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Shams, scams and trans fats: Bioethics in 2006

It is never too late, despite what traditionalists may say, to start a tradition.  As all eyes turn to 2007, I’m compelled to create a number of end-of-the year awards in bioethics.  Let's start with the losers.
/ Source: contributor

It is never too late, despite what traditionalists may say, to start a tradition.  As all eyes turn to 2007, I’m compelled to create a number of end-of-the year awards in bioethics.

I will dub these awards the Halos & Horns, following a long tradition of, well, admittedly there is no long tradition of annual ethics awards. But there is a long tradition of ridiculous self-congratulatory awards involving movies, magazines, music and TV shows. But these industries have no moral souls. The Halos & Horns are different. To receive a Halo is a priceless honor only bestowed upon the morally deserving by moi, of course. Horns, on the other hand, are my way of mocking the morally flawed. 

OK, enough explaining. Let’s start with the biggest losers.

The first Horn Award of 2006 goes to New York City's health officials for Least-Meaningful Public Health Gesture.  They win — er, lose — for deciding to make The Big Apple the Skinny Nanny by yanking trans fats out of the foods available in the city’s restaurants. Now New Yorkers know they can sit down to an egg cream, pastrami and potato pancake lunch surrounded by soot, smog and noise secure in the knowledge that trans fats pose no risk to their health.

Shame on the scam-artist scientist
The Horn for Biggest International Medical or Scientific Embarrassment goes to Hwang Woo-suk of South Korea. He lapped the field by going from the one-and-only South Korean government-designated "Supreme Scientist" complete with his own postage stamp to the most disgraced scientist in recent memory. He achieved this remarkable fall when it became clear that he had completely fabricated the research supporting his claim to be the first person to make embryonic stem cells from cloned human embryos. 

Hwang’s crash was felt all over the science world. Indeed, a Horn also is due to the editors of Science magazine as the Biggest Repentant Dupes of the year, easily outpacing Miss USA. Having published Hwang’s bogus opus, Science did not seek out Donald Trump for forgiveness.  Instead the editorial board published a report from an independent panel analyzing how the world’s leading journal of science could avoid being taken to the cleaner by an outright con artist. The independent report brought nothing to mind so much as the advice police departments offer 85-year-old granddads about not sending their bank account numbers in response to Internet entreaties from wanna-be Nigerian "friends" with suddenly acquired vast fortunes in needs of a bank account number. 

The bullet stays
I’m not sure if a Halo or Horn is due for this next one, but the distinction of Weirdest Bioethical Conundrum of the year goes to a last-minute contender, the young man in Texas who just last week caught a slug in the head while apparently involved in a store robbery. The man who fired the shot, the store owner, could not identify him as one of the robbers since it was dark and he was far away.  Getting a look at the bullet to see if it matched the owner’s gun became the fervent wish of the cops and courts.  However, ethically, a person does not have to undergo risky surgery even with a judge issuing a court order. So the bullet remains firmly lodged in the likely miscreant’s head for now. Should he agree to its removal he would become a strong candidate for a future Halo award  — incentive enough for anyone, I should think.

The Halo for biggest slam-dunk (that bounced off the rim) goes to the new HPV vaccine put on the market by Merck and now being heavily promoted through the "Less One" ad campaign.  This is a very safe and relatively effective vaccine against cervical cancer. But its cost is high — a total of three shots costing $120 each. And it only works against two of the strains of human papilloma virus that cause cancer. Public health departments, Medicaid programs, private insurers, parents, working women and HMOs are struggling with the question of whether to pay for the vaccine knowing that it may not greatly reduce the need for or cost of Pap smears or the rate of cervical cancer for many years. 

Missed opportunities
This complicated story leads to a related award for Ignoring Your Own Nose Smack in the Middle of Your Face.  This Horn goes to the Gates Foundation. 

While doing huge amounts of good — and earning a lifetime achievement Halo — with their efforts to find cures and treatments for HIV, Tuberculosis and malaria, the foundation has not moved forward to make HPV vaccine available where it is really needed — China, India, parts of South and Central America and sub-Saharan Africa, places where cervical cancer kills hundreds of thousands of women every year due to a lack of gynecological care and in some cases plain old sexism. Pursuing cures for the world’s biggest killers is a worthy moral enterprise but when a cure pops up for a major third world killer such as cervical cancer, foundations and governments need to rethink their funding priorities.

Paying for parts?
Finally, the Milton J. Friedman award and the Horn for The Bad Idea That Just Won’t Die goes to the editors of the Economist magazine and the many other free-market devotees who continue to yammer on about the need to institute a market in the United States and Europe for organs. The pay-for-parts crowd seeks to relieve the current shortage of organs that is resulting in thousands of deaths in the U.S. every year, a worthwhile goal. However, the free-market devotees simply refuse to recognize the antipathy that major religions feel toward the sale of the body or its parts that would lead to an instant condemnation of any market and the withdrawal of many donors from the transplant system. Nor do they seem capable of wrapping their ideologically skewed minds around the idea that many Americans and Europeans feel nothing but anger about proposals to permit body part sales given the long ongoing battles to rid the world of slavery, indentured servitude, baby-selling and child prostitution. 

Morally, the solution to the organ shortage is certainly not to pay a poor soul money to saw out a vital part and having doctors engage in the business of maiming for hire. Better to simply shift to a system of presumed consent where governments and doctors assume you are an organ donor unless you tell them you don’t want to be by carrying a card or putting your name on a national computerized registry of refusers.

By the way, it would be nice if the losers in this category could try to compete for a Halo next year by showing the least bit of interest in the plight of poor persons who have no chance at getting organs for their lack of ability to pay — a state that somewhat reduces their enthusiasm to act as altruistic donors to the rich who do. Offering cash prizes for kidneys may not be the best way to assure the poor that you really have their best interests at heart when it comes to transplantation.

I could go on but I worry your patience may wear thin despite the fact that I did not invite a single award-winner to address you in gratitude for their selection or make you sit through a long listing of nominees who did not quite make the cut.  But there’s always next year, which looks like it will be ripe with moral quandaries and plenty of opportunities for Halos and Horns. Write me when you spot them.