In recent years the term "systems biology" has become widespread in the biological literature, but most of the papers in which these words appear have surprisingly little to do with older notions of biological systems: they often seem to imply little more than reductionist biology applied on a large scale, with a little attention to interactions between some of the components, but with minimal attention to the kinetic properties of enzymes, which supplied much of the reductionist foundation of biochemistry. A systemic approach to biology ought to put the emphasis on the entire system; insofar as it is concerned with components at all, it is to explain their roles in meeting the needs of the system as a whole. Genuinely systemic thinking allows us to understand how biochemical systems are regulated, and why clumsy attempts to manipulate them for biotechnological purposes may fail. At a more abstract level, it is necessary for understanding the nature of life, because as long as an organism is treated as no more than a collection of components, one cannot ask the right questions, and certainly cannot answer them.
Rea, Thomas J.
Brown, Christine M.
Sing, Charles F.
Coronary heart disease -- Developed countries -- Etiology.
Despite remarkable advances in diagnosis and therapy, ischemic heart disease (IHD) remains a leading cause of morbidity and mortality in industrialized countries. Recent efforts to estimate the influence of genetic variation on IHD risk have focused on predicting individual plasma high-density lipoprotein cholesterol (HDL-C) concentration. Plasma HDL-C concentration (mg/dl), a quantitative risk factor for IHD, has a complex multifactorial etiology that involves the actions of many genes. Single gene variations may be necessary but are not individually sufficient to predict a statistically significant increase in risk of disease. The complexity of phenotype-genotype-environment relationships involved in determining plasma HDL-C concentration has challenged commonly held assumptions about genetic causation and has led to the question of which combination of variations, in which subset of genes, in which environmental strata of a particular population significantly improves our ability to predict high or low risk phenotypes. We document the limitations of inferences from genetic research based on commonly accepted biological models, consider how evidence for real-world dynamical interactions between HDL-C determinants challenges the simplifying assumptions implicit in traditional linear statistical genetic models, and conclude by considering research options for evaluating the utility of genetic information in predicting traits with complex etiologies.
Among the many recent attempts to demonstrate the medical benefits of religious activity, the methodologically strongest seem to be studies of the effects of distant intercessory prayer (IP). In these studies, patients are randomly assigned to receive standard care or standard care plus the prayers or "healing intentions" of distant intercessors. Most of the scientific community has dismissed such research, but cavalier rejection of studies of IP is unwise, because IP studies appear to conform to the standards of randomized controlled trials (RCTs) and, as such, would have a significant advantage over observational investigations of associations between religious variables and health outcomes. As we demonstrate, however, studies of IP fail to meet the standards of RCTs in several critical respects. They fail to adequately measure and control exposure to prayer from others, which is likely to exceed IP and to vary widely from subject to subject, and whose magnitude is unknown. This supplemental prayer so greatly attenuates the differences between the treatment and control groups that sample sizes are too large to justify studies of IP. Further, IP studies generally do not specify the outcome variables, raising problems of multiple comparisons and Type 1 errors. Finally, these studies claim findings incompatible with current views of the physical universe and consciousness. Unless these problems are solved, studies of IP should not be conducted.
President's Council on Bioethics (U.S.) Beyond therapy: biotechnology and the pursuit of happiness.
Biotechnology -- Moral and ethical aspects.
Psychopharmacology -- Moral and ethical aspects.
Advances in neuroscience and biotechnology have heightened the urgency of the debate over "cosmetic psychopharmacology," the use of drugs to enhance mood and temperament in the absence of illness. Beyond Therapy: Biotechnology and the Pursuit of Happiness (2003), the report of the President's Council on Bioethics, has criticized the use of cosmetic psychopharmacology. The Council claimed that cosmetic psychopharmacology will necessarily lead to "severing the link between feelings of happiness and our actions and experiences in the world," but it provided no satisfactory arguments to support this claim and ignored the possibility that cosmetic psychopharmacology might actually enhance the link between happiness and experience. The Council's arguments against cosmetic psychopharmacology depend heavily on the mistaken belief that Prozac and similar antidepressants are mood brighteners in healthy subjects. The empirical evidence, however, clearly indicates that these drugs are not forms of cosmetic psychopharmacology, thus negating much of the Council's arguments. The use of pharmaceutical agents to enhance mood or personality in normal individuals should not be rejected a priori. Instead, the effects of each agent on the individual and on society must be weighed using sound ethical reasoning and the best evidence available.
Doctors who become patients due to serious illnesses face many challenges related to issues of identity, work, and professionalism. In-depth interviews with such doctors reveal the complex ways in which illness threatens identity in these professionals. In comparison with "medical student's disease," these doctors now exhibit "post-residency disease"—minimizing physical symptoms that are in fact present, leading to decreases in care sought. Doctors often feel they are somehow invulnerable to disease and have to remain strong, not burdening others. Many describe themselves as "workaholics," which can prove to be a double-edged sword, posing problems as well as providing benefits. This professional commitment could interfere with preventive health behaviors and with "practicing what they preach." Some view their illness with their "medical self"—as if they were a physician observing another patient rather than themselves. These doctors often support their approach by choosing a colleague as a doctor who will not challenge them, thereby establishing a "denial system" as opposed to a support system. These doctor-patients confront difficult issues of how much their physicianhood is an identity or an activity, illustrating the intricate relationships and tensions between work, identity, professionalism, and health in contemporary medicine.
Iraq War, 2003- -- Prisoners and prisons, American.
Prisoners of war -- Abuse of.
Iraqi detainees subjected to torture and mistreatment at Abu Ghraib prison may continue to suffer from significant physical and psychological consequences of their abuse. This article reports two cases of Iraqi individuals allegedly tortured at Abu Ghraib. Detailed forensic evaluations were conducted approximately one year after their abuse in accordance with international guidelines. The findings of these evaluations substantiate their allegations of torture and confirm the profound health consequences of torture. Furthermore, these cases support assertions that abuse of prisoners was not limited to being perpetrated by guards, but also occurred systematically in the context of interrogations. These cases also raise concerns about inadequate medical care for Iraqi detainees.
Male homosexuality has been viewed by evolutionary psychologists as a Darwinian paradox, and by other social scientists as a social construction. We argue that it is better understood as an evolutionary social construction. Male homosexuality as we now know it is an 18th-century invention, but nonexclusive same-sex sexual behavior has a long evolutionary history. According to the alliance-formation hypothesis, same-sex sexuality evolved by natural selection because it created or strengthened male-male alliances and allowed low-status males to reposition themselves in the group hierarchy and thereby increase their reproductive success. This hypothesis makes sense of some odd findings about male homosexuality and helps to explain the rise in exclusive male homosexuality in the 18th century. The sociohistorical conditions around 1700 may have resulted in an increase in same-sex sexual behavior. Cultural responses to same-sex sexuality led to the spread of exclusive homosexual behavior and to the creation of a homosexual identity. Understanding male homosexuality as an evolutionary social construction can help us move beyond the traditionally polarized debate between evolutionary psychologists and social constructionists.
In non-Western and premodern societies, approaches to sickness involved moral considerations laden with existential and spiritual implications. Healers and physicians had access to this aspect of their patient's lives, were expected to use it constructively, and often did so. The contemporary biomedical theory of disease no longer assigns to illness such metaphysical connotations. While general physicians are permitted—perhaps even advised—to avoid involvement in morally laden dialogues tied to illness and the self, such dilemmas are more prominent and qualitatively different in psychiatry, as psychiatric conditions often entail changes in self-conception, psychological disaffection, unacceptable behavior, and untoward personal reactions to social circumstances. Manifestations of psychiatric conditions can overwhelm an individual's control in areas of cognition, emotion, autonomy, social responsibility, behavior, and body functions—exactly those matters that "modern" individualistic minds are supposed to master. Consequently, psychiatric conditions challenge basic presuppositions of the modern, secular credo about personhood, disease, and behavior. They comprise a species of human problems ontologically distinct from the conditions handled by other medical disciplines.
In this paper, we examine the notion put forward by certain groups (largely as a consequence of their opposition to elective abortion) that the immediate post-fertilization cellular entity—the zygote—is a person and should be given full moral status. Because the zygote has none of the inherent characteristics necessary to be regarded as a person in the traditional philosophical sense (e.g., John Locke or Immanuel Kant), some advocates of this position attempt to advance their case with arguments based on the genetic potential of the human zygote to develop into a person. We argue that this position represents a flawed use of human genetics and ignores the extraordinarily inefficient and wasteful nature of human reproduction. We then explore the public policy consequences that would follow from granting the zygote full moral status. We conclude that the logical consequences of granting the zygote full moral status would require a revolutionary restructuring of many basic social institutions, especially the health care system. The social, political, and economic changes that would be required if the zygote is enshrined as a person in law constitute a convincing reductio ad absurdum that demonstrates the danger in taking this position seriously.
Americans' recent weight gains have been widely described as an "obesity epidemic." Such a characterization, however, has many problems: the average American weight gain has been relatively low (eight to 12 pounds over the last 20 years), and the causal linkages between adiposity, morbidity, and mortality are unclear. Nevertheless, the media and numerous health officials continue to sound dire warnings that obesity has become an epidemic disease. In this article, I examine how and why America's growing weight became an "obesity epidemic." I find the disease characterization has less to do with the health consequences of excess weight and more with the various financial and political incentives of the weight loss industry, medical profession, and public health bureaucracy. This epidemic image was also assisted by the method of displaying information about weight gain with maps in PowerPoint slides. Such characterizations, I argue, are problematic. Given the inconclusive scientific evidence and the absence of a safe and effective weight loss regimen, calling America's growing weight an epidemic disease is likely to cause more harm than good.