Avoiding Eugenics: It's Easy!

Src: wired.com

I want to prevent inheritable disease. I think we should explore pre- and perinatal therapies as part of this. And not all the therapies I can imagine are approved by Church officials. Am I a eugenicist?

It the original sense of the word, no. I'm not a member of a "social movement claiming to improve the genetic features of human populations through selective breeding and sterilization." But more recently, the eugenics ideal has gone underground, and motivates some (not all) uses of prenatal diagnosis and abortion (related to race and mental disability). It creeps behind the language of "every child a wanted child," "working together for stronger healthier babies," and "healthy babies are worth the wait."

What if you could freeze oocytes (not morally illicit per se according to Dignitas Personae) and inject them later (e.g. after chemotherapy) in a woman's ampulla and allow conception to occur after natural intercourse? We'd need to learn more about construction of a zona pelucida and cumulus oophorous, but I bet we could do it.

What if you could CRISPR the ΔF508 out of all of a man's sperm, not only preventing this from being passed onto his sons, but also assisting the act of procreation, allowing him to build working sperm? This is germline gene therapy.

What if you could engineer a neo-ovary for a BRCA-positive woman, with her genome, minus the affected gene? That way, her offspring would not carry her genetic predisposition to breast and ovarian cancer. CRISPR would make it possible, and bioprinting would could make it real.

I don't think any of these things are eugenic in themselves (per se). Eugenics is marked by the erroneous equation between essential dignity and accidents like quality of life, health, beauty, intellect, usefulness, etc (paragraph 319 in the link). This error affects the intention behind the action, and the selection of means to the end of promoting those separable accidents.

None of the techniques I just listed are evil in themselves (malum in se). Printing tissue is not immoral, even printing tissue to replace reproductive organs. (Even though the reproductive system is set apart as half of a whole, meant to be used with a complementary system by a couple in a very sacred act, replacing an organ is a medical act that promotes the natural act of the human body.) Freezing cells, thawing them, and implanting them without IVF might be a roundabout way to assist fertility, but is not evil in itself. And germline therapy (I'm arguing something that not everyone agrees about now) is no different from somatic cell therapy, since it assists, rather than replaces or demeans, procreation and the health of offspring.

But any of those actions could be used with eugenic motives. A woman who wants to "clean up" her family tree or her society should re-examine her motives for neo-ovary creation. A woman who wants to freeze her eggs so that she doesn't use "the Down's duds" at the end of her reproductive life needs to re-think her intentions for egg freezing (and don't get me started on women who do this for their careers; that's a disaster of mixed priorities and apparent goods). A woman who plans to use germline therapy because she doesn't want to raise a child with mental retardation, or lose a child early, or pay for expensive drugs, needs to reconsider her reasons for germline gene therapy.

With a loving intention to contribute to the health of children conceived, and an attitude of acceptance of whatever children are conceived, we can avoid becoming eugenicists when we use morally neutral means to achieve a good.

Ultrasounds before Abortions

Have you ever been so angry you couldn't speak? I have been meaning to write about a talk I attended, given by Dr. Rebecca Kukla on ultrasound viewing before abortion. Dr. Kukla argued that ultrasound screening has become a ritual in our society to establish parenthood and add (prematurely and irrationally) a new member to the family. Performing an ultrasound and explaining the findings to a woman desiring to end her pregnancy would thus cause unnecessary and severe psychological trauma. She also argued that this imposed moral harm on physicians as it required them to violate their fundamental duties to patients.

I have been meaning to write this post since January. I have kept the folded-up flier from the talk in my desk since then. There it sat, outlasting the semester, my STEP studying, and my move to a different city. Usually, when I keep a piece of paper as a reminder to complete a task (e.g. a blog post, or mailing something, or running an errand), the having of the paper bothers me just enough to make me want to complete the task. But this time, I preferred to keep the paper rather than write the post. I just couldn't do it.

Every time I sat down to do it I would formulate the ghost of an argument, take out the paper, unfold it, look at it, and recall the tone and content of the argument. The first few wisps of a post that I had would evaporate as I would become angry. Not desiring to be angry, I would just put the paper and the idea away.

Today I realized the pattern. And now the flier is in the trash, but I have a decision to make (I am literally making this decision as I type). I can either write the rebuttal now, or I can just forget about it.

I am still too angry for a level-headed, reasoned argument, so if you read this, Dr. Kukla, please excuse me as still young and full of idealism. I will strive to be professional, though.

Before most minor surgical procedures that require general anesthesia (e.g. cholecystectomy or gall bladder removal), an ultrasound or other imaging is done. Vaginal ultrasound is quite common in gynecology. It also doesn't stand out as uniquely invasive. (Ultrasound for cholecystectomy gets to the bile duct via the mouth, and I'm sure you can imagine how they stage colon cancer). Abortions actually become more like the minor surgical procedures they're touted to be when an ultrasound is performed. I would hope they're done anyway.

Adequate bedside manner during any exam or procedure in which a person is awake but unable to interpret the findings includes explaining the findings. "Mrs. Anderson, your lungs sound normal." "Ms. Patel, the skin biopsy is almost over and your back looks good." "Mr. Deere, this darkish color on the ultrasound means you have a lot of fat in your liver." Let's encourage abortionists to have good beside manner by requiring them to describe the findings. I would hope most of them do anyway.

Dr. Kukla's concludes that ultrasounds like this impinge on the physician's duty to do no harm, but she happily supports the procedure that follows, which will leave 14% of the women who undergo it with full PTSD (slide 42). (For reference, 15.2% of Vietnam vets have full PTSD.) Abortion increases the risk of suicide to 650% (slide 74), substance abuse (61 and following), and depression (9 and following)  is considered desirable, so desirable that even medically legitimate restrictions are deemed morally intolerable.

I think that's all I have to say. Dr. Kukla and I agree that vaginal ultrasound cannot be considered a kind of "rape," and we also agree that it's not ideal that these regulations come through a governing body (we'd both prefer they come through professional organizations). But I find her basic attitude (defending abortion while objecting to an ultrasound) to be inconsistent.

AAPLOG Conference

As I started to write this post, I had trouble labeling it. "Pro-life," obviously applies, as does "ob/gyn" and "research," but so does "ethics," "spirituality in medicine," "vocation," "advice," "surrender...." I had to stop myself from clicking almost all of them.

Today was the 2012 annual education meeting of the American Association for Pro-Life OB/GYNs. It was in Washington, D.C. (my first time in the capital); it snowed this morning, and the conference was great. I was impressed with the high and rigid standards for publications, recommendations, and protocols. I was fired up to start healing our culture, now!

The highlights:

• 8:45 Maureen Condic, PhD. “Defining the Beginning of Human Life”
• Dr. Condic was at the Vita Institute. She condensed several of her lectures into one (because the audience had a more uniform education) on when human life begins.
• Dr. Condic's white paper probably contains her arguments, although I freely confess I did not read it!



Credit: euthman

• 9:45 Theresa Deisher, Ph.D. “Current Ethical Issues in Drug Development”
• I had no idea that some cosmetics, several vaccines, and some drugs are made in cell lines derived from aborted fetuses (and they contain contaminants from those lines). I'm not advocating chucking all vaccines, but I agree with Dr. Deisher that we should make an effort to find ethical, economical, and technological superior alternatives. Check out some of these companies:
• AVM Biotechnology (website still under construction)
• CEVEC
• Transposagen
• Cellular Engineering Technologies
• 10:30 George Delgado, M.D. “Reversing Mifepristone: Case Reports”
• Repeated doses of 200mg IM progesterone in oil = stop a chemical abortion. He went through six cases (publication pending). Amazing.
• You know, it's impossible to reverse a surgical abortion, so I feel that the increasing use of RU-486 is almost a boon.
• 11:00 Paul Gray, M.D. “Medical and Surgical Naprotechnology”
• Naprotechnology is incredible. Mainstream gynecology treats menstrual disorders and infertility very quickly with birth control or IVF, without finding the cause; naprotechnology finds the cause of a woman's problems and addresses them to correct the symptoms or infertility (when possible). It corrects a cycle instead of suppressing it. Besides being a theoretically better approach, it also doesn't involve carcinogenic pills predisposing the patient to thromboembolism!
• If you want to learn more about naprotechnology, you can read up at naprotechnology.com or fertilitycare.org. Please note, I haven't explored these sites, and they weren't mentioned by Dr. Gray.
• 11:45 Priscilla Coleman, Ph.D. “The Psychology of Abortion: Addressing the Critical Questions to Maximize Patient Care in 2012”
• WECARE 
• Dr. Coleman carried out the largest meta-analysis to date on abortion after-effects. She's met with a lot of resistance, but she concluded that (yes; surprise) there is psychological morbidity following abortion, especially in high-risk groups (unsupportive relationship, hx of previous mental illness, ambivalence about the decision...).  
• 1:15 Frederick Dyer, Ph.D. “Horatio Robinson Storer, M.D. and the Physicians’ Crusade Against Abortion, with implications for the current practicing doctor’s responsibilities toward the abortion issue.”
• Interesting historical sketch of a gynecologist in the mid-1800s who advocated against clandestine abortion because of the harm it does. I didn't know there was abortion in the 1800s! 
• Dr. Storer was supported by the AMA and his work led to the laws against abortion that disappeared in 1973.
• 2:00 Michael New, Ph.D. ‘Analyzing How State Level Anti-Abortion Laws Impact Fertility Outcomes.”
• Dr. New was at the Vita Institute as well! Never hurts to hear it again.
• 2:45 George Mulcaire-Jones, M.D. “Safe Passages Program: Confronting Maternal Mortality in Rural Nigeria, Update.”

• Magnificat Maternal Health Project 
• Awesome teaching tool; reminds me of the Worth the Wait program, because it treats the disease, not the symptoms (it heals the culture and the family and doesn't just hand out contraceptives to African couples).
• My thoughts: it works in Africa? Good. Bring it here. I desire to touch the poor here.
• 3:30 Angela Lanfranchi, M.D.: “The Abortion Breast Cancer Link: The biologic basis and a review of the literature 1957-2011
• Breast Cancer Prevention Institute 
• There is a link all medical professionals already agree on: an abortion stops a full-term pregnancy, which has a protective effect.
• The link people debate about is the "independent" link: an abortion not only removes positive effect, but has negative effect on breast cancer risk. Just look at the physiology! Data supports this, too. (For instance, every time a study finds a statistically significant correlation, it's positive.)
• 4:15 Byron Calhoun. M.D. “Premature Labor: The At-Risk Patient”

• This presentation mostly went over my head. It was the only one that was purely clinical and all about management recommendations for patients, so there were lots of terms and acronyms that I didn't catch.... I learned what a cerclage is, but only because I looked it up on my phone in the middle of the session!
• The point of this talk was: 127 studies show that women with a previous abortion (surgical, medical, or spontaneous) show increased risk for preterm delivery. It's above a 300% increase for women with combined medical/surgical abortions (e.g. incomplete medical abortion requiring D&C) according to a study from China (Laoi).

I also enjoyed briefly meeting with someone from Students for Life, and also talking with some old OB/GYNs about being countercultural, not being afraid of lawsuits, and doing God's will. It's late and I've got to get up at 4:30am tomorrow to fly back home, so good night!

More die from abortion than childbirth?

Knowledge is valuable, even tiny details about obscure proteins, for two reasons:

1. Such knowledge may be practically useful in a current or future application.
2. Knowledge is inherently wonderful to have (just ask yourself if you'd like to be deprived of your eyesight, memories, or intellect, which are a few examples of the faculties we have for knowing the world).

But when I did clinical research a few years ago as a premed, I noticed the huge information glut in the scientific community.

This glut is mostly harmless but uselessly repetitive research published for the sake of publication. But the glut also includes false conclusions published and tolerated because of bias (conscious or unconscious, good or evil) and lack of skill (in the relevant field or in statistics).

One example of a false conclusion is The comparative safety of legal induced abortion and childbirth in the United States, by Elizabeth Raymond and David Grimes, promoted by Reuters the day after the March for Life. Its flaws are pointed out by Priscilla Coleman in this brief critique. Coleman's main thrust is that Raymond and Grimes' data is incomplete, because:

1. not all states count abortion-induced deaths,
2. not all abortion clinics report deaths,
3. not all abortion-induced deaths occur after first trimester abortions, and
4. not all autopsies correctly report abortion as a cause of death (e.g. if a women went to the ER after leaving an abortion clinic). 

Coleman also criticizes Raymond and Grimes of failing to discuss the protective effects of childbirth, though I think this might be legitimately outside the scope of their investigation.

I am ready to believe well of people, since I cannot read their intentions. However, I do not hold out that hope for research, which I can read and dismiss as poor.

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Update 1/29/12: AAPLOG recommends afterabortion.org's research on this.