Health, Ethics, and Policy News
By TuftScope Staff
From Glaucoma to Eyelashes?
Would you pay $120 per month for longer, thicker, and darker eyelashes? Now you can with Allergan’s new FDA approved drug Latisse®. Allergan, the maker of Botox®, hopes that their new drug will take a significant share of the five billion dollar mascara market. Latisse’s counterpart that has the same chemical formula, Lumigan® (also made by Allergan), is used to reduce the symptoms of glaucoma. The larger eyelashes induced by Lumigan are an inadvertent side effect Allergan hopes to use to its advantage. According to a study of 280 volunteers who took Latisse, eyebrows appeared 25% longer, 106% thicker, and 16% darker, while 3.6% of people had a side effect of darkening eyes. While Latisse seems to have cosmetic benefit to those seeking longer eyelashes, it remains to be seen whether people will pay four dollars a day for nicer eyelashes. - David Kudlowitz
A Cure for HIV?
A 42-year-old man suffering from leukemia and HIV was cured of HIV with a bone marrow transplant. While the stem cells given to this man were intended to reduce the symptoms of his leukemia, the marrow he received contained a genetic mutation that provided natural immunity against HIV. The mutation specifically cripples the CCR5 co-receptor on T-Cells. The man has now been HIV free for 2 years since his transplant. While a bone marrow transplant has cured this man’s HIV, it is unlikely that transplantation of bone marrow will become a standard in HIV care. Bone marrow transplants are extremely hazardous with 1/3 of patients dying during the immune suppressive stage induced after the transplant is completed. Furthermore, not only would an appropriate match have to be found for a proper transplant into the patient, but the donor would have to have the genetic mutation that prevents HIV (one that only 1-3 % of white Europeans have). This patient’s outcome may guide scientists to understanding the disease and ways of treating it better, but the treatment is unlikely to be a panacea cure for the disease. - David Kudlowitz
Castration of Sex Offenders
An increasing number of European nations have begun to use chemical castration in efforts to rehabilitate violent sexual predators. The procedure involves the removal of testosterone producing tissues, which the Czech Republic argues is the most foolproof way to curb the urges of dangerous predators. The optional program is not without criticism, the Council of Europe’s Anti-Torture Committee called the program mutilating and irreversible. Others have claimed that offering the procedure as a way out of a life-long prison sentence violates informed consent. Despite these critiques, Poland, Spain, and the Czech Republic have, or are considering similar programs. Closer to home, Texas, California, and Florida mandate chemical castration for those convicted of specific crimes. - Adam Snider
U.S. to Compare Medical Treatments
As part of the economic stimulus bill passed by Congress in February, more than $1 billion will be directed towards research comparing the efficacy of different treatments for the same illness. The goal of this funding is to accumulate knowledge about which courses of treatment are the most successful. Health care costs were estimated to be 16% of the nation’s GDP in 2007 and may rise to 25% by 2025; a reduction in the cost of health care to the economy could have a substantial impact on national savings. Historically, the government has funded research dealing with drug safety and efficacy, but never to compare alternative options for the same illness, even though several European countries do have programs to carry out this type of research. Critics have argued that this new program would allow the government to intrude on a person’s healthcare decisions and that it would limit the procedures covered by Medicare and private insurance policies; however it is not entirely clear yet how the findings of this research will be used. - Emily Clark
Stem Cell Restrictions Lifted
On March 9, 2009, via an Executive Order, President Obama lifted the restrictions on use of stem cells extracted from human embryos for scientific research. Previously the Bush Administration had restricted the use of federal funds to support research on any stem cells lines established after Aug. 9, 2001. These restrictions on research fueled initiations such as the three billion dollar California stem cell program (for more information see the Schecht paper in this issue). Stem cells are believed to be capable of being used to regenerate tissues necessary to treat illness such as Alzheimer’s disease, Parkinson’s, diabetes, and other conditions. At the same time recent advances into stem cell research call into question the need for sweeping policy changes. In 2007 Japanese biologist Shinya Yamanaka was able to reprogram adult cells into their embryonic state, raising the possibility that future research would no longer require embryonic cells. Scientists believe that any clinically applicable therapies that may be derived from stem cell research remain years in the future. – Michael Shusterman
The Case of the Octuplets
On January 26, 2009 Nadya Suleman gave birth to octuplets, two girls and six boys, now the longest-surviving octuplets in the country. Ms. Suleman, who had already given birth to six children ages 2 to 7 through in vitro fertilization (IVF), achieved this pregnancy by the same procedure at the West Coast IVF Clinic in Beverly Hills, California run by Dr. Michael M. Kamrava. Although the focus of the media has primarily been on the birth of these children, there has also been a considerable amount of attention given to the surrounding social and ethical issues. Concerns about Ms. Suleman’s ability to care for her children with expectedly high costs of raising 14 children have been raised. Furthermore, concerns regarding the doctor who performed the procedure and a legal system that does not restrict the number of embryos placed into a mother’s womb exist. Although fertility doctors generally take into account the mother’s physical, emotional, and social wellbeing, the number of embryo’s implanted by Dr. Kamrava is highly unusual. Financial issues remain a significant problem as well, with the children costing the California Medical System tens of thousands of dollars for their hospital stay alone. - Hyejo Jun
Research Highlight: Electronic Medical Records
A recent study in the New England Journal of Medicine has found that only 9% of hospitals in the United States have some form of electronic medical records. The study found that significant obstacles remain in the path of full computerization, with capital costs and maintenance acting as the primary obstructions to implementation. Furthermore, a “perspectives” piece in the same issue by Dr. Kenneth D. Mandl and Dr. Isaac S. Kohane finds that currently available electronics re- cords programs are often outdated and have limited upgradeability. You can find the complete study at, http:// content.nejm.org/cgi/content/full/NEJMsa0900592.
Research Highlight: Male Circumcision Reduces Incidence of HSV-2 and HPV
A recent study in the New England Journal of Medicine has found that male circumcision reduces the transmission of HS herpes simplex virus type 2 (HSV- 2) and human papillomavirus (HPV). Male circumcision has already been found to reduce the risk of HIV infection in men. You can find the complete study at, http://content.nejm.org/cgi/content/full/360/13/1298. (For a historical perspective on circumcision within the United States, see Teresa Lii’s paper in this issue.)
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