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Gaza is riddled with tunnels. Some are for smuggling; others are for transporting weapons; others are for hiding or ambushing Israeli troops. The crucial passageways—400 to 600, by recent estimates—run from Gaza to Egypt, circumventing the closed border. That's how Hamas gets parts and material for the missiles it fires into Israel. Any deal to end the current fighting has to include "an effective blockading" of that border, "with supervision and follow-ups," according to Israel's prime minister. To stop the war—and to keep it stopped—you have to figure out how to stop the tunnels.
But how? Here are some of the options.
More here.
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Here's the theory: Old people are bad drivers. And we're living longer, so there are more old people on the road, so they're causing more accidents. And they're already fragile, so they're killing more people, including themselves. Right?
Wrong. According to the latest data from the Insurance Institute for Highway Safety (flagged by Tara Parker-Pope of the New York Times), it's true that "older people now hang onto their licenses longer, drive more miles, and make up a bigger proportion of the population than in past years as baby boomers age." It's also true that "per mile traveled, crash rates and fatal crash rates increase starting at age 70 and rise markedly after 80," possibly because "physical, cognitive, and visual declines associated with aging may lead to increased crash risk."
That's what makes the bottom-line findings so surprising:
Despite growing numbers on the road, fewer older drivers died in crashes and fewer were involved in fatal collisions during 1997-2006 than in years past. ... Crash deaths among drivers 70 and older fell 21 percent during the period, reversing an upward trend, even as the population of people 70 and older rose 10 percent. Compared with drivers ages 35-54, older drivers experienced much bigger declines in fatal crash involvements.
The institute's chief of research adds: "No matter how we looked at the fatal crash data for this age group—whether by miles driven, licensed drivers, or population—the fatal crash involvement rates for drivers 70 and older declined, and did so at a faster pace than the rates for drivers 35-54 years old."
So what gives? "Reasons for the fatality declines aren't clear, but another new Institute study indicates that older adults increasingly self-limit driving as they age and develop physical and cognitive impairments," says the IIHS. In that study,
The oldest drivers were more likely to say they restricted their own driving. Drivers 80 and older were more than twice as likely as 65-69 year-olds to self-limit driving by doing such things as avoiding night driving, making fewer trips, traveling shorter distances, and avoiding interstates and driving in ice or snow. The percentage of drivers who said they limit their driving increased with each added degree of impairment. Drivers cited memory and medical impairments more often than vision or mobility ones.
In other words, as we age, self-knowledge and self-regulation compensate for our loss of abilities. As Farhad Manjoo reported four months ago in Slate,
Statistics on current road deaths show that people over the age of 65 are only 16 percent more likely to cause accidents than are people aged 25 to 64. Drivers under 25, meanwhile, are the most dangerous people on the road—they're 188 percent more likely to cause crashes than middle-aged adults.
Aging is a tragic but beautiful process: As we decay in some ways, we grow in others. We become less able to control the world but more able to control ourselves. As IIHS points out, our decline isn't just physical; it's mental, too. Yet we understand ourselves better than ever. Even as our vision deteriorates, we become more clear-eyed about our own limits. And even as our memory degrades, we develop a more important kind of knowledge: We know what we don't know.
Not everyone grows this way. To the extent that self-regulation has reduced fatal crash rates among aging drivers, the implication is that old people can be made more aware of their limits and can adjust accordingly. If you're aging, the lesson is to monitor and govern your driving. And if you're young, the lesson is to cultivate what old people have—self-knowledge and self-control—while your mind and body are still at full strength.
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First, we said IVF embryos weren't pregnancies. That's technically correct: Pregnancy begins when the embryo implants in the womb. Then we called early embryos "pre-embryos" so we could dismantle them to get stem cells. That was technically incorrect, but we did it because it made us feel better. Now we're adjusting the word conception. Henceforth, testing of IVF embryos to decide which will live or die is "preconception." Don't fret about the six eggs we fertilized, rejected, and flushed in selecting this baby. They were never really conceived. In fact, they weren't embryos. According to Serhal, each was just "an affected cluster of cells."
More here.
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Hey, cell-phone zombie! Wake up! The National Safety Council is trying to pull you over.
The council, a congressionally chartered nonprofit that helped lead the fight for seat-belt use, wants a nationwide ban on cell-phone use while driving. Not just a ban on holding your phone. A ban on using it.
It's about time. Three months ago, Human Nature looked up the research on cell-phone use at the wheel. It's brutal. Even with a hands-free device, talking on a phone can impair driving skills more than intoxication does. Brain scans show the phone conversation sucking the driver's mind from one world into another.
Just last week, a lawsuit in the "texting-engineer" train crash near Los Angeles alleged that the engineer's bosses knew about his texting habit but ignored it. This weekend, I was complaining that the company should have taken driving while texting as seriously as we take driving while drunk.
My complaint has been answered. On Monday, the NSC agreed. Council president Janet Froetscher cited the same flaw in hands-free cell-phone laws: "Even if both hands are on the wheel, your head is in the call, and not on your driving." And she drew the same comparison to alcohol: "When our friends have been drinking, we take the car keys away. It's time to take the cell phone away."
Can a total ban get through the legislative process, politically? It'll be hard, precisely because, as Froetscher notes, 270 million Americans use cell phones, and 80 percent of them use their phones while driving. But the council has succeeded before, and it will do so again, if it can persuade lawmakers and the public to see cell phones in cars the way we now see liquor. "We have been through this before with seatbelts, with drunk driving," says Froetscher. "We do research. When the research demonstrates that something is very dangerous and we can save lives, we educate the public about it."
The insurance industry agrees that a total cell-phone driving ban "makes sense based on the research." The council has also identified a proven mechanism for nationalizing such a ban: Congress can use its highway-construction legislation to financially reward states that pass no-cell laws. And 16 states have set a potentially useful precedent by banning cell-phone use among drivers with learner's permits, intermediate licenses, or both.
To me, the persuasive analogy is alcohol. Intuitively, cell phones in the car seem more justified and less objectionable than booze does, because booze is stupefying, whereas phones are engaging. But the more the phone engages you in its own world, the more it stupefies you in the one you're navigating. Nobody's saying you can't use your phone or your car. Just not at the same time.
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Would you like to take performance-enhancing drugs to boost your pro sports career? Are the drugs banned as a form of cheating? No problem. Just find a doctor willing to certify that you have a "deficit" of the performance factor in question.
That's what seems to be happening in Major League Baseball.
More here.
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Last month, we talked about the transition from George W. Bush to Barack Obama and what it might signify for biotech policy: a shift from a conservative interest in technological frontiers to a progressive interest in distributive justice. Less debate, for instance, about things like future artificial wombs, and more attention to things like incubators made from car parts. The point of car-parts incubators was that nobody cares about the latest million-dollar American baby born at 21 weeks when you live in a country where preemies die at 35 weeks. What most of the world needs is an affordable incubator that works for most preemies and can be reliably maintained.
Here's another target for the progressive ethic: eyeglasses. The man leading the charge is Joshua Silver, a physicist at Oxford. In Saturday's Washington Post, Mary Jordan explains the situation:
In the United States, Britain and other wealthy nations, 60 to 70 percent of people wear corrective glasses, Silver said. But in many developing countries, only about 5 percent have glasses because so many people, especially those in rural areas, have little or no access to eye-care professionals. Even if they could visit an eye doctor, the cost of glasses can be more than a month's wages. This means that many schoolchildren cannot see the blackboard, bus drivers can't see clearly and others can no longer fish, teach or do other jobs because of failing vision.
Silver's answer: Adjustable glasses.
[T]he more liquid pumped into a thin sac in the plastic lenses, the stronger the correction. Silver has attached plastic syringes filled with silicone oil on each bow of the glasses; the wearer adds or subtracts the clear liquid with a little dial on the pump until the focus is right. After that adjustment, the syringes are removed and the "adaptive glasses" are ready to go. Currently, Silver said, a pair costs about $19, but his hope is to cut that to a few dollars.
Silver has already distributed some 30,000 pairs, chiefly through the U.S. Department of Defense, which is giving away 20,000 (with U.S. public-relations inscriptions attached) in Africa and Eastern Europe. His next goal is to disseminate another million pairs in India. The ultimate target is 1 billion people who need glasses but don't have them.
Silver's glasses are ugly. They don't correct astigmatism or catch glaucoma. They're inferior to what the eye-care industry can sell you. But they're superior to what most people in need of vision correction can buy, which is nothing. I'm a congenital critic of utilitarianism (the idea of promoting the greatest welfare of the greatest number of people) when it threatens humanity. But when it serves us -- all of us -- I'm a big fan.
If you like Silver's vision, here's his Web site. Take a good look.
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Remember that train crash near L.A. in September, where the engineer was texting while driving? Twenty-five dead, 130 injured. In three hours of work before the crash, the engineer received 28 text messages and sent 29 more. He sent his last message 22 seconds before impact, just after passing a signal that would have alerted him to the disaster ahead.
Now some of the victims have filed suit. They're alleging that the engineer's bosses were warned about his texting habit. Here's the New York Times summary:
The plaintiffs' lawyers said at a news conference that a co-worker of Mr. Sanchez [the engineer] had told managers ... that Mr. Sanchez frequently used his cellphone while on duty, in defiance of company policy. ... The employee placed at least two calls to managers from July to September, [the plaintiffs' attorney] said. In addition, he said, the employee told him that on a routine inspection two months before the crash, a supervisor caught Mr. Sanchez violating the policy barring engineers' use of cellphones while on duty. Still, he said, the engineer was never punished.
Remember, these are just allegations. They'll have to be tested at trial, if it comes to that. But if they're borne out, let's not make the same mistake Sanchez's superiors allegedly made. Let's take driving while texting—or while phoning—as seriously as we take driving while drunk. After all, as this column mentioned three months ago, research shows that even with a hands-free device, talking on a phone can impair driving skills more than intoxication does.
Alcohol has been around for millennia. Cell phones have not. We evolved to function in the natural world, one setting at a time. Nature has never tested a species's ability to function in two worlds at once. We're now taking that test, and we're flunking it. So here's a message to the 45 states that let people drive while holding a phone, and to the 50 states that let allow driving while talking on a hands-free phone: Sober up.
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Are mental disorders as important as physical injuries? Many advocates say that they are and that we should treat them accordingly. Most of the fight is over insurance coverage of mental health. But part of the action is in the U.S. military. There, the question has been whether to award the Purple Heart for post-traumatic stress disorder. This week, the Defense Department announced its decision: No.
Eight months ago, when we first checked in on this debate, I was skeptical for two reasons. One was that PTSD would turn out to be widely overdiagnosed. In general, mental wounds are harder to define and identify than physical wounds are. There are obvious cases, but there are also fuzzy ones. Where do we draw the line? How do we keep the Purple Heart from being cheapened?
The second reason was that the Purple Heart, unlike basic health insurance, isn't a policy instrument. It's an honor. Officially, it denotes "meritorious action." And honor isn't the first step in a cultural transformation, no matter how worthy that transformation may be. It's the last.
I've been reading DoD's explanation of its decision and looking back at what I wrote eight months ago. And I'm beginning to think the decision may be wrong.
The reason has to do with gay marriage. The "honor" argument against the Purple Heart for PTSD is a lot like the argument against same-sex marriage. Marriage isn't a right or benefit, conservatives argue. It's a special commitment, a moral institution. Gays may deserve equal employment opportunity, just as mental-health patients deserve basic health insurance coverage. But marriage, like the Purple Heart, is a higher standard. It's an honor that should be awarded last, or maybe never.
Andrew Sullivan nailed this argument 20 years ago: Conservatives are largely right about what marriage is. They're just wrong that this understanding precludes extending it to homosexuals. In fact, they have it backward: Marriage would anchor gays, like straights, against "the chaos of sex and relationships to which we are all prone. It provides a mechanism for emotional stability, economic security, and the healthy rearing of the next generation." The key is to preserve the definition of marriage as commitment: to let go of the heterosexual requirement while fortifying the distinction between marriage and shacking up. My favorite proposal, to prove the point, is same-sex covenant marriage.
Something like that should be the solution to the Purple Heart debate. Opponents of the Purple Heart for PTSD say mental disorders can't qualify because the warrior doesn't "shed blood." That's foolish fundamentalism: Lots of people are wounded without literally shedding blood. DoD also says the wound must be "intentionally caused by the enemy." But the Purple Heart is already awarded for wounds that weren't precisely intended by the enemy. The enemy just throws his grenade at your platoon. Exactly which of you gets incapacitated and how—shrapnel, shock, whatever—isn't his concern.
On the other hand, DoD rightly points out that there have to be "objective" medical ways to distinguish clear-cut PTSD from fuzzy or fake versions. Otherwise, Purple Heart awards will become cheap or arbitrary. Along these lines, the department articulates three clear, reasonable, and tight criteria. First, the wound must be "the result of enemy action where the intended effect of a specific enemy action is to kill or injure the servicemember." Second, it must be "an injury to any part of the body." Third, it must be "caused by the enemy from an outside force or agent."
Can PTSD satisfy these criteria? In principle, I think so. The first criterion is relatively easy to address: You must face the same physical risks as any other Purple Heart recipient. The second is more difficult: Objective physical measures of PTSD must be established. This could be done, for example, with brain scans. We aren't there yet, so consider this a research project for the PTSD movement. The third criterion is a nexus of the first two: You would have to assemble some kind of case file showing that the signs of PTSD in the brain scans or other physical measures postdate the combat incident.
Will service members and veterans with PTSD actually meet these standards? Some won't, and even the most qualified cases will be hard to prove. But they should be, because the Purple Heart is sacred. It's just that there's nothing inherently more sacred about being wounded in your backside than in your brain.
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How carelessly is Israel killing civilians in Gaza? Let's ask the hospitals and the United Nations.
In Dense Gaza, Civilians Suffer
Among the total dead—between 320 and 390, according to the United Nations—Palestinian medical officials say that 38 were children and 25 were women. The United Nations agency that helps Palestinian refugees said 25 percent of those killed had been civilians. (New York Times, Dec. 31, paragraph 6)
Sounds bad. Or how about this:
Israel Deepens Gaza Incursion as Toll Mounts
Palestinian medical officials estimated that the death toll during the war reached 550 on Monday. The United Nations estimated that about a quarter of those killed were civilians. (Times, Jan. 5, paragraph 8)
It's amazing how high the ratio of civilian to combat injuries can be. For example:
Gaza Hospital Fills Up, Mainly With Civilians
In recent days, most of those arriving at Shifa appeared to be civilians. On Sunday, there was no trace here of the dozens of Hamas fighters that the Israeli military said its ground forces had hit in the past few hours in exchanges of fire. The exact reason was not clear. Many ambulance drivers refused to go near the fighting. It also seemed possible that Hamas and Israeli fighters were still battling at some less lethal distance. It was difficult to know whether fighters were spread out at other hospitals. (Times, Jan. 4, paragraph 16)
And now, today:
U.N. Suspends Food Aid Into Gaza
The United Nations suspended its food aid deliveries into Gaza on Thursday after one of its contract drivers was killed during an Israeli attack ... (Times, Jan. 8, paragraph 1)
Those nasty, reckless Israelis. All they seem to hit is one civilian or rescue worker after another. In fact, you have to read all the way down to the very bottom of today's 30-paragraph story to find this:
But Palestinian residents and Israeli officials say that Hamas is tending its own wounded in separate medical centers, not in public hospitals, and that it is difficult to know the number of dead Hamas fighters, many of whom were not wearing uniforms.
Oops! No wonder the Times couldn't find those Hamas fighters at Shifa. The fighters aren't at the hospitals. So we don't really know how many of them have been wounded—or killed, since they aren't in uniform, even if we had access to all the bodies. So we don't know what percentage of the dead or wounded are civilians. All we know is that the percentage is lower than you'd guess from counting patients at the hospitals.
Every life is precious. The bloodshed in Gaza is awful, and I hope it ends today. But the ratio of civilian to combat injuries and casualties being reported out of the war zone is inflated, and we simply don't know by how much. It makes one side look more careless than it actually is. And the other side, by concealing its dead and wounded, is controlling the inflation.
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Can you get paid for donating an organ?
In practice, you can. All over the world, people are being paid for their kidneys. But what about the United States? Under U.S. law, can you demand compensation for such a gift?
Richard Batista of Long Island, N.Y., thinks he can. He's suing his ex-wife for $1.5 million, citing, among other things, the kidney he gave her eight years ago. He says she rewarded his life-saving generosity by having an affair, divorcing him, and keeping their children away from him.
Newsday implies the case will go nowhere:
Medical ethicists agreed that the case is a nonstarter. Arthur Caplan of the University of Pennsylvania's Center for Bioethics said the likelihood of Batista getting either his kidney or cash was "somewhere between impossible and completely impossible." Robert Veatch, a medical ethicist at Georgetown University's Kennedy Institute of Ethics, noted that "it's illegal for an organ to be exchanged for anything of value."
I'm not so sure. Batista can't take his kidney back, but that's not what he's after. He wants his ex-wife to let him visit their kids, on pain of compensating him for what he gave her. And what he gave her, according to his attorney, wasn't just an organ but a livelihood. According to Newsday, the attorney says the $1.5 million demand "reflects damages, including how much money she made as a result of being able to continue working and not having to go on dialysis." So the dollar figure isn't based on the price of an organ (which would be considerably cheaper, based on the going rate of kidneys abroad); it's based on the income one spouse accrued thanks to the other's sacrifice. And sacrifices between spouses are treated differently, under the law, from sacrifices between strangers or friends. There's a tradition and expectation of common benefit. You and your spouse become one flesh—in this case, literally.
I'm sure some of you clever lawyers can figure out how to position this claim as an extension of those divorce cases where the wife gets compensated for devoting herself to her husband's executive career. "It's not the organ itself we're asking you to value. It's the financial benefit the defendant gained thanks to the risk, the pain, and the extensive, invasive medical procedures this good man, this loving husband, endured. Yes, it was a gift of love—but no less a gift of love than the other sacrifices so many spouses make for each other's careers. Let it be acknowledged in the same way."
I'm tearing up already. Will it work? I wouldn't bet a kidney on it. But it's worth a try.
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What is it with the Catholic Church and female anatomy?
The total opposition to abortion I can understand. The men in Rome believe that personhood begins at conception.
The opposition to artificial contraception strikes me as completely wrongheaded but not necessarily a guy thing. They believe that sex must be open to life and that life must arise through sex.
The misunderstanding of morning-after pills in their latest instruction to Catholics? Well, that's a bit ignorant. But even the average woman isn't familiar with the research on LH surges, luteal dysfunction, and endometrial damage.
On all these issues, I'm willing to give the men in Rome the benefit of the doubt. But then I read this report from the Vatican newspaper, via Agence France Presse:
The contraceptive pill is polluting the environment and is in part responsible for male infertility, a report in the Vatican newspaper L'Osservatore Romano said Saturday. The pill "has for some years had devastating effects on the environment by releasing tonnes of hormones into nature" through female urine, said Pedro Jose Maria Simon Castellvi, president of the International Federation of Catholic Medical Associations. ... "We have sufficient evidence to state that a non-negligible cause of male infertility in the West is the environmental pollution caused by the pill," he said, without elaborating further.
That's right: The new cause of male infertility is female urine. Specifically, the urine of women who are committing the sin of contraception.
Scientifically, the theory looks a bit wet. AFP continues:
The article was promptly dismissed by several organisations. "Once metabolised, the hormones contained in oral contraceptives no longer have any of the characteristic effects of feminine hormones," said Gianbenedetto Melis, vice-president of a contraceptive research association, quoted by the ANSA news agency. The hormones contained in the pill such as oestrogen "are present everywhere ... in plastic, in disinfectants, in meat that we eat," added Flavia Franconi, of the Society of Italian Pharmacology.
Perhaps it's a sign of the modern age that moralists feel obliged to associate their principles with health effects. Abortion isn't just murder; it causes breast cancer and psychological damage to women. Contraception isn't just a violation of God's will; it's an environmental toxin. But none of these health claims has turned out to be valid. And in this case, the claim is so perfectly consistent with the history of misogyny—blaming men's fertility problems on women's sins and fluids—that it risks not just scientific but moral discredit.
On the other hand, if it turns out to be true, I'll be really pissed.
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For ages, we've been telling children that ghosts aren't real. But the Department of Defense has just put out a request for proposals to create what are, in effect, virtual ghosts. Another truism of parenting is about to become untrue.
More here.
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I'm just back from vacation and trying to catch up on the war in Gaza. More on that later. But first, something I didn't have a chance to get to before the break: the Vatican's latest pronouncement on fertility technology. Apparently the men in Rome are having trouble understanding some nuances of the female reproductive system.
The pronouncement comes in the form of Dignitas Personae, an instruction from the Congregation for the Doctrine of the Faith, which articulates official Catholic positions. This document covers several interesting topics, which I hope to get to in the days ahead. But the one that calls for rebuttal right away is the section on "[n]ew forms of interception and contragestation." It says:
Alongside methods of preventing pregnancy which are, properly speaking, contraceptive, that is, which prevent conception following from a sexual act, there are other technical means which act after fertilization, when the embryo is already constituted, either before or after implantation in the uterine wall. Such methods are interceptive if they interfere with the embryo before implantation and contragestative if they cause the elimination of the embryo once implanted.
This is an astute and useful set of distinctions. Unfortunately, the CDF immediately proceeds to violate them. Here's its next paragraph:
In order to promote wider use of interceptive methods [a footnote here specifies "morning-after pills"], it is sometimes stated that the way in which they function is not sufficiently understood. It is true that there is not always complete knowledge of the way that different pharmaceuticals operate, but scientific studies indicate that the effect of inhibiting implantation is certainly present, even if this does not mean that such interceptives cause an abortion every time they are used. ...
Really? Is the effect of inhibiting implantation "certainly present"? Let's review the mechanics of morning-after pills, specifically levonorgestrel, marketed as Plan B. The problem with the CDF's statement is that this "interceptive" is chemically identical to the best-known contraceptive: the pill. And the risk that this drug
will prevent implantation of an embryo is purely theoretical. There is no documented case of such a tragedy, since we have no way to verify conception inside a woman's body prior to implantation without causing the embryo's death. Even theoretically, the risk is vanishingly small, since the primary effect of oral contraception is to prevent ovulation, and the secondary effect is to prevent fertilization. To classify oral contraception as abortifacient, one would have to posit a scenario in which the drug fails to block ovulation, then fails to block fertilization, and yet somehow, having proved impotent at every other task, manages to prevent implantation.
So, the assertion of an anti-implantation effect is theoretically unsound. But what do the data show? Two years ago, the world's leading expert on levonorgestrel, James Trussell, co-authored an analysis of the available research in the Journal of the American Medical Association. The analysis confirmed that that anti-ovulation effects wipe out any data suggesting a possible anti-implantation effect. It concluded:
Published evidence clearly indicates that Plan B can interfere with sperm migration by altering the cervical and uterine environment, and that preovulatory use of Plan B usually suppresses the LH surge either completely or partially, which in turn either prevents ovulation or leads to the release of ova that are resistant to fertilization. Epidemiological evidence rules strongly against interruption of fallopian tube function by Plan B. Evidence that would support direct involvement of endometrial damage or luteal dysfunction in Plan B's contraceptive mechanism is either weak or lacking altogether. Both epidemiologic and clinical studies of Plan B's efficacy in relation to the timing of ovulation are inconsistent with the hypothesis that Plan B acts to prevent implantation.
In fact:
Progestational drugs, including levonorgestrel, are used therapeutically in assisted reproduction because they increase the rate of successful implantation and pregnancy. That observation a priori reduces the likelihood that Plan B interferes with implantation; it even raises the counterintuitive but undocumented possibility that Plan B used after ovulation might actually prevent the loss of at least some of the 40% of fertilized ova that ordinarily fail spontaneously to implant or to survive after implantation.
So, in summary:
[T]he ability of Plan B to interfere with implantation remains speculative, since virtually no evidence supports that mechanism and some evidence contradicts it. ... [T]he best available evidence indicates that Plan B's ability to prevent pregnancy can be fully accounted for by mechanisms that do not involve interference with postfertilization events.
So much for the question of effect. But what about the other part of the moral equation: intent? The Vatican document, still referring to morning-after pills, says that "anyone who seeks to prevent the implantation of an embryo which may possibly have been conceived and who therefore either requests or prescribes such a pharmaceutical, generally intends abortion."
But a woman who requests a morning-after pill doesn't necessarily seek to prevent an embryo's implantation. In fact, as we just showed, it would be irrational of her to seek that effect, since no evidence supports it. In fact, given the evidence, it would make just as much sense for her to request the pill in order to prevent embryonic loss. And anyone who has ever taken a morning-after pill knows that at that moment, your actual intent is to avert pregnancy at the earliest possible stage of the process, which happens to be ovulation.
Bottom line: The perceptive analytical framework established by Dignitas Personae, combined with the best scientific evidence and analysis, clearly implies that morning-after pills are contraceptives, not interceptives. Therefore, from the standpoint of respecting embryonic life, you may take them in good conscience.
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Human Nature is on vacation and won't be back till after New Year's. In the spirit of the holidays, I'd like to thank each of you for staying in touch as a reader and, I hope, as a correspondent. In fact, I'd like to ask one favor of you: Tell me how you'd like me to do my job differently.
The mission of this column is to explore the ways in which science and technology are changing how we live, what we think, and who we are. It's a huge and growing part of modern life. Traditional media have covered it poorly, I think, because they're too accustomed to the old system of beats. There's the science beat, where you cover the latest studies. There's the health beat, where you cover the human body. And then there are political and cultural beats, which address how we live and govern ourselves.
The problem with the old system is that technology is moving so fast, and transforming society so extensively, that we can no longer adequately cover politics and culture without accounting for science and technology. Nor can we cover science and technology without examining how they're affecting culture and politics. Hence this column.
With that framework in mind, which topics should I be covering more? Which developments am I missing? Which questions am I neglecting to ask? And while you're at it: Which formats do you prefer to read? How often do you want to be updated? Do you prefer the longer pieces of previous years? The quick headline links of last spring? The daily, medium-length blog items of the last month or so? Something else?
Who are your favorite writers on science and technology? Your favorite news sources? Your favorite blogs? Last spring I drew up a list of blogs and news outlets. I'll probably adapt it to run in the right-hand column of this page. Should I add to it? If I narrow it, which links should I keep? Got any good books to recommend?
One thing I've come to admire about science, as opposed to politics, is its humility. Today's proudest theories are always at the mercy of tomorrow's inconvenient data, and today's seemingly straightforward data are always open to being reshuffled by tomorrow's perspective-shifting theories. We have a lot to learn from each other.
So give me your best advice. I can't learn without you. And I'll be back to return the favor in 2009.
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We have a verdict in the premature-organ-harvesting case.
Let's go to the Los Angeles Times for a summary of the case. Two years ago, the patient, Ruben Navarro, lay close to death after a heart attack.
His mother had given permission for organ donation, and a team that included [Dr. Hootan] Roozrokh flew in from San Francisco on behalf of a regional transplant network. Roozrokh ... was to supervise a donation after cardiac death ... In most transplants, the removal of organs occurs only after a patient is declared brain-dead. In donations after cardiac death, a patient's brain is irreversibly damaged but still functioning minimally. With a family's consent, the patient is removed from life support and, once the heart has stopped, the patient is declared dead, and organs may be removed minutes later. Many experts say, however, that organs are usable only if they can be retrieved within 30 minutes after the machines are turned off.
According to prosecutors, Roozrokh ordered up excessive doses of the painkiller morphine and Ativan, an anti-anxiety drug, so that Navarro would die within that crucial half-hour. As it turned out, he died eight hours later and Roozrokh did not remove any organs.
So the basic problem was that Navarro's medical care was being directed by a guy sent to the hospital to get his organs—and that the doctor's actions may have helped the organs but not the patient. The doctor was looking at a felony charge, dependent adult abuse, with a possible sentence of four years.
Verdict: Not guilty. But the jury also issued this statement (handwritten PDF here):
Ruben's case has identified that Donation by Cardiac Death (DCD) is in desperate need for further identification of prescribed policy in order to continue successfully as a viable option for organ donation in this country. Refining the nationwide protocol of DCD organ procurements will be an important part of Ruben's legacy...
In other words, Roozrokh may have crossed the line, but the jury blames the system, or lack thereof, for failing to draw the line clearly in the first place. I think the jury did the right thing. Most of us are selectively pious. We like to single out villains when bad things are done. It's harder to admit that the bad things are extensions of good ideas and that the people behind those ideas include us. What happened to Navarro wasn't a bad doctor. It was a system that has increasingly pushed boundaries to get organs that save lives. As Art Caplan puts it in the Times story:
There's a growing waiting list; there are more centers competing for donors; and it's a very lucrative procedure for hospitals. It's against that backdrop that the story of a doctor being sent out to come back with organs unfolds.
The pressure has reached the point where doctors at one hospital, as noted here,
removed hearts from infants 75 seconds after their hearts stopped. The infants were declared dead of heart failure even as their hearts, in new bodies, resume ticking.
It's a discomfiting new trend of treating people as bags of organs. But the driving force behind this trend isn't Hootan Roozrokh. It's all of us.
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I went to see President Bush's farewell chat with the American Enterprise Institute yesterday. It was an unusually frank conversation: He actually admitted mistakes. In fact, he wandered so far off-message that when he was asked about defense spending, he started talking about specific weapons systems, and pretty soon he said this:
Our soldiers are carrying unbelievably new technologies, using Predators to use over-the-wall intelligence to be able to have better battlefield awareness.
Over-the-wall intelligence? I've searched DefenseLink, and I don't see that term or anything like it. I do, however, see "through-the-wall surveillance," associated with the Air Force Research Laboratory. And the last time I checked, walls tended to be associated with roofs. So one way or another, the Predators have to see through something.
Is Bush possibly blabbing about the technology cryptically described by Bob Woodward and others? The ability of U.S. unmanned aerial vehicles to identify and track human targets "even when they are inside buildings"? If so, the convergence sketched here two months ago—unmanned vehicles that can see through walls—is indeed upon us.
By the way, as of this week's hit in North Waziristan, the number of U.S. drone missile strikes in Pakistan this year is approaching 30, and the body count is over 200.
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From yesterday's piece:
Don't look now, but a woman in Ohio has a new face. And the world has a new kind of medicine: socially necessary surgery.
The operation, announced yesterday at the Cleveland Clinic, was a face transplant from a corpse. ... Doctors replaced 77 square inches of the patient's face, from her eyelids to her chin.
More here.
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Hey, Detroit! We have a new job for you.
Just in time to bail out the auto parts suppliers, Madeline Drexler heralds the latest cool new (or is it old?) idea: car-parts incubators. Here's her description of them in yesterday's Science Times:
The heat source is a pair of headlights. A car door alarm signals emergencies. An auto air filter and fan provide climate control. ... Unlike the notoriously high-maintenance incubators found in neonatal intensive care units in the United States, it is easily repaired, because all of its operational parts come from cars. And while incubators can cost $40,000 or more, this one can be built for less than $1,000. The creators of the car parts incubator ... say it could prevent millions of newborn deaths in the developing world.
We're so used to incubators these days that we've forgotten how radical they are. Their function, Drexler notes, is "providing a warm, clean, womblike environment in which a baby can mature." In short, they're artificial wombs. They don't replicate every function, of course. But for millions of babies who would otherwise die, they replicate enough.
They also destabilize our notions of abortion and infanticide. U.S. abortion laws are organized around viability, the idea that a fetus is entitled to protection when it can survive outside the womb. That's a technical question, and incubators, by creating a kind of womb outside the womb, influence the answer. The earlier they can sustain preemies, the further the line of viability advances.
But that's the fancy far edge of incubator technology. Drexler is talking about something simpler and more immediate: making basic incubation available and functional around the world. Who cares about the latest million-dollar American baby born at 21 weeks when you live in a country where preemies die at 35 weeks? You can't spend that kind of money. You can't even find somebody local to fix a $20,000 incubator. You need an affordable machine that works for most preemies and can be reliably maintained. That's what the car-parts incubator is designed for: babies born at 32 weeks or later.
In the transition from George W. Bush to Barack Obama, we're going to see a big shift in the politics of biotechnology. The conservative preoccupation with technological frontiers will be replaced, for the time being, by a progressive preoccupation with distributive justice. That means less debate about things like future artificial wombs and more attention to things like car-parts incubators. In some ways, it'll be more boring. But tell that to the woman in Indonesia who gets to keep her baby.
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I'm now going to depict an adult and a minor having sex. The adult is represented by the character on the left. The minor is represented by the character on the right. Here is my depiction:
&i
Have I just committed a crime punishable by 10 years in jail?
Under a ruling issued last week in Australia, it's quite possible that I have. The ruling, issued by the Supreme Court of New South Wales, affirms that a cartoon can be prosecuted as child pornography. Here's the background of the case:
[T]he plaintiff was convicted ... of possessing child pornography contrary to s 91H(3) of the Crimes Act 1900 (the Act) and using his computer to access child pornography material contrary to s 474.19(1)(a)(i) of the Criminal Code Act 1995 (the Code). The alleged pornography comprised a series of cartoons depicting figures modelled on members of the television animated series "The Simpsons". Sexual acts are depicted as being performed, in particular, by the "children" of the family. The male figures have genitalia which is evidently human, as do the mother and the girl.
The Australian laws in question define child pornography as depictions of a "person" or depictions of "a representation of a person." A related memorandum says such definitions "are intended to cover all visual images, both still and motion, including representations of children, such as cartoons or animation." But even without the memorandum, the court says child pornography laws are in part "calculated to deter production of other material—including cartoons—that ... can fuel demand for material that does involve the abuse of children." Accordingly, "The depictions and representations of persons to which the definition refers include a drawing (or, for that matter, a model or sculpture) and, hence a cartoon, of a fictional character."
Does it matter that we're talking about the silly-looking Simpsons? No, says the court: "Even a substantial departure from realism will not necessarily mean that the depiction is not that of a person in this sense." The court upholds the initial ruling that the characters "were indeed depictions of persons" under the law. The convictions stand.
You have got to be kidding me.
Look: If you molest my kid, I'll see that you burn in hell. If you take a picture of my kid and Photoshop it so it looks like a sex act with you, I'll use any law I can find to put you away. If you make a sicko cartoon and digitally alter it so it looks like my kid, I'll throw the book at you. But if what you've made doesn't look like anyone's kid—if it's just a revolting mockery of the Simpsons—I'm supposed to convict you of child pornography? Really?
What's happening to child pornography is what's happening on the Internet and in software generally: Technology is blurring boundaries between action and thought, public and private, real and fake. On this point, the Australian court quotes the Supreme Court of Canada: "With the quality of contemporary technology, it can be very difficult to distinguish a 'real' person from a computer creation or composite." This gray area unnerves us, so we prosecute it. Two years ago, then-Rep. Mark Foley, R-Fla., was forced out of Congress for soliciting teenage boys online, though there's no evidence he ever touched a minor. This year, the U.S. Supreme Court upheld a ban on sexual images of children even if they're computer-generated or nonexistent. Apparently, more people are now arrested for using the Internet to solicit cops posing as kids than for using it to initiate relationships with real kids.
I understand why we do this: We're afraid that if we don't prosecute cyber-perverts, they'll move on to the real thing. But the danger runs both ways. How far will we extend felony prosecution into the realm of the private, the fake, and the abstract? If the Simpsons count as child pornography, what's next?
Actually, the Australian court has answered that question. Under the relevant child pornography laws, says the court, "a stick figure ... might well depict a representation of a person. No bright line of inclusion or exclusion can be sensibly described."
Well, then, come and get me. If there's no boundary between real and fake, between people and "depictions of representations," then prosecute me for my stick figures. Or admit it's ridiculous—and an insult to the real thing.
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The health police have crossed another line. Four months ago, they banned new fast-food restaurants in a 32-square-mile area of Los Angeles. In that case, they crossed the line from restricting food for kids to restricting it for adults. They also extended the practice of health zoning from liquor to food.
Now they've breach another line between paternalism for children and paternalism for adults. The Boston Public Health Commission has just banned the sale of all tobacco products at colleges. Not high schools. Colleges.
Anti-smoking activists are ecstatic. "Boston has taken another step that puts it in the forefront in the United States in protecting people against secondhand smoke," says the president of the Campaign for Tobacco-Free Kids. But the Boston regulations don't just restrict smoking. They forbid the sale of "any substance containing tobacco leaf, including but not limited to cigarettes, cigars, pipe, tobacco, snuff, chewing tobacco and dipping tobacco." Last I heard, there's no secondhand smoke from chewing tobacco. And the tobacco industry is constantly developing new products that confound the equation of tobacco with smoking. That's not because tobacco companies care deeply about public health. It's because secondhand smoke has become a political problem for them—and because, while addicting customers is good business, killing them isn't.
In a press release, the executive director of the Boston commission says the new regulations "will help reduce young people's exposure to tobacco products." Young people? That phrase used to mean minors. Now, apparently, it includes the targets of the new rule: students at "any public or private college, normal school, professional school, scientific or technical institution, university or other institution furnishing a program of higher education."
On what grounds do college students—not to mention students at professional schools—deserve the kind of paternalism previously reserved for minors? The commission offers two reasons. First, "educational institutions in the City of Boston also sell tobacco products to the younger population, which is particularly at risk for becoming smokers." Second, "the sale of tobacco products is also incompatible with the mission of educational institutions which educate the younger population about social, environmental and health risks and harms."
In other words, college students (henceforth known as "the younger population") are so vulnerable to smoking and to deception about the harms of smoking that their access to any tobacco products on campus must be legally forbidden.
It's true that laws across the United States set the legal drinking age at 21. But those laws are based on the argument that alcohol makes people aged 18 to 20 drive dangerously. Where's the evidence that chewing tobacco makes these people drive dangerously?
To repeat: I detest smoking. But if there's no secondhand smoke and no secondhand driving effects, what are the grounds for telling a 20-year-old college student—let alone a 25-year-old professional-school student—that tobacco is off-limits? And if that kind of paternalism can be extended so easily from minors to 25-year-olds, who's next?