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Errors in ethics of genetic sorting

In Uncategorized on January 21, 2010 at 12:32 pm

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Six day old human embryo implanting
Image by Hljod.Huskona via Flickr

The traditional ethical reasoning when it comes to embryo-sorting, is that sorting out embryos with a certain condition diminishes the value of those already born with this condition. Consequently, by this way of thinking, a selected embryo must have an increased value. The selection itself (the absence of a given condition) increases it’s value over any other embryo in the pool of embryo-candidates.

Using the following arguments one can see how this is a logical error.

All human life is valued equally, must have equal rights and must be paid equal respect. This is regardless of how it was made (sons of bitches are as valuable as sons of kings) – these concepts are straightforward, uncontroversial and commonly held by enlightened people.

It follows that the process of sorting is irrelevant to the value of the selected embryo. The human that is born has equal value to any other human, not more – not less.

How then, can this human born out of selection in any way influence the value of anyone else ?

Answer is: he cannot and he does not.

Sorting is not a process that creates or changes value. Not for humans, not for animals, not for any object. The value is assigned later and is usually set by arbitrary or fixed rules. Gold is worth more than silver due to scarcity, a race horse is worth more than a donkey due to the size of potential revenues. Nature does the sorting of humans (decides which individuals who will mate and when they mate, decides whether the fertilized egg will implant and so on..). We have striven to assign equal value to any and all life that is born, even if it is sorted by nature’s sometimes chaotic set of rules. We have reached the point where all civilized people agree upon equal value for all.

Us taking charge in the sorting process does not change that. Sorting is consequently not unethical in terms of human value. Sorting only becomes unethical if it becomes mandatory by rules set by others than the parent(s). The right to say no to sorting is vital. If the right to say no is respected, then embryo sorting is ethically uncomplicated.

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New years resolution: Respect anti-vaccers, believe it or not

In Uncategorized on December 29, 2009 at 10:08 pm

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I get mad at anti-vaccers. I get frustrated with extreme conservatives and overly religious people. Not necessarily because of their beliefs, but because of what their beliefs lead them to – like anti-abortion, anti-stem cell research and, in general, anti-technology and anti-science.

But, from now on, I’ll stop getting mad, and I’ll welcome my frustrations. I just realized that I need to take the consequences from advocating the right to say “no” to technology. I believe the right to say “no” or more importantly, accept this “no” as just as fair and worthy a choice as “yes”, is the only way to protect ourselves from the perils of technology, be they merely ethical or plain deadly. My motto has long been, and still is: Equal rights for tech-denialists.

Why I realized ? I read two H+ magazine columns, one on correcting color blindness and one in athletic enhancement, both predicting the imminent arrival of the slippery slope genetic sorting future. A slippery slope I have done much thinking on myself, and now some re-thinking.

I very strongly believe that the only way to avoid the pitfalls at the end of the slippery slope is by giving everyone the irrefutable right to refuse to use all or any technological (including biomedical) advancement. And then to respect their choice. Only by giving equal rights to naysayers and tech-proponents will you avoid that any potentially society-threatening technology becomes pervasive and/or all-dominant. There will always be “anti-vaccers” to any new technology, and if the technology proves dangerous, they will, like it or not, become humanity’s saviors.

The consequence is that I need to accept the existence of anti-vaccers, I even need to respect their personal choice.

This does not mean that I will stop arguing my own beliefs, nor should anyone else. I still think the anti-vaccers are crazy, no offense !, and achieves only evil by allowing all but eradicated diseases to re-emerge. But, it means that I need to argue from a respectful perspective. Respectful because the principle of “the right to say no” is more important than any single cause, regardless how worthy.

Let this be my new-years resolution.


2 year anniversary :-)

In Uncategorized on December 7, 2009 at 2:29 pm
Happy Birthday album cover
Image via Wikipedia

BIOpinionated is two years old today (7/12 2009). Will keep going !

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Calculating your health predictions

In Uncategorized on December 2, 2009 at 3:01 pm

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Casio COLLEGE FX-100 Pocket Calculator
Image by psd via Flickr

In our lab we’re setting up the PCA3-test designed to aid prostate cancer diagnostics. The test is representative of many emerging diagnostic tests in that it is a) a supplement to existing testing and b) useful only in a subset of conditions.

The PCA3-test complements results from digital rectal examination, PSA tests,  and prostate biopsies. Three tests that until recently have constituted the cornerstones of prostate cancer screening and diagnostics. The relationship between the results from these tests is dynamic and interpretation of test results is often complicated, sometimes very confusing and can, in the worst case, be very uncertain. Add the gene expression results from the PCA3-test and you have  a lot of valuable information, but a tough time filtering it into useful clinical information.

Physicians will learn how to combine the information either in med-school or in update learning courses later in their career. A slow and sometimes insufficient way to convey diagnostic information to the clinic, treating physician and ultimately, the patient.

Thankfully, we live in the information age and medicine 2.0 is well underway. Now the doctor or the patient can separately or together get online assistance in interpreting prostate cancer test-results. Well designed and user-friendly calculators like the “Risk of Biopsy Detectable Prostate Cancer” calculator or prostatecancer-riskcalculator.com (professional use) will help anyone undertand and begin to interpret lab-results. A big step forward in my opinion since information flow becomes quick and targeted.

Such calculators have also been made available for cancer risk prediction:  nomograms.org, for Marevan/Warfarin dosing: Warfarindosing.org, and as demonstrated in a previous post, for Testosterone: Testosterone.

There are probably a lot of calculators out there that I haven’t found yet and it’s highly likely that many more will be developed.

It seems clear to me that interpretation of clinical lab-results may not remain entirely in the physician domain much longer. Hopefully such automated interpretation will lead to patient empowerment and make  deciding on clinical action an easier task.

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Quote of the month November 09

In Uncategorized on November 26, 2009 at 9:32 am

It is a sad truth, but we have lost the faculty of giving lovely names to things. Names are everything. I never quarrel with actions. My one quarrel is with words….The man who could call a spade a spade should be compelled to use one. It is the only thing he is fit for.

Oscar Wilde, Irish playwright, poet, and novelist, The Picture of Dorian Gray, 1890

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Swine flu. A family history

In Uncategorized on November 20, 2009 at 11:30 am

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Swine flu
Image via Wikipedia

Here’s how the flu season has played out in my own family (parents (38 and 40) and three kids, a daughter 10 years old, and twin boys  6 years old). I’ve added a couple of references for comparison with public health recommendations and published swine-flu info.

Late August 09: The boys were coughing and had slight fever, our daughter was coughing only. One son, the daughter and the father (me) tested positive for fluA, but negative for SwineFlu. At this time the public health information available said that only SwineFlu was going around since “Any widespread influenza activity in August is uncommon.” (ref). Clearly not in our family though – we had seasonal flu of some sort.

Late September 09: Our daughter gets high fever and headache. I felt scruffy, but did not have any fever. None of us were tested since we were abroad on holiday. We, gave our daughter Tamiflu®, since symptoms suggested possible SwineFlu infection.

Early November 09: One of the boys gets Swine flu vaccinated since he is in one of the risk groups (asthma). I get vaccinated for seasonal flu.

Mid November 09: The other boy gets high fever and headache. He is given Tamiflu®. He is later tested positive for SwineFlu. I tested negative. The rest of the family was not tested since they had no symptoms.

Late November 09: Our daughter is scheduled for SwineFlu vaccination.

This fall our family has had influenza two times, possibly three. We had seasonal flu first and this at a time where seasonal flu is not expected to be common. This infection had very mild symptoms in my family. Two of us then had more severe flu symptoms a month later, but this infection was not confirmed by testing. Some weeks later one of us gets a confirmed SwineFlu infection while the rest of the family apparently escapes disease.

One should not draw epidemiological conclusions based on results from one family, but nevertheless, working in a diagnostic lab being able to test so often has been an interesting experience. If i may, I’d like to speculate a little bit:

1. Seasonal flu may not be as “seasonal” as we think since seasonal flu can give very mild symptoms and remain undiagnosed.

2. Vaccination has worked fine in our family since the vaccinated boy did not get infected through his brother.

3. Seasonal flu does not protect against SwineFlu in children (same boy tested positive for seasonal flu and later on SwineFlu), but may protect against SwineFlu in adults. This is supported by a recent NEJM publication.

4. Following infections longitudinally could give valuable insight into the epidemiology of influenza and other seasonal viral infections.

5. Frequent testing reduces worrying to a minimum. While I realize that I am subjective since I have my own laboratory to develop tests in (and run them as often as I want), I strongly recommend that such frequent testing be performed for everyone.

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The Testosterone Project II

In Uncategorized on November 10, 2009 at 2:58 pm

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A vial of the injectable anabolic steroid, dep...
Image via Wikipedia

Previous post in series: The Testosterone project.

Recap: Project Testosterone is my main project aimed at alleviating  mature age growing pains.

Plan is as follows:

  1. Test my testosterone levels.
    - Done. Twice now. Turns out I’m still at the low end of the normal spectrum. This second time I also measured Sex Hormone Binding Globulin (SHBG) to get an accurate measure of Bioavailable Testosterone. Detailed results were: Testosterone – 8,1 nmol/L (normal level 8-35 nmol/L), SHBG – 12,6 (normal level 8-60 nmol/L), Bioavailable Testosterone (calculated from here) – 10,20 nmol/L (normal level 3,85-13,67 nmol/L).
  2. If low (and yes it feels low, even if it is within the normal spectrum, it’s my manliness we’re talking about after all), then learn more.
    - Done, but will continue reading about this.
  3. If not to scary, find out how to get a hold of it.
    - Have gone to see a gullible physician, but was turned down because I was in the normal range. Plan was to measure a second time to see if values were lower and then go back, but it seems values are reasonably stable. Legally prescribed testosterone plan scrapped. Next: probe the illegal substance market.
  4. If not too illegal, then get some. Topic for next blog post.
  5. Try low doses. Future posts.
  6. If adverse events acceptable, continue and report effects continously on blog.
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Thoughts on H+

In Uncategorized on November 5, 2009 at 2:38 pm

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The last H+ magazine is full of articles telling us that we’ll soon rid ourselves of various body parts, mood swings and even the physical acts of sexual relations. I am still a transhumanist, but will have to distance myself from H+ if this continues because:

Bodies are nice – I like them. Mood swings are nice – I like them too. Sex is also nice, and anticipation of physical sex can be even nicer. Probably because  constant and unhindered sexual interaction is unattainable. Consequently, such anticipations are major drivers of behavior. Messing with the availability of sex is not something one should do without caution.

Fellow transhumanists, please put some restraint on your desires to remove yourselves from the physical world. And, do not underestimate our biology – it isn’t always as bad as you’d think.

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Nothing is ever absolutely negative

In Uncategorized on October 31, 2009 at 1:19 pm

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Homer Simpson exclaiming the famous quote
Image via Wikipedia

On a late Friday afternoon

Quality control department:  “You missed the last two samples in this dilutions series”.

Me:  “Yeah, that’s kind of why we use dilution series – to find our detection limit”.

Quality control department: “But, even though very diluted, those two samples were positives. That means this was an error and needs an error-report”.

Me: “Well no, we define a limit where we can be 99,99% certain that we can reproduce a positive result, these dilutions will be well below that limit”.

Quality control department: “But, that means that you can newer be 100% sure of a negative answer”.

Me: “That’s correct, although the concept you are touching upon (the lack of absolute negation/negativity) is valid for any test and consequently, of a philosophical nature”.

Quality control department: “Then we can never give out a negative answer, at least not without saying that there’s a chance it may be positive after all”.

Me: in silence “¤%%”&&¤…doh” and out loud “”Would that be wise ?”.

Quality control department: “We believe so !!”.

Please notice the use of the word “believe”.

So there you go, hit in the face by the same arguments that created the vaccine-autism wars, the ID vs. natural evolution discussion, the religion meets atheism quarrel……..you cannot prove the absence of something, ergo – it must be there. The mother of all fallacies, but impossible to scientifically refute.

I’ll keep trying though.

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The Scheveningen Meeting: a Thrilling and Uncensored Story of European Molecular Diagnostics

In Uncategorized on October 27, 2009 at 11:30 am

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Sunset @ Scheveningen (HDR)
Image by Harm Rhebergen via Flickr

Well, while the title alluringly suggests so, this was not a conference for reporting spicy hot ground-breaking news like twelfth generation ultra-high through(the roof)put sequencing, full biome DTC chiponomics or gene-enhanced elisaluminetics or what have you. I’m kind of glad it wasn’t.

Instead this was a down to earth meeting where labs presented their experiences with molecular methods that are used every day in labs. Tests actually ordered by physicians in real-life medical settings. Methods are still PCR and sequencing…..and they are still used in microbiology (including virology), oncology and genetics… but, that’s it basically.

Being a diagnostic lab-professional I had many valuable insights to help in my everyday routines, which is what was expected from the meeting. I’m not going to blog that since it has limited general interest.  I’d like to however, expand on three trends that made me especially happy to see:

1. Economy: Many of the speakers emphasized the skewed nature of health care funding. Diagnostics normally receive between 0,5 and 5 % of the total health care budget. Usually, diagnostics is also one of the first places were budget cuts are effectuated. This stands in a mind boggling contrast to the potential savings one could achieve by investing in more testing. A sobering example is the swine flu testing policy applied by my own country which is……..don’t test. In  fear of capacity problems and over-diagnosing, the recommendations have been to stay home for a week if you have flu like symptoms – in addition you are strongly advised not to go see your doctor and doctors are advised not to test those patients that violate these recommendations. Of course, this does not work very well, labs are still swamped by swine flu samples, but the net result, nevertheless is the huge cost of absence from work and an immense amount of people worried for no good reason. Testing everyone, I strongly believe, would have been a lot cheaper……and…..although I am admittedly not objective in the matter, I think extensive testing should be a general principle. Investment in diagnostics is a good investment…..over diagnosing I simply do not believe in. Feeding diagnostic knowledge down to the treating physicians on the other hand is a real problem. But, a solvable one.

2. Networks: Many speakers spoke of collaborations between labs. In the research field such collaborations are common and acknowledged by most as a necessity. Not so much in the diagnostic lab until know. It makes me very happy to see that this is changing.

3. Web-tools: The above collaborations are of course aided by interaction on internet. It would be strange if not at some point, the facebook spirit didn’t reach diagnostics too. Now it seems, it have or at least is starting too. In addition, web 2.0 diagnostic tools are becoming more and more accepted, and several talks mentioned such tools. This I found so exiting, I will cover them in a separate post.

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