Weekly Pulse: Stem Cell Hell, Bad Eggs, and DIY Abortions

Lindsay Beyerstein

Tainted eggs are in the stores, do it yourself abortion drugs are on the black market, and now stem cells are unavailable thanks to a new court ruling.

This article is published in partnership with The Media Consortium, of which Rewire is a member organization.

On Monday, U.S. District Judge Royce Lamberth ruled that all federally funded human embryonic stem cell (hESC) research is illegal, thereby throwing the scientific community into turmoil. The judge decided that any experiments on these cells is research “in which a human embryo is to be harmed or destroyed,” and is therefore disqualified for federal funding under an obscure provision known as the Dickey Amendment. Researchers called the ruling “absolutely devastating.”

The ruling flies in the face of science and logic. True, a human embryo must be destroyed in order to create a line of stem cells. However, once the line is established, the cells will keep dividing forever. In nature, stem cells have the potential to develop into any kind of specialized cell in the body. There are no guarantees, but in theory, stem cell research could lead to treatments for anything from severe burns to heart failure to blindness.

The lineage of stem cells

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The first line of human embryonic stem cells was created in 1998. In 2001, President George W. Bush banned federal funds for research on stem cells created after Aug. 9, 2001. Even Bush acknowledged using old stem cell lines wasn’t destroying embryos. In 2009, President Barack Obama loosened the rules for funding human embryonic stem cell research. Under Obama’s rules, researchers can’t use federal funds to create new hESC lines, but they can study stem cell lines of any age, not just the ones created before 2001.

According to the judge’s logic, a scientist is destroying an embryo when she tests a drug on an embryonic stem cell that is the great-great-great-granddaughter of a cell that belonged to a 5-celled embryo that was destroyed in 1998. Hundreds of scientists all over the world might be working with cells from that embryo at this very moment. According to the judge, each of them is destroying an embryo that ceased to exist 12 years ago. So, every day, they all get up, go to work and destroy the same non-existent embryo? What happens when come back from a coffee break? Do they destroy it again?

Ignoring the facts

“We strongly disagree with the judge’s ruling because, by definition, embryos and stem cells are two entirely different organisms. Today’s ruling is the case of one judge ignoring the scientific fact that research on pluripotent stem cells is not the same as research on an embryo,” Rep. Diana DeGette (D-CO) said in a strongly-worded reaction to Monday’s ruling. DeGette is a longtime champion of stem cell research, according to Scot Kersgaard of the Colorado Independent.

Lynda Waddington of the Iowa Independent asked officials of at the University of Iowa, a center of excellence in stem cell research, how the ruling might affect their work. The officials declined to comment, saying that they were still reviewing the implications of the injunction. The Obama administration announced that it would appeal the judge’s ruling.

What’s next? Bioethicist Arthur Caplan told Amy Goodman of Democracy Now! that the only way to get hESC back on a firm legal footing would be to abolish the Dickey Amendment. Dickey needs to go, but the judge’s latest appeal to Dickey is extremely weak. The notion that studying a 1-day-old cell descended from an embryo destroyed 12 years ago is harming that embryo is absurd. Of course, getting rid of Dickey would also open the door for federal funds to create new stem cell lines, which would be a boon to society in its own right.

Bad eggs

Half a billion eggs have been recalled because they may be tainted with deadly salmonella bacteria. The eggs may have already sickened thousands of people. Democracy Now! reports that the entire batch can be traced to just two factory farms in Iowa, Hillandale Farms and Wright County Egg. This is the largest egg recall in U.S. history. Critics say the mass contamination exposes deeper failures in the U.S. food system.

Steve Benen of the Washington Monthly notes that Wright County Egg’s parent firm has a rap sheet of health, safety, and labor violations stretching back two decades. However, Benen argues, the problem is deeper than one poorly inspected operation.

After the outbreak, former FDA Commissioner William Hubbard admitted in an interview that the George W. Bush White House would not let the FDA impose tougher standards on the egg industry because the administration was “very hostile to regulation.” If the Invisible Hand of the Market tries to make you breakfast, don’t eat it!

Back alley abortions are back

More women are inducing their own abortions with a drug called misoprostol, Robin Marty reports at RH Reality Check. Misoprostol, aka “Cytotec,” is usually prescribed to treat ulcers. Doctors use it in combination with the so-called “abortion pill” RU-486 to induce chemical abortions, but only under controlled conditions.

Misoprostol is a prescription drug in the U.S., but it is available over the counter in many other countries. Some women misuse misoprostol that is prescribed for other conditions, some buy it on the black market, and some have families send it from overseas. Unsupervised misoprostol abortions are risky because about 10%-15% of the time, the drug will start the process but not finish the job. If that happens the woman is at risk for bleeding, infections, and other complications.

The anti-choice movement has campaigned for decades to throw obstacles in the path of women seeking abortions. The longstanding ban on federal funding for abortion means that many poor, uninsured women are stuck paying the costs of an abortion out of pocket. Even a few hundred dollars for the procedure and the cost of transportation to the nearest abortion clinic may be beyond the reach of many women. It’s not surprising that these women are taking matters into their own hands.

Thanks to the machinations of anti-choicers and the compromises of the Obama administration, health care reform will provide little relief for women who can’t afford abortions.

This post features links to the best independent, progressive reporting about health care by members of The Media Consortium. It is free to reprint. Visit the Pulse for a complete list of articles on health care reform, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Audit, The Mulch, and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.

News Politics

Congressman Touts Stem-Cell Lab Tour Despite Opposing Stem-Cell Research

Jason Salzman

Rep. Mike Coffman (R-CO), who’s widely seen as one of the most vulnerable incumbents in Congress, touted his visit to a stem-cell laboratory even though he’s on record opposing research with embryonic stem cells, which are used in the lab he toured.

Rep. Mike Coffman is on record opposing embryonic stem-cell research, but that didn’t stop the Colorado Republican from touring a stem-cell laboratory at the University of Colorado School of Medicine and tweeting, “Happy to get the chance to tour the Stem Cell Research facility.”

A spokesman for the school, which is located in Coffman’s district, confirmed that the stem-cell facility visited by Coffman November 8 uses stem cells obtained from human embryos.

In 2008 and 2010, Coffman supported Colorado’s failed “personhood” initiatives, which aimed to define life as beginning at conception, when embryos form, and would have banned not only embryonic stem-cell research but also all abortions and some common forms of birth control.

Coffman’s November 8 tweet about his tour of the stem-cell facility included a photo of the Congressman viewing laboratory machines.

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“This is a ‘what’s wrong with this picture’ situation,” said Karen Middleton, executive director of Pro-Choice Colorado, in an email offering a response to Coffman’s tweet. “Mike Coffman’s support for anti-choice personhood measures and his opposition to stem-cell research don’t really fit here. If he is sincere about supporting women and science, he needs to issue a statement about his new policy position, not just stage a photo-op.”

Coffman’s office did not return a phone call seeking comment.

Coffman’s opposition to embryonic stem-cell research was spotlighted in a political advertisement by the House Majority Project during the 2012 election, which Coffman won by a 2 percent margin over Democratic challenger Joe Miklosi.

A fact check of the ad by 9News, Denver’s local NBC affiliate, confirmed Coffman’s opposition to embryonic stem-cell research.

9News reported, “This year, Congressman Coffman was asked point blank by Colorado Right to Life, ‘Will you oppose any research or practice that would intentionally destroy the tiniest living humans, embryonic stem cell research?’ With a pen he wrote, ‘Yes.'”

9News also reported, “A spokesperson says, he isn’t against stem-cell research in general, just embryonic, because the cells are harvested from embryos, and he says, that is a human life.”

Responding to Coffman’s position, Rep. Diana Degette (D-CO) said last year, “If a candidate like Mike Coffman says, ‘I don’t support embryonic stem cell research but I support other types,’ that’s not supporting the full range of ethical stem cell research, which could block off research into some diseases and would impede the progress of the research in general.”

University of Colorado School of Medicine spokesperson Mark Couch said that the university’s stem-cell laboratory, called the Gates Center for Regenerative Medicine and Stem Cell Biology, mostly relies on induced pluripotent stem cells, which are derived from adult stem cells, though embryonic stem cells are also used.

“The [embryonic stem-cell] lines that have been approved by the federal government are used for comparison purposes with the induced pluripotent stem cells,” said Couch.

Coffman’s congressional seat is widely seen as one of the most competitive in the country, after it was re-drawn after the 2010 Census. Political observers here expect the stem-cell issue to come into play again next year, as it did in 2012, as Coffman and his Democratic challenger Andrew Romanoff vie for the support of moderates, especially women and Hispanics, whose votes will likely decide the election.

Commentary Health Systems

Do Religious Restrictions Force Doctors to Commit Malpractice?

Valerie Tarico

Across the United States, religious health-care corporations are absorbing once secular and independent hospitals and in the process imposing religious restrictions that sometimes pit standard medical practice against theology.

Cross-posted with permission from AwayPoint.

Picture this: You wake up far too early one morning because your hand is intensely painful and you don’t know why. When the pain gets worse, you go to the ER. The attending doctor, a gray-haired man, examines you, draws blood, and then tells you an unusual flesh-eating infection in your finger is putting your health at risk. He recommends amputating the hand immediately before the infection causes more harm. What he doesn’t tell you is that at this early stage the simple injection of a state-of-the art antibiotic would solve the problem. Why the omission? His hospital is managed by a self-described religious health-care ministry that forbids the use of antibiotics.

Across the United States, religious health-care corporations are absorbing once secular and independent hospitals and in the process imposing  religious restrictions that sometimes pit standard medical practice against theology. To the best of my knowledge, no religious system that is licensed to serve the general public forbids the use of antibiotics. But facilities under the direct or indirect control of Catholic bishops are providing maternity care that is tantamount to unwarranted amputation.

Catholic Directives Delay Care, Compel Unnecessary Surgery

Ectopic pregnancy types

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Recently a woman was traveling across the Midwest when she developed abdominal pain. She and her husband went to the nearest hospital, where she was diagnosed with a potentially fatal ectopic pregnancy. The doctors recommended immediate surgery to remove the fallopian tube containing the misplaced embryo, a procedure that would reduce by half her future chances of conceiving a child. They failed to mention that a simple injection of Methotrexate would solve the problem, leaving her fertility intact. Why the omission? The Catholic hospital where she got diagnosed was subject to the “Ethical and Religious Directives” of the Catholic bishops, which state, “In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.”

According to Catholic moralists, an injection that destroys an ectopic embryo is a direct abortion, while removing the part of a woman’s reproductive system containing the embryo is not. While this may sound strange (or abhorrent) to outsiders, it has its own internal logic. Catholic ethics ultimately are determined by theologically-based perceptions of what actions God approves and doesn’t approve. While compassion does matter, the end goal is to improve the spiritual standing or righteousness of the person performing the action. These theological dictates may or may not align with the questions that govern secular medical ethics and practice: how to minimize harm and suffering or maximize well-being while respecting patient autonomy.

In 2010, a pregnant Nicaraguan woman with metastatic cancer was denied treatment because chemotherapy could harm her fetus, which doctors refused to remove. Though many Protestants disagree, Catholic theology treats any product of conception as a fully formed human being, with rights equal to a woman from the moment of conception whether or not there is any possibility of it actually becoming a person. This means that abortion is an inherently bad action, regardless of outcomes. Nicaraguan law, rooted in this theology, prohibits all abortion even when a woman’s life is at stake. In 2012, a 16-year-old Dominican girl also was denied treatment for weeks while doctors debated whether chemotherapy would constitute an abortion. She eventually miscarried and later died.

Christianity traditionally has regarded women as vessels—vessels for evil and for babies. For Adam was formed first, then Eve. And Adam was not the one deceived; it was the woman who was deceived and became a sinner. But women will be saved through childbearing—if they continue in faith, love and holiness with propriety (1 Timothy 2: 13-15). As a consequence, Catholic rules addressing reproduction are particularly convoluted, and sometimes patients pay the price:

A Catholic doctor at a Catholic hospital went against my daughter’s wishes and signed consent to have a hysterectomy because of severe endometriosis. One ovary had already exploded. My daughter had never intended or desired children nor was she in a suitable situation to have a child. She was single, in her late 20s. When she awoke from surgery she learned that the doctor had over-ridden her wishes and consent in an attempt to save her fertility. The operation was botched, leaving my daughter on permanent disability, in pain, with even more health problems than she’d had before. – Comment at Truthout

Religious Directives and Malpractice Law

Secular medical ethics evolved to promote patient welfare and autonomy. As better treatment options become available, providers are expected to keep their skills and knowledge up to date so that they can provide accurate information about the range of options and offer the services most likely to create the best health outcomes for patients. Violation of these norms is considered malpractice.

Medical malpractice can be defined as: “Improper, unskilled, or negligent treatment of a patient by a physician, dentist, nurse, pharmacist, or other healthcare professional.” Whether or not a health-care provider has provided excellent or unacceptable care depends on the general state of health care at the time service is provided.

The critical element is standard of care, which is concerned with the type of medical care that a physician is expected to provide. Until the 1960s the standard of care was traditionally regarded as the customary or usual practice of members of the profession. This standard was referred to as the “locality rule,” because it recognized the custom within a particular geographic area. This rule was criticized for its potential to protect a low standard of care as long as the local medical community embraced it. The locality rule also was seen as a disincentive for the medical community to adopt better practices.

 

Most states have modified the locality rule to include both an evaluation of the customary practices of local physicians and an examination of national medical standards. Physicians are called to testify as expert witnesses by both sides in medical malpractice trials because the jury is not familiar with the intricacies of medicine. Standards established by medical specialty organizations, such as the American College of Obstetricians and Gynecologists, are often used by these expert witnesses to address the alleged negligent actions of a physician who practices in that specialty. Nonconformance to these standards is evidence of negligence, whereas conformance supports a finding of due care. –Legal Dictionary

The recent case of a young Salvadorian mother named Beatriz offered a graphic example of how religious interference in medical care can force a doctor to commit malpractice. Beatriz, who suffers from lupus, was pregnant with a nonviable anencephalic fetus yet was refused an abortion clear through the second trimester, as her condition became increasingly risky. Salvadorian minister of health, Maria Isabel Rodriguez, called her situation a “grave maternal illness with a high probability of deterioration or maternal death.”

“I just want to live,” Beatriz told the press—echoing the sentiments of Savita Halappanavar who died last year after being denied an abortion in Catholic Ireland. Salvadoran doctors were willing to perform the needed abortion, but their hands were tied by laws based in Catholic theology. Finally, at 26 weeks gestation and under international pressure, a Salvadorian court ruled that Beatriz could end the pregnancy—via caesarean section. As in the case of the ectopic pregnancy, Beatriz was offered an invasive surgical procedure rather than the standard treatment which would minimize recovery time and leave her body intact. As best can be determined from news reports, the only reason the doctors had to cut her was to satisfy the Catholic pretense that this was an attempt to deliver a viable baby.

Protest Poster -- Savita Deserved Better.  All Women Do.In the wake of Halappanavar’s death and Beatriz’s dangerously substandard care, Marge Berer, founder of the international journal, Reproductive Health Matters, questioned the ability of Catholic-controlled facilities to provide emergency obstetric services and asked whether they should be formally stripped of their right to provide maternity care more broadly. Unfortunately, with Catholic theology encoded as law in many countries and with Catholic health-care ministries buying up independent care facilities here in the U.S., a woman may have few other options. If all currently proposed mergers are completed in Washington State, for example, nine counties will have all hospital beds tied to religious institutions by the end of 2013, including the University of Washington system.

Senior Citizen with sign - Give Me Liberty at my DeathWhen bishop directives trump science and patient preference, pregnant women are not the only ones at risk. According to a litany of articles at two watchdog sites, CatholicWatch.org and Mergerwatch.org, the problem of religious interference in health decisions extends far beyond obstetrics and family planning, spanning end of life care, treatment of queer families, and any drugs remotely derived from embryonic stem cell research. As medical science offers us more and more ability to manage sexuality, reproduction, body modification, and our dying process, religious dictates will be increasingly at odds with secular standards of care. Doctors working under these mandates will be forced to offer treatments that, by contrast with the best available, can be classed only as malpractice—a pattern that both patients and personal injury attorneys are bound eventually to notice.