older contraceptives.

It sounds like young women should avoid 3rd generation contraceptives because of the increased risk of blood clots, right?
Wrong.

Here are the hidden, yet important details on prevalence:

In reality, the contraceptive studies found that one out of every 7,000 women who took the 2nd generation pills had blood clots. This number doubled with 3rd generation pills where two out of every 7,000 women who took 3rd generation pills had blood clots. Hmm? So is a 100% increase from 1 to 2 blood clots in a sample of 7,000 women something to get deeply concerned about? Not likely.

If the prevalence rate of a disease is low, then a 2, 3, or 4 fold increase may not be important, unless you are among the few who get the disease. 

This fallacy also works its deceptive magic the other way – in preventing disease.

What if I told you that vaccine A cuts your child’s risk of getting disease X in half? Hmm? Sounds good, eh? Wait a minute. What is disease X’s prevalence rate? The prevalence rate/risk of getting disease X is 2 in 10 million, or 0.00002%. Now if your child is vaccinated, the risk of getting the disease is cut in half to 1 in 10 million, or 0.00001%. Does this sound reasonable? Probably not. Think about it this way: we would need to vaccinate 10,000,000 children in order to prevent one child from getting disease X.

Should we spend millions to vaccinate children against a disease most will never get? To do so might be a waste of healthcare resources and dollars that could be utilized elsewhere. 

So the next time you read or hear a result like “It increases the risk of disease X by 200%” or "It cuts the likelihood of developing disease X in half," look for the prevalence rate. As the prevalence in the population goes up, so does the significance of the risk. For instance, if the prevalence rate is 10% (10% of people are at risk for developing disease X), then a vaccination that cuts that risk in half to 5% is something to crow about.

(Source: Gigerenzer et al. (2008). Helping doctors and patients make sense of health statistics. Psychological Science in the Public Interest, 8(2), 53-96.)
 
 
Experienced bloggers know that when posts are read in haste, the chances of the main message being misunderstood increase. I am sure most of you skim read posts. I do it when time or interest are lacking. Of course there is nothing wrong with “skimming” through posts. The problem comes in, however, when skimmers post replies based on their limited understanding of posts. They are more likely than careful readers to assume that bloggers said something they did not say.

Recently I posted an article on carbon footprinting and having babies. I got a few replies, which I am grateful for. But I am disappointed with those who, for one reason or another, misread or incorrectly interpreted my main message. I was accused of calling people who are concerned for the environment and the earth’s resources “tools of the devil”. If this were the case then I would be a tool of the devil because I recycle and occasionally take mass transit out of concern for the environment.

What I said in the blog post (see below) was that people who are concerned about the environment and resources to the point of positing limited reproduction through education and government action are doing the devil’s bidding. They are putting their eco-fanaticism ahead of the God-given command for humans to reproduce.

There are a lot of reasons, many of them personal, for couples to have or not have children. Government mandated zero population policies in the name of environmental and resource management should not be one of them.

China’s harsh and ungodly One Child policy is a classic example. As BYU political science professor Valerie Hudson pointed out, the decision among many Chinese families to have a boy through selective reproduction practices (typically through abortion of female fetuses) is creating a huge problem. She warned that by the year 2020, China will have 30 million surplus uneducated, unskilled, unemployed, and unmarried young males. Historically when such surpluses existed in China, totalitarian regimes have used the boys as soldiers in war. (Source: http://www.washingtonpost.com/wp-dyn/articles/A24761-2004Jul2.html?referrer=emailarticlepg)

It is interesting that supposedly enlightened academics, writers, and government bureaucrats in the US are making similar arguments. Here is an example. An environmental writer for the SF Chronicle recently wrote the following about scientific research which implicates babies in carbon footprinting.

Thinking about zero population growth as something that can be obtained by empowering people, rather than forcibly sterilizing them, makes the issue more approachable. I'm glad the [carbon footprint] study reveals childbearing as an important environmental decision, but science will have to learn how to stop considering women and fertility to be interchangeable if we are to make any progress on the population issue. (Source: http://www.sfgate.com/cgi-bin/blogs/green/detail?entry_id=45122)

Another example of eco-fascism at its worse.
 
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