Journal 2008

Columbia University Journal of Bioethics 1
2 Fall 2007
Columbia University Journal of Bioethics

And Supplement on BIOCEP
V o l um e V I . N o 1 , Fa l l 2 0 0 8
Editorial Board Faculty Editors

Editors-in-Chief Dr. John D. Loike
Dr. Ruth L. Fischbach
Copy Editors
Soo Han Cover Design: “Entwine‖
Komal Kaothari Robyn Scheinder and
Dr. John D. Loike
Please send your comments
to Dr. John D. Loike
at: jdl5@columbia.edu
Production & Creative Directors
Robyn Scheinder
Web Version is available through the undergraduate page: http://www.columbia.edu/cu/

Or through http://www.bioethicscolumbia.org/
Copyright 2008 by: Columbia

University Center for Bio-
ethics-NO PART OF THIS
JOURNAL MAY BE COP-
IED OR USED WITHOUT
PERMISSION.
All views in the articles re-
flect those of the authors
only.
T AB L E O F C O N T E N T S
Acknowledgements ............................................................................................................................. 5
Introductions by Dr. John Loike and Dr. Ruth Fischbach ............ …………………………………..…….6-7
Section I: Genetics
The Sound and the Fury
By Katie O‘Neill and Wei-Jen Hsieh………………………………………………..
Majority Report: DNA Data-banking As an Opt-Out System

By Emilia Javorsky and Robyn Schneider………………………………………...
Could Genetic Research Interfere with Medicine?

By Jorge Jara and Joanna Etra……………………………………………….
Charging You for Being You

By Elisa Fung and Gabriela Vargas………………………………………….
Section II: Stem Cells and Reproductive Medicine
Altered Nuclear Transfer: A Novel Way of Developing Pluripotent Stem Cells

By Sarah Eberle and Tabby Khan………………………………………………...
Secrets and Lies: Mandating Disclosure in Oocyte Donation

By Tiffany Hsieh…………………………………………………………………..
Diagnosing Disability… And Keeping It

by David Yin and John Tseng………………………………………………..
Section III: Neuroethics
Programmed Free Will

By Elisa Fung and Lindsay Kugler…………………………………………………..
Neuroimaging for InterGender Peace

By David Yin and Kathleen O‘Neill………………………………………………….
Do You Mind If I Read Your Mind?

By Adela Aguirre and Alan Daboin………………………………………………
GLBT Flies: The Application of Mind Control To Sexual Preference

By Viktor Gamarnik and Shu Pan…………………………………………………..
Memory Upgrades: Not Just For Your Computer

By Emilia Javorsky & Wei-Jen Hsieh………………………………………………...
4 Fall 2007
T AB L E O F C O N T E N T S ( c o n t i n u e d )
Section IV: Contemporary Issues
Say No to Blow: Preventing Cocaine Addiction through Vaccination

By Soo Han and Tabby Khan
Building Athletes
By Yonah Heller and Jean Pierre Rabbah
Molecular Imaging and Ultrasound-assisted Drug Delivery

By Ashok Ilankovan and Andrew Arnold
Bioartificial Hearts, Bioethical Issues

By Esty Rajwan and Ditty Vick
One Word: ―Synthetics‖: The Ethics of Synthetic Biology

By Savino Sguera and Benjamin Stern
A Dearth of Donations
By VikrumThimmappa and Jocelyn Lo
A Bun in the Oven

By Jennifer Gillman, Anna Plitt and Andrew Behrens
Paying For Patient Performance

Viktor Gamarnik and Ben Koo
Section V: Cross-cultural Bioethics-BioCEP

Sex and Education. Can they go together?
By Elizabeth Edwards, Yoon Joo Kang, and Caroline Leone
Behind Their Smiles: Cosmetic Dentistry and Medical Tourism in Thailand

By Mikilena Greusel and Dr. William Bloch
The Ethical Concerns of Propranolol and Memory Dampening

By Donna Taraborelli, Tasha Smith, and Siwachapol Monyakul
Finding the Middle Path to Stem Cell Nirvana

By Melissa Bauer and Shanshan Tang
To breach or not to breach doctor-patient confidentiality involving children with AIDS

By Risa Hoshino, Janice Liu, and Sun-Chai Waleecharoenpong
Enlightenment: Just a Pill Away!

By Marlon Danilewitz, Margarita Borovka, Mariangels de Planell-Saguer
Acknowledgements
Columbia University Journal of Bioethics would like to acknowledge the following

individuals and organizations for their advice and support to help publish this journal: Dr.
Deborah Mowshowitz, Director of Undergraduate Programs; , Chief Communications
Officer of the Department of External Relations; Anna Sobkowski, Director of Science
Communications of the Department of External Relations; Dr. Ruth Fischbach, Director of
the Center for Bioethics, Columbia University College of Physicians and Surgeons; Ms.
Jana Bassman, Center for Bioethics, Dr. John D. Loike, course director for Topics in
Biology: Frontiers in Bioethics (W3995) and Ethics for Biomedical Engineers (BEN4010);
and all the students who contributed to this Journal.
6 Fall 2007
Introduction
In 2008, the number of articles submitted to The Journal increased almost three fold
as more and more students became captivated with bioethics. Bioethical issues related to
reproductive medicine, neuroethics, and genetics received high visibility in both the public
press and in scholarly journals. The authors of papers published in this Journal have voiced
their opinions and proposed innovative insights and solutions in response to these issues.
These student contributors are aspiring scientists, physicians, lawyers, and philosophers
whose thoughts and opinions are the heartbeat of this Journal. These students will emerge
as the front line of scientific and medical discovery. Their future innovative research and
ability to communicate science to the public will elicit and inspire bioethical debates.
Furthermore, they will become essential players in helping society resolve many bioethical
dilemmas.
This year‘s Journal volume also includes a special section on Cross-cultural

bioethics with articles written by those American University students and students from
Mahidol University in Bangkok, Thailand, who participated in an innovative cross-cultural
educational program called Bioethical Cross-cultural Educational Program (BIOCEP).
Twenty students from various universities in the East Coast and ten Mahidol students
attended this special two week program in Bangkok, Thailand exchanging ideas and learning
how culture and religion influence bioethical dilemmas. Their articles reflect some of the
lessons derived from their exposure to various cross-cultural humanistic values.
John D. Loike, Ph.D.

Course Director for Frontiers in Bioethics and Ethics for Biomedical Engineers
Co-Director of Graduate Studies, Department of Physiology,
Director of Special Projects, Center for Bioethics, Columbia University College of Physicians
and Surgeons
Preface
Ruth L. Fischbach, PhD, MPE

Professor of Bioethics
Director, Center for Bioethics
Columbia University College of Physicians and Surgeons
8 Fall 2007
I. Genetics
The Sound and the Fury

By Katie O‘Neill and Wei-Jen Hsieh
Columbia University
If you were given a choice to be diameter to be drilled into the patient‘s skull
deaf or to hear, which would you choose? in order for the device‘s electrode array to
Now, what if you had to make the decision be threaded into the scala tympani (Papsin
for someone else? and Gordon, 2007). Three to four weeks
later, the device is activated when a
One out of every thousand children transmitter and microphone are placed over
is born deaf, and for the parents of these the ear. Since stimulation levels may shift
children, this question is not just hypothetical over time, the implant must be continuously
(Papsin and Gordon, 2007). Ninety percent monitored throughout the patient‘s life.
of deaf children have hearing parents who Moreover, implantation may cause inner ear
want their child to be ―normal‖, yet members
of the deaf community contend that
deafness is a normal and natural condition
(National Association of the Deaf). Only
recently has this issue have practical
implications. Due to a new technology, the
sensation of sound can be transmitted to the
brain through the implantation of an
electrical device.
The cochlear implant was approved

by the FDA in 1985 and since then it has
been successful in delivering auditory
stimulation to both children and adults. damage and children who undergo this
However, in a study following eighty-two procedure are often at an increased risk for
children for ten years after implantation, only contracting meningitis (Papsin and Gordon,
40% had speech that was intelligible to the 2007). Furthermore, three to six percent of
average listener. The same study found that the time, re-implantation is necessary due to
although 79% of these children could use traumatic or ―hard failure‖ which may result
the telephone, more than 70% had in intracochlear changes.
vocabulary scores that were below average.
For the most part, cochlear implants
For these reasons, many parents are imperfect, yet many physicians view
believe that the implant is not worthwhile. deafness as pathology: a disease that needs
The invasive procedure is performed under to be cured. Thus, pediatricians will strongly
general anesthesia and calls for a small hole encourage parents to pay $40,000 to give
of approximately two to three centimeters in their child the gift of sound. On the other
hand, the deaf community insists that allowed to decide for himself? Scientific
deafness is a natural condition and allows literature suggests that cochlear implants
for the survival of a unique culture. are most successful if the procedure is done
Moreover, deaf parents want their children to before the child‘s first birthday; thus, we
be a part of the community to which they depend on the child‘s parents to make the
were born, a community whose primary best decision.
language is American Sign Language.
If society were to conceptualize
The media often describes deafness deafness as a disease, do parents even
in a negative light, portraying deaf children have the right to choose for their child to be
and adults as ―handicapped‖ or ―second- deaf? As the technology is now, there are
class citizens‖ in need of being ―fixed‖ with many complications with cochlear implants.
cochlear implants. Yet for those of us who However, if technology improves so that this
are accustomed to hearing, can we form an procedure becomes common practice,
objective opinion about a life without sound? should the child have the right to hear
regardless of his parents‘ opinions?
We, as hearers, have come to rely Although it is currently very expensive, pre-
on our ears for cues about the world in implantation genetic diagnosis suggests that
which we live. We derive pleasure from live as a society we could theoretically wipe out
concerts, films with deafness by
f a n t a s t i c s c r e e n i n g
soundtracks, and embryos. Should
our favorite this become as
c h i l d h o o d routine for families
Christmas carols. with a history of
As musicians, it is deafness as it is
impossible to with other genetic
imagine a life diseases? This is
without music. Yet, the logic that
Beethoven, one of threatens the deaf
the greatest community. For
composers of those who are
classical music, deaf, a silent life is
was completely just as valid as one
deaf when he wrote with sound.
some of his most
prolific works, including the well-known References:
Symphony No. 9. Thus, even for a
musician, deafness is not an impediment to National Association of the Deaf: http://
profound genius. www.nad.org/site/apps/s/content.asp?
c=foINKQMBF&b=3930755&ct=166093.
To hear or not to hear, that is the
question. But, in choosing the fate of a Papsin BC, Gordon KA. Cochlear implants
child, who gets to make the ultimate for children with severe-to-profound hearing
decision? In a society which values loss. New England Journal of Medicine, Dec
individual freedom, shouldn‘t the child be 6, 2007: 2380.
10 Fall 2007
Majority Report: DNA Data-banking As an Opt-Out System

By Emilia Javorsky and Robyn Schneider
Columbia University
It is the stuff of science fiction does not fit crime scene DNA can be
novels and dystopian futures in 2007 a man excluded.
was convicted of a crime he committed over
30 years ago. The local police, unable to Although this system is more
obtain a warrant for his arrest based on successful than eyewitness evidence, it is
existing evidence, followed their suspect neither large nor successful enough.
until he spat on the sidewalk and then Restricting the information contained within
collected the saliva for a DNA profile. the databank to reflect only those with
previous convictions is an unethical and
DNA evidence has now surpassed skewed use of this valuable technology,
fingerprinting as the most unfairly singling out a
scientifically accurate marker portion of the population
of guilt. Evidence is with a message of
examined based on Short mistrust. We believe that
Tandem Repeat (STR) crimes and multiple
technology, which evaluates offences could be more
specific regions within the successfully and ethically
DNA. The FBI currently uses prevented, rather than
a standard set of 13 specific merely solved, were the
STR regions for CODIS, their United States to enact an
C om b i n e d D N A I n d e x opt-out system and require
System. The odds that two all citizens to submit their
individuals share the same DNA information to a
set of STR DNA regions is national databank.
approximately one in a billion.
The national
However, the under the DNA databank would contain number-coded
fingerprint act of 2005 and its January 2006 sequences of 13 STR regions and would be
Amendment, the FBI‘s CODIS databank used only for direct identification against a
only contains select DNA information from known DNA sample from a crime scene.
convicted criminals, those arrested on DNA would be collected upon issue of an
suspicion of a crime, and any non-US citizen identification card through a government or
who is detained under federal authorities. state office, or, for minors, during a doctor‘s
And thus, reliance on DNA evidence has visit for school vaccinations. Ethically
largely prevented racial profiling as well as speaking, the DNA would not be analyzed to
wrongful imprisonment. Retroactively, those reveal genetic traits, such as predisposition
who are wrongfully imprisoned can be for diseases, partial/familial matches,
exonerated and those whose DNA evidence ethnicity, or certain behaviors, and would
only be run on a computer to rule out guilt in justice system, such as racial profiling and
a criminal case. If a match occurs, the false or coerced confessions, can be
corresponding ID number would be instantly overturned.
submitted by the forensic lab to a
government office that deals with this According to the American
information, relaying it to the appropriate Constitution Society for Law and Policy, over
court system as pertinent evidence. If an 30% of crimes are committed by repeat
individual does not wish to have their DNA offenders. To follow this logic, if offenders
submitted to this databank for whatever were caught using DNA evidence on their
reason, that individual would need to be a first infraction, the crime rate would
U.S, citizen who has not been convicted of a decrease by 30% from this alone. And
previous misdemeanor or felony. If this that‘s not counting the would-be criminals
individual is later convicted, he or she will be who, knowing that their information is
required under law to submit DNA to the already in the system, would be hesitant to
system. DNA will be retained in the commit a crime.
databank 25 years post-mortem.
In fact, Great Britain requires
The term ―national DNA databank‖ submission of DNA to a national databank
conjures visions of surrendering one‘s civil upon arrest, and this law has proved
liberties to an all-powerful government able successful, netting 116 DNA matches from
to punish without trial, but that could not be 11,000 cold cases in 2005-2006.
farther from the truth. Imagine taking part in Concerns about widespread DNA data-
a police lineup, at the mercy of a distraught banking center primarily upon the transfer of
victim‘s unreliable eyewitness testimony. sensitive health information obtained from
Now imagine going to the grocery store, DNA samples to employers or health
unknowingly followed by cops who are on insurance providers. However, in our
the lookout for a stray hair or other proposed system, the DNA would not be
abandoned piece of your DNA that they can tested for sensitive health information and
profile if there is not enough evidence to would only serve coded data for criminal
obtain a warrant. With a national databank, cases, acting as a sophisticated fingerprint.
these situations would be as obsolete as the As to Fourth Amendment rights, this system
notion of guilty until proven innocent. Under would not constitute an unlawful search or
our system, while you went about your daily seizure, as we are not searching people
routine, a number-coded sample of your specifically but matching markers on their
DNA could be checked by computer nuclear DNA, i.e. their genotypes, which is
program against known DNA from the crime analogous to the criminal justice system‘s
scene, with only a one in a billion chance it matching of phenotypic characteristics.
would match erroneously. With the spotlight these days on DNA
databanking and its infringement upon civil
In contrast, eyewitness liberties, we must stop and consider the
misidentification is the single greatest cause alternative: that if we don‘t willingly
of wrongful convictions nationwide, submitour DNA, it could be unwittingly
contributing misleading data to over 75% of obtained, which is a much more severe
convictions that are later overturned by DNA encroachment of our constitutional rights
testing. Thus, with the proposed system, and privileges.
common limitations of the current criminal
12 Fall 2007
Could Genetic Research Interfere with Medicine?

By Jorge Jara and Joanna Etra
Columbia University
Could it become medically beneficial with this new information come several
not to medicate? Based on a recent study, it bioethical issues as to how to properly treat
seems that in certain situations, that may patients with heart disease, specifically
just be the case. those for whom beta-blockers are
ineffective. Identifying the genetic mutation
Heart disease is one of the leading causes involved in the rate of success in prescribed
of death in the United States. Still, there are beta-blockers could potentially give
many drugs available to treat the condition, physicians the ability to discontinue use of
and patients with heart disease are often the drugs on these patients, eliminating any
prescribed multiple drugs to try and control negative side effects. The possible side
it. One of the drugs most commonly used for effects of most beta-blockers (and for that
heart disease is a beta-blocking drug – a matter, many medications) are plenty –
drug that blocks the beta-receptors in the
heart that responds to epinephrine. In effect,
the drug disables the heart‘s increase in
strength and strain in response to stimuli,
saving heart power and energy in those with
heart disease (Pritchett and Redfield,2002).
However, one study found that altered
genetic characteristics present in
approximately 40% of African Americans
and 2% of Caucasians renders beta-blocker
drugs ineffective. The genetic alteration is
such that the individual produces its own
form of a ―beta-blocker drug,‖ naturally
producing and evoking the same result as
would be derived from taking medication
beta-blockers (http://www.nature.com/nm/ nausea, diarrhea, bronchospasm, fatigue,
journal/vaop/ncurrent/). hallucinations, insomnia, clinical depression,
erectile dysfunction, among others, along
The discovery of this particular gene with negative drug interactions (http://
alteration has answered many questions for www.cvpharmacology.com/cardioinhibitory/beta
researchers and physicians about the -bloc).
differences in effects of drugs on patients
with similar conditions. From the results of The implications of this study are
this particular study, it is shown that there is vast and somewhat disconcerting. In terms
a clear link between genetics and the of medical ethics, healthcare providers must
outcome of patient drug treatment. However, now determine whether or not to treat all
patients with a drug effective on only some. studies would likely show many drugs as
Bioethically, the implications are quite less universally effective. This research
complicated. In the expectation that a would then reduce the market base of the
physician, in following with his pledge to ―do pharmaceutical companies, as it could be
no harm,‖ must scan for the particular gene determined explicitly for whom these drugs
alteration, comes a new standard level for are of no use. Since it is not in the interest of
patient care in reference to heart failure. If the pharmaceutical industry to conduct
the best form of healthcare can only be studies whose results would lower their
provided with inclusion of genetic screening, profit margin, the funding of such studies to
it would seem that this information should be better healthcare would be difficult. How
included in the future in the usual treatment should a physician assess whether the beta
plan. Yet, genetic mapping and screening blocker is working on a specific patient?
remains an extremely expensive procedure Lastly, were the practice of genetic
typically not covered by health insurance. screening to be routinely included in
Since this gene is primarily found in the treatment for heart failure or any other
African-American community is there ethnic medication process, the issue of privacy
bioethical issues elicited? Therefore, if the would offer another consideration. To screen
expectation of proper treatment expands to for the gene involved in the result of
the point of genetically testing for these medicated beta-blockers, private genetic
protective factors, policy needs to be information would need to be gathered and
implemented to enforce this treatment‘s analyzed. Though consent forms and
coverage by health insurance. Since not privacy forms could easily be erected to
covering a procedure established as reconcile a patient‘s particular desires and
standard care for a condition would result in rights in relation to privacy, screening for
a severe discrepancy between healthcare genetic specificities has many possible
for those of able means and those unable to obstacles. If in the screening process
afford it, the question of cost absorption another genetic mutation or notable disorder
accountability remains. were to be discovered, a slew of medical
and bioethical problems would arise as to
Though the discovery of the how to proceed. For instance, would the
possible inefficacy of beta-blockers as researchers then have the moral or ethical
treatment for heart disease is great, what obligation to alert these patients of the
may be a larger and more significant result potential diseases facing them? Also, the
of the study is its application to other drugs idea that an ―immunity‖ to a commonly used
and their respective usefulness. With the medicine is traceable leads to the possibility
myriad of drugs available with different rates of required testing. Since such a gene
of success in patients harboring similar alteration may increase one‘s risk for heart
conditions, it would seem that studies should failure or other complications, could
be conducted to determine possible genetic employers – or worse, health insurance
links associated with the specific success companies – mandate genetic screening as
rates of these drugs. However, these studies part of their hiring process or policy
would be extremely costly, so much so that decision? In addition, because of the privacy
the government would likely have trouble and quality of life implications from
absorbing the cost. Yet, it is unlikely to screening, could patients abstain from
expect the pharmaceutical industry to screening and continue taking beta-
sponsor such studies, as results of the blockers, possibly only to their detriment?
14 Fall 2007
Furthermore, with the gathering of this data, greatly reduced and healthcare in our
a new policy must be implemented outlining country would greatly improve, enabling
the storage of such information as well as its genetics to more easily be considered in the
usage in studies and other works published treatment of patients.
to protect the privacy of the individuals
involved. Pritchett AM, Redfield MM (2002). "Beta-
blockers: new standard therapy for heart
As with many ethical matters, there failure". Mayo Clin. Proc. 77 (8): 839–45;
is no unambiguous and comprehensive quiz 845–6
solution to the specific issue. However, in
the interest of improving healthcare and
ensuring not to medicate patients to only
negative effects, the screening for the gene
effecting beta-blockers must be included in
routine treatments for those patients
suffering from heart disease. As the
discovery of the gene‘s presence can
prevent the patient from further enduring the
side effects of an operatively useless
medicine, it could also prove useful in the
diagnosis and treatment of offspring of that
individual patient. Further, the data collected
should be collected and stored as part of the
ongoing statistical information gathered on
patients by organizations such as the
National Center for Health Statistics, and it ,
should be used to conduct longitudinal
studies to determine associations with
aspects of health and living. Though HIPAA
regulations lend some solution to the issue
of privacy in healthcare, further
developments in technology and policy
would need to be assumed to enable the
keeping and tracking of genetic information
without the possibility of infringement upon
human rights. The most difficult issue
remains to be the continued conduction of
studies to find genetic linkage to medication
efficacy. Though a clear-cut route to these
studies is yet unavailable, a possible
solution to lower costs all around is the
funding of such studies by those companies
that complete the genetic testing
procedures. As the results of such studies is
likely to prove profitable to their particular
field, the limits of such studies would be
Charging You for Being You
By Elisa Fung and Gabriela Vargas
The man sitting on your left eyes knowledge on a universal level. The
your wrist with an eerie smirk on his patent holders are then entitled to
face. The woman on your right points at licensing rights for the entire gene, and
your mouth. He is not looking at your thus sole control over the production
new Rolex watch, and she is not and marketing of any diagnostic test
pointing out spinach between your teeth. involving the gene. In these cases,
The man owns your wrist; the woman however, it is important to recognize the
owns your two front teeth. Who else difference between discovery and
owns another part of you, and whose invention. While the former is simply
parts can you own? making something known, the latter is
defined by original thought and for this
The field of biotechnology reason should be allowed to be
undoubtedly advocates the need to patented.
protect intellectual property and spur
scientific advancement. This has Patenting a particular DNA
contributed to many medical sequence inevitably gives one human
breakthroughs, yet it has also taken an being partial ownership of another
unexpected turn. The allure of financial human being. DNA is a naturally
profits and personal recognition has occurring phenomenon that is common
transformed the motivation behind the to all human life. More specifically,
common practice of patenting. Once individuals share 99.9% of the same
aimed to spread scientific knowledge for DNA sequences. This allows each
the betterment of society, patents now person to own only 0.1% of himself or
serve as an impediment to this purpose herself. Thus for sometone to have
in certain cases. Thousands have filed exclusive rights to a certain gene is as
gene patent applications for specific unfounded as copyrighting the individual
DNA sequences as they try to stake letters of the alphabet, as our ACTG‘s
their claim in the realm of genetics. and our ABC‘s arethe fundamental
building blocks of humans and novels,
Human DNA patenting has respectively. Just as authors are
emerged as a major issue faced with an recognized for the originality of their
assortment of public scrutiny. In the works through copyright privileges, DNA
U.S., DNA patents are currently issued patenting should only provide
to those who determine at least one compensation for the discernment of
specific function of a DNA sequence innovative ideas regarding genes.
which facilitates the sharing of However, patents have been issued for
16 Fall 2007
decades and this is not the DNA patenting is unethical due to a lack
case.Patenting human DNA sequences of respect for humankind. It objectifies
is essentially allowing ownership and humans as property. Less obvious but
commercialization of the basic building equally significant effects exist on
block of human nature. Making the healthcare; the average citizen‘s
human body a subject of property right
objectifies individuals and violates the
underlying human rights to life and
liberty.
Ownership of genes not only

stands in the way of human rights, but
also detracts from scientific
advancement due to the appeal of
capitalism. A study from the Center of
Bioethics at both Stanford University
and the University of Pennsylvania
found that 53% of clinical laboratories
decided against developing new clinical
genetic tests because of a patent or
license. The decision to initiate or common dilemma of treatment versus
continue genetic research is associated cost worsens. In the growing field of
with increased financial burden. This genetic biotechnology, it is vital that
elevated spending, however, does not proper regulation is set to protect
provide direct scientific benefits. It scientific property without exploiting
simply gives them permission to conduct individuals. This will prevent repetition
their research. If research is of cases such as the famous Moore v.
nonetheless successfully completed and Regents of the University of California.
it revolutionizes the standard of medical Despite his cell lines were
care, it ultimately places a strain on the commercialized after treatment for
cost of healthcare. The increased costs leukemia, he retained no rights to the
of conducting research translate into profits. In this particular case gene
increased treatment costs, which patenting had the positive effect of
exacerbate the already large price tags providing many people with cancer
of healthcare for most patients. While treatments. However, it sacrificed the
there is obvious interest in patents from rights of an individual to ownership of
the corporate world because of the his own body. This effort should be
potentially large monetary profits it seriously considered to prevent any
would rake in, a line mustbe drawn downstream consequences in the
between what can be done and what future. Who knows, kids may have no
should be done for the improvement of choice but to pay patent holders for
society. inheriting their parents‘ genes.
II. Stem Cells and Reproductive Biology
Secrets and Lies: Mandating Disclosure in Oocyte Donation

By Tiffany Hsieh
Coilumbia University College of Physicians and Surgions
Although conception with changed requiring any donor of gametes

egg donation has been available for or embryos to agree to the disclosure of
over 20 years, it still remains a largely their identity to any adult offspring.
unregulated process. One aspect of
assisted reproduction using donor eggs The United States has no
that is receiving increased attention is legislation on a federal or state level that
whether parents should disclose to their either prohibits or enforces anonymous
children the facts of their conception: donation, with fertility centers and egg
what are the consequences of learning donation agencies drawing up their own
that one has an anonymous genetic contracts and guidelines. Furthermore,
parent? there is no legislation that addresses the
issue of information disclosure. In 2002,
Anonymity, in which both donor the Ethics Committee of the American
and recipient couple consent to the Society for Reproduction Medicine
process but are mutually unknown and encouraged disclosure from parents to
unidentifiable, has largely accompanied children about the use of donor gametes
both sperm and egg donation. In recent in their conception, and recommended
years, however, the tendency to that fertility clinics and programs
maintaining strict secrecy is shifting, maintain permanent records of donor
with more parents telling children about screening and selection data, donor
the method of their conception and (in examinations, and clinical outcomes as
cases of non-anonymous donation), a future medical source for offspring
establishing relationships with the (Ethics Committee of the American Society
donor. Several European countries for Re-productive Medicine,
(Sweden, Austria, Switzerland, and the 2004). Whether anonymous or not,
Netherlands) have begun to ban relationships between donors, parents,
anonymous gamete donation. In 2005, and the child must be agreed on prior to
the UK Government determined that the procedure—but is this fair to the
children born from egg donation have child conceived from the donor egg, who
the same right to know their biological cannot contribute to this decision?
parent as adopted children on reaching
the age of 18; legislation was then Anonymity has its benefits from
18 Fall 2007
both a pragmatic and legal The GIVF donation procedure is

standpoint. It frees donors and not ―anonymous‖ per se: GIVF allows
recipients from entanglement in issues recipients to browse an extensive donor
of custody and liability, especially since database, one that details everything
parental rights are interpreted differently from the donor‘s eye and hair color to
from state to state. Furthermore, it also her personality type. One recent study
protects a booming and extremely surveyed 62 sets of oocyte donation
lucrative industry from scandals and parents from fertility programs across
the country and found that over 90% of
both partners knew their donor‘s age,
ethnicity, hair color, eye color, height,
weight, education, and medical
history. 80% knew the donor‘s blood
type and 45% had seen a
photograph. Even though the majority
of recipients described their donors as
―anonymous,‖ the fact that almost half
had seen a photograph seems to render
this concept moot. Whether or not the
parents choose to disclose this
information and the nature of the
conception to their children is left to their
own discretion.
lawsuits resulting from these same Yet this only reinforces

issues. As a result, anonymity allows tendencies toward secrecy, especially
the fertility industry to escape since the nature of egg donation makes
accountability, not only for important it easy to conceal the method of
information such as the donor‘s health conception—the child is genetically
background, but also for personal related to the father, and the mother
characteristics reported by the donor, acts as the gestational
from educational background to test parent. (Nevertheless, for privacy to
scores, few of which are independently remain a choice, the matching of donor
verified. Additionally, some argue that and recipient blood types and physical
anonymity is a more compassionate characteristics is
approach for a couple struggling with important.) Furthermore, the donor is
infertility, since creating a personal often untraceable or unknown (which
relationship between the donor, would obviously change if all donation
recipient, and child has the potential to were made non-anonymous), and some
give the donor an unwanted investment argue that this means there is little value
in the family. to disclosing information to the
child. However, many couples disclose
to family members and close friends; right to privacy. By bringing these

attempting to keep the same information children into the world, parents have the
from the child creates the very real moral obligation to tell them where (and
threat of accidental disclosure, whether who) they came from.
from a third party or a genetic test.
As genetic testing plays an
In one UK study, half of recipient increasingly large role in the diagnosis
parents surveyed did not intend to tell and treatment of disease and in
their child about the way he was reproductive decisions, the child has a
conceived. The non disclosing parents medical need to know his genetic
were concerned with potential negative history. Separating genetic from
gestational motherhood means that
children may be deceived about their
genetic background. Does a patient‘s
autonomy, in this case the right to
choose not to tell one‘s child the truth,
take precedence over the possible harm
done to that child if he goes through life
conveying a false medical
history? Another related problem
arising from the use of anonymous egg
donation is the possibility that children
consequences of disclosure, such as may have several half siblings they do
stigma surrounding the donation not know. Patients have the
process, loss of privacy, psychological reproductive freedom to procreate with
harm, concern that donors might try to unknown eggs, but children also have
find the child (and vice versa) or claim the right to avoid inadvertent
parental rights, confusion regarding consanguinity. Although children
maternal identity, and disruption of conceived using donor eggs may be
family relationships. They believed that unable to access the specific genetic
they were acting in the child‘s best information of the donor, with disclosure
interest by withholding information they will not believe that their mother‘s
regarding the donation process. There genetic history is their own—a false
is no denying that paternalism is assumption that may lead to
necessary for the sake of a child‘s well- misdiagnoses, unknowingly foregoing
being, but parental responsibility also critical medical care, or undergoing
dictates that the child‘s right to the truth unnecessary treatment. What children
about his conception and genetic don‘t know can‘t hurt them—unless it
background be honored. Since this can.
constitutes an integral part of the child‘s
personal identity, such information falls It is important to note that
outside the boundaries of the parental guaranteeing children access to their
20 Fall 2007
genetic heritage is distinct from in multiple ways. Parents‘ privacy

guaranteeing them knowledge of the concerns and the intended benefits for
method of their conception. In the case the parents and child are outweighed by
of egg donation, these two issues are the negative consequences of keeping
inextricably linked. Gamete donation in family secrets, and also by the child‘s
the UK, without knowledge of the nature medical need for information about his
of one‘s conception, one cannot origin. Nondisclosure the child is being
proceed to secure identifying used as a means to the parents‘ end of
information; most children simply having a ―normal‖ family. In this way it
assume that they are genetically related neglects a child‘s rights to autonomy
to their parents. Neither the child‘s and to information about himself.
parents nor any state body is required An essential part of good
by law to inform the child about the practice should be openness with
circumstances of conception. As the children about their genetic origins, and
child has no legal right to be told the their moral right to this information
truth about his conception, this implies should be reflected legally. (Frith, 2001)
that he has a moral right to be told and The most obvious solution is to institute
his parents have a moral duty to a method to ensure that all donor
disclose. In practice, this means that a offspring know the true nature of their
child‘s legal right to information depends conception. Frith (2001) proposes a
on his parent‘s inconsistent fulfillment of model in which children conceived with
this moral duty. With non-anonymous donor eggs can be provided with a birth
donation, leaving the duty of disclosure certificate that records the details of
to the parents implicitly gives priority to their ―social‖ parents, as well as a donor
the parent‘s right to privacy. certificate that records the details of
their gamete donor. Making all egg
But this right to privacy regarding donation non-anonymous would
the nature of the child‘s conception does necessitate radical policy changes
not extend to the child. Here, the within the current system, in which
parents‘ interests conflict with the child‘s medical practices, legal requirements,
fundamental right to know his biological and control and supervision all vary
origins (in this case, his genetic identity widely. Just as importantly, it would
and the identity of the egg donor). By carry tremendous legal and medical
withholding information and thereby import, since information disclosure not
having their child grow up assuming that only affects parents and their children,
his social parents are his genetic but donors and health care providers as
parents, parents who do not inform their well. If the US is not yet ready to follow
children are being indirectly in the footsteps of the 2005 UK
dishonest. Furthermore, nondisclosure legislation and create a donor registry,
implies that there is some shame children should, at the very least, be
surrounding this truth, which allowed access to as much information
undoubtedly harms family relationships about donors as was given to their
parents. 1:S212-6.
To this end, regulations should Frith L. Beneath the rhetoric: the role of
include standardized requirements for rights in the practice of non-anonymous
the collection and maintenance of gamete donation. Bioethics. 2001, 5-6:473-
records by fertility centers and egg 84.
donation agencies, as per the ASRM
Ethics Committee
recommendations. Additionally,
information concerning disclosure
should be included as part of the
counseling that couples receive during
their fertility treatment. Parents should
be encouraged to inform their children
about the use of donor gametes, and
disclose the medical history of the
gamete donor in situations that concern
the child's own health. Offering peer
and professional support and guidance
to parents will assist them with
disclosure, both initially and after their
children are born.
Conception with egg donation

calls into question the very definition of
parenthood. As the use of oocyte
donation increases, so do concerns
about its psychological and social
impact on families and children. It also
remains to be seen how attitudes
towards disclosure and non-anonymous
donation will change as the growing
acceptance of assisted reproductive
technologies gradually removes some of
the social stigma surrounding infertility.
References:
Ethics Committee of the American Society

for Reproductive Medicine. Informing
offspring of their conception by gamete
donation. Fertil Steril. 2004 Sep;82 Suppl
22 Fall 2007
Altered Nuclear Transfer: A Novel Way of Developing Pluripotent Stem Cells
by Sarah Eberle and Tabby Khan
Columbia University
Embryonic stem cell (ESC) research access to the DNA. However, only ESC-
has generated widespread controversy associated transcription factors, not factors
across various social, religious and associated with zygote formation, are
geographical factions due to the destruction expressed in the oocyte. When fusion
of embryos that is inherent in the process. occurs, the factors are directly transferred to
For this reason, some type of ESC the somatic nucleus, which is subsequently
substitute that retains their remarkable reprogrammed. In ANT-GD, gene deletion,
pluripotent properties while circumventing rather than activation (such as that used in
these ethical and moral issues must be ANT-OAR) is used to prevent the expression
generated. A new technology, altered of genes involved in the development of a
nuclear transfer (ANT), has recently been zygote. Condic argues that life begins at
proposed as a way to generate pluripotent trophoblast formation; trophoblast cells
stem cells with embryonic stem cell-like induce the production of the amnion, chorion
qualities without the creation or destruction and placenta, and if trophoblast formation is
of an embryo. This noteworthy development inhibited, implantation does not occur. The
represents a potentially ground-breaking transcription factor Cdx2 controls
step towards avoiding many of the trophoblast formation. In ANT-GD, Cdx2 is
prominent bioethical issues relating to stem removed from the somatic cell. This cell is
cell research. then fused to the oocyte, and clusters of
cells—rather than distinct masses with
ANT attempts to answer the global organization—form. Condic argues
following question: ―Is it possible to generate that global organization and coordinated
cells with the properties of embryonic stem communication between cells necessarily
cells from something that is not an and sufficiently constitute and embryo. If one
embryo?‖ (Condic 2008). ANT addresses of these two criteria is not met, a mass of
this question in two ways; a scientists must cells cannot be described as an embryo.
first generate stem cells, and then test for This combination of ANT-OAR and ANT-GD
the absence of embryonic qualities. In order prevent embryo formation because the
to generate the cells, two steps are transcription factors that encourage
involved—ANT-OAR, which involves oocyte- pluripotency are inhibited at the same time
assisted reprogramming, and ANT-GD, that transcription factors that encourage
which involves gene deletion. In ANT-OAR, trophoblast formation and global
the oocyte is altered to express transcription organization are inhibited. Thus, an embryo
factors that are key in development of is not formed in ANT.
pluripotent cells and epigenetic
modifications of the genome are altered to ANT bypasses many of the
allow these transcription factors greater bioethical concerns that have impeded upon
the prospect for gene therapy through create or destroy embryos, this method still
embryonic stem cell research. Although raised several bioethical issues. The point
advances have been made in stem cell at which life begins is still unavoidably
research over the past several years, all controversial. Fertilization still occurs in Ant
procedures currently available for obtaining because somatic cell nucleus fuses with an
embryonic stem cells destroy embryos. The oocyte. Thus, ANT does not resolve
act of destroying a human embryo bioethical issues for individuals who believe
generates significant controversy because that life begins at fertilization rather than
many people feel that destroying an implantation; ANT still creates an embryo
embryo‘s potential for life is unethical on for the purpose of destroying it later.
multiple social, spiritual, and moral levels. Irregardless of whether or not the embryo
implants, it is still a potential life, and so
ANT remains controversial.
In addition to the question of when

life begins, an issue arises in the way this
research defines life. The researchers base
life on purely one transcription event. The
deactivation of Cdx2 is just another mode
of attempting to circumvent the bioethical
issues inherent in ESC research. Multiple
Little testing on human ESCs has other transcription factors can play a role in
been permitted by the United States embryogenesis, so how can we possibly
government due to widespread outcry define life through the actions of just one? It
against this technology. These regulations is true that in cells in which this
have prompted research involving non- transcription factor is deactivated,
embryonic stem cells. Although non- trophoblasts do not form, but again, there
embryonic stem cells have shown promise are events prior to this that could also be
in research, these treatments ―do not live construed as the beginning of life.
up to the expectation of . . . ‗stem cell
cures‘ that the public has been promised ANT allows scientists to ―play God,‖
from embryonic stem cells‖ (Condic 2008). which causes further bioethical
Additionally, cells from non-embryonic discrepancy. This technology essentially
sources ―cannot stand in for the properties reverses the normal course of
and therapeutic potential of ESCs‖ (Condic development—it transforms an already
2008). One method, the derivation of non- differentiated cell into a cell that serves as a
pluripotent stem cells from adults, bypasses precursor to various cell types. This
the use of embryonic stem cells. anomaly discounts the natural properties of
Unfortunately, this method has limited cells; normally, cells do not go through life
therapeutic potential. Adult stem cells in this manner. In the process of
cannot differentiate into all types of cells deactivating and activating various
and thus, they do not have the same transcription factors, important qualities of a
reconstructive and therapeutic value of cell could be altered. While it is known, for
embryonic or ANT-derived stem cells. example, that Cdx2 plays a role in
trophoblast formation, the total functions of
Despite the fact that ANT does not the transcription factor are unknown. For
24 Fall 2007
Bioartificial Hearts, Bioethical Issues

By Esty Rajwan and Ditty Vick
Columbia University
Each year, cardiovascular used to overcome this problem (Ott, et

diseases top the list of the most serious al., 2008). With this technology the
health problems around the globe, with organ from the ―donor‖ is not
22 million people living with heart failure. transplanted directly into the recipient.
Heart transplantation remains the most Rather, it is decellularized and reseeded
effective treatment and for many, the with endothelial cells and
only chance of survival. In the United cardiomyocytes. In their study, the
States, there are between 60,000 and scientists collected 140 cadaveric rat
100,000 people who could benefit from hearts and removed their DNA and
a new heart. Due to an acutely limited intracellular structural proteins. The
supply, only 2,300-2,400 transplants are decellularized rat heart was then
performed each year, meaning that mounted in a bioreactor and seeded
about 70% of patients in need of heart with freshly isolated neonatal cardiac
transplants cannot get them and die cells through intramural injection. The
because of the limited availability of researchers concluded that given
donor hearts (AMA, 2008). enough maturation time to reestablish
its vascular architecture, an organ
The lack of supply of processed in this way could be
transplantable hearts is not, however, transplantable, in part or in entirety, for
the only obstacle facing transplant end stage heart failure. This
recipients. Those who do receive decellularization procedure (leaving an
donated organs face aggressive medical acellular scaffold with perfusable
treatments that might have harmful side vascular architecture, competent
effects, to keep their bodies from acellular valves, and intact chamber
rejecting the transplanted organs. geometry) was also successfully applied
in this study to a porcine heart,
Several attempts have been indicating that the technology could also
made to engineer an artificial heart. be scaled to hearts of human size and
Most approaches have been limited by complexity.
the inability to create the geometry
necessary to support the high oxygen Further study and improvements
and energy demands of cardiomyocytes of this technology might lead to its
in areas deeper than the surface tissue application to human trials and potential
(Eschenhagen and Zimmermann, 2005). solve the problems of immunological
Cadaverous hearts have been recently rejection and obtaining sufficient organs.
Bioartificial hearts would be obtained carrying‖ organ donor is necessary in

from cadavers and could be reseeded the current system of organ donation
with a patient‘s own cells, thereby because there is little time available
eliminating immune system rejection between the moment of death and the
complications. The potential to apply time that the organ is harvested. There
this technology to humans appears real is little time to contact family members
especially since this technology has to get approval for organ harvest if the
been used to create a human trachea potential donor does not carry
that was transplanted into a woman identification of his desire to donate his
(Webster, 1998). organs. However, this would be different
if the donor‘s heart would be useful with
There are three bioethical a high ischemic time (and we assume
concerns related to this new technology. here that the technology described in
First, would obtaining human hearts the study at hand could be applied to
using this technology create hearts with high ischemic times). A new
inappropriate issues with respect to bioethical question arises: Can a family
organ donation and the selling of decide to donate a family member‘s
organs. Second, what bioethical issues heart even if that person did not
are related to the use of animal hearts to consider the possibility of becoming an
form the architecture of these organ donor during his lifetime? If the
bioartificial organs. Lastly, what are the person has no immediate family
bio-legal issues that might emerge using members, might someone else close to
this technology. him or her also make this decision for
the potential donor?
The scarcity of donor hearts in
the current system is partially due to The possibility of using hearts
very limited criteria for who might be with large ischemic times becomes an
considered as an eligible heart even bigger issue when we consider
transplant donor. In addition to strict that these hearts might, with the advent
requirements of age of donor, ischemic of bioartifical heart technology in
time (the time between interruption of humans, come from foreign countries
circulation to the organ and where there might be less oversight
reestablishment of circulation), size of than in America. It is possible that an
donor, medical history of the donor, and underground market might develop in
conditions of the donor heart, in most which the poor are forced to sell the
countries a patient must be rendered corpses of their family members in order
brain dead in order for his heart to be to make money. It is also possible that
harvested (Wittwer and Wahlers, 2008). the bodies of prisoners might be used
As of now, the donor (before his death) for this sort of organ donation, without
must have given explicit approval for any consideration of the ―donor‘s‖
organ donation in order for the organs to desire.
be removed. This decision to be a ―card-
26 Fall 2007
instance, the transcription factor could play completely resolved; however, all scientific
another role in non-embryonic cells essential research involves some degree of
to their survival. By knocking out the manipulation and ―playing God.‖ The only
transcription factor, the scientists might alter way to somewhat resolve this issue is to is
more than just development. further research about mechanisms of
imparting pluripotency; scientists should
Cost is also a significant factor in examine different epigenetic modifications
this research. The motivation behind ANT is and transcription factors that lead to this
to generate stem cells with ESC-like process. Understanding the exact
qualities to fulfill the hypothetical promises mechanisms behind the process will help
proposed by ESC. Due to government researchers be more conscious of their
limitations, the total therapeutic value of research. The last major issue to address
ESC has not been conclusively proven. is that of cost. To prevent wasting grant
Lack of conclusive ESC research makes it money, the government could initially
difficult to successfully gauge how much provide money to only a few labs to do
more therapeutic value ANT will have over such research; if it appears that this
already existing adult stem cell therapies. research does have tremendous
The tremendous amount of grant money therapeutic potential, then more money can
necessary to fund ANT could ultimately be pumped in. To ameliorate some
result in therapies equal to those that allocation issues, the government could
currently exist. If ANT does produce fund therapies for those who cannot afford
impressive therapeutic results, the extreme it in the form of clinical trials. As a novel
costs of the process will create an allocation therapy, ANT would need to be tested in
problem. Who should receive this therapy— humans as much as possible before it
people who can afford the procedure or the becomes more widely available.
people who need it the most? This issue is ANT provides an interesting alternative to
inherent to all types of stem cell research, using embryos. By avoiding the use of
and ANT does not correct for it. embryos, the government may become
more receptive to funding stem cell
In conclusion, ANT does resolve research. Perhaps the key to effective and
several of the bioethical issues generated ethical gene therapy does not lie in stem
by traditional embryonic stem cell research, cells, but rather, in some mechanism that
but it incurs a controversy of its own. Many has yet to be discovered. In the meantime,
of these bioethical dilemmas must be however, further research on ANT could
resolved to make this process marketable resolve the current questions about the
to the public. It is impossible to resolve the efficacy of ANT‘s success in gene therapy.
question of when life begins because
various groups of people answer it References:
differently. If ANT could be altered to
bypass the fertilization event altogether, it Condic, ML. ―Alternative sources of
might appeal to a broader constituency. pluripotent stem cells: altered nuclear
This issue could be involved by conducting transfer.‖ Cell Proliferation, 2008. 41: 7-19.
further research to develop a somatic cell
capable of de-differentiating without the
assistance of an oocyte. The issue of
unnatural cell manipulation cannot be
Diagnosing Disability… And Keeping It
by David Yin and John Tseng
Columbia University
Genetic engineering is most Oath to ―do no harm‖. Defenders of the

often negatively associated with the practice have argued that deafness
societal harms it could create: holds cultural value among the deaf,
discr im inat ion, entrenchm ent of that the disability only occurs where
economic disparity, and a terrifying auditory and visual communication
movement toward a homogenous super- contact, but that this ―contact zone‖
race. Issues of individual rights rarely dissolves in a deaf household where not
come into play because the traits hearing is the norm, and even, a
engendered would be almost universally blessing. Others have cited the fact that
considered beneficial. Who wouldn‘t the family might actually be happier
want Einstein‘s intelligence, Michael when they can share experiences and
Phelps‘s Olympic prowess, and the capacities.
good looks of Jude Law or Uma
Thurman? Who wouldn‘t want a healthy Much of the dispute centers on
child over one that might suffer from Tay the goodness of the trait, but we would
-Sachs or cystic fibrosis? argue that this is immaterial in so far as
this trait is not given or created, but
In recent years, however, there merely selected for. Most can agree that
have been controversial reports of deaf parents who attempted to deafen a
negative selection taking place—parents child after birth would likely be
choosing to ―impair‖ their children with prosecuted for child abuse. The parents
―disabilities‖ such as deafness or would be making an active choice for
dwarfism—that bring up issues of their child that is likely against both the
individual rights and possible child‘s preferences and interests, and
government intervention. The social bias where parental decisions impact their
against this selection is clear. In a 2006 children in significant negative ways, we
New York Times article, it was reported say the government may step in to
that most doctors found requests for protect the rights of the children.
negative selection unacceptable. Opponents of parents choosing
Deafness was perceived to be a deafness seem to structure their
disability, and critics have accused such arguments on similar lines: parents
parents of harming their children, and should do what is best for their children;
such doctors of violating the Hippocratic parents should not create disabilities for
28 Fall 2007
their children. A quick inspection of the procedure enables us to create an

actual scientific process used in alternate analogy from the deaf parents
selection, however, dismisses the actively creating deafness in their child.
premise of that analysis. Imagine a scenario where our deaf
couple is choosing a baby to adopt, and
The pertinent technological can choose between a deaf baby and a
method in embryo screening and baby with normal hearing. Now it is clear
selection is pre-implantation genetic that neither baby has a greater right to
diagnosis (PGD). It should be noted that be chosen for adoption, nor that society
this procedure is already commonly does not prefer one or the other. The
used for couples to select against parents may exercise their own
disadvantageous traits like Tay-Sachs preferences in choosing which child is
or cystic fibrosis, with little uproar. best suited to them, taking into account
These tests reveal the genetic hearing, but also all of the other traits
composition of each embryo created, that we might find disturbing if
and the information gathered can be genetically ―engineered‖: hair color, eye
used to choose which embryo will be color, sociability, or intelligence.
implanted in a woman for further Returning to our genetic choice, the
development into a baby. By studying deaf parents are now choosing between
the genes of the embryo, scientists can two embryos, two potential babies. One
determine the likely traits the resultant will develop into a deaf child, and the
adult person will have, such as deafness other will hear normally, but both have
or normal hearing. an equal ―preference‖ to be chosen, to
be born and to live. The parents are not
The methodology of PGD choosing a trait that would be against
clarifies some of the underlying their child‘s interest, because both
assumptions in this ethical dilemma. potential children have the same interest
First, each embryo is naturally in being born. Now the parents are
occurring, usually as a result of sperm choosing between two equally moral
or eggs donated from the prospective decisions, and, like the adoption
parents, and fertilized using example, their own wishes can be used
conventional IVF techniques. If the to make the final call.
donor couple had naturally conceived,
any of the embryos could have been This is not to say that the
potentially created, and so the chance question of whether or not parents
for a deaf baby or normal baby would should choose a disability is completely
also naturally occur. Second, no person resolved. There are other arguments
is actually harmed, there is simply that this commodifies children, and lets
selection between the several embryos parents impose incapacities because it
that are created. is in their best interest, and not the
child‘s, or that ex ante the child that is
Und er st a nd ing t he act ua l born is the same, and that even if
scientifically distinct, are still morally

indistinct. However, it is clear that, as in
all bioethical debates, there must be an
understanding of the fundamental
techniques involved before conclusions
can be formulated. In this dilemma, the
elucidation of the technology showed
that no individual rights (those of the
children) are actually violated; there is
simply parental selection between
equally deserving but unfortunately
competing rights claims.
30 Fall 2007
III. Contemporary Issues
Say No to Blow: Preventing Cocaine Addiction through Vaccination
By Soo Han and Tabby Khan
While the United Nations‘ anti-drugs At this point in time, there is no

chief Antonio Maria Costa recently ―magic bullet‖ that can cure cocaine
condemned both British supermodel Kate addiction. Most cocaine users are forced to
Moss and Grammy-winning artist Amy enter rehabilitation clinics in order to fight
Winehouse for glamorizing the use of their addictions. Recently, scientists
cocaine, he failed to condemn the millions of developed a vaccine for cocaine addiction
people around the world who are also that could enter the market by 2010. This
addicted to the drug. According to the vaccine acts by inducing the immune system
to form antibodies that attack cocaine. The
antibody binds to cocaine, forming a
complex that is too big to cross the blood-
brain barrier, preventing the drug from
reaching the reward center of the brain.
This essentially eliminates the high that
cocaine users feel upon taking the drug.
It is important to note, however, that

this is not a preventive vaccine; it is
necessary that cocaine is present in the
bloodstream in order for the antibodies to
have something to which they can
successfully bind. This means that while the
drug prevents the user from getting ―high,‖ it
does not prevent addiction. Addiction, as
United States‘ Office of National Drug defined by the NIDA, refers to ―a chronic
Control Policy, the number of chronic brain disease that causes compulsive drug
cocaine users in the United States alone is seeking and use‖. This vaccine, rather than
3.6 million. In addition to this number, 11.2% eliminating the desire to take the drug,
of all people above the age of 12 have suppresses the ―pleasurable feeling‖ that
reported at least one instance of cocaine users feel upon administration of the drug.
use; due to the addictive nature of the drug, Currently, while this vaccine has the
up to 75% of these users will become potential to prevent relapse and wean
addicted, and only 25% of people who try to people off of the drug, it is unable to prevent
quit will be able to do so without help. the onset of cocaine addiction. In addition to
conducting clinical trials on the effectiveness Basing vaccine allocation on purely genetic
of this current vaccine, scientists are in the history, however, has a great deal of risks. It
process of developing another vaccine that is dangerous to discount the influence of
will prevent the cocaine addiction before it epigenetic and social factors in drug
starts. While the current vaccine targets the addiction. Even if a teen has no history of
dopamine receptors in the reward centers of drug abuse, peer pressure has been shown
the brain, a preventive vaccine could act by to have a significant impact on one‘s ability
enhancing dopamine reuptake in these to try drugs. Because of the highly addictive
rewards centers, essentially eliminating the nature of cocaine, it is entirely possible that
effects of the drug. Kosten believes his a teenager who tries it once will become
vaccine could potentially be used to addicted, family history or not. By only
vaccinating those teenagers whose families
have a history of cocaine abuse or other
addictive behavior, we are leaving an entire
segment of the population at risk.
The development of a vaccine for

cocaine is a noble and groundbreaking
advance in pharmaceutical research, but it
does give rise to many ethical and social
questions. If we are to place our faith
completely behind such a vaccine, we are
diminishing the value of rehabilitation and
social intervention programs that have
shown to help over fifty million people
combat addiction in the past. Many former
addicts who have seen success in
―vaccinate high risk teens until they mature overcoming their addiction through such
to an age of better decision-making‖. programs see vaccines as a ―crutch‖ rather
than a means to true sobriety. A vaccine is
Kosten‘s suggestion brings about not a cure for addiction, but rather a quick-fix
many ethical questions regarding the use of that requires persistent administration to
the cocaine vaccine. It is not possible to work properly. If we tout this addiction
vaccinate everyone against cocaine vaccine as a cure-all, much as we do for
addiction, so how exactly are we supposed vaccines for diseases such as polio and
to determine who falls into a high-risk measles, we are essentially condoning drug
group? According to a study conducted in use and dismissing it as ―not a big deal
1993, cocaine addiction exists across all anymore.‖ America has a drug problem, and
racial, economic, and ethnic strata. There is a quick fix vaccine is no way to solve it. For
no way to label one cultural group as any now, we should just stick to going to rehab.
more ―at-risk‖ than another group.
Therefore, will it be necessary to turn to Referneces:
genetics in order to decide to whom to
allocate the vaccine? For example, children Orson FM, Kinsey BM, Singh RA, Wu Y,
and teenagers with a history of addiction in Gardner T, Kosten TR. Substance abuse
their family are more vulnerable to addiction. vaccines. Ann N Y Acad Sci. 2008,
32 Fall 2007
Building Athletes
By Yonah Heller and Jean Pierre Rabbah
Columbia University
Is Tiger Woods, the world‘s top- (blurred vision). The LASIK operation is
ranked golfer, a cheater? Two thoughts performed in two stages, beginning with the
immediately pop into the reader‘s head. The creation of a corneal tissue flap and followed
first reaction is ―Oh no…not another athlete by laser modification of the cornea itself.
juiced up on steroids,‖ followed by ―Really? The flap is resected through the use of a
Tiger Woods? ‖. Steroid use is at the metal blade called a microkeratome.
forefront of issues regarding unfair Leaving a hinge at one side, the flap is
competitive advantages in sports. It has folded back, exposing the middle of the
become the epitome of athletic wrongdoing, cornea, called the stroma. An ultraviolet
a notion bolstered by the recent disclosure laser is used to remodel the cornea, and
of the Mitchell Report, which investigated athin layer of stroma (middle of the cornea)
the use of steroids and performance- tissue is vaporized with the laser in a finely
enhancing drugs in Major League Baseball, controlled manner. The flap is restored and
and concluded that steroid use tarnishes the remains in position by itself.
integrity of the sport by giving the user an The general purpose of this procedure is to
unfair and illegal competitive advantage. reduce or eliminate reliance on glasses or
But where does the moral line of competitive corrective lenses. However, Many athletes
advantage begin and end? With rapidly have undergone this surgery to improve
emerging biotechnology, ―athletic their vision--including Tiger Woods, NBA
engineering‖ is becoming an increasingly player Lebron James, and baseball player
viable prospect. Not only is it possible to Greg Maddux. Woods claims that the
improve athletic prowess through the procedure has enabled him to perform the
ingestion of performance- enhancing daunting task of ―reading the greens‖ more
substances, but technology involving effectively. Few professional athletes would
prostheses, body modifications, and, in the admit that they have undergone a voluntary
future, perhaps even genetic modification medical procedure for the primary purpose
may all produce an ―improved‖ athlete. At of gaining competitive advantage. However,
what point is the use of these technologies it is reasonable to assume that if a
considered cheating? competitive advantage may be gained
through such a relatively non-invasive
It is currently possible to improve procedure, its popularity will increase among
one‘s vision to ―normal‖ 20/20, or even to an both professional athletes and those who
enhanced visual acuity of 20/15 or 20/10 aspire to professional status. If such a
through LASIK, or Laser-Assisted In Situ procedure improves the patient‘s ability to
Keratomileusis, procedure. This procedure see the ball, or the greens, or the basket,
is performed to correct refractive errors, what prevents him/her from choosing to
whether myopic (nearsightedness), undergo this surgery?
hyperopic (farsightedness), or astigmatic
Another medical treatment that has others pertaining to the particular surgery.
reportedly provided athletes with a Furthermore, doesn‘t seeing athletes throw
competitive advantage is the ―Tommy John‖ harder, shoot the basketball better, or hit the
surgery, or ulnar collateral ligament (UCL) golf ball more accurately post-surgery
reconstruction. After injuring the UCL in the encourage children to believe that
inside of the elbow, most sufferers unnaturally modifying one‘s body is
experience pain and joint instability. In order acceptable?
to stabilize the joint, a tendon from the
forearm is harvested and tunneled through There is no clear answer to this
the ulna and humerus. Due to the continual question. Standards of acceptable and
tensile stress experienced in their elbows, unacceptable means and methods
this injury is very common in baseball modification need to be developed. With the
players, especially pitchers. Most pitchers various emerging biotechnologies, we must
perform as well as they did before the be vigilant in monitoring their intended uses,
procedure, and some pitchers perform even in order to prevent athletes and those who
better post surgery. Kerry Wood of the emulate them from putting themselves at
Chicago Cubs said, ―I hit my top speed (in risk.
pitch velocity) after the surgery." Is this a
fair way for an athlete to gain a competitive So, is Tiger Woods a cheater? Not today.
edge?
The question arises as to why the

use of steroids and other performance-
enhancing substances is considered
―tampering‖ while the Tommy John surgery
is not. And what about more ―benign‖
enhancements, such as swimmers shaving
their bodies to become more hydrodynamic,
or wrestlers dieting to ―make weight,‖ or
even gymnasts employing ports
psychologists? All these methods create a
physical advantage over the natural
(unadulterated) athlete.
Perhaps the health risk of a

procedure is the issue. In contrast to
shaving one‘s chest, which has few health
implications, (aside from potential razor
burn), one might argue that steroid use is
maligned because of the myriad associated
health risks, and that allowing their use
sends the message to young people that
taking them is acceptable. However, there
are many health risks involved in surgery as
well, including pain, anesthesia
complications, infection, and countless
34 Fall 2007
Molecular Imaging and

Ultrasound-assisted Drug Delivery
By Ashok Ilankovan
Andrew Arnold
The history of ultrasound is

strongly correlated with discoveries re-
lated to sound. In 1822, Swiss physicist
Daniel Colladen calculated the speed
of sound. In 1877, Lord Rayleigh pub-
lished his treatise The Theory of
Sound. It clearly described the funda-
mental physics behind sound waves. A
few years later, the Curie brothers dis-
covered the piezo-electric effect, pro-
viding the breakthrough for voltage-
based generation of sound waves and
the detection of subsequent echoes.
The next few decades saw develop-
Fig. 1: Diagnosis of a breast malignancy
ments in SONAR systems for underwa-
ter navigation. In 1942, Karl Theodore
Dussik became the first scientist to em- field of echocardiography involved the
ploy ultrasound for medical diagnosis. two dimensional static images of the
In 1953, Wild and Reid published the heart. However, developments in ultra-
first two-dimensional clinical ultrasound sound technology have allowed for 3D
images, shown to Fig.1. Within a few and real-time imaging of the heart.
years, ultrasound was used in various Overall, improvements in transducer
imaging applications. The first ultra- design, control in focusing of the ultra-
sound system to image a fetus was sound beams, and digital encoding of
implemented in 1961. ultrasound echo-pulses, have allowed
for improvement of the quality and de-
Ultrasound is most commonly tail of ultrasound images, as shown in
known for its use in imaging of the fetus
during pregnancies. However, it is used Fig. 2. Furthermore, by using the con-
for many other purposes. Currently, it cept of the Doppler Effect and ultra-
uses are mostly diagnostic. However, a sound‘s ability to detect frequency
lot of research is being conducted for shifts, engineers are able to develop
its use in therapy. One of its major uses ultrasound systems that display flow
is echocardiography, which involves properties of blood. Hence, echocardi-
the use of ultrasound to image the ography also incorporates imaging of
heart and its blood flow. Initially, the the direction of flow of blood through
the advent of microbubble contrast

heart valves, allowing echocardiologists agents, which led to revolutionary inno-
to determine if heart valves are func- vation in the form of contrasts specific
tioning appropriately. Currently, the imaging modes‖. Contrast specific imag-
main therapeutic application is ultra- ing significantly improves the detail ob-
sound‘s use in physiotherapy. The ther- served in ultrasound images, allowing
mal energy generated from ultrasound for the possibility of imaging at the mo-
lecular level. Contrast imaging relies on
the injection of microbubbles into the
patient‘s blood circulation. These micro-
bubbles resonate when in contact with
the ultrasound‘s acoustic field and pro-
vide a non-linear response. Hence, the
microbubbles provide an echo that has
multiple harmonics. Contrast imaging
receives the second harmonic from the
response through filtration of the funda-
mental frequency and generates an im-
age with a much higher signal to noise
Fig. 2: (a) An image generated through conven-
ratio than conventional ultrasound imag-
tional ultrasound. (b) An image generated
through digitally encoded ultrasound. Note, ing. Current microbubbles are capable
of passing through the smallest capillar-
is used to stimulate muscle relaxation. ies in the body, preventing the obstruc-
Research is being conducted on its ul- tion of blood flow. However, larger mi-
trasound‘s use for thermal ablation to crobubbles allow for better contrast im-
destroy cancerous cells and other dis- aging. Hence, it is important to find a
eases. balance between the safety of the mi-
crobubble size and its ability to improve
Ultrasound uses high frequency imaging. Microbubbles must also be du-
sound as the basis for ultrasound imag- rable, so they can reach the site of im-
ing and therapy. Exposure of ultrasound aging and endure the energy imparted
to body has shown no side effects; a by the ultrasounds acoustic field. In or-
major benefit over X-ray, CT, or PET der to allow for stability, the microbubble
imaging. In addition, it is a relatively low is filled with heavy gases, since they
-cost imaging solution; a major benefit have a low solubility and high persis-
over MRI imaging. Hence, ultrasound tence. ―The preferred gases include
imaging is a non-invasive, low-cost, real fluorinated gases such as sulphur
-time capable imaging modality. hexafluoride, octafluoropropane, or de-
cafluorobutane, which are innocuous
―Many of the most important re- and exhibit, low solubility in aqueous
cent technological achievements in the media.‖2 The shell of the microbubble is
US imaging industry were prompted by designed to be elastic to prevent break-
36 Fall 2007
ing and to promote resonance. technique is known as sonoporation. It

Contrast imaging has allowed of is important to note that microbubbles
various lesions in the body; primarily can be destroyed with ultrasound in the
those that show contrast enhancement range of diagnostic imaging. Hence, the
patterns. Therefore, in Europe they are acoustic field created for drug delivery
commonly used as a means of ruling out will provide no damage to the body. In
the existence of certain lesions. Further- addition, the pores opened by sonopora-
more, ultrasound can be used for moni- tion are seen to close a few seconds
toring the blood supply to tumors. Fi- after opening. The goal of such tech-
nally, contrast agents have allowed for niques would be to focus therapies to
detailed imaging of the perfusion of the tumor sites. If drug delivery becomes a
kidney, allowing for improved detection feasible modality, it could be improved
of prostate cancer in clinical tests. with targeted microbubbles.
A number of pathologies result in Microbubbles, though a potential

the upregulation of specific receptors. solution for many diseases, has many
This provides the possibility for design- ethical issues surrounding both its deliv-
ing microbubbles that are capable of ery methods and its availability. The
targeting these receptors, allowing for delivery methods raise ethical issues
imaging of the pathology. Recent scien- regarding use of viruses and DNA ma-
tific studies have designed microbubbles nipulation, targeting the correct site, and
with specific antibodies bound to their release point for the drug. Other ethical
shell allowing for targeting. Targeting issues surround the availability of micro-
microbubbles can open up possibilities bubbles, as they may be expensive and
for detection of inflammation, volumetric have possible negative side effects.
reconstruction of a tumor, and the de- However, despite all of these ethical is-
tection of smaller lesions. Essentially, sues, the potential of microbubbles-
targeted contrast agents can improve based ultrasound offers hope for many
the specificity of imaging beyond the people who need gene and cancer ther-
improvements provided by free flowing apy.
contrast agents. When applied to ther- One of the largest ethical issues
apy, microbubbles could be used for surrounding microbubbles is that it could
drug delivery. Essentially, this would in- manipulate the genes of the patient by
volve containing the drug within delivery injecting DNA or a virus into the system
systems, such as lyposomes and mi- via the microbubbles. The microbubbles
celles. Then the microbubbles can be would be sent to targeted tissues and
ruptured at the location of the pathology. initiate the release of DNA or a virus, as
The ruptured microbubble causes pores described in the previous section on
to be opened in the membrane of the drug delivery, to help rectify the prob-
drug delivery system and the mem- lem. This raises many ethical issues,
branes of cells at the site of pathology, including a physician breaking the Hip-
allowing for localized drug delivery. This pocratic Oath. Is injecting a virus into
someone‘s body ―doing no harm‖? Is it not unnecessarily affected by sonopora-

unethical to manipulate a patients DNA? tion. In addition, the biological effects of
Considering that current medical science sonoporation must be seriously ana-
cannot address the long term effects of lyzed through clinical trials. In addition,
gene manipulation, there is a great de- the delivery of potentially harmful drugs
bate over the use of gene manipulation to sites of pathology open a whole new
in humans. Some argue that it is playing dimension of ethical concerns. If a mi-
god and that manipulating human DNA is crobubble containing a cytotoxic sub-
unethical, while others wave it in as the stance to help combat cancer is re-
cure of the future. While these debates leased in the wrong spot, it could be po-
rage on, it is important to realize that sci- tentially fatal to the patient. This means
entists are not that the microbubbles must target the
sure of the long precise location of pathology and the
lasting effects ultrasound must be specifically focused,
and that it will because permanent damage can occur
take a f e w from the smallest error. Also, there are
m o r e years of issues with how to inject someone. Is it
r e - search safe to let microbubbles flow through a
before it would patients bloodstream to get to the target
b e close to location or should the bubbles be ap-
testing on hu- plied as close as possible to the in-
mans.3 Once it is testable in humans, it fected site? If the drug is released at
will be the FDA‘s choice as to whether the wrong point, the procedure is poten-
using gene manipulation is reasonable tially fatal; however, it isn‘t always possi-
for the public sphere or not. Hence, this ble to inject microbubbles directly into
example provides a possible controver- the targeted area. This leads to a co-
sial use of ultrasound-assisted delivery nundrum, since the medication needs to
systems. get into the body, but it could be poten-
tially fatal if released in the wrong spot.
The FDA will also have to decide However, the risks are dropping rapidly
if the substances being injected are as modern science has found it possible
safe. Many ethical issues surround the to target areas of the body easily with-
use of the targeting mechanism of mi- out having the microbubbles break pre-
crobubbles and their effects on the maturely (Tsuitsui). All that needs to be
body. The rupturing of microbubbles worried about now is the human error in
opens pores on the cell membranes, targeting.
and thus, has a direct effect on cell
physiology. Hence, a physician must Humans, as a species, tend to create
ensure that the microbubbles are going many ethical issues out of societal is-
to be broken down in the right spot so sues. One of the ethical issues that
that the medication takes effect in the plagues the use of microbubbles is the
right area, but also that other cells are socio-economic benefits that will be
38 Fall 2007
reaped only by those who can afford the involved. Currently, Contrast En-
cost of a new technology. Though it will hanced UltraSound (CEUS) is used for
be much more cost effective for finding identifying cancers, inflammatory dis-
heart disease early (UNMC), microbub- eases, and blood perfusion in organs.
bles, as a treatment, would still be in the In these cases, the risk of not finding
thousands of dollars. Unfortunately, one of these problems is greater than
when approximately 45 million Ameri- the risks of using microbubbles. Stan-
cans don‘t have health insurance, it dards and applications are really risk
seems very unlikely that everyone will optimizations in which physicians tries
get an equal opportunity to have micro- to way the risks of using microbubbles
bubble therapy if they need it. Also, cur- for a more enhanced image versus the
rent medical science doesn‘t understand risks of the issue that the microbubbles
the possible negative side effects, which would be trying to enhance. A pregnant
can lead to disaster for a family that is woman doesn‘t really need to see the
not well off and now has to take care of finer details of the fetus but a doctor
a family member who is incapacitated. may seriously need to consider en-
Though microbubbles are still not ready hancing the image of a middle age
for human testing, it is important to no- mans heart to see the development of
tice the possible issues that may arise heart disease. Stopping heart disease
from such a technology and to be pre- from developing inside a person is
pared for worst case scenarios. worth the risks of microbubbles causing
potential problems.
There are also ethical issues Though many ethical issues sur-
that concern nanotechnology that apply round microbubbles, their potential use
to microbubbles. Microbubbles greatly in medical technology are boundless.
enhance the images that ultrasound Though the use of microbubbles may
gives; however, is it always necessary come at a risk to the patient, very few
to inject microbubbles for these im- things in life do not involve some form of
ages. Considering the risks mentioned risk. The concern is if the potential
above, it is plausible that for some ul- benefits out way the risks. Since scien-
trasounds, the level of detail created by tists cannot be sure of the side effects or
the microbubbles in unnecessary. This potential negative impacts, it is hard to
leads to an ethical issue about when is determine; however, the potential bene-
the use of microbubbles appropriate. A fits make microbubbles an almost nec-
pregnant woman probably doesn‘t need essary medical technology to research.
microbubbles for her ultrasound where Despite the fact that microbubbles rup-
as trying to find evidence of heart dis- ture cell walls and can potentially cause
ease in a middle age man may neces- damage to the body, it offers options for
sitate the use of microbubbles.5 This fighting cancer, finding heart disease
leads to issues over the standards of early, and delivering medications to spe-
practice such as when microbubbles cifically targeted areas. As technology
should be used and how much risk is improves, hopefully microbubbles will
become useful form of treatment for though possibly a little unethical, is fam-
those who truly need it. ily history and screenings. Though it
may be unethical to discriminate due to
The potential risks of modern mi- someone‘s family history, the effects of
crobubble technology can be impeded microbubbles is still widely unknown;
through many different methods. First, therefore, the use of CEUS should be
physicians should not use microbubbles reserved for people with family histories
Konofagou, Elisa. ―History of Diagnostic Ultra- of heart disease and cancers, thus limit-
sound.‖ Lecture 1: Introduction: Diagnostic Ul- ing the risk of damaging a person who is
trasound Imaging. Department of Biomedical perfectly healthy. If a person potentially
Engineering, Columbia University: 2008. on has a chronic disease and it runs in the
areas where damage to microvascula- family, it is worth the risk to have micro-
ture could be potentially very harmful. bubbles injected; however, if your family
This would include the eyes, brain, or a history shows no sign of a chronic dis-
fetus. Second, the use of electrocardio- ease, it might not be worth using micro-
grams will help physicians monitor how bubble for the sharper image.
a patient‘s heart is doing as CEUS can
cause disturbances in cardiac rhythm. References:
Finally, there has been evidence that in
rare cases, certain people show an al- Barnett, Stanley B. et al. ―Recommendations
lergic reaction to microbubbles6. If this is on the Safe Use of Ultrasound Agents.‖ Ul-
the case, it is important for a doctor to trasound in Medicine and Biology. World
be ready for a patient to suffer from an Federation of Ultrasound in Medicine and
Biology. Volume 33, Number 2: 2007.
allergic reaction.
As microbubbles begin to evolve into a Blomley, Martin. ―Which US Microbubble
potential medical treatment, many of the Contrast Agent is best for gene therapy?‖
issues discussed previously require an- Radiology. Volume 229, Number 2: Novem-
swers. Currently, institutions from the ber 2003.
U.S.A, U.K, and Australia believe that
there are five basic solutions to help Schneider, Michel. ―Molecular Imaging and
minimize the risks of using microbub- Ultrasound-assisted Drug Delivery.‖ Journal
bles. These include scanning at lower of Endourology. Mary Ann Liebert, Inc. Vol-
mechanical indices, scanning at higher ume 22, Number 4: April 2008.
frequencies, reducing total acoustic ex-
Tsuitsui, Jeane et al. ―The use of microbub-
posure time, reducing contrast agent bles to target drug delivery.‖ Cardiovascular
dose, and adjusting the timing of cardiac Ultrasound. Volume 2, Number 23: Novem-
triggering.6 Since this is a very recent ber, 2004.
technology, more research needs to be
done before determining exactly what UNMC. ―Microscopic bubbles unlock key to
steps need to be done to solve some of detecting heart disease early.‖ University of
the dilemmas mentioned. However, a Nebraska Medical Center: February 10,
plausible solution for the time being, 2005.
40 Fall 2007
One way to bypass some of unethical because the wealthy would be

these issues is use animal hearts as able to obtain better treatment.
donors. Generally, when bioethicists
think about xenotransplantation, the If this technology becomes
transplantation from one species to clinically approved there will emerge
another, one of the main issues of three sources for heart transplants.
concern is the possibility of unwittingly They are: (1) hearts obtained from
spreading animal diseases to the human human donors and transplanted
recipients, such as porcine endrocrine immediately after the death (2)
retroviruses (PERVs). If the animal- bioartificial hearts engineered from
donated cadaveric hearts are human cadaveric hearts, and (3)
completely decellularized however, this bioartificial hearts engineered from
i s s u e b e c o m e s i r r e l e va n t , t h e animal cadaveric hearts. Although
assumption being that the acellular information describing how the waitlist
matrix will not retain animal diseases system works currently is not readily
that could be transmitted to a human a va i l a b l e , t he Am e r i c a n H e ar t
recipient. New screening tests would Association states that ―Donor organs
substantiate that the acellular hearts are given according to the severity of
were in fact, viral free. However, there the illness or status level of the patient,
are still bioethical issues of concern. size and blood group compatibility, and
First of all, some people think that the length of time spent on the
xenotransplantation is an unethical waitlist‖ (Jurt, et al., 2002).
process because it is ―unnatural‖ or
against their cultural and religious We suggest the implementation
ideals. Although m any medical of a more complicated algorithm than
processes are ―unnatural‖ and are the one implied by this sentence. We
generally not considered to be unethical, propose an algorithm that would match
medicine must accept that some people any heart (of the first, second, or third
will find the possibility of a xenograft to type) to a donor based on the factors
be anathematic to their values because already in place, but also other factors
they do not want their bodies or the having to do with the bioethical
bodies of their loved ones to be part preferences of the particular donors and
animal. There is the possibility that recipients. For example, a recipient
animal-based bioartificial hearts will be might decide he doesn‘t want an
less expensive to obtain, and therefore animal‘s heart, and he would be able to
there will be a division along the lines of input this information into the database.
class for who receives a human-based Also, patients might be able to input the
heart and who received an animal- amount of risk they‘d be willing to take if
based heart. If we assume that a a heart of a certain non-ideal profile
human-based heart would be preferred would become available. Although the
over an animal-based heart, we‘d have scientific data is not yet available to
a class divide of health that seems compare the efficacy of the three
different types of hearts, we assume References:

there would be differences and patients
would be able to determine their comfort ―Heart Disease and Stroke Statistics.‖
in taking a certain risk for a potential American Heart Association, American
benefit for these non-ideal organs.1 This Stroke Association. 2008 Update At-a-
complex algorithm would also take into Glance.
account the medical history of the
donors and recipients and the locations Eschenhagen, T. & Zimmermann, W.H.
Engineering myocardial tissue. Circ. Res.
of both donors and recipients. It could
97, 1220-1231 (2005).
also take into account a donor‘s
preferences about the destination of
Jurt, U., K. Delgado, K. Malhotra, H. Bishop,
their heart, such as if they wished their and H. Ross, Heart Transplant: What to
organ to go to a recipient with children Expect. Circulation 106, 1750-1752 (2002).
or to a recipient for whom it is predicted
that the organ will extend life by a Ott, Harold C., Mattheisen, Thomas S., etc.
certain number of years. Perfusion-decellularized matrix: using
nature‘s platform to engineer a bioartificial
One might think that it would be heart. Nature Medicine 14, 213-221.
easy for a potential recipient to put in all (January 2008).
the ―right answers‖ that will move him to
the top of the waitlist for an organ. But Webster NR. Animal Tissues into Humans.
these ―right answers‖ would not exist Br J Anaesth 80, 281-282, 1998.
because the algorithm would take into
account so many different factors Wittwer, Thorsten and Thorsten Wahlers.
contributing to the match between donor Marginal donor grafts in heart transplantion:
and recipient. Even with this complex lessons learned from 25 years of
system, however, no transplantable experience. Transplant International 21, 113
-125 (2008).
heart is likely to be perfect. The key
issue, as has been mentioned 1
The idea that less-than-ideal donor hearts
repeatedly in the bioethical literature, is
should be accepted and used has been
to always respect autonomy. This suggested in recent literature (Wittwer T,
translates in practical terms to an Wahlers T. Transpl Int. 2008;21:113-25.
upholding of the importance of Epub 2007). The authors suggest that the
transparency of information and potential benefits of using non-ideal hearts
informed consent, so that any potential are likely to far outweigh the risks
recipient of a heart transplant knows associated with using these hearts in
and approves of exactly what he‘s transplantations. atients could then decide,
getting in to or actually, he knows on a numerical scale, how willing they are
exactly what is getting into him. to take the risks associated with less-than-
ideal hearts.
42 Fall 2007
A Dearth of Donations
By VikrumThimmappa and Jocelyn Lo
Columbia University
In 2008, for the first time in of money, reports suspecting Chinese

United States history, a physician was authorities of selling executed prisoners‘
charged with overprescribing drugs to a organs without their or their families‘
patient. Dr. Roozrokh didn‘t just consent, blazed through the media in
overprescribe Ruben Navarro; he mid 2007. Opportunistic individuals and
expedited Navarro‘s death in order to groups have stepped up to illegally fill
recover his salvageable organs for the void in organ supply.
transplantations.
Perhaps it is time to authorize
This is only the beginning of the the questionable sale of organs. The
ethical tensions arising in response to questions that arise then are whether
the increasingly limited number of organ this is ethical and if permitting the sale
donations. Physicians, patients, and and purchase of organs in the U.S.
their families are now questioning how would transform organs into just another
and where to procure these organs commodity.
since the supply has not proportionally
increased with the demand. There would certainly be benefits
to this policy. On a societal level, the
One possible solution to prevent supply of organs from those persuaded
other physicians from acting like Dr. by financial incentives would
Roozrokh is to legalize the sale of theoretically increase, while
organs. Currently in the United States, it individually, donors could turn a profit
is illegal to purchase and/or sell organs from items obtained free of charge at
according to the National Organ birth. In addition, black market
Transplant Act of 1984, and organs are transactions of organs would decline,
only available as donations from since these goods would be available
the living or the recently deceased. through legal avenues. Even crimes
Already evident by the surge of black related to organ thievery would wane
market transactions in organ sales and since making the sale of organs legal
transplant tourism, these would reduce their price in the
populations are being forced to pursue market. Hopefully, situations like the
alternate, illegal routes. Illustrating the recent kidney racket in India, where a
desperation of patients in need of doctor solicited poor individuals with
organs and businessmen in need promise of work then stole and sold their
kidneys, will no longer have reason to most urgently. The financially

occur. disadvantaged would inevi-
tably be exploited. Legalization would
Conversely, while neglecting the catalyze the struggle to balance the
practical limitations of legalizing organ need for organs to save patients‘ lives
purchases from deceased individuals‘ and the manipulation of desperate
families, this system has ethical individuals willing to sell their organs to
implications and consequences that are the highest bidder. This would
enough to highlight its inadequacies. By undoubtedly result in a steady stream of
placing financial value transplantable organs flowing to the
on deceased family members' organs, rich.
cultural and religious values are called
into question. True, the body no longer
serves a practical purpose after a Although there are benefits to
person's death, but the issue of legalizing the sale of organs, the
distinguishing betweena person‘s body negative conclusions drawn from an
and a person‘s identity emerges. ethical perspective clearly
overshadow this system's practicality as
On a more fundamental level, a means to increase the supply of
families must consider whether the organs in the U.S. Do we really want a
sentimental value of a family member‘s society in which organs are primarily
body can be translated into monetary given to those with the greatest ability to
gain. This is where the difference lies pay? Other options need to be
between selling and donating an organ. examined.
Selling an organ transforms the act of
saving a person‘s life into one of Undoubtedly, the U.S. should
personal benefit. One consequence of revamp its donation system,
organ selling is the donor‘s concern which currently relies on the consent of
about pre-mortem patient care. In donors before their deaths or their
extreme circumstances, like that families after the fact, to that
involving Dr. Roozrokh, patients' well- of presumed consent. Spain and
being and care could be neglected, Austria have already effectively
since through the patient's anticipated enacted versions of this presumed
death, a commodity would become consent system to raise organ
available. supply. Currently, the U.S. registered
21.4 organ donors per million while
Although increased dona- Spain boasts 35.1 organ donors per
tions because of financial benefits could million as the highest of any country. It
theoretically increase the organ supply is time for the U.S. to enact the same
by encouraging unethical medical policy.
action, organs would still most likely
come from those who need the money
44 Fall 2007
Instead of sending out

renewed drivers' licenses with donor
card forms that indicate an individual is
willing to donate organs, the forms
should request the explicit dissent of
organ donations. In this case, as
opposed to the former, explicit dissent
opens the possibility for those on-the-
fence or indifferent individuals to
contribute their organs, thereby
increasing the organ supply but also
creating an additional purpose for their
passing--to save another person‘s life.
A Bun in the Oven
By Jennifer Gillman, Anna Plitt and Andrew Behrens
Columbia University
It‘s 3 AM and your child is attachment. Currently, she intends to

asleep. But something is happening in continue her research up to the 14-day
the world: this child is being developed limit placed on growing human embryos
in a laboratory. Years ago, a child born in laboratories.
prematurely at 26 weeks was not
expected to survive, or would survive With emerging technologies that
only with severe lifelong illness. aim to simulate a uterine-like
Attempting to save these babies was an environment, it is necessary to
act of heroism. Now, with new understand the effects on the
improvements in neonatal technology, developing fetuses. At birth, a
many of these infants can be stabilized premature infant‘s brain is not
and sent home after months of sufficiently wired, and therefore the rest
treatment. As research in neonatal of its development depends on the
technology continues, investigators are environment in the NICU. Generally,
also examining how to grow embryos research shows that extremely low
and fetuses outside of the womb – will gestational age infants are more prone
this be this seen as an act of triumph, or to brain injury and lung diseases.
are the ethical implications too much of Furthermore, the NICU has been shown
a burden on our society? to put these preemies at a higher risk of
neuro-developmental disorders. Until
It has been predicted that these artificial wombs become fully
growing a full baby in an artificial womb developed, children maintained in them
will be made possible in just a few may survive but will face serious
years. Nine years ago,Yosinori medical challenges.
Kuwabara designed a tank, filled with
amniotic fluid and equipped with an Our bodies have evolved in such
umbilical cord, to develop a 20-week old a way that the intrauterine environment
goat fetus for additional 21 weeks (to full provides the perfect conditions for
term). Furthermore, Dr. Hung-Ching Liu embryologic and fetal development.
showed that human embryos would Sigmund Freud called the womb the
attachto a uterus-like chamber lined with ―stimulus barrier,‖ because it is where
human cells. The artificial uterus was the fetus can develop undisturbed. The
simply a mold of collagen plastered with stress of a typical NICU or an artificial
endometrial tissue to prompt the embryo womb works against the intricate and
46 Fall 2007
delicate development of the human first develop environments that are safe
body, while the architecture of the enough to promote the normal
mother‘s womb provides the perfect development of premature babies.
conditions to sustain life. If this womb is
replaced with a highly irregular and Nevertheless, even though it
variable NICU environment before 37 sounds like science fiction, we may one
weeks of gestation, the preemie day see the use of these artificial
experiences shock. wombs in our local hospitals, and we will
be left to deal with the ethical
The natural womb goes beyond consequences. Artificial wombs could
assisting the physical development of one day be considered another
the child. The child‘s regulation of alternative to abortion. While the
emotional behavior begins in the abortion issue looks at the woman‘s
mother‘s uterus and continues after birth right over her own body, the artificial
for full term babies. Disrupting this womb takes the woman‘s body out of
bonding time leads to disorganized the picture; these fetuses could be born
behavior. When the child is in the womb, extremely prematurely and raised
it becomes familiar with the mother‘s instead of being aborted. However, with
heartbeat, and later learns the sound of the ―birth‖ of this baby comes the birth of
her voice. Thus, if we were to have a many social dilemmas. Would this
child develop completely outside of the technology make abortions illegal once
mother‘s womb, there could be the and for all, eliminating the choice of
psychological consequences due to the abortion for the prospect of transferring
absence of this mother-child bond. the fetus to an artificial womb? That is -
do we have the right not to reproduce? If
Frank Duffy, a physician at the not, will women have to acquiesce to
Children‘s Hospital of Boston states, ―In surgery to withdraw the fetus? The
the early days of neonatology, just problem would then snowball into the
having these babies survive was a question of how to support these
miracle. Now it‘s more or less expected children in our already crowded foster
that these ‗miracle babies‘ will survive. care facilities.
We have to help these babies to be
comparable to full term infants. That On a more positive note, if
goal is within our grasps.‖ It is more regulated appropriately, this kind of
important to improve on the outcomes of technology could become the sequel to
the children that we know will survive, in vitro fertilization and in vitro
as opposed to funneling money and implantation. If this technology is proven
resources towards technologies that will to be safe, the responsible application
most likely lead to more underdeveloped would be towards women who wouldn‘t
children. Researchers often get ahead be able to otherwise conceive a child.
of themselves, and that is a great path Also, it is very likely that if this
towards innovation, however, we must procedure is approved, it will be very
expensive, and artificial wombs will not

become the norm.
Assuming that the reproductive

assistance method would be the most
practical usage of artificial wombs, the
major ethical priority would once again
focus on the well being and
development of the child. This is an
issue that is relevant today, and work is
being done to improve the environment
of the NICU to promote the child‘s
neurological as well as physical
development. This seemingly small step
is the key that justifies opening the door
to the realm of artificial wombs.
48 Fall 2007
Paying For Patient Performance
Viktor Gamarnik and Ben Koo
Columbia University
As a highly regarded right, will result in higher quality patient

endocrinologist, one day you are rather care leading to increased physician and
puzzl ed t o discover t hat your patient satisfaction.‖ However, the
reimbursement rates have just been illustration above reveals one glaring
lowered because several of your problem in the P4P model: physicians
patients in the diabetes chronic care are held wholly responsible not only for
program that you run have been their performance, but for the actions of
presenting with consistently worsening their patients. Many physicians have
symptoms. You also know that amongst expressed their concern about the P4P
all your patients, these are the ones who reimbursement model‘s dependency on
have most often disregarded your patient outcomes, as it is a commonly
medical orders. This is a possible held belief that a doctor ought to take
scenario under the recently emerging the role of a healer, not an enforcer. By
health insurance movement known as m e as ur ing p at ie nt per f or m a nc e
Pay for Performance (P4P). The main standards, the P4P model will effectively
obj ect ive of t his new m edica l punish physicians for their non-
reimbursement system is to reward compliant patients. Inevitably, this will
physicians, hospitals, and other lead to the rejection of non-compliant
healthcare providers for the quality and patients by physicians; if physicians‘
efficiency of their treatment. P4P is an incomes and reputations are dependent
alternat ive plan t o m ainstr eam on how many non-compliant patients
reimbursement fee-for-service models, they have, such patients will soon find
such as Medicare, which have been that the quality healthcare at the very
showing deteriorating healthcare quality core of P4P programs is impossible to
and decreasing emphasis on effective find.
patient treatments. There are currently
over a hundred different voluntary pilot We believe the P4P paradigm
P4P programs; by using rewards as has enormous potential for raising the
incentives, many have shown evidence- overall quality of healthcare available to
based increases in both the quality and every patient. However, this system
efficiency of patient health care. The cannot be implemented under the
American College of Physicians (ACP) presumption that patient improvement is
stated that the ―adoption of appropriate solely a function of the physician‘s input.
quality improvement strategies, if done Our solution relies on the establishment
of a more secure relationship between young diabetic patient who avoids

physicians and insurance providers. insulin injections and blood sugar
Such a system may be achieved by a monitoring for cosmetic or social
variety of means, including the purposes, however, does present an
enforcement of harsher punishments for increased and highly avoidable risk to
insurance fraud activities. Most the insurer, and as such, ought to face
importantly, the institution of a more the prospect of increased premiums
honest affiliation between the financers unless behavior is altered. Under this
and actual providers of healthcare will system, insurers will retain the ability to
allow the focus on performance to shift objectively assess physician
toward the patient. When an insurer performance without alienating doctors
detects a case of a patient with a from the process with the presupposition
deteriorating condition, the first course of wrongdoing. At the same time,
of action will be to assess the situation physicians will embrace this type of P4P
with the physician. If there is sufficient approach because it will provide them
reason to believe that the patient‘s with a positive reason to ensure patient
condition is worsening due to a compliance (e.g. maintaining the
voluntary non-compliance issue, a patient‘s ability to pay for treatment), as
closer investigation of patient behavior opposed to the negative prospect of
will be warranted. Finally, if non- losing income. Patients too will be far
compliance is verified, oversight then more likely to respond to the tangible
becomes the insurer‘s responsibility. For prospect of increased costs.
example, the patient‘s premiums may be
increased, and in extreme cases We therefore believe that our
patients may be presented with the modified P4P reimbursement model will
possibility of losing coverage altogether. benefit not only the insurance providers
Though such methods of enforcement but participating physicians and, most
may seem contrary to common notions, importantly, patients. In addition to the
the rationale is clear: a patient who already proven positive effects on
refuses necessary and proper treatment overall healthcare quality, our model will
for a condition presents the insurer with encourage greater patient compliance,
unacceptable risk, and a guarantee of ultimately leading to decreased long-
increasing expenditures in the future. term costs.
The crucial feature of this system is that
physicians become key participants (as
opposed to sole victims) of the
performance assessment process. As
such, they are responsible for ensuring
t h e d i s t i n c t i o n s b e t we e n n o n -
compliance: an elderly Alzheimer‘s
patient who frequently forgets to take
medications ought not to be punished; a
50 Fall 2007
One Word: ―Synthetics‖

The Ethics of Synthetic Biology
Savino Sguera
Benjamin Stern
It will soon be possible to design and length. Then, the plasmids underwent
construct a live organism without a progenitor. recombination in engineered yeast, which can
The science of ―synthetic biology‖ has existed accommodate up to 2 megabases of extra genetic
since the early days of genetic engineering, but material. The native M. genitalium genome was
the synthesis of novel organisms without a modified to include a few genetic markers and an
genetic ancestor of any kind represents a additional gene that prevents adhesion to
qualitative advance over previous work. The mammalian cells (incorporating the safety
philosophical and ethical issues raised by recommendations proposed by Alisomar
synthetic biology suggest an imperative to set conferences of the 1970s). Though no bacterium
clear guidelines for the investigation and was generated from this synthetic genome, the
application of the science. With the recent next logical step is sure to happen soon (if it has
synthesis of viruses, and soon bacteria, the not already).
power in the hands of individuals who can wield
it for good or evil. Rather than simply implore The applications of synthetic biology
scientists and engineers to ―do no evil,‖ we must are limited only by the extent to which science
take active precautions to regulate synthetic chooses to pursue them. Engineered bacteria
biology. Philosophers, ethicists, and religious could, among other things, produce life-saving
figures should be included in the discussion drugs at relatively little expense, remove carbon
about the synthesis of organisms so that the dioxide from the atmosphere, process toxic
technology can be used for the betterment of pollutants, and capture solar energy. Conversely,
humankind and our planet. the potential evil is rivaled only by nuclear
weapons: the engineering of infectious diseases
In January 2008, Daniel Gibson, Craig or even a ―superbug‖: a virus or bacterium that is
Venter, and others (Gibson et al., 2008) reported fatal, easily transmitted, and resistant to known
the first successful fabrication of a bacterial drugs. After decades of debate and speculation
genome, that of the Mycoplasma genitalium. about the plausibility of engineering an
Though this species possesses the smallest organism, Pandora‘s Box has been opened. The
known bacterial genome, the accomplishment abundance of concerns throughout the
represents a landmark in synthetic biology. philosophical spectrum has prompted many
Previously, the longest DNA sequence individuals to demand a broader public
synthesized was 32 kilobases long. However, the awareness of the implications of this new
M. genitalium genome, the shortest of any biology. (IDEA League Summer school, August
bacterial genome, is over 500 kilobases. To 2007).
synthesize the bacterial genome, Gibson‘s team
divided it into 101 parts, each overlapping by 80 Of utmost concern is the security of
base pairs for joining later. These were biosynthesis technology from malicious
synthesized and joined together in vitro to form interests. Can humankind create a more virulent
plasmids of approximately 144 kilobases in and dangerous life-form than nature already has?
The development of pathogens for the purpose of goals of the conference should be far-reaching
bioweaponry could conceivably occur without and address the future possibilities of synthetic
bound with the use of widely-available protein biology, notably the complete design of higher
components as the science improves. forms of life—including humans. However, the
conference should also focus on the technologies
Some have looked beyond these immediate that will appear in the coming decade. Here are
risks to the possibility of negative impacts on our recommendations for some of the measures
nature. The introduction of a new organism to be considered, with specific attention to
whose existence is not the result of common bacteria.
evolution can significantly affect not only the
natural environment but the natural gene pool as To address the possibility of uncontrolled
well. Synthetic and traditional bacteria can reproduction and infection, all bacteria
interact to compete for nutrients or even engineered from scratch should include multiple
exchange genetic material; there are as of yet no suicide pathways for use as an ―abort‖ system.
means to predict the specifics and magnitude of Each pathway would be activated by an existing
the resultant environmental changes. compound not found in most natural
environments, but known to be generally safe to
The arrival of engineered bacteria has other organisms (alternatively, a novel
renewed the debate in the scientific community engineered compound could be used). The
regarding the definition of life. (A simple multiplicity of pathways reduces the chance of
distinction between ―natural‖ and ―artificial‖ life adaptation to the abort system. The abort toxins
becomes blurred when speaking of extant life would be used to kill off bacteria in the event of
forms recreated from proteins). Synthetic unwanted escape, unforeseen behavior, or simply
biology also raises questions to which scientific when they are no longer needed for industrial or
inquiry may never provide a definite answer. environmental purposes.
This is true because, contrary to the beliefs of
most of the world‘s population, conventional Before synthetic bacteria are constructed,
science is based almost entirely upon each should be simulated in a computer program
reductionist methods. That is, it holds that a that uses the latest artificial intelligence methods
system can be completely accounted for through to model interactions of genes. This will require
study of its constituent parts. This belief the use of powerful computers and the
contradicts the doctrines (religious or otherwise) development of robust algorithms, but is feasible
to which a majority of humans adhere: life is on the bacterial scale. The simulation, of course,
greater than the sum of its parts. Most religions should screen for harmful effects.
go further to claim that an unquantifiable force
governs the creation and sustenance of life; Next, after the bacteria are cultured and
synthetic creation is hence seen to be ―playing constructed, they should undergo DNA
God.‖ microarray analysis3 for a full genome-wide
assessment of expression levels. A range of
These ethical issues should be addressed in stimuli should be applied to cultured bacteria to
an organized and timely way. First, the scientific predict their response in a variety of
community should strive to reach a consensus on environments. This will generate an ―expression
the proper design, engineering, production, and profile‖ for the bacteria across the stimuli. Each
use of synthetic organisms. Scientists, ethicists, expression profile should then be compared to
religious leaders, and jurists should be convened the expression profiles of existing strains of
in a conference similar to Asilomar in 1975. The bacteria with known mutations. After this
52 Fall 2007
assessment animal testing should be conducted to who will face future issues. If we set forth
assess the bacteria‘s effects on various animals, principles and connect them directly with policy,
including mammals. we can set a precedent for future generations and
help ensure technologies are used in a safe and
If for some reason a toxic strain of ethical way.
synthetic bacteria is necessary for an industrial
application, the facilities in which that strain will
be cultured should follow strict safety and References:
containment protocols. Toxic bacteria should
have an additional abort pathway: they will be
engineered to be susceptible to several known Gibson DG, Benders GA, Andrews-Pfannkoch
antibiotics. C, Denisova EA, Baden-Tillson H, Zaveri J,
Stockwell TB, Brownley A, Thomas DW, Algire
Inevitably, there will be biological MA, Merryman C, Young L, Noskov VN, Glass
designs sufficiently different from known JI, Venter JC, Hutchison CA 3rd, Smith HO.
organisms that their behavior outside the Complete chemical synthesis, assembly, and
laboratory cannot be predicted. To address this cloning of a Mycoplasma genitalium genome.
concern, we propose building a series of Science. 2008 Feb 29;319(5867):1215-20.
―biosphere‖ testing centers funded by the
government and an industry consortium. Each IDEA League Summer school, Synthetics: the
center will harbor a wide range of ecological ethics of Synthetic Biology‖ August 2007, The
environments and animal species. The bacteria Netherlands.
should be released into the hermetically-sealed
environment and the results carefully surveyed.
Each experiment would be terminated by release
of the ―abort‖ toxin. These ―in-terra”
experiments may be prohibitively expensive at
first, but the concept represents a new way of
assessing the impact of technology. If we are to
craft new forms of life, we must take care that
our creations will not detrimentally alter the
balance of our environment. Even with the best
intentions, computer models, in vitro studies,
and animal testing, we are likely to encounter
unforeseen consequences should a truly novel
life form enter the picture.
While humans built ―from the dust of

the earth‖ are still far off, engineered bacteria are
right around the corner. Those engaged in policy
debate should keep in mind the far-reaching
possibilities of synthetic biology, but should still
pay close attention to the technologies that will
appear soon. Setting environmentally conscious,
ethical, and clear guidelines for the use of
synthetic bacteria will set a precedent for those
A Revised View on Scientific Fraud
By Anshu Das and KrishnKhanna
The recent breakthrough in research. The basic concept of supply

deriving embryonic stem cells from skin and demand is such that with an
cells, reminded us of another increase in supply, the value of a
―breakthrough‖ in stem cell research that commodity decreases. In the case of
shocked the world. In 2004, Professor research, the commodity is information.
Hwang Woo-Suk of Seoul National With the advent of the Internet, the
University claimed to have cloned the amount of information accessible to the
first embryonic human stem cell scientific community has skyrocketed.
(Saunders and Savulescu, 2008). Yet, at times, the value of this
information seems to falter. Publications
As pre-med students, Hwang are arising which may not only be of
was our idol. However, our memory of little practical use, but may even be
him ends tragically, when in 2005, the completely false.
university found that he had fabricated
his results. Our hero was convicted of Yet while scientific fraud
violating bioethical law. smudges academic integrity and ethics,
to say that its impacts are only injurious
And yet, as new stem cell would be incorrect.A silver lining does
developments appear, we cannot help exist around this dark cloud of scientific
but continue to idolize our embezzling negligence. In one word: hype.
role model. However, is this such a bad
thing? Regardless of the lack of truth Lets take an example outside of
behind his studies, Hwang shook the the world of hard science and look at the
scientific community just as much as hoaxes surrounding the infamous
transforming these skin cells did. And Bigfoot. The footprints that fooled
that is what a researcher aims to do: millions were revealed as a hoax in
discover something that will grab 2002. The hoax made most skeptics
people‘s attention to his/her work, so the ever more skeptical. But when it was still
field can thrive on. considered legitimate, the hype it
created excited both adventurous hikers
Manufactured data and and rogue researchers alike.
fraudulent research is, undoubtedly, a
slap in the scientific community's face. It was this hype that was
So why would something like this responsible for placing the field of
happen? There is an interesting analogy cryptozoology on the map. By bringing
between economics and scientific this subject into the mainstream, new
54 Fall 2007
species, whose existences were Call it a fiasco, but when

rumored, were finally discovered. Even Professor Hwang published his radical
the attention given to the search for the claims, the scientific community was
missing link between ape and man can ecstatic. Professor Hwang‘s
be partially attributed to the public breakthrough changed the way the
interest in Sasquatch. masses looked at stem cells. Up until
then, cloning had taken place only with
Public interest is necessary for cows and sheep, but the creation of a
the scientific community, and crucial to human embryonic stem cell meant that
any scientific field‘s survival. When the a human clone was no longer science
masses become captivated bya new fiction.
discovery, the research in the field shifts
into overdrive. In the field of stem cell But such news was too good to
research, this is manifested in numerous be true. In late 2005, the university
ways. determined that Hwang‘s results were
fabricated. He was found guilty for
In the fervor of excitement, embezzlement and bioethics law
grants are won and funding is no longer violations. His title was stripped and his
a hurdle. More researchers begin papers retracted.
working on similar projects and the field
startsto prosper. Newer discoveries are Did he deserve it? Through the
made. And, in the end, it is the public lens of academic integrity: absolutely.
who benefits from the results of new Sure, the scientific community was
technology. embarrassed. Scientists and the public
both harbored distrust towards the world
But the politics of the issue are of research. But this doubt dissipated
brought into the limelight as well. very quickly, and the same fervor
Politicians are by no means experts on surrounding stem cell research is
stem cell research. Rarely are they present in the air today. For the sake of
impacted by minor developments in the the developments and the excitement
science of cloning. Instead, they want to Hwang initiated in the field of stem cell
see the very tangible applications of the research, doesn‘t he at least deserve
new research. some credit?
That is exactly what Hwang‘s His fraud, like many others

―discoveries‖ showed them. It is these before his, intrigued and inspired those
types of leaps and bounds that cause inside and outside of the scientific
the lawmakers to shift their attitude community. But when the truth is
towards this controversial but potentially revealed, the same falsifications smash
life saving research. And it is these the listeners back down to reality. And it
types of breakthroughs materialize the is our crushed fantasies that we
research‘s future potential. generally remember. Seldom are the
moment of epiphany, and the feeling of

hope, and the vision of future potential
taken into account.
In the case of Professor Hwang,

the rejuvenating energy his false
publications brought to the field are still
quite visible. His lab stated that they
hoped he would return. A number of
lawmakers have pledged their ongoing
support, regardless of their party
affiliation. And from the general public,
over 700 women volunteered to donate
their eggs to his lab so that his study
could continue.
And if you count us, he will

surely have at least two supporters on
this side of the world. He had the
audacity to give the field of stem cell
research the boost it needed to bring
about the developments we see today.
He may not have shown that human
cloning is possible, but he at least
inspired us to believe that it could be.
References:
Saunders R, Savulescu J. Research

ethics and lessons from Hwanggate:
what can we learn from the Korean
cloning fraud? J Med Ethics. 2008
Mar;34(3):214-21.
56 Fall 2007
IV. Neuroethics
Programmed Free Will
Elisa Fung and Lindsay Kugler
Columnbia University
In the movie Minority Report, the asked to push either a left or right button
U.S. had developed a precrime police whenever they felt the urge to do so.
unit to predict crimes before they While they were deciding, a screen
happened. Through the use of flashed a random letter every half
advanced technology, genetically second. Subjects were asked to record
altered humans were thought to which letter they saw directly before
flawlessly predict a criminal‘s actions deciding when they were going to press
before they were carried out and so they a button. Results showed that there
were arrested before they could do was a significant time delay between a
anything. In this movie, crime was peak in the fMRI reading and when the
virtually eliminated. Although this movie letter the subject recorded was flashed
was based on science fiction, there is on the screen. This indicates that the
potential for a precrime unit to come to decision was made in the brain (shown
fruition. by the fMRI peak) before the subject
was conscious that they were going to
Research has shown that brain make a decision (indicated by the letter).
signals can be detected through a This research implies that technology
―readiness potential‖ in the prefrontal can be used to predict someone‘s
and parietal cortex up to ten seconds actions before he even knows that he
before a subject actually makes a will make a decision to act. Perhaps
decision to act (Soon et al., 2008). with more investigation, earlier brain
Through the use of the emerging activity (more than ten seconds before
technology of fMRI, the supplementary the decision is made) can be imaged to
motor area (SMA), which is known to be predict the actions of the individual.
involved in motor preparation, can be
imaged. Corresponding changes in This research is new and
peaks on the fMRI image are visible exciting, however there are some issues
during the process of decision-making. of concern. It can be useful in very
In Soon‘s experiment, subjects were select cases, but generally its use is
detrimental. For instance, society could even know what that decision would be.
benefit from further development of this The peak does not show what the
technology for use in spying on terrorist decision is, just that a decision was
activity and preventing unnecessary made. According to Soon‘s research, if
fatalities. This technology may have the present technology were used,
been able to prevent the September 11th predictions of a decision made between
tragedy, given that an fMRI image of the two choices would only be accurate
terrorist‘s brain could have been 60% of the time. These results are only
obtained at airport security. However, slightly better than if random selection
its use should be regulated because it had occurred. This accuracy level
can be easily abused. For example, if would only decrease as the decision
police were to use it to make arrests, the becomes more complicated and more
so-called criminal would not know what choices are available. As Soon
he would be arrested for because he continues with his research, society
would not be aware that he would have must be ready for the ramifications that
committed a crime in the future. People will result from his findings.
could be arrested for their thoughts and
not their actions. Everyone has The lack of free will, which is
inappropriate thoughts, at times, but implied by these findings, will cause the
most of these thoughts are not acted religious community to question their
upon. choice in faith. From the Christian
perspective, there is a moment of re-
birth, meaning that an individual ―makes
a decision to follow Christ‖. This
moment is currently defined as the time
when God reaches into the individual‘s
life, not necessarily when the anatomy
of his brain decides his faith. The
individual is thought to play an active
role in deciding when to let God into his
life, yet Soon‘s research challenges this
fundamental moment. The whole issue
of faith is refuted by the research
because the brain decides before the
individual decides. Faith is no longer a
personal decision, but an anatomical
signal. According to the religious
communities, faith cannot be proven; it
is not a result of neuron activation but a
I f a co n vi ct e d cr im i na l ‘ s conscious choice.
―readiness potential‖ were shown on the
fMRI, then current technology would not Conscious choice is also
58 Fall 2007
important in potential.
anyone‘s
mental health. Despite
Soon stated t h e s e
― t h e ramifications,
impression this research
that we are could be
able to freely valuable to the
c h o o s e scie ntif ic
b e t w e e n community. The
different more scientists
p o s s i b l e know about the
courses of brain and its
action is processes, the
fundamental to greater the
our mental potential for
life.‖ The ability b e t t e r
to make understanding.
decisions Specifically, this
separates research could
humans from be used to
being as understand and
automated as possibly find a
robots. The cure for
knowledge that people make their own complications in the brain, such as
decisions is not only vital to their sanity Parkinson‘s Disease, Alzheimer‘s, or
but also to their ambitions. If people even minor injuries that affect the SMA
cannot claim ownership to their own region. Despite the potential gain from
thoughts, it removes the need for this technology, there may be too many
motivation and encouragement because adverse consequences to promote
the brain will fire and actions will be further investigation if the current
done according to the connections of research is applied to public society. If
the brain. For example, students will no the research is purely used for the
longer feel the need to push for the advancement of the medical and
greatest achievement possible. They scientific community, then continuing
will have the mentality that there is a set this research will be beneficial.
level that they can reach because their
brain has decided what level of Although Soon‘s research seems
accomplishment it can reach, and it like it thoroughly analyzes the decision
cannot be altered by their persevering process, there are several additional
attitude. In the long run, this will lead to factors that need to be considered. His
a society that will settle for less than its research does not take into account that
people can change their minds during action. The information from initial
that ten-second frame between the brain signals does not suffice to
―readiness potential‖ and the time of conclude that a particular action will
action. Within these ten seconds, the take place.
conscious will of the individual could
decide not to act out what the Soon‘s research has sparked
―readiness potential‖ predicts. If an controversy in the cognitive science
fMRI is taken in the region that shows field. His preliminary results show
conscious decisions, then there may be potential for advanced knowledge about
a more accurate projection of the action the brain, however, more definitive
that is later taken. While accuracy may results are necessary for practice in the
improve, this peak will appear much public sector. As previously mentioned,
closer to the time of action, and so the use of this technology would not be
there is not enough time to act upon the well received by society. There is a
given data. This means that the reason why the audience of Minority
technology could not be used to convict Report was routing for Tom Cruise‘s
future criminals, simply because there character to fight against the precrime
is not enough time to act. As for the unit and what it stood for. Americans
religious and mental health effects, the pride themselves on their right to
ability to refute the ―readiness potential‖ freedom and liberty, which means their
indicates there is a personal choice and choices are not restricted by something
we are not simply programmed to follow they cannot control. However, if they
the commands of our brain signals. were told that their choices were not
This means that an individual can their own, the foundation of America
choose to ―make the decision for Christ‖ would be challenged.
or include motivation in his final
decision to act. Free will does, in fact, Reference:
play a role in the final instant before an
individual does something. Soon CS, Brass M, Heinze HJ, Haynes
JD. Unconscious determinants of free
Decisions may change due to decisions in the human brain. Nat
external factors in mere seconds before Neurosis' 2008 May 11(5):543-5
an action is made. For example, a
driver‘s brain may signal for a lane
change due to slow traffic, however, his
consciousness decides when it is safe
to act upon this impulse. When driving,
the environment rapidly changes, and
so a decision cannot be made ten
seconds before an action is taken. In
general, decisions are made with
outside influence up to the moment of
60 Fall 2007
Neuroimaging for InterGender Peace
By David Yin and Kathleen O‘Neill
Neurotechnology has been A March 2008 New York Times

used to measure brain activity in order article reported on the growing trend in
to understand the relationship between American public schools of separating
brain function and behavior. girls and boys into different classrooms
Neuroimaging techniques trace http://www.nytimes.com/2008/03/02/
different proxies hypothesized to be magazine/02sex3-t.html?
correlated with increased mental _r=1&scp=1&sq=separating % 20girls %
activation. Positron emission 20and%20boys%20into%20different%
tomography (PET) allows scientists to 20classrooms&st=cse). In 1995, there
visualize the accumulation of were only two single-sex public
radioisotope-tagged molecules (e.g. schools; today there are 49, most of
glucose). Functional magnetic which opened in the past three years.
resonance imaging (fMRI) measures The number of gender-segregated
the localized increase of cerebral blood schools is even higher. One expert
flow. Other techniques measure estimated the number at 360, up from
electrical activity, magnetic fields, and only a dozen in 2002. This change is
oxygen absorption. Although the result of an increasing awareness
neuroimaging can be used to or acceptance on the part of educators
investigate brain activity of humans in that girls and boys learn differently, a
general, it can also be used to measure phenomenon long-observed by
differences between brains of different teachers but only in the past decade
groups—across genders, races, and buttressed by scientific explanations.
ages. How and why groups are Girls generally use more cortical areas
different are questions of interest to of their brains for verbal and emotive
social groups as well as neuroethicists functioning, while boys use more
who must consider the ethical problems cortical areas for spatial and
created by their research. Here we mechanical functioning. Reduced
discuss ethical dilemmas related to the concentrations in serotonin and
use of neuroimaging to uncover oxycontin in male brains make boys
behavioral or cognitive differences more likely to be physically impulsive
between men and women in the areas and less likely to sit still and empathize
of education and sexuality. with friends.
This separation of boys and girls resolve this question we present two
into separate classrooms to promote thought experiments. If neuroimaging
better learning for each group is fraught and genetics prove James Watson‘s
with both practical and ethical problems. claim that certain races were less
On a practical level, it is not clear that intelligent than others, would that be a
this is actually the best way in which to justification for unequal allocation of
group children; gender is a very crude resources in school for the ‗smarter‘
delineation of talents. In most studies, races versus the ‗dumber‘ races?
there is only one standard deviation Imagine that some individuals were
between the differential measurements expelled from school for being ―anti-
of boys and girls, which suggests that in social‖ but modern science revealed that
any school there will be a number of they actually had some neurological
boys that would have learned better in a difference related to autism, should they
girls‘ classroom and vice versa. It would still be rejected for poor behavior?
be less convenient to administer
personal MRIs or learning tests to each There are other social-ethical
individual student, but those would be considerations. First, it would exclude
better indicators of differences than sex. outliers; the intelligent members of an
There is also the problem of unintelligent group would be left behind.
pigeonholing children into jobs or careers Second, it would constitute unfair
at an early age. If the implication of the punishment. Society does not and should
research is that girls should take more not punish for something out of
humanities classes and boys should take someone‘s control. Ethical treatment of
more science and math classes, the individuals handicapped by chance is not
schools are essentially guiding their different and negative, but different and
wards into particular life paths without positive. For historically disadvantaged
considering the personal interests or minorities we have affirmative action, for
wishes of the children themselves. paraplegics we have wheelchair ramps,
and for autistic children there are special
From a legal and moral classrooms. If there are differences
perspective, gender-segregated schools between men and women, the only type
are reminiscent of the race-segregated of discrimination justified is one that
schools of recent past. American law benefits the lacking. Boys should never
forbids different educational policies be deprived of language arts to focus on
promulgated on the basis of sex. Is it math, but instead taught language arts in
different if the separation of boys and a better way. In sum, differential
girls is done out of scientific belief and treatment inside and outside the
benevolent intent, rather than likely racist classroom based on scientific discovery
or sexist bias? Could different brain should exist only to dissipate and
development justify other types of compensate for inherent differences, not
segregation in society (American to exacerbate them or to artificially raise
Psychiatric Association, 2007)? To barriers to opportunity.
62 Fall 2007
what is ‗normal‘ for a woman? For some

The second area to explore is women, achieving orgasm is difficult,
female sexuality (Kenneth et al., 2008; verging on the impossible. Without the
Georgiadis et al., 2006). It was not too easy standard for men, how can
long ago that people thought that scientists determine this natural state for
women did not have orgasms, and most women? Neuroimaging is being used to
women were not worried if they did not study female orgasms. As the women
orgasm. Today much of this has were stimulated, brain activity rose in
changed and studies have scientifically one sensory part of the brain, called the
proven the existence of the female primary somatosensory cortex, but fell in
orgasm, as well as localized arousal the amygdala and hippocampus, areas
and orgasm in the female brain. involved in alertness and anxiety. During
Moreover, medicine has suggested that orgasm, activity fell in many more areas
any woman should be able to achieve of the brain, including the prefrontal
orgasm. This opens up new doors for cortex, compared with the resting state.
medicine and science to enter a Understanding the areas of the brain
woman‘s definition of her own sexuality. involved in female orgasms will lead to
If all women should be able to achieve developing better medications for
orgasm, does every woman have a right treating the absence of orgasm. While
to her orgasm? If a woman can‘t men currently have Viagra for erectile
achieve orgasm, is it not longer her fault dysfunction, drugs based on targeted
or her partner‘s fault, but merely a neurotransmitters will soon create a
medical condition that can and should sister industry for women. Would such a
be treated? By attempting to better pill be considered as equally important
understand the causes and complexities or as valid a medication that should be
of female orgasm, this part of sex covered by health insurance? Erectile
becomes something that could soon be dysfunction is defined as a medical
controlled by science. condition—a diseased state for a man.
In a woman, however, inability to
Critical to this discussion is one achieve orgasm is certainly not
question: what is natural sex? In order conceptualized in the same way—yet.
to have sex (the kind that allows for
procreation), a man must orgasm. Ultimately, whether or not health
Therefore, it is safe to say that orgasm insurance can cover drugs for a female
for men in sex is natural. It is clear that orgasm will not depend on the scientific
normally, many women do not achieve definition of biologically natural sex,
orgasm, and in fact no not need to which seems to invite the same flawed
orgasm to get pregnant. Does this mean anthropological surveys as a quest to
that her sex in that instance was not find the natural number of menstrual
correct? Since science has already cycles. It will simply depend on a
found some answers to the genesis of a cultural definition of what is natural. The
female orgasm, should it also define DSM-IV, for example, defines female
orgasmic disorder as a ―persistent or http://www.psychnet-uk.com/dsm_iv/

recurrent delay in, or absence of, _misc/complete_tables.htm
orgasm following a normal sexual
excitement phase.‖ Orgasm medicines
will be developed out of market forces, Kenneth R. Maravilla MD, Claire C.
and health insurance companies will no Yang MD (2008) Magnetic Resonance
doubt cover those medicines because of Imaging and the Female Sexual
the same market forces as well as Response: Overview of Techniques,
political and cultural pressures. As Results, and Future Directions. Journal
scientific knowledge about the nature of of Sexual Medicine. Published article
female orgasm increases, we predict online: 11-Apr-2008.
female orgasmic disorder will be more
commonly accepted and medications Georgiadis JR, Kortekaas R, Kuipers R,
treating it will be more widespread. Nieuwenburg A, Pruim J, Reinders AA,
Holstege G. Regional cerebral blood
That there are cognitive, flow changes associated with clitorally
emotional, and behavioral differences induced orgasm in healthy women. Eur J
between men and women has long been Neurosci. 2006 Dec;24(11):3305-16.
accepted as fact and summarized in the American Psychiatric Association.
phrase, ―men are from Mars, women are Diagnostic and Statistical Manual - Text
from Venus.‖ Neuroimaging technology Revision (DSM-IV-TR™, 2000)
has given society a new way of exploring
just what causes those differences in the
brain. The practice of selectively imaging
male and female brains for differences
has the potential for justifying unequal
and unfair practices, but it also has the
potential to increase our ability to rectify
long-standing biological inequalities. The
standard for utilizing information about
group differences should always be to
increase opportunities for a previously
left behind group, and never to
rationalize harm.
References:
American Psychiatric Association.

Accessed January 1, 2007.
64 Fall 2007
Do You Mind If I Read Your Mind?
Adela Aguirre and Alan Daboin
Columbia University
If you ask people what special in the brain in order to describe responses
power they wish they could have, you will evoked by natural images. Two volunteers
surely come across this answer: ―I‘d like to were used and, with varying degrees of
read minds.‖ Now imagine what you could surprisingly high accuracy, the pictures they
do with such a power. You would be able to were looking at from a specific set were
know what people think about you, what will recognized simply from the brain signals.
be on the exam the following day, as well as The experiment demonstrated that
what another person‘s real intentions are. successful identification can be drawn from
But if mind-reading is not under your control, a set of 120 images and they also used a
it can easily become your worst nightmare. more general visual decoder to assess
And believe it or not, these dreams and performance for larger sets. Results indicate
fears may soon become an integral part of in one volunteer that accuracy barely
your grandchildren‘s lives. Dr. Jack Gallant‘s declined from 92% to 82% when the set of
team of researchers have begun the first images was increased from 120 to 1000
steps that may ultimately culminate in real (about eightfold). As such, this new study is
mind-reading technology (Kay et al., 2008). a frontier in neuroscience which may
They claim that science is at a stage where potentially lead to the reconstruction of a
we can reasonably detect what somebody is picture of a person‘s visual experience from
looking at by interpreting their brain signals. measurements of brain activity alone.
This calls for analysis, both in terms of Eventually this may lead to more complex
looking at potential benefits it brings as well and accurate mind-reading.
as in becoming aware of the bioethical
ramifications that may stem from the What are the benefits derived from
technology as it becomes more advanced in this study. Learning about how pictures
the upcoming decades. interact with the brain and recognizing
where they come from it is possible that we
Functional magnetic resonance may learn a lot more about the mysteries
imaging, or fMRI, studies were carried out to behind dreaming. And, more practically, we
decode certain neurological activities in the may become better able to make diagnoses
visual cortex of the brain. A decoding in the brains of people with mental diseases
method based on quantitative receptive-field by comparing how their brains operate
models that characterize the relationship compared to normal and healthy people in
between visual stimuli and fMRI activity in the same activities. Or, it might become
early visual areas was used. These models possible for paraplegics to make use of the
were used to decode orientation, position technology by picturing images which a
(spatial frequencies) and object categories computer would be able to recognize via
fMRI so that they ―may be one day able to fix or alter for their own purposes, will we
operate machines by remote control.‖ value virtues like honesty and sincerity, or
Clearly then, it looks like this could be very will they lose their worth? One can argue, no
promising if developed well. doubt, that less people will lie, but what
matters is whether it will be out of a sense of
The bioethical issues concerning goodness or fear. There would still be a
this emerging technology are both complex lingering doubt, and good people may bear
and numerous. First of all, the ability to the brunt of it. This, of course, would be
detect an image that an individual has seen resolved if mind-reading were to develop to
from a set of images is very valuable the extent that we would know why
information. An individual‘s privacy of mind somebody is thinking as they are, but this
and thought may soon be invaded and used surely sounds like something for the next
for purposes that might not be in the best millennium.
interest of the subject. And how will we
determine who will have the access to this As for relationships between friends
information? Will it be open to everybody or and couples, there may be more interesting
a select and privileged few? And if knowing things to imagine. For instance, once Apple
an individual‘s has an fMRiPOD
personal experiences available for purchase,
via measurements of we may have a hard
brain activity may time making friends at
reveal information all. With processes
about behavioral where we weed out
tendencies, those that are
intelligence standards, uninteresting or
and possibly even unusual, we may think
past traumatic and we are speeding up
emotional events that the process of friend-
have occurred in their searching, but we may
lives—how will we use end up depriving
such information in ourselves of those
court and hiring friendships we often
employees or have for no obvious
accepting students? It reasons. Furthermore,
is interesting to consider how much of each you have to wonder who wants to be friends
quality somebody will have to possess in with people who will read their minds. Then
order to be accepted for something, and again, it may also become the standard way
how many well-qualified people will be left of operating. But what will it mean to be a
out from good opportunities because a brain friend? To share secrets or private thoughts
scanner says so. will surely not play a role anymore, and
probably everyone will be ―trustworthy‖ by
And, of course, we must also then. As for couples, there will be similar
consider how the state of interpersonal issues. How will issues of trust between
relationships will be in the future. If mind- couples be solved, and how high will divorce
reading software were to become a sort of rates go once a spouse‘s mind can be read?
open-source technology that anybody can These ponderings only hint at the complexity
66 Fall 2007
that will arise in an era when mind-reading possibilities for therapeutic value might be
becomes accessible. very beneficial for clinical medicine. The
challenge, however, will be finding a way to
Another issue looming over this convince people and companies that the
technology deals with the issue of how well negatives will outweigh the positives if
we know how the brain system actually technologies like these are abused.
works. Because our level of knowledge is
quite limited and the field of neuroscience is In sum, with the advent of new
constantly growing, scientists may be technologies there always comes some
conveniently simplifying the mechanisms degree of uncertainty and risk. This is
used by the brain and yielding linear especially the case when dealing with
explanations for their experimental results. technologies that concern brain activity and
Although consistent correlations can be the possibilities of privacy-destroying
found via this new use of fMRI technology, techniques such as mind-reading. As we
we risk the possibility of excluding alternate can clearly see, neuroscience is at the
reasons for patterns that have been forefront of this, and there may soon come
discovered. A more holistic way in needed to the day when humanity undergoes a
account for the way the body responds to its revolution of a type never seen before. It will
environment since factors such as race, extend to just about everything, and the
class and other socioeconomic issues may adjustments we make will have to be
be responsible for visual experiences and considerable. It should be no wonder, then,
trends. Furthermore, because the potential that subjects like neuroethics are becoming
of abuse of personal information can ensue, ever more popular, as we become ready to
it would be unlawful to base any kind of face the incredible implications on
conclusion regarding a person‘s ability on everything once we understand the enigma
their experimental results. So we must set that is the human brain.
up some neuro-policies dealing with
technologies like the ones that will emerge References:
from Dr. Gallant‘s study.
Kay KN, Naselaris T, Prenger RJ, Gallant
Some solutions to the problems that JL.Identifying natural images from human
can arise from this are in fact associated brain activity.Nature. 2008;452:352-5.
with limiting, but not prohibiting its use. A
possible source of regulation can come from
the federal government. However, since this
kind of federal oversight may lead to a stunt
progression in the experiments for political
reasons, a private non-profit intellectual and
scientific organization can be placed in
charge (maybe, quite fittingly, a think tank).
Additionally, ensuring the technology does
not diffuse easily in order to avoid societal
problems is a first necessity. Furthermore,
encouraging the makers of this new
neuroscientific application to place a
significantly higher degree of focus on its
GLBT Flies: The Application of Mind Control To Sexual Preference
Viktor Gamarnik and Shu Pan
Columbia University
Can the biology of Drosophila be from these observations was that both males and
applied, ethically, to human beings? In 2008, females possess almost identical circuitry, and
Clyne and Miesenbock sought to characterize the the differences are dictated merely by the
basis for the mandatory behavioral display (in presence or absence of a command signal
the form of a courtship song) that precedes pathway.
successful copulation in Drosophila. They found
subtle differences between male and female These findings exhibit a potential
central nervous systems, which could result in paradigm shift in the way neuropsychological
the male-only display of courtship song (a low- research is conducted. Namely, scientists may no
frequency single-sided wing vibration). Two longer be required to rely merely on observations
genes, fruitless (fru) and doublesex (dsx), are of wild-type and abnormal outward behaviors,
implicated in development of sex traits. but may be able to induce arbitrary behavioral
Moreover, the authors felt that two potentially patterns at will by exerting control at the genetic
interrelated explanations were plausible: 1) and sensory levels. Such techniques are clearly
gender specific gene expression resulting in much more subtle and elegant than elucidation of
differences in neuronal circuitry, or 2) both trained responses to stimuli. To the layman
males and females possessing the song circuitry, observer, videos of the Drosophila experiments
with the necessary command signals being appear to be Hollywood-style mind-control:
present only in the males. The authurs of this flashes of light produce arbitrary behaviors, even
paper 1 developed optogenic technology to in subjects who do not normally exhibit nor are
address these issues. This technique relies on the even aware of having such abilities (Cleveland
co-expression of light-activated ion channels and Clinic Foundation, ―A Pacemaker for the Brain,‖
P2X2 ATP receptors in neurons which express http://www.clevelandclinic.org/health/health-
the fru gene. Selective depolarization of fru- info/docs/1900/1937.asp).
expressing neurons is then achieved by injecting
a ―caged‖ ATP molecule into the cervical stalk More importantly, there is ample reason
and stimulating the system with UV light, which to assume that this type of neural pathway is
photolyses the ATP cage, activating the system. conserved in higher species. Courtship behaviors
This configuration was then used to induce are displayed across all varieties of animals, and
courtship songs in male, female, and she-male there are remarkable similarities even across
flypods (flies with the brain excised who still different species. Because sexual reproduction is
retain the ventral thoracic ganglia). Going one the fundamental method of maintaining a life
step further, the authors utilized the recorded form for multiple generations, it is quite
songs of she-male flypods to prompt mating in reasonable to postulate that such neuronal
mute (de-winged) males and virgin females. pathways evolved at an early stage, and have
They found that while the induced female songs since been conserved to some extent, even in
did not lead to copulation, recordings obtained organisms such as humans. Though human
from induced she-males were sufficiently courtship rituals are far more complex, the
convincing. The most striking conclusion arising facility of courtship and reproduction is so
68 Fall 2007
fundamental that we are compelled to wonder if distant future, such methodology may become a
at least some types of similar neural pathways modern day brain washing technique.
are at work. If such is the case, the notions of Overzealous parents who believe their children
sexual preference in humans may need to be to exhibit homosexual tendencies could
reexamined: perhaps humans too possess male potentially selectively activate, and in other
and female circuits, and differences in behavior cases selectively repress, the neural pathways for
and preference arise simply from variations in same-sex attraction. Even without the genetic
which command signals are present. A male‘s technology to choose a child‘s sexual orientation
preference for female mates may be due to (which, given the complex nature of sexuality in
activation of the ―traditional male‖ or general may never come to fruition), the ability
suppression of ―traditional female‖ neural to repeatedly stimulate specific neural pathways
circuits. Similarly, homosexual or transgender could accomplish the same goal. Today, deep
behaviors may not arise from ―abnormal‖ brain stimulation (DBS, commonly called ―brain
genetics (as is commonly believed), but might pacemakers‖) is being used to treat diseases such
simply result from under/ overstimulation of as Parkinson‘s, clinical depression, and epilepsy.
certain pathways. The discoveries and especially Even though the technology is still in
the methodologies presented by Clyne and experimental stages, there is already discussion
Miesenböck (2008), as well as the recent of non-disease applications, such as
advancement of such techniques in higher enhancement of emotions. It is not difficult to
animals (e.g. mice), raise concerns about see how such technology can transition into the
potential applications in humans. realm of sexual preference modification. In
essence, if the correct neuronal pathways are
The manipulation of ion channels to the identified, children could readily be
extent of behavioral mapping and optogenic rep ro grammed to d isp lay ―no r mal‖
‗mind-control‘ may someday be extended to heterosexual—or if the parent so chooses,
human subjects, perhaps even falling prey to homosexual behaviors. Since the command
misuse and exploitation. Given the immense signals are given directly to neuronal pathways,
similarity in the underlying framework for the recipient of such a procedure may not even
sexuality, one should consider the possible be aware of the external command signals, let
ramifications for this technology. Aside from its alone rationalize their subsequent actions.
obvious uses as an invaluable tool in the field of
neuroscience, the technology has other Obvious restrictions must be instated
potentials, some being ethically questionable. for such a technology. With the exception of
scientific research, such a technology should not
As mentioned before, a good portion of gain approval for use in higher mammals.
the population still hold dear the notion that Responsible use aside, the underlying mentality
homosexuality is a deviation from the norm. regarding sexuality must be re-evaluated.
Making numerous arguments against Contrary to popular belief, homosexuality may
homosexuality as being unnatural, such prove to not be an aberration of nature. As seen
individuals have referenced sources as far in the aforementioned results, males, females,
ranging as religious texts to even the Darwinian and even transgender organisms have
model of evolution, to support their claims. The mechanistically functional circuitry for
technology, as developed by Clyne and producing the specific behavioral patterns.
Miesenböck, may still be in its infant stages, but Perhaps humans are no different in this regard.
its principles nevertheless apply to more The heterosexual phenomena of male preference
complex, mammalian organisms. In the not too for female (or vice versa) may purely be the
result of selective activation and/or repression of

ingrained neural pathways. If such pathways are
present in both sexes, then one can reasonably
infer that any one individual is fully capable of
exhibiting heterosexual, as well as homosexual
tendencies. Through this biological perspective,
homosexuality is no longer viewed as a physical
defect from the so-called ―wild-type‖ sexuality.
As such, sexual preferences varying from the
male-female majority may be a valid product of
continued evolution. Especially in a scenario of
dwindling resources, homosexuality acts as a
deterrent to overpopulation and benefits survival
on a species level.
Clyne J.D., Miesenböck G., ―Sex-specific

control and tuning of the pattern generator for
courtship song in Drosophila
Morelle R., ―Flies get ‗mind-control sex swap‘,‖

BBC News 18 April 2008, http://
news.bbc.co.uk/2/hi/science/nature/7350403.stm.
Cleveland Clinic Foundation, ―A Pacemaker for

the Brain,‖ http://www.clevelandclinic.org/
health/health-info/docs/1900/1937.asp.
70 Fall 2007
Memory Upgrades: Not Just For Your Computer
Emilia Javorsky & Wei-Jen Hsieh
Columbia University
Scientists are beginning to results are merely ―suggestive‖ and can

identify genes that contribute to the only be portrayed in a qualitative fashion
manifestation of memory. The with vague descriptors such as ―barely
identification of such genes could detectable‖, ―normal‖, ―strong
provide a genetic epidemiology of expression‖.
cognitive dysfunction as well as
diagnostic tools to indentify individuals In contrast to this subjective
carrying different allelic forms of these methodology, gene chip technology can
genes. Ultimately, these new genes provide a more quantitative analysis of
may become targets for the discovery of gene expression. Tully hopes that this
drugs to ameliorate various forms of new technology will provide confirmatory
cognitive dysfunction. Timothy Tully is information, gene-by-gene, as to which
interested in the genetic basis of transcripts are involved with memory.
memory and hopes that his recently Its potential to yield ―exact coordinated
patented ―gene chip technology‖ will transcriptional response to different
allow him to identify the genes stimuli across all gene transcripts‖ is
expr essed dur ing t r anscr ipt ion - extremely informative (Tully et al, 2008).
dependent memory (long term memory) In particular, the coordinated effect that
formation, specifically candidate a gene transcript has on memory begets
memory genes (CMGs) and candidate many novel questions regarding the way
plasticity genes (CPGs) (Tully et al., in which memories are processed and
2007,2008). stored in the brain. One advantage to
Previously, Tully has taken a gene chip technology is that given a
molecular biologist‘s approach to large sample size, it is possible to
identifying memory genes (Tully et al, quantify gene expression using a signal
2007). His work relies on Western transformation algorithm; thus, helping
analysis and immunohistochemistry to to improve the statistical reliability and
detect the proteins produced by specific validity of one‘s results. An increased
genes involved in memory cascades. sample size, or larger ―n‖, can allow
By generating dsRNA-based transgenes memory researchers to look at the entire
(UAS-dsNR1 and UAS-dsNR2), Tully organism‘s genome under the same
attempts to identify which NMDARs are experimental conditions. This removes
required during memory formation. Yet, the subjective components that arise in
there are many implicit flaws with the techniques such as Western blotting,
techniques of Western blotting. His im m unopr ecipit at ion and in - sit u
hybridization. Similarly, this technology therapies would be invaluable for

makes it is easier to replicate one‘s professions with high cognitive
results with a higher degree of demands; however, these benefits
specificity and accuracy. would only be reaped by those who can
afford them, further propagating the
Though Tully is utilizing mouse expansion of the achievement gap. As
and Drosophila models, most genes in a result, the members of the highest
these model systems have been shown economic echelon will also become the
to have human homologs. There is a intellectual elite. Though there may be
growing knowledge that ―mammalian obvious benefits to understanding and
homologs can be functionally developing therapies for memory related
substituted in Drosophila for its fly disorders and disabilities, the possibility
homolog [and in such] the present of selecting for ―superior‖ memory
discovery directly implicates the alleles is disconcerting.
corresponding mammalian
homologs‖ (Tully et al, 2008). As a By researching memory genes
result, there are many ethical dilemmas you embark on the slippery slope of
that can potentially arise if this eugenics. If this new technology is
technique is successfully replicated in coupled with emerging reproductive
humans. techniques such as PGD, then it
becomes possible to select for embryos
With any new technology, there with superior memory alleles. Genetic
is always the risk of exploitation. It is select ion artif icially acceler ates
the potential for therapeutic application Darwinian evolution; thus, upsetting the
that often troubles ethicists. A gene natural order. But this isn't just another
chip technology that could screen for ―designer baby‖ issue. An improved
enhanced memory genes suggests that memory capacity allows an individual to
treatments to improve memory function be more efficient, perceptive and
may be possible in the near future. enhances cognitive faculties. By
Though memory enhancing therapies selecting for a genotype associated with
could prove invaluable for patients with improved memory function, there is a
memory disorders such as Alzheimer's risk of creating a demographic of
disease and Parkinson's disease, there intellectually and ultimately economically
is the possibility that these treatments elite.
could be abused by individuals without
any memory pathologies. If the I n a r g u a b l y, a n e n h a n c e d
therapies were shown to improve memory would be extremely
memory function in both patients and advantageous for one's personal
controls, individuals with a normal endeavors. Just think, how often have
memory capacity could use the you wished you had a photographic
therapies to enhance their cognitive memory? For professions that require
performance. Memory enhancing substantial cognitive demands, genetic
72 Fall 2007
profiling may be used to selectively hire improve alertness and mental

candidates. Employers could screen for concentration by purchasing a cup of
individuals possessing a greater coffee from a corner kiosk or one can
capacity to remember and recall, which choose to take prescription enhancers
would result in a pool of employees with such as Ritalin or Adderall. While many
the capacity to consistently outperform will argue that taking expensive
their peers. Using this logic, it is prescription medications to enhance
possible that one's genetic profile could performance is unethical, very few
be used to discriminate and determine individuals will oppose the consumption
employment opportunities. of a daily cup of Joe. What if Ritalin, like
coffee, only cost a dollar a day—would it
Memory is a hallmark of still be problematic? If there was a
individuality. To lose sole possession of memory enhancing pill that was as cost-
one's memory processes strips us of effective as caffeine, it is doubtful that
wh a t d if f er e nt i a t es t he hu m a n there would be an ethical debate. Thus,
experience. The use of gene chip the question becomes an issue of
technology to examine the genes access. By allowing all individuals equal
involved in long term memory pose a opportunities to medical treatments, one
threat to an individual's autonomy. If it removes the socio-economic barriers
is eventually possible to correlate which limit our modern health care
specific CMG's and CPG's to types of system.
events or experiences, then it may be
possible to look at the profile of gene Though the idea of memory
activation to make inferences about enhancing drugs is frightening,
one's experiences. W ith such understanding the way memory works is
advancements in biotechnology, it would essential to the progression of science.
then be possible for science to bridge While research concerning the genetic
the gap of cognitive isolation and some basis of memory should not be limited,
of your most intimate and precious the translation of laboratory findings to
memories could be revealed in a mosaic clinical applications must be tightly
of fluorescent dots. regulated. The prospect of artificially
enhancing our learning capacity seems
The polemic is two-fold. We attractive; however, there may be
need to separate diagnostic tools from unexpected detrimental effects. Our
enhancement procedures. Selecting for current social paradigm views learning
superior memory alleles through PGD as advantageous and adaptive, however
encompasses the latter and should not recent research questions this theory. A
be conflated with screening for life- recently published paper by T.J.
threatening pathologies. On the other Kawecki (2008) examines the costs of
hand, memory enhancing drugs raise an incr e ase d le ar n ing capac it y in
ethical debate with economic Drosophila and remarks that
implications. Today, one can either ―populations selected for improved
learning lived on average 15% shorter

than the corresponding unselected
control populations.‖ The findings of
Kawecki‘s research highlight the
physical toll of increased cognitive
capacity, suggesting that a delicate
equilibrium exists between physiological
well being and the ability to learn. With
the advent of memory enhancement, we
risk upsetting the balance which could
ultimately contribute to our early demise.
References:
Kawecki, TJ. Learning Ability and

Longevity: A Symmetrical Evolutionary
Trade-Off in Drosophila. Evolution
Tully, T. et al. Specific requirement of

NMDA receptors for long-term memory
consolidation in Drosophila ellipsoid
body. Nature Neuroscience 10, 1579
(Dec. 2007).
Tully, T. et al. Specific requirement of

NMDA receptors for long-term memory
consolidation in Drosophila ellipsoid
body. Nature Neuroscience 10, 1579
(Dec. 2007).
74 Fall 2007
V. Cross-cultural Bioethics: BioCEP
Sex. Education. Can they go together?

Ethical Dilemmas Facing Sexual Education in Thailand and the United States
By Elizabeth Edwards*, Yoon Joo Kang** and Caroline Leone*
*Columbia University and **Mahidol University International College
Talking about sex makes people it is paramount that young people are
uncomfortable. Talking about sex with able to make informed sexual decisions
teenagers makes people even more that may help keep both themselves and
uncomfortable. However, many people their partners healthy. Gone are the
feel that if children and teenagers are days when teenagers can worry solely
not educated about sex they cannot about pregnancy when trying to hide
learn how to keep themselves safe and sexual activity from parents.
healthy.
Let’s Talk About Sex—in the United
Sexual education has been a States
fiercely contested issue ever since the
discovery of sexually transmitted What should be taught? One of
infections and the beginning of the the more common answers in sexually
women‘s rights movement. The biggest conservative countries, like the United
questions have always been what States, is abstinence. A 2004 poll by
should be taught, where it should be NPR (NPR, 2004) found that fifteen
taught, and to whom it should be taught. percent of Americans believe that
These same questions are asked all schools should teach only about
over the world but responses can be abstinence from sexual intercourse and
astoundingly different depending on should not provide information on
religious persuasion, past experiences contraception. Abstinence-only sex ed
and cultural norms. relies on the reality that abstinence is
the only completely fool-proof method of
One current challenge is who birth control and STI prevention.
should teach sex education. Should sex However, the teaching of abstinence-
education be the responsibility of only sex ed in schools in the United
parents, teachers, religious leaders, States has proven woefully ineffective.
peers or the media. But with the rapidly An increase in teen pregnancy rates has
increasing rates of HIV and STI‘s that been shown within schools that teach
have been seen in the last two decades, abstinence-only sex education
(Guttmacher Institute, 2006). Is pregnancy and STI‘s when they became

abstinence really working? Since sexually active ( http://www.urban.org/
abstinence-only sex ed teaches that one publications/900037.html). Many parents
should refrain from sexual activity, an fear that teaching young children about
abst inence- only method of sex sex before they are even interested in it
education could not possibly teach will only cause curiosity and will leave
young people about healthy sexual the door open for unsafe
habits such as contraception-use, the experimentation. The reality, however,
importance of communication in sexual is that children in the U.S. are exposed
relationships, and sex as part of normal to sex by our widely sexed media, even
(albeit unique) human relationships. if the exposure is as minimal as
Even in schools that teach more than billboards and commercials. Even
just abstinence, sex ed in the U.S. is still young children need to begin to
quite conservative. In 2002, one-third of understand how they came to be and to
teens in the U.S. said they had never understand appropriate sexual
received any formal instruction about behaviors in the event that this
contraception (Guttmacher Institute, information is being withheld at home. A
2006). If schools in the U.S. are not reasonable and rational argument is that
even teaching about contraception, one sex education should be taught
can hardly expect them to discuss more gradually, beginning with basic topics at
controversial sexual issues such as the a young age and progressing to
morning after pill, abortion, coverage of the more complicated and
homosexuality, S&M and masturbation. controversial topics as children mature.
Because there is no clear consensus on
what is right and what is wrong these
issues m ake people especially Let’s talk about sex—in Thailand
uncomfortable, and as a result they are
often completely neglected in sexual Young adults in Thailand are no
education courses. different from their peers in any other
country in their curiosity and eagerness
Who should be taught? Most people to learn about sex. However, because
believe that sex education should be the word ―sex‖ is still regarded as a dirty
taught to young people at some point, word in Thailand, no one ever talks
but there is controversy over what age is openly about it among adults, let alone
appropriate to begin sexual education. A with kids. There seems to be little or no
more liberal belief is that children should explanation as to why the topic is taboo
be taught about the birds and the bees other than outdated traditions, worried
as early as elementary school. parents, conservative teachers and self-
Research has shown that many students righteous do-gooders that lament
in the U.S. feel that they were not taught Thailand‘s cultural degradation and
even general information early enough blame permissive Western influences for
to protect themselves against things like young people‘s continual rise in ―loose
76 Fall 2007
sexual behavior.‖ only two circumstances in Thailand, it is

The common Thai approach, a key issue that should be addressed in
―no sex please; we‘re Buddhists‖, sex education classes. Women may only
parallels abstinence-only sex education get a legal, and therefore safe, abortion
in the U.S.; both make teenagers‘ eyes if the pregnancy was a result of a rape
glaze over. Thais perpetuate a system of or if the mother‘s health is in danger.
modesty because of the long-standing Because under most circumstances
tradition of keeping one‘s personal life abortion is not an option in Thailand,
private. Many Thais fear that sex youth need to understand how to
education will send the wrong message prevent pregnancy. Because of the
to youth, prompting promiscuity and pre- issues relating to HIV and abortion in
marital sex. In modern Thai culture, Thailand, sex education should be
however, such excuses are antiquated targeted at young people, before they
and ignore the fact that the majority of begin blindly experimenting.
teenagers are sexually active. Limited
knowledge of safe sex behavior due to In a country that doesn‘t talk
lack of formal sex education is about sex the issue of sex education is
contributing to the resurgence of the quite challenging. Although a liberal
HIV/AIDS epidemic and the rising teen method of sex education seems counter-
pregnancy and abortion rates in intuitive to a sexually modest country,
Thailand. Can sex ed fix this? trends seem to show that a lack of
education is causing some of the
When attempting to answer the country‘s most devastating problems.
question of what should be taught in
sexual education in Thailand, the Let’s talk about sex. No, really!
answers are similar to those in the
United States. From the point of view of Although Thailand and the
nearly anyone concerned with public United States are very different
health and individual safety, all children countries with different religions, cultures
deserve to be informed. In Thailand, it is and morals, youth in both countries face
especially important for people to have very similar issues when it comes to sex.
correct information about HIV and Although sex education should always
abortion due to the problems the country respect individual cultures, cultural
is facing regarding these issues. For differences do not change the fact that
many reasons, including the popularity sex is a universal behavior. No one is
of the sex-trade, the lack of education, immune to sexually transmitted
and lack of resources, the HIV rate has infections. Not all teens will abstain from
begun rising once again (Kittimunkong, sex just because they are told to.
2008). In order to combat the rising HIV Pregnancy occurs the same way in
rate, education efforts should be aimed Thailand as it does in the United States,
at people before they become exposed. and can be prevented using the same
Additionally, because abortion is legal in contraceptive methods. No matter the
language, talking about sex keeps

people healthy, keeps their partners
healthy, keeps their children healthy and
keeps a population healthy. Talking
about sex is healthy.
NPR.Org. National Public Radio, Sex

Education in America.‖ . 2004.
<http://www.npr.org/templates/story/
story.php?storyId=1622610>.
Guttmacher Institute. 2006. Facts on

Sex Education in the United States.‖
<htt p: // www. g ut tm acher . org/ pubs/
fb_sexEd2006.html>
Kittimunkong, Somyot. ―Resurgence of

HIV/AIDS epidemic in Thailand‖.
Lecture, Ministry of Public
Health, Thailand (August 6. 2008).
78 Fall 2007
Behind Their Smiles: Cosmetic Dentistry and Medical Tourism in Thailand
By: Mikilena Greusel* and Dr. William Bloch**

―
Would you buy used dentures off The gap in dental care in
the street? How about braces from a Thailand has become so extreme due to
man in a tent? In Thailand, where financial realities that it has forced many
dental care is provided by government Thais to seek alternative forms of dental
insurance plans, these are common treatment. Ironically, the largest dental
practices. However, international dental clinic in Bangkok is located in a hospital
reconstructive surgeries are booming in specializing in alternative medicine. At
Bangkok, making it a capital for Eastern Jubilee hospital, where Chinese
medical tourism. As progress continues alternative medicine is studied,
in this developing world, the ethics of practiced and perfected, there is an
medical tourism and cosmetic versus entire wing dedicated to dental care that
necessary dental care must be explored is empty. Just a block away from the
in Thailand. hospital is a market where dentures are
sold in makeshift glass cases – one can
How is it that a nation regarded only assume they were either sold by
on an international scale as a center for someone who needed the money or
reconstructive medical procedures is donated by families of the deceased.
reduced to taking dental care into the These fixtures will not fit properly in the
hands of street vendors? According to mouths of those who need them; they
the healthcare professionals at Siriraj may be contaminated to the point of
Hospital in Bangkok, Thailand, the causing infection; they may even be
rampant lack of dental care throughout stolen property. It is shocking to
the country is due to the continually consider that the people who purchase
decreasing ratio of dentists to patients. these dentures could just walk a short
In 2004, when the last survey was distance to Jubilee hospital‘s empty
taken, there were 14,000 patients per dental clinic for treatment – where
dentist in Thailand. Even though Siriraj insurance pays for at least part of the
Hospital contains the Faculty of charge. In Thailand, this is just not
Medicine of Mahidol University, one of done. Why waste money on a set of
Bangkok‘s most prestigious higher professionally crafted dentures when
education centers, that ratio has you could save the cash? If a tooth
continued to grow over the past four aches, why fix it? There are others, just
years, resulting in a critical lack of dental pull it out.
care among the Thai populace.
In addition, Thai dentists often dental procedures listed on their

treat patients without measuring the brochure, the hospital is mainly a plastic
patient‘s blood pressure or taking surgery/oral & maxillofacial center for
diagnostic x-rays. By taking the personal beautification. The Yanhee
patient‘s blood pressure, the dentist is vision is, ―To be at the forefront of the
screening for high blood pressure. The health care industry in Asia, to gain
procedure costs nothing and can save international recognition for its quality of
lives, as dentists see many patients that service particularly for beauty and for
have never been screened for other medical services, as well.‖ Among
hypertension. Also, dental x-rays are the forgotten ‗other medical services‘ is
invaluable in oral diagnosis and much needed dental care for patients –
treatment planning. Thai dentist not only for those seeking cosmetic
generally have x-ray facilities, yet x-rays alterations.
are not always taken before dental
treatment. This means that much dental The most common oral &
treatment is rendered without complete maxillofacial procedure (what they dub
diagnostic information, as x-rays allow ―Aesthetic Dentistry‖) performed at
the dentist to see what is present below Yanhee hospital is rhinoplasty, or a
the gum line, between the teeth and in nose job. In today‘s world market, the
the jawbones. This radiographic ideal image of physical perfection,
information can be used for early according to Asian people, is to have a
detection of serious conditions such as Western physique. In Asia, apart from
oral carcinoma. eyelid reductions and jaw procedures,
the most prominent facial marker of
For the disadvantaged Thai ethnic identity is the nose. Because of
citizens, who unfortunately comprise the this, Asian men and women – especially
majority of the nation‘s population, those in the professional circuit – are
dental care is a luxury. For those who going under the knife to erase their
can afford dental procedures, they elect ethnic features in hopes of looking
to have unnecessary reconstructive American, European, German… pretty
surgeries so that they can appear more much any ethnicity that is Western and
―Western‖ looking. Among the many not Asian. Yes, this is a cultural
hospitals in Bangkok, Yanhee hospital preference, perhaps even a fad, but it
stands apart from the others in its cannot be ignored.
international appeal. The advertising
directors of Yanhee hospital are proud On some flights to Thailand part
to inform visitors that their hospital of the on-board entertainment includes a
attracts more Koreans than any other for brief documentary describing Thai
jaw line reduction surgeries. Even culture. This video details the fear
though Yanhee hospital, ―a convergence among Thai‘s that their customs and
of Health and Beauty‖, is a fully culture are being forgotten and left
functional healthcare facility with various behind as Thailand progresses. One
80 Fall 2007
must ask, in a country that is afraid of

morphing into something without a
remembered cultural past, why is it so
popular to elect painful, involved
procedures to eliminate distinct Thai
facial characteristics? What will be the
consequences within Thai culture and
society if people continue to pursue
these body-altering, image-altering and
culture-altering treatments? If left
unchecked, the cultural ramifications of
this trend will be catastrophic.
You are born with your identity

and no matter how you change your
body, who you are inside will forever be
intact. However, changing the face of a
culture goes beyond personal
modification. To escape confused
generations of Asian children who do
not see their ancestry reflected in the
faces of their parents, ethical guidelines
must be explored and set so that the
option of cosmetic dentistry does not go
too far. Instead of nose jobs and jaw
line procedures, Thai people need
proper prosthetic care, they need more
dentists and, most importantly, they
need to maintain the true expression of
their identity.
The Ethical Concerns of Propranolol and Memory Dampening
Donna Taraborelli, Tasha Smith**, Siwachapol Monyakul***
*University of Pennsylvania, **Columbia University and ***Mahidol University

International College
Psychopharmaceuticals are common for a particular drug to be ap-

currently being tested that could allow proved to treat one problem and used
victims of traumatic experiences to ―off-label‖ to treat other conditions that
cope better by fading their memory. have shown to benefit from it.
The potential for drugs such as pro-
pranolol to relieve people of tragic Several scientists are conducting
memories and make bad experiences experiments that suggest propranolol
tolerable is the subject of much debate. may blunt memory by making a person
Should we have the right to choose less likely to develop the emotionally-
what drugs we want to use in order to charged memories associated with trau-
alter the way our minds work? Or is it matic experience (McGaugh, 2003).
unethical to erase our memories, un- Propranolol is shown to work best if
dermining our true identity as a person given to a person within six hours of the
by doing so? This paper will explore traumatic event occurring. Not only
the ethical concerns of using memory does propranolol remove the emotional
dampening drugs for the treatment of aspect of the memory, it may also cause
Post-Traumatic Stress Disorder a person to forget factual information
(PTSD), as well as compare Western regarding an incident. Propranolol may
arguments to Buddhist philosophy on dampen positive memories as well as
the topic. negative ones.
Propranolol is currently approved Post-traumatic stress disorder is

by the FDA and mainly used to treat hy- a severe and ongoing emotional reac-
pertension, as well as a host of other tion to an extreme psychological
conditions such as migraine prophylaxis trauma. The emotional reaction to the
and myocardial infarction. It is also able trauma is so great that psychological
to cross the blood-brain barrier and get defenses are incapable of coping. Most
to where stress hormones are causing people who experience a psychological
chaos in the brain. Experimentally, pro- trauma do not go on to develop PTSD.
pranolol is being used to treat post- The emotional effect from the trauma
traumatic stress disorder because it has usually subsides after several months.
been shown to fade memories. It is PTSD is thought to be primarily an anxi-
82 Fall 2007
ety disorder and is different than normal systems we can set in place, such as
grief and adjustment after traumatic social support from loved ones or psy-
events. It may also be closely related to chotherapy. Others develop PTSD and
panic attack disorder. About 20 percent have a much harder time functioning in
of people who are exposed to severe, life after the experience.
even repetitive traumatic events develop
PTSD. Most people recover from the It may be problematic if we medi-
acute stress reactions following the cate ourselves after mildly traumatic ex-
event after a few weeks (Pittman, 2006). periences and do not attempt to deal
with situations that could be considered
Memories, whether good or bad, natural parts of life, such as broken
do not form instantly after an event but hearts or the death of a loved one. Peo-
solidify over time. Traumatic memory ple have developed adequate coping
does not behave like other memories. It skills without being victims of devastat-
is very active and does not decay and ing car crashes or violent crimes. There
its the major purpose of memory is to will be some of those people who are
predict the future . However, there is able to recover from such experiences
good reason that memories are not in- over time and with the help of therapy
delible since the ability to forget is also and then there will be people who are
an important human characteristic unable to cope and need the help of
(McGaugh, 2003). medication.
One criticism on the use of mem- Another criticism of memory

ory dampening drugs is that they will dampening is that it would dehumanize
somehow damage the psychological people by giving us too much control
well-being of people or degrade the over our life experiences. ―We are not
quality of their lives. For example, free to decide everything that happens
Meilaender says that it is better to strug- to us; some experiences, both great
gle through our traumatic experiences joys and terrible misfortunes, simply be-
with the help of others and to fit them fall us. These experiences become part
into a coherent story within the scope of of who we are,‖ part of our lives ―as
our lives (President‘s Council for Bio- truthfully lived‖ (Kolber, 2006). Living
ethics, 2003). This may be the brave or truthfully is what we as individuals make
romantic way of describing how we of it. Taking medication to help with a
should overcome the difficulties thrown disorder is not being untruthful, it is part
at us in life, but for people who have of our truth. When overcome with
PTSD, it is easier said than done. trauma, helping ourselves by taking
Some people are able to cope with medication is acknowledging truthfully
trauma and it does not overtake their that we are overwhelmed and need help
identity and ruin their lives. They are coping. Propranolol will not make a
able to deal with the traumatic experi- painful experience non-existent; it will
ence over time with the natural support give someone a chance to overcome a
hurdle they otherwise could not. It could Based on this teaching, when an indi-
also help a person overcome a trau- vidual encounters an incident that
matic experience faster, rather than causes distress we should remember
spending years in therapy and missing a that these incidents will not last forever.
significant amount of time being a better Therefore, the individual will not always
spouse, parent, or friend to those suffer.
around them.
The second structure is the suf-
Research done on propranolol fering body (Tuk Kata). Buddha
has demonstrated that some factual teaches that an individual will suffer
memory may be distorted after taking when they live with things which are
the drug. However, if a person were disliked. Suffering also occurs when
to develop PTSD after a traumatic ex- things beloved are lost. (Auppayehi
perience, a consequence of the disor- Sumpayoko Tukko Piyehi Vippayoko
der is memory loss. Additionally, we Tukko). One suffers because of the
hardly ever remember events exactly desire to hold on to the things we love
the way they occurred. Memories and the struggle to rid ourselves of the
fade over time and actually may be things we dislike. An individual must
distorted each time we think about face both without exception. Loss and
them and go over scenarios in our gain are the nature of life and suffering
minds. Certain details may change occurs because an individual cannot
slightly as we recount the situation accept this truth. The third and last
and then a new version of the event structure is the eternal body (Anatta).
stored. It is unlikely the experience In Buddhism, eternal means empti-
will be remembered completely differ- ness. One should know that the only
ent than what actually happened, but thing that is eternal is the truth that
there is a good chance that over time everything will be gone in the end.
certain details slip away or alter Good and bad will exist in concert until
slightly (Kolber, 2006). the end of time.
It is also worthwhile to consider the From these three structures, Bud-

use of memory dampening drugs from dha taught that suffering comes from
alternative perspectives, such as from within us. Nothing causes us to suffer if
Buddhist philosophy. In Buddhism, all we do not allow it. A person who suffers
living things are composed of three dif- from a bad incident can be healed by
ferent structures (Tri Gaya). The first understanding the three truths that Bud-
structure is the unstable structure dha taught. In Buddhism, the idea is not
(Anijjata). Since life has a beginning to get rid of suffering, but rather learn
and an end, nothing in this world is sta- how to live with suffering in a way that
ble. All living things that we see, touch, will not affect us. We should not try to
and hear are composed of both happi- forget the past, but instead we should
ness and sadness at the same time. keep it as a reminder not to make the
84 Fall 2007
same mistake again.
Under the control of medication,

patients may feel they are getting bet-
ter and relief from their suffering. If
patients stop taking medication, how-
ever, it is likely that the pain and suf-
fering will come back to them. A drug
like propranolol may block the neuro-
transmitters that cause people to suffer
emotionally, but it may not provide
resolution to the problem. Drugs are
usually created to provide cures for
problems, but in using those drugs we
are not dealing with the underlying
cause of the suffering.
References
Lemonick, M.D. The Flavor of Memo-

ries. Time Magazine: Mind and Body
Special Issue. Januay29, 2007; pages
102 – 104.
Kolber, A.J. (2006). Therapeutic Forget-

ting: The Legal and Ethical Implications
of Memory Dampening. Vanderbilt Law
Review, 59:5, 1561-1626.
Marchione, Marilynn. A pill to fade trau-

matic memories? Doctors are working
o it. January 14, 2006.
www.signonsandiego.com/news/
science/20060114-0917-traumapill.html
McGaugh, J.L. Memory and Emotion.

Published by Columbia University
Press, United Kingdom,
2003;McGaugh, J.L. (2006) Make Mild
Moments Memorable: add a little
arousal. Trends in Cognitive Sciences,
10:8, 345-347.
Finding the Middle Path to Stem Cell Nirvana
Melissa Bauer* and Shanshan Tang**

On opposite sides of the globe, the Land with the research giants of the West.
of Smiles and Land of Opportunity showcase the
extremes in stem cell research regulation while Unlike many western powers, the
facing similar bioethical dilemmas. In the public United States is experiencing a deceleration in
hospitals of Thailand many scientists are the progress of stem cell and reproductive
frustrated by the lack of regulation on stem cell cloning research. However, this effect is an
research. Although many of these facilities outcome of over-regulation by the government
possess the technological capacity for highly rather than a result of lacking regulatory
advanced stem cell research, the lack of measures. Multiple bills have been proposed in
regulations instilled extreme hesitation among the United States Congress to charge individuals
the Thai scientific community to progress with who engage in reproductive cloning with a ten
such studies. Currently, embryonic stem cell and million dollar fine and with up to ten years in
reproductive cloning research projects are not prison. Public funds for embryonic stem cell
conducted at public institutions. This opened the research are also limited by major regulations
door for a mass influx of foreign private mandated by the federal government ((New York
companies to hire researchers at Thai private and Stem Cell Research, 2008). First, embryos
hospitals. Dr. Suradej Hongeng of Ramathibodi derived before 9:00 P.M. on August 9, 2001 and
Hospital of Bangkok expressed an urgent need which are no longer needed for reproductive
for the Thai government to establish regulatory purposes may be used for research after
legislation of stem cell and cloning research to informed consent. Second, there should be no
allow for publicly funded Thai hospitals to financial inducements in obtaining the embryos
contribute to the advancement of science in these from donors. This suffocating legislation created
fields as allowed in other Asian countries. a situation similar to that found in Thailand.
In the highly competitive and rapidly Although not as prevalent as in Thailand, due to
developing Asian markets, the stifling of the greater financial burden of conducting
scientific creativity and advancement sets research in western countries, there still exists a
Thailand behind many of its neighbors. In China, significant increase in the American business
for example, research on both embryonic and sector for funding research centered at private
adult stem cells is supported by the Chinese institutions. A revision of the excessive
Ministry of Science and Technology which aims regulations on federally funded stem cell
to launch the country to the forefront of the research and cloning projects will jumpstart
research ranks. Supplying funds to local, American ingenuity and assist the United States
provincial and national institutions, China is in a in reclaiming its leading role among
highly advantageous position for streamlining industrialized countries in this scientific field.
their funds into those facilities that produce the
most promising results (Liao et al., 2007). Stem cell research will unlikely offer
Greater involvement in the Thai government will any cures to diseases in the near future.
allow stem cell research to flourish domestically However, it may offer treatments for millions of
and on the global scale, placing Thailand on par people worldwide suffering from a variety of
86 Fall 2007
ailments. In Thailand, researchers hope that stem change the country‘s policy regarding publicly
cell therapies may be used to treat Thalassemia, funded stem cell research ( <http://
referring to a group of inherited hematological stemcells.nih.gov/policy>). The House of
disorders. There are approximately 500,000 Representatives, in 2005, voted in favor of
clinical patients in the country and 30-40% of federally funded research with surplus frozen
Thais are carriers for this genetic disorder embryos (<http://en.wikipedia.org/wiki/
(Mahidol Report, 2008). Ethical guidelines on stem_cell_research_policy>.). One year later, the
stem cell research will encourage Thai scientists Senate passed three different bills in support of
to experiment with these therapies to lead to legalizing federal money allocation to
improvements in the quality of life in the Thai experiment with embryos left over from in vitro
population. fertilization. Although President Bush vetoed
these proposals, the efforts to lift limitations of
As in Thailand, many Americans will stem cell and cloning research continue to be
benefit from the advancements in stem cell challenged by politicians at the national level.
research. With the variety and incidence of
chronic diseases skyrocketing in the US Legislative and research communities
population, American researchers are looking must agree on a policy to regulate the private
toward stem cell therapies to treat many sector‘s involvement in these research
illnesses. As of 2005, 5 million Americans with disciplines. This will protect the public from
Alzheimer's disease, 60 million individuals ethically controversial treatments. Also,
inflicted with cardiovascular disease and over 40 immediate efforts must be made to educate the
million people with osteoporosis may be treated public on the current expectations and benefits of
using this technology (SNAP, 2008). Without a stem cell and reproductive cloning therapies. The
reassessment of the ethical implications of coupling of revised legislation and education will
banning stem cell research, American creativity boost scientific creativity in both Thailand and
in this field will continue to be strangled by the United States and assist civilians in clarifying
excessive regulation. the potential of such technologies‘ impact on
their own health and quality of life.
A promising advancement for
establishing guidelines for stem cell research in References:
Thailand is the Stem Cell Network – Asia-
Pacific (SNAP). Created in September of 2007, Liao, Lianming, Lingsong Li, and Robert C.
this organization aims to create a framework for Zhao. "Stem Cell Research in China."
conducting research in these in these frontiers Philosophical Transactions of The Royal Society
focusing on patient needs, research interests, 362 (2007): 1107-112.
business sector priorities and research regulation
and funding. Member countries include some of New York and Stem Cell Research"New York
the rising powerhouses of scientific advancement and Stem Cell Research: a Scientific, Policy and
including China, South Korea, Japan, Taiwan, Economic." New York and Stem Cell Research:
Singapore and Australia. Although a promising a Scientific, Policy and Economic. Jan. 2006. 12
collaboration, SNAP is still in its infancy and it Aug. 2008 <http://www.rochester.edu/news/
will be many more years before Thailand will pdfs/stemcellwhitepaper.pdf
see significant regulations evolve from this body.
Mahidol Report: "Thalassemia Research Center."
In the United States, both the House of Mahidol University. 12 Aug. 2008 <http://
Representatives and the Senate passed bills to www.st.mahidol.ac.th/thalassemia/modules/
mypage/>.
SNAP- "Stem Cell Network Asia Pacfic." SNAP
- Stem Cell Network Asia Pacfic. 12 Aug. 2008
<http://www.asiapacificstemcells.org/>.
88 Fall 2007
To breach or not to breach doctor-patient confidentiality involving children with AIDS
By Risa Hoshino*, Janice Liu*, and Sun-Chai Waleecharoenpong**
*Columbia University, ** Mahidol University International College
AIDS has infected more than for a check-up. However, the parents
one million Thai citizens and has killed have never disclosed his diagnosis to
more than 460,000 people since the be- the child. During the visit, the doctor
ginning of its epidemic during the finds that he is old enough to start hav-
1980‘s. However, with Thailand‘s anti- ing sexual intercourse and believes that
AIDS campaign, the number of new in- not telling him will endanger his sexual
fections has dramatically fallen since partners‘ health. The doctor asks for
1991. The country used creative and their permission to disclose his diagno-
persistent ways to educate the Thai sis for the sake of others‘ safety but the
people about preventing the spread of parents refuse. Should the doctor
this debilitating disease. In its initial breach the doctor-patient confidentiality
phase, non-governmental organizations oath or abide by it under all circum-
(NGO‘s) such as the Red Cross and stances (Weiner et al., 2004)?
Population and Community Develop-
ment Association (PDA) tackled AIDS In both Thai and American law,
by educating people about the preven- the parents have full control of the confi-
tion of AIDS such as handing out con- dentiality of their children‘s medical re-
doms at brothels and promoting HIV cords. They can legally hide any medi-
education in schools. By 2003, there cal information from their children when-
were only 19,000 new HIV cases, much ever they feel it is necessary. Several
lower than the original 143,000 at its factors have been associated with the
peak. parents‘ decision not to disclose the HIV
diagnosis to their child. Among the top
But the war has just begun. In- reasons were that the child is not old
stead of a continued progress, the num- enough or ready, the child would not
ber of new HIV positive cases in Thai- keep the diagnosis private, or that the
land has increased significantly and is child will be subject to ostracism from
currently the leading cause of death the community and family. Another rea-
among young adults. Precautionary son is the fear that the children will be-
measure to slash AIDS in Thailand must come angry with the parents for trans-
be re-instituted. mitting AIDS to them.
A Thai couple brings their thir- However, even though the par-
teen year boy with AIDS to the doctor ents may have concerns about the
child‘s well-being when not being told givers. They are the one who tend to
their status, there may still be psycho- their children‘s grown both physically
logical damage to the child if the status and mentally, while providing love, pas-
is not revealed. Clinical reports have sion and care to their children. Second,
indicated positive outcomes associated parents are the first teachers of their
with disclosure including the promotion children. Parents are obliged to teach
of trust, improved adherence, enhanced their children all basic needs to survive
access to support services, open family and also help develop their children
communication, and better long-term thoughts and characters. Lastly, parents
health and emotional well-being in chil- are ―Phra Orrahun‖ or ―Buddhist saint.‖
dren (Wiener et al, 2004). Parents who Parents have to love their children con-
disclose the diagnosis to their children sistently and unconditionally. Hence, in
believe in a child‘s right to know their Thai culture, parents have the final say
health status and that their child will in making decisions for their child. They
learn the diagnosis elsewhere. In addi- can choose to tell or not to tell their chil-
tion, the parents fear the child would get dren about their HIV status.
involved in sexual activities without pro-
tection and hope that disclosure will lead In Buddhism, each action has a
to improved health care or improved karmic effect that follows, whether it is
medication adherence. These children good or bad. Karma is not a point sys-
may also endanger other people‘s lives tem where good karma and bad karma
if they are not told their status and per- can cancel each other out, but is rather
form unprotected sexual intercourse with two separate columns where a tally of
their partners. Should the doctor-patient each category is kept. If we look at the
confidentiality oath be observed in all point of view from the karma effect, it is
circumstances or can they be overridden considered bad karma to go against the
in situations where public safety is will of parents which we consider to be
threatened? Both Thai and American the supreme figure. The Buddhist monk,
cultures and values are employed to ex- Phra Chainarong, believes that one
plore the conundrum of whether to dis- should act according to what one be-
close diagnosis information to children lieves will have the least harm and the
against the caregiver‘s will when it en- most benefits to the individual and to
dangers societal safety. society. If the doctor believes that more
harm will be caused if the parents do
Thailand Perspective not inform their children of their status,
then there will be more good karma and
In Thai culture, all decisions are less bad karma in telling the child (both
at least influenced by, if not based on, come into play). Though both karmas
the teachings of Buddha for hundreds of still exist in the decision, the intention
years. According to sutra, Buddha said behind the action determines the signifi-
that parents have three roles in caring cance of each. In addition to karmic
for their children: First, parents are birth effects, Buddhism also teaches people
90 Fall 2007
to ―know all truths‖. If children are not American Perspective

told their HIV status, they will never
know all truths and will not reach nir- In the United States, individual-
vana in this life. This goes against Bud- ism dominates American culture, shifting
dhist principles and is therefore another from a political concept to a personal life-
reason to inform the child of his or her style. In modern day America, individual-
state. ism has now become a cultural mindset
that span issues like the freedom of
Even though the law favors the speech, to intrinsic values of everyday
parents in making the final decision for life.
their child, the law is not as strict be- This concept governs almost
cause of the Buddhism theme of commu- every aspect of society, including health-
nity unity. Even though parents may not care. In the medical field, the law gives
want to tell their child, the doctors and individuals the right to make healthcare-
parents have the mutual respect and cul- related decisions for themselves, as long
tural backgrounds to be able to make as he or she has the mental capacity to
decisions together without the doctor be- do so and is at least at the legal age of
ing out of his or her place. Even though 18. This means that parents of minors
disobeying the parents wishes is against have absolute control in making medical
Buddhist teachings, going against the decisions for their child, despite sugges-
Buddhist principle of ―do no harm‖ is tions from the doctor. Nowadays, more
even more, in a western sense, sinful. and more Americans are practicing their
Community plays a large role in decision individual rights in court cases, including
making of the people. By not telling in- medical lawsuits. Studies show that an
fected children about their disease, once estimated 25% of all doctors in the
the child has reached an age of in- United States get sued on an annual ba-
creased sexual activity, their ignorance sis (When Good Doctors Get Sued,
may cause other innocent people in the 2001), creating a more cautious atmos-
community to also be infected. Hence, phere between doctors and patients.
with the Buddhist perspective to do no This increases the potential for a dichot-
harm and a communal sense of respon- omy between opinions of doctors and
sibility, doctors may have the right to go parents when it comes to making deci-
against the will of infected children‘s par-sion for the child, instead of integration
ents if they believe it is better for the between the two as Thai culture sup-
community. With the knowledge in the ports.
hand of the children, they will be more
cautious of their actions, possibly inhibit- Doctors are trained from the very
ing further increase to the already esca- beginning to never breech doctor-patient
lated number of HIV infections in Thai- confidentiality. With such a heavy em-
land. phasis on that confidentiality and the
high percentage of lawsuits threatening
in the background, doctors face one of
the most controversial medical issues the idea that one should act according to
where they must decide between their what one thinks will do the least harm to
moral values and respecting the individu- people. A policy that gives Thai doctors
alism of their patients. the right to disclose information to the
HIV infected children about their status
This controversy is also imbed- once they reach the age of twelve will
ded in the issue of pediatric disclosure of benefit the community, and follow the
HIV. Having HIV is considered to be ta- cultural philosophy. Some ethicists may
boo, where parents and children have promote an earlier age to inform the child
become social pariahs once the informa- of his or her status. However, a study
tion has been released to the public. It is shows that early disclosure of diagnosis
then understandable if parents of an HIV to the child may not necessarily be better
positive child refuse to disclose this infor- than at an older age. Of 40 HIV-infected
mation to him or her, with the hopes that adolescents and young adults, the inves-
the child will be able to live out a normal tigators found no relationship between
childhood. However, if an HIV positive timing of disclosure and psychological
child is at an age where he or she is adjustment, social support, or the adoles-
sexually active, and the parents still recent‘s own decision to disclose his or her
fuse to tell the child of his or her status HIV status to others (Wiener et al, 2004).
for fear of social ostracism, does the doc- But whether or not the disclosure comes
tor compromise his trained values for at an early or late age, the process must
moral ones? Should the physician over- still be gradual for the child. The disclo-
step his boundaries in disclosing such sure must be carried out in a sensitive
information for the sake of protecting the fashion through counseling.
community? American law strictly prohib-
its doctors from releasing such informa- The Thai perspective on this is-
tion without the consent of the parents sue uses a more communal approach
because individual rights favor the legal versus the more individualistic attitude of
guardians. But has individualism finally American culture. It better serves the
overstepped its own boundaries? needs of the community while performing
the least harm to the most number of in-
Conclusion dividuals. If the doctors feel that it would
be more harmful to hold back the infor-
Thailand has taken more control mation, then they should have the right
over its growing statistics in terms of to override the parents in this decision.
educating the public and HIV prevention Even though there are less occurrences
programs because of the higher inci- of HIV/AIDS infection among the United
dences of HIV infection spreading across States population, adopting an attitude of
the country. However, an important part social and communal responsibility will
of its success is due to its Buddhist- further efforts in the fight against AIDS.
integrated culture of having communal
responsibilities. The culture incorporates References:
92 Fall 2007
Wiener LS, Battles HB, Heilman

N.Public disclosure of a child's HIV in-
fection: impact on children and families.
AIDS Patient Care STDS. 2000 Sep;14
(9):485-97.
Enlightenment: Just a Pill Away!
Marlon Danilewitz, Margarita Borovka, and Mariangels de Planell-

Saguer
Oek the monk began his rigorous thermore, suffering is perceived to be the
Buddhist training when he was eight years result of desire and lust. The path to ac-
old. Moving to a Buddhist temple with other cess Nirvana is also of prime importance.
monks, he dedicated the bulk of his daily Meditation and introspection comple-
hours to studying the words of the Buddha mented with the study of some of the
and meditating to undergo personal growth seminal Buddhist texts including the Su-
and improvement. Finally after forty years tra, the words and teachings of the Bud-
of training and tremendous personal sacri- dha, are the avenue that with work, dedi-
fice and perseverance, Oek achieved cation, maturity, growth, and time will aid
enlightenment, a state without desire and one in attaining enlightenment. Alterna-
lust, free from suffering. Barney, an Ameri- tively, Western society achieved its nas-
can businessman and financial trader was cence in Greece and has incorporated
the envy of all of his colleagues. His prow- many of the Greek values such as happi-
ess on Wall Street stemmed from his supe- ness, beauty, speed, and strength. It
rior intelligence and creativity. Notwith- could be argued that they were a culture
standing his natural endowments, Barney of desire. All of these notions have been
desired to be better, smarter, and happier. compounded with the advent of capitalism
One day, he decided to visit his psychiatrist and the rise of competition and primacy of
to procure some cognitive and mood en- the result over the process.
hancing drugs. After only a few days of
ingesting these powerful pharmaceuticals, The enhancement of normal neuro-
Barney emerged a smarter and happier cognitive function by pharmacological
man. While both of these stories are en- means is no longer terrain of fiction, but has
tirely fictitious, there is a common senti- become a fact of everyday life for many
ment that is reflective of Buddhist culture, people in our society. For the most part,
and Western society. these drugs are used ethically to treat neu-
rological and psychiatric illnesses, including
One of the more well known Bud- Alzheimer‘s, ADD, strokes, dementias asso-
dhist ideas concerns the topic of enlight- ciated with Parkinson‘s disease and schizo-
enment, or Nirvana. Nirvana is the highest phrenia. However, psychopharmacology is
stage of existence in Buddhism and is also increasingly being used for
defined as a state of cessation of all de- ―enhancement‖ purposes. Such drugs,
sires, or emptiness. It is a point of satis- known as cognition enhancers, work on the
faction, and complacency, where one be- neural processes that underlie mental activi-
comes at peace with things and no longer ties including attention, perception, memory,
experiences desires. By achieving Nir- language, planning and decision-making, by
vana one has in fact achieved an exis- altering the balance of the chemical neuro-
tence free from suffering, and pain. Fur- transmitters involved in these processes.
94 Fall 2007
In some school districts in the A critical question is how to differen-

United States the proportion of boys taking tiate treatment from enhancement. How-
methylphenidate, usually prescribed to ever, as today‘s technologies for treatment
treat attention deficit-hyperactivity disorder are being introduced into a bitterly competi-
(ADHD), exceeds the highest estimates of tive society, they become necessary requi-
the incidence of ADHD, implying that at sites for the general public who believes that
least a part of the normal childhood boister- improvement is a moral obligation. Imagine
ousness and distractibility are being tar- a scenario in the future, when you‘re apply-
geted for pharmacological intervention. ing for a job, and the employer says, ―Sure,
Similarly, the spike in the usage of pre- you‘ve got the talent for this, but we require
scription stimulants (such as methypheni- you to take Adderall.‖ Our analysis will focus
date and dextroamphetamine) as study on cognitive and mood enhancing drugs and
aids by high school and college students, the ethical questions that have been raised
with no prior history of ADHD, has drawn concerning their use and prospective use in
public attention. The market for nutritional Western society, and societies rooted in
supplements, which is estimated to be in Buddhism.
the billions of dollars worth of sales, signals
that society is eager and waiting for the rise Western Perspective
drugs that promise cognitive enhancement.
Another growing phenomenon per- The reference to the first ten years of
tains to the off-label use of existing drugs the new millennium by some as the ―decade
such as Ritalin (methylphenidate) and of the mind‖ is in part a reflection of the trend
Provigil (Modafinil) by people who want to of enhancement of cognition and mood
‗pep up‘. Provigil has been shown to im- through the prescription and use of brain
prove one‘s working memory, allowing indi- stimulants (Rose, 2006). Protestant work
viduals to remember an extra digit (most ethic and the source of self-fulfillment, propa-
people can hold seven random digits in their gates the desire to do work in a better way,
memory but have difficulty with eight). It has with or without the use of un-prescribed pre-
also been able to improve individual‘s test scription drugs. Americans feel driven to
taking performance, and ability to plan. work harder and are ashamed if they are not
These positive effects has elicited the inter- working. They generally work more hours
est of normal people into using these drugs and take fewer vacations than workers in
to stave off fatigue, boost exam perform- other advanced economies. Therefore, if
ance and aid recovery from the effects of drugs like Ritalin or Prozac allow one to do
long-distance flights. Furthermore, an infor-
work in a faster, better, more efficient way,
mal study in Nature found among 1,400 of
and to do so enthusiastically, then their ef-
its readers that one in five said they had
fects may help to understand more clearly
taken Ritalin, Provigil or beta blockers
(drugs that can have an anti-anxiety effect) the experimentation with ―cosmetic psy-
to bolster their ability to focus, concentrate chopharmacology‖ in American culture.
and enhance their memory. Surveys of col- Americans also place importance
lege students have found that 4 to 16 per- on acquiring the happiness they see idolized
cent of respondents say that they have used around them in popular culture. The media
stimulants or other prescription drugs to im- portrays leisurely and worry-free lifestyles
prove their academic performance. as the norm. However, if one is unhappy-
(Persaud, 2006). However, with the advent

then is there something wrong? Are all peo- of these drugs and their habitual use, peo-
ple mandated to feel self-satisfied and nos- ple will lose their emotions and critical ele-
talgic at all times? If not, have they failed? In ments by undermining the human element
the United States, not only has happiness of trying. They will also limit what it means
become a right, but a duty, and one that to be human to one personality type – the
should be pursued aggressively. Interest- extroverted, confident, daring individual.
ingly enough, ―Life, liberty, and the pursuit of While the effects appear worthwhile to try
happiness " is one of the most famous these medications, it is important to think
phrases in the United States Declaration of about the long-term effects they will bring
Independence. These three aspects are about in future generations.
listed among the inalienable rights of man.
One of the most immediate effects of
However, this ethic can be oppressive to the
enhancement drugs, however, will be an
average American, who encounters prob-
increased gap between the rich and the
lems at work, fights with his/her spouse, and poor. While enhancement technology will
experiences a financial crisis (Elliott, 1998). provide supposed benefits for some, it will
Enhancement drugs appear to be the easy also become a disabling force for those who
way out of their conundrums. However, it is cannot afford it. The number of people in
important to note that these pills allow peo- this country perceived as impaired will in-
ple to pursue happiness on an individual crease because the definition of what it
basis, rather than on a collective one. Indi- means to be disabled will change. In fact, a
vidualism is another aspect of American new underclass could be created – ―the un-
culture, which may explain why enhance- enhanced‖ (Wolbring, 2006). As a society,
ment medications have become so popular. we must think about the consequences of
The transformation of the ―pursuit of happi- reaching a higher level of cognition through
ness‖ from a right to a duty engenders the external means, especially at the cost of
mental pressure to search for joy and find it losing our interconnectedness and human-
by any means available and to do so in the ity.
privacy of one‘s home. If being happy is a
duty, then mood and cognition-enhancing Buddhist Perspective
drugs are the road to eternal bliss, as long
as the prescription does not run out. Or at Buddhism voices many ethical con-
least, they are a temporary shortcut to the cerns regarding the potential use of Am-
happiness that Americans seek. pakines, Prozac and other pharmaceuticals
that can bolster one‘s cognitive capabilities,
and brighten one‘s mood. The Buddhist
The convergence of enhancement notion of Karma, the belief of cause and
technology and capitalism creates the mar- effect whereby bad actions merit suffering
kets necessary to convince the American and good actions result in happiness,
people that they possess defects, while a poses a number of ethical concerns to the
free market society encourages a competi- use of enhancement drugs in a normal
tion for the most successful improvement population. In particular, with the advent of
within these respective markets. In other pharmaceuticals of this nature which have
words, capitalist society will create any the unique ability to alter one‘s own natural
markets necessary to make a profit cognitive endowments and temperament/
96 Fall 2007
personality, an argument has arisen among Buddhism is the belief that the root of suffer-
Buddhists concerning how to react to these ing lies in desire. If the aim of a Buddhist
miracle drugs. The more traditional ap- existence is to achieve a state of Nirvana
proach maintains that these drugs interfere and the eradication of suffering, desire must
with one‘s karmic destiny, and as a result, first be extinguished (Bodhi, 2000). Thus it
should not be used. The alternative ap- would seem that intention for taking en-
proach, does not perceive these drugs to hancement aiding drugs so as to increase
tamper with one‘s karmic fate, as they fall one‘s cognitive abilities and to manipulate
within the normal and acceptable realm of one‘s personality and enjoy more happiness
permissible actions. It could be understood would in fact further delay one from attaining
that the development and possibility to use the enlightened state of Nirvana.
these types of pharmaceuticals are a part
of one‘s karmic balance and as such, are The potential of achieving enlight-
intended to be utilized. enment, Nirvana, applies equally to every
single human being. Buddhism does not
Similarly, Buddhism places a tre- discriminate between creed, sex, race, re-
mendous value on the individual and the ligion, or financial status; enlightenment is
primacy of his own actions and work in within the grasp of everyone. Although, one
achieving Nirvana. The key to fulfilling our can argue that the level of one‘s cognitive
need for happiness lies ―within, not outside faculties can either increase or decrease
us. This means that all we need right here, one‘s chances of attaining enlightenment,
inside, without looking to external the journey towards spiritual completeness
things‖ (Tsering, 2005). This would suggest is not subject to fierce competition between
that despite Prozac‘s potential to increase individuals but is rather a self directed mis-
one‘s self esteem, truncate one‘s bouts with sion, void of rivalry. As such, the social ine-
depression and gird one with a greater qualities that are glaringly apparent in the
sense of independence and extraversion, intense competition to get ahead in Amer-
because the impetus for this change was ica, and which have the potential to be fur-
external to the self this type of development, ther exacerbated by the rise of cognitive
it is inappropriate for Buddhists. and mood enhancement drugs, are not a
part of the Buddhist path to Nirvana.
This sentiment is echoed by the
words of the Buddha ―He who fills his lamp Conclusion
with water will not dispel the darkness, and
he who tries to light a fire with rotten wood The concept of enlightenment, striv-
will fail. And how can anyone be free from ing to be better, exists in both cultures. For
self by leading a wretched life, if he does not example, American society thrives on a
succeed in quenching the fires of lust, if he work ethic that has been maturing for over
still hankers after either worldly or heavenly three centuries-the journey to achieve su-
pleasures. But he in whom self has become premacy first. As Gregory Stock has said,
extinct is free from lust; he will desire neither ―Future generations will not want to remain
worldly nor heavenly pleasures, and the sat- ‗natural‘ if that means living at the whim of
isfaction of his natural wants will not defile advanced creatures to whom they would be
him‖(Carus,1974). little more than intriguing relics from an
abandoned past‖ (Franklin, 2006). Similarly,
Another concern championed by enlightenment is the state that Buddhists
strive for: ―This, bhikkhus, is that middle way 69-70.

awakened to by the Tathagata, which gives
rise to vision, which give rise to knowledge, Tsering, Geshe G. The Four Noble
which leads to peace, to direct knowledge, Truths: The Foundation of Buddhist
to enlightenment, to nibbana‖. It is interest-
Thought Volume 1. Boston: Wisdom
ing to note that both societies are deter-
mined in achieving a greater goal; however, Publications, 2005.
their means are in stark contrast to each
other. Wolbring, Gregot. ―The unenhanced
underclass‖. Better Humans? The Poli-
References: tics of Human Enhancement and Life
Extension. Ed. Paul Miller, James Wils-
Bodhi, Bhikku. The Connected Dis- don. London: Demos, 2006. 126.
courses of the Buddha. Boston: Wisdom
Publications, 2000.
Carus, Paul. The Gospel of Buddha.

United Kingdom: Alcove Press Ltd, 1974.
Elliott, Carl. ―The Tyranny of Happiness:

Ethics and Cosmetic Psychopharmacol-
ogy‖. Enhancing Human Traits. Ed. Erik
Parens. Washington, D.C.: Georgetown
University Press, 1998. 184-187.
Franklin, Sarah. ―Better by design?‖ Bet-

ter Humans? The Politics of Human En-
hancement and Life Extension. Ed. Paul
Miller, James Wilsdon. London: Demos,
2006. 89.
Persaud, Raj. ―Does Smarter mean hap-

pier?‖ Better Humans? The Politics of
Human Enhancement and Life Exten-
sion. Ed. Paul Miller, James Wilsdon.
London: Demos, 2006. 129.
Rose, Steven. ―Brain Gain‖. Better Hu-

mans? The Politics of Human Enhance-
ment and Life Extension. Ed. Paul Miller,
James Wilsdon. London: Demos, 2006.
98 Fall 2007

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Columbia University Journal of Bioethics 1

Columbia University Journal of Bioethics

Editorial Board Faculty Editors

Web Version is available through the undergraduate page: http://www.columbia.edu/cu/

Copyright 2008 by: Columbia

Majority Report: DNA Data-banking As an Opt-Out System

Could Genetic Research Interfere with Medicine?

Charging You for Being You

Section II: Stem Cells and Reproductive Medicine

Altered Nuclear Transfer: A Novel Way of Developing Pluripotent Stem Cells

Secrets and Lies: Mandating Disclosure in Oocyte Donation

Diagnosing Disability… And Keeping It

Programmed Free Will

Neuroimaging for InterGender Peace

Do You Mind If I Read Your Mind?

GLBT Flies: The Application of Mind Control To Sexual Preference

Memory Upgrades: Not Just For Your Computer

Say No to Blow: Preventing Cocaine Addiction through Vaccination

Molecular Imaging and Ultrasound-assisted Drug Delivery

Bioartificial Hearts, Bioethical Issues

One Word: ―Synthetics‖: The Ethics of Synthetic Biology

A Bun in the Oven

Paying For Patient Performance

Section V: Cross-cultural Bioethics-BioCEP

Behind Their Smiles: Cosmetic Dentistry and Medical Tourism in Thailand

The Ethical Concerns of Propranolol and Memory Dampening

Finding the Middle Path to Stem Cell Nirvana

To breach or not to breach doctor-patient confidentiality involving children with AIDS

Enlightenment: Just a Pill Away!

Columbia University Journal of Bioethics would like to acknowledge the following

This year‘s Journal volume also includes a special section on Cross-cultural

John D. Loike, Ph.D.

Ruth L. Fischbach, PhD, MPE

The Sound and the Fury

The cochlear implant was approved

Majority Report: DNA Data-banking As an Opt-Out System

Could Genetic Research Interfere with Medicine?

Charging You for Being You

By Elisa Fung and Gabriela Vargas

Ownership of genes not only

II. Stem Cells and Reproductive Biology

Secrets and Lies: Mandating Disclosure in Oocyte Donation

Coilumbia University College of Physicians and Surgions

Although conception with changed requiring any donor of gametes

both a pragmatic and legal The GIVF donation procedure is

lawsuits resulting from these same Yet this only reinforces

to family members and close friends; right to privacy. By bringing these

genetic heritage is distinct from in multiple ways. Parents‘ privacy

Conception with egg donation

Ethics Committee of the American Society

Altered Nuclear Transfer: A Novel Way of Developing Pluripotent Stem Cells

by Sarah Eberle and Tabby Khan

In addition to the question of when

Bioartificial Hearts, Bioethical Issues

Each year, cardiovascular used to overcome this problem (Ott, et

Bioartificial hearts would be obtained carrying‖ organ donor is necessary in

Diagnosing Disability… And Keeping It

by David Yin and John Tseng

Genetic engineering is most Oath to ―do no harm‖. Defenders of the

their children. A quick inspection of the procedure enables us to create an

scientifically distinct, are still morally

III. Contemporary Issues

Say No to Blow: Preventing Cocaine Addiction through Vaccination

By Soo Han and Tabby Khan