Robert Klitzman, Director of the Masters of Bioethics Program at Columbia University, penned a July 2, 2014 CNN.com article entitled "Did Facebook's Experiment Violate Ethics?".  This article details Dr. Klitzman's opinion about Facebook's admission that the company "had subjected nearly 700,000 users" to "an experiment without their knowledge, manipulating these individuals' news feeds, reducing positive or negative content, and examining the emotions of these individuals' subsequent posts."  Was the LIBERTARIAN BIOETHICS BLOGger one of these guinea pigs?

Dr. Klitzman rightly asserts that Facebook's experiment was unethical.  He cites violations of the 1974 National Research Act (but also correctly notes that Facebook is not legally required to follow this law), which mandates informed consent of subjects in research studies.  He skewers Facebook's claim that the experiment was ethical because the Facebook user policy states that Facebook may use information added to the website for research purposes.  He notes that two of the three principal investigators for Facebook's experiment "are affiliated with universities - Cornell and the University of California at San Francisco - that publicly uphold" the National Research Act guidelines.  He explains that the journal that published the article that presented the study to the scientific community (The Proceedings of the National Academy of Science, commonly referred to as PNAS) ignored its own editorial standards that require experiments to follow the Declaration of Helsinki guidelines, which also mandate informed consent of subjects in research studies.  Finally, he informs the reader that experiments that do not need informed consent typically "debrief" the subjects afterwards, which Facebook also did not do.  Strong work Dr. Klitzman.

Yes it is clear that Facebook's experiment was unethical but legal.  I should find out if I was a victim of this malfeasance and, if so, I should seek damages - by informing my dispute resolution organization (DRO) of my victimhood so it can negotiate with Facebook's DRO.  What?  Did you say my DRO is the same as Facebook's DRO (the American State) AND Facebook is a fascist organization that collaborates extensively with our mutual DRO AND therefore I can't get no relief?  Yes there truly is nothing new under the sun.

Religious fanatics are sometimes as bad as statists when it comes to interfering with societal progress.  An August 17, 2014 New York Times article by Kevin Sack entitled "A Clash of Religion and Bioethics Complicates Organ Donation in Israel" explores this phenomenon.  Kidney donation is the victim in this scenario.

The crux of the conflict is as follows: Jewish religious fundamentalists believe the Bible states that a human is not dead until respiratory function ceases, yet the best time for organ donation is when brain death has occurred but circulatory and respiratory function have not ceased.   

Of interest, the story notes that a few "Israelis favor the more radical solution of legalizing compensation for donors."  Bizarrely, the author did not interview Sigrid Fry-Revere, J.D. Ph.D. for this story (as readers of this blog know, Dr. Fry-Revere published a book entitled The Kidney Sellers: A Journey of Discovery in Iran, which evaluates the Iranian organ donor compensation program, on February 1, 2014).  Don't hold your breath, however, - pun intended - waiting for the Israeli State to legalize the sell of kidneys or any other organ.

This is not a bioethics post, but State propaganda intrigues me so I felt compelled to share.  Recently, an Abraham Lincoln impersonator visited the Montessori school my daughter and elder son attend.  At the conclusion of his Lincoln portrayal, he gave each child a bookmark.  

One side of the bookmark, interspersed with black-and-white photographs of a log cabin, Lincoln and his wife Mary Todd standing arm in arm, and the White House, reads as follows:

HIS HUMBLE BEGINNINGS
"I'll Study, Get Ready, My Chance Will Come"
LINCOLN'S GUIDING
PRINCIPLE
Matthew 22:37-38
Love the Lord your God with all 
your heart all your soul all your
mind and love thy neighbor as
thyself, all the laws of the prophets 
hang on these two commandments.
HIS HISTORIC FINISH
"Four Score and Seven Years Ago …"

The other side of the bookmark, beneath a picture of Lincoln sitting on his throne at the Lincoln Memorial, reads as follows:

ABRAHAM LINCOLN
16th President of the United States
"Saved Our Nation"
WORDS HE LIVED BY
Adversity - Adversities are just
   installments on later successes.
Bible - The Greatest Gift God ever
   gave to man.
Ridicule - I have endured a great deal
   of Ridicule without much malice and
   I have received a great deal of
   kindness, not quite free from ridicule.
Achievement - The way for a young
   man to rise is to improve himself
   every way he can.
Humor - Laughter is medicine to my
   bones.
Altruism - I have an irrepressible
   desire to live till I can be assured
   that the world is a little better for
   me having lived in it.
Mercy - Have malice toward none
   and charity for all.
Slavery - If slavery isn't wrong,
   nothing is wrong.
     Love - Love thy neighbor as
        thyself.
     Integrity - I am not bound to 
        win, I am bound to be true.
     Forgiveness - I am always
        willing to forgive on the 
        Christian terms of repentance.
     Emancipation - All men are
        created equal.

The State propaganda technique of creating a child's poem with each line starting, in sequence, with a letter from a ruler's name is not new.  I recall a Kuwaiti poem utilizing George W. Bush's name.  I bet Stalin and Hitler and Mao have been "honored" in the same way.

Bizarre.

Levi Garraway's article entitled "Genomics-Driven Oncology: Framework for an Emerging Paradigm" is the second paper in the May 20, 2013 edition of the Journal of Clinical Oncology to address "the ethical return of genetic results to oncologists and their patients."  Unfortunately such ethical issues are discussed in only two paragraphs.  LIBERTARIAN BIOETHICS BLOGger NOT HAPPY!!!

The first paragraph notes the typical pros and cons cited by bioethicists "regarding the extent to which such results should be returned to patients and their physicians."  Pros include beneficence, respect for persons, and incentivizing participation in clinical trials.  Cons include the need for additional staffing to explain the results to physicians/patients and the possibility of poor decision-making by physicians/patients based on genetic variants of unknown significance.  The second paragraph admits that "a substantial majority of patients … prefer to receive their individual research results in exchange for enrolling onto clinical studies based on these data."  The author then recommends creation of a protocol to guide the ethical return of genetic results to physicians/patients.  Garraway envisions empirical development of such a protocol via multiple ethical genetic studies performed synchronously in conjunction with multiple clinical genetic studies. 

My analysis: The potential negatives of releasing genetic results to physicians/patients are perceived to be so minor by the average patient that the average patient, who usually fears anything associated with genetics (e.g. the anti-GMO craze), insists on access to such results.  I agree with the average patient.  Elitists beware, for the average patient is not as stupid as you believe. 

The November 2013 edition of the Journal of Oncology Practice contained an original contribution entitled "The National Cancer Institute-American Society of Clinical Oncology Cancer Trial Accrual Symposium: Summary and Recommendations".  This article was penned by Andrea Denicoff and multiple other physicians and summarized the details of the symposium mentioned in the title.  Per usual, I have yet been able to read the entire document AND maintain consciousness.

Problem #1: The relevant symposium occurred from April 29-30 in the year of your lord 2010.  Yes, approximately 3 years and 7 months later a peer-reviewed article analyzing the symposium was published.  Ridiculous.
Problem #2: Of course the symposium participants believe clinical oncology clinical trial accrual is in crisis.  They are correct.  Sadly they misdiagnose the problem and, therefore, recommend inappropriate treatment.
Problem #3: I am not surprised to report that "the symposium was supported by a public-private partnership".  American fascism rules, even in oncology.  Shameful. 

The LIBERTARIAN BIOETHICS BLOGger could critique this paper for days, but he frankly does not have the energy.  His summary: Medical fascists meet to discuss medical problems caused by medical fascism and recommend more medical fascism.  Don't waste your time with this nonsense.    

The silliest editorial I read in any medical journal in 2013 was entitled "The Just Price of Cancer Drugs and the Growing Cost of Cancer Care: Oncologists Need to Be Part of the Solution".  This article was published in the October 01, 2013 edition of the Journal of Clinical Oncology.  In this essay the author, David Pfister, applauds the self-professed goal of other physicians "to identify Justum Pretium - the Just Price" of oncology drugs.  The other physicians that Dr. Pfister supports include Hagop Kantargian, Tito Fojo, Michael Mathisen, and Leonard Zwelling, who penned the silliest special article I perused in any medical journal in 2013.  Their article was entitled "Cancer Drugs in the United States: Justum Pretium - The Just Price".  This article was also published in the  October 01, 2013 edition of the Journal of Clinical Oncology. In their article, Kantargian et al bizarrely "propose a value-based system for setting the initial price" of all new oncology drugs.

Pfister and Kantargian et al do not understand that the value of an oncology drug to an individual patient cannot be objectively measured because such value is subjective.  They also do not understand that the price (the money price) of a good in a free market is an objective measure of market exchange value.  And, finally, they do not understand that the "just" price concept was refuted by economists several hundred years ago.

In the words of the illustrious Mr. T, I pity these fools.      

Male circumcision (MC) is an exceedingly controversial issue in the libertarian and non-libertarian worlds.  Anecdotally, however, it seems to me that the percentage of libertarian intactivists far exceeds the percentage of non-libertarian intactivists.  But I could be wrong about this.

Libertarian intactivists claim that male circumcision is an act of aggression because it is a violent procedure with severe medical risks but no medical benefits performed on the body of an infant/child without informed consent of the relevant infant/child.  

I disagree with the libertarian intactivisits.  Why?  Let us start at the beginning.  First, the guardian of an infant male has the duty/obligation to make decisions, medical or otherwise, about the body of the infant male because the infant male cannot make such decisions for himself.  Thus, informed consent of the infant male is not required.  Second, the guardian of the infant child can only justly consent to an invasive procedure on an infant child's body if the intent of the procedure is to treat or prevent a medical illness.  If the intent of the proposed procedure is not to treat or prevent a medical illness (such as tattoos, ear piercing, or aesthetic plastic surgery), the guardian's consent for the procedure is invalid and, if performed, the procedure is an act of aggression.  Third, MC has been shown in clinical trials to lower the risk of acquiring sexually transmitted infections (STIs) such as genital herpes/HIV/high-risk strains of HPV, penile cancer, and infant urinary tract infections (UTIs) AND lower the risk of transmitting HIV/HPV/bacterial vaginosis/trichomoniasis to female sexual partners.  In addition, clinical studies show that female sexual partners of circumcised men have a decreased risk of developing cervical cancer.  Fourth and finally, the rate of adverse events for MC of infants is 0.5%, of children is 9%, and of adults is 5%.  Therefore, the safest time to perform MC is when the person is an infant.

The preceding paragraph debunks the primary assertions of the libertarian intactivists.

And I am not wrong about this.

Typically the LIBERTARIAN BIOETHICS BLOGger posts initial thoughts about a bioethical issue on this blog and then, at a distant time in the future, pens a 1-2 page related article, which is published on the LIBERTARIAN BIOETHICS space at liberty.me.  This  routine was exactly reversed with regards to the Marlise Munoz case.  On May 3, 2014 I published a liberty.me article entitled "Pregnant Brain-Dead Bioethics", which analyzed the Marlise Munoz fiasco from a libertarian point of view, and now I submit related commentary on this blog.  Except I just reread the 05/03/14 article and am impressed and don't think I have anything to add.  So, please read the liberty.me article linked here, or await the link I shall ultimately provide on the home page of this website.

A February 12, 2014 www.cnn.com story entitled "Brain-Dead Canadian Woman Dies after Son's Birth" detailed a tragic scenario in which a pregnant woman named Robyn Benson suffered a cerebral hemorrhage and was declared brain-dead.  Fortunately such horrors are rare.  The "silver lining" in this tale, however, was the fact that the fetus remained viable and was able to be delivered safely, via C-section, after the father requested that his brain-dead pregnant wife remain on a ventilator until a safe birth could be accomplished.

The LIBERTARIAN BIOETHICS BLOGger has no complaints about the handing of this tragedy by anyone involved in the case.  Justice was served.  The husband of the brain-dead woman was clearly the "owner" of his brain-dead pregnant wife's body.  Thus, he wielded ultimate decision-making authority regarding the disposition of the body.  After learning that the fetus remained viable, he chose to request that her brain-dead body remain on a ventilator until a safe C-section delivery could be attempted.  The relevant physicians and hospital administration agreed to proceed with the husband's request due to the probable positive outcome of the C-section.  After the C-section was performed (the birth of the apparently health baby), the mother was disconnected from the ventilator and died peacefully.

The only quibble I have with this story is that the reporter, Paula Newton, failed to mention the age of the fetus at the time of the fatal cerebral hemorrhage.  I am curious if the fetus was more or less than 24 weeks status-post fertilization at the instant of brain-death.  Why?  I believe that a rights-bearing human emerges at approximately week 24 status-post fertilization based on functional brain activity (evidenced by bilaterally synchronous EEG activity).  If the fetus was 24 weeks of age or older and viable at the time of the tragedy, then it would have been a crime - murder to be specific - to disconnect the brain-dead body from the ventilator, for this action would have caused the death of the rights-bearing fetus.  If the fetus was 24 weeks of age or older and non-viable at the time of the tragedy, then it would have been medical malpractice to not disconnect the brain-dead body from the ventilator.  If the fetus was less than 24 weeks of age and viable at the time of the tragedy, then it would not have been a crime to disconnect the brain-dead body from the ventilator, for this action would have caused the death of a non-rights-bearing fetus.  If the fetus was less than 24 weeks of age and non-viable at the time of the tragedy, then it would have been medical malpractice to not disconnect the brain-dead body from the ventilator.  So, without additional information, I cannot further categorize this story.

A February 13, 2014 The New York Times article entitled "Ethics Questions Arise as Genetic testing of Embryos Increases" caught my eye.  It reviews the bioethics issues that are accumulating due to the rapidly evolving field of preimplantation genetic diagnosis (P.G.D.).  The LIBERTARIAN BIOETHICS BLOGger supports P.G.D.

What is P.G.D.?  P.G.D. is the genetic testing of embryos for specific disease-causing gene mutations.  Such testing is commonly the first test in a multistep pregnancy process, in which embryos with horrific disease-causing gene mutations are discarded while embryos without horrific disease-causing gene mutations are implanted into an eager female.  The relevant NYT article details the case of a young woman with Gerstmann-Straussler-Scheinker disease (GSS), which is a fatal neurologic disorder.  She originally planned to forgo childbirth to prevent the GSS gene from affecting any others in her family, but P.G.D. allowed she and her husband to have three children without the GSS gene.

Three bioethicists were interviewed for this article.  ECU bioethicist Janet Malek supports P.G.D., Yeshiva University bioethicist David Wasserman opposes P.G.D., and Columbia bioethicist Dr. Robert Klitzman waffles.  The reasons that neo-Luddite Wasserman gives to oppose P.G.D. are incoherent, so I won't waste your time.  

One P.G.D. negative mentioned by the author is the cost, "typically about $20,000".   

P.G.D. is the future of medicine.