Category Archives: Ethics

Should Payments to Egg Donors Be Limited?

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Jake Meyer by Jake Meyer

The New York Times published a May 10, 2010 article about payments to women who donate their eggs titled “Payment Offers to Egg Donors Prompt Scrutiny,” and also asked the question of The New York Times readers Should Egg Donors Be Paid?  The process of donating eggs is time consuming, involves discomfort, and carries some physical risks to the donor, so do you compensate the donor?  Donation can cause abdominal swelling, mood swings, hot flashes and ovarian hyperstimulation syndrome, which can cause bloating, abdominal pain, and in some cases, blood clots, kidney failure, and other life-threatening ailments.  And if you do compensate an egg donor, how much do you pay an egg donor? 

The current practice in the U.S. is to allow egg donors to be paid.  The American Society for Reproductive Medicine has set guidelines for payments to egg donors.  The guidelines require justifications for payments over $5,000 and set a maximum compensation at $10,000 and also do not allow for the higher payments for specific traits.  However, advertisers are ignoring these guidelines.

A study by Dr. Aaron Levine at the Georgia Institute of Technology found that out of a sampling of 100 ads from 63 different college campuses, over a quarter of those ads exceeded the $10,000 maximum compensation guidelines set by the American Society for Reproductive Medicine.  The ads also offered higher average payments at schools with higher average SAT scores – ads averaged $2000 more for every 100 point difference in the average SAT scores.  Ads in the newspapers at Yale, Princeton, and Harvard offered $35,000 and an ad in the newspaper at Brown offered $50,000.

Are these guidelines necessary?  Should couples looking to reproduce be allowed to pay whatever price they wish for a donor egg?  Critics fear that young women will see the amount of money offered for egg donation and may overlook or not understand the potential physical and psychological risks.  Should the offers for donated eggs allowed to be higher for specific attributes?  Is an offer asking to pay $50,000 for the eggs of a donor who is tall, athletic, Ivy League educated, and with a score of at least 1400 of 1600 on the SAT appropriate?  Or are offers like this more akin to eugenics, where couples using donated eggs to conceive are paying higher premiums and selectively breeding certain traits.  The ASRM guidelines seem reasonable when the risks that an egg donor undertakes are weighed against the concern that women will donate against their best interests because of a large pay day.  Setting a limit on what an egg donor can be paid allows for an egg donor to be adequately compensated, and also addresses the issue eugenics-like trait selection.  Efforts should be made to ensure that these guidelines are more strictly followed.

Guilt by Association: Familial DNA Searching Implicates Many On the Quest to Find The One

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JenAckerby Jen Acker

When DNA is left behind at a crime scene, investigators usually run the sample through a DNA database.  All states collect DNA samples from convicted felons, and some even collect DNA from suspects brought into custody.  If the DNA found at the crime scene matches a sample in the database, a suspect has likely been identified.  Sometimes, an exact match may not be found, but a very close match may exist:  this is the essence of familial DNA searching.  These near-matches may spell trouble for the innocent relatives of people with criminal histories. 

Individuals related by blood have similarities in genetic material.  Therefore, the stored DNA of a man who has a criminal record could be used to identify his brother who does not have a criminal record.  Similarly, DNA taken from children born out of a rape has been used to identify their father, the rapist.  In at least one high profile case, familial DNA searching was used to free an innocent man who spent 19 years behind bars.

Despite the potential for identifying suspects, familial searching is not without debate, and its legality has not been vetted in the courts.  Critics contend that familial DNA searching raises concerns regarding privacy and illegal search and seizure.  While DNA near-matches indicate that a relative of a convicted criminal is likely implicated, near-matches do not indicate precisely which relative.  The fear is that family members become guilty by DNA association even when law enforcement has no other evidence to support the connection.

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The Lancet Can Erase Its Pages But Can’t Put out the Fire — Exploring the Retraction of Wakefield’s 1998 Study Connecting Childhood Vaccination with Autism

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Keith Syverson by Keith Syverson

This month, The Lancet retracted a 1998 study conducted by Andrew Wakefield that demonstrated a connection between the MMR vaccine and autism.  The Lancet made the retraction in response to the findings of a UK General Medical Council’s Fitness to Practice Panel, which found that Wakefield falsely claimed that the study participants were referred by routine methods and that the investigations were approved by local ethics committees.  The Lancet retraction reignited the debate over whether vaccines cause autism and invites a brief history of the Wakefield paper and a discussion on the more recent debate over the connection between mitochondrial disorders, autism, and vaccines.

In 2004, The Lancet published results of its own investigation of Wakefield's alleged professional misconduct concerning the 1998 study.  The editors reviewed all available documentary evidence and interviewed the study's authors to determine the validity of six claims of misconduct: (1)that the study falsely claimed it received ethics approval; (2)that the study was completed under the ethics approval of an entirely different study; (3) that the children involved were invited to participate directly by Wakefield and his co-authors, rather than through outside referrals; (4) the children from the study were also part of a Legal Aid Board funded project led by Dr. Wakefield with the goals to investigate the "grounds for pursuing a multi-party legal action on behalf of parents allegedly vaccine-damaged children;" (5) that the results of the study were passed to lawyers to justify the legal action; and (6) that Wakefield received £55,000 from the Legal Aid Board to conduct the study and that, "since there was a substantial overlap of children in both the Legal Aid Board funded pilot project and the Lancet paper, this was a financial conflict of interest that should have been declared to the editors and was not."

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FDR’s Cancer and Abe Lincoln’s DNA: What Rules Should Govern “Biohistory?”

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Lori Andrews by Lori Andrews

Historians traditionally probed the lives of past presidents by analyzing their speeches, reading their diaries, and tracing the trajectories of their lives.  But now medical and genetic tools have been added to the arsenal of historic inquiry.  And questions have arisen about the ethical and legal ramifications of the emerging field, “biohistory.”

A new book, FDR’s Deadly Secret by neurologist Steven Lomazow and The New York Post reporter Eric Fettmann, hypothesizes that Franklin Delano Roosevelt had cancer.  The authors and came to that conclusion by analyzing photos of small lesion above his eye, thought to be a melanoma.

The assertion is nothing new. For at least half a century, physicians and journalists, including a 1979 Time magazine article, reported on just such a speculation.  But newspaper and blog responses in the past few days are filled with anger about how FDR could have kept this from the public.  There’s even a sense of outrage that his decision-making during World War II might have been impaired due to the spread of the cancer to his brain.  In yesterday’s Post, Fettman accused FDR of endangering the nation by running for president with this supposed malady.

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From Rabbits to Humans: Transplanting Wombs

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SarahBlennerBy Sarah Blenner, JD, MPH

In 2000, the first human womb transplant was attempted in Saudi Arabia.  The transplant failed when the 26 year old woman developed a blood clot and the transplanted uterus had to be removed.  But now scientists believe that they are close to perfecting a reproductive technology that could solve some women’s infertility: transplanting a womb into a woman who lacks a functioning uterus. 

Infertility affects one in six women.  Some women are unable to get pregnant because they either do not have a uterus or do not have a properly functioning uterus.  At least 15,000 women in Britain alone are infertile because of a condition associated with uterine function.  A woman may lack a uterus because she has had a hysterectomy or may not have a properly functioning uterus because of a medical condition, such as intrauterine adhesions, also known as Asherman’s syndrome.  Currently, if women without a properly functioning uterus wish to have children, they must either adopt or turn to surrogacy.  Despite the availability of these alternatives, some women want to bear their own children and are willing to undergo surgery to achieve pregnancy. 

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The Story of a Sperm with a Bad Heart

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Keith Syverson by Keith Syverson

A study published in last week's issue of the Journal of the American Medical Association (JAMA) raises concerns about regulation of sperm banks.  The study describes the case of a 23-year-old man in good health who donated sperm to a U.S. sperm bank almost a hundred times over a two year period.  The sperm bank followed protocols standard in the industry at the time of the donation: doctors gave the donor a comprehensive medical evaluation including a complete personal and family medical history in addition to laboratory testing for communicable diseases. Several years later, a woman inseminated with the donor's sperm gave birth to a child diagnosed with Hypertrophic Cardiomyopathy (HCM) — a heart disease characterized by the thickening of the heart muscle.  The sperm bank notified the donor and all other recipients of his sperm that their children were at risk for HCM.  Twenty-two children were born using the donor's sperm in addition to two children born to the donor's wife.  Five children showed evidence of HCM including one two and a half year old child who died waiting for a heart transplant.

This case study underscores the need for more stringent testing protocols for gamete donation.  The American Society for Reproductive Medicine has published recommendations on genetic screening for gamete donors, but compliance with these guidelines is voluntary.  Studies have shown that most gamete donor agencies do not follow these protocols.  For sperm banks, only half of programs surveyed performed a chromosome analysis and about a quarter of egg donor agencies reported that they do not screen egg donors.  Moreover, the authors of the JAMA article note that it is a surprise that the sperm bank was able to contact the donor and everyone who received the sperm because this is uncommon in the industry.

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“What if our perception of normal exposure is skewed?”: Analyzing the Science of BPA

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SarahBlennerBy Sarah Blenner, JD, MPH

Bisphenol A (BPA) is an estrogen mimicking chemical commonly used to create both polycarbonate plastics and the resin lining of cans.  This chemical can be found in plastic food and beverage containers, cans, dental sealants, household products, cell phones, computers, and medical devices.  Hundreds of studies link the synthetic hormone, BPA, to a variety of adverse health conditions, including, breast cancer, prostate cancer, ADHD, autism, obesity, insulin resistance, type 2 diabetes, liver enzyme abnormalities, early onset of puberty, and cardiovascular disease.

In a study conducted by the CDC, scientists found that BPA was present in 93% of Americans tested, signifying the high prevalence of BPA exposure in the American population.  One participant of the “Is It In Us?” study, which measured the presence of toxic chemicals, such as BPA, in the blood and urine of participants, was relieved to know that her results were no different than the results of most of the other participants.  But then she thought: “what if our perception of normal exposure […] is skewed?”

Last May, Chicago became the third jurisdiction in the United States to successfully pass legislation regarding Bisphenol A when it banned the sale of baby bottles and other empty food and liquid receptacles intended for the use by children under the age of three.  Prior to Chicago City Council’s passage of the BPA Free Kids Ordinance, the State of Minnesota and Suffolk County New York passed legislation regulating BPA.  In June, Connecticut became the fourth jurisdiction in the United States to address the health risks of BPA through legislation, when it passed an “Act Concerning Banning Bisphenol-A in Children’s Products and Food Products.”  According to the Public Act, beginning October 1, 2011, the sale of infant formula, baby food, and reusable food or beverage containers that contain the chemical Bisphenol A will be banned.

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Robin Cook and Bioethics

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Lori Andrews by Lori Andrews

Robin Cook attended medical school before the birth of the patients’ rights and bioethics movements.  Last month in New York at Thrillerfest, the national meeting of thriller writers, Cook explained that he began writing medical mysteries as a way to make the public aware of the dangers and risks inherent in modern medicine.

“Patients used to come to me and say, ‘I want to be put to sleep during the operation.’  They had no idea what was going on.  I’d say to them, ‘It’s not like being put to sleep.  It’s like being poisoned and then revived.'”

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Michael Jackson’s DNA Will Be Used to Make Jewelry

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Lori Andrews by Lori Andrews

During his life, Michael Jackson's hair was at the center of a legal dispute.  When he filmed a Pepsi commercial, the pyrotechnics on the set set his hair aflame, leading to a lawsuit against the soft drink company.  In that case, Jackson donated his $1.5 million settlement to the burn unit that treated him.

Now, after his death, his hair is raising an issue central to bioethics:  What right do people have to control the use of their tissue?

During the ill-fated commercial–which some commentators think led to the singer's use of painkillers–executive producer Ralph Cohen picked up charred hairs from the floor.  John Reznikoff, a hair collector, purchased the hair and now has an arrangement with an Elk Grove Village, Illinois company, Life Gems, to create man-made diamonds out of the carbon in Jackson's hair.

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Did I Say I was 16? I meant 20. The MLB tries DNA Testing to Thwart a New Generation of Cheaters.

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Keith Syverson by Keith Syverson

Another testing controversy has arisen in the world of baseball.  This time it was not Alex Rodriguez or Roger Clemens testing positive for performance enhancing drugs, but rather it was an amateur baseball player from the Dominic Republic named Damian Arredondo "failing" a DNA test as part of an investigation to confirm his age.  It does not come as a big surprise that in an era where Bud Selig, the Commissioner of Major League Baseball (MLB), is trying to clean up the sport's image and punish cheaters such as those who use performance enhancing drugs, that the MLB is also testing to prevent other forms of cheating such as misrepresenting one's age.  A young prospect is valuable because it gives the potential signing team more time to develop the player and teach him how to be a successful hitter or pitcher in the Major League.  Additionally, as players age, they become more injury prone and are less productive as hitters.  Teams usually take a players age into account when offering a contract extension later in life.  For example, a 30-year-old player will generally be paid more and receive a longer contract then a 34-year-old player.

 Most baseball fans remember when Miguel Tejada, a Dominic Republic native, announced to the Houston Astros that he was in fact 33 years old and not 31, or when investigators discovered that a Washington Nationals prospect assumed an alter ego that was four years younger then his actual age.  In the aftermath of the steroid scandal, the MLB has established an investigative team taking extreme measures to ensure that this does not happen again by subjecting potential players and their family members to bone scans and DNA testing.

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