Obama and stem cell research...

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U.S. President Barack Obama has signed an executive order lifting funding limits on research with embryonic stem cells imposed by his predecessor, George W. Bush.

"Today, with the executive order I am about to sign, we will bring the change that so many scientists and researchers, doctors, and innovators, patients and loved ones have hoped for, fought for these past eight years," Obama told reporters at a news conference at the White House on Monday.

"We will lift the ban on federal funding for ... embryonic stem cell research."

The long-promised move will allow a rush of research aimed at one day better treating, if not curing, ailments from diabetes to paralysis — research that has drawn broad support, including from notables like Nancy Reagan, widow of the late Republican president Ronald Reagan.

Under Bush, taxpayer money for that research was limited to the 21 stem cell lines that were created before Aug. 9, 2001. But researchers have said that these lines have, in many cases, had some drawbacks that limited their potential usability.

The research is controversial because days-old embryos must be destroyed to obtain the cells. They typically are culled from fertility-clinic leftovers otherwise destined to be thrown away.

"In recent years when it comes to stem cell research, rather than furthering discovery, our government has forced what I believe is a false choice between sound science and moral values," Obama said.

"In this case the two are not inconsistent. As a person of faith I believe we are called to care for each other and work to ease human suffering."

Obama qualified his support for stem cell research by saying that his administration "will never undertake this research lightly."

"We will support it only when it is both scientifically worthy and responsibly conducted. We will develop strict guidelines which we will rigorously enforce, because we cannot ever tolerate misuse or abuse."

Obama also said his administration will never open the door to human cloning, which he called "dangerous." Embryonic stem cells are master cells that can morph into any cell of the body. Scientists hope to harness them so they can create replacement tissues to treat a variety of diseases — such as new insulin-producing cells for diabetics, cells that could help those with Parkinson's disease or maybe even Alzheimer's, or new nerve connections to restore movement after spinal injury.

Change gives greater flexibility for research

Since Bush's decree, hundreds of new stem cell lines have been created. Researchers say these new lines, funded by private dollars, are healthier and better suited to creating treatments for people rather than doing basic laboratory science.

Obama's change does not fund creation of new lines. But it means that U.S. scientists who until now have had to rely on private donations to work with these newer stem cell lines can apply for government money for the research, just like they do for studies of gene therapy or other treatment approaches.

The reversal of the Bush ban on funding for new lines fulfills a promise made repeatedly by Obama during his presidential campaign. Obama called on Congress to "act on a bipartisan basis" to provide further support to stem cell research.

But critics have questioned Obama's eagerness in implementing the change at a time when the United States is struggling through a severe economic tailspin.

Eric Cantor, the No. 2 Republican in the House, said in a Sunday interview with CNN that the White House should focus on the economy instead.

"[Obama's] response to that is that the economy's a big problem, it's going to take a long time to turn around so we can do other things at the same time," said the CBC's Paul Hunter from Washington, D.C.

"Nonetheless, he's doing it very quickly and ... sending that strong signal in his remarks there that his administration wants to put science ahead of ideology."

Obama also announced Monday that his administration would draw up "a strategy for restoring scientific integrity to government decision-making."

The strategy would "ensure that in this new administration we base our public policies on the soundest science, that we appoint scientific advisers based on their credentials and experience, not their politics or ideology."

He did not offer further details.

http://www.cbc.ca/world/story/2009/03/09/obama-stem-cells.html

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Pros and cons of stem cell research as a federal issue or a states right issue can be found here

Recent legislative action on Georgia prohibiting stem cell research can be found here

A news clip on Obama and stem cell research can be accessed here

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Your assignment is to create an 11 sentence paragraph based on the prompt

"Should individual states create their own legislation concerning stem cell research?"

Please provide details and examples. Publish your assignment as a comment to this post. Questions, please me doug@dougabshire.com Thanks, Mr. A

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Death With Dignity

Oregon Death with Dignity Act

From Wikipedia, the free encyclopedia

Measure 16 of 1994 established the U.S. state of Oregon's Death with Dignity Act (ORS 127.800-995), which legalizes physician-assisted dying with certain restrictions. Passage of this initiative made Oregon the first U.S. state and one of the first jurisdictions in the world to permit some terminally ill patients to determine the time of their own death.

The measure was narrowly approved in the November 8, 1994 general election. 627,980 votes (51.3%) were cast in favor, 596,018 votes (48.7%) against.

The Act was challenged by the George W. Bush administration, but was upheld by the Supreme Court of the United States in Gonzales v. Oregon in 2005.

Under the law, a capable adult Oregon resident who has been diagnosed by a physician with a terminal illness that will kill them within six months may request in writing, from his or her physician, a prescription for a lethal dose of medication for the purpose of ending the patient's life. Use of the law is voluntary and the patient must initiate the request. Any physician, pharmacist or healthcare provider opposed on moral grounds does not have to participate.

The request must be confirmed by two witnesses, one of whom cannot be related to the patient, be entitled to any portion of the patient's estate, be the patient's physician, or be employed by a health care facility caring for the patient. After the request is made, another physician must examine the patient's medical records and confirm the diagnosis. The patient must be determined to not suffer from a mental condition impairing judgment.

If the request is authorized, the patient must wait at least fifteen days and make a second oral request before the prescription may be written. The patient has a right to rescind the request at any time. Should either physician have concerns about the patient’s ability to make an informed decision, or feel the patient’s request may be motivated by depression or coercion, the patient must be referred for a psychological evaluation.

The law protects doctors from liability for providing a lethal prescription for a terminally ill, competent adult in compliance with the statute restrictions. Participation by physicians, pharmacists, and health care providers is voluntary. The law also specifies a patient's decision to end his or her life shall not "have an effect upon a life, health, or accident insurance or annuity policy."

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3.5.9

State's hospitals formulate assisted-suicide plan
By Janet I. Tu
Seattle Times staff reporter

University of Washington Medicine health system and Group Health Cooperative have opted in. Swedish Medical Center is, for the most part, opting out. Virginia Mason Medical Center's hospital will not be participating, though its outpatient clinics can.

As Washington's Death with Dignity Act takes effect today, hospitals both locally and statewide vary in terms of whether they'll take part. Washington voters approved Initiative 1000 — the Death with Dignity Act — in November. Modeled closely on a decade-old Oregon law, it allows physicians to prescribe lethal doses of medication to terminally ill patients determined to have six months or less to live.

The act allows health-care facilities and individual health-care providers not to participate. Since the law passed, health-care facilities have been scrambling to come up with policies.

Now, it appears that about a third of the state's hospitals seem to be opting out, said Cassie Sauer, spokeswoman for the Washington State Hospital Association. That means caregivers operating in their facilities or on their behalf are forbidden from helping a patient die, and their pharmacies may not dispense the medications.

About a third of the hospitals are participating, meaning they're letting each individual doctor, pharmacist and caregiver decide whether to take part. And about a third seem to be somewhere in the middle, Sauer said. That could mean a hospital might forbid doctors and pharmacists from prescribing and dispensing lethal medications on its premises. But the hospital could let its doctors prescribe a lethal dose to an outpatient.

"I'm surprised by the middle ground," Sauer said. "I thought people would be all in or all out. I think people are finding a third way."

For UW Medicine — which includes the UW Medical Center and Harborview Medical Center — and Group Health Cooperative, opting in means allowing each doctor to decide whether to participate.

Swedish will not allow providers to participate on Swedish premises and will not allow its pharmacies to fill prescriptions for life-ending medications. But it will give referrals to other providers and pharmacies if the patient requests it. Physicians can also choose whether or not to participate when they're not in Swedish facilities.

Virginia Mason will not provide Death with Dignity services in its inpatient hospital. But individual providers in Virginia Mason's outpatient clinics — which includes a cancer institute — can choose whether to participate. Virginia Mason pharmacies will not dispense the lethal medications but its pharmacy staff may tell providers who will.

Regardless of how hospitals and other facilities decide, patients and families that want to use the law should be able to find a doctor who will work with them, said Terry Barnett, president of Compassion and Choices of Washington, the right-to-die organization that was behind much of Initiative 1000.

The organization is providing a model letter that patients can give to their doctors to start a conversation and can refer patients to participating physicians. That policies vary widely points to the law's complexity and controversial nature. Opponents have formed a grass-roots group called True Compassion Advocates and are planning to demonstrate at the UW Medical Center today.

They want to show that there are still advocates for "life-affirming choices that don't include ending the life of the patient who needs care," said spokeswoman Eileen Geller.

"Let's not underestimate that this is still a very controversial issue in the United States," said Paul Root Wolpe, director of Emory Center for Ethics in Atlanta. It's also one that's making headlines in other states.

In December, Montana became the third state to allow physician-assisted death when a district-court judge ruled that the state's constitutional guarantees of privacy and dignity mean terminally ill patients have a right to "die with dignity." The state has appealed that decision. And late last month, four members of the Georgia-based Final Exit Network were arrested in a sting operation and charged with assisted suicide in the death of a cancer patient.

"Perhaps we'll end up with a patchwork of states, with some allowing physician-assisted suicide and some not allowing it," Wolpe said. "Right now, it's too volatile to really know."

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Based on the Oregon Law and the recently enacted Washington law, your assignment is to respond to the following prompt in an 11 sentence paragraph format:

Should Colorado pass and enact a "Death with Dignity Law?

Please complete this assignment by 3.13. Thanks, Mr. A

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Happy 200th Birthday Charlie...

February 10, 2009

Essay

Darwinism Must Die So That Evolution May Live

By CARL SAFINA

“You care for nothing but shooting, dogs and rat-catching,” Robert Darwin told his son, “and you will be a disgrace to yourself and all your family.” Yet the feckless boy is everywhere. Charles Darwin gets so much credit, we can’t distinguish evolution from him.

Equating evolution with Charles Darwin ignores 150 years of discoveries, including most of what scientists understand about evolution. Such as: Gregor Mendel’s patterns of heredity (which gave Darwin’s idea of natural selection a mechanism — genetics — by which it could work); the discovery of DNA (which gave genetics a mechanism and lets us see evolutionary lineages); developmental biology (which gives DNA a mechanism); studies documenting evolution in nature (which converted the hypothetical to observable fact); evolution’s role in medicine and disease (bringing immediate relevance to the topic); and more.

By propounding “Darwinism,” even scientists and science writers perpetuate an impression that evolution is about one man, one book, one “theory.” The ninth-century Buddhist master Lin Chi said, “If you meet the Buddha on the road, kill him.” The point is that making a master teacher into a sacred fetish misses the essence of his teaching. So let us now kill Darwin.

That all life is related by common ancestry, and that populations change form over time, are the broad strokes and fine brushwork of evolution. But Darwin was late to the party. His grandfather, and others, believed new species evolved. Farmers and fanciers continually created new plant and animal varieties by selecting who survived to breed, thus handing Charles Darwin an idea. All Darwin perceived was that selection must work in nature, too.

In 1859, Darwin’s perception and evidence became “On the Origin of Species by Means of Natural Selection, or The Preservation of Favored Races in the Struggle for Life.” Few realize he published 8 books before and 10 books after “Origin.” He wrote seminal books on orchids, insects, barnacles and corals. He figured out how atolls form, and why they’re tropical.

Credit Darwin’s towering genius. No mind ran so freely, so widely or so freshly over the hills and vales of existence. But there’s a limit to how much credit is reasonable. Parking evolution with Charles Darwin overlooks the limits of his time and all subsequent progress.

Science was primitive in Darwin’s day. Ships had no engines. Not until 1842, six years after Darwin’s Beagle voyage, did Richard Owen coin the term “dinosaur.” Darwin was an adult before scientists began debating whether germs caused disease and whether physicians should clean their instruments. In 1850s London, John Snow fought cholera unaware that bacteria caused it. Not until 1857 did Johann Carl Fuhlrott and Hermann Schaaffhausen announce that unusual bones from the Neander Valley in Germany were perhaps remains of a very old human race. In 1860 Louis Pasteur performed experiments that eventually disproved “spontaneous generation,” the idea that life continually arose from nonliving things.

Science has marched on. But evolution can seem uniquely stuck on its founder. We don’t call astronomy Copernicism, nor gravity Newtonism. “Darwinism” implies an ideology adhering to one man’s dictates, like Marxism. And “isms” (capitalism, Catholicism, racism) are not science. “Darwinism” implies that biological scientists “believe in” Darwin’s “theory.” It’s as if, since 1860, scientists have just ditto-headed Darwin rather than challenging and testing his ideas, or adding vast new knowledge.

Using phrases like “Darwinian selection” or “Darwinian evolution” implies there must be another kind of evolution at work, a process that can be described with another adjective. For instance, “Newtonian physics” distinguishes the mechanical physics Newton explored from subatomic quantum physics. So “Darwinian evolution” raises a question: What’s the other evolution?

Into the breach: intelligent design. I am not quite saying Darwinism gave rise to creationism, though the “isms” imply equivalence. But the term “Darwinian” built a stage upon which “intelligent” could share the spotlight.

Charles Darwin didn’t invent a belief system. He had an idea, not an ideology. The idea spawned a discipline, not disciples. He spent 20-plus years amassing and assessing the evidence and implications of similar, yet differing, creatures separated in time (fossils) or in space (islands). That’s science.

That’s why Darwin must go.

Almost everything we understand about evolution came after Darwin, not from him. He knew nothing of heredity or genetics, both crucial to evolution. Evolution wasn’t even Darwin’s idea.

Darwin’s grandfather Erasmus believed life evolved from a single ancestor. “Shall we conjecture that one and the same kind of living filaments is and has been the cause of all organic life?” he wrote in “Zoonomia” in 1794. He just couldn’t figure out how.

Charles Darwin was after the how. Thinking about farmers’ selective breeding, considering the high mortality of seeds and wild animals, he surmised that natural conditions acted as a filter determining which individuals survived to breed more individuals like themselves. He called this filter “natural selection.” What Darwin had to say about evolution basically begins and ends right there. Darwin took the tiniest step beyond common knowledge. Yet because he perceived — correctly — a mechanism by which life diversifies, his insight packed sweeping power.

But he wasn’t alone. Darwin had been incubating his thesis for two decades when Alfred Russel Wallace wrote to him from Southeast Asia, independently outlining the same idea. Fearing a scoop, Darwin’s colleagues arranged a public presentation crediting both men. It was an idea whose time had come, with or without Darwin.

Darwin penned the magnum opus. Yet there were weaknesses. Individual variation underpinned the idea, but what created variants? Worse, people thought traits of both parents blended in the offspring, so wouldn’t a successful trait be diluted out of existence in a few generations? Because Darwin and colleagues were ignorant of genes and the mechanics of inheritance, they couldn’t fully understand evolution.

Gregor Mendel, an Austrian monk, discovered that in pea plants inheritance of individual traits followed patterns. Superiors burned his papers posthumously in 1884. Not until Mendel’s rediscovered “genetics” met Darwin’s natural selection in the “modern synthesis” of the 1920s did science take a giant step toward understanding evolutionary mechanics. Rosalind Franklin, James Watson and Francis Crick bestowed the next leap: DNA, the structure and mechanism of variation and inheritance.

Darwin’s intellect, humility (“It is always advisable to perceive clearly our ignorance”) and prescience astonish more as scientists clarify, in detail he never imagined, how much he got right.

But our understanding of how life works since Darwin won’t swim in the public pool of ideas until we kill the cult of Darwinism. Only when we fully acknowledge the subsequent century and a half of value added can we really appreciate both Darwin’s genius and the fact that evolution is life’s driving force, with or without Darwin.

Carl Safina is a MacArthur fellow, an adjunct professor at Stony Brook University and the president of the Blue Ocean Institute. His books include “Song for the Blue Ocean,” “Eye of the Albatross” and “Voyage of the Turtle.”

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Your assignment is to go to the original article and read all of the 45 comments posted to it. Cut and paste two comments (one you agree with and another that you disagree with) into the comment section for this post and then explain why you agree with one and disagree with the other. Questions? Please ask! Thanks. Mr. A

The original article can be found here.

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hybrids.... good or bad?

Chimera (genetics)

From Wikipedia, the free encyclopedia

This article is about a type of hybrid animal.

An example of a sheep-goat chimera.

Typically seen in zoology (but also discovered to a rare extent in human beings), a chimera is an animal that has two or more different populations of genetically distinct cells that originated in different zygotes; if the different cells emerged from the same zygote, it is called a mosaicism. Chimerism in human beings has very few (about 40) reported cases^{[citation needed]}.

Chimeras are formed from four parent cells (two fertilized eggs or early embryos fuse together) or from three parent cells (a fertilized egg is fused with an unfertilized egg or a fertilized egg is fused with an extra sperm). Each population of cells keeps its own character and the resulting animal is a mixture of tissues. An analogy is two jigsaw puzzles cut using an identical cutter, but with different pictures. A single puzzle can be made out of the mis-matched parts, but the completed puzzle will show parts of both pictures.

This condition is either inherited, or it is acquired through the infusion of allogeneic hematopoietic cells during transplantation or transfusion. In nonidentical twins, chimerism occurs by means of blood-vessel anastomoses. The likelihood of a child being a chimera is increased if the child is created via in vitro fertilization. Chimeras can often breed, but the fertility and type of offspring depends on which cell line gave rise to the ovaries or testes; intersexuality and hermaphroditism may result if one set of cells is genetically female and another genetically male.

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Concerns About Chimera Research

This is an excerpt from an article on Chimeras at the Center for Bioethics at the University of Minnesota. Their website is located at: http://www.ahc.umn.edu/bioethics/

While not completely opposed to the research, some experts and interested members of the public raise concerns about techniques and possible outcomes if initial problems are ignored. Their major concerns are the following:

Could chimeras have human brains?

If a chimera's brain is comprised of mostly human neurons with an appropriate structure, experts are questioning whether a human brain—and mind—could develop within an animal or human-animal body. The National Academies Guidelines for Human Embryonic Stem Cell Research cautions that experiments in which there is a possibility that human cells could contribute in a "major organized way" to the brain of an animal require strong scientific justification.

Projects such as the following give rise to questions regarding chimeras with human brains:

* Researchers at Stanford University are injecting human neural stem cells into mouse fetuses to study development of neurologic diseases (see project description in Definition section, above). Initial results were mice with brains that were about 1% human, but researchers could increase that percentage to 100% human brains in the laboratory mice. They anticipate that the structures of the brain, and certainly the size, would still be mouse-like even though the neurons of the brain would be 100% human. Responding to concerns that the experiment could result in brains that were more human than mouse, Stanford University's ethics committee has approved the research on the condition that if the mice developed indicators of human intelligence, such as improved memory or problem-solving, it would be time to stop the project.

* At St. Kitts Biomedical Foundation in the Caribbean, scientists are transplanting immature human brain cells into the brains of vervet monkeys, generating a human-monkey chimera.xxi This kind of research could create human-primate chimeras, with human brain cells.

An expert panel was convened by John Hopkins University in 2005 to study the potential for just such human-primate experiments to significantly change the cognitive and emotional capacities of primates—in effect, to humanize them.

The Working Group on Interspecific Chimeric Brains consisted of primatologists and other scientists, ethicists, and lawyers. They concluded that any shift in brain capacities toward the human end of the spectrum would be more likely to occur if human brain cells were introduced early in the development of the brains of great apes. Experiments in which small numbers of human cells were grafted into healthy adult brains of the most distantly related monkey species were the least likely to raise concerns.

What is the potential for humanized chimeras?

If human embryonic stem cells were to be injected into an animal embryo very early in its development, the human cells might spread through every organ system in the animal embryo. Conversely, animal embryonic stem cells could do the same thing when introduced into an early-stage human embryo. The results of such techniques could be a humanized animal (or animalized human), with physical features and behaviors that are distinctly human.

Considering this possible outcome, the National Academies' Guidelines for Human Embryonic Stem Cell Research say that no animal embryonic stem cells should be transplanted into a human blastocyst (early embryo). In addition, approval by an Embryonic Stem Cell Research Oversight committee should be secured before any human embryonic stem cells are put into an animal.

Could chimeras mate and produce human offspring?

If a female chimera with human ova (egg cells) mated with a male chimera with human sperm cells, scientists believe that it would be possible for a human fetus to be the result. Potentially, a chimera could give birth to a human. To address this issue, the National Academies Guidelines for Human Embryonic Stem Cell Research states: “No animal into which human embryonic stem cells have been introduced at any stage of development should be allowed to breed.”

How will human-primate chimeras be treated?

While already being used a t St. Kitts Biomedical Foundation (mentioned above), primates are likely to be the animal of choice in some human-animal chimera projects because of their close genetic similarities (especially in chimpanzees) to humans. While the guidelines state that “no human embryonic stem cells should be put into nonhuman primate blastocysts [early embryos],” they do not exclude chimera research at a later stage of development. While some oppose this research outright, others are assuming that human-primate chimeras will become more widespread in research and question whether they will be treated as humans or animals.

A.M. Chakrabarty, of the University of Illinois College of Medicine, asks:

"What is a human? This is not a question of the moral dilemma to define a human but is a legal requirement as to how much human material a chimpanzee must have before it is declared a part human and therefore falls under the protection of the Thirteenth Amendment….We must move beyond moral and philosophical discussions of hybrid human-nonhuman animals and be prepared to tackle the difficult legal questions that will attend not-so-distant attempts at creating such hybrids say for organ harvesting, for use as a subhuman species to perform hard manual labors, or simply for curiosity’s sake.”

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From the Center of Bioethics at the University of Minnesota:

Because human-animal chimeras contain human cells—or even tissues or organs that are primarily human—ethical concerns surround the question of just what or who chimeras are. Because they were created under laboratory conditions for research purposes, are chimeras lab animals? Or, will chimeras eventually be developed that are too human to be considered otherwise?

http://www.ahc.umn.edu/img/assets/25857/chimeras.pdf

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Your assignment is to respond to this prompt in an 11 sentence paragraph format. Publish your response as a comment to this post. When stating your opinion, consider the bio-ethic positions of both the Republican and Democratic ideologies on medically related issues such as stem cell research, right-to-life / abortion policy, human cloning, organ transplants etc.

“Should United States scientists have governmental support through tax dollars and facilities to pursue research on chimeras for use in organ transplants, neurological interventions or other possible applications to medicine? If yes, what guidelines or restrictions would you impose? If no, why not?"

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Questions? Ask in class or email me at doug@dougabshire.com. This assignment is by the end of this week. Thanks, Mr.A

US Foreign Policy on AIDS

Bush's AIDS Initiative: Too Little Choice, Too Much Ideology

Restrictive funding, emphasis on abstinence hinder $15 billion effort

By Wendell Rawls Jr.

WASHINGTON — Just two months before ordering the invasion of Iraq, President Bush in his 2003 State of the Union address asked Congress to appropriate $15 billion for care, treatment and prevention of HIV/AIDS in developing countries. The subsequent President's Emergency Plan for AIDS Relief (PEPFAR) served to burnish his "compassionate conservative" credentials even as he took the nation into war.

This pro-abstinence billboard in Kampala is sponsored by the Office of the First Lady. Uganda's first lady Janet Museveni, a fervent Christian who embraces PEPFAR's policies, said in 2003 that condoms are unnecessary for young people. (Associated Press Photo by Morgan Mbabazi)

And it has enabled his administration to funnel tens of millions of dollars to Christian faith-based organizations that support his ideology and form his political base.

Congress authorized the money to be spent over five years primarily in 15 "focus countries," although more than 100 other countries receive smaller amounts. The major goals were to treat those infected with HIV/AIDS, care for those dying of or orphaned by AIDS and prevent the spread of the disease.

"This was an unprecedented moment in history," said Dr. Paul Zeitz, executive director of the Global AIDS Alliance, a Washington-based AIDS advocacy group, and a former official with the U.S. Agency for International Development (USAID). "We've never had this opportunity before. We are the first generation in 100,000 years to have such an opportunity to face a global scourge and defeat it.

"We have the information technology, the communication technology, the transportation technology, the developmental and health systems technology, the biological technology, the global wealth and the moral compass to face this pandemic and change the course, change the reality faster than ever before. There's never been a time when we had all these technologies" to work with.

Dr. Mark Dybul, ambassador for the Office of the Global AIDS Coordinator, refused repeated requests for an interview about the PEPFAR program and its restrictions. But Zeitz was not so reluctant to make an assessment.Despite some successes, PEPFAR has not worked out the way it was envisioned.

"In fact," Zeitz said, PEPFAR "is failing to stop the global spread of AIDS and failing to help lead the world to stop this deadly disease." Instead of "empowering local people," he said, "we are restricting them. We have a flawed framework with flawed policies that have kept us from being where we should be by now."

Information accumulated by reporters in the International Consortium of Investigative Journalists (ICIJ) through more than 100 interviews, examination of thousands of pages of documents and reporting on the ground in affected countries indicates that this historic opportunity may be slipping away, because PEPFAR's "flawed framework" has stressed a restrictive use of the funds earmarked to combat HIV/AIDS.

Experts and activists say that attacking one of the most deadly pandemics in history is an extraordinarily complex venture, dealing with abject poverty and starvation; civil wars and rebellions; devastating violence against women; centuries of such cultural mores as male domination and polygamy, political and corporate corruption, and religions.

In the face of all of that, critics say, PEPFAR has proved at times to be too simplistic and narrow to deal with the complexities of the epidemic.

Initially, the program relied heavily on the use of brand-name antiretroviral drugs instead of more affordable generic drugs. Its prevention theories are mostly limited to what is known as ABC — for Abstinence, Be Faithful, and correct and consistent Condoms use — an approach that some experts say is not responsive to situations of violence and gender inequality.

And while the president set a goal of preventing 7 million new AIDS infections, the proportion of money in focus countries going for prevention has fallen by more than a third over the first three years of the program, from 34 percent of the total PEPFAR budget in 2004 to 22 percent this year.

The U.S. government supports the "ABC" strategy for HIV/AIDS prevention as illustrated on this DKT Ethiopia poster in Shashemenē General Hospital, south of Addis Ababa. (Photo by Marina Walker Guevara)

In fact, the actual prevention practices stress the "AB" messages — abstinence until marriage and being faithful to one partner. The "C" has moved to a small c, and the use of condoms is lumped into the category of "other preventions" that includes prevention of mother-to-child transmission, blood safety, safe medical injections and control of intravenous drug use.

While Dybul would not be interviewed for this article, in testimony at a House subcommittee hearing, he defended the ABC approach in all of its manifestations.

"To the extent any controversy remains around ABC," he swore, "I believe it stems from misunderstanding. ABC is not a narrow, one-size-fits-all recipe. It encompasses a wide variety of approaches to the myriad of [sic] factors that lead to sexual transmission. The interventions that help people choose to avoid the risk of HIV infection entirely, to reduce their risk, vary according to the circumstances of their lives."

In a speech delivered Nov. 27 at Georgetown University, he acknowledged that, concerning the AB and C programs, "It is all very complicated and we don't have it right everywhere and need to improve still."

A major source of HIV infection is sexual transmission through commercial sex work. But the administration requires organizations receiving PEPFAR funding to take an "anti-prostitution loyalty oath," a signed statement saying they oppose prostitution. As a result, many organizations that have worked on health, safety and rights issues of sex workers can't sign the oath and don't qualify for U.S. funding.

Many of the faith-based groups, nongovernmental organizations, American universities and private companies whose HIV/AIDS programs PEPFAR is funding have accepted the strings attached. But many others interviewed by ICIJ said they devise ways to get around the rules to spread their prevention messages. Some American evangelical groups are revising their own procedures and including condoms information in their abstinence-centered programs.

While some organizations receiving PEPFAR funds have extensive experience running public health programs in developing countries, others, such as Food for the Hungry and the International Orthodox Christian Charities (IOCC) started their first stand-alone HIV programs only when PEPFAR funds became available.

Critics say that some PEPFAR-funded groups lack the know-how to run HIV programs. In one instance, a politically well-connected U.S. faith-based group, Children's AIDS Fund (CAF), was found by an expert panel of reviewers to be "not suitable" for PEPFAR funds, according to published reports. But this finding was overruled by the then head of USAID, and the group was awarded a $10 million grant anyway to run abstinence-centered programs in Uganda, Zambia and South Africa. The president of CAF, Anita Smith, a longtime vigorous promoter of abstinence programs, has been the co-chairwoman of President Bush's Advisory Council on HIV/AIDS.

The president was an early subscriber to Smith's abstinence education views and he pushed them when he was Governor of Texas. But abstinence-only sex education programs in Texas were found to have had no impact in teenagers' sexual behavior, according to a Reuters news service report of a study by researchers at Texas A&M University.

In fact, reflecting statewide trends, teenagers in 29 high schools became increasingly sexually active despite taking courses emphasizing abstinence-only themes, according to the study commissioned by the Texas Department of State Health Services.

The President's and his supporters' focus on abstinence programs provides some perspective on their approach to the global epidemic. Here are some salient facts regarding the U.S. response and the president's global plan and actions:

Many medicines used to treat HIV/AIDS patients, such as these stored in a Partners in Health facility in Cange, Haiti, require constant refrigeration. Despite receiving PEPFAR funding, Partners in Health chooses not to use it to buy drugs; the organization prefers to purchase less expensive generics from other sources. (Photo by Guy-Claude Jean-Baptiste Jr.)

• About 40 million people in the world are living with HIV/AIDS, two-thirds of them in sub-Saharan Africa.
• More than 20 million people died from AIDS in the quarter-century before PEPFAR was established.
• Of the $15 billion appropriated for PEPFAR, only 60 percent was new federal funding. The remainder includes other, previous international commitments. And $1 billion of the $15 billion went to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.
• About half of the treatment money is going for antiretroviral drugs, which at the beginning were required to be highly expensive name-brand drugs approved by the Food and Drug Administration and provided largely by major American pharmaceutical companies. More recently, some two dozen generic formulations have been approved for PEPFAR use by the FDA.
• Congress mandated that one-third of the prevention money (about 20 percent of the total appropriated) be earmarked to go to abstinence and fidelity programs. A 2006 Government Accountability Office report concluded that this spending requirement was hurting other programs in the field, such as prevention of mother-to-child transmission.
• The discussion of condoms is routinely discouraged as a primary prevention approach among youth and cannot even be mentioned to those under age 15 in school programs, even if they are already involved in sexual conduct. Condoms can be addressed in out-of-school settings among youth who engage in high-risk behavior.
• In general, at least two-thirds of all foreign aid funds never leaves the United States, according to a Congressional Research Service report. The money buys U.S. products, pays for U.S salaries, overhead, benefits packages, travel, American-made vehicles, office expenses, computers and other equipment. USAID awards 87 percent of its consultant dollars to U.S.-based firms.

How well has PEPFAR worked?

A yearlong investigation by ICIJ, a division of the Center for Public Integrity, including in-country reporting from Ethiopia, Kenya, Nigeria, Uganda, South Africa, Haiti, India and Thailand, disclosed that ideology has at times trumped science in the Bush administration's rules, regulations and support of the organizations that have received taxpayer money.

The precise amounts are difficult to discover. While the State Department, through its Office of the Global AIDS Coordinator, claims pride in its "transparency," the agency routinely takes a year or more to provide public documents requested under the Freedom of Information Act. Facing long delays with not even an estimated delivery date, the Center for Public Integrity filed lawsuits to gain access to PEPFAR records. By comparison, USAID was relatively prompt, but the State Department held the bulk of the requested documents.

When the State Department did provide the documents, under a schedule arbitrated by a federal court, it blacked out the significant financial information. Almost none of the public documents were made available except in response to the litigation.

Finally, to settle the Center's lawsuit, the State Department released data that included PEPFAR money flows for 2004 and 2005, but the numbers didn't always add up correctly, and officials admitted that their database contains flaws and errors.

Interviews with scores of activists, people living with HIV/AIDS, physicians, health care workers, government officials and academics, along with examination of thousands of pages of incomplete documents, also show a pattern of contradictory, conflicting and confusing policies. The picture presented is one of an extraordinarily disorganized operation.

More than 3½ years after President Bush's State of the Union address that led to PEPFAR's creation, about $8.3 billion has been spent for PEPFAR activities, according to the State Department. That is the about same amount spent in three weeks of war in Iraq.

Less than $1 billion has actually been spent preventing people from contracting AIDS in the 15 focus countries — about the same amount of money that is spent in three days of war in Iraq.

Meanwhile, the number of people who become infected with HIV continues to rise in some countries, and three-quarters of them are infected through sexual intercourse. More than 450 people contracted HIV each hour last year, constituting more than 4 million new cases.

While the spread of HIV/AIDS has continued and sub-Saharan Africa remains the global center of the pandemic, the people in some countries are faring worse than others.

An exceedingly high percentage of the population is infected in some of those countries, such as Swaziland, Lesotho and Zimbabwe. In Swaziland, infections among pregnant women rose from 4 percent in 1992 to 43 percent in 2004. In Lesotho and Zimbabwe, more than a fifth of the population is infected, although a new UNAIDS report released last week said the national adult HIV rate in Zimbabwe is declining.

But none of the three is included among the 15 PEPFAR focus countries, and no one in the administration could offer an explanation of how the focus countries were selected.

Still, the problems facing those included on the list are extensive.

Ethiopian women participate in a Family Health International-funded literacy program in Addis Ababa, learning to read and write with the hope of making a better life for themselves. Women are at the bottom of society in Ethiopia and HIV infection rate of women is higher than that of men.(Photo by Marina Walker Guevara)

In South Africa, for example, almost one of every three pregnant women attending prenatal clinics in 2004 was infected with AIDS. The 2006 United Nations Report on the Global AIDS Epidemic reported no clear signs of declining HIV/AIDS prevalence throughout southern Africa.

In Botswana, more than 24 percent of adults are infected.

A dynamic epidemic is under way in Mozambique, and infections are spreading particularly fast in areas linked by major transportation corridors to Malawi, South Africa and Zimbabwe, the U.N. reports.

In Uganda, whose programs President Bush touted and used to pattern PEPFAR's ABC prevention approach, success seems to be reversing. In the two years since the new U.S. emphasis on youth abstinence began, the rate of new HIV infections has almost doubled, from 70,000 in 2003 to 130,000 in 2005, according to the director general of the Uganda AIDS Commission.

Since the arrival of PEPFAR money, the student and teacher materials in schools now stress abstinence. One student handbook advises: "Young people do not need condoms; they need skills for abstaining from premarital sex."

According to documents, PEPFAR requires its partners to emphasize condoms' failure rates, which is exaggerated to approach 20 percent, when studies have shown that latex condoms are vigorously tested and, when used properly, have a success rate in excess of 98 percent.

Ethiopia is a nation staggering under the weight of poverty and famine, and rural women and girls move into cities in search of jobs. Many of them are not able to find steady employment and some become commercial sex workers along the main transportation routes. Even university students engage in sex in exchange for money to buy food and books.

A government survey found that 70 percent of the sex workers in the capital city, Addis Ababa, were HIV-positive in 1998. Only $110,000 of PEPFAR funds was allocated in 2006-2007 for condom promotion among sex workers, truck drivers and other high-risk groups along the Djibouti corridor, Ethiopia's main route to the seaports and an area where sex work is widespread. But almost five times that amount was allocated for abstinence and fidelity activities.

Over the entire country, PEPFAR's budget for prevention increased between 2005 and 2006. The funding for abstinence and fidelity activities increased by 63 percent, while condom funding increased 28 percent.

After Thailand went to a "100 percent condom" program in 1991, the rate of HIV infection among female sex workers declined from 30 percent in the mid-1990s to less than 10 percent in 2004. By 1995, the number of men coming to government clinics for treatment of sexually transmitted diseases declined by more than 90 percent.

Samples of the different brands of condoms distributed in Thailand are posted on the wall at the Bangkok headquarters of the Rainbow Sky Association, a nongovernmental organization that works with MSM (men who have sex with men) groups.(Photo by Sheetal Doshi)

When condom use was enforced on sex workers and in the brothels, the number of annual new HIV infections fell from 143,000 in 1991 to about 20,000 by 2003. The condom promotion program was so successful that public health experts urged that it be copied in other developing countries where prostitution was common.

Thailand has a long history with AIDS and a large HIV-infected population, but it was not selected to be a focus country.

Now the HIV/AIDS epidemic is feared to be resurging. A 2005 World Health Organization report said that new infections are no longer declining as rapidly as they did in the 1990s.

In Thailand between one-third and one-half of newly infected Thais are women in stable relationships, indicating that their male partners are engaging in risky sexual activity with others.

India, also not a PEPFAR focus country, has a relatively low HIV prevalence rate, but because of the country's population, it translates into almost 6 million HIV-infected people — the largest group in the world. About 85 percent of HIV/AIDS cases in India are attributed to heterosexual sexual activity, and commercial sex work is the major contributing factor.

Bharati Dey, a former sex worker who is a program director of a successful HIV/AIDS prevention project, sees commercial sex work not only surviving, but also expanding. "Traditional occupations of women are diminishing, and so the amount of female sex workers has increased over the past decade," she said.

That condition exists for women all over the globe, and the poorer the country, the worse their plight. There are limited opportunities for women in India as well as in Haiti, where fewer jobs, widespread starvation and more desperation to care for themselves and their children have put women at greater risk of contracting such sexually transmitted diseases as HIV/AIDS.

According to U.N. data, women and girls in the Caribbean, 15 to 24 years old, are up to six times as likely as men to contract HIV, often as the result of sexual violence. In rural areas of Haiti, economic dependence on men is one of the primary risk factors for infection.

Haitian women have the highest rate of new AIDS cases in the Americas. But while the World Health Organization says that violence against women is often a cause and a consequence of HIV, the money being spent by the U.S. government on HIV prevention in Haiti has not yet seriously addressed the issue of violence against women.

And the violence feeds on the poverty. In some communities in Haiti, people eat just one meal a day. Along with Afghanistan and Somalia, Haiti has one of worst caloric deficits per inhabitant in the world.

While PEPFAR orchestrates programs for abstinence and fidelity, reality in the developing world moves to different music. In many places, poverty and hunger are constant companions of women and playmates for their children. For some, survival sex is the only way of life.

The bottom line is that, for most women, abstinence is rarely an option. In fact, as Anne Sosin, the head of a rape crisis center in Haiti, says, "Abstinence, Be Faithful and Condom use works in a context where women are able to exercise their sexual rights." That is not the norm in many communities around the world.

More than 80 percent of new HIV infections in women results from sex with their husbands or primary partner. The men usually became infected from extramarital sexual partners.

Beatrice Were is a small, delicate Ugandan woman, mother of three, devoted HIV/AIDS activist and care volunteer.

In Uganda, she says, polygamy and promiscuity among men are both significant and socially acceptable. "This [PEPFAR] approach places a huge burden on a woman to abstain and, when she's married, to be faithful," she said in an interview with ICIJ reporters. "Personally, I did all of that, but I still got infected."

ICIJ members and Sheetal Doshi, Sarah Fort, Victoria Kreha and Marina Walker Guevara contributed to this story.

This article was published on the website for the Center for Public Integrity

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Your assignment is to respond to this prompt in an 11 sentence paragraph format. Publish your response as a comment to this post. When stating your opinion, consider US foreign policy, Republican and Democrat partisan politics, the current economic crisis and the recent elections.

“Should newly elected President Obama continue or change the US policy advanced by President Bush known as the President's Emergency Plan for AIDS Relief (PEPFAR)?

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Questions? Ask in class or email me at doug@dougabshire.com. This assignment is due by Monday 1.18. Thanks, Mr.A

"Dignitas Personae"

12/12/2008
Press release
Issued by the CBCEW (Catholic Bishops Conference of England and Wales)

Vatican releases document on bioethics

The Congregation for the Doctrine of Faith (CDF) today released Dignitas Personae, a document which addresses a range of issues including stem cell therapies, embryo experimentation and infertility treatments. It reaffirms the Vatican’s existing teachings, Donum Vitae (1987) and Evangelium Vitae (1995), and addresses new bioethical questions about issues such as hybrid embryos and human cloning. Dignitas Personae focuses on the dignity of the human embryo, and promotes biomedical research that is respectful of the dignity of every human being and procreation.

Key principles it uses to determine whether new biomedical research is ethical include:

• “‘The human being is to be respected and treated as a person from the moment of conception; and therefore from the same moment his or her rights as a person must be recognized, among which in the first place is the inviolable right of every innocent being to life.’” (Dignitas Personae, n.4)

• “The origin of human life has its authentic context in marriage and in the family, where it is generated through an act which expresses the reciprocal love between a man and a woman. Procreation which is truly responsible vis-à-vis the child to be born ‘must be the fruit of marriage’.” (Dignitas Personae, n.6)

• “[The Church] hopes moreover that the results of such research may also be made available in areas of the world that are poor and afflicted by disease, so that those who are most in need will receive humanitarian assistance.” (Dignitas Personae, n.3)

“The Bishops of England and Wales welcome this new Instruction on bioethics,” said the Most Reverend Peter Smith, Archbishop of Cardiff. “It affirms the Church’s support of ethical scientific research that seeks to cure disease and relieve suffering.” Dignitas Personae acknowledges the great strides biomedical research has made in the treatment of diseases and calls for more scientific development in areas such as adult stem cell research:

• “Methods which do not cause serious harm to the subject from whom the stem cells are taken are to be considered licit. This is generally the case when tissues are taken from: a) an adult organism; b) the blood of the umbilical cord at the time of birth; c) fetuses who have died of natural causes. The obtaining of stem cells from a living human embryo, on the other hand, invariably causes the death of the embryo and is consequently gravely illicit…” (Dignitas Personae, n. 32)

• “Research initiatives involving the use of adult stem cells, since they do not present ethical problems, should be encouraged and supported.” (Dignitas Personae, n. 32)

The Vatican’s comments about this issue are particularly timely given recent news reports of a woman in Spain whose trachea was repaired using adult stem cells. Other promising surgeries involving adult stem cell therapies were announced last week in Hanover, Germany to help stroke victims regain movement and speech and at Imperial College London to help heart attack patients. Archbishop Smith welcomed the development of these new adult stem cell therapies and called for more research in this area:

“These developments demonstrate the power of medical science and the potential of adult stem cells in curing diseases and relieving suffering,” said the Most Reverend Peter Smith, Archbishop of Cardiff. “We hope to see more research focusing on adult stem cells, as their use raises none of the problems created by embryonic stem cells which require the destruction of human embryos.”

Dignitas Personae recognises the important role that professionals in the biomedical community play in society:

“The Magisterium also seeks to offer a word of support and encouragement for the perspective on culture which considers science an invaluable service to the integral good of the life and dignity of every human being. The Church therefore views scientific research with hope and desires that many Christians will dedicate themselves to the progress of biomedicine and will bear witness to their faith in this field.” (Dignitas Personae, n.3)

Dignitas Personae also responds to new bioethical questions about hybrid embryos and human cloning:

Hybrid embryos
"From the ethical standpoint, such procedures represent an offense against the dignity of human beings on account of the admixture of human and animal genetic elements capable of disrupting the specific identity of man. The possible use of the stem cells, taken from these embryos, may also involve additional health risks, as yet unknown, due to the presence of animal genetic material in their cytoplasm. To consciously expose a human being to such risks is morally and ethically unacceptable.” (Dignitas Personae, n.33)

Human Cloning
“Human cloning is intrinsically illicit in that…it seeks to give rise to a new human being without a connection to the act of reciprocal self-giving between the spouses and, more radically, without any link to sexuality. This leads to manipulation and abuses gravely injurious to human dignity.” (Dignitas Personae, n.28)

The complete document can be accessed here

Also try here

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Your assignment is to respond to this prompt in an 11 sentence paragraph format. Publish your response as a comment to this post. When stating your opinion with details and examples, consider divergent religious beliefs, government regulation of biomedical research, current "discoveries" in the areas of stem-cells, in-vitro fertilization, cloning etc.

“I (support / partially support / do not support) the Roman Catholic Church's positions stated in the Dignitas Personae because_____________"

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