Date: 12/7/2008
By MALCOLM RITTER
AP Science Writer
NEW YORK (AP) — Healthy people should have the right to boost their brains with pills, like those prescribed for hyperactive kids or memory-impaired older folks, several scientists contend in a provocative commentary.
College students are already illegally taking prescription stimulants like Ritalin to help them study, and demand for such drugs is likely to grow elsewhere, they say.
“We should welcome new methods of improving our brain function,” and doing it with pills is no more morally objectionable than eating right or getting a good night’s sleep, these experts wrote in an opinion piece published online Sunday by the journal Nature.
The commentary calls for more research and a variety of steps for managing the risks.
As more effective brain-boosting pills are developed, demand for them is likely to grow among middle-aged people who want youthful memory powers and multitasking workers who need to keep track of multiple demands, said one commentary author, brain scientist Martha Farah of the University of Pennsylvania.
“Almost everybody is going to want to use it,” said Farah.
“I would be the first in line if safe and effective drugs were developed that trumped caffeine,” another author, Michael Gazzaniga of the University of California, Santa Barbara, declared in an e-mail.
The seven authors, from the United States and Britain, include ethics experts and the editor-in-chief of Nature as well as scientists. They developed their case at a seminar funded by Nature and Rockefeller University in New York. Two authors said they consult for pharmaceutical companies; Farah said she had no such financial ties.
Some health experts agreed that the issue deserves attention. But the commentary didn’t impress Leigh Turner of the University of Minnesota Center for Bioethics.
“It’s a nice puff piece for selling medications for people who don’t have an illness of any kind,” Turner said.
The commentary cites a 2001 survey of about 11,000 American college students that found 4 percent had used prescription stimulants illegally in the prior year. But at some colleges, the figure was as high as 25 percent.
“It’s a felony, but it’s being done,” said Farah.
The stimulants Adderall and Ritalin are prescribed mainly for people with attention deficit hyperactivity disorder, but they can help other people focus their attention and handle information in their heads, the commentary says.
Another drug called Provigil is approved for sleep disorders but is also prescribed for healthy people who need to stay alert when sleep-deprived, the commentary says. Lab studies show it can also perk up the brains of well-rested people. And some drugs developed for Alzheimer’s disease also provide a modest memory boost, it says.
Ritalin is made by Switzerland-based Novartis AG, but the drug is also available generically. Adderall is made by U.K.-based Shire PLC and Montvale, N.J.-based Barr Pharmaceuticals Inc., and some formulations are also available generically. Provigil is made by Cephalon Inc. of Frazer, Pa.
While supporting the concept that healthy adults should be able to use brain-boosting drugs, the authors called for:
—More research into the use, benefits and risks of such drugs. Much is unknown about the current medications, such as the risk of dependency when used for this purpose, the commentary said.
—Policies to guard against people being coerced into taking them.
—Steps to keep the benefits from making socio-economic inequalities worse.
—Action by doctors, educators and others to develop policies on the use of such drugs by healthy people.
—Legislative action to allow drug companies to market the drugs to healthy people if they meet regulatory standards for safety and effectiveness.
Dr. Nora Volkow, director of the National Institute on Drug Abuse, said she agreed with the commentary that the nonprescribed use of brain-boosting drugs must be studied.
But she said she was concerned that wider use of stimulants could lead more people to become addicted to them. That’s what happened decades ago when they were widely prescribed for a variety of disorders, she said.
“Whether we like it or not, that property of stimulants is not going to go away,” she said.
Erik Parens, a senior research scholar at the Hastings Center, a bioethics think tank in Garrison, N.Y., said the commentary makes a convincing case that “we ought to be opening this up for public scrutiny and public conversation.”
One challenge will be finding ways to protect people against subtle coercion to use the drugs, the kind of thing parents feel when neighbor kids sign up for SAT prep courses, he said.
And if the nation moves to providing a basic package of health care to all its citizens, it’s hard to see how it could afford to include brain-boosting drugs, he said. If they have to be bought separately, it raises the question about promoting societal inequalities, he said.
___
On the Net:
Nature: http://www.nature.com/nature/
Copyright 2008 The Associated Press.
US family opposes end to care for brain-dead boy
Date: 11/8/2008
By DAVID B. CARUSO
Associated Press Writer
NEW YORK (AP) _ A U.S. hospital has asked a judge for permission to stop treating a brain-dead 12-year-old cancer patient, even though his ultra-religious New York parents want to keep him on life support.
Motl Brody of Brooklyn was pronounced dead this week after a half-year fight against a brain tumor, and doctors at Children’s National Medical Center in Washington say the seventh-grader’s brain has ceased functioning entirely.
But for the past few days, a machine has continued to inflate and deflate his lungs. As of late Friday afternoon, his heart was still beating with the help of a cocktail of intravenous drugs and adrenaline.
That heartbeat has prompted Motl’s parents, who are Orthodox Jews, to refuse the hospital’s request to remove all artificial life support.
Under some interpretations of Jewish religious law, including the one accepted by the family’s Hasidic sect, death occurs only when the heart and lungs stop functioning.
That means Motl “is alive, and his family has a religious obligation to secure all necessary and appropriate medical treatment to keep him alive,” the family’s attorney wrote in a court filing this week.
The family has asked the hospital to leave the breathing machine on and keep administering drugs until the boy’s heart and lungs no longer respond.
Disagreements between families and medical providers over when to end care for terminally ill patients are common, experts say, but this case wound up in court with unusual speed.
Unlike Terri Schiavo or Karen Ann Quinlan, who became the subjects of right-to-die battles when they suffered brain damage and became unconscious, Motl’s condition has deteriorated beyond a persistent vegetative state, his physicians say. His brain has died entirely, according to an affidavit filed by one of his doctors.
His eyes are fixed and dilated. His body neither moves nor responds to stimulation. His brain stem shows no electrical function, and his brain tissue has begun to decompose.
“This is death at its simplest,” the hospital’s lawyers wrote in a court filing.
The hospital said it would help the family move what it called the boy’s “earthly remains” to another medical facility, but has found none willing to accept a brain-dead child.
The dispute wound up in court Sunday, when the family asked a federal judge to block the hospital from doing any further tests for brain activity.
The hospital responded by asking a District of Columbia Superior Court judge for permission to discontinue treatment.
Jeffrey I. Zuckerman, the attorney for Motl’s parents, says they have been “utterly shattered” by the hospital’s actions.
He stressed that the family’s demand for continued life support was based on their obligations under religious law, not an unrealistic hope that their boy will recover.
“You can always hope for a miracle, but if you are asking if they are in denial about their child’s medical condition, no, they are not,” Zuckerman said.
A hearing was scheduled for Monday, but Children’s National Medical Center said it would ask for a postponement until Wednesday.
“We respect the family’s beliefs, and have tried since the patient’s arrival in June to work closely with them in a spirit of mutual respect,” the hospital said in a written statement.
It added, however, that attempts to discuss end-of-life issues with the family had been complicated.
Motl’s mother and father, Eluzer and Miriam Brody, haven’t been to the hospital since July. The medical center says its requests to speak directly with them have been rebuffed, and in recent days, hospital employees “have been inundated with harassing and threatening calls” regarding the case.
A substantial delay in resolving the disagreement may render it moot. The hospital suggested in legal filings that the boy’s remaining body functions will cease within weeks, if not days.
Dr. Edward Reichman, an associate professor of medicine at Albert Einstein Medical College in New York, said the question of how to accommodate religious beliefs regarding brain death comes up occasionally in New York, where there is a large population of Orthodox Jews.
While there is intense debate over whether to accept brain death as the spiritual end of life, hospitals usually find a way to work through it, he said.
“More often than not, the medical team … will accept the wishes of the family, especially if cardiac death is anticipated in a short window of time,” he said.
Arthur Caplan, a professor of bioethics at the University of Pennsylvania, said physicians aren’t obligated to provide care that can’t possibly be medically helpful.
“Doctors are well within their rights to say, ‘We are stopping,’” he said. “I don’t think medicine can become subservient to religious, spiritual or mystical hopes and beliefs concerning how to manage death.”
Copyright 2008 The Associated Press.
By DAVID B. CARUSO
Associated Press Writer
NEW YORK (AP) _ A U.S. hospital has asked a judge for permission to stop treating a brain-dead 12-year-old cancer patient, even though his ultra-religious New York parents want to keep him on life support.
Motl Brody of Brooklyn was pronounced dead this week after a half-year fight against a brain tumor, and doctors at Children’s National Medical Center in Washington say the seventh-grader’s brain has ceased functioning entirely.
But for the past few days, a machine has continued to inflate and deflate his lungs. As of late Friday afternoon, his heart was still beating with the help of a cocktail of intravenous drugs and adrenaline.
That heartbeat has prompted Motl’s parents, who are Orthodox Jews, to refuse the hospital’s request to remove all artificial life support.
Under some interpretations of Jewish religious law, including the one accepted by the family’s Hasidic sect, death occurs only when the heart and lungs stop functioning.
That means Motl “is alive, and his family has a religious obligation to secure all necessary and appropriate medical treatment to keep him alive,” the family’s attorney wrote in a court filing this week.
The family has asked the hospital to leave the breathing machine on and keep administering drugs until the boy’s heart and lungs no longer respond.
Disagreements between families and medical providers over when to end care for terminally ill patients are common, experts say, but this case wound up in court with unusual speed.
Unlike Terri Schiavo or Karen Ann Quinlan, who became the subjects of right-to-die battles when they suffered brain damage and became unconscious, Motl’s condition has deteriorated beyond a persistent vegetative state, his physicians say. His brain has died entirely, according to an affidavit filed by one of his doctors.
His eyes are fixed and dilated. His body neither moves nor responds to stimulation. His brain stem shows no electrical function, and his brain tissue has begun to decompose.
“This is death at its simplest,” the hospital’s lawyers wrote in a court filing.
The hospital said it would help the family move what it called the boy’s “earthly remains” to another medical facility, but has found none willing to accept a brain-dead child.
The dispute wound up in court Sunday, when the family asked a federal judge to block the hospital from doing any further tests for brain activity.
The hospital responded by asking a District of Columbia Superior Court judge for permission to discontinue treatment.
Jeffrey I. Zuckerman, the attorney for Motl’s parents, says they have been “utterly shattered” by the hospital’s actions.
He stressed that the family’s demand for continued life support was based on their obligations under religious law, not an unrealistic hope that their boy will recover.
“You can always hope for a miracle, but if you are asking if they are in denial about their child’s medical condition, no, they are not,” Zuckerman said.
A hearing was scheduled for Monday, but Children’s National Medical Center said it would ask for a postponement until Wednesday.
“We respect the family’s beliefs, and have tried since the patient’s arrival in June to work closely with them in a spirit of mutual respect,” the hospital said in a written statement.
It added, however, that attempts to discuss end-of-life issues with the family had been complicated.
Motl’s mother and father, Eluzer and Miriam Brody, haven’t been to the hospital since July. The medical center says its requests to speak directly with them have been rebuffed, and in recent days, hospital employees “have been inundated with harassing and threatening calls” regarding the case.
A substantial delay in resolving the disagreement may render it moot. The hospital suggested in legal filings that the boy’s remaining body functions will cease within weeks, if not days.
Dr. Edward Reichman, an associate professor of medicine at Albert Einstein Medical College in New York, said the question of how to accommodate religious beliefs regarding brain death comes up occasionally in New York, where there is a large population of Orthodox Jews.
While there is intense debate over whether to accept brain death as the spiritual end of life, hospitals usually find a way to work through it, he said.
“More often than not, the medical team … will accept the wishes of the family, especially if cardiac death is anticipated in a short window of time,” he said.
Arthur Caplan, a professor of bioethics at the University of Pennsylvania, said physicians aren’t obligated to provide care that can’t possibly be medically helpful.
“Doctors are well within their rights to say, ‘We are stopping,’” he said. “I don’t think medicine can become subservient to religious, spiritual or mystical hopes and beliefs concerning how to manage death.”
Copyright 2008 The Associated Press.
