Can Physicians Work in US Immigration Detention Facilities While Upholding Their Hippocratic Oath? | JAMA

The modern successor to the Hippocratic oath, called the Declaration of Geneva, was updated and approved by the World Medical Association in 2017. The pledge states that “The health and well-being of my patient will be my first consideration” and “I will not use my medical knowledge to violate human rights and civil liberties, even under threat.”1 Can a physician work in US immigration detention facilities while upholding this pledge?

https://jamanetwork.com/journals/jama/fullarticle/2749507


Scientists Just Detected Brain Waves in Mini Lab-Grown Brains | Mother Jones

For the first time, scientists have detected brain waves similar to those of a pre-term baby in miniature, lab-grown brains.

The results, published Thursday in the journal Cell Stem Cell, have big implications for the medical field. Access to human brains are a consistent barrier to studying conditions like Alzheimer’s, autism, or schizophrenia; for obvious reasons, infant brains are even more difficult to obtain. So models that are grown from stem cells like these mini-brains (known to scientists as “cortical organoids”) may offer a solution.

https://www.motherjones.com/politics/2019/08/scientists-just-detected-brain-waves-in-mini-lab-grown-brains/

‘They are together, they are equal’: the agonising choice facing father of conjoined twins | The Guardian

Marieme and Ndeye each have a sticker on their faces: a butterfly for Ndeye, and a green smiley face for her twin sister. They giggle as they take them off and stick them back on; then Ndeye decides it’s their dad’s turn, placing the smiley face over his right eye.

“Ndeye is the lively one, she likes attention, and Marieme is a quieter personality – calm and thoughtful,” said Ibrahima Ndiaye, the twins’ father. “Ndeye is fire and Marieme is ice.”

Their behaviour – and their differences – are typical for three-year-old twins, but Marieme and Ndeye are not typical at all. The sisters are conjoined: they have separate brains, hearts and lungs, but share a liver, bladder and digestive system, and have three kidneys between them.

Ndiaye brought his daughters from Senegal to Great Ormond Street hospital (GOSH) in London at the age of eight months after a desperate search for medical help. Over the past two and a half years, he and the hospital have wrestled with an agonising decision about whether to go ahead with a surgical separation that Marieme would not survive, but that could give Ndeye a chance of a reasonable life. Without a separation, both will almost certainly die.

https://www.theguardian.com/society/2019/aug/04/separation-conjoined-twins-dilemma


Japan approves first human-animal embryo experiments | Nature

A Japanese stem-cell scientist is the first to receive government support to create animal embryos that contain human cells and transplant them into surrogate animals since a ban on the practice was overturned earlier this year.

Hiromitsu Nakauchi, who leads teams at the University of Tokyo and Stanford University in California, plans to grow human cells in mouse and rat embryos and then transplant those embryos into surrogate animals. Nakauchi's ultimate goal is to produce animals with organs made of human cells that can, eventually, be transplanted into people.

Until March, Japan explicitly forbid the growth of animal embryos containing human cells beyond 14 days or the transplant of such embryos into a surrogate uterus. That month Japan’s education and science ministry issued new guidelines allowing the creation of human-animal embryos that can be transplanted into surrogate animals and brought to term.

https://www.nature.com/articles/d41586-019-02275-3

Scientists Are Giving Dead Brains New Life. What Could Go Wrong?

A few years ago, a scientist named Nenad Sestan began throwing around an idea for an experiment so obviously insane, so “wild” and “totally out there,” as he put it to me recently, that at first he told almost no one about it: not his wife or kids, not his bosses in Yale’s neuroscience department, not the dean of the university’s medical school.

Like everything Sestan studies, the idea centered on the mammalian brain. More specific, it centered on the tree-shaped neurons that govern speech, motor function and thought — the cells, in short, that make us who we are. In the course of his research, Sestan, an expert in developmental neurobiology, regularly ordered slices of animal and human brain tissue from various brain banks, which shipped the specimens to Yale in coolers full of ice. Sometimes the tissue arrived within three or four hours of the donor’s death. Sometimes it took more than a day. Still, Sestan and his team were able to culture, or grow, active cells from that tissue — tissue that was, for all practical purposes, entirely dead. In the right circumstances, they could actually keep the cells alive for several weeks at a stretch.

When I met with Sestan this spring, at his lab in New Haven, he took great care to stress that he was far from the only scientist to have noticed the phenomenon. “Lots of people knew this,” he said. “Lots and lots.” And yet he seems to have been one of the few to take these findings and push them forward: If you could restore activity to individual post-mortem brain cells, he reasoned to himself, what was to stop you from restoring activity to entire slices of post-mortem brain?

https://www.nytimes.com/2019/07/02/magazine/dead-pig-brains-reanimation.html

German Ethics Council: Germline editing “not ethically out of the question” | European Scientist

On Monday, the German Ethics Council made public a 230-page report discussing their current position on human genome manipulation and in particular, germline editing. According to the press release published on 9 May, a few days before the report, “germline interventions currently too risky, but not ethically out of the question”.

The council made up of 26 ethicists, legal scholars, scientists, and other experts unanimously agreed there are no compelling philosophical arguments against altering human germlines, which they write is not “in principle, ethically reprehensible.” […]

The World Health Organization called for the establishment of a global registry of gene editing research on humans last March. And many scientists would now agree, genome-editing in the human germline should not be regulated by the scientific community but by law.

All members agreed “ the human germline is not inviolable”, although not all are in favour of the pursuing germline interventions – some are concerned the possible benefits may not outweigh the potential downsides.

https://www.europeanscientist.com/en/public-health/germline-editing-not-ethically-out-of-the-question/

Prepare Yourself For The Shock Of Mass Implantable Brain Technology | Forbes

Patient Undergoing Implantable Brain Technology Procedure

Patient Undergoing Implantable Brain Technology Procedure


[…] The first wave of evolution is expected to offer healing-of-sorts for various individuals such as those profiled in the film with Parkinson’s Disease, paralysis, blindness and more. The next wave is more about general usage.

Of course, who would deny any person suffering from neurological disorders the ability to possess a better quality of life through brain implants? But when such technology is beginning to be touted via interviews in this documentary as that which will be able to help you jump higher, run faster, rid oneself of this habit or that, or that annoying personality trait or another via programming, we could be teetering on some very shaky moral and spiritual ground.

https://www.forbes.com/sites/laurencoleman/2019/05/12/prepare-yourself-for-the-shock-of-mass-implantable-brain-technology/


A war made me realize: The world needs biomedical engineers | Zahra Moussavi

It was a sunny and pleasant spring day in Dezful, a small city in the south part of Iran. There were not many people on the street but I remember a young teenager pedalling slowly on his bike. I remember him because a moment later he was decapitated by a piece of metal when an Iraqi missile hit the neighbourhood.

His headless body pedalled for a while before falling to the ground. Everything in that moment registered in my brain like a scene in slow motion.

In shock, all I was thinking was: “Wow! How can the body balance without the brain? The body’s motion must have also been programmed in the spinal cord!”

It was spring of 1981 and I was 20 at the time, a second year university student with no background in biology or human physiology. A year earlier, I wanted to become a nuclear physicist and work on a Nobel Prize winning project. Then the war between Iran and Iraq started and the universities closed. I went to the Red Cross and to hospitals to learn first aid and then to the fronts to help with the war casualties.

The war scenes — and particularly the teenage cyclist on that particular day — made me decide to become a biomedical engineer.

https://theconversation.com/a-war-made-me-realize-the-world-needs-biomedical-engineers-84759

AI MIT CSAIL’s AI can predict the onset of breast cancer 5 years in advance

Breast cancer is the second leading cancer-related cause of death among women in the U.S. It’s estimated that in 2015, 232,000 women were diagnosed with the disease and approximately 40,000 died from it. And while exams like mammography have come into wide practice — in 2014, over 39 million breast cancer screenings were performed in the U.S. alone — they’re not always reliable. About 10% to 15% of women who undergo a mammogram are asked to return following an inconclusive analysis.

Fortunately, with the help of AI, scientists at MIT’s Computer Science and Artificial Intelligence Laboratory (CSAIL) and Massachusetts General Hospital are making steps toward more consistent and reliable screening procedures. In a newly published paper in the journal Radiology, they describe a machine learning model that can predict from a mammogram if a patient is likely to develop breast cancer as many as five years in the future.

https://venturebeat.com/2019/05/07/mit-csails-ai-can-predict-the-onset-of-breast-cancer-5-years-in-advance/

Should fentanyl dealers be charged with manslaughter if their customers die? | CBC News

The Sarnia, Ont., case of a drug dealer charged with manslaughter after a customer died from taking cocaine laced with fentanyl is raising questions about the legal and moral implications of such charges. 

As the opioid crisis in Canada deepens, the defence lawyer who represented the Sarnia drug dealer thinks there will be more such charges. 

In 2017, a drug dealer sold cocaine laced with fentanyl to someone who died of an overdose. The dealer was charged with trafficking and manslaughter, and this week, she pleaded guilty to the lesser charge of criminal negligence causing death. 

https://www.cbc.ca/news/canada/london/london-ontairo-fentanyl-should-dealers-be-charged-with-manslaughter-1.5120166

For people with dementia, a fight for the right to die | MacLean's

Minister of Health Ginette Petitpas Taylor speaks outside the House of Commons, in Ottawa on Thursday, Nov. 30, 2017., about medical assistance in dying (Adrian Wyld/CP)

Minister of Health Ginette Petitpas Taylor speaks outside the House of Commons, in Ottawa on Thursday, Nov. 30, 2017., about medical assistance in dying (Adrian Wyld/CP)

Ron Posno was diagnosed with mild cognitive impairment—a precursor to dementia—in 2016, and soon after, the London, Ont., resident re-wrote his will. He already had a Do Not Resuscitate order in place, and to this he added instructions for the niece who was his substitute decision maker that at a specific point in the progress of his illness, she was to seek medical assistance in dying on his behalf.

The eight conditions that Posno identified as signalling the proper time for his death are like a photographic negative that also reveals what he considers a life worth living. When I am unable to recognize and respond to family and friends; when I frequently experience hallucinations, paranoia or acute depression; when I become routinely incontinent; when I am unable to eat, clean or dress myself without assistance: that is when I want it to be over.

But then Posno’s niece, a lawyer in Toronto, informed him that an advance request like this for medical assistance in dying (MAID) was against the law and she would have no ability to act on it once he could no longer consent.

Posno had assumed that this request was basically an extension of his DNR: a statement of his desires for medical treatment in a given set of circumstances. He found it incomprehensible that he could legally state that he did not want CPR and the instruction would be followed if he were unconscious with a DNR in place, but in the face of an illness that would eventually render him unable to provide informed consent, he couldn’t request MAID on behalf of a carefully delineated future version of himself.

https://www.macleans.ca/society/for-people-with-dementia-a-fight-for-the-right-to-die/

Decoded Brain Signals Could Give Voiceless People A Way To Talk | NPR

Scientists have found a way to transform brain signals into spoken words and sentences.

The approach could someday help people who have lost the ability to speak or gesture, a team from the University of California, San Francisco reported Wednesday in the journal Nature.

"Finding a way to restore speech is one of the great challenges in neurosciences," says Dr. Leigh Hochberg, a professor of engineering at Brown University who wasn't associated with the study. "This is a really exciting new contribution to the field."

https://www.npr.org/sections/health-shots/2019/04/24/716790281/decoded-brain-signals-could-give-voiceless-people-a-way-to-talk

Adopt a moratorium on heritable genome editing | Nature

Eric Lander, Françoise Baylis, Feng Zhang, Emmanuelle Charpentier, Paul Berg and specialists from seven countries call for an international governance framework.

We call for a global moratorium on all clinical uses of human germline editing — that is, changing heritable DNA (in sperm, eggs or embryos) to make genetically modified children.

By ‘global moratorium’, we do not mean a permanent ban. Rather, we call for the establishment of an international framework in which nations, while retaining the right to make their own decisions, voluntarily commit to not approve any use of clinical germline editing unless certain conditions are met.

In Spain, prisoners’ brains are being electrically stimulated in the name of science | Vox

A team of scientists in Spain is getting ready to experiment on prisoners. If the scientists get the necessary approvals, they plan to start a study this month that involves placing electrodes on inmates’ foreheads and sending a current into their brains. The electricity will target the prefrontal cortex, a brain region that plays a role in decision-making and social behavior. The idea is that stimulating more activity in that region may make the prisoners less aggressive.

This technique — transcranial direct current stimulation, or tDCS — is a form of neurointervention, meaning it acts directly on the brain. Using neurointerventions in the criminal justice system is highly controversial. In recent years, scientists and philosophers have been debating under what conditions (if any) it might be ethical.

The Spanish team is the first to use tDCS on prisoners. They’ve already done it in a pilot study, publishing their findings in Neuroscience in January, and they were all set to implement a follow-up study involving at least 12 convicted murderers and other inmates this month. On Wednesday, New Scientist broke news of the upcoming experiment, noting that it had approval from the Spanish government, prison officials, and a university ethics committee. The next day, the Interior Ministry changed course and put the study on hold.

https://www.vox.com/future-perfect/2019/3/9/18256821/prisoner-brain-study-spain-aggression-neurointervention-ethics

Scientists Successfully Double the DNA Alphabet | Smithsonianmag.com

In 1953, when scientists conclusively identified DNA’s structure, it was a monumental, Nobel-Prize-winning revelation: four nucleotides, each containing a letter-labeled base, were arranged in a double helix structure. These four bases, or “letters,” form pairs: adenine, A, matches with thymine, T, and cytosine, C, bonds with guanine, G. These pairs are essentially the building blocks of life on Earth; the way in which the pairs are arranged creates the genetic instructions for how proteins are made, which in turn aid in pretty much every critical process that keeps us alive.

Now, an interdisciplinary team of researchers has expanded the genetic alphabet by creating synthetic DNA that uses eight letters rather than four, according to a new study published in the journal Science. The new manufactured structure is called "hachimoji DNA," from the Japanese words for "eight" and letter." Creating hachimoji DNA was, as Carl Zimmer writes in The New York Times, “a chemical tour-de-force” for the group led by Steven Benner, a synthetic biologist at the Foundation for Applied Molecular Evolution. The advance offers new possibilities in many fields, including medical research and data storage.

https://www.smithsonianmag.com/smart-news/scientists-just-doubled-number-letters-dna-alphabet-180971552/

China’s CRISPR twins might have had their brains inadvertently enhanced | MIT Technology Review

The brains of two genetically edited girls born in China last year may have been changed in ways that enhance cognition and memory, scientists say.

The twins, called Lulu and Nana, reportedly had their genes modified before birth by a Chinese scientific team using the new editing tool CRISPR. The goal was to make the girls immune to infection by HIV, the virus that causes AIDS.

Now, new research shows that the same alteration introduced into the girls’ DNA, deletion of a gene called CCR5, not only makes mice smarter but also improves human brain recovery after stroke, and could be linked to greater success in school.

“The answer is likely yes, it did affect their brains,” says Alcino J. Silva, a neurobiologist at the University of California, Los Angeles, whose lab uncovered a major new role for the CCR5 gene in memory and the brain’s ability to form new connections. 

“The simplest interpretation is that those mutations will probably have an impact on cognitive function in the twins,” says Silva. He says the exact effect on the girls’ cognition is impossible to predict, and “that is why it should not be done.” 

https://www.technologyreview.com/s/612997/the-crispr-twins-had-their-brains-altered/


Ketamine Could Be the Key to Reversing America’s Rising Suicide Rate | Bloomberg Businessweek

[…] Wright decided to try again in 2016, this time using a cocktail of drugs he’d ground into a powder. As he tells the story now, he was preparing to mix the powder into water and drink it when his dog jumped onto his lap. Suddenly he had a moment of clarity that shocked him into action. He started doing research and came upon a Columbia University study of a pharmaceutical treatment for severe depression and suicidality. It involved an infusion of ketamine, a decades-old anesthetic that’s also an infamous party drug. He immediately volunteered.

His first—and only—ketamine infusion made him feel dreamlike, goofy, and euphoric. He almost immediately started feeling more hopeful about life. He was more receptive to therapy. Less than a year later, he married. Today he says his dark moods are remote and manageable. Suicidal thoughts are largely gone. “If they had told me how much it would affect me, I wouldn’t have believed it,” Wright says. “It is unconscionable that it is not already approved for suicidal patients.”

https://www.bloomberg.com/news/features/2019-02-05/ketamine-could-soon-be-used-to-treat-suicidal-ideation

Wanting to die at 'five to midnight' - before dementia takes over | Andrew Bomford

It's not unusual for Dutch patients with dementia to request euthanasia, but in the later stages of the disease they may be incapable of reconfirming their consent - one doctor is currently facing prosecution in such a case. But fear of being refused is pushing some to ask to die earlier than they would have liked.

Annie Zwijnenberg was never in any doubt.

"The neurologist said: 'I'm sorry, but there's no way we can mistake this - its Alzheimer's," says Anneke Soute-Zwijnenberg, describing the moment her mother was first diagnosed.

"And she said: 'OK, then I know what I want.'"

Anneke's brother Frank chips in: "Maybe she hesitated for five seconds, and said: 'Now I know what to do.'"

They both knew she was referring to euthanasia.

You could say Annie's story is a textbook case of how euthanasia is supposed to happen in the Netherlands - with very consistent and clear consent. But there are other cases where the patient's consent is less consistent, and at the final moment, less clear.

https://www.bbc.com/news/stories-47047579

Europe's top rights court to hear Belgian euthanasia case | AP

LONDON (AP) — Europe’s top human rights court has agreed to hear a case being brought against Belgium by a man whose mother was euthanized in 2012 for depression, the second case that implicates one of Belgium’s leading euthanasia doctors.

In a statement Tuesday, lawyers for Tom Mortier said they brought their case to the European Court of Human Rights in Strasbourg after Belgian authorities declined to pursue it.

Robert Clarke, one of Mortier’s lawyers, said there were some “deeply worrying” details about the case.

“This was a woman who was under the care of a psychiatrist and according to medical definition was a vulnerable person,” Clarke said. “The state had a duty of care to protect her and it failed.

https://apnews.com/8217108af4f841b3a2d551ca73eecb9c

Ethics in genetic counselling | Journal of Community Genetics

Difficult ethical issues arise for patients and professionals in medical genetics, and often relate to the patient’s family or their social context. Tackling these issues requires sensitivity to nuances of communication and a commitment to clarity and consistency. It also benefits from an awareness of different approaches to ethical theory. Many of the ethical problems encountered in genetics relate to tensions between the wishes or interests of different people, sometimes even people who do not (yet) exist or exist as embryos, either in an established pregnancy or in vitro. Concern for the long-term welfare of a child or young person, or possible future children, or for other members of the family, may lead to tensions felt by the patient (client) in genetic counselling. Differences in perspective may also arise between the patient and professional when the latter recommends disclosure of information to relatives and the patient finds that too difficult, or when the professional considers the genetic testing of a child, sought by parents, to be inappropriate. The expectations of a patient’s community may also lead to the differences in perspective between patient and counsellor. Recent developments of genetic technology permit genome-wide investigations. These have generated additional and more complex data that amplify and exacerbate some pre-existing ethical problems, including those presented by incidental (additional sought and secondary) findings and the recognition of variants currently of uncertain significance, so that reports of genomic investigations may often be provisional rather than definitive. Experience is being gained with these problems but substantial challenges are likely to persist in the long term.

https://link.springer.com/article/10.1007/s12687-018-0371-7