Bioethics, healthcare policy, and related issues.
Here’s an interesting peer-to-peer phone-line support service for women who have had an abortion and want to talk to other women about it.
Exhale serves women who have abortions, and their partners, friends and family. We respect the cultural, social and religious beliefs of all our callers.
Apparently they’ve been in operation for about 8 years, and claim to have taken close to 20,000 calls; I’m embarrassed to say I’d never heard of them before. Their Web site makes them sound like a neutral listening post for those who want to talk about their experiences and feelings about them, regardless of what those feelings might be or what the caller’s perspective on the whole issue is. I have no direct experience with this group, so I can’t say how accurate this is or how well it works, but the Web site seems to me like it takes just the right tone:
- Exhale views each individual as a “whole person,” respects their belief system and strives for cultural competency.
- Exhale believes that self-awareness, self-care, and knowledge can empower individuals.
- Exhale seeks to transform oppression by challenging its roots and empowering each other and our communities.
- Exhale values the spirit of collaboration.
- Exhale believes abortion can be a normal part of the reproductive lives of women and girls.
The problem, of course, is that the entire notion of abortion “counseling” is generally a deception perpetrated by anti-choice groups to trick women into being manipulated with slut-shaming and false information. That makes me leery of any group – however honest and above-board – that sets itself up to provide such counseling. And, given the documented fact that abortion is not uniquely associated with psychological trauma, and since we don’t normally set up support groups for every individual outpatient surgical procedure (“Expel seeks to transform colonoscopy . . .”), the implication that there needs to be one for abortion specifically also smacks – just a bit, perhaps – of a negative, or at least defensive, stance toward abortion in general. But their Web site specifically disclaims this, and, without direct knowledge, I’m willing to take them at their word.
It is valid to recognize that abortion can be an emotionally fraught experience. While it is an important, useful, and sometimes life-saving procedure, abortion is unusual (though hardly unique) in that it is a treatment for a condition that is often regarded as actually desirable, and that most women, including most women who have abortions, will seek voluntarily at some point in their lives. There is no contradiction in the fact that pregnancy can be wanted under some circumstances and unwanted under others, and it makes only the most obvious kind of sense that there should be treatments available for those cases in which it is unwanted, and that many women will want “an abortive remedy” when that serves their needs and interests under their particular circumstances. But it is understandable, too, that an unwanted pregnancy may call up thoughts about pregnancies they patient may want or embrace under other circumstances, and that a particular pregnancy may be unwanted due to immediate circumstances that the patient wishes she could change, and would be wanted under those changed circumstances. So it’s easily understandable that some women’s feelings about their abortions would be complex, even while they are firm in their conviction that having one is/was right under the circumstances at the time.
Given the virulent campaign to make women feel guilty for making their own decisions about pregnancy, and to use that manufactured shame and guilt as a tool to keep them from doing so, even admitting that women may have conflicted feelings about abortion, or indeed that it is possible to be conflicted about one’s decisions without that fact undermining the right to make one’s own decisions at all, is the kind of frank discussion of fact that becomes so dangerous in the face of organized campaigns of falsehood that consistently distort facts to attack women’s independence. But an honest discussion of abortion, and honest, respectful, and welcoming acknowledgment of the women who have abortions, requires treating simple facts in a true and honest way. It in no way undermines the pro-choice principle – even if it will be used as a dishonest political attack – t0 say that women may have complicated feelings about pregnancy and abortion and may want to talk about them, and it serves those women more fully and respectfully to address that need openly and provide a tool for meeting it.
One bit of the Exhale Web site took me aback, and then left me even more impressed with their apparent devotion to honest and value-neutral service to women. They say:
If you have been diagnosed, or have self-diagnosed, as having Post-Abortion Stress Syndrome, Exhale understands that having a name for what you’re feeling and experiencing can feel important. Many women find the experience of identifying with this syndrome as positive and affirming. It is also important to know that having feelings about a significant life event doesn’t mean that you have a major psychological condition that requires medical care. For many women, naming and expressing their emotions, and having the space and support to do so, can be more empowering than being identified as having a disorder. Whether or not you think you have PASS, the most important thing is that you get support for what you’re feeling, not what someone else thinks you should be feeling. Exhale trusts you to know what feels right for yourself.
Exhale follows the findings of the American Psychological Association, which has not found a link between feelings that follow an abortion and a psychological condition in need of medical care.
This is startling, but strikes me as exactly right. “Post-Abortion Syndrome” is a wholly imaginary and deeply dishonest “diagnosis” invented out of whole cloth by anti-choicers. It exists (actually, is claimed to “exist”) only to discredit abortion – a procedure that serves women’s health and autonomy interests in a centrally vital way, and is actually safer than childbirth in almost all cases – as somehow pathological, in open defiance of established data (yet another example of a tactic that is pervasive on the right wing). The campaign to tout this fraudulent “syndrome” as a real condition has misled many women, often the youngest and most vulnerable among them; this is not just a travesty of medical science but an assault on women and their freedom. But the fact that some women have been conned into worrying about this fake disease, or mistaking their own natural complexity of feelings, or even regret, for some sort of illness on their part, must be met sensitively and with respect for the women who have those feelings, and the feelings they have.
It is unconscionable to participate in or endorse the deceptions the misogynist right practices against women and women’s independence, but it is vital to meet those women themselves, where they are and as they are feeling, and to validate their own perceptions of their situations and help them deal with them on their own terms. Exhale seems to walk this line bravely (given how easily such a stance can be misconstrued and used against them) and sensitively (given the difficulty of managing such a delicate distinction).
From what I see here – and again, I have no direct knowledge – the group hits the nail right on the head, in terms of acknowledging the range of women’s experiences and prioritizing their own perspectives on their situations, without downplaying every woman’s right to make her own decisions about reproductive health. (Including family and friends, including men, in their services is also a sign of a sensitive and realistically broad approach.) Healthcare has more and more come to recognize the importance of a wholistic approach to patients’ needs and experiences, including post-treatment support. In a field in which any admission of need is turned into yet another attack on women’s strength and claim to independence, simple decency and understanding can become a liability. By refusing to play those games, the approach that Exhale seems to embody returns the truly important issue – women’s need for service, support, acceptance, and respect – to the center of the abortion issue where it belongs.
I’d be interested in hearing what others think or have seen, regarding Exhale or similar services. Has anyone who is willing to discuss it here participated in such counseling, or served as a facilitator? How significant is this sort of support, and does it help?
UPDATE: Wow, am I a dumbass! Somehow I completely forgot about this organization, after I had previously blogged about it back when they were first starting up! Guess I should read my own blog more often.
Additionally, I have heard from well-respected sources that Exhale is legit – they will talk to anyone in a non-judgmental way, but are in no way anti-choice.
Just once, I wish we could have a debate over an important political issue that wasn’t entirely shaped and determined by sheer stupidity and ignorance from the right wing. Today will not be that day.
The winger blogs are all a-twitter over a story noting that the Omnibus Budget bill that was (finally) just passed contains a provision – known as the Dickey-Wicker Amendment, which the religious wingers have stuck in every budget since 1996 – prohibiting federal funding for research “in which human embryos are created, destroyed, discarded, or knowingly be subjected to risk of injury or death”. Setting some kind of a record for intellectual incompetence, the right-wing CNSNews mis-reported this as “Obama Signs Law Banning Federal Embryo Research Two Days After Signing Executive Order to OK It” – which, in one single sentence, misrepresents the event (he did not sign a law on embryo research, he signed the budget bill, which contained one small amemendment addressing embryonic research among its reported 3,500 pages of text and appendices), false as to fact (his executive order did not address embryo research), and completely wrong in its implication (the budget amendment does not undo the research policy Obama announced, as this headline implies). Despite this falsity and confusion, the event is viewed as some sort of humiliation for, or hypocrisy by, President Obama, since he had made a point of repealing the Bush ban on stem-cell research funding just two days before signing the budget with its unrelated embryo-research amendment. Much chortling and back-slapping is now underway, among people who know nothing about the issue and are apparently too dumb to read.
Yuval Levin was a staff manager of the Bush-era “President’s Council on Bioethics”, a body widely derided for its almost comically right-wing leanings and gross intellectual malfeasance. Today he steps in it trying to say something all clever and sophisticated about the new authorization for stem-cell research. I got as far as the second paragraph before the crankery blew me away:
I have no freaking idea what this means:
Researchers identified 72 female students who said they favored voluntary euthanasia. Researchers then gave orange juice to these subjects, but half of them got juice spiked with caffeine. The students then read a series of arguments against voluntary euthanasia. An after study showed that the subjects receiving the caffeinated juice remembered more of the arguments AND were more likely to shift towards anti-voluntary euthanasia views. Similar results obtained in a study of 76 males.
["Coffee for Persuasion, "The Chronicle of Higher Education, July 7, 2006, A17; thanks Timothy Murphy UIC]
More seriously, I guess it’s not surprising that short-term memory retention would be affected by neuroactive drugs – though it’s a bit worrisome that such an ubiquitous one would have such a notable effect. Taking a total wild-ass guess, I would assume that the change in position is a function of the greater retention of the material – that is, that ingesting caffeine doesn’t inherently make you anti-euthanasia, but rather that a differential retention of arguments specifically against that position, caused by the drug, would then tend to skew respondents’ answers in that direction simply because they then had more such arguments in their heads.
Looking further, the original report is here. The situation is more complicated than explained in the blurb above: The students were selected for having opinions favorable to voluntary euthanasia (so the researchers could test the affect of the reading on changing their opinions). They were not just told to read the articles about euthanasia, but were divided into groups and given one of two tasks: either a mechanical editing chore or a specific instruction to read the articles carefully and consciously try to remember the arguments they used; they were then tested on retention and the affect of the articles on influencing their opinions. They were then given counter-messages (articles in favor of voluntary euthanasia) and re-tested on the degree to which receiving the counter-messages undid the change in opinion they had undergone from reading the original arguments.
The results indicated that reading the first (anti-euthanasia) arguments had no effect on opinion or retention, with or without caffeine, for the students who were given the simple editing task without being told to concentrate carefully. However, reading the first argument with careful concentration did improve both retention of the arguments and a change in the students’ opinions; the effect was present in both the caffeinated and the no-caff groups, but it was greater with caffeine. Then, after reading the counter-arguments, students who did not take caffeine reverted their opinions back to their original opinions, but students who did take caffeine were not affected by the counter-messages and retained the new opinions they had adopted after reading the first arguments. (A summary of the report appears below.)
The researchers attribute this to the differential affect of initial arguments and counter-messages: apparently, there is a theory in psychology that when people are exposed to new information, they tend to favor the first message they hear, which sets up a defense in their minds against a counter-message that they hear afterwards. Interestingly, in the above experiment this effect was not observed for the non-caffeine group, but the caffeinated group did show a defensive effect against the counter-message. This seems to me just as important a result from this experiment as the basic effect of the caffeine itself.
The results seem to suggest that caffeine not only aids retention of information (that one is consciously processing already), but somehow fixes it more firmly in the mind or increases one’s susceptibility to being swayed by it. The first part doesn’t seem so startling, but the latter is, to my inexpert perspective at least. It would be interesting to repeat the experiment with, say, bioethicists or others well-versed in the issue, to say whether their opinions would be more vulnerable under caffeine than those of students presumably reading about the issue seriously for the first time. I would predict the professors would not change their existing opinions even with the caffeine boost; if they did, that would suggest that the caffeine not only increases receptivity to new messages but somehow overrides existing strongly held opinions (a result that, frankly, I hope is not the case).
The Onion drops more science (from 1999):
HOPE SPRINGS, AR—The holy and sacrosanct miracle of birth, long revered by human civilization as the most mysterious and magical of all phenomena, took place for what experts are estimating “must be at least the 83 billionth time” Tuesday with the successful delivery of eight-pound, four-ounce baby boy Darryl Brandon Severson at Holy Mary Mother Of God Hospital.
The milestone was achieved by Carla Severson, 32, an unemployed cosmetology-school graduate and homemaker, and her husband of 14 years, Dwayne Severson, also 32, a former screen-door factory worker and freelance lawncare contractor. Experts say the miracle most likely was the result of the pair engaging in an otherwise routine act of sexual intercourse at some point during late May 1998. . . .
“This truly is a miracle,” said OB-GYN floor nurse Sandra Meese, placing Darryl Brandon in the New Births Room of the hospital’s maternity ward, where he joined 32 other equally miraculous babies. “Looking down into this precious child’s red, screaming face, so barely distinguishable from all the other wailing children surrounding him on all sides, one is reminded of just how special and unique the gift of life really is.” . . .
Noted essayist and biologist Stephen Jay Gould . . . call[ed] the latest addition to the Severson household “a miracle beyond compare.”
“It’s an amazing turn of events, no doubt about it,” Gould said. “Just think: A spermatozoa from a male mammal fertilized the ovum of a female mammal, causing a fetus to develop and, in time, come to term and pass through the female’s birth canal as a new being. It just goes to show that there are some mysteries even science cannot explain.”
[Note to Pete at March Together for Life, and all his little friends: not everything above is strictly true.]
Roman Catholic Cardinal Alfonso Trujillo has announced that anyone who participates in research that involves the destruction of an embryo – specifically, stem-cell researchers – is liable to excommunication from the Catholic church. This is apparently an expansion of existing Catholic doctrine regarding abortion providers. (Trujillo, you may recall, is the clown who released a lengthy report, quickly demonstrated to be scientifically false in almost every respect, concluding that condoms do not help prevent AIDS.)How much impact the excommunication policy will have remains to be seen. Trujillo’s justification for it, however, is more worrisome.
Psychologist David Barash makes a welcome, and very overdue, point in an interesting Op-Ed in the LA Times: the well-documented decline in birthrate, and the rise in voluntary childlessness in Western cultures, not only does not conflict with a theorized evolutionary-psychological drive to reproduction, but is an expression of the fundamental freedom from evolutionary pressures that gives human nature its unique qualities.
In traditional evolutionary theory, reproductive success is all; those who die with the most kids win. Evolutionary psychology and sociobiology put this in more complicated perspective – altruism, kin selection, and all that – but it was still understood that getting your gametes over the hump, as it were, was the goal of life. This makes voluntarily non-reproductive lifestyles – whether homosexuality, delayed reproduction (with its risk of failure), or plain “childlessness by choice” – seem positively unnatural, and thus, in the naive fallacious naturalism that so often characterizes the right wing, that much more immoral. “Contracepting”, or not having kids by whatever means, becomes not merely religiously irritating to those of the familiarly thin skin, but somehow perverse, an attack on the species imperative to survive and prevail. Or so it may seem.
Barash defends sex for its own sake (a stance the more pathetic for its boldness in this benighted day):
For more than 99.99% of their evolutionary history, humans haven’t had the luxury of deciding whether to reproduce: simply engaging in sex took care of that, just as eating solved the problem of nutrition. But then something quite wonderful arrived on the scene: birth control. Because of it, women (and men) can exercise choice and, if they wish, save themselves the pain, risk and inconvenience of childbearing and child-rearing, indulging themselves rather than their genetic posterity.
There has been a flurry of attention recently to the notion of a “poverty of the stimulus” argument in moral development. Briefly, the “Argument from the Poverty of the Stimulus” (“APoS”) was advanced by Noam Chomsky in support of his theory regarding an innate (“nativist”), universal human grammar, on which children draw as they learn language. (The argument has a formal structure, but it basically consists in the observation that the specific grammar of the particular language the child is exposed to is underdetermined by the stimulus the child receives – the sentences the child hears from others. Given a limited set of inputs, a variety of possible grammatical structures capable of producing those sentences could be deduced, so the child cannot learn one particular language from that input; instead, the child learns the one language that is capable of generating the set of sentences it has heard and which is possible under the set of universal grammatical rules hardwired into its brain. When it has heard enough sentences, only one plausible grammatical structure will be available from within the universal grammar the child possesses, although many possible grammars could still have been deduced if that constraint were not present. The existence of the universal grammar is required to make accurate language acquisition possible in spite of the poverty of the stimulus, and therefore the fact that language is acquired at all is evidence for such a universal grammar and therefore the truth of the nativist theory of language.) The moral parallel is the idea that there is a universal, nativist moral sense. Just as the existence of hardwired language rules allows the child to generate new sentences, despite its exposure to impoverished language stimuli previously, so the nativist moral sense allows the child to make moral judgments regarding situations it has not already encountered. Just as the nativist language theory is a refutation of the empiricist school of language – holding that language skills are acquired essentially by behaviorist-style mimicry – the nativist moral theory is a refutation of the claim that moral judgments are culturally determined.
Adam Colber of Neuroethics & Law Blog has a good post, referencing an interesting recent journal article on the topic. Kyle Swan of Pea Soup had a more detailed discussion of the subject about 18 months ago (I just found the link after being “stimulated” by Colber’s post), which provides some excellent speculation and a very insightful comments thread. He also provides a useful bibliography, and links to a preceding series of posts on moral realism. There’s some excellent work going on over there at Pea Soup.
But what does this all cash out to?
The Spanish Socialist Workers’ Party (“PSOE”) has apparently signed on to the agenda of the “Great Ape Project” – namely, to establish legal and moral standing for most species of apes by virtue of what the Project perceives as their sufficient mental capacity for moral personhood. To my knowledge, this is the first time an organized political party of any consequence (including the Greens) has taken this stance.
The Spanish Socialist Party will introduce a bill in the Congress of Deputies calling for “the immediate inclusion of (simians) in the category of persons, and that they be given the moral and legal protection that currently are only enjoyed by human beings.” The PSOE’s justification is that humans share 98.4% of our genes with chimpanzees, 97.7% with gorillas, and 96.4% with orangutans.
Note that the citation of genetic closeness is both a somewhat contentious issue and not directly morally relevant. The Great Ape Project itself refers to mental capacity, not genetic consanguinity. This is still an interesting development, however.
I’m not on the animal-rights bandwagon (though I think there are interesting questions to be asked about intelligence in some primates). I generally have no strong objections to those who are, though I think they’re on the wrong track. I am offended by irresponsible groups like ALF and PETA, and think their illegal acts should be strongly punished, and I am equally offended by false accusations often raised against animal experimenters (though I also agree there have been lapses that should themselves be corrected and punished). In general, I think that the animal-rights activist community is as believable, mature, and responsible as the anti-choice activist community – which is sad, because in many ways their issues and arguments are in fact better grounded.
However, I’m always amused by and contemptuous of the labels on “green” foods and products self-righteously proclaiming that “this product was not tested on animals”. (Today I tried some shaving cream, from a cosmetics company run by two gay men, which was reassuringly labeled “tested only on boyfriends, not animals”. Great product, by the way.) There are only two things that can mean, and they both are predicated on the assumption that you’re an idiot.
I previously posted on controversial remarks by UT biologist Eric Pianka regarding the advisability of a global pandemic that could kill up to 90% of the human species. Relying on an article written by respected amateur scientist and writer Forest M. Mims III, based on his notes of the public address, I accepted Mims’s report that Pianka had openly advocated the deliberate release of Ebola virus for the purpose of accomplishing this mass killing, on grounds that it was necessary to drastically reduce the human population to ensure the ecological stability of the planet. There are a few problems with this scenario, however.
First, Mims appears to be the only witness who believes that is what Pianka was saying that day. Pianka himself denies it, and others present give a different version of his message. Second, Mims’s article has been picked up by the right-wing blogosphere, with predictable results: Pianka has received death threats against himself and his family; many members of the Texas Academy of Science who had nothing whatsoever to do with Pianka or his beliefs have received illiterate, but angry and harrassing, messages, in one case filled with misspellings and all-caps references to the Nazis and, for some reason, the movie Soylent Green; there have been calls for disciplinary action by the university (which to its credit is standing firmly on academic freedom, with the exception of a few board members); and right-wing ideologue and “Intelligent Design” guru William Dembski has reported Pianka to the Department of Homeland Security as a terrorist. The Director of Mims’s parent organization, the Society for Amateur Scientists, has also published an inane and scientifically garbled essay claiming psychological insights into Pianka’s mental health, based on his reading of a second-hand paraphrasal of Pianka’s lecture (“I can only conclude that years ago Eric Pianka must have lost touch with his essential humanity, that is, a strong emotional need for his own kind. Now, perhaps driven by that terrible depression that can occur in old men, he seems to have lost touch with reality. I offer this under the touchstone of Ockham’s razor: I think that depression provides the least remarkable explanation for Pianka’s mental descent. . . . [D]epression can be a side effect of aging, especially in men. Moreover, men often express their depression by becoming angry at the world . . . elderly depressed men often become fixated on death. . . . If this explanation is the right one, then he needs to be treated by a psychopharmacologist with expertise in depression. Until he does receive the necessary care, we must think of him as a person in pain . . .”).
In other words, an ordinary display of scholarly debate from the right wing.
I previously blogged on the question “how much freedom of inquiry is too much?“, specifically regarding controversial or outrageous policy proposals by respected scholars. Dr. Autumn Fiester of the UPenn Center for Bioethics approaches the same question from the perspective of outrageous or frivolous research. She particularly notes the development of a genetically-engineered pig clone containing an enzyme that converts omega-6 fatty acid to the more healthy omega-3, arguing that this is a pure waste of money:
First: the omega-3 pig represents the worst type of “research waste:” precious scientific resources of time, mental energy, and money that could be used to tackle serious human and environmental threats are being devoted to frivolous causes. The list of devastating problems begging for a scientific solution include: chronic, genetic, and infectious diseases, famine, food and water safety, global warming, the destruction of ecosystems – the list goes on and on…
Second: the one problem we don’t have is a shortage of omega-3. Not only is it found naturally in readily available foods like walnuts and fish, but it can be found in supplements and nutritionally supplemented foods like Smart Balance Peanut Butter. We certainly do have a very serious problem of obesity and nutrition in this country, but neither are problems science needs to solve. We are fat because we eat too much, and we are unhealthy because we choose to eat the wrong foods. . . . Offering us genetically modified pork to provide us with a plentiful nutrient is an obvious attempt to drum up a need that justifies the science.
How much freedom of inquiry is too much? How outrageous do someone’s remarks have to be to call down censure? And what should the reaction of the scholarly community be to someone who seems clearly off the deep end on questions of policy, but is otherwise a respectable scholar?
Some on the right wing are taking perhaps-understandable exception to reported remarks of Dr. Eric Pianka, a herpetologist at UT Austin. Pianka was recently awarded the Texas Academy of Science’s Distinguished Scientist of 2006 award – and to all accounts deservedly, on the basis of his biological research. Pianka, however, is apparently kind of a “character”, and he offered remarks at the same session at which he received that award advocating a program of deliberate biological warfare with the goal of mass genocide of 90% of the human species. Which seems a bit extreme.
The recent South Dakota law banning almost all abortions is clearly intended as a strategic move in an effort to allow and newly-anti-choice Supreme Court to overturn Roe v. Wade; the content of the law or its supposed justification are almost beside the point, and its backers have hardly pretended otherwise. It is still somewhat startling, however, to read the actual words of the rube who wrote this law. The gasping scientific ignorance, legal confusion, and sheer dunderheadedness they betray is almost as dismaying as the law itself.
Iocaste, guest-blogging at Majikthise, quotes the below Wall Street Journal Op-Ed at length:
“The belief that there are such things as witches is so essential a part of the faith that obstinately to maintain the opposite opinion manifestly savors of heresy.” So begins “Malleus Maleficarum” (“The Hammer of Witches”), a book commissioned by Pope Innocent VIII and published in 1484. For three centuries “The Hammer” was the principal reference for witch hunters determined to punish sorcerers and rid them of the world.
A no less sweeping manifesto recently appeared in the Journal of the American Medical Association (JAMA). It called for total extermination of contemporary witchery — “financial conflicts of interest” — caused by the malign influence of pharmaceutical and device manufacturers in academic health centers. It argues that these companies pervert altruism, misinform physician education and cause breaches of scientific integrity in medical research. . . .
The [American Board of Internal Medicine] Foundation, like the medieval church, liberally taxes without consent [by charging certification fees] to fund its crusade against “profit-seeking in medicine.” . . .
In their zeal, both “The Hammer” and the JAMA cited scripture selectively. “The Hammer” trolled the Bible and ecclesiastical works for references to support the existence of witches and witchcraft, which remained uncontested until the retraction of anti-witch doctrines centuries later. The JAMA article baldly states that “a systematic review of the medical literature on [industry] gifting . . . found that an overwhelming majority of [commercial] interactions had negative results on patient care,” although the source it cites explicitly says: “No study used patient outcome measures.” The JAMA piece reminds us that industry marketing influences the prescribing habits of physicians. But it repeatedly neglects documented evidence that physicians frequently fail to prescribe appropriate drugs according to evidence-based guidelines for nearly all diseases.
WSJ scores a minor point by noting that the studies mentioned in the editorial did not include clinical data. But they engage in apparently deliberate equivocation by using that point to discredit the actual claim made, regarding the much broader concept of “negative results on patient care” – which can easily be demonstrable without clinical outcome data (though would be better demonstrated with it). The point about sub-optimal prescription patterns is simple misdirection – the (well-documented, and much-criticized) fact that most doctors write the same prescriptions over and over, without close adherence to best-practices standards, will hardly be improved on if they shift to letting perky former college cheerleaders tell them what to prescribe in exchange for a paltry bribe.
What’s really interesting about this, though, is its place in the growing anti-science stance of the right wing. The Bush administration’s outright medievalism on scientific questions is well-documented, as is their wholesale dismissal and distortion of data on science-related policy issues, in favor of positions dictated by their religious or corporate supporters. But it is important to recognize this as a characteristic tactic of the right wing in general, not just the Bush fringe.
The basic position of the right wing on scientific issues that cut across their religious or economic interests is that nothing is ever believable. Distorting the honorable scientific position of keeping all questions open to new data, the right holds that this means nothing science tells us is ever true, or should ever be accepted. The fact that a question can be raised about a given scientific claim means that that claim is “controversial” – whether or not the question raised has actually been answered in a way that implicates the prevailing consensus, or answered at all, or even has any data whatsoever behind it. (Cf. William Hurlbut’s imaginary “altered nuclear transfer” cells, or “intelligent design”, for examples.) Thus every scientific question is controversial, since science allows that challenges can always be raised. Thus, it is always true to say that “science hasn’t proven _____”, and never proper to regard a scientific claim as reliable; for the right wing, “proven” means necessarily true (a category philosophers generally regard as populated only by purely logical constructs), while “reliable” means “proven”. (In clinical-ethics terms, right wingers are in “clinical equipoise” about every scientific fact ever discovered, where the alternative is anything they want it to be no matter what. Now that’s keeping an open mind!)
Thus, the great thing about being a right-wing critic of scientific consensus is that you never have to back up your own claims. To support their points, those advocating for change, or for the adoption of any new policy of any kind, must “prove” (in the right-wing’s impossible sense) whatever they are claiming, while those opposed to change merely have to repeat, after every new study, “it still isn’t ‘proven’”. Conservatism being defined as opposition to change, this is a strategy that works perfectly for conservatives, and has the bonus of making them sound like sophisticated philosophers of science while requiring absolutely no scientific knowledge at all.
From there, it’s simply a matter of putting the rhetorical touches on it. Creationists like to claim science is infected with “a naturalistic bias”; WSJ prefers the historical analogy of equating science with witch-hunting. Since factual claims have no meaning, none of this has to make sense; still, the arrogance of it is breathtaking. The JAMA editorialists cite studies showing impact on patient treatment from the non-patient-directed interference of pharmaceutical advertising; WSJ admits that the advertising is actually effective in distoring doctors’ treatment patterns, then calls this fact-based criticism a witch-hunt. (The alleged reason is that the studies could have been made stronger with more data – a point that makes little difference since WSJ conceded the main point anyway.) Witches, of course, don’t exist. WSJ is not merely calling for more data (and more data, and more data . . . remember how much data it takes to “prove” anything to the right wing?): they are claiming that there is no such thing as deleterious interference with doctors’ prescribing decisions. (But they said the advertising was effective . . .)
This is true in the same sense that there is no such thing as global warming, evolution, or tobacco-caused cancer. Only in the latter case have corporate shills been this shameless in declaring science irrelevant to science policy. That level of intellect, and discourse, is now the conservative standard for evidence-based decisionmaking. It’s going to hurt if we let them get away with it.
Here’s another story of politically-appointed FDA brass overruling the overwhelming consensus of its own scientific board to make a scientifically dubious decision on approval of a marketing application. The best-known – and previously unique – example of behavior of this kind was the bizarre saga of Plan B emergency contraception; now another case has surfaced involving experimental therapeutic usage of a surgical-implant device that FDA reviewers say – on the basis of the manufacturer’s own data showing no statistical difference between the experimental and control groups – is worthless. The division Director unilaterally approved the device anyway.
If “two data points is a trend”, this establishes a very puzzling and very disturbing trend at the FDA. It is fast squandering its reputation as “the world’s most reliable medical safety agency”.
A top federal medical official overruled the unanimous opinion of his scientific staff when he decided last year to approve a pacemaker-like device to treat persistent depression, a Senate committee reported Thursday.
The device, the surgically implanted vagus nerve stimulator, had not proved effective against depression in its only clinical trial for treatment of that illness. As a result, scientists at the Food and Drug Administration repeatedly and unanimously recommended rejecting the application of its maker, Cyberonics Inc., to sell it as such a treatment, said the report, written by the staff of the Senate Finance Committee.
But Dr. Daniel G. Schultz, director of the Center for Devices and Radiological Health at the agency, kept moving the application along and eventually decided to approve it, the report said.
That approval did follow the backing of a divided F.D.A. advisory committee. Still, the Senate committee, which for two years has been investigating the decision-making processes at the F.D.A., could find no previous instance in which the director of the center had approved a device in the face of unanimous opposition from staff scientists and administrators beneath him, the report said.
There is no explanation what the “divided advisory committee” refers to. It is clear that the actual scientific review committee was unanimously against the device, and it’s not hard to see why:
The vagus nerve stimulator is surgically implanted in the upper chest, and its wires are threaded into the neck. Batteries in the device stimulate a nerve leading to the brain.
The nerve stimulator has been approved since 1997 for the treatment of epilepsy in some patients. Common side effects include voice alteration, increased cough, shortness of breath, neck pain and difficulty swallowing. The device has also been linked to rare reports of death, heart problems and vocal cord paralysis.
When some epilepsy patients reported that their moods had changed after receiving the devices, Cyberonics, based in Houston, implanted them in 235 depressed patients and turned the machines on in half of them. After three months, the two groups were equally depressed. The trial had failed.
Cyberonics then turned the devices on in all 235 patients and determined that 30 percent showed significant improvement after six months or more. Without a control group, however, it was impossible to determine if the device had caused the improvement.
Cyberonics is now defending the device as “the only safe and effective treatment option ever specifically developed, studied, F.D.A.-approved and fully informatively labeled for the treatment of chronic or recurrent treatment-resistant depression.”
This is shocking. If the description above is correct, the company not only failed to demonstrate any therapeutic effect from their device, they actively manipulated the trial to obscure disconfirmatory data and then claimed a positive result based on an uncontrolled trial which they had purposefully initiated after the controlled trial failed. This goes beyond a merely questionable device: based on this news report (which may not be reliable, it is important to remember), this appears to be deliberate scientific fraud.
The company’s behavior is absurd: they deliberately eliminated the control group and then claimed a positive result that was only apparent in the trial group when no control group was available for comparison – doing so after the controlled trial demonstrated no distinct effectiveness in the experimental group! This is just outrageous. And their claimed “benefit” is laughable – famously, about one-third of untreated psychiatric patients show improvement over time, and at any rate you would expect some percentage of the experimental group to get at least somewhat better after 6-9 months; to openly embrace the post hoc fallacy by claiming it was due to your device simply because something happened (as if nothing would have happened without the device – when we know patients change naturally), is nonsense. (Based on the company’s reasoning, it would be equally valid to claim that the device prevents improvement in 70% of patients!) Again, this is indistinguishable from fraud.
Even ignoring the company’s outrageous behavior, however, that an FDA Director overruled the scientific panel, and in such an egregiously obvious case!, is worse yet. It’s hard to tell what motivation this Director would have had – it doesn’t appear to be a case of pandering to the right wing, as with Plan B – and there is yet no reported evidence of payoffs or conflicts of interest. But clearly something went very wrong on this case, and clearly, too, the FDA has become the kind of organization at which such things can and do happen.
Once that would have been unthinkable. Under the current administration – anti-science, pro-business, and with a conviction that truth is what you say it is – it appears to have become policy.
I haven’t had much to say about the South Korean cloning meltdown; I don’t think it’s really very important in the long run, though of course it was a shock, and remains a kind of horror-show as it unfolds.
What we know is, essentially, that a South Korean team headed by the now-disgraced Hwang Woo-suk galvanized the world last year by announcing that they had successfully cloned a large number of human embryos – becoming the first group in the world to do so in volume. What’s more, they had made sure to do so under close IRB supervision, imposing strict protocols for how eggs were to be harvested for the attempts, and what kinds of insulation there would be between the cloning team and the egg donors to prevent coercion. Some time after that announcement, questions were raised as to whether those guidelines had been followed, as Hwang claimed they had; discrepancies were noted between the time the team’s first results were reported and the time that would have had to pass for eggs gathered under the new protocol to produce a cloned embryo (and some of the first reported results may even have dated from before the development of the new protocol). Later, it developed that at least one of the eggs used in the reported successful clonings came from one of Dr. Hwang’s research assistants, both violating the harvesting protocol and raising important questions of coercion in Korea’s highly hierarchical and authoritarian culture and academic system. This revelation prompted one of the American co-researchers to resign from the project to avoid affiliation with unethical practices. And then, most recently, it was revealed (one agonizing step at a time) that some of the reported cloning results may not have been correct, or that some of the reported clones were not in fact real, or that almost none or in fact none of the clones had been created as described. The major paper announcing the results was withdrawn, and at least one other paper was withdrawn. Finally Dr. Hwang resigned his position, and the entire episode is now regarded as contributing no reliable science at all to the field of cloning/stem-cell research, and as being in every respect a mind-boggling fiasco. Scientifically, we are back where we started, as if the Korean episode had never happened. In the court of public opinion – especially as spun by right-wing opponents of cloning and embryonic research – things are worse than before.
OK – so much, so bad. A scientific mess of the first water, with important ethical lapses thrown in: the IRB protocol was violated; material donors were subject to possibly overt, and probably implicit, coercion; the protocol breach was lied about in print and in public; research results were falsified in journals and in public statements; the falsifications were only uncovered slowly and in the face of further prevarications. Yet it played out as all such cases of scientific dishonesty always do: although opponents of science are constantly harping on the rare cases of scientific misconduct – Piltdown Man, Haeckel’s embyos – as if they invalidate science itself, or the field of science in question (always either evolution or human sexuality), the disparagers themselves have never succeeded in actually identifying or correcting any cases of scientific misconduct. To do that, they would have to understand science, which they resolutely refuse to do. In all such cases – and The Case of the Crazy Korean Cloner is merely one more example – it is scientists themselves, and in this case ethicists, who unveil the dishonesty and set the record straight.
Ethicists, and the defenders of academic honesty, do not expect that falsifications will never occur – though we may hope so. But we know that the procedures of real science, and of careful ethical oversight, will catch almost all such cases, and most especially the ones that are important enough to matter. The inherent self-correction mechanism of science – the fact that people can and will attempt to replicate, and to falsify, one’s reports – all but guarantees that the only science that remains false is the bits that no one pays attention to in the first place. Fields of heated scientific ferment are bad places to publish prominent faked papers (something Hwang must have been a fool to overlook).
Merely wrong science – and there are incalculably many good-faith wrong turns in science, it’s how the field works – will certainly be corrected by further efforts. Dishonest science in any prominent forum will very likely be uncovered. (Dishonesty usually results from thinking you can get the results you have not yet gotten, and so claiming them anyway – but if you are wrong, you will be found out, and even if you are right you are likely to be found out. Human cloning is almost certainly possible – Hwang wasn’t wrong about that – but he claimed he had the goods when he didn’t, and then couldn’t produce them as claimed.) Research ethics does not possess such a self-correction mechanism – you can’t re-run an informed-consent procedure to prove that it works – and so vigilance rather than mere good work is the necessary corrective. But in the Hwang case the ethicists did all they could to guide the process, then raised red flags when it went off the rails. A researcher resigned what was arguably the highest-profile scientific project in the world at that moment – and while the science itself was still believed to be good – over ethical violations that themselves seemed more technical than substantive. And those ethical revelations prompted widespread criticism even from supporters of the basic research project itself – partly fueling the scrutiny that eventually brought the whole thing down.
In this case, the process worked perfectly, and with amazing speed – regarding both the ethics and the science. Right-wing opponents were incensed that the project was taking place at all – that it went badly adds nothing to their objections, nor proves them right. But the fact that these lapses were found out, publicized without hesitation, and then publicly proven, by supporters of the research, demonstrates that there is a core of solid professionalism in science, and that it works to enforce the self-imposed guidelines and principles that scientists and pro-science ethicists themselves have developed. And, as said above, the fact that the scientific lapses were discovered and publicized by scientists – specifically, scientists who supported the research, only proves again that science when it goes wrong is more reliable than the anti-science crowd pretends it to be even when it goes right.
In the end, this is a riveting, but singularly uninstructive, event. We know nothing more about cloning than we did, thanks to Hwang and his boobish debacle. But we also know nothing more about science, or about research ethics. We know that the corrective processes they both impose on the substantive matter, and ethical conduct, of scientific research are remarkably effective, and the more so in prominent and important cases, and that they are driven by the devotion to good science of the scientists and ethicists themselves. But we knew that already. We see it on every (rare) occasion that one of these incidents pops up, when it is the scientists who uncover the bad science, and the pro-science ethicists who set it back on the right track.
Whatever the right-wing noise machine may make of this incident, it provides no fodder for their beliefs, and they have contributed nothing either to our scientific knowledge or our ethical infrastructure. Science will proceed, rightly for the most part, and entirely without their contributions or insight – as it always has done.
A researcher from Georgetown U. Law School has published a paper arguing that data from studies of people’s intuitive reactions to “trolley problem” scenarios (a classic ethical hypothetical first posed by Philippa Foot, in which one has the option of either allowing a runaway trolley to hit a group of people in its path, or stopping it in a way that involves killing just one person who would otherwise have lived if you hadn’t intervened) demonstrates that they have similar sets of intuitive moral principles that reside below the level of cognitive awareness.
Aspects of the Theory of Moral Cognition: Investigating Intuitive Knowledge of the Prohibition of Intentional Battery and the Principle of Double Effect
Where do our moral intuitions come from? Are they innate? Does the brain contain a module specialized for moral judgment? Does the human genetic program contain instructions for the acquisition of a sense of justice or moral sense? Questions like these have been asked in one form or another for centuries. In this paper we take them up again, with the aim of clarifying them and developing a specific proposal for how they can be empirically investigated. The paper presents data from six trolley problem studies of over five hundred individuals, including one group of Chinese adults and one group of American children, which suggest that both adults and children ages 8-12 rely on intuitive knowledge of moral principles, including the prohibition of intentional battery and the principle of double effect, to determine the permissibility of actions that require harming one individual in order to prevent harm to others. Significantly, the knowledge in question appears to be merely tacit: when asked to explain or justify their judgments, subjects were consistently incapable of articulating the operative principles on which their judgments appear to have been based. We explain these findings with reference to an analogy to human linguistic competence. Just as normal persons are typically unaware of the principles guiding their linguistic intuitions, so too are they often unaware of the principles guiding their moral intuitions. These studies pave the way for future research by raising the possibility that specific poverty of the stimulus arguments can be formulated in the moral domain. Differences between our approach to moral cognition and those of Piaget (1932), Kohlberg (1981), and Greene et al. (2001) are also discussed.
Mikhail, John, “Aspects of the Theory of Moral Cognition: Investigating Intuitive Knowledge of the Prohibition of Intentional Battery and the Principle of Double Effect” (May 2002). Georgetown Public Law Research Paper No. 762385
Without reading the whole paper, it’s hard to tell exactly what argument is being made here. However, this seems to me to smack of the common sociobiological strategy of observing a behavioral pattern and then asserting that the fact that it is common proves it must have a biological origin. In particular, statements such as “data from six trolley problem studies . . . suggest that both adults and children ages 8-12 rely on intuitive knowledge of moral principles” implies both that there are such things as intuitive moral principles and that they are relied on in making the decisions the respondents make to the problems. But even if moral responses are hardwired, as sociobiologists tell us, and even if these responses cover such scenarios as the trolley problem, it is unlikely they take the form of “principles” except in the sense in which they result in behavior patterns that could be predicted by reference to moral principles. That is to say, the brain doesn’t work by way of principles, but by way of a network of mutually-reinforcing weighted signals; there is no more “principle” consulted by the brain in adducing an intuitive response to a moral problem than there is a rule saying “be aroused by attractive persons” that results in sexual excitation, or a rule that says “swing now” that results in hitting a baseball.
It is common to describe empirically-observed behavior as if it was rational-rule-driven (“the subordinate ape engages in submissive posturing to avoid conflict with the dominant ape”), but this has to be understood as an abstraction from the actual phenomenon in question. That’s fine in most cases. But when you are attempting to infer, from observed behavior, general behavior-guiding principles for the purpose of establishing a behavior-guiding system of principles, i.e., a moral theory, then the reification of the “principle” analogy becomes a problem.
It seems even more apparent that that is what Mikhail is doing when he says “Just as normal persons are typically unaware of the principles guiding their linguistic intuitions, so too are they often unaware of the principles guiding their moral intuitions.” Again, the assumption is made that “principles” are somehow consulted in the brain, both to produce effective linguistic behavior and to drive intuition-guided responses to moral scenarios. But they are not. In the linguistic case, the inference of principles contributes to the development of a theory that describes how language can be said to work – as long as we don’t believe the brain actually works by way of the same rules that structure the theory we use to describe what the brain does. In the moral case, however, we construct moral theories not to describe human behavior, but to prescribe it. Mikhail is observing behavior to craft a rule-based system to model that behavior, which he then apparently regards as the correct system for determining that behavior where it is not automatic (e.g., among persons with “defective” intuitions, or in scenarios that do not immediately generate any governing intuition).
This is a perilous enterprise for two reasons, one obvious and one less so. The obvious one is a variation of the “is/ought” problem – the fact that certain behavior is what people do has nothing to do with whether it is what they ought to do. The less obvious reason is the one I have been emphasizing above: it is a form of circular reasoning to assume the brain works by way of moral principles, infer those principles from the way the brain works, and then declare that those are the principles by which the brain ought to work. And, aside from circularity, it is false on its face because the brain does not work by way of principles except in a metaphorical sense.
There is certainly a place for prescriptive moral principles – it is the place of normative ethics. But we must find or create the right ethical principles ourselves – not merely observe them in the modal intuitive responses of random persons to moral hypotheticals. Those responses neither encode moral principles nor establish moral norms. The local maxima of psycho-physiological signalling networks, Mr. Mikhail, are what we are put on this earth to rise above.
Hat tip: HealthLawProf Blog (in an interesting roundup of articles on “the principle of double effect” in various contexts).
Wesley J. Smith is, as usual, all het up about animal rights activism – this time on Constitutional Law grounds. I can hardly understand what he’s trying to say, but it makes little sense (again, as usual).
A few years ago, animal rights/liberation activists successfully convinced Florida voters to grant pregnant pigs the state constitutional right to have enough space within which to turn around. Now, that may be a perfectly fine and humane animal husbandry policy. But, pigs do not belong in human constitutions.
Human constitutions should be about guaranteeing human rights and establishing our democratic methods of governance. Animal protection measures belong in legal statutes. In this way, it isn’t the animals having a “right,” but rather, humans having the affirmative obligation to act toward them in appropriate ways.
But, of course, protecting pigs was not the point of that exercise. Blurring the crucial distinction between animals and humans was the real agenda.
Though I agree with Smith that animal-rights groups often go too far, I’m having a hard time seeing this as some sort of conspiracy. But Smith is aghast at the potential consequences. In the post linked above, he quotes his own editorial on the same subject:
If we are to avoid “speciesism,” [animal rights advocates'] thinking goes, we must give up our belief that life has ultimate value simply because it is human. This objective standard, in their thinking, being steeped in religion or outmoded notions of natural law, must be replaced by a “rational” approach that accords value to each individual — animal or human — based primarily on the level of the individual’s perceived level of consciousness or the ability to feel pain.
One expression of this view is the bioethical theory of “personhood,” according to which rights are based on whether one’s “quality of life” is sufficient to qualify for membership in the “moral community” made up of sentient, self-aware “persons.” Since value is based on gray matter and not genome, non-sentient humans — including newborn infants, Alzheimer’s patients, the severely retarded, and the comatose, among others — would be excluded from this community. At the same time, some “nonhuman animals” would be included in the moral community, including dogs, pigs, elephants, dolphins, whales — perhaps all mammals.
The consequences of such a radical shift in core societal beliefs would be profound. As animal rights author and lawyer Steven M. Wise recently told the Village Voice, establishing legal personhood for animals would grant them “the [same] fundamental rights that we humans have.” This would mean, according to Wise, that “If you wanted to do something to violate the animals’ rights, at the very least they should have a guardian appointed to represent their interests, the way a human child or any severely impaired human would.”
Of course, it is a long way from granting limited constitutional rights to pregnant pigs to expanding coverage of the Bill of Rights to all animals. But it would definitely be a first step on the proverbial thousand-mile journey.
This is a fair characterization of the thinking of some animal-rights advocates (and of many bioethicists who do not go so far as to include animals in the sphere of personhood). But it is a far cry from accepting mental capacity as a criterion for moral personhood to imagining that writing animal rights into a state Constitution will establish animals as persons in the legal sense. Though this is a much-honored tactic of the anti-choice right wing, who have been feverishly writing fetal-protection statutes into the law wherever they can manage it, in the expectation that calling a fetus a person will make it a person, it is just as irrational in the case of fetuses as it is in the case of animals. The entire enterprise (if indeed this is what animal-rights activists are attempting to do, as Smith imagines) is logically backward: for “rights” for these entitities to make any sense, you must first demonstrate that they are moral persons; then you can talk about what legal status they ought to have. But merely imposing certain legal regulations on the treatment of a given entity does not make it a moral (or a legal) person. You can mandate legal protections for non-persons (and we do so all the time: flags, parklands, national monuments, dead bodies, etc.). You can demand “humane” or non-harmful treatment for non-persons as well, as again we do in many cases (pets, farm animals, etc.). But simply declaring that we think certain entities should be treated in certain ways does not mean we think those entities are persons. Even declaring that we think they should be treated in the way that they would have to be treated if they were in fact persons does not make them persons. (You can treat something as if it was a person even when it’s not one.) The claim that a given entity is a person is logically prior to the claim that the entity enjoys the rights of personhood by virtue of being a person, and nothing can change that.
Strangely, Smith seems to believe that legal constitutions must not contain anything that does not pertain to specifically human rights.
Granting animals constitutional rights would cheapen these charters. Indeed, it would undermine constitutions as exclusively establishing and protecting human rights.
But it’s clear that constitutions do much more than that. They establish the structures of government and the law, stipulate terms, powers, and privileges of offices, decree relations between the constitutional entity and other entities, declare and regulate the rights of subjects, and many other things. Democratic government may embody certain notions of human rights, but nothing about human rights is invoked in stipulating that a President shall serve for 4 years, or 6, or 7, or what have you. Whether the government includes a unicameral or bicameral legislature is of great political significance but has nothing to do with personhood and almost nothing to do with rights. Smith states that animal-protection is all right in the statutory laws, but takes on some sort of ominous moral significance if written into the constitution; this seems not only a distinction that makes very little moral difference, but one founded on a delusion about what a constitution is. And the fact that many US states use their constitutions as a kind of repository for laws passed by referendum (California’s state constitution is over 200 pages long and has been amended over 400 times), without trespassing on any grave moral concepts in doing so, makes it clear Smith is working from assumptions that have nothing to do with legal reality.
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