Thursday, May 24, 2007

HIV and Condom Use: Deceiving the People?

Much has been talked about the “great” benefit of condom use to prevent transmission of HIV and other sexually transmitted diseases. However, experimental collection of data seems to show that this strategy is not preventing it.

The United Nations has proven that all condom promotion has failed to prevent HIV to keep spreading in Africa. In fact, the only country that had a significant reduction was promoting abstinence and monogamy “the Uganda miracle” though condoms were also available. They had been available but were not able to stop HIV spread without adding policies that foster abstinence and promote monogamy. Both are behavioral means solutions.

The reason of the condom failure to protect against HIV infection is not behavioral or sociological but mathematical or statistical: condoms have a failure rate different than zero. Therefore its repetitive use will eventually lead to transmission of the infective agent. Condoms may delay an individual's chance of infection, but that is all, a delay. The statistical approach is similar to crossing the street without looking whether cars are coming or not: you may get away the first time, the second time but eventually (as you accumulate repetitions) you will be hit by a car. You will transmit the virus or will get infected.

There is evidence of the above. Condoms are not able to prevent pregnancy. Even with their used in wide combination with other contraception techniques, undesired pregnancies do happen. Condoms are not able to prevent unwanted pregnancies, thus abortion remains. The hard evidence of this events is that countries like US and Europe where plenty of condoms and contraception methods are available are unable to prevent unwanted pregnancies. Then, why should we think that condoms will protect from transmission of HIV in sexual intercourse? Why are there organizations that make us to believe so?

If condom use is not able to prevent HIV infection, why is it promoted? The answer seems to be to satisfy short-term policy goals. With the introduction of condom promotion policies Goverments hope for delay in new infections to claim success in controling HIV spread and adquire some international recognition. However, this policy also provokes a promotion of casual sex and social effects. In a deeper analysis, we cannot but think that the promotion of condoms does not seem to seek protection from sexually transmitted diseases, as evidence shows the contrary. It looks like it seeks to promote, encourage and perpetuate a life style based on self-satisfaction and non-commitment, seeking only the physical sexual pleasure that each one can provide to the other within a purely transient relationship--a weekend, a night or a few years until the divorce clause is executed.

Condom use and promotion perpetuates a life style which avoids taking responsibilities for actions: sex without commitment, sex without love but physical pleasure. It, ultimately, promotes promiscuity and the dehumanization of the sexual partner. It promotes abortion and contraception: A culture or death.

It is a fact that today there are not effective drugs against HIV infection, nor its cure. The only way that infection can really be prevented is by avoiding exposure to the infecting agent. This can only be done through long term social education policies that (1) encourage having sexual relationships only with the spouse, (2) foster monogamy and discouraging divorce and (3) abstaining from casual sex prior to civil or religious marriage. All these actions are possible, and have shown success. However, they demand loyalty and fidelity to each other-- the very opposite of casual sex.

If the Health Authorities of any country were really committed to HIV transmission eradication, they would learn from the failures in other countries. Governments would foster long term policies that seek behavioral changes in society through appropriate person-centered, parent-sponsored sexual education. Governments would not focus on short term policies that generate false hope.

It is not ethical to continue a "condom promotion" policy due to its proven failure.

It is a lie.
[BioEthics Forum]

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Friday, February 23, 2007

Patents, Drugs and Social Ethics

The main issue when patents are broken by Goverments is the compensation for the companies that develop the drugs for these “emergency diseases”. My opinion is that social ethics demands going beyond the strict letter of the law but it should not exercise potentially damaging policies for the companies that discovered and developed the drugs for those “emergency diseases”. The solution is in the companies that also develop the so-call “life style” drugs and drugs for pets. Obviously, these drugs have a very secondary benefit for public health.

In order to avoid a scenario like the one generated in Thailand that seriously puts at risk further long-term R&D investment and marketing of new drugs, I would advocate for the creation of a National Drug Fund (NDF). The NDF would buy the drugs under the emergency situation to the companies that produce them at a renegotiated price. This should satisfy covering the over US $1 billion cost of “making a drug” and therefore would not punish the companies for their successful R&D that made the drugs possible. The financial burden is transferred to how to replenish the NDF for further purchasing of drugs. This could be done through mandatory contribution from the profits derived from the sales of the “life style” drugs and drugs for pets.

It is good that the pharmaceutical industry develop drugs for pets (pets can be important for the life of some people). However, I find lack of social ethics to develop drugs for pets ignoring the needs of underprivileged patients. A pharmaceutical company that collects profits from drugs for pets should contribute with a percentage of those profits to the NDF. The Health Authorities of the country would manage the NDF to purchase necessary drugs without having to break patents and without financially “punishing” the companies that produced them with their investment (over a US $1 billion).

Those companies that profit from drug for pets and “life style” markets would keep the NDF alive and would make their social contribution to the underprivileged with the profits they make from the “over-privileged”.

More on social ethics at

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Wednesday, August 09, 2006

BIOETHICS -- The Masters, the Slaves and the Martyrs in a Cloning Society

Cloning and embryonic stem cell (ESC) research have appeared again in the front lines in the world media. Two articles published in Singapore captured the debate in depth with its clearly divergent views. The first article "Send in the clones- for a good cause" in Today (May 17, 2006) attempts to introduce and display the promises to come from ESC research and cloning. But it stops there: words and promises without a single real fact. The second article titled "Science under the moral microscope" that appeared in the Strait Times (May 22, 2006) went far beyond science to bring into perspective the respect we ought to have for human goods, and as such, human life: it is a-back-to-the-reality of principles.

We should look at the data and make a sensible call to all this events, not just from the human biology point of view but also from the practical and therapeutic stand. And this analysis seems to indicate, looking at the facts exposed at and the literature selection at about the ability of the adult and cord blood stem cells to cure patients. It seems that adult stem cells do succeed in the "clinic" cure patients while the ESC seem to be lacking any therapeutic potential, besides destroying human life: Biological potential is very different from clinical (or therapeutical potential). However, looking at data alone is not enough to come to a sound judgment on the matter. As any research on human beings interact with the human goods, we must look also beyond the data and assess the effect on the human goods. In this case life, human life in a society.

This is an additional thought that I would like to bring here - it is usually a forgotten thought. It is that ESC research and cloning technology advocate for a two-tier human beings society of masters and slaves. The masters generate IVF babies, screen them, select the perfect one (under their subjective criterion), put it into the womb of a want-to-be-a-mother and collect the fee. The slaves are the IVF embryos who are not perfect to the eyes of the beholder, they are the surplus of an enterprise, a kind of merchandise in storage that needs an exit.They are disposable: they can be put to death for the benefit of another former embryo. They are the slaves of others. And we even have infra-slaves. The same masters may also create human embryos that are mutilated, with genes that have been tampered, altered: chimeras. The direct antithesis of medical sciences: mutilation of human beings ath the beginning of their existance.

A policy that allows social inequality is a dubious policy for mankind and society. The United Nations saw it that way and voted strongly to ban any kind of cloning (70% of countries voted against cloning). It is that cloning methodology is against human love (this is better understood after wantching the movie Artificial Intelligence), that extracting stem cells from an embryo causes the death of a human being; and it is also the bizarre scenario where a person has power over the life of another one. A master can decide over the future of a simple innocent baby girl or baby boy who has existence in a test tube. A master can even have the power to cause a genetic mutilation in another human being to produce a disease or a mutated boy or girl to see how it goes - a kind of Nazi-like experiment.

Do we allow destruction, termination, killing or interruption of human life in its embryonic state? If so, who is allowed to be implanted in the womb? Who do we clone? And who decides who? As Dr. Chia elaborates in his article in the Strait Times, technological determinism is the denial of ethics. Human life is to be protected and respected. The egg taken from a woman is alive and human, so is the sperm. The resulting IVF embryo is alive and human and when the nucleus of its stem cells is transferred to an enucleated egg the cloned “baby” embryo is alive and human and the first embryo is death. Somatic cell nuclear transfer –the nucleus of an adult cell transferred into an enucleated egg– also results in a human “baby-clone” embryo. The biology facts cannot be denied: the embryo is human because it was human in origin and thefore human since the beginning. This is acknowledged by Singapore's Bioethics Advisory Committee: “There is continuous development from independent gametes all the way through to an independent human being. Attempting to define a point at which this new human being begins based on embryology is, the BAC concedes, arbitrary.” (Recommendations, Chapter 7, paragraph 16).

Now we should ask ourselves: is it good to destroy human embryos? What if it is for a good cause? The ultimate question is not what a good cause is, but who the good cause is. Well, whoever determines who is allowed to be born may think also that the patient is not qualified to render the destruction of another human being: he is not the good cause. Human life is not relative; it cannot be subordinated to other life: that is the ultimate reason why we do not tolerate slavery. Here the words of Dr. Chia are also consequential, “Utilitarian ethics is the inspiration behind many different expressions of eugenics”. Who is more who?

Clearly, we need to break through the current biological and scientific relativism and realize life is the best good: that is why we cure diseases and protect the defenseless. We can do this with good science, good medicine and good profit. Current clinical experience employs your own adult stem cells from a variety of tissues: nose, fat, bone marrow, skeletal muscle, etc. They proliferate and show plasticity as scientists have reported in Nature and Nature Medicine. The main rationale to use your own cells is to avoid rejection and to prevent cancer development derived from the ESC (reported also in Nature Medicine, Nature Biotechnology, and Cancer).

There is great hope for patients and scientists if they stop seeing themselves as martyrs, the misunderstood persons put in the fry to die because of the intolerance of others: the modern martyr, a victim of intolerance; a false martyrdom. Patients are given false hopes with ESC based therapy. Scientists compromise violating their biology-based-ethics to destroy human life to benefit others.

Life sciences and regenerative medicine will be in the right direction if it respects the most basic human good: human life. These upright scientists can bring real hope to patients. The scientific community and peoples can also capitalize on the benefits coming from adult stem cell based therapy. Israel, Thailand, Australia, US, etc are doing it: scientists have set up companies, research centers, etc. Patients flight in, stay in and flight out. Patients also bring their families, stay in a hotel, etc, an indirect gain for that community.

However, some countries may have moved too slow, wanting to make palatable the dislike of the unnecessary destruction of human embryos risking missing the train of umbilical-cord blood and adult stem cell therapies.

Looking at the strong scientific outlook fostered by several Government Agencies, Singapore can be the center of excellence for adult stem cell based treatments bringing cures –and revenue– to a society that allows neither masters, slaves or martyrs. Science must re-focus its aim to uphold human life as a non-nogotiable human good. It is a necesary policy.

The challenge is here. Pasteur, Fleming or Lejeune became great because they cured people. Today's scientists can too be great without devaluating human life, without destroying embryos, without exploiting the weakest. They can cure, save and always confort the sick.